Adherence to Hypertensive Treatment among Vietnamese Patients in New Orleans.

OBJECTIVES: Our principal objectives were to identify the level of adherence and identify the attitudes, beliefs, and behaviors that influence adherence to antihypertensive treatment among Vietnamese patients in New Orleans, Louisiana. METHODS: By partnering with a community health center serving the Vietnamese community in New Orleans, we conducted reviews of 250 medical records of hypertensive patients receiving care there, 3 provider interviews, and 8 patient interviews. Descriptive and thematic analyses were used. RESULTS: The level of treatment nonadherence in our sample population was 20.40%. Findings highlighted several key factors that may contribute to adherence, including easy access to providers, who are culturally competent and have used several strategies to help increase adherence, and the social support network of patients within a close-knit community. Other sociodemographic factors, such as age, sex, and tobacco and alcohol use also may play a role in adherence. CONCLUSIONS: Adherence to antihypertensive treatment among Vietnamese patients in New Orleans was relatively high compared with other ethnic and racial groups in the United States. Further assessment of the characteristics of patients, providers, and the community may improve adherence to other chronic conditions in this population and patients of other ethnicities and races.

Resistance within hemodialysis shunts predicts patency.

The authors examined the relationship between patency after thrombectomy of clotted dialysis grafts and intraoperative measurements of flow (Q), pressure gradient (PGR), and longitudinal resistance (RL). Eighteen thrombosed arteriovenous (AV) grafts underwent 21 thrombectomies. Pressures at arterial (P1) and venous (P2) ends of the AV grafts were determined with 22-gauge catheters and standard transducers; flow was measured with transit-time probes; arithmetic averaging of waveforms was used to compute mean Q, PGR, and RL. Kaplan-Meier patency curves were analyzed by using log rank methods. Mean patency for all grafts was 164 +/-152 days. For each variable, the 21 measurements were split and the patency curve for the grafts with the 11 lowest value grafts was compared to the curve representing the 10 highest value grafts. The difference between high RL versus low RL patency curves was significant with high-resistance grafts having a median patency of 55 days and low-resistance grafts having a median patency greater than 151 days (p = 0.0089). In contrast, the high Q group median patency was 151 days versus 174 days for the low Q group (p = 0.86). Median patency for the low PGR group was 115 days compared to 62 days for the high PGR group (p = 0.162). Longitudinal resistance within AV grafts, but not flow or pressure gradient, showed a significant correlation with patency after thrombectomy. Increased resistance to flow within AV grafts appears to be an important factor affecting the propensity of dialysis grafts to thrombose.

Use of MALDI-TOF mass spectrometry in a 51-mutation test for cystic fibrosis: evidence that 3199del6 is a disease-causing mutation.

PURPOSE: We developed a 51-mutation extended cystic fibrosis (CF) panel that incorporates the 25 previously recommended CFTR mutations, plus 26 additional mutations including 3199del6, which was associated with I148T. METHODS: This assay utilizes an integrated matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry system. RESULTS: CF testing was performed on over 5,000 individuals, including a 3-year-old Hispanic-American patient with a compound heterozygous G542X/3199del6 genotype. He is negative for I148T, or other mutations assessed by CFTR gene sequencing. CONCLUSION: These results demonstrate the successful implementation of MALDI-TOF mass spectrometry in CF clinical testing, and establish 3199del6 as a disease-causing CF mutation.