High flow nasal oxygen therapy utilization: 7-year experience at a community teaching hospital.

OBJECTIVE: To examine the use of high flow nasal cannula oxygen therapy (HFNC) between 2008 and 2014 in patients 18 years or older at a community teaching hospital. METHODS: Yearly utilization rates of HFNC, noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) were calculated among admissions with a set of cardiopulmonary diagnoses (heart failure, COPD, asthma or pneumonia). RESULTS: Among the 41,711 admissions with at least one of the above cardiopulmonary condition, HFNC was utilized in 1,128 or 27.0/1000; NIV was used in an average of 169/1000 and IMV in 231/1000. HFNC was accompanied by IMV or NIV 71.3% of the time. From 2008 to 2014 HFNC utilization increased an average of 17.5% annually; NIV increased by 10.2% annually while IMV's utilization increased by 1.6% annually. The highest rate of change in HFNC use was among admissions with pneumonia and those with COPD. CONCLUSION: HFNC utilization increased steadily over a 7-year period at our hospital. Frequently, HFNC therapy was used in combination with other ventilatory modes to support patients' respiration. Similar with other technologies in healthcare, the uptake of HFNC has preceded the evidence from robust clinical trials.

Knowledge of structured treatment interruption and adherence to antiretroviral therapy.

We conducted a survey of 106 HIV-infected patients on antiretroviral therapy at a community hospital in Lancaster, Pennsylvania, to determine the extent of patient knowledge and attitudes about structured treatment interruption (STI) and whether these were factors in adherence to antiretroviral regimens. Thirty-six percent of patients possessed knowledge of STI as a treatment option and four patients reported that they had stopped taking antiretroviral therapy without specific recommendation from their physician based on information they had heard or read about STI. There was no difference in median adherence based on whether a patient was aware of STI, however, in the group who had heard of STI, attitude that STI is very beneficial was correlated with greater adherence to medication. More than one third of HIV-infected patients on antiretroviral therapy possessed knowledge of STI, and this knowledge affected adherence to antiretroviral regimens. Providers caring for HIV-infected patients should routinely inquire about patient knowledge of STI as another factor in assessing adherence to antiretroviral therapy.

Hepatitis C virus NS3 ATPases/helicases from different genotypes exhibit variations in enzymatic properties.

The NS3 ATPase/helicase was isolated and characterized from three different infectious clones of hepatitis C virus (HCV). One helicase was from a genotype that normally responds to therapy (Hel-2a), and the other two were from more resistant genotypes, 1a (Hel-1a) and 1b (Hel-1b). Although the differences among these helicases are generally minor, all three enzymes have distinct properties. Hel-1a is less selective for nucleoside triphosphates, Hel-1b hydrolyzes nucleoside triphosphates less rapidly, and Hel-2a unwinds DNA more rapidly and binds DNA more tightly than the other two enzymes. Unlike related proteins, different nucleic acid sequences stimulate ATP hydrolysis by HCV helicase at different maximum rates and with different apparent efficiencies. This nucleic acid stimulation profile is conserved among the enzymes, but it does not result entirely from differential DNA-binding affinities. Although the amino acid sequences of the three proteins differ by up to 15%, one variant amino acid that is critical for helicase action was identified. NS3 residue 450 is a threonine in Hel-1a and Hel-1b and is an isoleucine in Hel-2a. A mutant Hel-1a with an isoleucine substituted for threonine 450 unwinds DNA more rapidly and binds DNA more tightly than the parent protein.