Relation between policies and work related assault: Minnesota Nurses' Study

Aims: To assess the relation between violence prevention policies and work related assault. Methods: From Phase 1 of the Minnesota Nurses'' Study, a population based survey of 6300 Minnesota nurses (response 79%), 13.2% reported experiencing work related physical assault in the past year. In Phase 2, a case-control study, 1900 nurses (response 75%) were questioned about exposures relevant to violence, including eight work related violence prevention policy items. A comprehensive causal model served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were conducted for potential exposure misclassification and the presence of an unmeasured confounder. Results: Results of multiple regression analyses, controlling for appropriate factors, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR = 0.5, 95% CI 0.4 to 0.8) and having policies regarding types of prohibited violent behaviours (OR = 0.5, 95% CI 0.3 to 0.9). Analyses adjusted for non-response and non-selection resulted in wider confidence intervals, but no substantial change in effect estimates. Conclusions: It appears that some work related violence policies may be protective for the population of Minnesota nurses.     

Eliminating a severely retarded blind adolescent's tantrums using mild behavioral interruption: A case study

A blind 19 yr old severely retarded man was referred for behavior therapy because of violent and disruptive tantrums. Previous behavioral strategies had failed for various reasons. A very mild, brief, vestibular oriented physical procedure was designed to provide a low level disruptive effect. Intervention consisted of loud teacher demands to stop and work appropriately as well as guiding him through one 360° turn while standing. The data demonstrated rapid and long term success in eliminating the client's tantrums. The results were interpreted in terms of a behavioral interruptor of a chained sequence allowing refocusing of client attention and increased levels of reinforcement.     

Neomycin-induced neuromuscular blockade

The unusual complication of neuromuscular blockade secondary to neomycin absorption is described. The syndrome characterized by acute muscle flaccidity, diaphragmatic breathing, and central nervous system depression presents a potentially fatal situation. Appropriate treatment of this complication includes respiratory assistance and calcium gluconate administration (IV). A review of the pediatric literature reveals 12 previous cases, of which 2 were secondary to urologic procedures.     

Vaginal perforation during transvaginal ultrasound-guided follicle aspiration in a woman undergoing multiple cycles of assisted reproduction

OBJECTIVE: To report a case of vaginal perforation during transvaginal ultrasound-guided follicle aspiration. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 41-year-old woman who had undergone transvaginal ultrasound-guided follicle aspiration five times previously for IVF-embryo transfer. INTERVENTION(S): Retrospective evaluation of past medical history and surgical treatment. MAIN OUTCOME MEASURE(S): Medical follow-up after surgical repair of the perforation. RESULT(S): Simple vaginal perforation with no damage to the gastrointestinal or genitourinary systems can be repaired at the time of perforation through the vagina. CONCLUSION(S): Perforation of the vagina is a possible complication of transvaginal ultrasound-guided follicle aspiration in older patients with a history of repeated transvaginal aspiration of follicles, particularly when the ovaries are difficult to visualize.     

Bioadhesive, non-drug-loaded nanoparticles as modulators of candidal adherence to buccal epithelial cells: a potentially novel prophylaxis for candidosis

Adherence of microorganisms, such as Candida albicans, represents the initial step in the establishment of infection and, accordingly, modification of this step represents a method by which the incidence of infection may be reduced. Therefore, this study uniquely examined the effects of polymeric nanoparticles on the adherence of blastospores of C. albicans to human buccal epithelial cells (BEC) in vitro. Poly(propylcyanoacrylate) nanoparticles were produced by emulsion polymerisation using a range of anionic, cationic and non-ionic surfactants, their particle size and zeta potential characterised and incubated with stationary phase blastospores of C. albicans for a defined period. Following this, the surface properties and size of blastospores with adsorbed nanoparticles were characterised. phosphate buffered saline-treated and nanoparticle-treated blastospores were incubated with human BEC for 2 h, following which the number of adherent blastospores was enumerated by light microscopy. The size and zeta potential of the nanoparticles were dependent on the surfactant employed in the manufacture process. Following nanoparticle adsorption, alteration of the zeta potential and an increase in the diameter of blastospores were observed. However, as this increase in diameter was indirectly related to the size of the nanoparticles, this may indicate a preference for the adsorption of smaller particles. In addition, following nanoparticle adsorption, the cell surface hydrophobicity (CSH) of C. albicans blastospores was increased and, importantly, the subsequent adherence to BEC in vitro was reduced. Most notably, the adherence of blastospores that had been treated with nanoparticles (stabilised with docusate sodium) was circa 73% lower than that of untreated blastospores. A moderate correlation between increased CSH and reduced adherence and a low correlation between blastospore zeta potential and adherence were observed, inferring that other mechanisms, most likely stearic hindrance, are responsible for the antiadherent properties of adsorbed nanoparticles. In light of their ability to reduce candidal adherence to BEC, it is suggested that polymeric nanoparticles may be useful in the prophylaxis of candidosis of the oral cavity.     

Causes of apparent life threatening events in infants: a systematic review

Aims: To determine the most likely diagnoses when infants first present with an apparent life threatening event (ALTE). Methods: Medline (1966–2002), Embase (1980–2002), and Cinahl (1982–2002) were searched. Primary authors and content experts were contacted to identify further studies. Bibliographies from studies, reviews, and textbooks were searched. Foreign language studies were translated. Articles were included if the ALTE was clearly defined and if the evaluation recorded was from the initial contact. Case reports and studies focusing on single conditions or non-clinical data were excluded. Results: From an initial 2912 papers, eight studies involving 643 infants (aged 0–13 months) were included. All studies were non-randomised and methodological quality varied. All diagnoses were made after evaluation in hospital but investigation protocols varied widely. There were 728 diagnoses assigned overall. Some infants had multiple diagnoses. The most common diagnoses were gastro-oesophageal reflux (n = 227), seizure (n = 83), lower respiratory tract infection (n = 58), and "unknown" (n = 169). Five deaths were noted in total. Conclusions: There is a wide range of diagnoses reported after evaluation of an ALTE. Differing management protocols contributed to variations in the frequency of the diagnoses. The development and validation of an evidence based management plan may contribute to the care of this common condition.