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The authors discuss the use of rosiglitazone (Avandia[R]) and pioglitazone (Actos[R]) for patients with type-2 diabetes. [ABSTRACT FROM AUTHOR]

The relationship between antecedent life events, clinical profile, and hypothalamic-pituitary-adrenal function was examined in 72 depressed patients. Antecedent life events were associated with first episodes of depression and with greater severity of illness, but their presence did not distinguish between patients diagnosed as endogenous or neurotic, and status on the dexamethasone suppression test was not associated with a greater or lesser likelihood of antecedent events. However, urinary free cortisol levels were higher in those patients with life events and difficulties. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic suddenly changed the scene of primary care visits. As clinics abruptly transitioned to telehealth visits, health care providers and students were required to use digital technologies to deliver health care from a distance. This article highlights 5 steps used by faculty to integrate telehealth concepts into the graduate curriculum for all advanced practice registered nurse programs. As patients and providers recognize its widespread acceptance, telehealth will likely have a permanent place in traditional health care delivery long after the COVID-19 pandemic., (© 2020 Elsevier Inc. All rights reserved.)

Background and Purpose: Refugees resettling to the United States are at increased risk for mental health disorders, which can lead to difficulty with adaptation and poor health outcomes. Standardized mental health screening of refugees is often neglected at primary care and community health clinics. A pilot project aimed to initiate early mental health screening for newly resettled adult refugees was implemented at a community health center in Fargo, North Dakota., Methods: Current refugee screening processes were evaluated to determine appropriate timing for refugee mental health screening. This took into consideration time, staffing, interpreter availability and the refugee "honeymoon" phase following resettlement. The Refugee Health Screener-15 (RHS-15) was identified as an efficient, valid, and reliable tool for assessing emotional distress in this population and was integrated into refugee health screening practices., Results: The RHS-15 was administered to 178 adult refugees with arrival dates between August 1, 2013 and July 31, 2014. Of those screened, 51 (28.6%) screened positive for risk of emotional distress. Follow-up with primary care provider was completed with 30 (59%) of those who screened positive. Half (15) requested mental health treatment. Although the largest group of refugees during this period of time were resettling from Bhutan, refugees from Iraq had greater incidence of positive screening compared with those from Bhutan. Refugees from Iraq were also found to have significantly higher scores on the RHS-15., Conclusions: Although there are some challenges to implementing a standardized mental health screening for refugees, this pilot reiterates the need for standardized mental health screening of refugees. Routine mental health screening should be a part of the overall comprehensive health assessment provided to refugees nationwide. Considerations should be taken in regards to how refugees from Iraq have even greater risk of mental health disorders compared to other refugee groups., (© The Author(s) 2016.)

Background: Both robotic pulmonary operations and anatomic segmentectomy are being increasingly performed. The largest published series of anatomic robotic segmentectomy comprises 35 patients, and the specific details of port placement are poorly understood., Methods: This is a review of a consecutive series of patients from a single surgeon's prospective database. All patients in the study were scheduled to undergo robotic anatomic segmentectomy., Results: Between February 2010 and December 2014, 100 patients went to the operating room for a planned pulmonary segmentectomy. A robotic approach was chosen for all. Seven patients underwent conversion to robotic lobectomy, and the remaining 93 patients had an anatomic robotic segmentectomy. There were no conversions to thoracotomy. Indications for resection were lung cancer in 79 patients, metastatic lesions in 10 patients, fungal infections in 4 patients, and other conditions in 7 patients. The median age was 69 years, and 50 patients were men. The median blood loss was 20 mL (range, 10-120 mL), the median number of lymph nodes removed was 19, the median operative time was 1.28 hours (88 minutes), the median length of stay was 3 days, and major morbidity occurred in 2 patients (pneumonia in both). All had undergone R0 resection. There were no 30- or 90-day mortalities. Of the 79 patients with lung cancer, the median follow-up was 30 months, and 3 patients (3.4%) had recurrence in the operated lobe. Overall survival was 95% at 30 months., Conclusions: Completely portal robotic anatomic segmentectomy is safe and effective and offers outstanding intraoperative 30-day and 90-day results. The recurrence rate is approximately 3% at 2.5 years., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. A CDSS is a promising approach to the aggregation and use of patient data to identify patients who would most benefit from interventions by pharmacy clinicians. However, there are limited published reports describing the impact of CDSS on clinical pharmacy measures. In February 2011, Good Shepherd Medical Center, a 425-bed acute care community hospital in East Texas, implemented a CDSS (TheraDoc clinical surveillance system). Prior to CDSS implementation, clinicians struggled with obtaining and documenting the data needed to support clinical initiatives. The value of having both clinical and staff pharmacists utilizing the CDSS has improved communication and knowledge among staff and improved relationships with medical staff, nursing, and case management. The department of pharmacy increased its clinical interventions from an average of 1,986 per month to 4,065 per month; this represents a 105% increase in the number of interventions. The annual estimated cost savings after CDSS implementation is $2,999,508, representing a 96% increase per year and translating into a $1,469,907 annual return on investment.

As a discipline, nursing has espoused a philosophy of caring for the whole person, including not only the physical but also the psychosocial and spiritual realms. Health promotion and the desire to promote healthy communities are a focus of the discipline and are evidenced by the curricula in nursing programs as well as community activism by individuals and groups of nurses. Although health promotion should include measures to address not only physical but also mental health, there is a disparity in the nursing literature regarding mental health promotion. Is this because mental health promotion is assumed to be a natural outgrowth of the caring aspect of nursing or because mental health promotion is relegated only to those who specialize in mental health? Is there a research gap in the area of mental health promotion or is there a failure to use research-based actions to promote mental health in nursing curricula? This article addresses the current state of mental health promotion in nursing.

A schedule (the Cambridge Neurological Inventory) has been constructed for standardized neurological assessment of psychiatric patients. Normative data and data resulting from its application to a group of patients with schizophrenia are reported. The instrument is comprehensive, reliable, and easy to administer. In conjunction with other forms of clinical assessment, it may be useful for identifying soft neurological signs and other patterns of neurological impairment relevant to neurobiological localization and prognosis in schizophrenia and other psychiatric disorders.

Aerophagia has been shown to occur in association with hiatus hernia, and it has been suggested that it may have an aetiological role. Two behavioural methods are described, which are designed to reduce the rate of swallowing. They were applied to a group of 12 patients with hiatus hernia, in whom aerophagia had been demonstrated. Patients were on the whole successful in reducing their rate of spontaneous swallowing. An association was observed between symptomatic improvement and successful reduction of swallowing rate. This was still apparent on follow-up at nine months. Symptomatic improvement, however, on the whole appeared to be short-lived. The possible clinical significance of aerophagia in hiatus hernia is discussed.

Creatine kinase isoenzyme BB (CK-BB) is found in high concentrations in the brain. Normally concentrations in blood are undetectable or low. Blood concentrations of CK-BB were measured in 16 boxers before and after a fight and in 16 track cyclists before and after a race. Blood CK-BB rose to significantly higher concentrations in the boxers than in the cyclists. The number of blows received to the head was estimated in half the boxers and correlated significantly with the rise in CK-BB. This increase in blood CK-BB may indicate disruption of the blood-brain barrier. This may be one of the mechanisms accounting for brain damage in boxers.

The effect of two experimental tasks aimed at inducing emotional arousal on spontaneous swallowing rates was investigated. An anxiety-inducing cognitive task and a Velten-type depression-inducing manipulation were both found to increase spontaneous swallowing rates in normal subjects. This confirmed previous anecdotal reports of elevated swallowing rates associated with emotional arousal. The implication of this finding for a possible pathway between emotional factors and gastrointestinal disorders is discussed.

The authors found a significant negative correlation between human growth hormone (HGH) response to clonidine and urinary free cortisol level in 14 depressed patients. The HGH response did not distinguish endogenous depression from nonendogenous depression.