Calcitonin prescribing criteria for the management of hypercalcemia in a community hospital

Purpose/Background: Hypercalcemia is a clinical condition in which serum calcium levels exceed the upper limit of normal (\u3e10.5 mg/dL). The most common causes of hypercalcemia are primary hyperparathyroidism and malignancy, however, it can also be caused by vitamin D intoxication, endocrine disorders, and immobilization due to an increase in bone resorption. First-line treatment of hypercalcemia includes hydration with intravenous (IV) normal saline and IV bisphosphonates. Calcitonin (Miacalcin®) is a synthetic hormone with a rapid onset of action and used intramuscularly (IM) or subcutaneously (SQ) as a second-line treatment in the management of hypercalcemia, specifically in severe and in symptomatic cases. The purpose of this performance improvement initiative is to assess the prescribing practices of calcitonin at Baptist Hospital of Miami (BHM) and to optimize the utilization of calcitonin in patients with hypercalcemia by facilitating the establishment of a calcitonin prescribing criteria. Methods: This was a single center biphasic study including both a retrospective and prospective phase of adult patients receiving calcitonin for hypercalcemia management at BHM. Phase I retrospective data was obtained from October 1st 2017 to September 30th 2019 and phase II prospective data was collected during January 6th 2020 to April 24th 2020. Data collection for both phases included patient demographics, indication, prescriber’s specialty, severity of hypercalcemia, presence or absence of symptoms, duration of therapy and use of first line therapy. Furthermore, pharmacy interventions pertaining to first line therapy usage or adjustments of duration of calcitonin as well as financial impact of accepted interventions were calculated for phase II. Primary outcome of the study included duration of calcitonin therapy for correction of hypercalcemia. Secondary outcomes included number of pharmacy interventions and percentage of patients treated with IV fluids and IV bisphosphonates. Results: A total of 94 patients in phase I and 16 patients in phase II met study inclusion criteria. The baseline demographics were primarily differentiated by the severity of hypercalcemia in the two phases. A greater proportion of patients in phase I (43.6%) was noted to have severe hypercalcemia compared to phase II (18.8%). In both phases, hypercalcemia of malignancy and oncology specialty accounted for the most common indication and prescriber specialty, respectively. In terms of primary outcome, duration of calcitonin therapy was significantly improved through pharmacist interventions in phase II as evidenced by 0% of patients receiving calcitonin beyond 48 hours versus 28.7% of patients in phase I (p= 0.0107). Evaluation of first line therapy demonstrated that 81% of patients received IV fluids and 88% of patients received IV bisphosphonate therapy in phase I while 100% of the patients in phase II received both IV fluids and IV bisphosphonates (p= 0.0689; p= 0.3613). In phase II, a total of 16 pharmacy interventions were performed with 75% acceptance rate including discontinuation or reduction in duration of calcitonin therapy and addition of IV fluids. These interventions resulted in 29 calcitonin doses avoided during phase II study period that amounts to an extrapolated annual cost savings of ~ $158,000. Conclusion: Implementation of a calcitonin prescribing criteria through prospective pharmacist review and recommendations can facilitate the optimization of calcitonin use in patients with hypercalcemia at BHM and potentially lead to significant cost savings

An Analysis of Weight Loss Articles and Advertisements in Mainstream Women’s Health and Fitness Magazines

Background: Magazines are a commonly used source for health and fitness information. Little is known about the nature and extent of weight loss strategies and products presented in mainstream women’s health and fitness magazines. Methods: This preliminary cross-sectional study evaluated the prevalence of articles and advertisements featuring weight loss content and products in mainstream US-based health and fitness magazines, as well as assessed weight loss themes presented. Thirty-one US health and fitness-focused magazine issues were coded. Prevalence of, product type, and themes related to weight loss in articles and advertisements were assessed. Results: Among the 31 issues of the five US-based women’s magazines examined, we identified 39 articles (4.8% [95% CI = 3.3% to 5.5%] of 819 articles) related to weight loss with 14 identified weight loss topics. The most prevalent article topics covered were exercising/workouts (32.0% [95% CI = 28.8% to 33.6%]) followed by dieting (18.6% [95% CI = 15.9% to 19.9%]). The most common product advertised was weight loss pills (46.0% [95% CI = 42.6% to 47.7%]). Fat burners were also frequently advertised (14.9% [95% CI = 12.5% to 16.1%]) followed by hunger reduction strategies (10.3% [95% CI = 8.2% to 11.3%]) and fat blockers (6.9% [95% CI = 5.2% to 7.8%]). Conclusion: Articles presented information about exercise and dieting whereas advertisements supported potentially harmful health beliefs and behaviors. As a well-utilized American media format, health and fitness-focused magazines have an opportunity to communicate frequent, accurate messaging about healthy weight reduction and limit advertisements that may include misleading claims

Skin Cancer Prevention Coverage in Popular US Women’s Health and Fitness Magazines: An Analysis of Advertisements and Articles

The desire to be tan is a phenomenon that public health researchers have investigated, as exposure to UV radiation increases the chances of developing skin cancer. Media messages in women’s magazines have been shown to contribute to this problem. Much less is known about the prevalence of skin cancer prevention messages in these magazines. This study\u27s aim was to identify the number and type of articles and advertised products devoted to skin health (sun protection and skin cancer prevention in particular) within five popular U.S. greater than women’s health and fitness magazines. We analyzed articles and advertisements over seven months of issues of the following popular women’s health and fitness magazines: Fitness, Health, Self, Shape, and Women\u27s Health, March 2013 through September 2013. Overall, 31 issues of the five magazines with a total of 780 articles and 1,986 advertisements were analyzed. Of the 780 articles, a mere 2.9% (n=23) were devoted to skin. Of the 258 skin product advertisements, less than 20% of the products contained sun protection factor (SPF). These findings suggest that women’s health and fitness magazines can improve their efforts in informing women of skin cancer risks and preventive measures to minimize these risks. The role of these magazines in building health literacy among their readers is also discussed

THE EFFECT OF A NOVEL REHABILITATION DEVICE ON MUSCLE ACTIVATION DURING GAIT IN PERSONS WITH MULTIPLE SCLEROSIS

This study examined the acute effect of a novel rehabilitation device, NewGait™, on muscle activation in persons with Multiple Sclerosis. Through electromyography, muscle activation of the vastus medialis (VM), gastrocnemius lateralis (GL) and tibialis anterior (TA) was measured in seventeen patients (n=17). Three trials were conducted in each condition: a 10-meter control walk and 10-meter NewGait™ walk. Results showed a non-significant change in muscle activity with moderate effect sizes in the right VM (increase of 39.72% MVC, p=0.082, d=0.626) and right TA (decrease of 12.71% MVC, p=0.069, d=0.427). In general, no change in muscle activation was noted when wearing the NewGait™ device. Future research should include a larger sample size and differentiation between the stance phases to accurately measure the outcomes of the NewGait™ device on muscle activation

CHANGES IN GAIT AND COORDINATION VARIABILITY IN PERSONS WITH MULTIPLE SCLEROSIS FOLLOWING A REHABILITATION PROGRAM

This study investigated changes in gait and coordination variability in persons with Multiple Sclerosis (MS) after an 8-week rehabilitation intervention. Data for eight participants (Control: 4, Intervention: 4) were analyzed via Cortex Motion Analysis software and Visual 3D to calculate knee and ankle joint angles as well as discrete spatiotemporal parameters. The knee and ankle joint angles were further analyzed using a vector coding technique to quantify coordination between these joints and how they produce a functional gait pattern. No significant changes in gait or coordination variability were found after rehabilitation, but some meaningful changes with large and moderate effect sizes were present. This study demonstrated a comprehensive overview of the relationship between process and outcome variability in a clinical population

Substrates of the \u3cem\u3eArabidopsis thaliana\u3c/em\u3e Protein Isoaspartyl Methyltransferase 1 Identified Using Phage Display and Biopanning

The role of protein isoaspartyl methyltransferase (PIMT) in repairing a wide assortment of damaged proteins in a host of organisms has been inferred from the affinity of the enzyme for isoaspartyl residues in a plethora of amino acid contexts. The identification of PIMT target proteins in plant seeds, where the enzyme is highly active and proteome long-lived, has been hindered by large amounts of isoaspartate-containing storage proteins. Mature seed phage display libraries circumvented this problem. Inclusion of the PIMT co-substrate, S-adenosylmethionine (AdoMet), during panning permitted PIMT to retain aged phage in greater numbers than controls lacking co-substrate or when PIMT protein binding was poisoned with S-adenosyl homocysteine. After four rounds, phage titer plateaued in AdoMet-containing pans, whereas titer declined in both controls. This strategy identified 17 in-frame PIMT target proteins, including a cupin-family protein similar to those identified previously using on-blot methylation. All recovered phage had at least one susceptible Asp or Asn residue. Five targets were recovered independently. Two in-frame targets were produced in Escherichia coli as recombinant proteins and shown by on-blot methylation to acquire isoAsp, becoming a PIMT target. Both gained isoAsp rapidly in solution upon thermal insult. Mutant analysis of plants deficient in any of three in-frame PIMT targets resulted in demonstrable phenotypes. An over-representation of clones encoding proteins involved in protein production suggests that the translational apparatus comprises a subgroup for which PIMT-mediated repair is vital for orthodox seed longevity. Impaired PIMT activity would hinder protein function in these targets, possibly resulting in poor seed performance

PV Ceph: Young Star Caught Speeding?

Three independent lines of evidence imply that the young star PV Ceph is moving at roughly 20 km/s through the interstellar medium. The first, and strongest, suggestion of motion comes from the geometry of the HH knots in the "giant" Herbig-Haro (HH) flow associated with PV Ceph. Bisectors of lines drawn between pairs of knots at nearly equal distances from PV Ceph imply an E-W motion of the source, and a plasmon model fit to the knot positions gives a good fit of 22 km/s motion for the star. The second bit of damning evidence comes from a redshifted "trail" of molecular gas, pointing in the same E-W direction implied by the HH knot geometry. The third exhibit we offer in accusing PV Ceph of speeding involves the tilt apparent in the high-velocity molecular jet now emanating from the star. This tilt is best explained if the true, current, jet direction is N-S, as it is in HST images, and the star is moving at roughly 20 km/s. Tracing the motion of PV Ceph backward in time, to the nearest cluster from which it might have been ejected, we find that it is very likely to have been thrown out of the massive star-forming cluster NGC 7023 (more than 10 pc away). We propose that PV Ceph was ejected, at a speed large enough to escape NGC 7023, at least 100,000 years ago, but that it did not enter the molecular cloud in which it now finds itself until more like 35,000 years ago. Our calculations show that the currently-observable molecular outflow associated with PV Ceph is about 10,000 years old, so that the flow has had plenty of time to form while in its current molecular cloud. But, the question of what PV Ceph was doing, and what gas/disk it took along with it in the time it was traveling through the low-density region between NGC 7023 and its current home is an open question.Comment: To be published by the Astrophysical Journal. Figures 1, 6, and 7 are in gif format. See material from the AAS press conference related to this work at: http://cfa-www.harvard.edu/~agoodman/Presentations/aas04PVCeph

The GoodHope Exercise and Rehabilitation (GEAR) Program for People With Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders

Introduction: The Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorders (G-HSD) comprise a heterogeneous group of genetic disorders of abnormal synthesis and/or maturation of collagen and other matricellular proteins. EDS is commonly characterized by manifestations such as multi joint hypermobility that can lead to musculoskeletal pains, subluxations and dislocations, fragile skin, organ dysfunction, and chronic significant diffuse pain with fatigue, deconditioning eventuating to poor quality of life. Evidence suggests exercise and rehabilitation interventions may ameliorate symptoms of unstable joints, recurrent subluxations/dislocations, and chronic widespread musculoskeletal pain. To date, there have only been a few reports describing exercise and rehabilitation care strategies for people with EDS.Methods: In this manuscript, we describe the GoodHope Exercise and Rehabilitation (GEAR) program, its overarching principles, as well as the program development and delivery model. The GEAR program aims to decrease functional impairment, reduce pain, increase confidence in symptom self-management, and provide a community of support for people with EDS/G-HSD. To achieve these goals, we detail the model of care that includes exercise and rehabilitation therapy, education for self-management, and support accessing relevant community resources.Strengths and Limitations of the Study: GEAR represents a novel exercise and rehabilitation care model for people with G-HSD and various clinical EDS subtypes, beyond the commonly included hEDS subtype. Systematic collection of data via validated measurements is ongoing and will guide the refinement of GEAR and support the development of emerging exercise and rehabilitation programs for people with EDS