Patch testing with thimerosal in a Canadian center: an 11-year experience.

BACKGROUND: Thimerosal has been used for decades as an antiseptic, a disinfectant, and a preservative in various consumer products. It is also a notoriously frequent contact allergen, but the significance of positive patch-test reactions has been debated over the past decade. OBJECTIVE: The aim of this study was to assess the prevalence and relevance of positive patch-test reactions to thimerosal in a large Canadian center and to compare our results with those of previous publications. METHODS: A retrospective analysis of data collected over the course of 11 years in the contact dermatitis clinic of a university hospital was performed. RESULTS: Of 2252 subjects patch-tested for thimerosal, positive reactions were observed in 102 individuals (4.53%), placing thimerosal as the fifth most common allergen in our practice. The sensitization rate was equivalent between the patients who underwent aimed patch testing and those who were routinely tested for reaction to thimerosal when this allergen was included in our standard patch-testing series 8 years into the study. There was an increased incidence of thimerosal sensitization in chemists and laboratory technicians, as well as in health care workers, including medical doctors, registered nurses, dentists, and dental assistants. While eight reactions were deemed possibly relevant, in none of the cases was it possible to definitely establish the relevance of positive reactions to thimerosal, either because the presence of this allergen could not be verified in patients' products or because patch testing with these products gave negative results. CONCLUSION: In agreement with previous reports, we conclude that even though positive reactions to thimerosal are frequent, very few seem to be clinically relevant.     

Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement

Aims and objectives. To consider the validity and reliability of risk assessment scales for pressure ulcers. Background. Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. Design. A literature review and commentary. Methods. Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. Results. There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Conclusions. There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. Relevance to clinical practice. Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.     

The theory-practice gap: ECMO research example

AIM: The time taken for research findings to enter clinical practice can be very lengthy. A contributing factor is the time lag between the research literature identifying the issue, and medical and nursing texts discussing it. The example of ECMO (Extracorporeal Membrane Oxygenation) is used to examine this issue, specifically the extent to which relevant nursing journals and textbooks discuss the effects of ECMO on medication. METHOD: A systematic review of papers identifying the problem (pharmacokinetics in ECMO patients) and the dissemination of this to clinicians was undertaken. Publications used by those exploring the problem were most likely to be found in Medline, and those disseminating to nurses in CINAHL. Textbooks on neonatal nursing and paediatric intensive care with sections on ECMO were also explored. RESULTS: There are several studies that show drug delivery is altered in patients receiving ECMO, dating back to 1989. Only three papers likely to be accessed by clinicians were found to address the effect of ECMO on drug delivery. Two of the textbooks addressed these issues but it took eight years from the issue being first raised to any medical or nursing text discussing it. CONCLUSION: Nurses will most likely not be aware of the latest research in their area if they rely on textbooks. Advanced education that gives critical appraisal and literature-searching skills, such as found in master's courses, should help the clinical nurse employ evidence based practice.     

The Lyon brace

The Lyon Brace or adjustable multi-shells brace has been used for more than 60 years. Three types of braces have been developed: Lyon thoracic brace, Lyon thoraco lumbar brace and Lyon lumbar brace. Considering the conservative orthopaedic treatment of scoliosis we outline the results of this orthosis. The management of the Lyon Brace includes: (i) The use of one or two reductive plastered brace which enable a flow of the concavity ligaments; (ii) a moulding either hand-oriented or electronic after the resection of the plastered brace; (iii) a blueprint adapted to Lenke's classification; and (iv) a specific physiotherapy. The protocol of the wearing of the orthosis depends on the initial angulation of the scoliosis. The effectivity index of 1338 scoliosis checked at least two years after the weaning of the brace, is 0.95. The effectivity index is 0.80 when the Lyon brace is put in place at Risser 0. If the angulation is globally stabilized, the rib hump is, on average, half reduced. We get the best results for lumbar scoliosis and double major. The technological progresses allow a precise use. The adjustment becomes easy during puberty growth.     

Physiological effects of noninvasive positive ventilation during acute moderate hypercapnic respiratory insufficiency in children

Introduction  A prospective physiological study was performed in 12 paediatric patients with acute moderate hypercapnic respiratory insufficiency to assess the ability of noninvasive positive pressure ventilation (NPPV) to unload the respiratory muscles and improve gas exchange. Materials and methods  Breathing pattern, gas exchange, and inspiratory muscle effort were measured during spontaneous breathing and NPPV. Results  NPPV was associated with a significant improvement in breathing pattern, gas exchange and respiratory muscle output. Tidal volume and minute ventilation increased by 33 and 17%, and oesophageal and diaphragmatic pressure time product decreased by 49 and 56%, respectively. This improvement in alveolar ventilation translated into a reduction in mean partial pressure in carbon dioxide from 48 to 40 mmHg (P = 0.01) and in respiratory rate from 48 to 41 breaths/min (P = 0.01). No difference between a clinical setting and a physiological setting of NPPV was observed. In conclusion, this study shows that NPPV is able to unload the respiratory muscles and improve clinical outcome in young patients admitted to the paediatric intensive care unit for acute moderate hypercapnic respiratory insufficiency. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Perception of the auditory-visual illusion in speech perception by children with phonological disorders

An example of the auditory-visual illusion in speech perception, first described by McGurk and MacDonald, is the perception of [ta] when listeners hear [pa] in synchrony with the lip movements for [ka]. One account of the illusion is that lip-read and heard speech are combined in an articulatory code since people who mispronounce words respond differently from controls on lip-reading tasks. A same-different judgment task assessing perception of the illusion showed no difference in performance between controls and children with speech difficulties. Another experiment compared children with delayed and disordered speech on perception of the illusion. While neither group perceived many illusions, a significant interaction indicated that children with disordered phonology were strongly biased to the auditory component while the delayed group's response was more evenly split between the auditory and visual components of the illusion. These findings suggest that phonological processing, rather than articulation, supports lip-reading ability.