Πέμπτη, 20 Ιουλίου 2017

Concurrent electrical cervicomedullary stimulation and cervical transcutaneous spinal direct current stimulation results in a stimulus interaction

Abstract

Transcutaneous spinal direct current stimulation (tsDCS) can modulate neuronal excitability within the human spinal cord; however few studies have used tsDCS at a cervical level. This study aimed to further characterise cervical tsDCS by observing its acute effects on motor responses to transcranial magnetic stimulation (TMS) and cervicomedullary stimulation. In both Study 1 and 2, participants (Study 1: n = 8, 4F; Study 2: n = 8, 3F) received two periods of 10 min, 3 mA cervical tsDCS on the same day through electrodes placed in an anterior-posterior configuration over the neck; one period with the cathode posterior (c-tsDCS) and the other with the anode posterior (a-tsDCS). In Study 1, electrically-elicited cervicomedullary motor evoked potentials (eCMEPs) and TMS-elicited motor evoked potentials (MEPs) were measured in biceps brachii and flexor carpi radialis (FCR) before, during and after each tsDCS period. In Study 2, eCMEPs and magnetically-elicited CMEPs (mCMEPs) were measured before, during and after each tsDCS period. For Study 3, computational modelling was used to observe possible interactions of cervical tsDCS and electrical cervicomedullary stimulation. Study 1 and 2 revealed that eCMEPs were larger during c-tsDCS and smaller during a-tsDCS compared to those elicited when tsDCS was off (< 0.05), with no changes in MEPs or mCMEPs. Modelling revealed that eCMEP changes may result from modifications of electrical field direction and magnitude when combined with cervical tsDCS. Bidirectional eCMEP changes are likely caused by an interaction between cervical tsDCS and electrical cervicomedullary stimulation, thus care should be taken when combining such electrical stimuli in close proximity.

This article is protected by copyright. All rights reserved



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A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates

Abstract

Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration. From program admission to exit, 10% more participants were in their own housing, 12% more were receiving VA benefits, but only 1% more were employed. Controlling for background characteristics, a history of incarceration predicted poor criminal justice, housing, and employment outcomes. Participants with property offenses or probation/parole violations and those with substance use disorders were more likely to experience a new incarceration. Participants with more mental health problems were more likely to be receiving VA benefits and less likely to be employed at program exit. Together, these findings highlight the importance of proper substance abuse treatment as well as employment services for VTC participants so that they can benefit from the diversion process.



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In Vitro Activity of Telavancin Against Clinically Important Gram-Positive Pathogens from 69 U.S. Medical Centers (2015): Potency Analysis by U.S. Census Divisions

Microbial Drug Resistance , Vol. 0, No. 0.


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Acute Volume Loading Exacerbates Direct Ventricular Interaction in a Model of COPD

Volume loading increases left ventricular (LV) stroke volume (LVSV) through series interaction but may paradoxically reduce LVSV in the presence of large increases in right ventricular (RV) afterload due to direct ventricular interaction (DVI). RV afterload is often increased in COPD as a result of pathological changes to respiratory mechanics, namely increased negative intrathoracic pressure (nITP), dynamic lung hyperinflation (DH) and increased pulmonary vascular resistance (PVR). These hallmarks of COPD negatively impact LV hemodynamics in normovolemia. However, it is unknown how these heart-lung interactions are impacted by acute volume loading. Twenty healthy subjects (23±2 years) completed the study protocol, involving acute volume loading via 20° head-down tilt (HDT) in isolation and with: 1) inspiratory resistance of -20 cmH2O (HDT+nITP) and 2) nITP, expiratory resistance to induce DH and hypoxic-mediated increases in PVR (HDT+COPD model). LV volumes and geometry were assessed using tri-plane echocardiography. HDT significantly increased LVSV by 10±10% through an 8±6% increase in LV end-diastolic volume (LVEDV). HDT+nITP paradoxically decreased LVSV by 11±12% and LVEDV by 6±9% from supine baseline, or -14±10% LVSV and -15±13% LVEDV from HDT [p<0.001]. HDT+COPD model decreased LVSV (21±10% and 28±11%) and LVEDV (16±10% and 22±10%) from both supine and HDT, respectively (p<0.001). Under all conditions, significant septal flattening (increased radius of septal curvature) occurred, indicating DVI. Thus, when RV afterload is increased and/or an external constraint to ventricular filling exists, acute volume loading appears to paradoxically reduce LVSV. These findings have important implications for understanding how volume status impacts cardiopulmonary interactions in COPD.



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Edward F. Adolph Distinguished Lecture: Skin-deep insights into vascular aging

The skin is an accessible model circulation for studying vascular function and dysfunction across the lifespan. Age-related changes, as well as those associated with disease progression, often appear first in the cutaneous circulation. Further, impaired vascular signaling and attendant endothelial dysfunction -- one of the earliest indicators of cardiovascular pathogenesis -- occurs in a similar fashion across multiple tissue beds throughout the body including the skin. Because microvascular dysfunction is a better predictor of long term outcomes and adverse cardiovascular events than is large vessel disease, understanding age-associated changes in the control of the human cutaneous microcirculation is important. This review focuses on (1) the merits of using skin-specific methods and techniques to study vascular function, (2) microvascular changes in aged skin (in particular the role of the endothelial-derived dilator, nitric oxide) and (3) the impact of aging on heat-induced changes in skin vasodilation. While skin blood flow (SkBF) is controlled by multiple, often redundant, mechanisms, our laboratory has used a variety of distinct thermal provocations of this model circulation to isolate specific age-associated changes in vascular function. Skin-specific approaches and techniques such as intradermal microdialysis coupled with laser Doppler flowmetry (in vivo) and biochemical analyses of skin biopsy samples (in vitro) have allowed for the targeted pharmaco-dissection of the mechanistic pathways controlling skin vasoreactivity and studying the impact of aging and disease states. Aged skin has an attenuated ability to vasodilate in response to warm stimuli and to vasoconstrict in response to cold stimuli.



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Relationship between exercise volume and muscle protein synthesis in a rat model of resistance exercise

Resistance exercise (RE) volume is recognized as an important factor that stimulates muscle protein synthesis (MPS) and is considered, at least in part, to be involved in the mammalian target of rapamycin complex 1 (mTORC1)-associated signaling. However, the effects of relatively high doses of muscle contractions on mTORC1 and MPS remain unclear. In the present study, we used an animal model of RE to investigate the relationship between RE volume and MPS. Male Sprague-Dawley rats were subjected to RE, and muscle samples were obtained 6 h after performing 1, 3, 5, 10, or 20 sets of RE. Although one set of RE did not increase MPS (measured by the SUnSET method), multiple sets (3, 5, 10, and 20 sets) significantly increased MPS. However, the increase in MPS reaches a plateau after 3 or 5 sets of RE, and no further increase in MPS was observed with additional RE sets. In contrast to the MPS response, we observed that p70S6K phosphorylation at Thr389, a marker of mTORC1 activity, and Ser240/244 phosphorylation of rpS6, a downstream target of p70S6K, gradually increased with higher RE volume. The above results suggest that the relationship between RE volume and MPS was not linear. Thus, the increase in MPS with increasing RE volume saturates before p70S6K phosphorylation suggesting a threshold effect for the relationship between p70S6K activation and MPS.



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Severe energy deficit up-regulates leptin receptors, leptin signaling and PTP1B in human skeletal muscle

In obesity, leptin receptors (OBR) and leptin signaling in skeletal muscle are down-regulated. To determine whether OBR and leptin signaling are up-regulated with a severe energy deficit fifteen overweight men were assessed before (PRE), after 4 days of caloric restriction (3.2 Kcal/kg BW/day) in combination with prolonged exercise (CRE) (8h walking + 45min single-arm cranking/day) to induce an energy deficit of ~5500 Kcal/d, and following 3 days of control diet (isoenergetic) and reduced exercise (CD). During CRE, the diet consisted solely of whey protein (n=8) or sucrose (n=7) (0.8 g/kg BW/day). Muscle biopsies were obtained from the exercised and the non-exercised deltoid muscles, and from the vastus lateralis. From PRE to CRE, serum glucose, insulin, and leptin were reduced. OBR expression was augmented in all examined muscles associated to increased maximal fat oxidation. Compared to PRE, after CD phospho-Tyr1141OBR, phospho-Tyr985OBR, JAK2, and phospho-Tyr1007/1008JAK2 protein expression were increased in all muscles, while STAT3 and phospho-Tyr705STAT3 were increased only in the arms. The expression of PTP1B in skeletal muscle was increased by 18 and 45%, after CRE and CD, respectively (P<0.05). SOCS3 tended to increase in the legs and decrease in the arm muscles (ANOVA interaction P<0.05). Myosin heavy chain I isoform was associated with OBR protein expression (r=-0.75), phospho-Tyr985OBR (r=0.88) and phospho-Tyr705STAT3 /STAT3 (r=0.74). In summary, despite increased PTP1B expression, skeletal muscle OBRs and signaling are up-regulated by a severe energy deficit with greater response in the arm than in the legs likely due to SOCS3 up-regulation in the leg muscles.



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Body fat of rats of different age-groups and nutritional states: assessment by micro-CT and skinfold thickness

Obesity presents a growing public health problem. Therefore, the analysis of body composition is important in clinical practice as well as in animal research models of obesity, hence precise methods for the assessment of body fat would be essential. We aimed to evaluate in vivo abdominal micro-computed tomography scan restricted to the L1-L3 region (micro-CT(L1-L3)), a skinfold thickness-based method (STM) and post mortem body composition analysis (PMA) with regard to whole-body micro-CT scan in rats. Male Wistar rats of different age-groups (from 3 to 24 months) and nutritional states (normally fed, high-fat diet-induced obese, calorie-restricted) were used. The fat percentage was determined with micro-CT(L1-L3) and whole-body scan in anesthesized rats. Their skinfold thickness was measured in five locations with Lange caliper. Wet weights of epididymal and retroperitoneal fat pads were determined via PMA. With regard to fat mass, the strongest correlation was observed between abdominal and whole-body micro-CT. The other methods showed weaker associations with whole-body micro-CT and with each other. Micro-CT(L1-L3) and PMA showed similar age-associated increase in fat mass between 3-18 months. Micro-CT(L1-L3), STM and PMA were efficient to detect differences in fat mass values in groups of different nutritional states. Micro-CT(L1-L3) appears to be a useful method for body fat assessment in rats with reduced scanning time. In rats STM may also be a useful, low-priced, non-invasive and simple in vivo technique to assess obesity.



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Time-course effects of aerobic physical training in the prevention of cigarette smoke-induced COPD

A previous study by our group showed that regular exercise training (ET) attenuated pulmonary injury in an experimental model of chronic exposure to cigarette smoke (CS) in mice, but the time-course effects of the mechanisms involved in this protection remain poorly understood. We evaluated the temporal effects of regular ET in an experimental model of chronic CS exposure. MaleC57BL/6 mice were divided into four groups: Control (sedentary+air), Exercise (aerobic training+air), Smoke (sedentary+smoke) and Smoke+Exercise (aerobic training+smoke). Mice were exposed to CS and ET for 4, 8 or 12 weeks. Exercise protected mice exposed to CS from emphysema and reductions in tissue damping and tissue elastance after 12 weeks (P<0.01). The total number of inflammatory cells in the BAL increased in the Smoke group, mainly due to the recruitment of macrophages after 4 weeks, neutrophils and lymphocytes after 8 weeks and lymphocytes and macrophages after 12 weeks (P<0.01). Exercise attenuated this increase in mice exposed to CS. The protection conferred by exercise was mainly observed after exercise adaptation. Exercise increased IL-6 and IL-10 in the quadriceps and lungs (P<0.05) after 12 weeks. Total antioxidant capacity and SOD was increased and TNF-α and oxidants decreased in lungs of mice exposed to CS after 12 weeks (P<0.05). The protective effects of exercise against lung injury induced by cigarette smoke exposure suggests that anti-inflammatory mediators and anti-oxidant enzymes play important roles in COPD development mainly after the exercise adaptation.



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Walking economy is predictably determined by speed, grade and gravitational load

The metabolic energy human walking requires can vary by more than 10-fold depending on the speed, surface gradient and load carried. Although the mechanical factors determining economy are generally considered to be numerous and complex, we tested a minimum-mechanics hypothesis that only three variables are needed for broad, accurate prediction: speed, surface grade, and total gravitational load. We first measured steady-state rates of oxygen uptake in 20 healthy adult subjects during unloaded treadmill trials from 0.4-1.6 m•s-1 on six gradients: -6º, -3º, 0º, 3º, 6º, and 9º. Next, we tested a second set of 20 subjects under three torso-loading conditions (no-load, +18, and +31% body weight) at speeds from 0.6-1.4 m•s-1 on the same six gradients. Metabolic rates spanned a 14-fold range from supine rest to the greatest single-trial, walking mean (3.1±0.1 to 43.3±0.5 mls O2•kg-body-1•min-1, respectively). As theorized, the walking portion (VO2-walk=VO2-gross-VO2-supine-rest) of the body's gross metabolic rate increased in direct proportion to load and largely in accordance with support force requirements across both speed and grade. Consequently, a single minimum-mechanics equation was derived from the data of 10 unloaded-condition subjects to predict the pooled mass-specific economy (VO2-gross, mls O2•kg-body+load-1•min-1) of all the remaining loaded and unloaded trials combined (n=1412 trials from 90 speed-grade-load conditions). The accuracy of prediction achieved (R2=0.99, SEE=1.06 mls O2•kg-1•min-1) leads us to conclude that human walking economy is predictably determined by the minimum mechanical requirements present across a broad range of conditions.



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The Double Edge Sword of Intermittent Hypoxia - Can intermittent hypoxia be both deleterious and protective in OSA?

none - since it is an Editorial



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Effects of acute hypoxia on human cognitive processing: A study using ERPs and SEPs

Although hypoxia has the potential to impair the cognitive function, the effects of acute hypoxia on the high-order brain function (executive and/or inhibitory processing) and somatosensory ascending processing remain unknown. We tested the hypothesis that acute hypoxia impairs both motor executive and inhibitory processing and somatosensory ascending processing. Fifteen healthy subjects performed two sessions (Sessions 1 and 2) consisting of electroencephalographic event-related potentials (ERPs) with somatosensory Go/No-go paradigms and somatosensory-evoked potentials (SEPs) under two conditions (hypoxia and normoxia) on different days. On one day, participants breathed room air in the first and second sessions of the experiment; on the other day, participants breathed room air in the first session, and 12% O2 in the second session. Acute hypoxia reduced the peak amplitudes of Go-P300 and No-go-P300, and delayed the peak latency of Go-P300. However, no significant differences were observed in the peak amplitude or latency of N140, behavioral data, or the amplitudes and latencies of individual SEP components between the two conditions. These results suggest that acute hypoxia impaired neural activity in motor executive and inhibitory processing, and delayed higher cognitive processing for motor execution, while neural activity in somatosensory processing was not affected by acute hypoxia.



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Leg blood flow is impaired during small muscle mass exercise in COPD patients

Skeletal muscle blood flow is regulated to match the oxygen demand and dysregulation could contribute to exercise intolerance in patients with COPD. We measured leg hemodynamics and metabolites from vasoactive compounds in muscle interstitial fluid and plasma at rest, during one-legged knee-extensor exercise, and during arterial infusions of sodium nitroprusside (SNP) and acetylcholine (ACh), respectively. Ten patients with moderate to severe COPD and eight age- and sex matched healthy controls were studied. During knee-extensor exercise (10 W), leg blood flow was lower in the patients compared with the controls (1.82±0.11 versus 2.36±0.14 L/min, respectively, P<0.05) which compromised leg oxygen delivery (372±26 versus 453±32 mLO2/min, respectively, P<0.05). At rest, plasma endothelin-1 (vasoconstrictor) was higher in the COPD patients (P<0.05) and also tended to be higher during exercise (p=0.07), while the formation of interstitial prostacyclin (vasodilator) was only increased in the controls. There was no difference between groups in the nitrite/nitrate levels (vasodilator) in plasma or interstitial fluid during exercise. Moreover, patients and controls showed similar vasodilatory capacity in response to both endothelium-independent (SNP) and endothelium-dependent (ACh) stimulation. The results suggests that leg muscle blood flow is impaired during small muscle mass exercise in patients with COPD possibly due to impaired formation of prostacyclin and increased levels of endothelin-1.



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Cervical flexion and extension includes anti-directional cervical joint motion in healthy adults

Anti-directional cervical joint motion has previously been demonstrated. However, quantitative studies of anti-directional and pro-directional cervical flexion and extension motions have not been published.

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Risk factor analysis for predicting vertebral body re-collapse after posterior instrumented fusion in thoracolumbar burst fracture

In the posterior instrumented fusion surgery for thoracolumbar (T-L) burst fracture, early postoperative re-collapse of well-reduced vertebral body fracture could induces critical complications such as correction loss, post-traumatic kyphosis, metal failure, often lead to revision surgery. Furthermore, re-collapse is quite difficult to predict because of the variety of risk factors and no widely accepted accurate prediction systems existed. Although load sharing classification (LSC) has been known to help to decide the need for additional anterior column support, this radiographic scoring system has several critical limitations.

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BMP-2/7 heterodimer strongly induces bone regeneration in the absence of increased soft tissue inflammation

Bone morphogenetic protein (BMP)-2/7 heterodimer is a stronger inducer of bone regeneration than individual homodimers. However, clinical application of its potent bone induction ability may be hampered if its use is accompanied by excessive inflammatory reactions.

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Incidental durotomy during total en bloc spondylectomy

The incidence of incidental durotomy (ID) during total en bloc spondylectomy (TES) tends to be higher than that during other spinal surgeries because of the peculiarities of TES, including its highly invasive nature, epidural tumor extension, and use in patients who often have complicated medical backgrounds. However, there have been no detailed reports on ID associated with TES.

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Platelet-rich plasma enhances bone union in posterolateral lumbar fusion: a prospective randomized controlled trial

Platelet-rich plasma (PRP) accelerates bone union in vivo in a rodent model of spinal fusion surgery. However, PRP's effect on bone union after spinal surgery remains unclear.

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Measuring participation in chronic back pain patients – the 5-item pain disability index

Of the three broad outcome domains of body functions and structures, activities, and participation (e.g., engaging in valued social roles) outlined in the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), it has been argued that participation is the most important to individuals, particularly those with chronic health problems. Yet, participation is not commonly measured in back pain research.

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Traumatic Neuropathy of the Trigeminal Nerve in a College Trumpet Player: A Case Report

A 20-year-old college trumpet player presented with a 3-month history of upper lip numbness and worsening playing ability after a marching band performance. Examination demonstrated anesthesia of the upper lip following the borders of the trumpet mouthpiece. While playing, the patient had poor range and an airy tone quality. A prescription of complete embouchure rest for 6 weeks and a tailored return to play regimen resulted in resolution of upper lip numbness and improved trumpet playing. Neuropathy of the lip in a brass player is uncommon but highlights the uniqueness of injuries that may be sustained by performing artists.

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Within session and between session reliability, construct validity and comparison between individuals with and without neck pain of four neck muscle tests

A variety of tests have been proposed to measure the performance of neck flexor muscles, but head-to-head comparisons have been hardly documented.

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Tone-inhibiting insoles enhance the reciprocal inhibition of ankle plantarflexors of post-stroke hemiparetic subjects: an electromyographic study

Spasticity is a common sequela of upper motor neuron pathology, such as cerebrovascular diseases and cerebral palsy. Intervention for spasticity of the ankle plantarflexors in physical therapy may include tone-inhibiting casting and/or orthoses for the ankle and foot. However, the physiological mechanism of tone reduction by such orthoses remains unclarified.

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Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents

This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6–11 years) with persistent asthma and their parents. Thirty-four parent–child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = −.50, p < .01).

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Inside EMS Podcast: The EMS system of the future

Download this podcast on iTunes, SoundCloud or via RSS feed ​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the EMS system of the future. Is it time to respond with BLS units and have paramedic intercept" If so, what additional training do we need to give our BLS providers to prepare for 911 response" Learn more about the EMS1 Academy and schedule a free demo ...

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Improving Early-adolescent Girls' Motor Skill: A Cluster Randomized Controlled Trial.

Background: Physical activity (PA) levels decline substantially during adolescence, and are consistently lower in girls. Competency in a range of fundamental movement skills (FMS) may serve as a protective factor for the decline in PA typically observed in adolescent girls; yet, girls' mastery in FMS is low. Whilst interventions can improve FMS, there is a lack of interventions targeting girls, and very few are conducted in high schools. Additionally, interventions are usually conducted by researchers, not teachers, and thus have little chance of being embedded into curricula. Purpose: To evaluate the effectiveness of a school-based intervention, delivered by teachers, in improving adolescent girls' FMS. Method: Four all-girls Australian secondary schools were recruited and randomised into intervention or control groups. In total, 190 Year 7 girls (103 control/87 intervention, mean age 12.4 +/- 0.3 years) completed baseline and post-test measures at 12 weeks. Six FMS (i.e., catch, throw, kick, jump, leap and dodge) were measured using the Victorian FMS Assessment instrument. Mixed models with post-test skill (i.e., locomotor, object control and total skill) as the outcome, adjusting for baseline skill, intervention and control status, and relevant covariates, as well as accounting for clustering at school and class level, were used to assess the intervention impact. Results: There were significant intervention effects, and large effect sizes (Cohen's d) noted in locomotor (p = 0.04, t = 5.15, d = 1.6), object control (p =

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Serum Bupivacaine Concentration After Periarticular Injection With a Mixture of Liposomal Bupivacaine and Bupivacaine HCl During Total Knee Arthroplasty.

Background and Objectives: A relatively new technique to reduce postoperative pain for total knee arthroplasty is to inject a mixture of 266 mg of liposomal bupivacaine and 125 mg of 0.25% bupivacaine HCl with epinephrine 1:300,000 around the knee joint at the time of surgery. Currently, no publications report serum bupivacaine concentrations over time after periarticular injection of liposomal mixed with free bupivacaine. This information is important to ensure safe serum bupivacaine concentrations are maintained especially when considering supplemental or rescue peripheral nerve blocks. Methods: A total of 40 subjects scheduled for primary unilateral total knee arthroplasty with intraoperative periarticular injection of the liposomal bupivacaine and bupivacaine HCl mixture were included. Total serum bupivacaine concentrations were measured after the last injection at selected time points and calculated by gas chromatography. Quantile regression techniques were used to analyze the data over time. This study is registered with ClinicalTrials.gov (ID NCT02626559). Results: Peak serum concentration ranged from 0.17 to 1.2 [mu]g/mL and occurred from 10 minutes to 48 hours. Across all time points, the 48-hour interval had the highest mean concentration of total serum bupivacaine at 0.55 [mu]g/mL (SD, 0.27). Quantile regression showed total serum bupivacaine concentrations increased over the 48 hours measured. None of the participants demonstrated signs or symptoms of local anesthetic toxicity. Conclusions: Total serum concentrations of bupivacaine after periarticular administration of liposomal bupivacaine mixed with bupivacaine HCl remained below the described toxicity threshold (2.5 [mu]g/mL) within the first 48 hours, and no patients demonstrated signs or symptoms of toxicity. However, peak serum concentration time was not achieved within the 48-hour interval. Additional studies are needed to describe the course of serum bupivacaine levels after 48 hours and to ascertain the risk of toxicity when combining this method of periarticular injection with peripheral nerve blocks. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate.

Background and Objectives: The primary aim of this study was to review the impact of inserting thoracic epidural catheters in a preoperative block room setting on operating room efficiency. Methods: We conducted a retrospective preintervention/postintervention review of thoracic epidurals inserted over a 12-month period. The review included 6 months of data prior to implementation of the regional anesthesia block room and 6 months of data following implementation. The primary outcome measure was anesthesia-controlled operating room time, defined as time from patient arrival to the operating room to time of surgical site sterile preparation. Secondary measures included operating room waiting time for the patient arrival, thoracic epidural failure rate, and number of epidural insertion attempts. Results: Data from thoracic epidurals for 112 patients of preblock room and 142 patients of postblock room implementation were collected. Anesthesia-controlled operating room time was reduced by an average of 22.9 minutes per patient (95% confidence interval, 19.3-26.3 minutes; P

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Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial.

Objectives: Assess growth and nutritional biomarkers of preterm infants fed human milk (HM) supplemented with a new powdered HM fortifier (nHMF) or a control HM fortifier (cHMF). The nHMF provides similar energy content, 16% more protein (partially hydrolyzed whey), and higher micronutrient levels than the cHMF, along with medium-chain triglycerides and docosahexaenoic acid. Methods: In this controlled, multicenter, double-blind study, a sample of preterm infants

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Preterm Infants with Biliary Atresia, a Nationwide Cohort Analysis from The Netherlands.

OBJECTIVES: atresia (BA) occurs in 0.54/10.000 of overall live births in The Netherlands. BA has an unfavorable prognosis: less than 40% of patients are cleared of jaundice after Kasai portoenterostomy (KPE), 4-year transplant-free survival rate is 46% and the 4-year survival rate is ~75%. Little is known on difficulties in diagnosis and the outcome of BA in preterm infants. We aimed to analyze the incidence and outcome of BA in preterm infants in The Netherlands. METHODS: Retrospective study including Dutch preterm infants treated for BA. Parameters included gestational age (GA), congenital anomalies, age at KPE, days between first symptoms and KPE and referral interval (first hospital to KPE). Outcome parameters were clearance of jaundice (COJ) and (transplant-free) survival. Data are presented as medians [ranges]. RESULTS: included 28 preterm infants (13 males/15 females) between March 1988 and December 2015. The incidence of BA was 1.06/10.000 preterm live births. GA was 34.8 [27.3-36.9] weeks. Congenital anomalies were present in 11/28 (39%) infants. Time between first symptoms and KPE was 57 [9-138] days. Referral interval was 28 [8-86] days. Age at KPE was 70 [35-145] days. COJ was achieved in 23% of cases. 4-year transplant-free survival rate was 21%. Four-year overall survival was 61%. CONCLUSIONS: BA has a higher incidence in the preterm population compared to the overall BA population. The outcome of BA in preterm infants is poor, regarding COJ and (transplant-free) survival. We speculate that timely recognition of BA-related signs and symptoms in preterm infants will improve prognosis. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Potential Association of IL1B Polymorphism with Iron Deficiency Risk in Childhood Helicobacter pylori Infection.

Objective: Helicobacter pylori (H. pylori) infection occurs predominantly in childhood. Host immune response gene polymorphism is reported to affect the susceptibility to H. pylori infection and the outcome of H. pylori-related gastric cancer. However, not all H. pylori-infected patients exhibit iron deficiency. The relationship between host genetic polymorphisms and iron deficiency mediated by H. pylori infection is not well understood. Methods: Subjects (n = 644) from the general population aged 10 to 18 years were divided into two groups based on serology testing for anti-H. pylori IgG: (1) seropositive study group; (2) seronegative control group. Five single nucleotide polymorphisms (SNPs) in IL1B (rs1143627 and rs16944), IL8 (rs4073), IL10 (rs1800896), and ABO (rs505922), were genotyped and the iron status of the two groups was compared. Results: The seroprevalence rate for H. pylori was 10.7% in this study. Infected subjects were significantly older and had lower serum iron levels than uninfected subjects (P = 0.0195 and 0.0059, respectively). Multivariate analysis revealed a significantly higher frequency of the T allele of rs505922 (OR = 6.128; P

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Cholic Acid to Treat HSD3B7 and AKR1D1 Deficiencies.

No abstract available

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Intravenous Iron Sucrose for Treatment of Iron Deficiency Anemia in Pediatric Inflammatory Bowel Disease.

Objectives: Iron deficiency anemia (IDA) is a common complication of pediatric inflammatory bowel disease (IBD), yet the effectiveness of oral iron supplementation is limited. Intravenous iron sucrose is an effective and safe alternative treatment for IDA in adults with IBD, but its role in the treatment of IDA in pediatric IBD is unclear. The primary aim of this study was to evaluate the use of iron sucrose in pediatric IBD subjects with IDA and determine the clinical response as measured by improvement in hemoglobin concentration. The secondary aim was to describe adverse events associated with iron sucrose use in this cohort. Methods: : A retrospective chart review was performed of all pediatric patients with IBD receiving iron sucrose infusions for IDA at a single tertiary care center between 2011 and 2015. Results: : Seventy-two subjects (53 with Crohn disease, 11 with ulcerative colitis, and 8 with IBD-unclassified) received a total of 273 iron sucrose infusions. Forty-three subjects qualified for the efficacy analysis. There was a significant increase in hemoglobin over the treatment course, with mean (+/-SD) hemoglobin increasing from 9.6 +/- 1.2 g/dL at baseline to 12.1 +/- 1.3 g/dL after iron sucrose treatment (p

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Pa. councilman saves wife after heart attack with CPR

Thanks to Tony Spadaro's quick thinking, EMTs were able to administer a defibrillator shock and bring back his wife's heartbeat

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EMS Poem: 'Not Lost'

By Chris Covey Not Lost I'll be the first to admit, that I am totally jaded. I'm a realist, not a pessimist. But my trust and hope have faded. I've taken the good and the bad, and the world's ugly truth on my shoulders. I face these so you don't have to, and in doing so I've grown colder. If it seems that I have no emotion, or as if I just don't care, I want ...

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Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach

Abstract

Introduction

A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure.

Material and Surgical Technique

An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications.

Discussion

This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required.



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Robotic hernia surgery: An attractive perspective



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Primary inguinal hernia: The open repair today pros and cons

Abstract

Open anterior repair for inguinal hernia offers several distinct advantages over endoscopic repair, especially when real-world effectiveness is taken into account. The learning curve for endoscopic techniques is long, whereas the Lichtenstein and other open tension-free techniques are easier to teach and replicate at all levels. The outcomes of Lichtenstein repairs for primary inguinal hernia as performed by non-experts and supervised residents are comparable to those of experts. Moreover, open tension-free repair does not require expensive instruments or dedicated equipment, other than the prosthetic mesh. As such, it is feasible in any operating room anywhere in the world with limited costs. In our opinion, the most important advantage offered by open tension-free repair is that it can be performed under local anesthesia. Nevertheless, local anesthesia has some disadvantages: it requires training, excellent knowledge of the anatomy and the necessary technique, patience, and gentle handling of the tissues. Open inguinal hernia repair is a procedure that every surgeon should know and be able to perform because it is necessary to treat two conditions, groin hernia recurrence after a posterior approach (both laparoscopic and open) and pubic inguinal pain syndrome.



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Laparoscopic transabdominal preperitoneal approach for umbilical hernia with rectus diastasis

Abstract

Introduction

Rectus diastasis, when coexistent with umbilical hernia, can benefit from mesh-based repair of the midline. Laparoscopic correction of an umbilical hernia involves the placement of a mesh in the peritoneal cavity, but this comes with the risk of bowel complications. However, newly developed dual-sided composite meshes have helped to reduce this risk.

Materials and Surgical Technique

Four men and three women with umbilical hernia and rectus diastasis were treated with laparoscopic transabdominal preperitoneal repair. Composite mesh with a hydrophilic 3-D polyester textile on the parietal side and an absorbable collagen barrier on the peritoneal side were placed in the preperitoneal pocket after hernial sac reduction. Mean hernia size was 2.5 cm, and no recurrences were observed during the mean follow-up period of 9.2 months.

Discussion

The laparoscopic transabdominal preperitoneal approach for umbilical hernia and rectus diastasis may be a safe surgical option when trying to avoid potential complications related to intra-abdominal mesh positioning.



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Issue Information

No abstract is available for this article.



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World-wide seasonal variation of 7Be related to large-scale atmospheric circulation dynamics

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Lucrezia Terzi, Martin Kalinowski




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Esophageal bezoar due to karaya gum granules used as a laxative

Abstract

Esophageal obstruction from soluble fiber laxatives, such as karaya gum, has been rarely reported in the literature. However, as such preparations are widely commercially available, it is important for gastroenterologists to be aware of their potential to form a bezoar in the esophagus due to swelling on contact with liquid. This report highlights such a case and discusses its challenging management.



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Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping

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Publication date: Available online 18 July 2017
Source:Clinical Neurophysiology
Author(s): Alonso Zea Vera, Gewalin Aungaroon, Paul S. Horn, Anna W. Byars, Hansel M. Greiner, Jeffrey R. Tenney, Todd M. Arthur, Nathan E. Crone, Katherine D. Holland, Francesco T. Mangano, Ravindra Arya
ObjectiveTo examine current thresholds and their determinants for language and motor mapping with extra-operative electrical cortical stimulation (ECS).MethodsECS electrocorticograph recordings were reviewed to determine functional thresholds. Predictors of functional thresholds were found with multivariable analyses.ResultsIn 122 patients (age 11.9 ± 5.4 years), average minimum, frontal, and temporal language thresholds were 7.4 (± 3.0), 7.8 (± 3.0), and 7.4 (± 3.1) mA respectively. Average minimum, face, upper and lower extremity motor thresholds were 5.4 (± 2.8), 6.1 (± 2.8), 4.9 (± 2.3), and 5.3 (± 3.3) mA respectively.Functional and after-discharge (AD)/seizure thresholds were significantly related. Minimum, frontal, and temporal language thresholds were higher than AD thresholds at all ages. Minimum motor threshold was higher than minimum AD threshold up to 8.0 years of age, face motor threshold was higher than frontal AD threshold up to 11.8 years age, and lower subsequently. UE motor thresholds remained below frontal AD thresholds throughout the age range.ConclusionsFunctional thresholds are frequently above AD thresholds in younger children.SignificanceThese findings raise concerns about safety and neurophysiologic validity of ECS mapping. Functional and AD/seizure thresholds relationships suggest individual differences in cortical excitability which cannot be explained by clinical variables.



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SCOPE-mTL: A non-invasive tool for identifying and lateralizing mesial temporal lobe seizures prior to scalp EEG ictal onset

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Publication date: September 2017
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Alice D. Lam, Douglas Maus, Sahar F. Zafar, Andrew J. Cole, Sydney S. Cash
ObjectiveIn mesial temporal lobe (mTL) epilepsy, seizure onset can precede the appearance of a scalp EEG ictal pattern by many seconds. The ability to identify this early, occult mTL seizure activity could improve lateralization and localization of mTL seizures on scalp EEG.MethodsUsing scalp EEG spectral features and machine learning approaches on a dataset of combined scalp EEG and foramen ovale electrode recordings in patients with mTL epilepsy, we developed an algorithm, SCOPE-mTL, to detect and lateralize early, occult mTL seizure activity, prior to the appearance of a scalp EEG ictal pattern.ResultsUsing SCOPE-mTL, 73% of seizures with occult mTL onset were identified as such, and no seizures that lacked an occult mTL onset were identified as having one. Predicted mTL seizure onset times were highly correlated with actual mTL seizure onset times (r=0.69). 50% of seizures with early mTL onset were lateralizable prior to scalp ictal onset, with 94% accuracy.ConclusionsSCOPE-mTL can identify and lateralize mTL seizures prior to scalp EEG ictal onset, with high sensitivity, specificity, and accuracy.SignificanceQuantitative analysis of scalp EEG can provide important information about mTL seizures, even in the absence of a visible scalp EEG ictal correlate.



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After-discharges and seizures during pediatric extra-operative electrical cortical stimulation functional brain mapping: incidence, thresholds, and determinants

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Publication date: Available online 18 July 2017
Source:Clinical Neurophysiology
Author(s): Gewalin Aungaroon, Alonso Zea Vera, Paul S. Horn, Anna W. Byars, Hansel M. Greiner, Jeffrey R. Tenney, Todd M. Arthur, Nathan E. Crone, Katherine D. Holland, Francesco T. Mangano, Ravindra Arya
ObjectiveThis study examined the incidence, thresholds, and determinants of electrical cortical stimulation (ECS)-induced after-discharges (ADs) and seizures.MethodsElectrocorticograph recordings were reviewed to determine incidence of ECS-induced ADs and seizures. Multivariable analyses for predictors of AD/seizure occurrence and their thresholds were performed.ResultsIn 122 patients, the incidence of ADs and seizures was 77% (94/122) and 35% (43/122) respectively. Males (odds ratio [OR] 2.92, 95% CI 1.21-7.38, p = 0.02) and MRI-negative patients (OR 3.69, 95% CI 1.24-13.7, p = 0.03) were found to have higher odds of ECS-induced ADs. A significant trend for decreasing AD thresholds with age was seen (regression co-efficient −0.151, 95% CI −0.267 to −0.035, p = 0.011). ECS-induced seizures were more likely in patients with lateralized functional imaging (OR 6.62, 95% CI 1.36-55.56, p = 0.036, for positron emission tomography) and presence of ADs (OR 3.50, 95% CI 1.12-13.36, p = 0.043).ConclusionsECS is associated with a high incidence of ADs and seizures. With age, current thresholds decrease and the probability for AD/seizure occurrence increases.SignificanceADs and seizures during ECS brain mapping are potentially hazardous and affect its functional validity. Thus, safer method(s) for brain mapping with improved neurophysiologic validity are desirable.



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Risk of depression enhances auditory pitch discrimination in the brain as indexed by the Mismatch Negativity

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Publication date: Available online 18 July 2017
Source:Clinical Neurophysiology
Author(s): L. Bonetti, N.T. Haumann, P. Vuust, M. Kliuchko, E. Brattico
ObjectiveDepression is a state of aversion to activity and low mood that affects behaviour, thoughts, feelings and sense of well-being. Moreover, the individual depression trait is associated with altered auditory cortex activation and appraisal of the affective content of sounds.MethodsMismatch negativity responses (MMNs) to acoustic feature changes (pitch, timbre, location, intensity, slide and rhythm) inserted in a musical sequence played in major or minor mode were recorded using magnetoencephalography (MEG) in 88 subclinical participants with depression risk.ResultsWe found correlations between MMNs to slide and pitch and the level of depression risk reported by participants, indicating that higher MMNs correspond to higher risk of depression. Furthermore we found significantly higher MMN amplitudes to mistuned pitches within a major context compared to MMNs to pitch changes in a minor context.ConclusionsThe brains of individuals with depression risk are more responsive to mistuned and fast pitch stimulus changes, even at a pre-attentive level.SignificanceConsidering the altered appraisal of affective contents of sounds in depression and the relevance of spectral pitch features for those contents in music and speech, we propose that individuals with subclinical depression risk are more tuned to tracking sudden pitch changes.



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Ictal Cardiac Activity: Towards a Wider, Dynamical Vista

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Publication date: Available online 18 July 2017
Source:Clinical Neurophysiology
Author(s): Ivan Osorio




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Interictal epileptiform discharge characteristics underlying expert interrater agreement

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Publication date: Available online 18 July 2017
Source:Clinical Neurophysiology
Author(s): Elham Bagheri, Justin Dauwels, Brian C. Dean, Chad G. Waters, M. Brandon Westover, Jonathan J. Halford
ObjectiveThe presence of interictal epileptiform discharges (IED) in the electroencephalogram (EEG) is a key finding in the medical workup of a patient with suspected epilepsy. However, inter-rater agreement (IRA) regarding the presence of IED is imperfect, leading to incorrect and delayed diagnoses. An improved understanding of which IED attributes mediate expert IRA might help in developing automatic methods for IED detection able to emulate the abilities of experts. Therefore, using a set of IED scored by a large number of experts, we set out to determine which attributes of IED predict expert agreement regarding the presence of IED.MethodsIED were annotated on a 5-point scale by 18 clinical neurophysiologists within 200 30-second EEG segments from recordings of 200 patients. 5538 signal analysis features were extracted from the waveforms, including wavelet coefficients, morphological features, signal energy, nonlinear energy operator response, electrode location, and spectrogram features. Feature selection was performed by applying elastic net regression and support vector regression (SVR) was applied to predict expert opinion, with and without the feature selection procedure and with and without several types of signal normalization.ResultsMultiple types of features were useful for predicting expert annotations, but particular types of wavelet features performed best. Local EEG normalization also enhanced best model performance. As the size of the group of EEGers used to train the models was increased, the performance of the models leveled off at a group size of around 11.ConclusionsThe features that best predict inter-rater agreement among experts regarding the presence of IED are wavelet features, using locally standardized EEG. Our models for predicting expert opinion based on EEGer's scores perform best with a large group of EEGers (more than 10).SignificanceBy examining a large group of EEG signal analysis features we found that wavelet features with certain wavelet basis functions performed best to identify IEDs. Local normalization also improves predictability, suggesting the importance of IED morphology over amplitude-based features. Although most IED detection studies in the past have used opinion from three or fewer experts, our study suggests a "wisdom of the crowd" effect, such that pooling over a larger number of expert opinions produces a better correlation between expert opinion and objectively quantifiable features of the EEG.



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Intraoperative ventilation and postoperative respiratory assistance

1A013C01

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Chicago Classification of Esophageal Motility Disorders: Lessons Learned

Abstract

Purpose of Review

High-resolution manometry (HRM) is increasingly performed worldwide, to study esophageal motility. The Chicago classification is subsequently applied to interpret the manometric findings and facilitate a diagnosis of esophageal motility disorders. This review will discuss new insights regarding the diagnosis and management using the Chicago classification.

Recent Findings

Recent studies have demonstrated that high-resolution manometry is superior to conventional manometry, and has a higher sensitivity to diagnose achalasia. Furthermore, the subclassification of achalasia as used in the Chicago classification has prognostic value and can be used to direct treatment. Diagnosis of esophageal spasm has been improved by using the distal latency as diagnostic criterion. Recently, criteria for minor disorders of peristalsis have been sharpened, leading to a lower rate of patients with abnormal results, thereby increasing the relevance of a diagnosis.

Summary

High-resolution manometry is now considered the gold standard for diagnosis of esophageal motility disorders. The Chicago classification provides a standardized approach for analysis and categorization of abnormalities that has led to a significant increase in our knowledge regarding the diagnosis and management of motility disorders. Further refinement of the classification will be required.



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Quality Improvement Initiatives in Inflammatory Bowel Disease

Abstract

Purpose of Review

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD).

Recent Findings

IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs—all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI).

Summary

Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.



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Changing Trends in Stomach Cancer Throughout the World

Abstract

Purpose of Review

The paper aims to discuss the global trends in gastric cancer incidence in relation to important factors involved in the pathogenesis of gastric cancer.

Recent Findings

Despite a significant worldwide decline, gastric cancer remains a common cause of cancer death. The decline has been multifactorial and preceded the fall in Helicobacter pylori prevalence. The initial decline was associated with changes in food preservation and availability, especially of fresh fruits and vegetables, followed by a decline in the primary etiologic factor, H. pylori. Gastric cancer incidence remains high in East Asia, intermediate in Latin America, and low in developed countries. Significant racial/ethnic variability exists.

Summary

The rapid decline in incidence in East Asia will continue as primary and secondary prevention strategies are implemented. The incidence in Latin America is unlikely to decline significantly over the next few decades given high H. pylori prevalence in the young. Ultimately, global H. pylori eradication will be needed to largely eliminate gastric cancer.



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Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature

Abstract

Purpose of Review

Esophageal diseases represent a wide variety of conditions affecting esophageal anatomy, physiology, and motility. Therapy focuses on pharmacotherapy and endoscopic or surgical management. Dietary therapy can be considered in management algorithms for specific esophageal diseases. This review focuses on outlining the literature related to dietary therapy in gastroesophageal reflux disease, eosinophilic esophagitis, Barrett's esophagus, and esophageal adenocarcinoma.

Recent Findings

Currently, data are strongest for dietary manipulation in eosinophilic esophagitis, specifically the six-food elimination diet. Dietary effects on gastroesophageal reflux disease are less clear, though newer research indicates that increased fiber with reduction in simple sugar intake may improve symptoms. In terms of Barrett's esophagus and esophageal adenocarcinoma, antioxidant intake may affect carcinogenesis, though to an unknown degree.

Summary

Outcomes data regarding dietary manipulation for the management of esophageal diseases is heterogeneous. Given the rising interest in non-pharmacological treatment options for these patients, continued research is warranted.



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Hiatus Hernia as a Cause of Dysphagia

Abstract

Purpose of Review

This review aims to discuss the putative relationship between hiatus hernia and dysphagia.

Recent Findings

Proposed mechanisms of dysphagia in patients with hiatus hernia are usually difficult to identify, but recent advances in technology (high-resolution manometry with or without concomitant impedance, ambulatory pH with impedance, videofluoroscopy, and the endoluminal functional lumen imaging probe (EndoFLIP)) and methodology (inclusion of swallows of various consistencies and volumes or shifting position during the manometry protocol) can help induce symptoms and identify the underlying disorder. Chronic reflux disease is often associated with hiatus hernia and is the most common underlying etiology. Dysmotility because of impaired contractility and vigor can occur as a consequence of repeated acid exposure from the acid pocket within the hernia, and the resultant poor clearance subsequently worsens this insult. As such, dysphagia appears to be more common with increasing hiatus hernia size. Furthermore, mucosal inflammation can lead to fibrotic stricture formation and in turn obstruction. On the other hand, there appears to be a difference in the pathophysiology of smaller sliding hernias, in that those with dysphagia are more likely to have extrinsic compression at the crural diaphragm as compared to those with reflux symptoms only.

Summary

Sliding hiatus hernia, especially when small, does not commonly lead to dysmotility and dysphagia; however, in those patients with symptoms, the underlying etiology can be sought with new technologies and, in particular, the reproduction of normal eating and drinking during testing.



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Stool Based Testing for Colorectal Cancer: an Overview of Available Evidence

Abstract

Purpose of Review

The goal of this review is to summarize stool-based testing for colorectal cancer (CRC). The key questions answered in this review were the advantages and limitations of each available stool-based test for CRC and to examine their comparative efficacy.

Recent Findings

Guaiac-based fecal occult blood testing (gFOBT) is no longer a relevant test for CRC screening. fecal immunochemical testing (FIT) tests, especially quantitative assays, are clearly a reliable stool-based test. Multitarget DNA (mtsDNA) stool testing may represent a viable option as well, although cost and test characteristics are yet fully defined.

Summary

FIT and mtsDNA represent the options for stool-based CRC screening. In larger screening centers, quantitative FIT assays represent an attractive option for stool-based testing. Qualitative FIT has applicability in smaller centers. Although a large validation trial showed promising results for mtsDNA, further head-to-head trials with FIT will help define the ultimate role of mtsDNA. Ultimately, however, the best test for CRC screening is the one performed stool-based CRC screening as an initial or alternative option can increase participation in CRC screening.



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Journal de Pharmacie Clinique


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480


 
 
JOURNAL DE PHARMACIE CLINIQUE
Volume 36, numéro 2, 2017

Retour sur la journée annuelle des internes en pharmacie

Cette 2è journée scientifique placée sous le thème de l'Économie de la santé : « Le prix du médicament en France : enjeux thérapeutiques contre enjeux économiques ? ».

 

 Retrouvez l'article paru dans le Journal de Pharmacie CliniqueN°2-2017.

 
 
 
SOMMAIRE :
ÉDITORIAL
L'importance du réseautage ! 
Aude DesnoyerAurélie GuérinAndré Rieutord
SYNTHÈSES
Formation et opportunités de carrières en pharmacie hospitalière : le point de vue de futurs et de jeunes diplômés du DES de pharmacie 
Chloé DuranLaura di TrapaniChristel HosseletMarie LenskiEvariste DelandeDelphine HeurtéAlexandre DrezetJérémie ZerbitEmmanuel CirotClément Delage
Comment le pharmacien peut-il prendre l'initiative pour coopérer avec les services cliniques ? 
Marc FrachetteVéronique Zardet
Votre temps-réponse est-il assez rapide ? Mise en œuvre d'un projet lean en pharmacie hospitalière afin de réduire le temps de préparation des ordonnances 
Lise VaillancourtMimi Truong
Évaluation des technologies de santé en milieu hospitalier : organisations possibles et exemples appliqués aux dispositifs médicaux 
Nicolas Martelli
Accompagnement pharmaceutique du patient obèse à l'officine : état des lieux territorial 
Audrey DecottigniesSophie RenetSophie CavalierGuillaume PourcherAndré Rieutord
CONGRÈS
2e Journée scientifique des internes en pharmacie d'Île-de-France 
Aurélie ChaigneauRémi PieragostiniMarie CabagnolsClément Delage
 
 
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©2017 - John Libbey Eurotext

Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial.

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study.

Quadriceps weakness has been associated with knee osteoarthritis (OA). High-frequency localized muscle vibration (LMV) has been proposed recently for quadriceps strengthening in patients with knee OA. The purpose of this study was (a) to investigate the clinical effectiveness of high-frequency LMV on quadriceps muscle in patients with knee OA and (b) to disentangle, by means of surface electromyography (sEMG), the underlying mechanism. Thirty patients, aged between 40 and 65 years, and clinically diagnosed with knee OA were included in this randomized, controlled, single-blinded pilot study. Participants were randomly assigned to two groups: a study group treated with LMV, specifically set for muscle strengthening (150 Hz), by means of a commercial device VIBRA, and a control group treated with neuromuscular electrical stimulation. Clinical outcome was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, knee range of motion, Timed Up and Go test, and Stair climbing test. To assess changes in muscle activation and fatigue a subgroup of 20 patients was studied with the use of sEMG during a sustained isometric contraction. The LMV group showed a significant change in Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, Timed Up and Go test, Stair Climbing Test, and knee flexion. These improvements were not significant in patients treated with neuromuscular electrical stimulation. sEMG analysis suggested an increased involvement of type II muscle fibers in the group treated with LMV. In conclusion, the present study supports the effectiveness of local vibration in muscle function and clinical improvement of patients with knee OA. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Hospital costs, length of stay and prevalence of hip and knee arthroplasty in patients with inflammatory bowel disease

World Journal of Gastroenterology

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Senate Republicans reluctantly consider bipartisan health care talks

Reuters Health News

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Transition of care in patients with anorectal malformations: Consensus by the ARM-net consortium

Journal of Pediatric Surgery

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Poor test results for Roche cloud growth prospects

Reuters Health News

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Plasma phytoestrogens concentration and risk of colorectal cancer in two different Asian populations

Clinical Nutrition

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Dietary flavonoid intake reduces the risk of head and neck but not esophageal or gastric cancer in us men and women

The Journal of Nutrition

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Cost-effectiveness of high-performance biomarker tests vs fecal immunochemical test for non-invasive colorectal cancer screening

Clinical Gastroenterology and Hepatology

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Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: A pilot study

European Journal of Gastroenterology & Hepatology

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Analysis of FNB vs FNA in diagnosis of pancreatic and abdominal masses: A prospective, multicenter, randomized controlled trial

Clinical Gastroenterology and Hepatology

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Postoperative course of laparoscopic subtotal colectomy is affected by prolonged preoperative anti-TNF therapy in patients with acute colitis complicating inflammatory bowel disease

International Journal of Colorectal Disease

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Outcomes of transcatheter vs. surgical aortic valve implantation for aortic stenosis in patients with hepatic cirrhosis

The American Journal of Cardiology

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Genotyping of HBV and tracking of resistance mutations in treatment-naive patients with chronic hepatitis B

Infection and Drug Resistance

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Study suggests caution in SPRINT-like BP targets in elderly

Reuters Health News

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An independent survival prognostic role for human epidermal growth factor receptor 2 in gastric cancer: Evidence from a meta-analysis

Clinical and Translational Oncology

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Frequency and prognostic significance of abnormal liver function tests in patients with cardiogenic shock

The American Journal of Cardiology

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The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized, double-blind clinical trial

Infant Behavior and Development

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Early radiological assessment of locally advanced pancreatic cancer treated with electrochemotherapy

World Journal of Gastroenterology

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Treatment strategies for rectal cancer with synchronous liver metastases: Surgical and oncological outcomes with propensity-score analysis

Clinical and Translational Oncology

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Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review

American Journal of Infection Control

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Nitrous oxide cryotherapy for treatment of esophageal squamous cell neoplasia: Initial multicenter international experience with a novel portable cryoballoon ablation system

Gastrointestinal Endoscopy

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The sound and the fury: Late positive potential is sensitive to sound affect

Abstract

Emotion is an emergent construct of multiple distinct neural processes. EEG is uniquely sensitive to real-time neural computations, and thus is a promising tool to study the construction of emotion. This series of studies aimed to probe the mechanistic contribution of the late positive potential (LPP) to multimodal emotion perception. Experiment 1 revealed that LPP amplitudes for visual images, sounds, and visual images paired with sounds were larger for negatively rated stimuli than for neutrally rated stimuli. Experiment 2 manipulated this audiovisual enhancement by altering the valence pairings with congruent (e.g., positive audio + positive visual) or conflicting emotional pairs (e.g., positive audio + negative visual). Negative visual stimuli evoked larger early LPP amplitudes than positive visual stimuli, regardless of sound pairing. However, time frequency analyses revealed significant midfrontal theta-band power differences for conflicting over congruent stimuli pairs, suggesting very early (∼500 ms) realization of thematic fidelity violations. Interestingly, late LPP modulations were reflective of the opposite pattern of congruency, whereby congruent over conflicting pairs had larger LPP amplitudes. Together, these findings suggest that enhanced parietal activity for affective valence is modality independent and sensitive to complex affective processes. Furthermore, these findings suggest that altered neural activities for affective visual stimuli are enhanced by concurrent affective sounds, paving the way toward an understanding of the construction of multimodal affective experience.



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The auditory oddball paradigm revised to improve bedside detection of consciousness in behaviorally unresponsive patients

Abstract

Active paradigms requiring subjects to engage in a mental task on request have been developed to detect consciousness in behaviorally unresponsive patients. Using auditory ERPs, the active condition consists in orienting patient's attention toward oddball stimuli. In comparison with passive listening, larger P300 in the active condition identifies voluntary processes. However, contrast between these two conditions is usually too weak to be detected at the individual level. To improve test sensitivity, we propose as a control condition to actively divert the subject's attention from the auditory stimuli with a mental imagery task that has been demonstrated to be within the grasp of the targeted patients: navigate in one's home. Twenty healthy subjects were presented with a two-tone oddball paradigm in the three following condition: (a) passive listening, (b) mental imagery, (c) silent counting of deviant stimuli. Mental imagery proved to be more efficient than passive listening to lessen P300 response to deviant tones as compared with the active counting condition. An effect of attention manipulation (oriented vs. diverted) was observed in 19/20 subjects, of whom 18 showed the expected P300 effect and 1 showed an effect restricted to the N2 component. The only subject showing no effect also proved insufficient engagement in the tasks. Our study demonstrated the efficiency of diverting attention using mental imagery to improve the sensitivity of the active oddball paradigm. Using recorded instructions and requiring a small number of electrodes, the test was designed to be conveniently and economically used at the patient's bedside.



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Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block.

Background and Objectives: This dose-finding study aimed to determine the minimum effective volume in 90% of patients (MEV90) of lidocaine 1.5% with epinephrine 5 [mu]g/mL for ultrasound-guided costoclavicular block. Methods: Using an in-plane technique and a lateral-to-medial direction, the block needle was positioned in the middle of the 3 cords of the brachial plexus in the costoclavicular space. The entire volume of lidocaine was deposited in this location. Dose assignment was carried out using a biased-coin-design up-and-down sequential method, where the total volume of local anesthetic administered to each patient depended on the response of the previous one. In case of failure, the next subject received a higher volume (defined as the previous volume with an increment of 2.5 mL). If the previous patient had a successful block, the next subject was randomized to a lower volume (defined as the previous volume with a decrement of 2.5 mL), with a probability of b = 0.11, or the same volume, with a probability of 1 - b = 0.89. Success was defined, at 30 minutes, as a minimal score of 14 of 16 points using a sensorimotor composite scale. Patients undergoing surgery of the elbow, forearm, wrist, or hand were prospectively enrolled until 45 successful blocks were obtained. This clinical trial was registered with ClinicalTrials.gov (ID NCT02932670). Results: Fifty-seven patients were included in the study. Using isotonic regression and bootstrap confidence interval, the MEV90 for ultrasound-guided costoclavicular block was estimated to be 34.0 mL (95% confidence interval, 33.4-34.4 mL). All patients with a minimal composite score of 14 points at 30 minutes achieved surgical anesthesia intraoperatively. Conclusions: For ultrasound-guided costoclavicular block, the MEV90 of lidocaine 1.5% with epinephrine 5 [mu]g/mL is 34 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and multiple-injection techniques. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Previous physical exercise alters hepatic profile of oxidative-inflammatory status and limits the secondary brain damage induced by severe TBI in rats

Abstract

Although systemic responses have been described after traumatic brain injury (TBI), little is known regarding potential interactions between brain and peripheral organs after neuronal injury. In this sense, we decided to investigate whether peripheral oxidative/inflammatory response contributes to the neuronal dysfunction after TBI as well as prophylactic role of exercise training. Animals were submitted to fluid percussion injury (FPI) after 6 weeks of swimming training. Previous exercise training increased mRNA expression of X receptor alpha (LXR-α), ATP-binding cassette transporter (ABCA1), and decreased inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), tumor necrosis factor alpha (TNF-α) and interleukin (IL)-6 expression per se in liver. Interestingly, exercise training protected against hepatic inflammation (COX-2, iNOS, TNF-α and IL-6), oxidative stress (NPSH and GSH decreases, and 2',7'-dichlorofluorescein diacetate oxidation and protein carbonyl increases) which altered hepatic redox status (myeloperoxidase and superoxide dismutase activities increase, and catalase activity inhibition) mitochondrial function (MTT, Δψ decrease and citrate synthase activity inhibition) and ion gradient homeostasis (Na+,K+-ATPase activity inhibition) when analysed 24 h after TBI. Previous exercise training also protected against the dysglycemia, impaired hepatic signalling (pJNK increase, pIRS and pAKT expression decrease) high levels of circulating and neuronal cytokines, opening of BBB, neutrophils infiltration and Na+,K+-ATPase activity inhibition in ipsilateral cortex after TBI. Moreover, the impairment of protein function, neurobehavioral (neuromotor dysfunction and spatial learning) disability and hippocampal cell damage in sedentary rats suggest exercise training also modulates peripheral oxidative/inflammatory pathways in TBI, which corroborates the ever increasing evidence on health-related outcomes of a physically active lifestyle.

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An Evaluation of the Addition of Critical Congenital Heart Defect Screening in Georgia Newborn Screening Procedures

Abstract

Objectives Each year in the U.S., approximately 7200 infants are born with a critical congenital heart defect (CCHD). The Georgia Department of Public Health (DPH) mandated routine screening for CCHD starting January 2015. The current study evaluated hospital performance of the mandated CCHD screenings in Georgia. Methods Utilizing the DPH newborn screening surveillance system, data from 6 months before and after the mandate were analyzed for reports submitted and positive CCHD screening results. Chi square tests of independence were performed to examine the association between reporting of results for CCHD screening after the mandate and hospital nursery level [level I (well-baby/newborn); level II (special care); level III (neonatal intensive care unit—NICU)] and NICU submissions. Results In the 6 months following implementation, reports of the screening increased, but the DPH had not received information for approximately 40% of newborns. Hospitals with level III nurseries had poorer reporting rates compared to hospitals with level I or II nurseries. Newborn screening (NBS) cards submitted by NICUs were less likely to contain the CCHD screening results compared to cards submitted by regular Labor and Delivery units. Conclusions for Practice Further attention should focus on improving both CCHD screening and reporting of screening results within hospitals with level III nurseries and from NICUs at all hospital levels. Identifying and addressing the root of the issue, whether it be hospital compliance with CCHD screening or reporting of the results, will help to improve screening rates for all newborns, especially those most vulnerable.



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Potentially Inappropriate Antidepressant Prescriptions Among Older Adults in Office-Based Outpatient Settings: National Trends from 2002 to 2012

Abstract

Using data from 2002 to 2012 National Ambulatory Medical Care Survey, we estimated that the prevalence of overall antidepressant prescriptions increased almost twofold from 5.2% in 2002 to 10.1% in 2012 in office-based outpatient visits made by older adults. In addition, older adults were exposed to the risk of potentially avoidable adverse drug events in approximately one in ten antidepressant-related visits, or 2.2 million visits annually. Amitriptyline and doxepin were the two most frequent disease-independent potentially inappropriate antidepressants. Racial/ethnic minorities, and Medicaid beneficiaries had higher odds of potentially inappropriate antidepressant prescriptions (P < 0.05). Efforts to minimize potentially inappropriate antidepressant prescriptions are needed.



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Mobilizing Community Health Workers to Address Mental Health Disparities for Underserved Populations: A Systematic Review

Abstract

This systematic review evaluates efforts to date to involve community health workers (CHWs) in delivering evidence-based mental health interventions to underserved communities in the United States and in low- and middle-income countries. Forty-three articles (39 trials) were reviewed to characterize the background characteristics of CHW, their role in intervention delivery, the types of interventions they delivered, and the implementation supports they received. The majority of trials found that CHW-delivered interventions led to symptom reduction. Training CHWs to support the delivery of evidence-based practices may help to address mental health disparities. Areas for future research as well as clinical and policy implications are discussed.



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