bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial
Authors: Ji Sang Gu , Kim Myoung Kwon
Published: July 2014

Objective:

To investigate the effect of mirror therapy on the gait of patients with subacute stroke.

Design:

Randomized controlled experimental study.

Setting:

Outpatient rehabilitation hospital.

Subjects:

Thirty-four patients with stroke were randomly assigned to two groups: a mirror therapy group (experimental) and a control group.

Interventions:

The stroke patients in the experimental group underwent comprehensive rehabilitation therapy and mirror therapy for the lower limbs. The stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy five days per week for four weeks.

Main measures:

Temporospatial gait characteristics, such as single stance, stance phase, step length, stride, swing phase, velocity, and cadence, were assessed before and after the four weeks therapy period.

Results:

A significant difference was observed in post-training gains for the single stance (10.32 SD 4.14 vs. 6.54 SD 3.23), step length (8.47 SD 4.12 vs. 4.83 SD 2.14), and stride length (17.03 SD 6.57 vs 10.54 SD 4.34) between the experimental group and the control group ( p < 0.05). However, there were no significant differences between two groups on stance phase, swing phase, velocity, cadence, and step width ( P > 0.05).

Conclusion:

We conclude that mirror therapy may be beneficial in improving the effects of stroke on gait ability.
The effects of foot geometric properties on the gait of planar bipeds walking under HZD-based control
Authors: Martin Anne E. , Post David C. , Schmiedeler James P.
Published: July 2014

It has been hypothesized by many that foot design can influence gait. This idea was investigated in both simulation and hardware for the five-link, planar biped ERNIE controlled under the Hybrid Zero Dynamics paradigm. The effects of walking speed, foot radius, and foot center of curvature location on gait efficiency and kinematics were investigated in a full factorial study of gaits optimized using a work-based objective function. In most cases, the simulation correctly predicted the trends observed in hardware, indicating that simulation can be used for foot design. As expected, increasing walking speed decreased the energetic efficiency. The dominant effect of speed on joint kinematics was to alter the timing of the peak hip flexion. Increasing foot radius up to the length of the shank improved the energetic efficiency and increased the range of motion of the hip and knee joints. Shifting the foot center of curvature location forward altered the energetic efficiency in a manner that interacted with changes in foot radius. The energetically optimal foot center of curvature location was coincident with the shank for a large foot radius and shifted far in front of the shank for a small foot radius. In all cases, the forward shift increased the range of motion of the hip and knee joints. Therefore, a robot designer can achieve similar energetic benefits across a range of speeds with either a larger radius foot or a smaller radius foot whose center of curvature is located forward of the shank.
Imaging characteristics of sinonasal organized hematoma
Authors: Hur Joonho , Kim Jae Kyun , Byun Jun Soo , Lee Woong Jae
Published: July 2014

Background

Sinonasal organized hematoma is a rare benign disease that may be mistaken for malignancy.

Purpose

To define the imaging characteristics of sinonasal organized hematoma.

Material and Methods

We retrospectively reviewed computed tomography (CT) images of eight patients (4 male patients, 4 female patients; mean age, 40 years; range, 9–83 years) with pathologically proven sinonasal organized hematomas; magnetic resonance imaging (MRI) was performed in one patient among them. The following lesions characteristics were analyzed: size, shape, location, expansile nature, density, signal intensity, internal structure, enhancement pattern, and surrounding bony wall change.

Results

The lesion sizes were in the range of 2–5.2 cm (mean, 3.55 cm), and the shapes were lobular, lumpy, or nodular. They were located in the nasal cavity ( n = 1), maxillary sinuses ( n = 2), or both nasal cavities and maxillary sinuses ( n = 5). Expansile lesions with locally aggressive margins were observed in two cases. All lesions were hyperdense on precontrast CT scans; the smaller lesions showed even hyperdensity, whereas the larger lesions showed uneven density. The signal intensity was mixed on MRI, consisting of hemorrhage, fibrosis, and neovascularization. Papillary or frond-like enhancement was noted after contrast injection. All cases showed smooth erosion of the medial walls of the maxillary sinuses, and the epicenters were the secondary maxillary ostia. Two lesions showed erosion of the lateral walls of the maxillary sinuses and were expansile in nature. Non-hemorrhagic polyps accompanied the organized hematomas in three cases.

Conclusion

Although sinonasal organized hematoma can be mistaken for a malignant tumor, the following characteristic imaging findings facilitate the diagnosis of an organized hematoma: erosion of the bony sinus walls, markedly heterogeneous signal intensity, and papillary or frond-like enhancement.
Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction
Authors: Westermann Robert W. , Wright Rick W. , Spindler Kurt P. , Huston Laura J. ,   MOON Knee Group, Wolf Brian R. , Cox Charles L. , Kaeding Christopher C. , Flanigan David C. , Magnussen Robert A. , Matava Matthew J. , Brophy Robert H. , Smith Matthew V. , McCarty Eric C. , Vidal Armando F. , Wolcott Michelle , Marx Robert G. , Parker Richard D. , Andrish Jack F. , Jones Morgan H. , Amendola Annunziato , Dunn Warren R.
Published: July 2014

Background:

Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair.

Purpose:

To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs.

Results:

In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR ( P < .01.

Conclusion:

Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.
Three-Dimensional Analysis of Bone Tunnel Changes After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Multidetector-Row Computed Tomography
Authors: Araki Daisuke , Kuroda Ryosuke , Matsumoto Tomoyuki , Nagamune Kouki , Matsushita Takehiko , Hoshino Yuichi , Oka Shinya , Nishizawa Yuichiro , Kurosaka Masahiro
Published: July 2014

Background:

The femoral and tibial bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction (ACL-R) has not been fully documented.

Purpose:

To evaluate the region-specific bone tunnel volume changes and those transpositions using 3-dimensional multidetector-row computed tomography (MDCT) after anatomic double-bundle ACL-R.

Study design:

Case series; Level of evidence, 4.

Methods:

Eleven patients who underwent unilateral double-bundle ACL-R with hamstring tendon autografts were included in this study. MDCT scanning of their knees was performed at 3 weeks and 1 year after surgery. The bone tunnel regions were extracted from the MDCT images, and the longitudinal axis of each bone tunnel was divided into 3 equal sections. The centroids of the outside and the articular thirds were then extracted from the bone tunnel position. Changes in the bone tunnel volume and the transposition of the articular third were calculated and compared.

Results:

At 1 year postoperatively, as compared with the 3-week postoperative value (set at 100%), the femoral bone tunnel volume of the anteromedial bundle (AMB) and posterolateral bundle (PLB) changed to 77.4% ± 15.3% and 102.3% ± 19.2% in the outside third and 122.3% ± 31.8% and 112.5% ± 34.4% in the articular third, respectively. The tibial bone tunnel volume of the AMB and the PLB changed to 108.6% ± 28.7% and 105.4% ± 22.6% in the tibial articular third and 54.9% ± 25.8% and 52.5% ± 26.9% in the outside third, respectively. The femoral outside third of the AMB and the tibial outside third of both the AMB and PLB were significantly reduced in bone tunnel volume. The centroid of the femoral articular third of the AMB moved 13°, 1.1 ± 0.6 mm posterodistally, and that of the PLB moved 35°, 0.8 ± 0.4 mm anterodistally. Furthermore, the centroid of the tibial articular third of the AMB moved 14°, 2.0 ± 1.6 mm posterolaterally, and that of the PLB moved 72°, 1.0 ± 1.3 mm posterolaterally.

Conclusion:

Compared with 3 weeks postoperatively, the articular side outlets of the femoral and tibial bone tunnels at 1 year postoperatively had enlarged slightly but statistically maintained their volume, and they had moved a little in the direction that the grafts were pulled.
Hybridization of short glass fiber polypropylene composites with nanosilica and graphite nanoplatelets
Authors: Pedrazzoli Diego , Pegoretti Alessandro
Published: July 2014

The effects of various types and amounts of fumed silica and graphite nanoplatelets on the microstructure and thermomechanical properties of polypropylene composites containing 5, 10, and 20 wt% of short glass fibers have been analyzed. Hybrid composites were produced by melt compounding and compression molding. The aspect ratio of the short glass fiber decreased with the fiber loading and the nanofiller amount. The tensile strength and elastic modulus increased, while the elongation at break decreased as the content of both short glass fiber and nanofiller increased. A two-population model, based on the Halpin–Tsai and Tsai–Pagano composite theories, was used to predict the elastic modulus of the nano-micro hybrid composites. Experimental values appear to be reasonably consistent with model predictions. Tensile energy to break under impact conditions increased with the short glass fiber content but decreased with nanofiller amount. Moreover, storage modulus and creep stability were remarkably enhanced in short glass fiber composites by the presence of both nanofillers.
The challenges for solid waste management in accordance with Agenda 21: A Brazilian case review
Authors: de Lorena Diniz Chaves Gisele , dos Santos Jorge Luiz , Rocha Sandra Mara Santana
Published: July 2014

This paper aims to evaluate the suitability of the Brazilian solid waste policy (BSWP) with global Agenda 21 and the challenges of implementing the BSWP in municipalities. For this, a review of the principles that guided the creation of this policy was performed to demonstrate that international pressures were important in determining its effectiveness. The contradictory relationship between the satisfactory legal framework that established the Brazilian waste management policy and its weakened implementation in the municipalities is also examined . To illustrate the difficulties faced at the local level, a case study involving municipalities that compose the state of Espírito Santowe was undertaken. In this state, the municipalities signed terms of environmental commitment with supervisory agencies who undertook, within a pre-established schedule, to implement a set of actions to shape the proper management of solid waste, adapted to the requirements of national policy and the guidelines of Agenda 21. Finally, the various difficulties in meeting the requirements are discussed. It is necessary and urgent that Brazil finds a way to coordinate the mechanisms of an innovative and well formulated legal instrument to ensure the successful implementation of solid waste management at the local level to achieve the environmental, economic and social objectives
Work Attitudes of Mexican Americans
Authors: Weaver Charles N.
Published: July 2014

Weaver compared the work attitudes of Mexican Americans and Euro-Americans with data from 19 nationwide public opinion surveys. He found Mexican Americans productive, cooperative, and networking with a strong sense of work ethic and job satisfaction. Since 2000, the Mexican American population has grown by 57% to 32.9 million. It is more native born, more proficient in English, better educated, more often in important jobs, and has spread across the country. Yet, many live in poverty, and their labor force participation and median household income have declined. To investigate whether their work attitudes have been affected, Weaver’s study was replicated with data from three recent nationwide public opinion surveys to compare 326 Mexican Americans and 2,166 Euro-Americans. The results showed Mexican American work attitudes had become even more favorable. The findings placed beyond doubt the question of whether the work attitudes of Mexican Americans limit their contributions to organizational effectiveness.
Hispanic Respondent Intelligence Level and Skin Tone
Authors: Hannon Lance
Published: July 2014

Using the 2012 American National Election Study, the present article explored the relationship between interviewers’ assessment of respondent skin tone and their perception of respondent intelligence ( n = 459). Results from logistic regression analyses indicated that Hispanic respondents with the lightest skin were several times more likely to be seen as having high intelligence compared with those with the darkest skin. Importantly, this relationship was independent of respondent self-identified race, educational attainment, vocabulary test score, and several other respondent and interviewer characteristics. Implications for the growing body of research on colorism are discussed.
Anxiety, Depression, and Smoking Status Among Adults of Mexican Heritage on the Texas-Mexico Border
Authors: Wilkinson Anna V. , Vatcheva Kristina P. , Pérez Adriana , Reininger Belinda M. , McCormick Joseph B. , Fisher-Hoch Susan P.
Published: July 2014

The goal of the current analysis is to examine relationships between smoking status and anxiety and depression among adults of Mexican heritage to inform the development of culturally relevant smoking cessations efforts. Mexican heritage residents ( N = 1,791) of the city of Brownsville, Texas, aged 18 years or older, enrolled in the Cameron County Hispanic Cohort, were selected through two stage cluster sampling of randomly selected census tracts from the first and third quartiles of socio-economic status (SES) using Census 2000. Among current smokers, anxiety and depression scores were highest among women who had not completed high school ( p< .05). Women who were former smokers, but not men, with at least a high school education and former smoking women born in the United States reported higher levels of anxiety and depression than never smoking women. Negative affective states may represent a greater barrier to smoking cessation among women than men.
Volunteerism Among Mexican Youth in the United States
Authors: Ishizawa Hiromi
Published: July 2014

This study investigates patterns of volunteerism within a rapidly growing segment of the population, Mexican immigrant and Mexican origin youth, using data from the Education Longitudinal Study of 2002. These data show that volunteerism varies by immigrant generational status. Contradicting classical assimilation theory, first-generation Mexican immigrant youth are found to be more likely to engage in volunteerism compared with their third-plus-generation counterparts. This difference is most pronounced at the lower end of the family income spectrum. The study also analyzes the effects of components of family capital, family income and parental education, on youth volunteerism. Family income and parental education both have a positive effect on volunteerism, but the former is associated with volunteerism of any frequency and the latter with regular volunteerism.
What High-Achieving Latino Students Need to Apply to College
Authors: Rivera Gwendelyn J.
Published: July 2014

This quantitative study investigated how well environmental and individual factors predicted college-going behavior for college eligible Latino/as. Three questions were addressed: (a) Is there a relationship between individual agency and college-going behavior after controlling for environmental factors? (b) What is the relationship between the individual agency and college-going behavior while controlling for environmental factors? and (c) What role do peers play in the relationship between individual agency and college-going behavior? One hundred and twenty-four college-eligible immigrant Latino/a students completed surveys assessing agency, peer resources, and perceived college-going practices. The odds of submitting a college application were dependent on a combination of individuals’ agency scores and peer resources, with the latter serving a meditational role. The results suggest the need to incorporate peer participation into college-going practices in middle and high school and outreach programs. Studies of underserved youth might usefully incorporate individual characteristics as well as environmental factors.
Combustion characteristics of a dual-mode scramjet injecting liquid kerosene by multiple struts
Authors: Yang Qingchun , Bao Wen , Zong Youhai , Chang Juntao , Hu Jichao , Wu Meng
Published: July 2014

In order to optimize fuel allocation between multiple injection struts in scramjet combustor, experimental investigation has been carried out to study the combustion characteristics of a dual-mode scramjet, in which liquid kerosene was injected from three staggered arranged struts, and the effect of fuel allocation between the three struts on the combustion characteristics has been analyzed. The results show strong influence of the quantity and streamwise position of struts on the wall pressure distribution and both the equivalence ratio limits of inlet unstarting and lean blowout. To obtain a wide stable operation range, just one strut is needed for injecting most of the fuel in the combustors with configuration and size as in this work, and a streamwise position closer to the downstream divergent segment is a better injection location. Lower lean blowout limit can be obtained by injecting the overall much lean fuel from just one strut with a relatively closer distance to the downstream flameholder.
Use of an automated system for detection of canine serum antibodies against Ehrlichia canis glycoprotein 36
Authors: Moroff Scott , Sokolchik Irene , Woodring Todd , Woodruff Colby , Atkinson Brett , Lappin Michael R.
Published: July 2014

Ehrlichia canis is the most common cause of monocytotropic ehrlichiosis in dogs around the world. The purpose of the present study was to validate a new automated fluorescence system (Accuplex4™ BioCD system; Antech Diagnostics, Lake Success, New York) to detect antibodies against the E. canis immunodominant glycoprotein 36 (gp36). Sera and blood samples (ethylenediamine tetra-acetic acid) were collected from mixed sex beagles ( n = 8) on days 0, 3, 7, 10, 14, 17, 21, 28, 42, 49, 56, 63, 70, 77, 84, and 98 after intravenous inoculation with culture-derived E. canis. Sera were assayed using the Accuplex4 BioCD system (Accuplex4), an E. canis indirect fluorescent antibody test (IFAT), and a commercially available kit. A complete blood cell count and a proprietary E. canis polymerase chain reaction (PCR) were performed on each blood sample. On the day thrombocytopenia was first detected for each dog, E. canis DNA was amplified from blood of all dogs. At those times, E. canis antibodies were detected in 7 of 8 dogs by the Accuplex4, 1 of 8 dogs by the commercial kit, and 4 of 8 dogs by IFAT. Ehrlichia canis DNA was amplified from blood before seroconversion in any antibody assay for 6 dogs. Antibodies against gp36 were detected by Accuplex4 within 3 days of PCR-positive test results and were detected up to 25 days sooner than the commercial kit. After starting doxycycline treatment, E. canis DNA was no longer amplified by PCR assay, but serum antibodies remained detectable by all assays.
Timing of Palliative Care Consultations and Recommendations
Authors: Kozlov Elissa , Carpenter Brian D. , Thorsten Michael , Heiland Mark , Agarwal Anupam
Published: July 2014

Palliative care consultation teams (PCCTs) provide care that enhances quality of life. The effectiveness of PCCTs depends, however, on their timely utilization by other providers. The goal of this study was to examine the timing of palliative care consultation requests and responses at a single Veteran Affairs Medical Center. The median interval between admission and consultation request was 5 days (range = 0-73 days). The median interval between consultation request and death was 23 days (range = 0-847 days). In logistic regressions, timing variables were not significant predictors of whether consultation recommendations were made or implemented. There is substantial variability in when patients receive a palliative care consultation. Many patients receive palliative care within the first week of hospitalization and their final month of life.
Psychosocial Care and the Role of Clinical Psychologists in Palliative Care
Authors: Fan Sheng-Yu , Lin Wei-Chun , Lin I-Mei
Published: July 2014

Objectives:

The aim of this study was to explore the works of clinical psychologists in palliative care in Taiwan.

Methods:

Clinical psychologists who were working or had experience in palliative care were recruited. A 2-stage qualitative method study was conducted, including semistructured interviews and a focus group.

Results:

The following 4 main themes were identified: (1) the essential nature of the psychologists’ care were caring and company; (2) the dynamic process included psychological assessment, intervention, and evaluation based on psychological knowledge; (3) they needed to modify their care using an integrative framework, by setting practical goals and using techniques with flexibility; and (4) they faced external and internal challenges in this field.

Conclusion:

Clinical psychologists have beneficial contributions but have to modify psychosocial care based on the patients’ needs and clinical situations.
Improving Vocabulary Skills of Kindergarten Students Through a Multi-Tier Instructional Approach
Authors: Cuticelli Mari , Coyne Michael D. , Ware Sharon M. , Oldham Ashley , Loftus Rattan Susan
Published: July 2014

There is a growing need for the inclusion of direct, explicit vocabulary instruction in the early elementary grades. Young children are entering school with a wide range of early literacy experiences, including vocabulary knowledge. Those students who are limited in their vocabulary knowledge are at a greater risk for later language and reading difficulties. When providing intensive vocabulary instruction to students who are at risk for language and reading difficulties, it is important to use features of effective instruction and intervention, including (a) direct, explicit instruction that includes extensive teacher modeling; (b) teacher and material scaffolding that carefully controls the level of task difficulty (e.g., moving from easier to more difficult tasks throughout the instruction); and (c) numerous practice opportunities with immediate and specific feedback.
Evolution and dispersal under climatic instability: a simple evolutionary algorithm
Authors: Grove Matt
Published: July 2014

It has long been known that temporally unstable environments are likely to promote the evolution of plastic adaptations, whilst it is equally clear that such adaptations are precisely those that characterize successful colonizers. These two established findings, however, are rarely related within a single framework. This article bridges this gap via the development of a very simple evolutionary algorithm that tracks both directional selection and the evolution of plasticity under various synthetic climatic regimes. The output of the model allows for the construction of a dispersal index that provides a measure of population-level dispersal potential under each particular climatic regime. The output thus establishes both the timing and extent of selection for plasticity and the consequences of that plasticity for the timing of probable dispersal events in the context of climatic instability. Results suggest that periods of low climatic instability abruptly following extended periods of higher climatic instability are particularly conducive to dispersal, leading to the formulation of the Accumulated Plasticity Hypothesis. These results, and the hypothesis they support, are discussed in relation to the varied manifestations of plasticity in biological systems and their relevance to human evolution.
Acute Hepatitis Induced by Cyproterone Acetate
Authors: Giordano Nicola , Nardi Paolo , Santacroce Clorinda , Geraci Simone , Gennari Carlo
Published: July 2014

OBJECTIVE:

To report a case of acute hepatitis resulting from the use of cyproterone acetate, an adjuvant treatment for prostate cancer.

CASE SUMMARY:

An 87-year-old white man, admitted to surgery for prostate cancer, received cyproterone acetate 300 mg/d orally and developed acute hepatitis, which initially was diagnosed clinically. A liver biopsy showed changes suggestive of acute cholestatic hepatitis. Cyproterone was stopped immediately, and the patient was subsequently treated with corticosteroids. He then improved rapidly.

DISCUSSION:

Cyproterone acetate is thought to be well tolerated, but some authors have reported severe hepatic reactions, in particular acute hepatitis, fatal fulminant hepatic failure, and hepatocellular carcinoma. The above-mentioned hepatotoxicity represents an idiosyncratic drug reaction, probably due to the hepatomitogen action of cyproterone, causing an increase of hepatocytes expressing placental glutathione S-transferase, which are considered preneoplastic elements.

CONCLUSIONS:

This case suggests the possibility of hepatotoxicity from cyproterone.
Mediators of Chronic Heart Failure: How Drugs Work
Authors: Terpening Chris M
Published: July 2014

OBJECTIVE:

To critically review the pathophysiology of chronic heart failure at the neurohormonal level, and discuss the effect of present and future therapeutic options on these neurohormones.

DATA SOURCES:

A MEDLINE search (1986–November 2000) was used to identify important primary literature and reviews. Additional references were obtained from these articles.

DATA SYNTHESIS:

Chronic heart failure is a common, progressive disorder with high morbidity and mortality. Progression is due in large part to several redundant neurohormonal responses. The neurohormones include angiotensin II, norepinephrine, aldosterone, endothelin-1, arginine vasopressin, and tumor necrosis factor. These responses are initially adaptive, but become maladaptive in the long term, impairing the function of the heart, vasculature, and kidneys. Counter-regulatory hormones, such as bradykinin and natriuretic peptides, are insufficient to offset the adverse effects of the other neurohormones. Most drugs used to treat chronic heart failure, such as angiotensin-converting enzyme inhibitors, β-adrenergic antagonists, and spironolactone, achieve their benefits through altering the neurohormonal pathways. New agents that affect more or different neurohormones may soon be available.

CONCLUSIONS:

Multiple agents are required for treatment of chronic heart failure, as no single agent can counteract all of the various adverse pathways. The appropriate prescription and use of such inherently complex regimens require significant physician and patient education.
Vancomycin Removal during a Plasma Exchange Transfusion
Authors: Foral Pamela A , Heineman Susan M
Published: July 2014

OBJECTIVE:

To report a case of clinically significant removal of vancomycin during a plasma exchange transfusion in a patient with sickle-cell anemia.

CASE SUMMARY:

A 46-year-old African American woman with sickle-cell disease was admitted on three separate occasions and treated with vancomycin. Vancomycin serum drug concentrations were obtained on all three admissions. During one of the admissions, a plasma exchange transfusion was performed the same day vancomycin concentrations were obtained. The vancomycin serum drug concentrations were considerably lower than predicted, resulting in potentially subtherapeutic vancomycin concentrations. Bayesian pharmacokinetic forecasting was used in interpreting the vancomycin concentrations.

DISCUSSION:

Searches from MEDLINE (1966–September 2000) and Drugs and Pharmacology (1990–September 2000) were performed to obtain pertinent published literature.

CONCLUSIONS:

Plasma exchange transfusions may result in clinically significant removal of vancomycin from the plasma. The potential exists of underdosing vancomycin in patients who are receiving frequent plasma exchange transfusions. Further research may be warranted to determine whether these patients may be candidates for more frequent and vigilant monitoring of vancomycin concentrations.
Topical Ivermectin 0.5% Lotion for Treatment of Head Lice
Authors: Deeks Louise S. , Naunton Mark , Currie Marian J. , Bowden Francis J.
Published: July 2014

Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5% lotion for head lice treatment. Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice–infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application. Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States.
Challenges of Anticoagulation for Atrial Fibrillation in Patients With Severe Sepsis
Authors: Darwish Omar S. , Strube Sarah , Nguyen Huan Mark , Tanios Maged A.
Published: July 2014

Background: Although numerous studies have shown that anticoagulation of nonvalvular atrial fibrillation (AF) significantly decreases the risk of stroke, anticoagulating critically ill patients in the intensive care unit (ICU) poses many challenges and the benefits have not been determined. Objective: To assess the safety and efficacy of anticoagulation in AF patients with sepsis. Ascertaining the incidence of complications associated with anticoagulation therapy, such as bleeding, can optimize patient care. Methods: This was a retrospective observational study to assess the incidence of stroke and anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia) in AF patients with severe sepsis. This study was undertaken in a surgical/medical ICU of a teaching, community-based hospital. A total of 115 patients with AF who were admitted with a diagnosis of sepsis were included in the study. Results: Among 115 patients (mean age 81 ± 9.5 years and CHADS2 [congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke] score 3.17 ± 1.20), 80 (69.6%) did not receive anticoagulation treatment during their hospitalization and none of these patients developed a stroke. Anticoagulation-related complications occurred more often in the group who received anticoagulation (8.6% [3/35] vs 0%, P = .008). In the anticoagulated group, a majority of the patients were within therapeutic range less than 50% of the time during their ICU stay. There was no statistically significant difference in survival rates during their hospitalization (66.2% [53/80] for the non-anticoagulated group vs 74.3% [26/35] in the anticoagulated group, P = .392). Conclusion: Administration of anticoagulation for elderly patients with a CHADS2 score at 2 or more in the setting of sepsis can be associated with an increased risk of anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia). Managing and targeting a therapeutic goal with warfarin therapy in critically ill patients with sepsis is challenging. Further studies are necessary to provide appropriate recommendations in this setting.
Performance of the Adverse Drug Event Trigger Tool and the Global Trigger Tool for Identifying Adverse Drug Events: Experience in a Belgian Hospital
Authors: Carnevali Lise , Krug Bruno , Amant Fabienne , Van Pee Dominique , Gérard Véronique , de Béthune Xavier , Spinewine Anne
Published: July 2014

Background: Medication-related harm can be detected using the adverse drug event (ADE) trigger tool and the medication module of the Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI). In recent years, there has been some controversy on the performance of this method. In addition, there are limited data on the performance of the medication module of the GTT as compared with the ADE trigger tool. Objectives: To evaluate the performance of the ADE trigger tool and of the medication module of the GTT for identifying ADEs. Methods: The methodology of the IHI was used. A random sample of 20 adult admissions per month was selected over a 12-month period in a teaching hospital in Belgium. The ADE trigger tool was adapted to the Belgian setting and included 20 triggers. The positive predictive value (PPV) of each trigger was calculated, as well as the proportion of ADEs that would have been identified with the medication module of the GTT as compared with the ADE trigger tool. Results: A total of 200 triggers and 62 ADEs were found, representing 26 ADEs/100 admissions. Nineteen ADEs (31%) were found spontaneously without the presence of a trigger. Three triggers never occurred. The PPVs of other triggers varied from 0 to 0.67, with half of them having PPVs less than 0.20. If we had used the medication triggers included in the GTT (n = 11), we would have identified 77% of total ADEs and 67% of preventable ADEs. Conclusions: Applying the trigger tool method proposed by the IHI to a Belgian hospital led to the identification of one ADE out of 4 admissions. To increase performance, refining the list of triggers in the ADE trigger tool and in the medication module of the GTT would be needed. Recording nontriggered events should be encouraged.
Treatment of Rhizobium radiobacter Bacteremia in a Critically Ill Trauma Patient
Authors: Ponnapula Supriya , Swanson Joseph M. , Wood G. Christopher , Boucher Bradley A. , Wells Diana L. , Croce Martin A. , Fabian Timothy C.
Published: July 2014

Objective: To report the first case of Rhizobium radiobacter bacteremia in a critically ill trauma patient. Case Summary: A 36-year-old female trauma patient hospitalized at The Regional Medical Center at Memphis developed bacteremia due to Rhizobium radiobacter on hospital day 9. The central line catheter tip culture from the same hospital day was negative. No source for the R radiobacter bacteremia was identified. Empirical and definitive antibiotic therapy consisted of cefepime 2 g intravenously every 8 hours for at total of 8 days. On completion of antibiotics, the patient demonstrated clinical resolution by immediate defervescence and gradual normalization of her white blood cell count. She demonstrated microbiologic success of therapy with negative blood cultures on hospital days 22, 34, 45, and 61. She was discharged on hospital day 80. Discussion: Rhizobium species are common soil and plant pathogens that rarely cause infections in humans. Previous reports of Rhizobium infections have been in immunocompromised patients; generally those with cancer or HIV infection. Intravenous catheters have commonly been cited as the source of infection. The trauma patient in this case constitutes a unique presentation of R radiobacter bacteremia when compared with other case reports. Her indwelling catheter was not the source of her infection, and her only identifiable risk factor for R radiobacter infection was hospitalization. However, she did possess potential reasons for development of an infection with an unusual organism such as R radiobacter. Potential immune modulating therapies included blood transfusions, opioid analgesics, benzodiazepines, general anesthetics, and surgical procedures. Finally, trauma itself has been associated with some degree of immunosuppression. All these issues may have placed the patient in this case at risk of an opportunistic infection like R radiobacter. Conclusion: Based on this case, R radiobacter may be considered a potential pathogen causing bacteremia in critically ill trauma patients.
Angiotensin-Converting Enzyme Inhibitors for Intermittent Claudication Associated With Peripheral Arterial Disease
Authors: Hunter Melissa R. , Cahoon William D. , Lowe Denise K.
Published: July 2014

Objective: To review published literature regarding the effectiveness of angiotensin-converting enzyme (ACE) inhibitors for managing intermittent claudication (IC) associated with peripheral arterial disease (PAD). Data Sources: A search of MEDLINE/PubMed (1966-July 2013) using the MeSH terms intermittent claudication and angiotensin-converting enzyme inhibitors was conducted. Limits included articles written in English with human participants. Additional data were identified through bibliographic reviews. Study Selection and Data Extraction: All English-language articles identified from the data sources were evaluated. Clinical trials and meta-analyses were included if they evaluated the efficacy of ACE inhibitors for improving functional capacity of patients with PAD with IC. In all, 9 clinical trials and 1 meta-analysis were identified and included for review. ACE inhibitors evaluated in the studies were captopril, lisinopril, perindopril, quinapril, and ramipril. Data Synthesis: Current medications approved for treating the symptoms and improving function in PAD with IC have limited efficacy. It has been suggested that ACE inhibitors may be effective in PAD with IC. Though data evaluating ACE inhibitors as a class in this patient population are conflicting, results of the largest and longest trial reported that ramipril increases maximum walking time and pain-free walking time and improves quality of life in patients with PAD with IC. Conclusions: ACE inhibitors may provide some relief of IC symptoms when used in patients with PAD. The greatest functional benefit has been seen with ramipril; it is unknown whether other agents in the class would show similar results. Well-controlled and designed studies with sufficient power and using diverse patient populations are needed.
Safety and Efficacy of Statins in Patients With End-Stage Renal Disease
Authors: Nemerovski Carrie W. , Lekura Jona , Cefaretti Michelle , Mehta Pooja T. , Moore Carol L.
Published: July 2014

Objective: To review statins in the prevention of cardiovascular disease (CVD) events and their associated safety in patients with end-stage renal disease (ESRD). Data Sources: Peer-reviewed clinical trials, review articles, and treatment guidelines were identified from MEDLINE (1966-July 2013) using the following search terms: end stage renal disease, statin, HMG-CoA (hydroxymethylglutaryl-coenzyme A) reductase inhibitor, chronic kidney disease, cardiovascular outcomes, and cardiovascular disease. Results were limited to human trials published in English. Citations from articles were reviewed for additional references. Study Selection and Data Extraction: Only clinical trials evaluating cardiovascular end points of statins used in patients with ESRD were included. Data Synthesis: In patients with ESRD, CVD is the leading cause of death. Statin therapy has been evaluated in 3 clinical trials in patients with ESRD. The 4D and AURORA trials failed to show a benefit with statin therapy, and the SHARP trial, although positive, also included patients with earlier stages of chronic kidney disease. Despite the lack of efficacy, statin therapy was well tolerated. The cause of cardiovascular death in this patient population may not be a result of atherosclerotic events and possibly dependent on the type of renal replacement therapy. For patients on hemodialysis, lipid profiles may not be amenable to statin therapy. Conclusions: Statin therapy has failed to significantly alter the course of CVD events in patients with ESRD. Evidence supports avoiding the routine use of statins in this patient population and instead reserving them for patients with elevated cholesterol levels or those with recent CVD events.
SIADH Associated With Ciprofloxacin
Authors: Babar Sultan M.
Published: July 2014

Objective: To report a case of ciprofloxacin-induced syndrome of inappropriate antidiuretic hormone (SIADH). Case Summary: A 68-year-old Caucasian woman presented on 2 separate occasions with generalized weakness. Both times, she was started on ciprofloxacin for a urinary tract infection. Prior to the first episode, she had also been on Augmentin for several days. On both occasions, her ciprofloxacin was discontinued on admission, and her sodium levels rose. On the first occasion, she was given 5% dextrose in water to slow the rate of rise, yet she still corrected faster than the recommended rate. After the second admission, she was briefly given hypertonic saline but remained off intravenous fluids, and her sodium again rose faster than the recommended rate. Discussion: An objective causality assessment using the Naranjo scale was done. A score of 8 revealed a probable causality between ciprofloxacin and SIADH. The likely mechanism of this reaction is ciprofloxacin crossing the blood-brain barrier and stimulating the γ-aminobutyric acid and N-methyl-D-aspartate receptors, which leads to the synthesis and release of antidiuretic hormone. Conclusion: Fluoroquinolones have the potential to cause SIADH. In this case, ciprofloxacin probably caused SIADH.
Evaluation of an Institution-Wide Guideline for Hyperglycemic Emergencies at a Tertiary Academic Medical Center
Authors: Beik Nahal , Anger Kevin E. , Forni Allison A. , Bawa Komal , Szumita Paul M.
Published: July 2014

Background: No previous studies exist examining implementation of an institution-wide guideline and order set for hyperglycemic emergencies (diabetic ketoacidosis [DKA] and hyperosmolar hyperglycemic state [HHS]). Objective: Evaluate the impact of an institutional guideline and order set for hyperglycemic emergencies. Methods: This retrospective descriptive study evaluated patients with a diagnosis of DKA or HHS. Two time periods were evaluated: phase 1 (PRE) assessed practice preguideline implementation, and phase 2 (POST) assessed practice postguideline and order set introduction. Results: A total of 172 patients (91 PRE and 81 POST) were included in the analysis. There was no difference in the mean hospital length of stay (LOS) in the PRE versus POST groups (5.2 ± 4 vs 5.9 ± 8.6 days, P = .49). The mean intensive care unit (ICU) LOS was shorter in the POST group (64.8 ± 19 vs 37.1 ± 74.8 hours, P < .01). The POST group had an increase in frequency of assessments for clearance of urinary ketones (18 vs 33.3%, P = .03) and β-hydroxybutyrate (16 vs 37%, P < .01). Frequency of point-of-care glucose testing (12.5 ± 4.6 vs 15.1 ± 4.7, P < .01) and time to anion gap closure (13 ± 9 vs 9.3 ± 7.4 hours, P < .01) improved in the POST group. There was no difference in the number of patients experiencing hypoglycemia or hypokalemia between both groups. Conclusions: Implementation of an institutional guideline and order set for hyperglycemic emergencies decreased ICU LOS and time to anion gap closure, with no difference in rates of hypoglycemia.