Pediatric Anesthesia, EarlyView.
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Τρίτη 26 Ιουνίου 2018
Association between sugammadex and anaphylaxis in pediatric patients: A nested case‐control study using a national inpatient database
PRUNE1‐related disorder: Expanding the clinical spectrum
Clinical Genetics, EarlyView.
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Genome-wide association study of body weight in Wenshang Barred chicken based on the SLAF-seq technology
Abstract
Chicken body weight (BW) is an economically important trait, and many studies have been conducted on genetic selection for BW. However, previous studies have detected functional chromosome mutations or regions using gene chips. The present study used the specific-locus amplified fragment sequencing (SLAF-seq) technology to perform a genome-wide association study (GWAS) on purebred Wengshang Barred chicken. A total of 1,286,715 single-nucleotide polymorphisms (SNPs) were detected, and 175,211 SNPs were selected as candidate SNPs for genome-wide association analysis using TASSEL general linear models. Six SNP markers reached genome-wide significance. Of these, rs732048524, rs735522839, rs738991545, and rs15837818 were significantly associated with body weight at 28 days (BW28), while rs314086457 and rs315694878 were significantly associated with BW120. These SNPs are close to seven genes (PRSS23, ME3, FAM181B, NABP1, SDPR, TSSK6L2, and RBBP8). Moreover, 24 BW-associated SNPs reached "suggestive" genome-wide significance. Of these, 6, 13, 1, and 4 SNPs were associated with BW28, BW56, BW80, and BW120, respectively. These results would enrich the studies on BW and promote the use of Chinese chicken, especially the Wenshang Barred chicken.
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Point of Care 2.0: Gerinnungsdiagnostik mit ROTEM® sigma und TEG® 6s
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 412-424
DOI: 10.1055/s-0043-107755
TEG® 6s und ROTEM® sigma sind die neueste Generation von 2 häufig perioperativ eingesetzten Point-of-Care-Methoden zur Gerinnungsdiagnostik. Sie basieren auf Systemen zur automatischen Probenvorbereitung und -analyse mit Einweg-Testkassetten – personal- und zeitintensives Pipettieren entfällt größtenteils. Dieser Beitrag beschreibt die Testprinzipien und diskutiert Vor- und Nachteile bei der Integration der Methoden in den klinischen Alltag.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Akutes Nierenversagen ist vermeidbar
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 406-407
DOI: 10.1055/a-0633-7284
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Pflegemangel in Intensivmedizin führt zu Versorgungsengpässen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 405-405
DOI: 10.1055/a-0597-4562
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Notfall-Traumatologie: Endexspiratorischer CO2-Wert ist prädiktiv für Überleben
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 406-406
DOI: 10.1055/a-0633-7339
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Point-of-Care-Diagnostik in der Traumatologie – Methoden und Evidenz
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 440-457
DOI: 10.1055/s-0043-107753
Jeder 4. Schwerverletzte weist bereits bei Krankenhausaufnahme eine traumainduzierte Koagulopathie (TIK) auf, die mit einer 4-fach erhöhten Mortalität einhergeht. Rasche und zielgenaue Behandlung kann die TIK-assoziierte Sterblichkeit senken. Point-of-Care-Tests ermöglichen im Vergleich mit herkömmlichen Labormethoden eine zeitnahe und umfassende Bestimmung des Gerinnungsstatus sowie eine zielgerichtete Therapie.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Abfall des endexspiratorischen CO2-Partialdrucks kann auf Anaphylaxie hinweisen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 407-408
DOI: 10.1055/a-0633-7322
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Point-of-Care-Gerinnungsdiagnostik: neue Methoden, neue Indikationen, neue Studienlage
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 410-411
DOI: 10.1055/a-0597-4581
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Interskalenäre Plexusblockade vs. Supraskapularisblockade in der Schulterchirurgie
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 408-408
DOI: 10.1055/a-0633-7210
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Point-of-Care-Gerinnungsdiagnostik in der Neurochirurgie
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 425-439
DOI: 10.1055/s-0043-107754
Gerinnungsstörungen können für neurochirurgische Patienten gravierende Auswirkungen auf den Krankheitsverlauf und das Outcome haben: Blutungskomplikationen können zu intrakraniellem Druckanstieg und Schädigung des Gehirns führen. Somit hat die Gerinnungsdiagnostik und ggf. -therapie hier einen hohen Stellenwert. Dieser Beitrag beleuchtet die Anwendung moderner Point-of-Care-Verfahren zur Gerinnungsdiagnostik bei neurochirurgischen Patienten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Intranasales Ketamin wirksam bei Kindern mit frischen Frakturen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 408-409
DOI: 10.1055/a-0633-7255
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Der sichere Gefäßzugang – britisch-irische Leitlinie 2016
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 458-465
DOI: 10.1055/s-0043-104546
Die Etablierung von Gefäßzugängen ist bei der Krankenversorgung die häufigste invasive Prozedur. Sie kann bei unsachgemäßer Durchführung äußerst traumatisierend für die Patientinnen und Patienten sein. Die neue Leitlinie der britisch-irischen Gesellschaft für Anästhesiologie wurde 2016 erstellt, da trotz existierender Handlungsempfehlungen immer noch schwere Komplikationen mit negativem Einfluss auf Morbidität und Mortalität auftreten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Die Rolle der Ernährung beim herzchirurgischen Patienten – eine Übersicht
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 466-479
DOI: 10.1055/s-0043-121440
Der präoperative Ernährungsstatus und die perioperative Ernährungsstrategie spielen eine wichtige Rolle für das Outcome herzchirurgischer Patienten – dennoch gibt es nur wenige Studien zu Ernährungskonzepten für diese Patientengruppe. In diesem Beitrag werden die Ursachen der Mangelernährung, der Einfluss der Ernährungstherapie auf den herzchirurgischen Patienten und Strategien zur Verbesserung der Ernährung beschrieben.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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A Missense Mutation in the Vacuolar Protein Sorting 11 (VPS11) Gene Is Associated with Neuroaxonal Dystrophy in Rottweiler Dogs
Canine neuroaxonal dystrophy (NAD) is a recessive, degenerative neurological disease of young adult Rottweiler dogs (Canis lupus familiaris) characterized pathologically by axonal spheroids primarily targeting sensory axon terminals. A genome-wide association study of seven Rottweilers affected with NAD and 42 controls revealed a significantly associated region on canine chromosome 5 (CFA 5). Homozygosity within the associated region narrowed the critical interval to a 4.46 Mb haplotype (CFA5:11.28 Mb - 15.75 Mb; CanFam3.1) that associated with the phenotype. Whole-genome sequencing of two histopathologically confirmed canine NAD cases and 98 dogs unaffected with NAD revealed a homozygous missense mutation within the Vacuolar Protein Sorting 11 (VPS11) gene (g.14777774T>C; p.H835R) that was associated with the phenotype. These findings present the opportunity for an antemortem test for confirming NAD in Rottweilers where the allele frequency was estimated at 2.3%. VPS11 mutations have been associated with a degenerative leukoencephalopathy in humans, and VSP11 should additionally be included as a candidate gene for unexplained cases of human NAD.
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On the Relationship Between High-Order Linkage Disequilibrium and Epistasis
A plausible explanation for statistical epistasis revealed in genome wide association analyses is the presence of high order linkage disequilibrium (LD) between the genotyped markers tested for interactions and unobserved functional polymorphisms. Based on findings in experimental data, it has been suggested that high order LD might be a common explanation for statistical epistasis inferred between local polymorphisms in the same genomic region. Here, we empirically evaluate how prevalent high order LD is between local, as well as distal, polymorphisms in the genome. This could provide insights into whether we should account for this when interpreting results from genome wide scans for statistical epistasis. An extensive and strong genome wide high order LD was revealed between pairs of markers on the high density 250k SNP-chip and individual markers revealed by whole genome sequencing in the Arabidopsis thaliana 1001-genomes collection. The high order LD was found to be more prevalent in smaller populations, but present also in samples including several hundred individuals. An empirical example illustrates that high order LD might be an even greater challenge in cases when the genetic architecture is more complex than the common assumption of bi-allelic loci. The example shows how significant statistical epistasis is detected for a pair of markers in high order LD with a complex multi allelic locus. Overall, our study illustrates the importance of considering also other explanations than functional genetic interactions when genome wide statistical epistasis is detected, in particular when the results are obtained in small populations of inbred individuals.
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Genomic Selection in Preliminary Yield Trials in a Winter Wheat Breeding Program
Genomic prediction (GP) is now routinely performed in crop plants to predict unobserved phenotypes. The use of predicted phenotypes to make selections is an active area of research. Here, we evaluate GP for predicting grain yield and compare genomic and phenotypic selection by tracking lines advanced. We examined four independent nurseries of F3:6 and F3:7 lines trialed at 6 to 10 locations each year. Yield was analyzed using mixed models that accounted for experimental design and spatial variations. Genotype-by-sequencing provided nearly 27,000 high-quality SNPs. Average genomic predictive ability, estimated for each year by randomly masking lines as missing in steps of 10% from 10% to 90%, and using the remaining lines from the same year as well as lines from other years in a training set, ranged from 0.23 to 0.55. The predictive ability estimated for a new year using the other years ranged from 0.17 to 0.28. Further, we tracked lines advanced based on phenotype from each of the four F3:6 nurseries. Lines with both above average genomic estimated breeding value (GEBV) and phenotypic value (BLUP) were retained for more years compared to lines with either above average GEBV or BLUP alone. The number of lines selected for advancement was substantially greater when predictions were made with 50% of the lines from the testing year added to the training set. Hence, evaluation of only 50% of the lines yearly seems possible. This study provides insights to assess and integrate genomic selection in breeding programs of autogamous crops.
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Sensitivity and Specificity of Patient-Entered Red Flags for Lower Back Pain
: Red flags are questions typically ascertained by providers to screen for serious underlying spinal pathologies. The utility of patient-reported red flags in guiding clinical decision-making for spine care, however, has not been studied.
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Value of standard radiographs, CT and MRI of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening – a prospective clinical trial
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.
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Lumbar Epidural Steroid Injections for Herniation and Stenosis: Incidence and Risk Factors of Subsequent Surgery
Lumbosacral ESIs have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI.
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Preoperative severity of facet joint degeneration does not impact the 2-year clinical outcomes and cervical imbalance following laminoplasty
The impact of preoperative facet degeneration (FD) on surgical outcomes following laminoplasty has not been established.
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Risk Factors for Newly Developed Osteoporotic Vertebral Compression Fractures Following Treatment for Osteoporotic Vertebral Compression Fractures
It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.
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Radiographic Methods to Estimate Surgical Outcomes based on Spinal Flexibility Assessment in Patients who have Adolescent Idiopathic Scoliosis: A Systematic Review
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity recognized with lateral curvature of the spine as well as axial vertebral rotation. Surgical interventions are recommended when patients with AIS have severe curvature (Cobb angle > 45o). Spinal flexibility is one of important parameters for surgeons to plan surgical treatment. Few radiographic methods have been developed to assess spinal flexibility.
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Sagittal spinal alignment deviation in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry
It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.
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Enrichment of rare copy number variation in children with developmental language disorder
Clinical Genetics, EarlyView.
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Evidence for HNRNPH1 being another gene for Bain type syndromic mental retardation
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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IL11RA‐related Crouzon‐like autosomal recessive craniosynostosis in ten new patients: resemblances and differences
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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IFT80 mutations cause a novel complex ciliopathy phenotype with retinal degeneration
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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The GBA p.Trp378Gly mutation is a probable French‐Canadian founder mutation causing Gaucher disease and synucleinopathies
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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Genotype‐phenotype correlations of low frequency variants in the complement system in renal disease and age‐related macular degeneration
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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How do consent forms for diagnostic high‐throughput sequencing address unsolicited and secondary findings? A content analysis
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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GPT2 mutations cause developmental encephalopathy with microcephaly and features of complicated hereditary spastic paraplegia
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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A ZPR1 mutation is associated with a novel syndrome of growth restriction, distinct craniofacial features, alopecia, and hypoplastic kidneys
Clinical Genetics, Volume 0, Issue ja, -Not available-.
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Folic acid supplementation does not attenuate thermoregulatory or cardiovascular strain of older adults exposed to extreme heat and humidity
Experimental Physiology, EarlyView.
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Membrane potential oscillations are not essential for spontaneous firing generation in L4 Aβ‐afferent neurons after L5 spinal nerve axotomy and are not mediated by HCN channels
Experimental Physiology, EarlyView.
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Improved brachial artery shear patterns and increased flow‐mediated dilation after low‐volume high‐intensity interval training in type 2 diabetes
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Targeted ablation of cardiac sympathetic neurons attenuates adverse post‐infarction remodeling and left ventricle dysfunction
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Motor cortical and corticospinal function differ during an isometric squat compared to isometric knee extension
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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The influence of sex and neonatal stress on medullary microglia in rat pups
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Hypoxic pulmonary vasoconstriction in isolated mouse pulmonary arterial vessels
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Intense physical exercise potentiates glucose inhibitory effect over food intake of male Wistar rats
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Mitochondrial regulation in skeletal muscle: A role for non‐coding RNAs?
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Cardiac β‐adrenergic responsiveness of obese Zucker rats: The role of AMPK
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Slow wave contraction frequency plateaus in the small intestine are composed of discrete waves of interval increase associated with dislocations
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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The emerging fibroblast‐like synoviocyte channelome
Experimental Physiology, Volume 0, Issue ja, -Not available-.
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Alteration of occlusal vertical dimension induces signs of neuroplastic changes in corticomotor control of masseter muscles: Preliminary findings
Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.
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Relationship between tongue pressure and maxillofacial morphology in Japanese children based on skeletal classification
Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.
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Association between chewing dysfunctions and temporomandibular disorders: a systematic review
Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.
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The efficacy of curcumin in managing acute inflammation pain on the post‐surgical removal of impacted third molars patients: A randomized controlled trial
Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.
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Cephalometric, Muscular and Swallowing changes in patients with OSAS
Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.
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Metabolic stress‐dependent regulation of the mitochondrial biogenic molecular response to high‐intensity exercise in human skeletal muscle
The Journal of Physiology, EarlyView.
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Age‐related changes in cardiac electrophysiology and calcium handling in response to sympathetic nerve stimulation
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Muscle sympathetic outflow during exercise: A tale of two limbs
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Functional relevance of stroke related losses in GABAB‐mediated interhemispheric inhibition for alternative modes of stroke recovery
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Effects of living at moderate altitude on pulmonary vascular function and exercise capacity in mice with sickle cell anemia
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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miRNA‐210: A hypoxamiRyad of possibilities
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Transverse cardiac slicing and optical imaging for analysis of transmural gradients in membrane potential and Ca2+ transients in murine heart
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Antenatal Prevention of Cerebral Palsy and Childhood Disability ‐ Is the Impossible Possible?
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Apparent calcium dependence of vesicle recruitment
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Altered synaptic and firing properties of cerebellar Purkinje cells in a mouse model of ARSACS
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Carotid Chemoreceptors: The link between Pulmonary and Cardiovascular Disease?
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Effect of Coil Orientation on Motor Evoked Potentials in Humans with Tetraplegia
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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A direct demonstration of functional TRPV1 in Cajal‐Retzuis cells
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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The impact of loading, unloading, ageing and injury on the human tendon
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Beyond LTP: increasing the safety factor for spike initiation
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Mechanisms Contributing to Persistently Activated Cell Phenotypes in Pulmonary Hypertension
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Sodium nitroprusside dilates cerebral vessels and enhances internal carotid artery flow in young men
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Mechanoadaptation: articular cartilage through thick and thin
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Modulation of ClC‐3 gating and proton/anion exchange by internal and external protons and the anion selectivity filter
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Title: Reduced blood volume decreases cerebral blood flow in preterm piglets
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Ancient genomes from North Africa evidence prehistoric migrations to the Maghreb from both the Levant and Europe [Genetics]
The extent to which prehistoric migrations of farmers influenced the genetic pool of western North Africans remains unclear. Archaeological evidence suggests that the Neolithization process may have happened through the adoption of innovations by local Epipaleolithic communities or by demic diffusion from the Eastern Mediterranean shores or Iberia. Here, we...
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Practice-based skill acquisition of pushrim-activated power-assisted wheelchair propulsion versus regular handrim propulsion in novices
Regular handrim wheelchair (RHW) propulsion is straining for the upper extremities and wheelchair users often experience overuse problems. A recent advancement in wheelchair technology that could assist users ...
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Decoding the grasping intention from electromyography during reaching motions
Active upper-limb prostheses are used to restore important hand functionalities, such as grasping. In conventional approaches, a pattern recognition system is trained over a number of static grasping gestures....
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Challenges in Recruiting African-Born, US-Based Participants for HIV and Tuberculosis Research
Abstract
Research is critical for developing HIV and tuberculosis (TB) programming for U.S. African-born communities, and depends on successful recruitment of African-born people. From January 2014 to June 2016, we recruited African-born people for HIV and TB research in King County, Washington. We compared the characteristics of study participants and the underlying populations of interest, and assessed recruitment strategies. Target enrollment for the HIV study was 167 participants; 51 participants (31%) were enrolled. Target enrollment for the TB study was 218 participants; 38 (17%) were successfully recruited. Of 249 prior TB patients we attempted to contact by phone, we reached 72 (33%). Multiple recruitment strategies were employed with variable impact. Study participants differed from the underlying populations in terms of gender, country of origin and language. Inequities in research participation and in meaningful opportunities for such participation may exacerbate existing health disparities.
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Perioperative Blood Management, Red Cell Recovery (Cell Salvage) Practice in an Australian Tertiary Hospital: A Hospital District Clinical Audit
BACKGROUND: Data on red cell recovery (cell salvage) utilization in Australia are limited and national guidance is based on a single Australian audit conducted at a hospital that excludes cardiothoracic surgery. This clinical audit aimed to analyze the utility of red cell recovery at a tertiary health care facility which includes cardiothoracic surgery. Secondary aims of this study were to identify specific surgical procedures in which red cell recovery is most beneficial and to quantify this benefit. METHODS: Data were collected retrospectively on all adult red cell recovery surgical cases conducted at a 2-campus health care facility over a 2-year period. Case demographic data, including surgical procedure, red blood cell return, and hematocrit levels, were collated and analyzed against national cell salvage guidelines. Average return per procedure was collated into a red cell recovery benefit analysis. RESULTS: A total of 471 red cell recovery cases for 85 surgical procedures met inclusion criteria. Of the 7 surgical subspecialties utilizing red cell recovery, orthopedics utilized the most cases (22.9%, n = 108), followed by urology (19.1%, n = 90) and cardiothoracic surgery (18.3%, n = 86). Radical retropubic prostatectomy (11.7%), revision (7.6%), and primary (6.6%) total hip replacement were the most utilized procedures. Red cell recovery use had a 79% compliance rate with national guidelines. Vascular surgery and urology had the highest average return at 699 mL (interquartile range, 351–1127; CI, 449–852) and 654 mL (interquartile range, 363–860; CI, 465–773), respectively. CONCLUSIONS: Overall, our center demonstrated good compliance with national red cell recovery guidelines. This audit adds to the existing data on red cell recovery practice in Australia and provides a benefit-specific surgical procedure guideline that includes cardiothoracic surgery. Accepted for publication May 5, 2018. Funding: None. The authors declare no conflicts of interest. Gold Coast Health Human Research Ethics Committee number: HREC/17/QGC/130. Reprints will not be available from the authors. Address correspondence to Elizabeth A. Forrest, MD, Department of Anaesthetics, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4214, Australia. Address e-mail to elizabeth.forrest3@health.qld.gov.au. © 2018 International Anesthesia Research Society
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Treating Anemia in the Preanesthesia Assessment Clinic: Results of a Retrospective Evaluation
BACKGROUND: Perioperative anemia is challenging during hospital stay because anemia and red blood cell (RBC) transfusions are associated with an increased morbidity and mortality. With the implementation of patient blood management (PBM), a preanesthesia assessment clinic to screen and treat anemia before elective surgery was institutionalized at Muenster University Hospital, Germany. The main objective of this study was to evaluate the association between treating preoperative anemic patients with intravenous iron (IVI) and (primarily) presurgical hemoglobin levels and (secondarily) use of RBCs and mortality. METHODS: Between April 1, 2014, and July 4, 2016, patients scheduled for elective surgery with a risk for RBC transfusions >10% in 2013 were screened for preoperative anemia and, if indicated, treated with IVI. Patients' data, time span between visit in the anesthesia/PBM clinic and surgery, demographic data, type of surgery, the difference of hemoglobin levels between visit and surgery, RBC transfusion, infectious-related International Classification of Disease codes during hospital stay, and 1-year survival were determined retrospectively by screening electronic data files. In addition, patients were interviewed about adverse events, health-related events, and infections via telephone 30, 90, and 365 days after visiting the anesthesia/PBM clinic. RESULTS: A total of 1101 patients were seen in the anesthesia/PBM clinic between days −28 and −1 (median [Q1–Q3], −3 days [−1, −9 days]) before elective surgery. Approximately 29% of patients presented with anemia, 46.8% of these anemic patients were treated with ferric carboxymaltose (500–1000 mg). In the primary analysis, hemoglobin levels at median were associated with a reduction between the visit in the anesthesia/PBM clinic and the surgery in all nonanemic patients on beginning of medical treatment (nonanemic patients at median −2.8 g/dL [−4, −0.9 g/dL], while anemic patients without IVI presented with median differences of −0.8 g/dL [−2, 0 g/dL] and anemic patients with IVI of 0 g/dL [−1.0, 0.5 g/dL]). Hemoglobin levels raised best at substitution 22–28 days before surgery (0.95 g/dL [−0.35, 1.18 g/dL]). Due to the selection criteria, transfusion rates were high in the cohort. Overall, there was no association between IVI treatment and the use of RBC transfusions (odds ratio for use of RBCs in anemic patients, no IVI versus IVI: 1.14; 95% confidence interval, 0.72–1.82). Patients treated with or without IVI presented a comparable range of International Classification of Disease codes related to infections. Telephone interviews indicated similar adverse events, health-related events, and infections. Cox regression analysis showed an association between anemia and reduced survival, regardless of IVI. CONCLUSIONS: An anemia clinic within the preanesthesia assessment clinic is a feasible and effective approach to treat preoperative anemia. The IVI supplementation was safe but was associated with decreased RBC transfusions in gynecology/obstetric patients only. The conclusions from this retrospective analysis have to be tested in prospective, controlled trials. Accepted for publication May 8, 2018. Funding: This work was supported by an industrial grant for the implementation of patient blood management to H.V.A. (AF 700501). A.U.S. receives funding from the German Research Foundation (DFG-STE1895-4/1). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical trial number: The implementation of Patient Blood Management and treatment of anemia was registered at clinicaltrial.gov NCT01820949. I. Ellermann and A. Bueckmann contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Andrea U. Steinbicker, MD, PD, MPH, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Albert-Schweitzer Campus 1, Bldg A1, Muenster 48149, Germany. Address e-mail to andrea.steinbicker@ukmuenster.de. © 2018 International Anesthesia Research Society
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Usefulness of the Korean Version of the CAGE-Adapted to Include Drugs Combined With Clinical Predictors to Screen for Opioid-Related Aberrant Behavior
BACKGROUND: As national opioid consumption in South Korea has soared, well-validated screening tools for opioid use disorder (OUD) have become indispensable. The aims of our study were to evaluate OUD using the Korean version of the CAGE-Adapted to Include Drugs (CAGE-AID) and the CAGE-Opioid (an alternative version of the CAGE-AID), and to investigate clinical predictors that might be useful to screen for OUD in conjunction with the CAGE-AID/Opioid questionnaires. METHODS: A single-center, prospective, observational study was performed. After linguistic validation of the Korean version of the CAGE-AID/Opioid questionnaires, we assessed OUD in patients with chronic opioid treatment. Multivariable logistic models of the CAGE-AID/Opioid questionnaires combined with relevant clinical predictors were established. Then, the receiver operating characteristic curve analysis of the multivariable CAGE-AID/Opioid models was conducted to assess diagnostic accuracy to screen for OUD. Next, we calculated predicted probability with >85% sensitivity and >50% specificity in each CAGE-AID and CAGE-Opioid model. Using the optimal value of the predicted probability, a cutoff score of the CAGE-AID/Opioid questionnaires combined with the relevant clinical factors was suggested to screen for OUD. RESULTS: Among 201 participants, 51 patients showed ≥1 OUDs. In the multivariable regression model, male sex, comorbid neuropsychiatric disorder, and current heavy drinking significantly remained as clinical variables to predict OUD combined with the scores of the Korean CAGE-AID/Opioid questionnaire. The area under the curve was 0.77 (95% confidence interval, 0.71–0.83) for the CAGE-AID model and 0.78 (95% confidence interval, 0.71–0.83) for the CAGE-Opioid model. The optimal predicted probability values to screen for OUD in the CAGE-AID/Opioid models were >0.135 (sensitivity, 0.86; specificity, 0.52) and >0.142 (sensitivity, 0.86; specificity, 0.53), respectively. When we used these predictive probabilities, the cutoff score of the CAGE-AID/Opioid questionnaires ranged from 0 to 3, which was dependent on the presence of the relevant clinical variables in each model. CONCLUSIONS: In this study, one fourth of the total participants with chronic opioid treatment showed OUD in the Korean population. The multivariable models of the CAGE-AID/Opioid with sex, comorbid neuropsychiatric disorder, and current heavy drinking are valid parameters to screen for OUD, with the cutoff scores of the CAGE-AID/Opioid questionnaires ranging from 0 to 3 depending on the presence of the clinical variables. Accepted for publication May 8, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Jee Youn Moon, MD, PhD, FIPP, CIPS, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 110 Daehang-ro, Jongno-gu, Seoul 110–744, Korea. Address e-mail to jymoon0901@gmail.com. © 2018 International Anesthesia Research Society
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Pediatric Intensive Care, 1st ed
No abstract available
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Incidence and Epidemiology of Perioperative Transfusion-Related Pulmonary Complications in Pediatric Noncardiac Surgical Patients: A Single-Center, 5-Year Experience
BACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly defined. We sought to delineate the incidence and epidemiology of pediatric TRPCs after intraoperative blood product transfusion. METHODS: In this retrospective cohort study, we evaluated all consecutive pediatric patients receiving intraoperative blood product transfusions during noncardiac surgeries between January 2010 and December 2014. Exclusion criteria were cyanotic heart disease, preoperative respiratory insufficiency, extracorporeal membrane oxygenation, and American Society of Anesthesiologists physical status VI. Medical records were electronically screened to identify those with evidence of hypoxemia, and in whom a chest x-ray was obtained within 24 hours of surgery. Records were then manually reviewed by 2 physicians to determine whether they met diagnostic criteria for TACO or TRALI. Disagreements were adjudicated by a third senior physician. RESULTS: Of 19,288 unique pediatric surgical patients, 411 were eligible for inclusion. The incidence of TRPCs was 3.6% (95% confidence interval [CI], 2.2–5.9). TACO occurred in 3.4% (95% CI, 2.0–5.6) of patients, TRALI was identified in 1.2% (95% CI, 0.5–2.8), and 1.0% (95% CI, 0.4–2.5) had evidence for both TRALI and TACO. Incidence was not different between males (3.4%) and females (3.8%; P = .815). Although a trend toward an increased incidence of TRPCs was observed in younger patients, this did not reach statistical significance (P = .109). Incidence was comparable across subsets of transfusion volume (P = .184) and surgical specialties (P = .088). Among the 15 patients experiencing TRPCs, red blood cells were administered to 13 subjects, plasma to 3, platelets to 3, cryoprecipitate to 2, and autologous blood to 3. Three patients with TRCPs were transfused mixed blood components. CONCLUSIONS: TRPCs occurred in 3.6% of transfused pediatric surgical patients, with the majority of cases attributable to TACO, congruent with adult literature. The frequency of TRPCs was comparable between genders and across surgical procedures and transfusion volumes. The observed trend toward increased TRPCs in younger children warrants further consideration in future investigations. Red blood cell administration was the associated component for the majority of TRPCs, although platelets demonstrated the highest risk per component transfused. Mitigation of perioperative risk associated with TRPCs in pediatric patients is reliant on further multiinstitutional studies powered to examine patterns and predictors of this highly morbid entity. Accepted for publication May 8, 2018. Funding: D.J.K. receives funding via National Institutes of Health grant R01-HL121232. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leanne Thalji, BM, MSc, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Address e-mail to thalji.leanne@mayo.edu. © 2018 International Anesthesia Research Society
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US Food and Drug Administration Disruption of Generic Drug Market Increases Hospital Costs
BACKGROUND: The purpose of the US Food and Drug Administration's Marketed Unapproved Drugs Initiative is to decrease marketing of older unapproved medications. The administration has recently extended its rulings by including sterile injectable drugs administered in the inpatient environment. The impact of this initiative on the inpatient environment has been minimally studied. METHODS: Consecutive retrospective purchase data of vasopressin for injection (vasopressin) and neostigmine methylsulfate for injection (neostigmine) from 720 hospitals and 746 hospitals, respectively, were included. Purchases occurred from January 1, 2010 to December 31, 2016. The average noncontract drug price was calculated and compared to the purchase data during the impact of the initiative. Comparison was made of hospital purchases made before and after the initiative. The year 2014 was considered a washout transition year due to the large amounts of discontinued unapproved formulations that were still available and purchased by hospitals. The analysis was completed using a matched paired t test. RESULTS: The noncontract price for vasopressin increased from $12.83 per vial to $158.83 per vial (1138% increase) and for neostigmine from $27.74 per vial to $175.14 per vial (531% increase) across the pre- and postinitiative intervals; however, purchase volumes after the price increases were not found to have a statistically significant difference compared to purchases before the price increases (P = .98 and P = .4, respectively). CONCLUSIONS: Health systems have experienced a significant cost increase of vasopressin and neostigmine and are absorbing price increases for these older, generic sterile injectable drugs. Accepted for publication May 21, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Philip J. Almeter, PharmD, Department of Pharmacy Services, University of Kentucky HealthCare, 800 Rose St, H110, Lexington, KY 40536. Address e-mail to philip.almeter@uky.edu. © 2018 International Anesthesia Research Society
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Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication March 27, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). LMA Unique is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Stavros G. Memtsoudis, MD, PhD, Departments of Anesthesiology, Critical Care & Pain Management and Public Health, Weill Cornell Medical College and Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Address e-mail to memtsoudiss@hss.edu. © 2018 International Anesthesia Research Society
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Use of Earlier-Reported Rotational Thromboelastometry Parameters to Evaluate Clotting Status, Fibrinogen, and Platelet Activities in Postpartum Hemorrhage Compared to Surgery and Intensive Care Patients
BACKGROUND: Rotational thromboelastometry (ROTEM) can provide clinical information in 10–20 minutes for guiding administration of fibrinogen, platelets, and fresh frozen plasma products. While ROTEM testing is well established for cardiac and other surgeries, it is less characterized for use in postpartum hemorrhage (PPH) patients. We wanted to determine if the earlier-measured ROTEM parameters (α-angle and amplitude at 10 minutes [A10]) could replace the later parameters (amplitude at 20 minutes and maximum amplitude [maximum clot firmness {MCF}]) in all patient groups studied. We also correlated the A10 and α-angle of the EXTEM and FIBTEM tests to the fibrinogen levels and platelet counts in these patients. METHODS: We retrospectively analyzed 100 sets of EXTEM and FIBTEM results ordered on patients undergoing operations for PPH, patients in intensive care units (ICU), and those undergoing cardiothoracic surgery (cardiothoracic operating room [C/T OR]). We determined if the correlations among the various parameters were similar among the PPH, ICU, and C/T OR patients. RESULTS: As expected, the EXTEM A10 (A10EX) and FIBTEM A10 (A10FIB) correlated highly to the EXTEM MCF and FIBTEM MCF in all patient groups. The A10EX parameter correlated significantly to both fibrinogen and platelet levels, and the A10FIB correlated to the fibrinogen levels. The difference between the A10EX and the A10FIB (PLTEM) is related to platelet activity, and we found that the PLTEM and platelet count correlated highly for all 100 PPH patients (r = 0.80), C/T OR patients (r = 0.70), and ICU patients (r = 0.66), despite 4 high platelet counts with relatively low PLTEM values in the ICU group. The earlier-reported parameter EXTEM α angle (α-EX) is an excellent indicator of the A10EX, with an α-EX ≥65° (ie, normal) giving a >96% probability that the A10EX was ≥44 mm, and an α-EX value below 65 mm giving an 86% probability that the A10EX was
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Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review
The choice of drug used to facilitate endotracheal intubation in trauma patients during rapid sequence induction (RSI) may have an impact on survival. Ketamine is commonly used in the hemodynamically unstable trauma patient although it has been associated with side effects. This review sought to investigate whether ketamine should be preferred over other induction agents for RSI in trauma patients. PubMed, Embase, and the Cochrane Library were systematically searched on September 19, 2016 for studies reporting RSI of adult trauma patients with ketamine compared with another induction agent (etomidate, propofol, thiopental, or midazolam). No language restrictions were applied. The primary outcome was 30-day mortality, and secondary outcomes included information on blood transfusions, length of hospital stay, and hospital mortality. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool for randomized trials and the Risk of Bias in Non-Randomized Studies of Interventions for nonrandomized studies of intervention. A total of 4 studies were included. A cohort study from 1976 compared thiopental (n = 26) with ketamine (n = 14) for RSI in trauma patients. The primary outcome was number of blood transfusions, and no significant difference was found. Risk of bias was judged to be serious. A randomized controlled trial from 2009 compared etomidate (n = 57) with ketamine (n = 47) and found no significant difference in 28-day mortality (odds ratio [OR], 0.8 [0.4–2.0]). The trial was judged to have a low risk of bias. Two cohort studies from 2015 and 2017 also compared etomidate (n = 116 and n = 526) with ketamine (n = 145 and n = 442). No significant difference in hospital mortality between the groups was observed (OR, 1.11 [0.38–3.27] and OR, 1.41 [0.91–2.16], respectively). Both studies were judged to have a moderate risk of bias, thus excluding the possibility of a meaningful meta-analysis. The study from 2017 also reported number of units of blood transfused during the first 48 hours after trauma and length of hospital stay. No significant differences were observed (OR, 1.14 [0.87–1.49] and OR, 1.1 [0.95–1.27], respectively). Extremely few studies have compared induction agents for RSI in trauma patients. No significant differences have been found in mortality, length of hospital stay, or number of blood transfusions after induction with ketamine compared to other induction agents, but a clinically relevant benefit or harm cannot be excluded. Accepted for publication February 27, 2018. Funding: The study group received funding from "Tryg Foundation." However, Tryg Foundation was not involved in any steps undertaken for this study. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Josefine S. Baekgaard, MD, Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Section 4231, Rigshospitalet, Juliane Maries Vej 10, DK-2100 Copenhagen, Denmark. Address e-mail to josefine.stokholm.baekgaard.01@regionh.dk. © 2018 International Anesthesia Research Society
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Oropharyngeal dysphagia in adults with dyskinetic cerebral palsy and cervical dystonia: a preliminary study
Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Han Gil Seo, You Gyoung Yi, Young-Ah Choi, Ja-ho Leigh, Youbin Yi, Keewon Kim, Moon Suk Bang
ObjectivesTo investigate the characteristics of oropharyngeal dysphagia in adults with dyskinetic cerebral palsy (DCP) and cervical dystonia (CD).DesignExploratory observational cross-sectional study.SettingUniversity hospital.ParticipantsSeventeen patients with DCP (8 males, 9 females; age, 45.7±6.3 years) enrolled in a randomized controlled trial on the effects of botulinum toxin injection on CD.InterventionsNot applicable.Main Outcome MeasuresBaseline clinical assessments and videofluoroscopic swallowing studies (VFSSs) were conducted. VFSS findings were evaluated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). The Gross Motor Function Classification System (GMFSC) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were also assessed. Relationships between outcomes were evaluated using Spearman's rank correlation.ResultsThe clinical assessment revealed abnormalities in chewing (10/17, 58.8%), tongue movement (10/17, 58.8%), and laryngeal elevation (8/17, 47.1%). The most common abnormality on the VDS was inadequate mastication (13/17, 76.5%), followed by premature bolus loss, vallecular residue, and penetration/aspiration (all: 10/17, 58.8%). A maximum PAS score of 8 was observed in 8/17 patients (47.1%). Total and pharyngeal VDS scores were significantly correlated with TWSTRS scores (ρ=0.543, p=0.024 and ρ=0.539, p=0.026, respectively); the VDS oral score did not correlate with the TWSTRS score (ρ=0.446, p=0.073). There was no significant correlation between VDS score and GMFCS level (ρ=0.212, p=0.414).ConclusionsThis preliminary observational study presents the characteristics of oropharyngeal dysphagia in adults with DCP and CD. Pharyngeal stage difficulties were negatively correlated with severity of CD, but not with GMFCS level. Screening for dysphagia may be recommended in adults with DCP and severe CD.
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Maximum walking speed at discharge could be a prognostic factor for vascular events in patients with mild stroke: A cohort study
Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hiroyuki Kawajiri, Hiromi Mishina, Sho Asano, Yuji Kono, Hironori Hayashi, Jun-ichi Niwa, Manabu Doyu, Shinya Kimura, Sumio Yamada
ObjectiveTo identify the prognostic value of physical activity-related factors as well as known vascular risk factors for vascular events in mild ischemic stroke.DesignSingle-center prospective cohort study.SettingUniversity hospital.ParticipantsConsecutive patients with acute ischemic stroke and transient ischemic attack with modified Rankin scale scores ranging from 0 to 2 were enrolled in this study.InterventionsNot applicable.Main Outcome MeasuresEnrolled patients were followed up for composite vascular events as primary outcomes up to three years post discharge. Primary outcomes included stroke and cardiovascular death, hospitalization due to stroke or TIA recurrence, cardiovascular disease, and peripheral artery disease. During hospitalization, known vascular risk factors such as previous history of vascular events, stroke subtype, white matter lesions, and ankle-brachial index were assessed. Moreover, at the time of discharge, physical activity-related factors such as maximum walking speed, handgrip strength, knee extensor isometric muscle strength, anxiety, and depression were assessed as potential predictors.ResultsA total of 255 patients (175 men, median age 70.0 years) were enrolled in this study. The Kaplan-Meier estimates of cumulative risk of composite vascular events at one-, two-, and three-years were 9.6%, 14.4%, and 15.2%, respectively. After multivariate analysis, cerebral white matter lesions of periventricular hyperintensity (grade=3; hazard ratio: 2.904; 95% confidence interval: 1.160 to 7.266; p=0.023) and maximum walking speed (<1.45m/s; hazard ratio: 2.232; 95% confidence interval: 1.010 to 4.933; p=0.047) were identified as significant independent predictors of composite vascular events.ConclusionsThe results of this study indicate that maximum walking speed could be an independent prognostic factor for composite vascular events in mild ischemic stroke.
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Building a rehabilitative care measurement instrument to improve the patient experience
Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Josephine McMurray, Heather McNeil, Alicia Gordon, Jacobi Elliott, Paul Stolee
ObjectiveTo develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure.DesignMixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design.SettingOutpatient rehabilitative care settings.ParticipantsSubject matter experts (N=3), healthcare providers (N= 137), patients and caregivers (N=5), contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients post-discharge (N=9) for cognitive interviews to optimize survey design and user interface.InterventionsNot applicableMain outcome measureThis novel survey instrument measures six concepts previously identified as key to outpatient rehabilitative care patients' experience: ecosystem issues, client and informal caregiver engagement, patient and healthcare provider relations, pain and functional status, group and individual identity, and open-ended feedback.Results502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analysed to create a ten item questionnaire representing six key constructs that influence patient experience quality. Cognitive interviewing with nine patients (three rounds of three participants each), produced three progressively edited versions of the survey instrument. A final version required no further modifications.DiscussionRehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector.ConclusionThe rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere.
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The development of a new computer adaptive test to evaluate anxiety in caregivers of individuals with traumatic brain injury: TBI-CareQOL Caregiver-Specific Anxiety
Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Noelle E. Carlozzi, Michael A. Kallen, Angelle M. Sander, Tracey A. Brickell, Rael T. Lange, Louis M. French, Phillip A. Ianni, Jennifer A. Miner, Robin Hanks
ObjectiveTo design a new measure of caregiver-specific anxiety for use in caregivers of individuals with TBI, the TBI-CareQOL Caregiver Specific-Anxiety item bank.DesignCross-sectional survey study.SettingThree TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.Participants344 caregivers of civilians with TBI and 216 caregivers of service members/veterans with TBI.InterventionsNot applicable.Main Outcome MeasuresTBI-CareQOL Caregiver-Specific Anxiety Item BankResultsThe retention of 40 caregiver-specific anxiety items was supported by exploratory and confirmatory factor analyses. Graded response model (GRM) and differential item functioning analyses supported the retention of 33 items in the final measure. Expert review and GRM calibration data was used to select a 6-item static short form, and GRM calibration data was used to program the TBI-CareQOL Caregiver-Specific Anxiety computer adaptive test (CAT).ConclusionsEstablished, rigorous measurement development standards were used to develop the new TBI-CareQOL Caregiver-Specific Anxiety CAT and corresponding 6-item short form. This measure is the first patient-reported outcome measure (PRO) designed to assess caregiver-specific anxiety in caregivers of individuals with TBI. The measure exhibits strong psychometric properties.
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Impact of 60 days of 6° head down tilt bed rest on muscular oxygen uptake and heart rate kinetics: efficacy of a reactive sledge jump countermeasure
Abstract
Purpose
The effects of 60 days of head down tilt bed rest (HDBR) with and without the application of a reactive jump countermeasure were investigated, using a method which enables to discriminate between pulmonary ( \(\dot{\text{V}}\) O2pulm) and muscular ( \(\dot{\text{V}}\) O2musc) oxygen uptake kinetics to control for hemodynamic influences.
Methods
22 subjects were randomly allocated to either a group performing a reactive jumps countermeasure (JUMP; n = 11, male, 29 ± 7 years, 23.9 ± 1.3 kg m− 2) or a control group (CTRL; n = 11, male, 29 ± 6 years, 23.3 ± 2.0 kg m− 2). Heart rate (HR) and \(\dot{\text{V}}\) O2pulm were measured in response to repeated changes in work rate between 30 and 80 W before (BDC-9) and two times after HDBR (R+ 2, R+ 13). Kinetic responses of HR, \(\dot{\text{V}}\) O2pulm, and \(\dot{\text{V}}\) O2musc were assessed applying time series analysis. Higher maxima in cross-correlation functions (CCFmax(x)) between work rate and the respective parameter indicate faster kinetics responses. Statistical analysis was performed applying multifactorial analysis of variance.
Results
CCFmax( \(\dot{\text{V}}\) O2musc) and CCFmax( \(\dot{\text{V}}\) O2pulm) were not significantly different before and after HDBR (P > 0.05). CCFmax(HR) decreased following bed rest (JUMP: BDC-9: 0.30 ± 0.09 vs. R+ 2: 0.28 ± 0.06 vs. R+13: 0.28 ± 0.07; CTRL: 0.35 ± 0.09 vs. 0.27 ± 0.06 vs. 0.33 ± 0.07 P = 0.025). No significant differences between the groups were observed (P > 0.05). Significant alterations were found for CCFmax of mean arterial blood pressure (mBP) after HDBR (JUMP: BDC-9: 0.21 ± 0.07 vs. R+ 2: 0.30 ± 0.13 vs. R+ 13: 0.28 ± 0.08; CTRL: 0.25 ± 0.07 vs. 0.38 ± 0.13 vs. 0.28 ± 0.08; P = 0.008).
Conclusions
Despite hemodynamic changes, \(\dot{\text{V}}\) O2 kinetics seem to be preserved for a longer period of HDBR, even without the application of a countermeasure.
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Assessment of the two-point method applied in field conditions for routine testing of muscle mechanical capacities in a leg cycle ergometer
Abstract
Purpose
The aim of this study was to compare the reliability and magnitude of the force–velocity (F–V) relationship parameters [maximum force (F0), maximum velocity (V0), F–V slope, and maximum power (P0)] obtained through the application of only two loads (i.e., two-point method) vs. six loads (i.e., multiple-point method).
Methods
Ten physically active men (age 19.5 ± 0.9 years, body mass 79.0 ± 9.0 kg, height 183.9 ± 8.4 cm) conducted four testing sessions after a preliminary familiarization session with the leg cycle ergometer exercise. In a counterbalanced order, subjects performed two sessions of the multiple-point method (six loads applied for the F–V modeling) over 1 week and two sessions of the two-point method (only the lightest and heaviest loads were applied) over another week.
Results
The main findings revealed that (I) the reliability of the F–V relationship parameters was very high and generally of comparable magnitude for both the multiple- [coefficient of variation (CV) range 1.91–3.94%; intraclass correlation coefficient (ICC) range 0.72–0.99] and two-point methods [CV range 1.41–4.62%; ICC range 0.76–0.95], (II) the magnitude of the same parameters obtained from both methods was highly correlated (r > 0.80), and (III) the P0 assessed from the multiple-point method was significantly lower than the obtained from the two-point method [P = 0.041; effect size (ES) 0.36] due to a significant decrease in F0 (P = 0.039; ES 0.41) with no significant differences observed for V0 (P = 0.570; ES − 0.15).
Conclusions
These results support the two-point method as a reliable, valid, and fatigue-free procedure of assessing the muscle mechanical capacities through the F–V relationship.
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Health Insurance Coverage and Access to Care Among US-Born and Foreign-Born Sexual Minorities
Abstract
Sexual minorities and immigrants face unique challenges to accessing health care in the United States. This study used data on nonelderly adults (n = 100,667) from the 2013–2016 National Health Interview Survey. Unadjusted prevalence estimates and multivariable logistic regression models (with and without interactions between immigration and sexual minority status) were used to compare health insurance coverage and access to care by immigration and sexual minority status. We did not find any differences in uninsurance, having a usual source of care, and a recent office visit by sexual orientation for US-born and foreign-born adults. However, compared to their heterosexual counterparts, US-born and foreign-born sexual minorities were more likely to have an emergency room visit in the prior year and report financial-related barriers to medical care, dental care, prescription medications, and mental health care. Foreign-born sexual minorities were more likely to have an emergency room visit and unmet mental health care needs due to cost compared to other subpopulations after controlling for sociodemographic characteristics. Broadening the knowledge and scope of research on sexual minority immigrants can inform targeted health policy approaches with the goal of achieving health equity for sexual minority immigrants.
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Evolution of the modern baboon (Papio hamadryas): A reassessment of the African Plio-Pleistocene record
Source:Journal of Human Evolution
Author(s): Christopher C. Gilbert, Stephen R. Frost, Kelsey D. Pugh, Monya Anderson, Eric Delson
Baboons (Papio hamadryas) are among the most successful extant primates, with a minimum of six distinctive forms throughout Sub-Saharan Africa. However, their presence in the fossil record is unclear. Three early fossil taxa are generally recognized, all from South Africa: Papio izodi, Papio robinsoni and Papio angusticeps. Because of their derived appearance, P. angusticeps and P. robinsoni have sometimes been considered subspecies of P. hamadryas and have been used as biochronological markers for the Plio-Pleistocene hominin sites where they are found.We reexamined fossil Papio forms from across Africa with an emphasis on their distinguishing features and distribution. We find that P. robinsoni and P. angusticeps are distinct from each other in several cranial features, but overlap extensively in dental size. Contrary to previous assessments, no diagnostic cranio-mandibular material suggests these two forms co-occur, and dental variation at each site is comparable to that within P. h. ursinus, suggesting that only one form is present in each case. P izodi, however, may co-occur with P. robinsoni, or another Papio form, at Sterkfontein Member 4.P izodi appears more primitive than P. robinsoni and P. angusticeps. P. robinsoni is slightly distinct from P. hamadryas subspecies in its combination of features while P. angusticeps might be included within one of the modern P. hamadryas varieties (i.e., P. h. angusticeps). No definitive Papio fossils are currently documented in eastern Africa until the Middle Pleistocene, pointing to southern Africa as the geographic place of origin for the genus. These results have implications for Plio-Pleistocene biochronology and baboon evolution.
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Examining Changes in Prevention Guidelines in Maternal and Child Health: Development of a Teaching Activity
Abstract
Purpose Recent changes in preventive guidelines (e.g., pap testing, mammography) have resulted in confusion for both providers and patients. These changes have occurred either because new research has been introduced or because evidence for the practice is not established. Public health has the responsibility to promote the dissemination and implementation of changing guidelines into practice to improve the public's health. Health literacy may facilitate this process. The purpose of this study is to describe a teaching tool applying principles of health literacy to changes in prevention guidelines. The objectives of the teaching activity were to: (1) understand the development of evidence-informed prevention guidelines; and (2) use health literacy to evaluate the target population's perspectives on the guideline change using a health literacy approach. Description An interactive lecture and a practice-based assignment were created; the assignment was pilot-tested in graduate Women's Health classes. Multiple final products were developed in order to facilitate the lecture and assignment: (1) lesson plan; (2) slide presentation; (3) health literacy interview guide worksheet; and (4) grading rubric. After the presentation, students interviewed women from the guideline target population using health literacy constructs and synthesized their findings to create an overall assessment report. Assessment Feedback from the pilot test informed the revision of the teaching activity. Conclusions This teaching tool can be applied in a wide variety of settings in higher education, such as courses in public health, nursing, or medicine. As health literacy continues to be an important determinant of health status, integrating this determinant into the dissemination and communication of preventive guideline changes is needed.
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Handgrip Strength and Health in Aging Adults
Abstract
Handgrip strength (HGS) is often used as an indicator of overall muscle strength for aging adults, and low HGS is associated with a variety of poor health outcomes including chronic morbidities, functional disabilities, and all-cause mortality. As public health initiatives and programs target the preservation of muscle strength for aging adults, it is important to understand how HGS factors into the disabling process and the sequence of health events that connect low HGS with premature mortality. Such information will help to inform interventions designed to slow the disabling process and improve health outcomes for those at risk for muscle weakness. Further, unraveling the disabling process and identifying the role of weakness throughout the life course will help to facilitate the adoption of HGS measurements into clinical practice for healthcare providers and their patients. The purposes of this article were to (1) highlight evidence demonstrating the associations between HGS and clinically relevant health outcomes, (2) provide directions for future research in HGS and health, and (3) propose a sequence of health-related events that may better explain the role of muscle weakness in the disabling process.
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The Relationship Between Training Load and Injury in Athletes: A Systematic Review
Abstract
Background
The relationship between training load and musculoskeletal injury is a rapidly advancing area of research in need of an updated systematic review.
Objective
This systematic review examined the evidence for the relationship between training load and musculoskeletal injury risk in athlete, military, and first responder (i.e. law enforcement, firefighting, rescue service) populations.
Methods
The CINAHL, EMBASE, MEDLINE, SportDISCUS, and SCOPUS databases were searched using a comprehensive strategy. Studies published prior to July 2017 were included if they prospectively examined the relationship between training load and injury risk. Study quality was assessed using the Newcastle–Ottawa Quality Assessment Scale (NOS) and Oxford Centre for Evidence-Based Medicine levels of evidence. A narrative synthesis of findings was conducted.
Results
A total of 2047 articles were examined for potential inclusion. Forty-six met the inclusion criteria and 11 known to the authors but not found in the search were added, for a total of 57 articles. Overall, 47 studies had at least partially statistically significant results, demonstrating a relationship between training load and injury risk. Included articles were rated as poor (n = 15), fair (n = 6), and good (n = 36) based on NOS score. Articles assessed as 'good' were considered level 2b evidence on the Oxford Centre for Evidence-Based Medicine Model, and articles assessed as 'fair' or 'poor' were considered level 4 evidence.
Conclusions
Our results demonstrate that the existence of a relationship between training load and injury continues to be well supported in the literature and is strongest for subjective internal training load. The directionality of this relationship appears to depend on the type and timeframe of load measured.
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