Musculoskeletal injuries among ERCP endoscopists in Canada.

BACKGROUND: There are few reports in the literature describing musculoskeletal complaints among endoscopists, and none are specific to those who perform endoscopic retrograde cholangiopancreatography (ERCP). PURPOSE: To examine the current practices of ERCP endoscopists and the prevalence of musculoskeletal injuries. METHODS: A self-report survey was sent to physicians practising ERCP across Canada identified through a pre-existing database. A second mailing was sent six weeks later to those who did not respond to the first mailing. RESULTS: Of 162 surveys sent, 122 responses were received, with five respondents indicating that they no longer performed ERCP and three declining to participate. Of the 114 participants, 67% reported at least one musculoskeletal complaint, and 58% reported two or more complaints. Seventy-four per cent attributed their symptoms to endoscopy and/or ERCP, and 79% reported that their condition was aggravated by performing ERCP. The most frequently reported pain symptoms were back pain (57%), neck pain (46%) and hand pain (33%), which are all consistent with the physical risks involved in performing ERCP. Only 51% reported taking regular breaks, and only 25% reported having fluoroscopy tables with adjustable heights. The room designs of the respondents' ERCP facilities were analyzed for ergonomic considerations: 67% had poor ergonomics and 33% had good ergonomics. Sixty-four per cent reported that they were interested in learning preventive strategies. CONCLUSIONS: Physicians who perform ERCP develop musculoskeletal injuries and are interested in learning about risk factor modification.     

A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis.

OBJECTIVE: To develop and validate a logistic regression model to predict need for admission and length of hospital stay in children presenting to the Emergency Department with bronchiolitis. SETTING: Two children's hospitals in Dublin, Ireland. METHODS: We reviewed 118 episodes of bronchiolitis in 99 children admitted from the Emergency Department. Those discharged within 24 h by a consultant/attending paediatrician were retrospectively categorized as suitable for discharge. We then validated the model using a cohort of 182 affected infants from another paediatric Emergency Department in a bronchiolitis season 2 years later. In the validation phase actual admission, failed discharge, and age less than 2 months defined the need for admission. RESULTS: The model predicted admission with 91% sensitivity and 83% specificity in the validation cohort. Age [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.76-0.97], dehydration (OR 2.54, 95% CI 1.34-4.82), increased work of breathing (OR 3.39, 95% CI 1.29-8.92) and initial heart rate above the 97th centile (OR 3.78, 95% CI 1.05-13.57) predicted the need for admission and a longer hospital stay. CONCLUSION: We derived and validated a severity of illness model for bronchiolitis. This can be used for outcome prediction in decision support tools or severity of illness stratification in research/audit.     

Internet-based randomised controlled trials for the evaluation of complementary and alternative medicines: probiotics in spondyloarthropathy

Background  

The clinical effectiveness of complementary and alternative medicines (CAMs) is widely debated because of a lack of clinical trials. The internet may provide an effective and economical approach for undertaking randomised controlled trials (RCTs) of low-risk interventions. We investigated whether the internet could be used to perform an internet-based RCT of a CAM fulfilling the revised CONSORT (Consolidated Standards of Reporting Trials) statement quality checklist for reporting of RCTs. A secondary aim was to examine the effect of probiotics compared to placebo in terms of well-being over 12 weeks.     

A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis

Objective

Motor subtypes have promise as a means of identifying clinically relevant delirium subgroups. Little is known about their relationship to etiologies, medication exposure, and outcomes.

Methods

Consecutive cases of DSM-IV delirium in palliative care patients were assessed twice-weekly throughout their delirium episodes using the Delirium Motor Subtype Scale (DMSS), Delirium Etiology Checklist (DEC) and Delirium Rating Scale Revised-98 (DRS-R98).

Results

100 patients [mean age 70.2±10.5] were assessed on 303 visits [range 2–9]. Over the entire episode, mean DRS-R98 Severity scores were 16.2±5.7. The mean number of etiologies per case was 3.4±1.2. Motor subtypes were no subtype throughout (6%), hypoactive subtype throughout (28%), mixed subtype throughout (18%), hyperactive subtype throughout (10%) and variable subtype (38%). DRS-R98 Total and Severity scales differed significantly across categories (highest in mixed) but only motor, sleep–wake cycle, perceptual and language disturbance items differed. The Generalized Estimating Equations (GEE) approach was used to explore the relationship between subtype profile and symptoms, medication exposure and etiology. This showed that apart from motor items, only delusions, affective lability, metabolic disturbance and CVA related to any subtype. Cross-sectional assessments indicated greater use of benzodiazepine and antipsychotics in hyperactive patients but GEE analyses did not identify major associations between motor subtype and medication exposure. Patients with sustained hypoactive subtype were significantly more likely to die within one month of study entry.

Conclusions

Motor profile in delirium is relatively consistent over episode course and relates more closely to delirium phenomenology than to etiology or medication exposure. Motor subtypes have comparable disturbance of key diagnostic features such as cognitive and thought process abnormalities. Although mixed subtype is the most phenomenologically intense, hypoactives have the poorest prognosis.     

Survey of management of neonatal haemolytic jaundice in Australasia

Background: Haemolytic jaundice is an important entity in neonatal clinical practice. Because of the decrease in rhesus isoimmunisation since the advent of anti‐D immunoglobulin and improved antenatal management strategies, its management in the neonatal period has become less intensive and exchange transfusions rarely performed. Aim: We planned to review the practice of Australasian perinatal units in light of recent advances and recommendations. Methods: An electronic survey was sent to the directors of all 25 tertiary‐level perinatal units across Australasia. The questionnaire comprised 20 questions dealing with the management of haemolytic jaundice. Results: Twenty out of the 25 neonatal units responded. Most were aware of the recent American Academy of Pediatrics guidelines, but only eight (40%) based their practice on it. Fifty per cent of neonatal units had written protocols to manage such infants, but almost all had written guidelines for performing exchange transfusions. Seven (35%) units started prophylactic phototherapy; however, the criteria used for early exchange were variable, most related to cord haemoglobin or rate of rise of bilirubin. Few units used high‐dose intravenous immunoglobulin in haemolytic jaundice. Average exchange rates (based on the last 2 years) were 3.5/year (0–10). Conclusion: Variable practice was noted across the Australasian units. Written protocols form the backbone of management of jaundice in such babies. The use of intravenous immunoglobulin is minimal, and the information available on its use needs to be critically appraised.     

Resveratrol sensitizes androgen independent prostate cancer cells to death-receptor mediated apoptosis through multiple mechanisms

BACKGROUND: A critical factor in prostate cancer development and progression is the altered expression of apoptotic regulatory proteins which renders cells resistant to both hormone- and chemo-therapies. Resveratrol, a dietary component with chemopreventive properties has been reported to resensitize a variety of cancer cell types to apoptosis. In the current study, the ability of resveratrol pre-treatment to sensitize hormone refractory prostate cancer cell lines (PC-3 and DU145) to apoptosis and the mechanisms involved were investigated. METHODS: Apoptosis was assessed using several established parameters and protein expression was analyzed by Western blot and flow cytometry. IAP knockdown was achieved using RNAi while inhibition of Akt phosphorylation was achieved by pre-incubation with the PI3-kinase inhibitor LY294002. RESULTS: Pre-treatment with resveratrol sensitized PC-3 and DU145 cells to agents that specifically target death receptors (TRAIL, Fas, TNFalpha) but not agents that initiate apoptosis through other mechanisms (Etoposide, Paclitaxel, Tunicamycin, Thapsigargin). Resveratrol pre-treatment altered the expression of IAPs and Bax, and decreased Akt phosphorylation in PC-3 cells, leading to increased caspase activation and apoptosis. While knockdown of IAPs using siRNA did not mimic the effects of resveratrol, inhibition of Akt phosphorylation using LY294002 sensitized PC-3 cells to TRAIL induced apoptosis but not to etoposide or tunicamycin. CONCLUSION: Altering apoptotic susceptibility in advanced androgen independent disease requires manipulation of a broad signaling pathway. Use of resveratrol or inhibition of Akt phosphorylation may represent an important therapeutic approach in combination with conventional therapies for the treatment of prostate cancer.     

The optimisation of the initial viscosity of an encapsulated glass-ionomer restorative following different mechanical mixing regimes

OBJECTIVES: An optimisation of the mixing ratio of an encapsulated glass-ionomer restorative in terms of compressive strength, working characteristics and pore distribution following mechanical mixing with different mixing machines was undertaken. METHODS: Mean compressive fracture strengths, standard deviations and associated Weibull Moduli (m) were determined from series of 30 encapsulated specimens with varying powder/liquid mixing ratios. Working characteristics were assessed using an oscillating rheometer and scanning electron microscopy and image analysis was used to investigate the influence of the mixing ratios and mixing regime on the pore distribution. RESULTS: Cement mixing regime or reducing the powder/liquid mixing ratio did not have any significant influence on the compressive strength. Utilising the one-way ANOVA and Tukey test comparisons at P<0.05 the cement manipulation regime significantly increased the compressive strength on increasing the powder content of the capsule by 10% (G110) when a combination of rotational and centrifugal action rather than vibration were employed. Utilising a Rotomix at a powder content of G110 was beneficial in reducing porosity levels within the restorative investigated compared with a conventional mixing machine. Increasing the powder content reduced the working characteristics regardless of the mixing regime. SIGNIFICANCE: The increased reliability of encapsulated restoratives reported in the literature following mixing with a combination of rotational and centrifugal compared with vibrational action was only evident when the powder content of the restorative under investigation was increased by 10%. The finding suggests that the initial viscosity of the cement mass of the Ketac Fil Plus Aplicap as supplied by the manufacturer may not have been optimised.     

Inhaled beta-agonists improve lung function but not maximal exercise capacity in cystic fibrosis.

BACKGROUND: To investigate the effects of inhaled beta-agonists on sub-maximal and maximal exercise capacity, breathing pattern, dyspnoea, leg-discomfort and spirometry in patients with cystic fibrosis (CF). OBJECTIVES: Eight patients performed two maximal incremental cycle-ergometry tests on separate days with inhaled placebo or salbutamol (600 microg) administered before each test in a randomized, double-blind, placebo-controlled crossover trial. Primary outcomes were exercise duration (Exdur) in seconds (s) and maximal oxygen uptake (VO2max) in litres/minute (L/min). Forced expiratory volume in 1 s (FEV1) was measured immediately pre-inhaler, post-inhaler and post-exercise. Dyspnoea and leg-discomfort were assessed post-exercise. RESULTS: Within-day FEV1 comparisons demonstrated that the placebo test day FEV1 improved significantly post-exercise (0.11 L, p<0.05) and the salbutamol test day FEV1 improved significantly post-inhaler (0.22 L, p<0.001) and post-exercise (0.07 L, p<0.01). Between-day FEV1 comparisons demonstrated significant improvements in post-inhaler (0.17 L, p<0.05) and post-exercise (0.13 L, p<0.05) FEV1 following salbutamol. Sub-maximal and maximal exercise showed no significant difference as shown by Exdur (547+/-154 s vs. 529+/-127 s) and VO2max (1.9+/-0.5 L/min vs. 1.9+/-0.6 L/min). No significant change in breathing pattern, dyspnoea or leg-discomfort was detected. The study had a power of 92% to detect a 10% improvement in Exdur. CONCLUSIONS: In adults with CF, salbutamol improves post-exercise FEV1 and is safe when administered immediately before exercise but does not improve exercise capacity, exercise-induced dyspnoea or leg-discomfort.