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Fourth-generation fluoroquinolones: new topical agents in the war on ocular bacterial infections.

The fourth-generation fluoroquinolones, moxifloxacin and gatifloxacin, were introduced in 2003 promising improved spectrum of activity and delayed development of resistance. Although these topical agents have recently been introduced in commercial form, there is already a growing body of evidence showing excellent potency in the war on ocular infections. The purpose of this review is to discuss the literature to date regarding these two agents. Since their introduction in 1990 in the United States, fluoroquinolones have rapidly become the standard of care in the topical antibiotic arena. Unfortunately, recent evidence has shown the widespread use of fluoroquinolones, not only in eye care, but also in agriculture, and general medical and surgical use, has lead to decreasing susceptibilities of important ocular bacterial pathogens. Moxifloxacin and gatifloxacin have improved potency and are able to overcome resistant isolates. These agents also provide improved penetration into ocular tissues. Moxifloxacin and gatifloxacin offer improved spectrum of activity, increased penetration into ocular tissues, and delayed propensity to the development of bacterial antibiotic resistance.

Why All the Fuss About Portion Size?: Designing the New American Plate.

In attempting to respond to current public concerns about nutrition when creating its health education program, the New American Plate, the American Institute for Cancer Research found it necessary to emphasize the importance of portion size. Justifiable concern about overweight and obesity and as yet unproved ideas about weight management were causing people to distort the shape of their diet. The focus of the new education program was reduction of cancer risk through a predominantly plant-based diet. To ensure a cancer-protective proportion of plant food to animal food, the American Institute for Cancer Research had to expound gradual reduction of portion size, accompanied by increased exercise as the primary means of weight management.

Forum on choices regarding treatment and health behaviors after breast cancer

In this issue, we introduce a new format of commentary on the state of women's health research and policy. The forums are designed to bring together the knowledge and opinions of leading experts in the field, each of whom approaches the topic from a different perspective. Taken together, the set of editorials is intended to shed light on both what is known and to highlight gaps in our knowledge or in health-related policy which affect women's health care. We plan to use this format occasionally to raise the level of dialogue and visibility of key research and policy issues of interest to WHI readers. We welcome readers' suggestions for future forum topics. Please email your suggestions to me, Chloe Bird, at [email protected] For the first forum, we have invited three editorials on choices regarding treatment and health behaviors after breast cancer. They were selected to shed light on gaps in our knowledge regarding the impact of medical treatments and health behaviors after breast cancer that hamper decision-making by women and their clinicians. While much has been learned in recent years the growing body of research provides only partial answers and substantial knowledge gaps remain. The first editorial speaks in broad terms about the general state of evidence and the ways it can and cannot guide patients and their clinicians in making optimal choices. The second focuses specifically on evidence from the recent clinical trials of Letrozole and related treatments used after breast cancer. The final editorial takes a different approach and examines evidence regarding the impact of health behaviors after breast cancer on survival and quality of life.

WHIM syndrome: a genetic disorder of leukocyte trafficking.

WHIM syndrome (the association of warts, hypogammaglobulinemia, recurrent bacterial infections, and 'myelokathexis') is a rare congenital form of neutropenia associated with an unusual immune disorder involving hypogammaglonulinemia and abnormal susceptibility to warts. In this review, we describe the clinical, laboratory and genetic features of WHIM syndrome. The identification of chemokine receptor CXCR4 as the causative gene of WHIM syndrome yields new interest in the study of this disease as a model for the comprehension of CXCR4 biology in humans and highlights the importance of the chemokine network for inducing effective immune responses and governing leukocyte trafficking. CXCR4 participates in several biological processes (bone marrow hematopoiesis, cardiogenesis, angiogenesis, neurogenesis) and is implicated in different clinical pathologic conditions (WHIM, HIV infection, tumor metastatization, autoimmunity). Pharmacologic agents that modulate CXCR4 expression/function are already available and promise a wide range of future clinical applications.

Ankle fractures resulting from rotational injuries.

Ankle fractures are among the most common skeletal injuries; selection of an optimal management method depends on ankle stability. Stable fractures (eg, isolated lateral malleolar) generally are managed nonsurgically; unstable fractures (eg, bimalleolar, bimalleolar equivalent) usually are managed with open reduction and internal fixation. Stress radiographs may aid in the management of incomplete deltoid injury in which there is medial swelling and tenderness without radiographic talar shift. A posterior malleolar fracture should be reduced and stabilized if it comprises >30% of the articular surface and remains displaced after fibular stabilization. Ankle fractures with syndesmotic injury have additional tibiofibular instability that can be controlled by screw fixation. However, the choice between metal and bioabsorbable screws, screw size, number of cortices fixed, and indications for screw removal remain controversial. Conditions such as diabetes or advanced age are no longer contraindications to usual management recommendations.

Strategies to improve end-of-life care in the intensive care unit.

Death is a frequent occurrence in the intensive care unit (ICU). Critical care nurses often feel unprepared to deliver expert end-of-life care. This article proposes specific strategies for critical care nurses to improve the delivery of end-of-life care in the ICU. Critical care nurses can examine beliefs about death; recognize that cure and palliative care coexist; create an environment that supports dying as well as curing; improve communication among providers, patients, and families; provide "small things that make a big difference" at the end-of-life; and locate and utilize support for improving end-of-life care.

Editorial

Editorial

Medical practices' sensitivity to patients' needs. Opportunities and practices for improvement.

This article presents the results of a national study of medical practices' patient satisfaction using data collected from January to December 2001 with Press Ganey Associates' Medical Practice Survey (n = 503,407). The question, "Our sensitivity to your needs" (r = 0.85), most highly correlated with overall patient satisfaction. Patients' age, sex, or first visit were not predictors of sensitivity to patients' needs. Responses highly correlated with sensitivity to patients' needs: (1) concern for patients' privacy, (2) cheerfulness of practice, (3) care received during visit, and (4) likelihood to recommend practice. Patient perception and satisfaction with medical practices' sensitivity to patient needs and recommended practices for improvement are discussed.

Building on the work of our colleagues

Building on the work of our colleagues

The Controversy over “Chemical Restraint” in Acute Care Psychiatry

In many healthcare settings, medications are considered a less invasive alternative to the use of physical restraint for agitated patients experiencing a behavioral crisis, a practice that is often referred to as "chemical restraint." However, recent federal regulations appear to equate chemical and physical restraint and to characterize both as extraordinary practices that should not be undertaken lightly. Although many clinicians consider the term "chemical restraint" pejorative, since it does not reflect the possibility that forced medication may be clinically necessary and have a beneficial effect, the term is embedded in recent regulatory language. The author first reviews the controversy over the concept of chemical restraint as it has developed in the mental health literature and regulatory policy. As yet there is no consensus among clinicians or policy makers whether such use of medications is a form of coercion or a form of patient-focused intensive care. The author then discusses precipitants of emergency care and clinical factors and situations that may lead to the use of medications in a way that might be considered chemical restraint. Such factors include clinical and demographic characteristics of patients, institutional characteristics, and staff perception and attitudes. In the final section of the article, the author reviews the recommendations concerning the emergency use of medications given in the Expert Consensus Guidelines on the Treatment of Behavioral Emergencies and discusses treatment developments that have occurred since the time of the survey on which those guidelines were based.

Editiorial

Editiorial

SMC proteins

What are SMCs? The Structural Maintenance of Chromosomes (SMC) proteins are a family of chromosomal ATPases highly conserved among the three phyla of life. First came to prominence… In 1993, when the first SMC protein was characterised as a gene product required for proper chromosome segregation in budding yeast. The following year, using a variety of approaches, a number of related proteins were identified in different organisms, laying the foundation of the SMC superfamily. What do SMCs look like? The SMC proteins are large polypeptides, each spanning 1000–1500 amino acids. They form dimers in which two anti-parallel coiled-coil arms are connected by a flexible hinge (Figure 1). The distal end of each arm constitutes an ATP-binding domain. How many SMCs in a single species? Whereas both the archaeal and bacterial genomes contain only one SMC gene, six distinct SMC paralogues are found in individual eukaryotes. Each of the eukaryotic SMCs has a specific dimer partner – SMC1–3, SMC2–4 and SMC5–6. What do SMCs do in the cell? Each SMC dimer forms a functional complex with a distinct set of non-SMC subunits. SMC1–3 forms the core of the cohesin complex that functions in sister chromatid cohesion (Figure 1, left). SMC2–4 forms part of the condensin complex, a key player in mitotic chromosome condensation (Figure 1, right). Bacterial SMC is involved in chromosome partitioning and is thought to be an ancestor of condensin and cohesin. The SMC5–6 complex is implicated in DNA repair and checkpoint responses. Do they have other functions? Yes… In Caenorhabditis elegans, an SMC4 variant associates with the canonical SMC2 to form a condensin-like complex that regulates chromosome-wide gene expression as part of the worm's dosage compensation mechanism. In many organisms, meiosis-specific subunits bind to SMC1–3. These play a crucial role in meiotic chromosome segregation. How do SMCs work? That is the million-dollar question in the field. Of particular interest is to understand how the two-armed structure – which is approximately 100 nm long when it's open! – captures DNA, and how these interactions are modulated by ATP binding and hydrolysis. Condensin is able to introduce positive supercoils into DNA by using the energy of ATP hydrolysis. Further studies are required to understand the functional diversity of the SMCs. Can we live without SMCs? No! Loss of any single SMC protein in budding yeast is lethal. Given their fundamental role in maintaining genomic stability, it is of future interest to determine whether loss or mutation of SMCs is associated with tumour formation or developmental disorders in mammals. If you have an interesting viewpoint on any issue relating to biological research that you would like to put before a general readership in a My Word article of about 800–900 words, email your proposal to: [email protected] If you have an interesting viewpoint on any issue relating to biological research that you would like to put before a general readership in a My Word article of about 800–900 words, email your proposal to: [email protected]

Neurovascular Assessment

The outcome of an injured extremity is affected primarily by initial assessment and immediate treatment of the extremity. Delaying the recognition of neurovascular compromise can cause the amputation of an extremity, or even the death of the patient. However, having the foundation of knowledge regarding total neurovascular function can equip the nurse with accurate assessment skills and the knowledge of the need for immediate action. This essential orthopaedic knowledge is used daily by the orthopaedic nurse to provide the best patient care possible with the best possible outcome.

On “Can a comprehensive lymphedema management program decrease limb size and reduce the incidence of infection in a woman with postmastectomy lymphedema?”

We encourage Journal readers to respond to articles in “Evidence in Practice.” E-mail your contribution to the dialogue to steveglaros@apta.org.? We would like to suggest an alternate search strategy for the “Evidence in Practice” article in the March issue written by Charles Ciccone, PT, PhD. Dr Ciccone selected the CINAHL database because he wanted “to focus on journals that might deal specifically with physical therapy interventions.” CINAHL is not restricted to physical therapy interventions. In contrast, the Physiotherapy Evidence Database (PEDro) (ptwww.cchs.usyd.edu.au/pedro/) is a database that is restricted to systematic reviews and randomized controlled trials (RCTs) of physical therapy interventions. We believe, therefore, that it might offer a potentially more efficient method to search for external evidence on the effectiveness of physical therapy interventions than generic databases, such as CINAHL or MEDLINE, could. In our opinion as the developers of PEDro, PEDro is a much more complete database of RCTs and systematic reviews in physical therapy than either MEDLINE or CINAHL are. A search of PEDRO was conducted on March 6, 2002. By typing lymphedema in the abstract search box, 6 records …

Two hats too many

My Word: Ronald N. Germain believes it's time scientists eliminated splits in their personality between researching and reviewing.

Do fungi play a role in the aetiology of cancer?

Do fungi play a role in the aetiology of cancer?

Up against the wall

Fairview, N.J. Please mail, fax, or E-mail your true, funny stories, quotes, signs, medical bloopers, or jokes, to Grin&Share It, Nursing2002, 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477 or via E-mail to [email protected].

Osseous Manifestations of Tuberculosis in Children

Forty-two children with tuberculous osteomyelitis were seen and treated between 1984 and 1999. The age ranged from 1 to 12 years (average 6); there were 31 boys and 11 girls. There were 50 osseous lesions (excluding spinal and synovial). Five children had multifocal bone involvement. There were four basic types of lesions: cystic (n = 26), infiltrative (n = 10), focal erosions (n = 8), and spina ventosa (n = 6). The majority of the lesions were in the metaphyses (n = 25); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones, and small round bones. The erythrocyte sedimentation rate was normal in seven, and the Mantoux test was negative in four. Bone lesions resembled pyogenic and fungal infections and benign and malignant bone tumors. Histologic confirmation was obtained in all patients. Curettage and antituberculous treatment yielded good results in the majority of patients, with follow-up of 6 months to 9 years. Biopsy is mandatory to confirm the diagnosis.

The New Dietary Reference Intakes and Zinc Deficiency: Is There a Dichotomy?

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print Collections Topical Collections CEFor Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions Supplements All Articles Images Videos Podcasts Blogs Advanced Search November-December 2001 - Volume 36 - Issue 6 Previous Abstract Next Abstract Full Text Access for Subscribers: Individual Subscribers Log in for access Institutional Users Access through Ovid® Not a Subscriber? Buy Subscribe Request Permissions You can read the full text of this article if you: Select an option Log In Buy Article Subscribe Content & Permissions Access through Ovid Log In Access through Ovid Article as EPUB Export All Images to PowerPoint File Add to My Favorites Email to Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Nutrition Today. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Export to End Note Procite Reference Manager Save my selection Special EditorialThe New Dietary Reference Intakes and Zinc Deficiency: Is There a Dichotomy?Hambidge, Michael ScD, MD Author Information From the University of Colorado Health Sciences Center, Denver, Colo. Dr Hambidge is Professor Emeritus of Pediatrics and Preventive Medicine at the University of Colorado Health Sciences Center. He is a former member of the Food and Nutrition Board, Institute of Medicine. Reprints: Michael Hambidge, ScD, MD, Section of Nutrition, Department of Pediatrics, Box C225, University of Colorado Health Sciences Center, 4200 E 9th Ave, Denver, CO 80262. Nutrition Today: November 2001 - Volume 36 - Issue 6 - p 278-280 Buy Abstract The new Dietary Reference Intakes for zinc, published in 2001, are reviewed in relation to reduced levels for Recommended Daily Allowances at a time when zinc deficiency is receiving increasing attention. Other discussion points include the geographic boundaries of the Dietary Reference Intakes, Upper Limit values for young children, interpretation of Adequate Intake values for infants, and the imperative requirement for research focused specifically on dietary requirements. © 2001 Lippincott Williams & Wilkins, Inc. Source The New Dietary Reference Intakes and Zinc Deficiency: Is There a Dichotomy? Nutrition Today36(6):278-280, November-December 2001. Full-Size Email + Favorites Export View in Gallery Email to Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Nutrition Today. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Related Articles Article as EPUB Export All Images to PowerPoint File Add to My Favorites Email to Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Nutrition Today. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Export to End Note Procite Reference Manager Save my selection Article Level Metrics Related Links Articles in PubMed by Michael Hambidge, ScD, MD Articles in Google Scholar by Michael Hambidge, ScD, MD Other articles in this journal by Michael Hambidge, ScD, MD Related Videos Data is temporarily unavailable. Please try again soon. 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A Physician by Any Other Name

MENTAL HEALTH AND WELLNESS CENTER Board-certified mentalist wanted for multi-specialty practice firm. Opportunity to work with other wellness providers including herbalists, acupuncturist, and chiropractors. Spanish skills a plus. Flexible work schedule and competitive salary with benefits. Email your CV and customer satisfaction ratings to: med@providerstaffing.com. Equal Opportunity Employer.