Σάββατο, 16 Ιουνίου 2018

Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial

Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection. Methods: In total, 53 patients (age range, 6 mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations (post-preopΔCl−) measured after surgery and at baseline. Secondary outcomes included the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema. Results: Saline infusion increased post-preopΔCl (6 [3.5; 8.5] mmol/L) compared with balanced crystalloid (0 [−1.0; 3.0] mmol/L; P

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Selection of Patients’ Recumbent Position Laterality According to Physician Handedness Bias Increases the Success Rate of Lumbar Puncture: A Multicenter Study

Background: Lumbar puncture (LP) is a medical procedure required during spinal anesthesia and for obtaining cerebrospinal fluid samples in the diagnosis of neurological disorders. The aim of this study was to assess the effects of physicians' handedness bias and the laterality of patients' recumbent position on the success rate of LPs. Methods and Patients: A prospective multicenter study including 36 physicians (18 left-handed and 18 right-handed) and 7200 patients was conducted in 6 medical centers. In each center, 1200 patients were randomized into group L (LPs performed by left-handed physicians) or group R (LPs performed by right-handed physicians). Each physician performed 200 cases of LPs, of which the laterality of the recumbent position (either on the left or right side) was decided after a second randomization. A successful LP was considered when the free flow of cerebrospinal fluid was observed upon the first attempt. Results: There was no significant difference in patient characteristics between groups L and R. Right-handed physicians had a significantly higher LP success rate with patients in the left lateral recumbent position (LRP) (1595/1800 vs. 1408/1800; odds ratio, 0.539; 95% confidence interval, 0.348-0.836; P=0.006). For left-handed physicians, the LP success rate was higher when patients were in the right LRP (1424/1800 vs. 1593/1800, odds ratio, 0.449; 95% confidence interval, 0.283-0.711; P=0.001). Patients' age, sex, height, and weight were not statistically related to LP success during multivariate analyses. Conclusions: Physicians handedness bias and patient laterality of recumbent position affects the success of LPs. Right-handed physicians have a greater chance of performing successful LPs when patients are in the left LRP, and vice versa. J.-L.Z. and Y.-R.S. contributed equally. Supported by the National Natural Science Foundation of China (81471241, 81271375, and 81171133), Shanghai Municipal Science and Technology Commission project (16411955300, 18441903300 and 18695841300), and Shanghai Minhang Natural Science Foundation (2014MHZ001). The authors have no conflicts of interest to disclose. Address correspondence to: Jin Hu, MD, PhD, Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, P.R. China (e-mail: 286644104@qq.com). Received January 7, 2018 Accepted May 8, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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An Unusual Case of Difficult Nasogastric Tube Insertion in a Patient With Displaced Cervical Spine Fracture

No abstract available

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Mental health assessment in rehabilitation: a descriptive study through an international internet survey

This cross-sectional study assessed international rehabilitation practitioners' views of mental health assessment (MHA), related specifically to assessment tools and needs in the field. We delivered an anonymous web-based survey capturing rehabilitation practioners' perspectives on MHA practices, assessment tools, and needs through the American Congress of Rehabilitation Medicine in the USA and through national rehabilitation networks in Finland and Norway. Altogether, 355 rehabilitation professionals answered the survey. Unmet MHA needs, most often attributed to insufficient time (112/269 responders), were recognized among rehabilitation professionals irrespective of the country of practice. When professional experience was weighed against barriers to conducting MHA, cost was statistically significantly linked to professional experience, with those with less experience viewing cost more as a barrier (P=0.019). Rehabilitation professionals from different professions, in different countries, and working with a variety of clinical populations recognize defined barriers to MHA in rehabilitation. An abstract based on the questionnaire has been accepted to the ACRM Annual Conference, 30 September-3 October 2018, Dallas, Texas, USA. Correspondence to Tanja Laukkala, MD, PhD, The Social Insurance Institution Kela, Höyläämötie 1aB, 00380 Helsinki, Finland E-mail: tanja.laukkala@kela.fi Received May 31, 2018 Accepted June 1, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Multi-component intrinsic brain activities as a safe, alternative to cortical stimulation for sensori-motor mapping in neurosurgery

Functional brain mapping for the precise identification of the primary sensori-motor area (S1-M1) prior to epilepsy surgery is key for reducing the risk of postoperative functional deficits. This particular functional brain map was traditionally introduced by several methodologies, such as functional magnetic resonance imaging (fMRI) (Chakraborty et al., 2008), somatosensory evoked potentials (Dinner et al., 1986), and electrical cortical stimulation (ECS) (Ojemann et al., 1989, Awad et al., 1991, Branco et al., 2003).

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Body mass estimates of the earliest possible hominins and implications for the last common ancestor

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Publication date: Available online 15 June 2018
Source:Journal of Human Evolution
Author(s): Mark Grabowski, Kevin G. Hatala, William L. Jungers
Many hypotheses regarding the paleobiology of the earliest possible hominins, Orrorin tugenensis and Ardipithecus ramidus, are dependent upon accurate body mass estimates for these taxa. While we have previously published body mass predictions for Orrorin and Ardipithecus, the accuracies of those estimates depend on the assumption that the postcranial skeletal dimensions and body masses of these taxa followed scaling patterns that were similar to those observed in modern humans. This assumption may not be correct because certain aspects of postcranial morphology in Orrorin and Ardipithecus differ from modern humans, and suggest that their overall body plans might be unique but more similar to modern non-human great apes than to modern humans. Here we present individual body mass predictions for O. tugenensis and Ar. ramidus assuming that they followed postcranial scaling patterns similar to those of chimpanzees. All estimates include individual prediction intervals as measures of uncertainty. In addition, we provide equations for predicting body mass from univariate postcranial measurements based on the largest sample (n = 25) yet compiled of common chimpanzee skeletons with known body masses, which is vital for calculating prediction intervals for individual fossils. Our results show that estimated body masses in Orrorin and Ardipithecus are generally larger when derived from a chimpanzee-like scaling pattern compared to estimates that assume a human-like pattern, though the prediction intervals of the two sets of estimates overlap. In addition, the more complete of the two known Orrorin femora has an overall scaling pattern that is more similar to common chimpanzees than to modern humans, supporting the application of a non-human great ape comparative model. Our new estimates fall near the male (Ardipithecus) average and in between the male and female averages (Orrorin) for wild-caught common chimpanzees. If a chimpanzee-like pattern of scaling between postcranial dimensions and body mass did exist in these earliest hominins, our results suggest the large body masses found in some early australopiths were already present in taxa near the origins of our lineage, and perhaps also in the Pan-Homo last common ancestor.



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Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH

Abstract

Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.



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