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OALib Journal期刊

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Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension
Aljadhey Hisham,Tu Wanzhu,Hansen Richard A,Blalock Susan J
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-93
Abstract: Background Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension. Methods We conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy. Results Compared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant. Conclusion Compared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.
Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence
Betsy Sleath,Susan J. Blalock,David Covert,Asheley Cockrell Skinner
ISRN Ophthalmology , 2012, DOI: 10.5402/2012/902819
Abstract:
Patient decision making in the face of conflicting medication information
Emily Elstad,Delesha M. Carpenter,Robert F. Devellis,Susan J. Blalock
International Journal of Qualitative Studies on Health & Well-Being , 2012, DOI: 10.3402/qhw.v7i0.18523
Abstract: When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.
Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence
Betsy Sleath,Susan J. Blalock,David Covert,Asheley Cockrell Skinner,Kelly W. Muir,Alan L. Robin
ISRN Ophthalmology , 2012, DOI: 10.5402/2012/902819
Abstract: Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications. 1. Introduction Between 9% and 12% of all blindness in the Unites States is attributed to glaucoma [1]. Proper use of glaucoma medications can lower intraocular pressure and reduce the progression of glaucoma [2]. However, nonadherence to treatment regimens remains a significant problem [3, 4]. Approximately half of all subjects who are started on glaucoma medications will discontinue treatment within 6 months [5]. Few prior studies have examined the relationship between race and adherence to glaucoma medications and these studies had contradictory results [3, 6–10]. Both Patel and Spaeth and Sleath et al. [7, 9] found that African Americans were more likely to report missing doses of their glaucoma drops than Whites, and electronic monitoring revealed African American race as a risk factor for poor glaucoma medication adherence [6]. However, other studies using electronic monitors [10] and pharmacy report [8] found no association between race and adherence to glaucoma medications. Racial
Falls Risks and Prevention Behaviors Among Community
Carri Casteel,James M. Bowling,Jennifer Jones,Paula Gildner,Susan J. Blalock
- , 2018, DOI: 10.1177/0733464816672043
Abstract: The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program
Medication-related Self-management Behaviors among Arthritis Patients: Does Attentional Coping Style Matter?
Delesha M. Carpenter,Joanne M. Jordan,Lorie L. Geryk,Paul K. J. Han,Robert F. DeVellis,Susan J. Blalock
- , 2016, DOI: 10.2174/1874312901610010060
Abstract: The aim of this study was to investigate the relationship between the attentional coping styles (monitoring and blunting) of rheumatoid arthritis (RA) and osteoarthritis (OA) patients and: (a) receipt of medication information; (b) receipt of conflicting medication information; (c) ambiguity aversion; (d) medication-related discussions with doctors and spouse/partners; and (e) medication adherence
Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence
Betsy Sleath,Charles Lee,Delesha M Carpenter,Doyle M Cummings,Jennifer E Scott,Lisa B Rodebaugh,Ryan P Hickson,Scott A Davis,Stefanie P Ferreri,Susan J Blalock
- , 2016, DOI: 10.2147/PPA.S101349
Abstract: Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence
Investigating Bacterial Sources of Toxicity as an Environmental Contributor to Dopaminergic Neurodegeneration
Kim A. Caldwell, Michelle L. Tucci, Jafa Armagost, Tyler W. Hodges, Jue Chen, Shermeen B. Memon, Jeana E. Blalock, Susan M. DeLeon, Robert H. Findlay, Qingmin Ruan, Philip J. Webber, David G. Standaert, Julie B. Olson, Guy A. Caldwell
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0007227
Abstract: Parkinson disease (PD) involves progressive neurodegeneration, including loss of dopamine (DA) neurons from the substantia nigra. Select genes associated with rare familial forms of PD function in cellular pathways, such as the ubiquitin-proteasome system (UPS), involved in protein degradation. The misfolding and accumulation of proteins, such as α-synuclein, into inclusions termed Lewy Bodies represents a clinical hallmark of PD. Given the predominance of sporadic PD among patient populations, environmental toxins may induce the disease, although their nature is largely unknown. Thus, an unmet challenge surrounds the discovery of causal or contributory neurotoxic factors that could account for the prevalence of sporadic PD. Bacteria within the order Actinomycetales are renowned for their robust production of secondary metabolites and might represent unidentified sources of environmental exposures. Among these, the aerobic genera, Streptomyces, produce natural proteasome inhibitors that block protein degradation and may potentially damage DA neurons. Here we demonstrate that a metabolite produced by a common soil bacterium, S. venezuelae, caused DA neurodegeneration in the nematode, Caenorhabditis elegans, which increased as animals aged. This metabolite, which disrupts UPS function, caused gradual degeneration of all neuronal classes examined, however DA neurons were particularly vulnerable to exposure. The presence of DA exacerbated toxicity because neurodegeneration was attenuated in mutant nematodes depleted for tyrosine hydroxylase (TH), the rate-limiting enzyme in DA production. Strikingly, this factor caused dose-dependent death of human SH-SY5Y neuroblastoma cells, a dopaminergic line. Efforts to purify the toxic activity revealed that it is a highly stable, lipophilic, and chemically unique small molecule. Evidence of a robust neurotoxic factor that selectively impacts neuronal survival in a progressive yet moderate manner is consistent with the etiology of age-associated neurodegenerative diseases. Collectively, these data suggest the potential for exposures to the metabolites of specific common soil bacteria to possibly represent a contributory environmental component to PD.
"I Wish for More Than I Ever Get": Employers’ Perspectives on Employability Attributes of Architecture Graduates  [PDF]
Susan J. Shannon
Creative Education (CE) , 2012, DOI: 10.4236/ce.2012.326153
Abstract: This research considers graduate recruitment for architecture graduates. Employers in small, medium and large Australian firms, from the private and public sector were surveyed about their graduate hiring practices. Through distilling the discipline specific Graduate Attributes for all Australian Architecture Schools’ Architecture Programs, and generic Graduate Attributes for their Universities, the researcher compiled a questionnaire which was administered to prospective employers of architecture graduates. The results reveal that the possession of technical knowledge is more highly rated as a Graduate Attribute in recruitment than the possession of design knowledge/skills, and that the possession of Computer Aided Design (CAD) representation skills is more important to graduate recruiters of all firm sizes than either technical or design knowledge and skills. The research further revealed that the presentation of a portfolio is a key recruitment tool for employers, and that the demonstration of team work is a highly valued generic attribute for employers.
Statistical implications of pooling RNA samples for microarray experiments
Xuejun Peng, Constance L Wood, Eric M Blalock, Kuey Chen, Philip W Landfield, Arnold J Stromberg
BMC Bioinformatics , 2003, DOI: 10.1186/1471-2105-4-26
Abstract: Modeling the resulting gene expression from sample pooling as a mixture of individual responses, we derived expressions for the experimental error and provided both upper and lower bounds for its value in terms of the variability among individuals and the number of RNA samples pooled. Using "virtual" pooling of data from real experiments and computer simulations, we investigated the statistical properties of RNA sample pooling. Our study reveals that pooling biological samples appropriately is statistically valid and efficient for microarray experiments. Furthermore, optimal pooling design(s) can be found to meet statistical requirements while minimizing total cost.Appropriate RNA pooling can provide equivalent power and improve efficiency and cost-effectiveness for microarray experiments with a modest increase in total number of subjects. Pooling schemes in terms of replicates of subjects and arrays can be compared before experiments are conducted.Researchers are increasingly realizing the importance of true biological replicates for assessing statistical confidence in microarray experiments [1-6], but replication is often hindered by financial or technical constraints. One problem is that large, prefabricated microarray chips can be relatively expensive, driving up the total cost of an experiment. (In fact, the cost of a subject is often lower.) Another obstacle to using replicates is that the biological tissues from which RNA is extracted can often be of such small quantity by nature that it is technically difficult to get enough RNA sample from one subject for hybridization to one array [3]. Either or both of these problems have motivated biologists to pool RNA samples together before hybridization. Many research papers using this method have been published [3-5], but the statistical properties of pooling have not been explicitly addressed. There are two different approaches of sample pooling. One is dubbed "complete pooling", where all samples from one treatmen
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