A survey of parent satisfaction with pediatric neuropsychological evaluations

Satisfaction with pediatric neuropsychological evaluations was surveyed by asking parents or guardians of children who completed pediatric neuropsychological evaluations at a large children's hospital over a 2-year period to complete a 30-item rating scale. The scale included items drawn from published measures of consumer satisfaction, and incorporated a well-validated measure of general satisfaction. A total of 338 surveys were distributed, with 117 completed, for a return rate of 35%. Respondents were generally similar to non-respondents, except that respondents had a higher average level of maternal education and were more likely to have been referred for neuropsychological evaluations by sources outside the hospital. Parents were generally satisfied with pediatric neuropsychological evaluations, although some parents indicated that the evaluations did not provide as much help as expected. A factor analysis of the survey instrument revealed four dimensions of satisfaction: General Satisfaction, Clinician Acceptance/Empathy, Provision of Help, and Facilities/Administrative Assistance. Maternal education was negatively correlated with all four factors, but no other demographic, patient, or clinician variables were significantly related to satisfaction. Future studies could survey physicians and educators to provide a more complete understanding of satisfaction with pediatric neuropsychological evaluations.     

Surface-engineered bacterial cellulose as template for crystallization of calcium phosphate

Bacterial cellulose (BC), produced by Acetobacter xylinum, and cotton linters as reference were surface modified by ozone-induced graft polymerization of acrylic acid and used as a template for crystallization of calcium phosphate. The grafting was verified using attenuated total reflection-infrared radiation (ATR-IR) and electron spectroscopy for chemical analysis (ESCA). ATR-IR revealed an additional absorption band at 1700 cm(-1), corresponding to the carbonyl group in polyacrylic acid. ESCA figures show, apart from the characteristic peaks for cellulose, additional peaks at 285 eV and 289 eV that correspond to groups in acrylic acid. The grafting yield is higher on cotton linters compared with BC, which most likely has to do with differences in crystallinity and reactivity of the different cellulose materials. No morphology difference directly caused by grafting could be seen with scanning electron microscopy (SEM), which might indicate that acrylic acid was grafted as a thin film on the surface of the cellulose micro fibrils. Calcium phosphate was formed on the surface-modified cellulose by first pre-soaking the materials in a saturated Ca(OH)2 and later in simulated body fluid (SBF). The atomic ratio of calcium phosphate was determined by ESCA to be about 1.5 for the different materials. Energy dispersive spectroscopy (EDS) was used to map and verify that the crystals were calcium phosphate. Secondary ion mass spectroscopy (SIMS) was also used to verify the presence of calcium phosphate complex onto BC. SEM images showed the difference in dimension, distribution and morphology of the crystals depending on the materials. Smaller and a greater number of crystals were obtained on the surface-modified BC and larger and fewer crystals on surface-modified cotton linters. Structural and grafting differences between the celluloses may lead to differences in nucleation sites and possibly differences in the morphology of the Ca-P crystals. The BC-calcium phosphate composite is expected to be useful as a scaffold for bone tissue regeneration.     

Cellular normalization of viral DNA loads on whole blood improves the clinical management of cytomegalovirus or Epstein Barr virus infections in the setting of pre‐emptive therapy

Two quantitative duplex real‐time PCR assays were developed for co‐amplification of human albumin and cytomegalovirus (CMV) or Epstein Barr virus (EBV) genes after automated extraction on whole blood, and compared two units for expressing viral DNA loads (copies per ml of blood or per 10⁶ peripheral blood leukocytes (PBLs)) on 1,138 positive samples. Both PCRs were characterized by high sensitivity, reproducibility, and linear range. Automated extraction by a MagNA Pure LC Instrument was shown to be more efficient when peripheral blood cell count was inferior to 5 × 10⁹ PBLs/L. Albumin co‐amplification allows the detection of PCR inhibitors and normalization of viral load according to the number of cells calculated in the sample. The two ways of expressing viral load results were highly correlated, but quantitative differences varied in relation to variations of blood cell count. As these two viruses are highly cell associated, viral loads can be underestimated in patients with leucopenia. In the setting of pre‐emptive strategies during CMV infection, the units in which results are expressed can influence clinical management, as illustrated in this article. J. Med. Virol. 81:90–98, 2009. © 2008 Wiley‐Liss, Inc.     

Predictors of 2-year drinking outcomes in a Swedish treatment sample

BACKGROUND: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples. METHODS: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes. RESULTS: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence. Satisfaction with treatment and affiliation with Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence. CONCLUSION: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.     

Comparison of first- and second-generation leadless pacemakers in patients with sinus rhythm and complete atrioventricular block

Introduction

The efficacy and safety of leadless cardiac pacemakers (LPMs) as an alternative to conventional transvenous cardiac pacing have been largely reported. The first generation of the Micra^TM transcatheter pacing system (VR; Medtronic) was able to provide single-chamber VVI(R) pacing mode only, with a potential risk of pacemaker syndrome in sinus rhythm patients. A second-generation system (AV) now provides atrioventricular synchrony through atrial mechanical (Am) sensing capability (VDD mode).

Objective

We sought to compare VR and AV systems in sinus rhythm patients with chronic ventricular pacing (Vp) for complete atrioventricular block.

Methods

All consecutive patients implanted with an LPM in our department for complete atrioventricular block were retrospectively screened. Patients with atrial fibrillation, sinus dysfunction, or Vp burden <20% at 1 month postimplantation were excluded. Patients were systematically followed with a visit at 1 month, and then at least once a year.

Results

A total of 93 patients—45 VR (2015–2020) and 48 AV (2020–2021)—were included. VR and AV patients had similar baseline characteristics, except for VR patients being older (80 ± 8 vs. 77 ± 9 years, p = 0.049). The mean Vp burden was 77% in the VR and 82% in the AV group (p = 0.38). In AV patients, the median AV synchronous beats rate was 78%, with 65% having a >66% rate. An E/A ratio <1.2 as measured on echocardiography was the only independent predictor of accurate atrial mechanical tracking (p = 0.01). One-year survival rate was similar in both groups. Five patients in the VR and 0 in the AV group eventually developed pacemaker syndrome within 1 year post-implantation (p = 0.02).

Conclusion

In sinus rhythm patients with chronic Vp for complete atrioventricular block implanted with an LPM, the atrial mechanical sensing algorithm allowed significant atrioventricular synchrony in most patients and was associated with no occurrence of—otherwise rare—pacemaker syndrome.