Staged bilateral thalamic electrode implantation utilizing frameless stereotactic guidance.

Deep brain stimulation (DBS) for medically intractable Parkinson's disease (PD) is well established, but carries the inconveniences of frame-based neurosurgery. Previous reports have demonstrated that ventricular shunt placement and some functional procedures can be accurately performed using frameless stereotaxy. We present a report indicating that staged deep brain electrode placement can be accurate and efficacious using a frameless skull-mounted guide.     

Eliminating Intensive Postoperative Care in Same-day Surgery Patients Using Short-acting Anesthetics

Background: A multidisciplinary effort was undertaken to determine whether patients could safely bypass the postanesthesia care unit (PACU) after same-day surgery by moving to an earlier time point evaluation of recovery criteria.

Methods: A prospective, outcomes research study with a baseline month, an intervention month, and a follow-up month was designed. Five surgical centers (three community-based hospitals and two freestanding ambulatory surgical centers) were utilized. Two thousand five hundred eight patients were involved in the baseline period, and 2,354 were involved in the follow-up period. Outcome measures included PACU bypass rates and adverse events. Intervention consisted of a multidisciplinary educational program and routine feedback reports.

Results: The overall PACU bypass rate (58%) was significantly different from baseline (15.9%, P < 0.001), for patients to whom a general anesthetic was administered (0.4-31.8%, P < 0.001), and for those given other anesthetic techniques (monitored anesthesia care, regional or local anesthetics; 29.1-84.2%, P < 0.001). During the follow-up period, the average (SD) recovery duration for patients who bypassed the PACU was significantly shorter compared to that for patients who did not bypass, 84.6 (61.5) versus 175.1 (98.8) min, P < 0.001, with no change in patient outcome. Patients receiving only short-acting anesthetics were 78% more likely (P < 0.002) to bypass the PACU after adjusting for various surgical procedures.     

Selective attention to facial emotion and identity in schizophrenia.

The selective attention to facial emotion and identity was investigated in 12 patients with schizophrenia and 12 healthy participants. Both patients and controls were required to perform two classification tasks (according either to identity or emotion). Two separate values for identity (person A/person B) and for emotion (fear/anger) were used. When the classification task was on one dimension, the other dimension was either correlated, constant, or orthogonal (Garner WR. The Processing of Information and Structure. Potomac, MD: Erlbaum, 1974, Garner WR. Interaction of stimulus dimensions in concept and choice processes. Cognitive Psychology 1976;8:98-123). Results indicated that both patients and healthy participants had an asymmetrical pattern of performance: they were able to selectively attend to the identity of the face presented, regardless of the emotion expressed on the face, but variation in identity interfered with the classification of facial emotion. Moreover, a correlational study indicated that the identity interference on emotion classification for schizophrenic patients covaried with the severity of their negative symptoms. The selective attention competencies in schizophrenia and the independence hypothesis of emotion and face recognition are discussed in the framework of current face recognition models.     

Advanced practice nurses in emergency care settings: A demographic profile.

INTRODUCTION: Very little is known about clinical nurse specialists and nurse practitioners (advance practice nurses [APNs]) who practice in emergency care settings. The Advanced Practice Committee of the ENA sought to determine a profile of these individuals. METHODS: Surveys were distributed to all registrants at 2 ENA conferences and posted on the ENA Web site. This survey asked 17 questions concerning the demographic characteristics of the APN respondents (eg, education, experience, certification, state recognition, and practice area). The survey was completed by 166 APNs. RESULTS: APNs had considerable experience as ED registered nurses before becoming an APN. They obtained their APN education at the master's degree or post-master's degree level. State recognition was required for 89.2% of the APNs. The majority of APNs (61.4%) obtained their certification through the American Nurses Credentialing Center. Nurse practitioners were predominantly family nurse practitioners (43%), and clinical nurse specialists were either critical care clinical nurse specialists (8.9%) or had other certifications (5.9%). APNs provided services in both the main emergency department and the fast track (45.7%) and were relatively new to their role as an APN. DISCUSSION: Consistent with current educational and certification requirements, the vast majority of APNs held a master's degree. Although relatively new to their role as APNs in emergency care, they were nonetheless very experienced as ED registered nurses. The majority of APNs were certified, even though that is not required for practice in all states. Continued research is needed to identify the most effective utilization of APNs, document their contributions to patient care outcomes, and develop strategies to meet their educational and practice needs.     

The effects of menstrual phase and nicotine abstinence on nicotine intake and on biochemical and subjective measures in women smokers: a A preliminary report

Nicotine intake, menstrual and smoking withdrawal symptomatology, and baseline cortisol and MHPG were assessed in nine women smokers under conditions of ad lib smoking and overnight abstinence in three menstrual phases (early follicular, mid-to-late follicular, and late luteal). A trend towards higher nicotine intake p <0.100 was observed in the mid-to-late follicular phase. Although me menstrual symptomatology was not significantly elevated during the smoking abstinence condition overall, abstinence appeared to prevent the normal reduction in symptomatology during the mid-to-late follicular phase that occurred under conditions of ad lib smoking. Menstrual and withdrawal symptoms were highly correlated, and both were most pronounced during the late luteal/abstinence condition. The smoking-specific item “craving” reflected this pattern, though in attenuated form, suggesting that the observed exacerbation of withdrawal symptomatology was not simply due to generalized dysphoria, as queried in both instruments. MHPG was significantly elevated in the late luteal phase, whereas cortisol was significantly higher during ad lib smoking than during abstinence and tended to be highest in the mid-to-late follicular phase. Further investigation will be needed to determine the functional significance of these findings for understanding and treating smoking in women.     

Measurement of tibial torsion--a new technique applicable to ultrasound and computed tomography.

A new method for measuring tibial torsion is described which can be applied to both ultrasound (US) and computed tomography (CT). The method has been validated in dry tibiae by comparison with direct measurements and with Jend's established CT method. In clinical practice a good statistical level of agreement has been demonstrated between the values obtained from US and CT scans. Both compared well with values obtained using Jend's CT technique. The use of US avoids exposure to radiation and is therefore suited to studying young subjects and controls and making repeat measurements.     

Gender differences in young adults' beliefs about sunscreen use.

This study employs focus group methodology to explore gender differences in sunscreen use. Guided by the theory of reasoned action, males and females were found to differ on each of the following constructs: behavior, behavioral beliefs, and normative beliefs. Males and females differed in their sunscreen use, with females adopting a more preventive style of sunscreen use and males a more reactive style. Males and females differed in their salient beliefs that motivated their sunscreen use, many of which were related to traditional American gender roles. In addition, although males and females were aware of both positive and negative sources of normative beliefs regarding sunscreen use, females received more encouragement from their mothers and peers than males. Findings are discussed in terms of their implications for the design of future interventions.     

Glycemic Carbohydrate: An International Perspective

Attention to the different types of carbohydrates and their role in health and disease is relatively recent. FAO and WHO jointly published a report on carbohydrates in human nutrition in 1998, with a number of recommendations about increasing carbohydrate intake as a sound approach to the prevention of obesity. The glycemic index (GI) was recommended as a means of classifying foods on the basis of their potential for raising blood glucose; this concept was based on the understanding that the state of hyperglycemia that is observed following the intake of certain high-GI carbohydrate foods could constitute a risk factor for diseases of lifestyle.