Neuronal plasticity and functional recovery after ischemic stroke

Ischemic stroke affects many new patients each year. The sequelae of brain ischemia can include lasting sensorimotor and cognitive deficits, which negatively impact quality of life. Currently, treatment options for improving poststroke deficits are limited, and the development of new clinical alternatives to improve functional recovery after stroke is actively under investigation. Anti-Nogo-A immunotherapy to reduce the central nervous system inhibitory environment, cell transplantation strategies, pharmacological agents, and movement-based therapies represent emerging treatments of poststroke deficits through enhancement of neuroanatomical plasticity.     

Predictors of pneumococcal vaccination uptake in hospitalized patients aged 65 years and over shortly following the commencement of a publicly funded national pneumococcal vaccination program in Australia

In January 2005, Australia became the first country to introduce a publicly funded pneumococcal vaccination program for persons 65 years and older which is free at point of service, although the vaccine cost had previously been partially subsidized. Hospitalization in this age group is an important indicator of risk of invasive pneumococcal disease but vaccine uptake has been suboptimal. To determine vaccination rates and predictors of vaccination in the elderly hospitalised patients before and after January 2005. We validated vaccination status against general practitioner (GP) records for patients aged > or = 65 years admitted to a large teaching hospital in Sydney between 16th of May 2005 and the 20th of February 2006 and examined predictors of vaccination. Commencement of the new program resulted in a significant increase in vaccination uptake from 39% of inpatients prior to the free program to 73% in the same cohort of inpatients post January 2005. We found that patient recall of vaccination status was not reliable. Self-report of pneumococcal vaccination had a sensitivity of 0.53 and a specificity of 0.55, highlighting that validation of vaccination status is required. Age over 80 years and dementia significantly predicted under-vaccination. This highlights the importance of integrating free vaccine supply and delivery in primary care to achieve high vaccination coverage. However, demented patients and the very elderly remain under-vaccinated, despite being admitted to hospital for active management of acute conditions.     

A rapid and fully-automated method for the quantitation of tricyclic antidepressants in serum using turbulent-flow liquid chromatography–tandem mass spectrometry

BackgroundWe describe a fully-automated turbulent-flow liquid chromatography–tandem mass spectrometry method for the detection of tricyclic antidepressant drugs (amitriptyline, desipramine, imipramine, and nortriptyline) in serum.MethodsHuman serum and an internal standard were injected directly onto a Cyclone-P online solid-phase extraction (SPE) column (0.5 × 50 mm). Following removal of serum proteins and other components the analytes were transferred to a Hypersil Gold C-18 (50 × 3 mm) analytical column. Elution occurred with a gradient of water and acetonitrile each with 0.1% formic acid. Analytes were ionized and detected over a 3.5 min analysis time by electrospray-ionization mass spectrometry with selected reaction monitoring (SRM). Matrix effects were well-characterized and carryover, precision, linearity, recovery and limits of detection and quantitation were evaluated.ResultsThe simple and complex precision CVs for all compounds were ≤ 16%. The limits of detection and quantitation for all drugs were ≤ 3 ng/ml and < 20 ng/ml, respectively. Recoveries were between 97 and 114%. Slopes for method comparison plots were all > 0.96. Proficiency testing materials had values within 2 SDI of peer group means for all drugs.ConclusionBased on validation data, this is a specific, sensitive fully-automated method for rapid quantitation of tricyclic antidepressants in serum.     

Clinical Transformation: Manager’s Perspectives on Implementation of Evidence-Based Practice

Implementation of evidence-based practices (EBPs) is highly encouraged within mental health services. This single case study examines the process of an EBP implementation effort, guided by the National Implementation Research Network (NIRN) implementation model, from the perspective of behavioural healthcare managers in a child and youth mental health provider organization. Qualitative methods identified process themes emerging over 3 years of an organizational change process that support and refine the NIRN model. Dedicated management oversight and implementation teams are essential for EBP implementation; practice leads and practice coaches are useful implementation innovations; and organizations seeking to implement several EBPs simultaneously must guard against organizational absorptive capacity. These findings can guide EBP implementation in child and youth behavioural healthcare.