EEG-Monitored ECT: A Comparison of Seizure Duration under Anesthesia with Etomidate and Thiopentone

Electroencephalogram-monitored electroconvulsive therapy (ECT) was carried out in 20 depressed inpatients. Before treatment, patients were randomly allocated to treatment using etomidate (Hypnomidat) (n = 10) or thiopentone (n = 10) for anesthesia. The groups were matched for sex, age, weight, and type and severity of depression. The seizure duration (seconds) was measured by electroencephalography (EEG), and the electrical energy (Joules, J) was determined for each treatment. A ratio of seizure duration:electrical energy (s/J) was computed. Both seizure duration and seizure duration:electrical energy were greater in the etomidate group than in the thiopentone group, whereas electrical energy did not differ significantly. The number of treatments in the etomidate group did not differ from that in the thiopentone group, as may be expected, perhaps because of the small size.     

Medical, social and occupational history as risk indicators for low-back trouble in a general population

Sixty-eight medical, social, and occupational history variables were analyzed in a general population of 442 men and 478 women, aged 30, 40, 50, and 60 years to identify possible indicators for first-time experience and recurrence or persistence of low-back trouble (LBT) during a 1-year follow-up. Variables that in univariate analyses showed statistically significant indications for future LBT were subjected to stepwise logistic regression analyses. The most important indicators for recurrence or persistence of LBT thus identified were, for men, intermittent claudication, restlessness, or other discomfort in the lower limbs, frequent headache, and living alone. For women, the corresponding indicators were rumbling of "the stomach" and feeling of fatigue. For first-time experience of LBT, the indicators identified by the regression analyses were frequent pain in the top of the stomach, previous hospitalizations and operations, daily smoking, and a long distance from home to work. The result suggests that the population likely to experience future LBT does not enjoy good general health even prior to its first LBT episode, and this, in turn, may be due to greater psychosocial pressure.     

Correction to: Middle School Effects of the Dating Matters® Comprehensive Teen Dating Violence Prevention Model on Physical Violence,Bullying, and Cyberbullying: A Cluster-Randomized Controlled Trial

Prevention Science - The article “Middle School Effects of the Dating Matters® Comprehensive Teen Dating Violence Prevention Model on Physical Violence, Bullying, and Cyberbullying: a...     

Job Accommodations,Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review

Journal of Occupational Rehabilitation - Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and...     

Protection From the Second Warm Ischemic Injury in Kidney Transplantation Using an Ex Vivo Porcine Model and Thermally Insulating Jackets

BackgroundKidney transplantation is the optimum treatment for kidney failure in carefully selected patients. Technical surgical complications and second warm ischemic time (SWIT) increase the risk of delayed graft function (DGF) and subsequent short- and long-term graft outcomes including the need for post-transplant dialysis and graft failure. Intraoperative organ thermal regulation could reduce SWIT, minimizing surgical complications due to time pressure, and limiting graft ischemia-reperfusion injury.MethodsA novel ischemic-injury thermal protection jacket (iiPJ) was designed and fabricated in silicone composite and polyurethane (PU) elastomer prototypes. Both were compared with no thermal insulation as controls. Time to reach ischemic threshold (15°C) and thermal energy transfer were compared. A water bath model was used to examine the thermal protective properties of porcine kidneys, as a feasibility study prior to in vivo translation.ResultsIn both iterations of the iiPJ, the time taken to reach the warm ischemia threshold was 35.2 ± 1.4 minutes (silicone) and 38.4 ± 3.1 minutes (PU), compared with 17.2 ± 1.5 minutes for controls (n = 5, P < .001 for both comparisons). Thermal energy transfer was also found to be significantly less for both iiPJ variants compared with controls. There was no significant difference between the thermal performance of the 2 iiPJ variants.ConclusionProtection from SWIT by using a protective insulation jacket is feasible. With clinical translation, this novel strategy could facilitate more optimal surgical performance and reduce transplanted organ ischemia-reperfusion injury, in particular the SWIT, potentially affecting delayed graft function and long-term outcomes.     

Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.     

The utility of the implementation science framework “Integrated Promoting Action on Research Implementation in Health Services” (i-PARIHS) and the facilitator role for introducing patient-reported outcome measures (PROMs) in a medical oncology outpatient department

Quality of Life Research - We evaluated the utility of the implementation science framework “Integrated Promoting Action on Research Implementation in Health Services” (i-PARIHS) for...     

Frequency of Acute Adverse Events to a Non-Ionic Low-Osmolar Contrast Medium: The Effect of Verbal Interview

Abstract: The effect of a standardized verbal interview on the frequency of reported adverse events to an intravenous injection of a non-ionic low-osmolar magnetic resonance (MR) contrast medium was studied during a low noise (low anxiety) magnetic resonance imaging (MRI) examination. During a 26-month period 863 patients had an intravenous bolus (<10 sec.) injection of either 0.1 mmol/kg b.wt. or 0.3 mmol/kg b.wt. gadodiamide, were examined in 0.1 Tesla (T) MRI unit. All patients received written information about the examination, but no specific information about possible adverse events to the contrast medium. During the first 15 months, 479 patients were asked after the examination by the same radiographer the following question "Did you feel anything in relation to or after the contrast medium injection?". If the answer was affirmative, the patient was asked to specify the experience. During the subsequent 11-month period, 384 patients had no interview about whether they felt anything in relation to the contrast medium injection. Only 9 out of 863 patients reported an adverse event and they all belonged to the group, which was interviewed. In 8 cases the adverse events lasted less than 5 min. The ninth patient had an attack of migraine 20 min. after the injection of the contrast medium. In one of the patients, who experiencied nausea, it was necessary to postpone scanning for 2 min. Two of the 9 adverse events were considered to be unrelated to the contrast medium. None of the 121 patients receiving the triple dose reported an adverse event. The frequency of reported adverse events depends on whether this information is obtained by active questioning. All reported adverse events were clinically mild and no dose-response effect was observed.