Tachyphylaxis to cisatracurium--case reports and literature review

Nondepolarizing neuromuscular blocking agents (NNMBAs) are commonly used in the intensive care unit (ICU), mainly to facilitate mechanical ventilation in critically ill patients who are not responding to sedatives and analgesics alone. Tachyphylaxis, also referred to as resistance, may develop during long-term infusion of NNMBAs. Several case reports of tachyphylaxis to NNMBAs have been reported. Although the definite mechanisms of tachyphylaxis to NNMBAs are not clear, several pharmacodynamic and pharmacokinetic changes have been described with the development of resistance. Tachyphylaxis to NNMBAs is associated with adverse outcomes including inadequate ventilation, increased risk of dose-dependent side effects, and increased drug costs. Patients who develop tachyphylaxis to one NNMBA should be treated with another NNMBA if neuromuscular blockade (NMB) is still indicated. We report three cases of tachyphylaxis to cisatracurium in a surgical intensive care unit (SICU): one in patient with acute respiratory distress syndrome (ARDS) and the other two with traumatic brain injury (TBI).     

How to get the most from the medical literature: Searching the medical literature effectively

Different clinical questions are best answered using different study designs. This paper describes the best methods for finding relevant studies for well-framed clinical questions. We focus on which database is best to search to answer your question, describe the structure of effective search strategies and explore ways to develop appropriate search terms. We illustrate these with sensitive and specific search strategies to answer different clinical questions arising from a hypothetical clinical scenario typical of a nephrologist's everyday practice.     

护士留职意愿的研究进展

从护士留职意愿的定义、测评工具、影响因素和干预策略等方面综合分析护士留职意愿的研究进展,讨论其有效干预策略。提出对护士留职意愿的研究可拓展质性研究,增加实验研究,开展干预策略效果研究,旨在为卫生行政监管机构和护理管理者提供决策依据。     

Xenotransplantation literature update, May to June 2012

Schneider MKJ, Seebach JD. Xenotransplantation literature update, May to June 2012. Xenotransplantation 2012; 19: 265–268.. © 2012 John Wiley & Sons A/S.     

Xenotransplantation literature update, March to April 2012

Schneider MKJ, Seebach JD. Xenotransplantation literature update, March to April 2012. Xenotransplantation 2012; 19: 207–211. © 2012 John Wiley & Sons A/S.     

Allergy to macrolide antibiotics. Review of the literature

MACROLIDE CLASSES: Macrolides are characterized by their basic structure made up of a lactonic cycle with 2 osidic chains. They are classified according to the number of carbon atoms in the cycle: 14-membered macrolides (erythromycin, troleandomycin, roxithromycin, dirithromycin, clarithromycin), 15-membered macrolides (azithromycin) and 16-membered macrolides (spiramycin, josamycin, midecamycin). MACROLIDE ALLERGY: Allergy to macrolides is extremely rare (0.4% to 3% of treatments). The little information available in the literature is insufficient to establish the usefulness of diagnostic tests. An immediate IgE-dependent hypersensitivity has been shown with erythromycin in some cases but the mechanism remains unknown and skin tests are quite often negative. Clinical manifestations are the same as those encountered with beta-lactams. It would appear that macrolide allergies are unlikely to be class allergies. This is important as eviction advice could be limited to the single causal macrolide.     

Ireland's contribution to orthopaedic literature: A bibliometric analysis

BackgroundBibliometric analysis of scientific performance within a country or speciality, facilitate the recognition of factors that may further enhance research activity and performance. Our aim was to illicit the current state of Irelands orthopaedic research output in terms of quantity and quality.MethodsWe performed a retrospective bibliometric analysis of all Irish orthopaedic publications over the past 5 years, in the top 20 peer-reviewed orthopaedic journals. Utilising the MEDLINE database, each journal was evaluated for articles that were published over the study period. Reviews, editorials, reports and letters were excluded. Each article abstract was analysed for research content, and country of origin. A nation's mean IF was defined by multiplying each journal's IF by the number of articles. Publications per million (PmP) was calculated by dividing the total number of publications by the population of each country.ResultsWe analysed a total of 25,595 article abstracts. Ireland contributed 109 articles in total (0.42% of all articles), however ranking according to population per million was 10th worldwide. Ireland ranked 18th worldwide in relation to mean impact factor, which was 2.91 over the study period. Ireland published in 16 of the top 20 journals, 9 of these were of European origin, and 1 of the top 5 was of American origin. In total, 61 Irish articles were assignable to clinical orthopaedic units. Clinical based studies (randomised controlled trials, observational, and epidemiology/bibliometric articles) and research based studies (In vivo, In vitro, and biomechanical) numbered 76 (69.7%) and 33 (30.2%) articles, respectively.ConclusionThis study provides a novel overview of current Irish orthopaedic related research, and how our standards translate to the worldwide orthopaedic community. In order to maintain our publication productivity, academic research should continue to be encouraged at post graduate level.     

Checklists to improve the quality of the orthopaedic literature

Several checklists have been developed in an effort to help journals and researchers improve the quality of reporting in research. The CONSORT statement and the CLEAR NPT evaluate randomized trials. The MOOSE and QUOROM checklists evaluate meta-analyses. The STROBE checklists assists readers in evaluating observational studies and the STARD checklist was developed for diagnostic test evaluation. The checklists presented here provide an invaluable source of guidance to authors, journal editors and readers who are seeking to prepare and evaluate reports. As evidence-based medicine continues to establish itself as the new paradigm by which medicine is practiced, the need for good reporting for all research designs must also become commonplace as opposed to the exception.     

From honest mistakes to fake news – approaches to correcting the scientific literature

The reconstruction of large head and face missing structures in the craniofacial region in children is very challenging for plastic surgeons. Expanded local and expanded axial-pattern flaps are widely used for the reconstruction of large-area scars. Free flaps are used very cautiously in children. 3D printing technology is a new technology with great development potential. 3D printing technology is used to assist in individualizing titanium alloy restorations for prefabricated skull defect repair. This application has great advantages in the repair of large skull loss. However, it is crucial to choose appropriate techniques and treat deformities of the head and face with integrated approaches and collaboration among multiple departments. This study proposes a method to combine the expanded flap method and 3D printing technology to achieve natural remodeling of the craniofacial region in a child. Large area of head and face missing structures can be reconstructed by using expanded skin flaps combined with 3D printing, and patients can get better new faces.     

A review of the breastfeeding literature relevant to osteopathic practice

Background

A review of the breastfeeding related literature was undertaken to provide background for a qualitative study that explores how osteopaths promote effective breastfeeding. Topics considered relevant to osteopathic practice are presented with the aim of informing and stimulating discussion and further inquiry.

Data Sources and Selection

Information is drawn together from the following databases: Lactation Resource Centre of Australian Breastfeeding Association, Cinahl, Cochrane Library, and Medline. Qualitative and quantitative studies of all designs, government and professional association websites, and conference presentations are included as the aim is to generate a broad background on the biological and psychosocial aspects of breastfeeding that could impact on osteopathic practise. The theoretical literature is included in areas where little research is available.

Conclusions

A strong evidence base promotes breastfeeding as important health behaviour for a mother and baby; influenced by many complex and sensitive biopsychosocial factors. The theoretical literature and studies that have investigated the biomechanics of breastfeeding provide a rationale for osteopathic treatment to facilitate effective breastfeeding; however little supportive research has been undertaken. Further well designed studies are needed to determine the role that osteopaths might play in supporting a mother–baby dyad to successfully breastfeed.     

Ileo-ileal intussusception secondary to a lipoma: a literature review

Intussusception is rare in adults and it can be a challenge to diagnose on admission. Non-specific and variable signs and symptoms, frequently only occurring episodically, may cause a considerable delay before treatment. However, in 90% a predisposing organic cause can be found in adults. A case is presented of small bowel intussusception secondary to a lipoma in a 54-year-old man in whom diagnosis was suggested by CT-scan. The patient was treated with a laparoscopic-assisted reduction and extracorporeal partial small bowel resection, followed by a latero-lateral anastomosis. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the rarity of the disease, but stresses the need for early referral and investigation in middle-aged patients with recurrent abdominal symptoms.