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Damien Lesenfants, Dina Habbal, Camille Chatelle, Caroline Schnakers, Steven Laureys, Quentin Noirhomme
OBJECTIVE: To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy. METHODS: Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study...
October 21, 2016: Neurology
Marit Hegg Reime, Tone Johnsgaard, Fred Ivan Kvam, Morten Aarflot, Marit Breivik, Janecke Merethe Engeberg, Guttorm Brattebø
Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams...
October 13, 2016: Nurse Education in Practice
David Altschul, Andrew Kobets, Jonathan Nakhla, Ajit Jada, Rani Nasser, Merritt D Kinon, Reza Yassari, John Houten
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period...
October 21, 2016: Journal of Neurosurgery. Spine
Bryan M Corbett, Charles O'Connell, Mallory A Boutin, Nabil I Fatayerji, Charles W Sauer
BACKGROUND Methylergonovine is an ergot alkaloid used to treat post-partum hemorrhage secondary to uterine atony. Mistaking methylergonovine for vitamin K with accidental administration to the neonate is a rare iatrogenic illness occurring almost exclusively in the delivery room setting. Complications of ergot alkaloids in neonates include respiratory depression, seizures, and death. CASE REPORT A term infant was inadvertently given 0.1 mg of methylergonovine intramuscularly in the right thigh. The error was only noted when the vial of medication was scanned, after administration, identifying it as methylergonovine rather than vitamin K...
October 21, 2016: American Journal of Case Reports
D J Murphy, A R Keraliya, M D Agrawal, A Aghayev, M L Steigner
Aortic infections are uncommon clinical entities, but are associated with high rates of morbidity and mortality. In this review, we focus on the cross-sectional imaging appearance of aortic infections, including aortic valve endocarditis, pyogenic aortitis, mycotic aneurysm and aortic graft infections, with an emphasis on CT, MRI and PET/CT appearance. Teaching Points • Aortic infections are associated with high morbidity and mortality. • CT, MRI and FDG PET/CT play complementary roles in aortic infection imaging...
October 19, 2016: Insights Into Imaging
C O'Connor, M G Kiernan, C Finnegan, J Powell, L Power, N H O'Connell, C P Dunne
BACKGROUND: The Mid-West of Ireland has higher than average national rates of invasive extended-spectrum beta-lactamase (ESBL) bloodstream infections and carbapenemase-producing Enterobacteriaceae (CPE), with increasing numbers of ESBL isolates detected in community-dwelling patients. AIMS: To conduct a point prevalence study in a convenience sample of the Mid-West population with the aim of determining the extent of ESBL colonisation. METHODS: Utilising anonymised community stool samples that had completed routine analysis, we conducted a point prevalence study over a 4-week period on all samples that met defined inclusion and exclusion criteria...
September 24, 2016: Irish Journal of Medical Science
Dirk Alexander Wittekind, Janek Spada, Alexander Gross, Tilman Hensch, Philippe Jawinski, Christine Ulke, Christian Sander, Ulrich Hegerl
OBJECTIVES: The arousal regulation model of affective disorders attributes an important role in the pathophysiology of affective disorders to dysregulation of brain arousal regulation. According to this model, sensation avoidance and withdrawal in depression and sensation seeking and hyperactivity in mania can be explained as auto-regulatory attempts to counteract a tonically high (depression) or unstable (mania) arousal. The aim of this study was to compare brain arousal regulation between manic and depressive bipolar patients and healthy controls...
September 2016: Bipolar Disorders
Daniel Corrigan, Christiana Prucnal, Christopher Kabrhel
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis...
September 2016: Clin Exp Emerg Med
Efraín Rodríguez-Vigil, Migdalia Rodríguez-Chacón, José J Ruiz Valcarcel
OBJECTIVE: The objective of this study was to assess the current relationship between certain demographics and chemical factors, and the risk of cardiovascular complications, within a Puerto Rican population with diabetes mellitus. RESEARCH DESIGN AND METHODS: A total of 2075 patients with diabetes mellitus were retrospectively evaluated to determine the influence of certain demographics and chemical variables on the appearance of cardiovascular complications. A group of demographic and laboratory variables were analyzed...
2016: BMJ Open Diabetes Research & Care
Gianantonio Rosti, Fausto Castagnetti, Gabriele Gugliotta, Michele Baccarani
The therapeutic armamentarium for chronic myeloid leukaemia (CML) comprises mainly tyrosine kinase inhibitors (TKIs), with several agents available for frontline treatment, or for the treatment of disease resistance or intolerance to the first-choice or second-choice drug. The availability of different drugs is a major achievement, but means that choices must be made - which can be difficult and questionable at times. The most important end point considered in decision-making regarding treatment for any cancer is overall survival, but additional factors (such as age, prognostic category, safety, or the possibility of achieving treatment-free remission) should be considered when selecting an agent for frontline treatment...
October 18, 2016: Nature Reviews. Clinical Oncology
Michael M Neeki, Christine Au, Aurora Richard, Carlos Peace, Sharon Jaques, Jens Johansson
PURPOSE: We aimed to describe a case of an incarcerated adolescent with acute disseminated encephalomyelitis (ADEM) presenting as acute psychosis. METHODS: This was a retrospective case report followed with chart and literature review. MAIN FINDINGS: An adolescent with ADEM presented with drastic behavior and personality changes that led to her incarceration for serious charges. Acute disseminated encephalomyelitis leads to neuropsychiatric effects and can be seen with magnetic resonance imaging as a large mass effect that may result in a poor prognosis...
October 4, 2016: Pediatric Emergency Care
Kristen M Little, Allan W Taylor, Craig B Borkowf, Maria C B Mendoza, Margaret A Lampe, Paul J Weidle, Steven R Nesheim
OBJECTIVE: Using published, nationally representative estimates, we calculated the total number of perinatally HIV-exposed and -infected infants born during 1978-2010, the number of perinatal HIV cases prevented by interventions designed for the prevention of mother-to-child transmission (PMTCT), and the number of infants exposed to antiretroviral drugs during the prenatal and intrapartum periods. DESIGN: We calculated the number of infants exposed to antiretroviral drugs since 1994, and the number of cases of mother-to-child HIV transmission prevented from 1994-2010 using published data...
September 30, 2016: Pediatric Infectious Disease Journal
Yun Li, Alexandros N Vgontzas, Julio Fernandez-Mendoza, Ilia Kritikou, Maria Basta, Slobodanka Pejovic, Jordan Gaines, Edward O Bixler
STUDY OBJECTIVES: Objective and subjective measures of excessive daytime sleepiness (EDS) are only weakly associated. No study, however, has examined whether these two measures of EDS differ in terms of underlying mechanisms and prognostic value. Pro-inflammatory cytokines, i.e., interleukin-6 (IL-6) appear to promote sleepiness/fatigue, while the stress hormone cortisol promotes vigilance. We hypothesized that objective sleepiness is associated with increased levels of IL-6 and decreased levels of cortisol...
October 10, 2016: Sleep
Ali Tafazoli
A 26-year-old woman developed symptoms of acute toxicity during cyclosporine (CsA) therapy for graft-versus-host disease prophylaxis. The standard regimen included CsA in a dose of 1.5 mg/kg (120 mg) every 12 h, but, as a medication error, she received a high dose of 500 mg of oral CsA. After 2 h, she developed nausea and vomiting and, subsequently, flushing, chest tightness, tremor and vertigo. Laboratory and clinical examinations revealed high blood CsA concentrations (1000 ng/mL after 12 h) with a mild increase in blood pressure...
December 2015: Drug Saf Case Rep
Sabyasachi Paik, Agnik Pal, Sukanta Sen, Netai Pramanick, Santanu K Tripathi
A 23-year-old human immunodeficiency virus (HIV)-infected Indian woman was admitted to a tertiary care hospital with generalized erythematosus rash all over her body with difficulty in swallowing for the previous 3 days. She also presented with swelling of the lips and redness of both eyes along with nausea, anorexia, slight headache, and fever, which appeared immediately after the initiation of a new regime of antiretroviral treatment with tenofovir (300 mg once daily), lamivudine (300 mg once daily), and efavirenz (600 mg once daily)...
December 2015: Drug Saf Case Rep
Marc D Cohen, Edward Keystone
Rituximab is a chimeric monoclonal antibody directed at the CD20 molecule on the surfaces of some but not all B cells. It depletes almost all peripheral B cells, but other niches of B cells are variably depleted, including synovium. Its mechanism of action in rheumatoid arthritis (RA) is only partially understood. Rituximab was efficacious in clinical trials of patients with RA, including those who are methotrexate naïve, those with an incomplete response to methotrexate, and those with an incomplete response to tumor necrosis factor inhibitors...
December 2015: Rheumatol Ther
Xiaojia He, Donee' McAlliser, Winfred G Aker, Huey-Min Hwang
Titanium dioxide nanoparticles (TiO2 NPs) are among the most widely manufactured nanomaterials on a global scale. However, prudent and vigilant surveillance, incumbent upon the scientific community with the advent of new technologies, has revealed potentially undesirable effects of TiO2 NPs on biological systems and the natural environment during their application and discharge. Such effects are likely best evaluated by first assessing the fate of the TiO2 NPs in natural environments. In this study, the effects of terrestrial humic acid (HA) and tannic acid (TA), two major members of the collective: dissolved organic matter (DOM), on the cytotoxicity of TiO2 NPs to Escherichia coli were investigated in the presence and absence of natural sunlight...
October 2016: Journal of Environmental Sciences (China)
Judith Marlene Scanlan, Wanda M Chernomas
Students who fail clinical courses is a long standing issue in nursing education. Although faculty intuitively "know" a student is in clinical difficulty, the research literature is limited to delineating and describing characteristics of these students. A retrospective analysis of students' files in which there was at least one clinical failure was conducted to identify clinical failure indicators. Files included students who were successful, required to withdraw, or voluntarily withdrew. This study integrates these characteristics in a manner not discussed in the literature...
October 13, 2016: International Journal of Nursing Education Scholarship
Phoebe E Bailey, Katherine Petridis, Skye N McLennan, Ted Ruffman, Peter G Rendell
OBJECTIVES: This study assesses age-related differences in the weighting and integration of appearance and behavior cues to trustworthiness. The aim is to assess whether it becomes more difficult with age to detect a cheater in disguise. METHOD: Young and older adults invested real money in a repeated trust game with trustees who varied on facial expression (smiling, neutral, angry) and return rate (high, low). Trustees were also rated for trustworthiness pre- and post-trust game...
October 14, 2016: Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
Maia Dorsett, Stephen Y Liang
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis...
November 2016: Emergency Medicine Clinics of North America
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