Chronic Diarrhea Associated with High Teriflunomide Blood Concentration.

OBJECTIVE: To report the case of a patient treated with leflunomide that presented with chronic diarrhea associated with high teriflunomide blood concentration. An 84-year-old woman taking leflunomide 20 mg once daily for the past 2 years to treat rheumatoid arthritis (RA) was investigated for severe chronic diarrhea that had been worsening for the past 5 months. The patient's general condition progressively deteriorated and included electrolyte imbalances and a transient loss of consciousness. Therefore, hospitalization was required. Teriflunomide blood concentration was 156 mg/L. After 11 days of cholestyramine washout therapy, teriflunomide blood concentration was reduced to 6 mg/L. As the teriflunomide levels decreased, diarrhea improved. All other possible causes of diarrhea were ruled out. The patient's diarrhea finally resolved 26 days after treatment with cholestyramine. DISCUSSION: Diarrhea is a known adverse effect of leflunomide. In this report, the severe diarrhea was associated with high blood teriflunomide concentrations. Available data suggests an association between teriflunomide concentrations greater than 50 mg/L and lower disease activity, but toxic teriflunomide levels still have to be clarified. CONCLUSION: Further studies are needed to establish the optimal therapeutic levels of teriflunomide. However, therapeutic drug monitoring of teriflunomide blood concentrations may be helpful to improve effectiveness and to prevent toxicity in patients taking leflunomide for RA, particularly in those with suboptimal therapeutic response to leflunomide or in patients with toxicity suspected to be induced by leflunomide.

Workplace violence reported by Canadian nurses.

The purpose of this study was to determine the prevalence, origins, and forms of workplace violence reported by nurses working in acute-care settings in the Canadian province of Quebec. The Quebec health-care system is currently undergoing a shortage of qualified nurses that has resulted in an oppressive work environment marked by violence towards nurses.A descriptive study design was used with a sample of 181 nurses (out of a possible 300).The data, collected in 2003 using a French translation of the Workplace Violence Events Questionnaire, show that 86.5% of the nurses were victims of violent incidents on more than 1 occasion.The nature of the abuse was physical (10.6%), psychological (86.4%), or sexual (30.7%), inflicted by a colleague (65.9%), a superior (59.6%), or a physician (59.1%). Nurses should be made aware of the prevalence of workplace violence. Preventive measures are urgently needed for the well-being of the nursing profession.

Hardiness, work support and psychological distress among nursing assistants and registered nurses in Quebec.

BACKGROUND: Although nursing assistants (NAs) represent a large segment of Canadian health care providers, little is known about psychosocial factors related to their physical and psychological well-being and how these compare with their registered nurse (RN) counterparts. AIM: Guided by Maddi and Kobasa's theoretical framework of Factors Affecting Health-Illness Status, the purpose of the present study was to examine relationships among hardiness, psychological distress and work support in NAs, and to compare results with those from a sample of RNs. METHOD: A random sample of 171 NAs in Quebec completed self-report questionnaires. The study instruments included validated French-Canadian versions of Kobasa's Hardiness Scale, Ilfeld's Psychiatric Symptom Index, and Moos' Work Relationship Index. RESULTS: As theoretically predicted, statistically significant correlations were found between hardiness and psychological distress (r = -0.42; P < 0.001), hardiness and work support (r = 0.27; P < 0.001), and between work support and psychological distress (r = -0.21; P < 0.001). Using a mediational model and multiple regression analyses, hardiness among NAs was found to be a significant mediator between work support and psychological distress. Comparative analyses revealed that whereas NAs and RNs reported similar levels of psychological distress (P = 0.25) and work support (P = 0.13), NAs reported significantly less hardiness (t = -5.58; P < 0.01). In addition, NAs and RNs reported significantly more psychological distress than the general population of Quebec, Canada (t = 9.07 and 22.84, P < 0.01, respectively). CONCLUSION: Results add support to Maddi and Kobasa's theoretical propositions linking personal and contextual resources to health-related outcomes and offer insights into specific factors that may affect the health and well-being of both NAs and RNs as well as their work climate.