A Case Control Study of the Implementation of Change Model Versus Passive Dissemination of Practice Guidelines for Compliance in Monitoring for Metabolic Syndrome

We developed an intervention to improve compliance with guidelines for monitoring metabolic syndrome and compared compliance prior to intervention and three times post-intervention at three community mental health clinics in Texas. One test clinic received intervention and two other clinics served as controls. Fifty random charts were reviewed from each clinic for three specific, 1–2 weeks periods over the course of 18 months. There were significant improvements in the ordering of labs, the presence of lab results in the chart, and documentation of blood pressure, body mass index and waist circumference in the intervention clinic over time in comparison to the control clinics. Documented evidence of physician action with respect to out of range values remained low. Metabolic monitoring is a multi-step process. Removing barriers, creating specific procedures, and dedicating staff resources can improve compliance with monitoring.     

Progressive sector retinitis pigmentosa due to c.440G>T mutation in SAG in an Australian family

ABSTRACT

Background

Heterozygous c.440 G > T mutation in the S-antigen visual arrestin (SAG) gene has been described as a cause of autosomal dominant retinitis pigmentosa (adRP) in a series of patients of Hispanic origin. This study presents the early and late clinical features and disease progression rates in an Australian family with SAG adRP.     

The Ideal Use of the Power Injectable Peripherally Inserted Central Catheter in the Pediatric Population

IntroductionThe peripherally inserted central catheter (PICC) is being used more frequently in pediatric populations in both hospital and home care settings in order to provide secure vascular access. In 2007, the Power PICC was introduced to pediatric populations. In contrast to traditional PICCs, the power injectable PICC withstands higher flow rates and can deliver contrast injections. Although effectiveness studies of power injectable PICCs have been performed in adults, only limited published research is available regarding pediatric populations.PurposeThis study aimed to develop criteria for identifying the ideal pediatric candidate for the power injectable PICC. A secondary aim was to identify contraindications and barriers to power injectable catheter use in pediatric populations.MethodsRetrospective and prospective chart reviews were used to analyze complication rates for 97 power injectable PICCs placed in patients aged 4 months to 17 years.ResultsA low incidence of catheter complications was identified during and post- insertion. Our documented infection rate of 1.30 per 1000 catheter days was similar to the infection rate of 1.27 per 1000 catheter days found in the Abedin & Kapoor (2008) study.DiscussionThe introduction into a pediatric hospital of power injectable PICCs for power injection scans for contrast injection was safe and effective in patients with many disease processes.ConclusionIn properly selected pediatric patients, the power injectable PICC is not associated with an increased risk to thrombosis or infection and can improve patient outcome.     

The use of conditional inference to reduce prediction error—A mismatch negativity (MMN) study

The brain uses regularities in the sound environment to build inference models predicting the most likely attributes of subsequent sounds. When the inference model fails, a prediction-error signal (the mismatch negativity or MMN) is generated. This study is designed to explore the capacity to use information about when a deviant sound will occur to switch between inference models in memory. We measured MMN generated to rare frequency, duration, intensity and spatial deviant sounds randomly occurring in a stream of identical repeating “standard” sounds. We then measured MMN to the same deviants in a linked sequence where deviants were paired—duration deviants followed an intensity change and spatial deviants followed a frequency change. To minimise prediction error, the brain should use the occurrence of the intensity and frequency deviant to prompt a change in the dominant inference (“expect-the-standard”) to anticipate the characteristics of the linked deviant. Anticipation was quantified as the proportion decline in duration and spatial MMN in the linked versus random sequence. We report three main outcomes on a sample of 23 healthy adults: (1) a significant reduction in duration MMN amplitude in linked versus random sequence; (2) a subgroup of participants exhibited significant reduction in spatial MMN amplitude in linked versus random sequence; and (3) the capacity to anticipate a linked deviant (reduce MMN) was a related to performance on the Continuous Performance Task-Identical Pairs. The results are discussed with respect to a possible co-reliance of CPT-IP and inference models on the inferior frontal gyrus.     

Dignity or denial? Decisions regarding initiation of dialysis and medical therapy in the institutionalized severely mentally retarded

Decisions regarding health care of the severely mentally retarded can be difficult. We present 2 cases of patients with severe mental retardation who lived in long-term care facilities. Both patients had progressive loss of renal function and eventually reached end-stage renal disease. In each case, the decision was made not to initiate dialysis. We discuss issues of dialysis and medical care of the severely mentally retarded and advocate using the principles of "best respect" and "best interest" in making medical decisions in this population.     

Carriage of Haemophilus influenzae and Streptococcus pneumoniae in healthy Chinese and Vietnamese children in Hong Kong

Nasopharyngeal carriage of Haemophilus influenzae and Streptococcus pneumoniae was studied in 621 healthy Chinese children and 300 healthy Vietnamese children aged from 2 months to 5 years in Hong Kong. The carriage rate of H, influenzae type b in Vietnamese children was 1.3% (CI 0.04-2.63%); it was zero in Chinese. The carriage rate of non-typable H. influenzae was 5.8% (CI 1.4-7.6%) in Chinese and 65.4% (CI 58.9-69.8%) in Vietnamese. The carriage rates of S. pneumoniae were 10.8% (CI 8.3-13.2%) and 55.7% (CI 50.1-61.3%) in Chinese and Vietnamese children, respectively. Univariate and multivariate logistic regression analyses were performed to search for factors associated with differences in carriage rates of both H. influenzae and S. pneumoniae between Chinese and Vietnamese children. Although older age, smaller living area and parental smoking were associated with higher carriage rates, these could not explain the remarkably low carriage rates of both bacteria in Chinese children.     

Neonatal infections with Haemophilus species.

During a 27 month study seven nonserotypable strains of Haemophilus influenzae and two of Haemophilus parainfluenzae were isolated from nine neonates. Seven had early infection associated with respiratory distress or conjunctivitis; three had septicaemia one of whom died. The incidence of haemophilus septicaemia was 0.23 per 1000 live births.