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Previous studies have suggested a role for pathogens as a trigger of systemic sclerosis (SSc), although neither a pathogen nor a mechanism of pathogenesis is known. Here we show enrichment of Rhodotorula sequences in the skin of patients with early, diffus

Background: Women from diverse backgrounds in India are now employed, facing challenges that impact their sleep and well-being. The demands of their jobs, extended working hours, family responsibilities, lifestyle changes, and various socio-demographic factors make unwinding and falling asleep difficult. Objective: The study was conducted to assess the quality of sleep and the sociodemographic factors affecting it among the working women of an urban area in Ernakulam District, Kerala. Methodology: A community based cross sectional study was conducted among 141working women aged 18 years and above residing at Perumbavoor municipality of Ernakulam district. Women who were paid wages for their work were considered as working women. From the 27 wards in the Perumbavoor municipality 14 wards were selected randomly. From each selected ward 10 households were sampled by systematic random sampling. If more than one working woman was found in a house only one woman was interviewed. Data was collected using semi structured questionnaire and Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality of sleep. Results: 69.5% of the working women belonged to the age-group of 30-39 years, 80.1% belonged to APL category by colour of ration card, 90.1% were married, 22% worked for more than 8 hours and 11% worked in night shifts. Poor sleep quality was seen in 70.9 % of working women with mean PSQI Score 6.17(SD + 2.68).76.37% married women had poor sleep quality compared to 21.4%of unmarried/widowed women (?2=18.46, d f=1, p

Objective: To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy.Methods: Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%-50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27.Results: Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants.Significance Of Results: Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding. [ABSTRACT FROM AUTHOR]

Objectives: To better understand the complexities of coexisting substance abuse, this study explored psychosocial and clinical differences between individuals diagnosed only with a depressive disorder and those diagnosed with a depressive disorder coexisting with a substance use disorder. Methods: Rates and sequelae of comorbidity were explored based on the medical records of patients admitted to the Alaska Psychiatric Institute (the only state-funded psychiatric hospital in Alaska) between January 1, 1993 and April 30, 2004. During this period, there were a total of 13,894 admissions for 7,317 patients. Of these patients, 469 met criteria for pure depressive disorders (with no past or current other psychiatric diagnoses); of these, 321 (68.4%) had coexisting substance use disorder and 148 (31.6%) had no coexisting substance use disorder. Results: Findings revealed that patients with a depressive disorder and coexisting substance use have greater complexity in terms of psychosocial circumstances, demographics, and clinical presentation than do patients with a depressive disorder only; however, such patients have fewer admissions, shorter lengths of stay, and fewer total days in hospital. Conclusions: These findings suggest that care must be taken when diagnosing individuals with depression as the presence of a coexisting substance use disorder may call for a different intervention strategy. These results differ from prior research examining coexisting schizophrenia and substance use disorders, suggesting that a substance use disorder has differing sequelae depending upon the type of coexisting psychiatric disorder. [ABSTRACT FROM AUTHOR]

BACKGROUND: The de-escalation skills of inpatient psychiatric nurses are considered key to violence prevention. Yet their efficacy and translation into practice remains in question.OBJECTIVE: The aim of this study is to describe the de-escalation skills of psychiatric nurses. In the process, the investigators uncover ways nurses interact with patients to create and maintain a safe environment.STUDY DESIGN: Grounded theory methods are used to collect and analyze data derived from staff interviews and direct observation of milieu interactions.RESULTS: Staff behaviors are seen to create a safe milieu and promote a positive unit culture. Skills critical to maintaining a safe environment center on nurses' awareness, attending, caring, and connecting.CONCLUSIONS: The behaviors identified in this study are at the heart of managing the clinical context of acute psychiatric units. Attention to these behaviors is especially critical in light of the staff expertise needed to keep the unit safe. [ABSTRACT FROM AUTHOR]

Objectives: Increasing numbers of research investigations have documented the coexistence of substance use and other psychiatric disorders in a variety of patient populations. The next step in understanding such comorbidity is the exploration of whether the type of psychiatric disorder coexisting with a substance use disorder makes a difference in terms of the sequellae of the disorders for the patient. Methods: This study explored a variety of psychosocial/demographic and clinical variables for patients with a substance abuse disorder, differentiating five groups based on the type of coexisting psychiatric disorder: schizophrenia, depression, bipolar disorder, adjustment disorder, and personality disorder. Rates and sequellae of comorbidity for the five groups of patients were explored based on a pool of patients hospitalized at the Alaska Psychiatric Institute (API) between 1993 and 2001. The records of 181 patients with coexisting schizophrenia, 251 with depression, 120 with bipolar disorder, 197 with adjustment disorder, and 145 with personality disorder were utilized to explore psychosocial/demographic and clinical differences and commonalities across groups. Results: Findings revealed significant differences between the five groups on almost all psychosocial/demographic and clinical variables. For example, patients with coexisting schizophrenia evidence more severe pathology and greater use of hospital resources; patients with coexisting personality disorder were more likely to be involved with the legal system; patients with bipolar disorder were most likely to evidence drug involvement at admission; and patients with adjustment disorders evidenced the fewest psychosocial challenges and a less severe course of treatment. Conclusion: Results confirmed the need to differentiate comorbid patients based on the type of coexisting other psychiatric disorder. Discussion of the implications of these findings for treatment service planning on an individualpatient and systemic-administrative level is presented. [ABSTRACT FROM AUTHOR]

The first article in this 2-part series discussed the challenge of quality health care, the need for sophisticated problem solving methods, the roles of process thinking and project prioritization, and some of the problem-solving methods utilized with Lean. This article describes Six Sigma and Lean Six Sigma. [ABSTRACT FROM AUTHOR]

It is critical for researchers to develop multidimensional models of prevention that reflect the complexity of the organization of a psychiatric unit. OBJECTIVE: The objective of the study was to develop a midrange theory of violence prevention on inpatient psychiatric units. DESIGN: Grounded theory methods were used for data collection and analysis. Data collection and analyses were conducted simultaneously, and the constant comparative method was used for analysis. RESULTS:The staff and patients were observed on two inpatient psychiatric units for approximately 400 hours. A total of 28 patients and staff was interviewed. The basic social process that emerged from the study was Keeping the Unit Safe. The dimensions of this process are ideology, people, space, and time. CONCLUSION: The findings from this study can be used to assess the safety of particular units and to identify changes that could potentially influence the outcome of patient and staff safety. [ABSTRACT FROM AUTHOR]

To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The current thrust toward evidence-based practice requires the use of systematic evaluations of clinically relevant research to guide practice. OBJECTIVE: The aim of this systematic literature review was to identify the significant factors associated with violence and aggression on inpatient psychiatric units. DESIGN: The databases Cumulative Index toNursing and Allied Health Literature (CINAHL), PsycINFO, and Medline were searched using the key wordsaggression and/orviolence. Studies included in the review were those that were published between 1992 and 2002, conducted on inpatient psychiatric units, used a prospective design, and provided the reliability and validity of the measurement tools. RESULTS: Twentyseven articles were reviewed. The findings were organized into the following categories: patient-related variables, staff-related variables, unit-related variables, interactional variables, and studies related to prediction of aggression and violence. CONCLUSIONS: The findings indicate that (a) much of the available evidence supports the experienced clinician's knowledge of who is at risk for becoming aggressive on inpatient psychiatric units; (b) among factors shown to be related to violence, some can be modified and others cannot; and (c) there is a critical need for well-designed nursing research that takes into account the complexity of the problem of aggression and violence on inpatient psychiatric units. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the use of emergency room services among out-of-treatment drug users in Long Beach, CA. Primary data collection occurred between 1991-1996. The study setting was a community-based location through which out-of-treatment drug users were recruited using a standard research protocol. The original study randomized 1,728 participants into a standard or enhanced HIV prevention protocol. Data were collected longitudinally at two points in time, with 1,201 returning for follow-up interview. Standardized instruments were used at baseline and follow-up. Logistic regression and test-retest reliability were performed using the SAS System. Factors associated with emergency room use included income from public assistance sources, ever using other opiates, income less than 500 dollars in the last month, reporting White race/ethnicity, and HIV positive serostatus. Having income from public assistance programs is highly predictive of emergency room use in out-of-treatment drug users. [ABSTRACT FROM AUTHOR]

Background: Falls related to balance dysfunction are among the major problems of older individuals. The timing characteristics of protective voluntary stepping are critically related to effective balance recovery and are often delayed and slowed with age. This study investigated the influence of step training on the timing characteristics of voluntary step initiation in younger and older adults.Methods: Voluntary reaction time stepping was evaluated before and after training in 12 younger adults and 8 healthy community-dwelling older adults who performed a 3-week regimen of either twice weekly induced step training (destabilizing large waist pulls) or voluntary step practice to a somatosensory reaction stimulus cue (nondestabilizing small waist pulls).Results: Overall, the first step initiation times were slower for the older than for the younger subjects for both the somatosensory reaction stimulus cue task and an auditory transfer cue task. Step completion time was completed earlier for the young posttraining subjects, and older subjects generally had a longer step length. Training resulted in significant reductions in step initiation timing for the old (17%) and young (15%) subjects. Across age groups, the induced training group showed greater reductions in step initiation time than the voluntary practice group for the auditory transfer cue task.Conclusions: A 3-week period of either voluntary or waist-pull-induced step training reduced step initiation time in older and younger adults. Moreover, compared with voluntary step practice, induced step training resulted in a significantly greater improvement in reaction time stepping for an auditory transfer cue task. At least in the short term, such step training has the potential to help older adults perform more like younger adults in their step initiation timing. [ABSTRACT FROM AUTHOR]

Based on a sample of 259 drug users not in treatment from five different sites, we examined the reliability of self-reported demographic and behavioral information and the validity of self-reported drug use. Data were collected twice with a 48-hr interval, using the Risk Behavior Follow-Up Assessment (RBFA; National Institute for Drug Abuse, 1992), a structured interview. We examined internal consistency and test-retest reliability and found that, overall, drug users were generally reliable reporters of information regarding their demographics, drug use, sexual behavior, work and income, and criminal behavior. Exceptions to these findings of reliability were noted for items that were phrased too broadly. Comparison of self-report data and urinalysis results indicates that drug users accurately report cocaine and opiate use, although reports of cocaine use were somewhat more valid. These findings indicate that self-report data from drug users, when collected by trained interviewers, can be considered reliable and valid. [ABSTRACT FROM AUTHOR]

Recently the relevance of the philosophy of Martin Heidegger has been critiqued in nursing literature. However, this critique is based primarily upon an appropriation of Heidegger that does not reflect an understanding of meaning as grounded in temporality. Therefore, this paper aims to (1) explicate Heidegger's grounding of meaning, (2) briefly contrast Heidegger's and Husserl's notions of the origin of meaning, (3) describe how Heidegger was first introduced to nursing, and (4) illustrate through examples from a research study how the philosophy of Heidegger might inform the phenomenological researcher. [ABSTRACT FROM AUTHOR]

Using the short form of the Woodcock Reading Mastery Test-Revised and the reading subtest of the Wide Range Achievement Test-Revised, the reading abilities of 284 male and 128 female drug users from five sites across the United States were evaluated. All subjects were participants in a National Institute on Drug Abuse HIV/AIDS prevention project aimed at intravenous drug users and cocaine smokers. Results revealed differences in reading abilities among ethnic groups with Native and white subjects having significantly higher reading levels than Hispanic and black subjects. Significant site differences were revealed, with mean grade equivalent scores ranging from 2.7 to 10.1 grades. Across all subjects, the average grade equivalent reading level was 5.8 to 7.7, indicating that the subjects read below the level of 81.5% to 93% of the general population. We provide implications for development of educational materials that are accessible for this population. [ABSTRACT FROM AUTHOR]

Abstract Background Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. Findings A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%), peripheral vascular disease (42%), and history of tobacco use (75%). Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50%) patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. Conclusions In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.

Abstract Background Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse. Methods/Design This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate. Discussion This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision. Trial registration ISRCTN74012786