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January
Kinds of January Terms modified by January Selected AbstractsEnvironmental factors during seed development of narrow-leaved bird's-foot-trefoil (Lotus tenuis) influences subsequent dormancy and germinationGRASS & FORAGE SCIENCE, Issue 4 2003A. A. Clua Abstract Narrow-leaved bird's-foot-trefoil (Lotus tenuis) is a perennial forage legume adapted to waterlogged and heavy and infertile soils and can replace alfalfa (Medicago sativa) in areas with these soils in Argentina. Its seeds are hard and water-impermeable but the effects of environmental factors on seed dormancy and germination are not known. The objective was to evaluate the hypothesis that water availability during seed development and maturation affects the degree of hardseededness in L. tenuis by changing seed coat properties, conditioning water uptake through the seed coat; and subsequently affecting dormancy, germination and speed of germination. Seeds were harvested in December/January and in February in both 1993/1994 and 1994/1995 from a permanent pasture of L. tenuis growing in a Hapludol soil in San Miguel del Monte province of Buenos Aires. Environmental conditions of each anthesis-harvest period were determined. Seeds of each harvest were subjected to chilling, washing and mechanical scarification. After 12 months seeds from each harvest were observed in a scanning electron microscope. The water deficit of the soil and relative humidity were greater in the second than the first anthesis-harvest period in both seasons. In 1993/1994 the control treatment in December had a higher germination rate than the February control seeds (0·40 vs. 0·20) and a faster germination rate. Mechanical scarification and chilling significantly enhanced the germination rate (0·95) and its speed in seeds of both harvests. Low temperatures significantly enhanced germination rate, starting after 60 d for the seeds harvested in December, and 90 d for the seeds harvested in February. In 1994/1995 the results were similar but both the January and February control treatments had higher germination rates (0·60 vs. 0·40) than in the previous year. Seeds harvested in February were more dormant in both years. These differences could be explained by the conditions in February anthesis-harvest period in both years that could have hastened the natural dehydration process of seed, changing integument structure and enhancing its impermeability. [source] THE HOWARD-TURNBULL NATIONAL PLAN FOR WATER SECURITY OF JANUARY 2007: RESCUE OR REJECTION?ECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 2 2008ALISTAIR WATSON A ten-point, ten-year, ten billion dollar National Plan for Water Security was announced by the (then) Howard Government in January 2007. The Plan was supported by State governments, with the exception of Victoria. The (then) Opposition supported legislation in August 2007 to implement the Plan. The main part of the Plan was investment in off-farm and on-farm irrigation infrastructure, ostensibly to promote water use efficiency. A smaller programme was proposed for buyback of irrigation water for environmental purposes. Various economic criteria would favour the opposite emphasis. Investment by governments in private irrigation infrastructure goes against the spirit of other recent policy changes and, for economic and technical reasons, is unlikely to achieve its objectives. Buyback for environmental purposes should continue, subject to appropriate procedures and discipline in the selection of environmental projects. Recent developments highlight continuing controversies over policy and administration of the Murray-Darling Basin. [source] LIST OF REFEREES/REVIEWERS FOR THE JOURNAL OF THE AMERICAN GERIATRICS SOCIETY FROM JANUARY TO JUNE 2010JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010Article first published online: 2 SEP 2010 No abstract is available for this article. [source] LIST OF REFEREES/REVIEWERS FOR THE JOURNAL OF THE AMERICAN GERIATRICS SOCIETY FROM JANUARY TO JUNE 2004JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Article first published online: 16 AUG 200 No abstract is available for this article. [source] Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus CommunisCONGENITAL HEART DISEASE, Issue 3 2010Pedro Curi-Curi MD ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source] Early Surgical Morbidity and Mortality in Adults with Congenital Heart Disease: The University of Michigan ExperienceCONGENITAL HEART DISEASE, Issue 2 2008Ginnie L. Abarbanell MD ABSTRACT Objectives., To review early surgical outcomes in a contemporary series of adults with congenital heart disease (CHD) undergoing cardiac operations at the University of Michigan, and to investigate possible preoperative and intraoperative risk factors for morbidity and mortality. Methods., A retrospective medical record review was performed for all patients ,18 years of age who underwent open heart operations by a pediatric cardiothoracic surgeon at the University of Michigan Congenital Heart Center between January 1, 1998 and December 31, 2004. Records from a cohort of pediatric patients ages 1,17 years were matched to a subset of the adult patients by surgical procedure and date of operation. Results., In total, 243 cardiac surgical operations were performed in 234 adult patients with CHD. Overall mortality was 4.7% (11/234). The incidence of major postoperative complications was 10% (23/234) with a 19% (45/23) minor complication rate. The most common postoperative complication was atrial arrhythmias in 10.8% (25/234). The presence of preoperative lung or liver disease, prolonged cardiopulmonary bypass and aortic cross clamp times, and postoperative elevated inotropic score and serum lactates were significant predictors of mortality in adults. There was no difference between the adult and pediatric cohorts in terms of mortality and morbidity. Conclusions., The postoperative course in adults following surgery for CHD is generally uncomplicated and early survival should be expected. Certain risk factors for increased mortality in this patient population may include preoperative presence of chronic lung or liver dysfunction, prolonged cardiopulmonary bypass and aortic cross-clamp times, and postoperative elevated inotropic score and serum lactate levels. [source] Outcomes Associated With Nesiritide Administration for Acute Decompensated Heart Failure in the Emergency Department Observation Unit: A Single Center ExperienceCONGESTIVE HEART FAILURE, Issue 3 2009Joseph F. Styron BA The authors' purpose was to determine 30- and 180-day readmission and mortality rates for acutely decompensated heart failure patients receiving nesiritide in the emergency department observation unit. The authors conducted a retrospective evaluation of all patients admitted to the emergency department observation unit, stratified by nesiritide administration, from January 2002 to January 2004. Eligible patients had a primary diagnosis of acutely decompensated heart failure. Observation unit treatment was by previously published protocols, except for nesiritide administration, which was per attending physician choice. Of 595 patients, 196 (33%) received nesiritide. The crude and adjusted odds ratios comparing readmission rates and mortality rates of the nesiritide group with the control group failed to demonstrate significant differences at either the 30- or the 180-day endpoints. The use of nesiritide for acute decompensated heart failure in the emergency department observation unit is not associated with mortality or readmission differences compared with standard therapy alone. [source] Carvedilol Produces Sustained Long-Term Benefits: Follow-Up at 12 YearsCONGESTIVE HEART FAILURE, Issue 1 2009John F. MacGregor MD The authors measured long-term outcomes of patients who initiated carvedilol between 1990 and 1992 to test the hypothesis that carvedilol produces sustained benefits in heart failure patients. The study population consisted of 57 patients who completed a carvedilol placebo-controlled phase II trial. Patients were given open-label carvedilol and were titrated to the maximum dose. Patients were assessed by serial multigated acquisition, echocardiography, and symptom scores. Survival was assessed for all patients and censored as of January 1, 2004. Survival for ischemic vs nonischemic patients was compared using the log-rank test and further compared using Cox regression, controlling for covariates. Etiology of heart failure was ischemic in 15 patients and nonischemic in 42 patients. Median follow-up was 12.9 years. Resting left ventricular ejection fraction (LVEF) and heart failure symptom scores improved at 4 months of treatment and were sustained at 24 months. Left ventricular internal diameter in systole (LVIDS) and left ventricular internal diameter in diastole decreased significantly at 4 and 8 months, respectively, and LVIDS continued to improve at 24 months. Overall mortality was 43% in nonischemic patients and 73% in ischemic patients. In a multivariate analysis, ischemic etiology and baseline LVEF were significant predictors of mortality. Carvedilol produces sustained improvements in left ventricular remodeling and symptoms. Long-term survival is good, particularly in nonischemic patients. [source] Validity of a Discharge Diagnosis of Heart Failure: Implications of MisdiagnosingCONGESTIVE HEART FAILURE, Issue 4 2008Cāndida Fonseca MD Heart failure (HF) costs are largely due to hospitalization. The validity of a death/discharge diagnosis of HF (DDHF) is largely unknown. The authors assessed the validity of DDHF and the impact of misdiagnosing. The case notes of patients consecutively admitted to a medical department between January and June 2001 were reviewed. Cases with DDHF or cardiovascular diseases, potential precursors of HF (PPHF), were included. The diagnosis of HF (European Society of Cardiology guidelines) was classified as definite, possible, or miscoded. Of the 1038 patients admitted, 234 were enrolled: 157 with DDHF and 77 with PPHF. One hundred eighty patients had a definite diagnosis of HF. Of the 157 diagnoses coded as definite HF, 130 were correct, 21 had possible HF, and 6 were miscoded. Of the 77 patients classified as having PPHF, 38 had definite HF. The accuracy of the DDHF diagnosis was 72.2%: 21.1% were underdiagnosed and 8.3% overdiagnosed. DDHF failed to capture many HF admissions and therefore alone underestimates the prevalence, burden, and costs of the syndrome. [source] Recently Received Books January , April 2009CONSERVATION BIOLOGY, Issue 4 2009Article first published online: 13 JUL 200 No abstract is available for this article. [source] Sensitization to 26 fragrances to be labelled according to current European regulationCONTACT DERMATITIS, Issue 1 2007Results of the IVDK, review of the literature To study the frequency of sensitization to 26 fragrances to be labelled according to current European regulation. During 4 periods of 6 months, from 1 January 2003 to 31 December 2004, 26 fragrances were patch tested additionally to the standard series in a total of 21 325 patients; the number of patients tested with each of the fragrances ranged from 1658 to 4238. Hydroxymethylpentylcyclohexene carboxaldehyde (HMPCC) was tested throughout all periods. The following frequencies of sensitization (rates in %, standardized for sex and age) were observed: tree moss (2.4%), HMPCC (2.3), oak moss (2.0), hydroxycitronellal (1.3), isoeugenol (1.1), cinnamic aldehyde (1.0), farnesol (0.9), cinnamic alcohol (0.6), citral (0.6), citronellol (0.5), geraniol (0.4), eugenol (0.4), coumarin (0.4), lilial (0.3), amyl-cinnamic alcohol (0.3), benzyl cinnamate (0.3), benzyl alcohol (0.3), linalool (0.2), methylheptin carbonate (0.2), amyl-cinnamic aldehyde (0.1), hexyl-cinnamic aldehyde (0.1), limonene (0.1), benzyl salicylate (0.1), ,-methylionon (0.1), benzyl benzoate (0.0), anisyl alcohol (0.0). 1) Substances with higher sensitization frequencies were characterized by a considerable number of ,++/+++' reactions. 2) Substances with low sensitization frequencies were characterized by a high number of doubtful/irritant and a low number of stronger (++/+++) reactions. 3) There are obviously fragrances among the 26 which are, with regard to contact allergy, of great, others of minor, and some of no importance at all. [source] Sensitivity to Myroxylon pereirae resin (balsam of Peru).CONTACT DERMATITIS, Issue 6 2005A study of 50 cases The Myroxylon pereirae resin (MP; balsam of Peru) is a natural resin used in the local treatment of burns and wounds. M. pereirae extracts and distillates are very often contained in a wide range of cosmetic products and causes frequently allergic contact dermatitis , to the extent of being considered an allergy marker to perfumes. We have carried out a retrospective study of 863 patients who have been submitted to patch tests from January 2002 to June 2004. A total of 50 patients were positive to MP. Thus, the prevalence was 5.79%, slightly higher in men (7.32%) than in women (4.91%). The positive patch tests were relevant in 64%. Over the last years, it appears that there is a clear increase of the prevalence of the sensitization to MP in all the studies published. We observe an increase of the prevalence especially in aged patients, where the sensitization is linked with the use of topical medications secondary to stasis dermatitis. The high frequency of allergy to MP in our area might be associated with manipulation of citrus fruits. The increasing use of cosmetic products by the male population can also be held responsible for the higher sensitization rate in this group of patients. [source] Contact allergy to farnesol in 2021 consecutively patch tested patients.CONTACT DERMATITIS, Issue 3 2004Results of the IVDK Farnesol is one of the fragrances considered to be a significant contact allergen. Therefore, it was decided by the European Union to label products containing farnesol. Farnesol was tested [5% petrolatum (pet.)] together with the standard series between 1 January 2003 and 30 June 2003 in 2021 consecutive patients, 1243 females and 778 males. Of these, 22 [1.1%, 95% confidence interval (CI): 0.7,1.6%] had a positive reaction to farnesol. 147 (8.1%) of those 1825 tested to Myroxylon pereirae resin (balsam of Peru, 25% pet.) at the same time reacted positively, 143 (7.8%) of those 1823 tested to the fragrance mix (FM) (8% pet.) and 34 (1.9%) of 1831 tested to propolis (10% pet.). With regard to concomitant reactions in farnesol-positive patients, 5 of 22 reacted additionally to the FM [odds ratio (OR): 4.3; CI: 1.53,12.15] and 2 (of these 5) additionally to M. pereirae resin (OR: 1.27; CI: 0.29,5.54). The strongest association was seen to propolis (OR: 6.2; 95% CI: 1.4,27.7). Compared to those with negative reactions to farnesol, the group of patients allergic to farnesol was characterized by a higher proportion of young females and office workers, and the hand and the face were more often affected. In conclusion, farnesol is an important allergen. We recommend that farnesol should be included in a fragrance patch-test preparation and that its use should be regulated for consumer safety reasons. Furthermore, the extent of exposure to farnesol should be further studied. [source] Are psychiatrists affecting the legal process by answering legal questions?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2008Timothy Hardie Background,Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known. Aim,To investigate how strongly psychiatrists in England and Wales express opinions on one legal question , that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. Method,Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. Results,Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. Conclusions,Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts should join in research to examine the consequences of different styles or approaches in presentation of essentially similar evidence in court. Copyright © 2008 John Wiley & Sons, Ltd. [source] Changes in patterns of excessive alcohol consumption in 25 years of high security hospital admissions from England and WalesCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2003Celia McMahon Background It is now generally acknowledged that alcohol abuse increases the risk of violence among people with major mental disorder. Studies in the 1980s and earlier, however, tended to report an inverse relationship between their alcohol use and violence. Aims A study was undertaken to test a hypothesis that among people with major mental disorder considered to pose a serious risk to others the likelihood of excessive alcohol consumption in a period leading up to a violent or dangerous act has increased over time. Methods Analysis was made of annual high security hospital admission cohort case register data of 1 January 1975 to 31 December 1999; alcohol use data were taken from interview and records, and problem drinking defined as consumption of alcohol in excess of 21 units per week during the 12 months prior to the index offence or act. Results There was a linear increase in the proportion of patients in five-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offence or act. The increase was steeper among women than men, but cut across all diagnosis and offending groups. It was strongly associated with increasing tendency to abuse illicit drugs. Conclusions The greater proportion of patients affected by excessive alcohol consumption occurred in spite of a reduction over the same period in admission of people in the diagnostic groups most likely to be implicated in substance misuse (personality disorder). This increased trend may simply reflect similar trends in the general population, but may also be associated with a lack of services or current consensus on appropriate treatment for patients whose mental illness is complicated by excessive alcohol use. Regardless, the trend suggests a growing need for ,dual diagnosis' services within and outside high security hospital. Copyright © 2003 Whurr Publishers Ltd. [source] THE SHORT-TERM EFFECTS OF EXECUTIONS ON HOMICIDES: DETERRENCE, DISPLACEMENT, OR BOTH?,CRIMINOLOGY, Issue 4 2009KENNETH C. LAND Does the death penalty save lives? In recent years, a new round of research has been using annual time-series panel data from the 50 U.S. states for 25 or so years from the 1970s to the late 1990s that claims to find many lives saved through reductions in subsequent homicide rates after executions. This research, in turn, has produced a round of critiques, which concludes that these findings are not robust enough to model even small changes in specifications that yield dramatically different results. A principal reason for this sensitivity of the findings is that few state-years exist (about 1 percent of all state-years) in which six or more executions have occurred. To provide a different perspective, we focus on Texas, a state that has used the death penalty with sufficient frequency to make possible relatively stable estimates of the homicide response to executions. In addition, we narrow the observation intervals for recording executions and homicides from the annual calendar year to monthly intervals. Based on time-series analyses and independent-validation tests, our best-fitting model shows that, from January 1994 through December 2005, evidence exists of modest, short-term reductions in homicides in Texas in the first and fourth months that follow an execution,about 2.5 fewer homicides total. Another model suggests, however, that in addition to homicide reductions, some displacement of homicides may be possible from one month to another in the months after an execution, which reduces the total reduction in homicides after an execution to about .5 during a 12-month period. Implications for additional research and the need for future analysis and replication are discussed. [source] CPA assessment , the regional assessors' experienceCYTOPATHOLOGY, Issue 2007G. Guthrie With the introduction in January 2006 of the new posts of Regional Assessors, the process and focus of CPA assessment changed to reflect the inclusion in the current standards of Quality Management systems and processes. Regional Assessors, trained in Quality Management Systems and their assessment against international standards, now form a vital part of the CPA assessment teams, looking specifically at this aspect of laboratory service provision. Their role in the new assessment process will be explained. The presentation will cover differences and similarities in the nature and number of non-compliances experienced since April 2006 when the new format of assessment was introduced. It will also look at a new format of timetable for assessment visits and explain the benefits of good two-way communication between all parties involved in the process - the laboratory, the assessors, particularly the Regional Assessor assigned to that site, and CPA Office staff. Understanding what is required by the standards, particularly in terms of evidential material, their interpretation and their classification of status , Critical, Non-Critical or Observation - is an aspect of assessment which is often not well understood. The presentation will seek to clarify these issues. The successful and timely clearance by laboratories of any non-compliances raised during the visits is vital to the achievement of accredited status and the presentation will give guidance as to how this is best achieved. The current standards, based on the international ISO 15189 standards, are considerably more challenging than the old ones. There is now a significant emphasis on Quality Management and its understanding, ethos and implementation within the laboratory, a key element which underpins all aspects of a laboratory's service. The achievement of accredited status assures our users of,the type of client and patient focused service expected of a modern laboratory. [source] Avulsion of primary teeth and sequelae on the permanent successorsDENTAL TRAUMATOLOGY, Issue 6 2005Pia Christophersen Abstract,,, The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury (P = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found. [source] Contribution of Dermatologic Surgery in WarDERMATOLOGIC SURGERY, Issue 1 2010MAJOR J. SCOTT HENNING DO BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source] Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic SurgeryDERMATOLOGIC SURGERY, Issue 3 2009ROGER S. SICA DO BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source] Therapeutic Hotline: Re-induction may be useful to manage psoriasis relapse during long-term maintenance treatment with infliximab: a retrospective analysisDERMATOLOGIC THERAPY, Issue 2 2010Gino Vena ABSTRACT Infliximab is an anti-tumor necrosis factor-alpha monoclonal antibody that is highly effective for the treatment of psoriatic disease. During maintenance treatment, some patients may experience a disease relapse, and, in such circumstances, dose intensification is frequently used to regain efficacy. We report our cumulative experience on the use of infliximab re-induction in patients whose psoriasis relapsed during long-term maintenance treatment with infliximab. From September 2005 to January 2009, 22 patients required re-induction because of a relapse of their psoriasis. Re-induction was effective in restoring response in most patients and was well tolerated in all cases, without occurrence of serious or unexpected adverse events. [source] Severe mental illness and criminal victimization: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009R. Maniglio Objective:, To estimate the prevalence of criminal victimization among people with severe mental illness and to explore risk factors. Method:, Four databases (MEDLINE, ScienceDirect, ERIC, and AMED) were searched for articles published between January 1966 and August 2007, supplemented with hand-search of reference lists from retrieved papers. The author and a Medical Doctor independently abstracted data and assessed study quality. Disagreements were resolved by consensus after review of the article and the review protocol. Results:, Nine studies, including 5195 patients, were identified. Prevalence estimates of criminal victimization ranged from 4.3% to 35.04%. Rates of victimization among severely mentally ill persons were 2.3,140.4 times higher than those in the general population. Criminal victimization was most frequently associated with alcohol and/or illicit drug use/abuse, homelessness, more severe symptomatology, and engagement in criminal activity. Conclusion:, Prevention and intervention programs should target high-risk groups and improve patients' mental health and quality of life. [source] Validity of ,post-traumatic stress disorder with secondary psychotic features': a review of the evidenceACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009M. H. Braakman Objective:, To review the evidence from empirical studies regarding the validity of ,post-traumatic stress disorder with secondary psychotic features' (PTSD-SP) as a separate diagnostic entity. Method:, The authors performed a review tracing publications between 1980 and January 2008. Results:, Twenty-four comparative studies were included. These studies indicate that PTSD-SP is a syndrome that comprises PTSD-symptoms followed in time by the additional appearance of psychotic features. The psychotic features are not confined to episodes of re-experiencing, but remain present continuously. PTSD-SP seems to have some biological features differentiating it from schizophrenia and PTSD, e.g. there are differences in smooth pursuit eye movement patterns, concentrations of corticotropin-releasing factor and dopamine ,-hydroxylase activity. Conclusion:, There is currently not yet full support for PTSD-SP as a nosological entity. However, the delineation of PTSD-SP from other psychiatric syndromes is notable and biological studies seem to support the validity as a separate diagnostic entity. [source] Mechanical ventilation for respiratory failure in children with severe neurological impairment: is it futile medical treatment?DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2010JOSEPHUS PJ VAN GESTEL Aim, To assess outcome for children with severe neurological impairment receiving invasive mechanical ventilation for respiratory failure. Method, Medical charts for all such children treated in our intensive care unit (ICU) between January 2003 and July 2008 were reviewed. Outcomes were compared with those for children with moderate neurological impairment. Results, Twenty-two children with severe neurological impairment were included (nine females, 13 males; median age 7y 10mo; range 4mo,17y). The median duration of mechanical ventilation was 16 days. Six children had an uneventful 1-year survival, the others required reintubation or readmission to the ICU, or died. Eleven children were still alive 1 year after discharge from the ICU. Nine patients died of respiratory failure. None of the children in the severe group died of a heart defect. Eleven children with moderate neurological impairment were included (eight females, three males; median age 1y 1mo, range 4mo,13y). Four children had an uneventful 1-year survival. Eight children were still alive 1 year after discharge from the ICU. Two of the three non-survivors died of their heart defects. Interpretation, Mechanical ventilation for respiratory failure in children with severe neurological impairment is complex and associated with limited survival. However, it cannot be regarded as futile medical treatment. Further studies are urgently needed for the rational guidance of clinical decision-making. [source] Session 1: Wednesday 16 January 2008DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2008Article first published online: 17 DEC 200 No abstract is available for this article. [source] Infantile spasms and cytomegalovirus infection: antiviral and antiepileptic treatmentDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2007Dorota Dunin-Wasowicz MD PhD From 1 January 1995 to 31 December 2004, 22 patients (13 males, nine females; age range 2-12mo) with infantile spasms and cytomegalovirus (CMV) infection were treated with intravenous ganciclovir (GCV) and antiepileptic drugs. GCV was given for 3 to 12 weeks with a 1-month interval (one, two, or three courses). Epileptic spasms occurred before (group A: eight patients), simultaneously (group B: eight patients), and after (group C: six patients) a diagnosis of human CMV (HCMV) infection and antiviral treatment. In 11 patients, DNA HCMV was found in cerebrospinal fluid by nested-polymerase chain reaction method (neuroinfection). All infants excreted CMV in urine. DNA HCMV and specific immunoglobulin M and immunoglobulin G antibodies were present in blood. Ten patients, including four with neuroinfection, have been seizure-free for at least the past 18 months. In two patients with neuroinfection, vigabatrin monotherapy was withdrawn after a 2 year 6 month seizure-free period. Eighteen patients required antiepileptic drugs polytherapy, four of whom required additional adrenocorticotropic hormone (ACTH). Six patients on polytherapy were seizure-free on follow-up, two of whom were treated with ACTH, but no patient with hypsarrhythmia who required ACTH treatment was seizure-free on follow-up. In five patients, psychomotor development was normal, 16 had tetraplegia (Gross Motor Function Classification System [GMFCS] Level V), and one had diplegia (GMFCS Level III). Early antiviral and antiepileptic therapy could result in the long-term cessation of seizures. [source] The 31st British Paediatric Neurology Association (BPNA) Annual Meeting, Institute of Child Health, London, UK, 19-21 January 2005DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2005Jean-Pierre Lin No abstract is available for this article. [source] Blood Cultures Do Not Change Management in Hospitalized Patients with Community-acquired PneumoniaACADEMIC EMERGENCY MEDICINE, Issue 7 2006Prasanthi Ramanujam MD Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. Results: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170. Conclusions: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. [source] Self-help treatments for disorders of recurrent binge eating: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2006S. C. Stefano Objective:, To evaluate self-help interventions for patients with binge eating disorder (BED) and bulimia nervosa (BN), tested in randomized controlled trials, and compared with waiting list or any other type of control group. Methods:, A systematic review including quality appraisal was conducted of randomized controlled trials, using self-help techniques in patients with BED and/or BN. Six databases were searched during the period between January 1994 and June 2004. Results:, A total of 2686 articles were identified, 1701 abstracts were evaluated in detail and, nine studies fulfilled the inclusion criteria for this review. All studies indicated that patients treated with active interventions had a reduced number of binge eating episodes at end of treatment. Conclusion:, The results support self-help interventions but shall be interpreted with caution. Because of the small number of studies using self-help techniques for BED and BN, further larger randomized, multi-center controlled studies that apply standardized inclusion criteria, evaluation instruments and self-help materials, are needed. [source] Managing childhood obesity: when lifestyle change is not enoughDIABETES OBESITY & METABOLISM, Issue 11 2010C. Hearnshaw The management of childhood obesity is a clinical dilemma. Paediatricians will see those children whose weight is at the severe end of the spectrum with obesity-related co-morbidities and for whom more intensive weight loss therapies may be appropriate. A literature review was performed (January 1995,January 2010) of the roles of pharmacotherapy or bariatric surgery in the management of childhood obesity. Three hundred and eighty-three abstracts were reviewed and 76 full-text articles were requested. Of these, 34 were excluded and a total of 21 pharmacotherapy papers and 22 papers on surgery were reviewed in detail. All studies involved adolescents. Pharmacotherapy: Most studies were small and of short duration, the notable exceptions being two large RCTs of sibutramine and orlistat. Sibutramine led to a mean estimated change in BMI from baseline of ,3.1 kg/m2 vs. ,0.3 kg/m2 for placebo over 12 months. Orlistat was also beneficial with a mean reduction in BMI of 0.55 vs. an increase of 0.31 kg/m2 in the placebo group at 12 months. Bariatric surgery: Most papers presented clinical observations and there were no randomised controlled trials (RCTs). Robust selection criteria were not used and ideal candidate selection remains unclear. Most papers showed a significant benefit of surgery in severely obese adolescents in the short term but long-term data were sparse. There were a surprisingly large number of papers examining the benefits of intensive weight management in obese adolescents. The study design of many was inadequate and the role of pharmacotherapy or surgery in childhood obesity remains unclear. [source] | ||||||||||||||||||||||||||||||||||||||||||||||