Κυριακή, 6 Αυγούστου 2017

Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support

Abstract

We examined the relationship between two forms of ethnic discrimination—interpersonal and institutional—and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.



from Health via xlomafota13 on Inoreader http://ift.tt/2uftIoL
via IFTTT

Complex disease: From non-coding risk variant to biological mechanism in CAD



from Genetics via xlomafota13 on Inoreader http://ift.tt/2hAj1el
via IFTTT

Epigenetics: Getting instructions from mum



from Genetics via xlomafota13 on Inoreader http://ift.tt/2fl3PRK
via IFTTT

Hepatic Dysfunction in Renal Cell Carcinoma: Not What You Think?



from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2uxV5tk
via IFTTT

Co-occurrence of Sturge–Weber syndrome and Klippel–Trenaunay–Weber syndrome phenotype: Consideration of the historical aspect



from Genetics via xlomafota13 on Inoreader http://ift.tt/2vEc4P9
via IFTTT

New Recommendations of the IFCN: from scalp EEG to electrical brain imaging

alertIcon.gif

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Louis Maillard, Georgia Ramantani




from Physiology via xlomafota13 on Inoreader http://ift.tt/2ufraLv
via IFTTT

Idiopathic intracranial hypertension: ocular vestibular evoked myogenic potentials as a new evaluation tool

alertIcon.gif

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Robert Gürkov, Luis Wittwer, Guillaume Speierer, René Müri, Georgios Mantokoudis, Roger Kalla




from Physiology via xlomafota13 on Inoreader http://ift.tt/2vtTp8F
via IFTTT

A smoking-related background helps moderate smokers to focus: An Event-Related Potential study using a Go-NoGo Task

alertIcon.gif

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Sandrine Detandt, Ariane Bazan, Elisa Schröder, Giulia Olyff, Hendrik Kajosch, Paul Verbanck, Salvatore Campanella
ObjectiveCognitive impairment is a major component in addiction. However, research has been inconclusive as to whether this is also the case for smokers. The present study aims at providing electrophysiological clue for altered inhibitory control in smokers and at investigating whether reduced inhibition was more pronounced during exposure to a smoking cue.MethodsERPs were recorded during a visual Go-NoGo task performed by 18 smokers and 23 controls, in which either a frequent Go signal (letter "M") or a rare No-Go signal ("letter W") were superimposed on three different long-lasting background contexts: black-neutral, smoking-related and non smoking-related.Results1) Smokers performed worse and had an earlier NoGo-N2 latency as compared to controls and independently of context, suggesting a general inhibition impairment; 2) With smoking-related backgrounds specifically, smokers made fewer mistakes than they did in other contexts and displayed a larger NoGo P3 amplitude.ConclusionThese data might suggest that background cues related to addiction may help smokers to be more accurate in an inhibition task.SignificanceOur results show the classical inhibitory impairment in smokers as compared to non-smokers. However, our data also suggest that a smoking-related background may bolster the inhibitory ability of smokers specifically.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2vbzLfm
via IFTTT

The Technology of Processed Electroencephalogram Monitoring Devices for Assessment of Depth of Anesthesia.

Commercial brain function monitors for depth of anesthesia have been available for more than 2 decades; there are currently more than 10 devices on the market. Advances in this field are evidenced by updated versions of existing monitors, development of new monitors, and increasing research unveiling the mechanisms of anesthesia on the brain. Electroencephalography signal processing forms an integral part of the technology supporting the brain function monitors for derivation of a depth-of-anesthesia index. This article aims to provide a better understanding of the technology and functionality behind these monitors. This review will highlight the general design principles of these devices and the crucial stages in electroencephalography signal processing and classification, with a focus on the key mathematical techniques used in algorithm development for final derivation of the index representing anesthetic state. We will briefly discuss the advantages and limitations of this technology in the clinical setting as a tool in our repertoire used for optimizing individualized patient care. Also included is a table describing 10 available commercial depth-of-anesthesia monitors. (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vaPDhW
via IFTTT

Atlas of Peripheral Regional Anesthesia Anatomy and Techniques, 3rd edition.

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vtAgUz
via IFTTT

Perioperative Drill-Based Crisis Management.

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vaCCoy
via IFTTT

Reduction in Operating Room Plasma Waste After Evidence-Based Quality Improvement Initiative.

Anesthesiologists request units of plasma in anticipation of transfusion. The amount of plasma transfused intraoperatively is less than that issued (requested, thawed, and sent). We presented institutional-specific data on plasma usage including anesthesiologist-specific ratios of plasma issued-to-transfused. In month-to-month comparisons from the year before the presentation (June-December 2015) to 7 months after (June-December 2016), plasma issued to the operating room was reduced from 434.9 +/- 81 to 327.3 +/- 65 units, a change of 107.6 units per month (95% confidence interval [CI], 22-193); plasma discarded by the blood bank was reduced from 109.7 +/- 48 units to 69.1 +/- 9 units, a change of 40.6 units per month (95% CI, 0.2-81); and plasma transfused went from 188.4 +/- 42 units to 160.7 +/- 52 units, a nonsignificant change of 27.7 units per month (95% CI, -27 to 83). (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vtOeFW
via IFTTT

An Appraisal of the Carlisle-Stouffer-Fisher Method for Assessing Study Data Integrity and Fraud.

Data fabrication and scientific misconduct have been recently uncovered in the anesthesia literature, partly via the work of John Carlisle. In a recent article in Anaesthesia, Carlisle analyzed 5087 randomized clinical trials from anesthesia and general medicine journals from 2000 to 2015. He concluded that in about 6% of studies, data comparing randomized groups on baseline variables, before the given intervention, were either too similar or dissimilar compared to that expected by usual sampling variability under the null hypothesis. Carlisle used the Stouffer-Fisher method of combining P values in Table 1 (the conventional table reporting baseline patient characteristics) for each study, then calculated trial P values and assessed whether they followed a uniform distribution across studies. Extreme P values targeted studies as likely to contain data fabrication or errors. In this Statistical Grand Rounds article, we explain Carlisle's methods, highlight perceived limitations of the proposed approach, and offer recommendations. Our main findings are (1) independence was assumed between variables in a study, which is often false and would lead to "false positive" findings; (2) an "unusual" result from a trial cannot easily be concluded to represent fraud; (3) utilized cutoff values for determining extreme P values were arbitrary; (4) trials were analyzed as if simple randomization was used, introducing bias; (5) not all P values can be accurately generated from summary statistics in a Table 1, sometimes giving incorrect conclusions; (6) small numbers of P values to assess outlier status within studies is not reliable; (7) utilized method to assess deviations from expected distributions may stack the deck; (8) P values across trials assumed to be independent; (9) P value variability not accounted for; and (10) more detailed methods needed to understand exactly what was done. It is not yet known to what extent these concerns affect the accuracy of Carlisle's results. We recommend that Carlisle's methods be improved before widespread use (applying them to every manuscript submitted for publication). Furthermore, lack of data integrity and fraud should ideally be assessed using multiple simultaneous statistical methods to yield more confident results. More sophisticated methods are needed for nonrandomized trials, randomized trial data reported beyond Table 1, and combating growing fraudster sophistication. We encourage all authors to more carefully scrutinize their own reporting. Finally, we believe that reporting of suspected data fraud and integrity issues should be done more discretely and directly by the involved journal to protect honest authors from the stigma of being associated with potential fraud. (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vaxYXF
via IFTTT

Mortality, Geriatric, and Nongeriatric Surgical Risk Factors Among the Eldest Old: A Prospective Observational Study.

BACKGROUND: Preoperative risk and postoperative outcomes among the elderly are the subject of extensive debate. However, the eldest old, that is, the fastest-growing and most vulnerable group, are insufficiently studied; even their mortality rate is unclear. This prospective observational study was performed with the aim of determining the mortality rate of this population and establishing which preoperative conditions were predictors of which postoperative outcomes. The study was undertaken between 2011 and 2015 in a major tertiary care university hospital. METHODS: All patients aged >=85 years undergoing any elective procedure during the study period were included. Patients were followed up for 30 days postoperatively. The preoperative conditions studied were demographic data, grade of surgical complexity (1-3), preoperative comorbidities, and some characteristically geriatric conditions (functional reserve, nutrition, cognitive status, polypharmacy, dependency, and frailty). The outcome measures were 30-day all-cause mortality (primary end point), morbidity, prolonged length of stay, and escalation of care in living conditions. RESULTS: Of 139 eligible patients, 127 completed follow-up. The 30-day mortality was 7.9%; 95% confidence interval (CI), 3.2-12.6. It had 3 predictors: malnutrition (odds ratio [OR], 15; 95% CI, 3-89), complexity 3 (OR, 9.1; CI, 2-52), and osteoporosis/osteoporotic fractures (OR, 14.7; CI, 2-126). Significant predictors for morbidity (40%) were ischemic heart disease (OR, 3.9; CI, 1-11) and complexity 3 (OR, 3.6; CI, 2-9), while a nonfrail phenotype (OR, 0.3; CI, 0.1-0.8) was found to be protective. Only 2 factors were found to be predictive of longer admissions, namely complexity 3 (OR, 4.4; CI, 2-10) and frailty (OR, 2.7; CI, 2-7). Finally, risk factors for escalation of care in living conditions were slow gait (a surrogate for frailty, OR, 2.5; CI, 1-6), complexity 3 (OR, 3.2; CI, 1-7), and hypertension (OR, 2.9; CI, 1-9). CONCLUSIONS: The eldest old is a distinct group with a considerable mortality rate and their own particular risk factors. Surgical complexity and certain geriatric variables (malnutrition and frailty), which are overlooked in American Society of Anesthesiologists and most other usual scores, are particularly relevant in this population. Inclusion of these factors along with appropriate comorbidities for risk stratification should guide better decision making for families and doctors alike and encourage preoperative optimization of patients. (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vue8cy
via IFTTT

Perioperative Considerations for the Use of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes.

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2vav4lS
via IFTTT

Cadaveric Study of the Articular Branches of the Shoulder Joint.

Background and Objectives: This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Methods: Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Results: Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Conclusions: Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wiR7H7
via IFTTT

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist.

This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic stenosis, hypovolemia, local anesthetic systemic toxicity, and massive pulmonary embolism. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2v8S9Xy
via IFTTT