Barriers to working with impaired trainees: A resident's viewpoint

Psychiatric trainees and educators alike know that significant impairment may occur during training. Although psychiatry programs can do much to identify, treat, and prevent trainee impairment, barriers that may hinder programs from adequately addressing the problems of the impaired trainee continue to exist. These barriers include stigmatization and rejection of the impaired trainee, lack of focus on primary prevention, problematic supervisor-resident relationships, and trainee resistance to intervention. An atmosphere of candor and support, impairment-related seminars, and informed and alert supervisors can be helpful in easing the stress of training and reducing trainee impairment.     

Recent developments and new applications of tandem mass spectrometry in newborn screening

PURPOSE OF REVIEW: To summarize recent developments in the field of newborn screening related to the use of tandem mass spectrometry as an analytic platform. RECENT FINDINGS: Novel inborn errors of metabolism with informative amino acid and/or acylcarnitine profiles have been characterized, increasing the complexity of the differential diagnosis of abnormal results. In addition, methods have been developed for the analysis in dried blood spots of steroids and lysosomal enzymes. Previously unrecognized genotype/phenotype correlations have been found among cohorts of patients whose conditions were diagnosed by screening rather than clinically. Several government entities and professional organizations have issued position statements on newborn screening, and worldwide outcome studies continue to underscore the clinical and financial benefits of expanded newborn screening. SUMMARY: Although it is done inconsistently, newborn screening in the United States is undergoing a rapid expansion driven by the introduction of tandem mass spectrometry in at least 34 state programs. This technology is also used to detect disease markers beyond acylcarnitines and amino acids, as both primary and second-tier tests. In addition to analytic improvements, there is a trend toward the development of joint programs not limited to contiguous geographic areas, often based upon public-private partnerships. This review will summarize several new developments in the field that have occurred since early 2003 and will mention others likely to occur in the near future.     

Morbid Obesity and Gastric Bypass Surgery: Biochemical Profile

Background: Morbid obesity (MO) and the pathologies associated with it constitute an important public health problem, accounting for 7% of the health expenditure in industrialized countries. An important percentage of this expense is attributed to the different biochemical tests performed in these patients, who suffer from several metabolic derangements. We evaluated the basic biochemical abnormalities in MO patients and their reversibility by weight loss after gastric bypass, to standardize the surveillance of the different metabolic abnormalities in obese patients. Methods: By a retrospective analysis on 125 patients operated in our hospital, we evaluated anthropometric and biochemical data before and 1, 3, 6, 12 and 24 months after gastric bypass. Results: Preoperatively hyperinsulinemia, hyperglycemia, dyslipidemia and hypertensive disease were present, and began to improve 1 and 3 months after surgery (although not significantly) and significantly at 6, 12 and 24 months after it. We also observed deficient protein nutrition and a deficiency of micronutrients both before bypass and during the follow-up. Conclusion: After gastric bypass, a marked decrease in insulin occurred, with normalization of blood pressure and the biochemical parameters associated with the metabolic syndrome. We propose a biochemical follow-up protocol for MO patients.     

高效毛细管电泳法测定利多卡因代谢产物单乙基甘氨酰二甲苯胺

目的 :建立一种测定利多卡因代谢产物单乙基甘氨酰二甲苯胺 (MEGX)含量的高效毛细管电泳法。方法 :用50mmol/L硼酸缓冲液 (pH =8.8)为电泳电解液 ,电压 1 2kV ,运行电流 1 8.8～ 2 3 .2 μA ,检测波长 2 1 4nm ,有效毛细管长度 50cm ,管径 50 μm ,氨茶碱为内标 ,展开 1 2min。 8只昆明种小白鼠腹腔注射 0 .2 %利多卡因 4 0mg/kg ,用本法测定其 5h尿液中MEGX累积排泄量。结果 :MEGX迁移时间 7.8min ,氨茶碱迁移时间 1 0 .7min。MEGX含量为 0 .0 62～1 .0mg/ml时 ,其浓度与色谱峰面积线性关系良好 ,r =0 .9991 ,日内、日间变异系数均小于 7.8% ,回收率为98.4 %～ 1 0 1 .6% ,常用 3 0种药物对其无干扰。 8只小鼠MEGX累积排泄量为 ( 2 95.2± 55.2 ) μg ,其中游离型MEGX为 4 4.7% ,结合型为 55.3 %。结论 :该方法简单、快速、灵敏 ,特异性和重现性良好 ,具有较强实用价值。     

The effectiveness of adding cognitive behavioural therapy aimed at changing lifestyle to managed diabetes care for patients with type 2 diabetes: design of a randomised controlled trial

Background  

In patients with type 2 diabetes, the risk for cardiovascular disease is substantial. To achieve a more favourable risk profile, lifestyle changes on diet, physical activity and smoking status are needed. This will involve changes in behaviour, which is difficult to achieve. Cognitive behavioural therapies focussing on self-management have been shown to be effective. We have developed an intervention combining techniques of Motivational Interviewing (MI) and Problem Solving Treatment (PST). The aim of our study is to investigate if adding a combined behavioural intervention to managed care, is effective in achieving changes in lifestyle and cardiovascular risk profile.     

Drilling speaking valves: A modification to improve vocalization in tracheostomy dependent children

Pediatric tracheostomy dependence is associated with a variety of sequelae. Vocalization delay is commonplace and may result in long‐term communication disability. Passy‐Muir speaking valves are routinely used to allow such children to vocalize. Unfortunately, not all tracheostomy dependent children can tolerate the placement of a speaking valve. Elevated transtracheal pressures are often associated with failure. We describe a method of modifying a standard Passy‐Muir valve to decrease transtracheal pressures and thus improve tolerance of the valve. In our practice, the modification allows a broader range of children experience the benefit of speaking valve placement. Laryngoscope, 119:176–179, 2009