BACKGROUND:The current variety of medication inhaler devices can be confusing to patients due to the many different delivery systems. Many health-care professionals who prescribe these devices may not be educated properly about the administration techniques for different inhalers. The objectives of this study were to evaluate various health-care providers' knowledge of specific inhaler devices and to assess their ability to retain this knowledge for a minimum period of 3 months. METHODS: This was a prospective study that included 4 different health-care professional groups (physicians, respiratory therapists, registered nurses, and pharmacists). All subjects underwent baseline written and practical tests. A checklist was developed for the practicum test for each inhaler on the correct delivery method. The written examination tested knowledge of 4 different inhaler techniques with true or false questions. Then subjects watched an instructional video that demonstrated the correct method of delivery for each device. Last, subjects were retested on the practicum and written tests after a minimum lapse of 3 months. RESULTS: The distribution of written and practical scores at baseline and postintervention was approximately normal (P > .05). The baseline written scores were significantly different across groups (P ؍ .002). The mean written score of respiratory therapists was significantly higher than those of registered nurses and physicians (P ؍ .02 and .01, respectively). Similarly, the baseline practical scores were significantly different across groups (P < .001). The mean practical score of respiratory therapists was significantly higher compared with those of registered nurses and physicians (P ؍ .002 and P < .001, respectively). CONCLUSIONS: We found a suboptimal number of medical professionals who have the proper knowledge base and technical skill to teach different inhaler device techniques. In order to increase the simplicity and effectiveness of delivering inhaler medication, we hope that the industry will provide more uniformity for future inhaler devices.
Following radiotherapy, many patients with osteoradionecrosis suffer from xerostomia, thereby decreasing their quality of life. Patients can develop problems with speech, eating, increased dental caries, dysphagia, fractured dentition, chronic refractory osteomyelitis and osteoradionecrosis. Symptoms associated with salivary gland dysfunction can be severe enough that patients terminate the course of their radiotherapy prematurely due to the decrease in their quality of life. Currently, the only treatments available to patients are palliative. A definitive treatment has yet to be discovered. Head and neck cancers, which comprise 5% of overall cancer treatments, rank 8th most expensive to treat in the United States today. Hyperbaric oxygen is being considered for the therapy of radiated salivary glands because it has been shown to stimulate capillary angiogenesis and fibroplasia in radiation treated tissues. It has been hypothesized that salivary acinar cells undergo apoptosis following radiation therapy. The purpose of this paper is to discuss the mechanisms of salivary gland injury and evaluate whether hyperbaric oxygen therapy improves salivary gland function in patients who develop xerostomia and osteoradionecrosis following head and neck radiation.
Ketogenic diets have the potential to lower glucose availability to cancer cells. However, the effect that the resulting increase in ketone bodies has on cancer cells is not fully understood. The present study explored the effect of β-hydroxybutyrate (BHB) on glucose-deprived MCF-7 and T47D breast cancer cells. Cell proliferation was decreased in response to lower glucose conditions, which could not be rescued consistently by 10 or 25 mM BHB supplementation. In addition, gene expression levels were altered when cells were glucose deprived. Reducing glucose availability of cancer cells to 225 mg/l for 4 days significantly decreased the expression of 113 genes and increased the expression of 100 genes in MCF-7 breast cancer cells, and significantly decreased the expression of 425 genes and increased the expression of 447 genes in T47D breast cancer cells. Pathway enrichment analysis demonstrated that glucose deprivation decreased activity of the Hippo-Yap cell signaling pathway in MCF-7 breast cancer cells, whereas it increased the expression of genes in the NRF2-pathaway and genes regulating ferroptosis in T47D breast cancer cells. Treatment of glucose-deprived cells with 10 or 25 mM BHB significantly changed the expression of 14 genes in MCF-7 breast cancer cells and 40 genes in T47D breast cancer cells. No significant pathway enrichment was detected when glucose-deprived cells were treated with BHB. Both cell lines expressed the enzymes (OXCT1/2, BDH1 and ACAT1/2) responsible for metabolizing BHB to acetyl-CoA, yet expression of these enzymes was not altered by either glucose deprivation or BHB treatment. In the publicly available The Cancer Genome Atlas (TCGA), increased expression of ketone body-catabolizing enzymes was observed in various types of cancer based on mRNA expression z-scores. Increased expression of BDH1 and ACAT1 significantly decreased overall survival of patients with breast cancer in TCGA studies, while decreased OXCT1 expression non-significantly decreased overall survival. In conclusion, neither MCF-7 nor T47D breast cancer cells were affected by BHB during glucose deprivation; however, screening of tumors for activation of ketone body-metabolizing enzymes may be able to identify patients that will benefit from ketogenic diet interventions.
BackgroundThe American Heart Association (AHA) has implemented several programs to educate the public about cardiopulmonary resuscitation (CPR). A common issue in bystander CPR is the fear of hurting the victim. As a result, the victim may not receive CPR in time. The purpose of this study was to measure the emotional impact of CPR training on high school students using two approved AHA courses.MethodsA total of 60 students participated in this study. These students had a mean age of 15.4 ± 1.2 years old and were selected from a high school in Southern California. Subjects were divided into two groups, Basic Life Support (BLS) (n1 = 31) and Hands-Only™ CPR (n2 = 29). Emotional impacts were assessed by having each subject answer a questionnaire based on given scenarios before and after their training session.ResultsThere was a significant difference in both groups when comparing positive-emotion scores before and after the training (BLS: 30.3 ± 6.0 vs. 34.5 ± 6.7, p < 0.001; Hands-Only 27.9 ± 5.0 vs. 32.1 ± 6.5, p < 0.001). In addition, both groups showed significant reductions in negative-emotion scores (BLS: 29.2 ± 6.7 vs. 23.7 ± 6.5, p < 0.001 and Hands-Only: 26.8 ± 6.1vs. 24.8 ± 7.7, p = 0.05).ConclusionOur results indicate that the AHA programs have positive effects on students’ emotional response. We recommend that future studies include an in-depth study design that probes the complexity of students’ emotions after completing an AHA session.
Childhood obesity is increasing at an alarming rate. Tall stature and accelerated skeletal maturation are hallmarks of obesity that have detrimental consequences such as limb bowing, slipped epiphyses, and fractures, which rapidly evolve into adult disability. One major treatment obstacle is lack of knowledge of the underlying cause of this growth acceleration. Circulating IGF‐1, the major hormone required for growth, is paradoxically low to normal in obese children. Obesity is characterized by chronic inflammation driven by cytokines such as interleukin‐6 (IL‐6), which suppresses bone elongation by inhibiting IGF‐1. Our lab found that a high‐fat diet accelerates bone elongation in mice before they had excess body fat, indicating that skeletal impacts of a high‐fat diet are well underway before physical signs of obesity emerge. Our goal was to determine whether high‐fat diet alters inflammatory cytokines that could serve as biomarkers for skeletal damage. We tested the HYPOTHESIS that mice on a high‐fat diet have higher levels of inflammatory cytokines before they exhibit overt obesity. METHODS Female and male 3‐week‐old C57BL/6 mice (N=6/diet/age) were put on high‐fat (60% kCal fat) or control (10% kCal fat) diets for 1 or 2 weeks. Serum cytokines (Leptin, TNF‐α, IGF‐1, IL‐6, VEGF, IL‐1α, IL‐1β, MCP‐1) were measured by ELISA, and glucose was measured with a blood glucose monitor. Statistical significance (p<0.05) was determined in SPSS using Mann‐Whitney and t‐tests. RESULTS At 4 weeks, after 1 week on diet, tibial elongation rate was over 20% higher in mice on a high‐fat diet (t=4.4, p<0.001) and body mass was 16% greater (t=5.6, p<0.001), though mice were not yet obese. By 5‐weeks, after 2 weeks on diet, tibial elongation rate was still over 10% higher in the high‐fat diet group (t=2.1, p<0.05) but with no difference in body mass (t=0.5, p=0.62). At 4‐weeks, IGF‐1 (z=2.3, p<0.05), IL‐6 (z=2.4, p<0.05), and IL‐1α (z=2.3, p<0.05) were all significantly decreased in the high‐fat diet mice. At 5‐weeks, TNF‐α (z=2.9, p<0.01) and IL‐6 (z=2.7, p<0.01) were decreased in the high‐fat diet group, while VEGF (z=2.7, p<0.01) was increased. There were no differences in glucose between diets at either age. DISCUSSION Our results support the hypothesis that a high‐fat diet alters inflammatory cytokines before the overt onset of obesity. Unexpectedly, most cytokines were decreased rather than increased as predicted. The most robust finding was the 2‐fold and 1.5‐fold decrease in IL‐6 at the 4‐ and 5‐week age points, respectively. In addition to inflammation, IL‐6 can regulate energy metabolism, with low IL‐6 possibly contributing to human obesity. Decreased IL‐6 is also consistent with our finding of increased bone elongation since high IL‐6 suppresses growth. SIGNIFICANCE These results are relevant for understanding the development of obesity‐related skeletal complications. Reduced inflammatory cytokines, particularly IL‐6, during juvenile growth could be a useful biomarker for assessing potential skeletal damage before a ch...
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