Stroke management: updated recommendations for treatment along the care continuum

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management.     

The impact of Degraded distractors on (Nondegraded) target identification

In this series of experiments, based on Biederman's Recognition by Components theory, we postulate that corners (vertices) of objects are crucial in programming and execution of goal-directed action. We used a distractor interference paradigm to present line drawings of letters (M and W) with distractors (also M and W), which were either nondegraded or degraded (that is, corners or line segments missing). Degraded distractors caused less interference overall (reduced response times and errors) than Nondegraded distractors, when these were presented peripherally or at fixation (Experiments 1 and 2). When presented at fixation, however, distractors with corners missing caused greater interference than distractors with line segments missing. This pattern was not replicated with non-identical, non-mirror reversed stimuli (H and E: Experiment 3). We speculate that corners are critical in determining the extent of distractor interference. When missing from view, and given sufficient attentional resources and structural similarity, they may be reconstructed by the visuomotor system to aid performance to the target.     

Reforming the Swiss nurse education system: a policy review

BACKGROUND: Western Europe has been swept in the last three decades by ongoing reforms within the nurse education systems. Within the Western European region, Switzerland is one of the last countries initiating the integration of nursing programs into higher education institutions. OBJECTIVES: This article examines the nurse education reforms recently enacted in Switzerland. The specific aims of the analysis were to: (a) examine modes of reform implementation and the current status of the Swiss nurse education system; (b) compare between two new Swiss nurse education models developed in the various linguistic regions. METHOD: A documentary search for policy documents, reports and studies related to the implementation processes of reforms was conducted through websites of various legal institutions and the Swiss university library system. FINDINGS: The analysis indicated that although a fit between environmental pressures and the reform agenda exists, the implementation of the nursing reform varied considerably between the various Swiss linguistic regions. This variation resulted in two newly created models of nurse education programs revealing a high level of variability and inconsistency. As such, the development of a unified system of nurse education, which was set as the primary goal of the reformed system, was not achieved. CONCLUSIONS: Overall, Switzerland is contributing to the widening heterogeneity rather than to the aspired homogeneity across Western European countries.     

Surgical site abscess caused by Lactobacillus fermentum identified by 16S ribosomal RNA gene sequencing

We report the first case of surgical site abscess caused by Lactobacillus fermentum from a 53-year-old woman with squamous cell carcinoma of the esophagus after transthoracic esophagectomy and neoadjuvant chemoirradiation. 16S rRNA gene sequencing is a useful tool to better characterize the epidemiology and clinical significance of L. fermentum.     

Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders

Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.     

Short-Term Skin Reactions Associated to Sleeve Gastrectomy in Eight Patients

Background

Bariatric procedures have beneficial effects on metabolic disturbances, including dermatological conditions. Short-term skin reactions associated with sleeve gastrectomy are not described in the literature.

Methods

We reviewed our database for patients who underwent bariatric surgery between May and October 2013 who reported a cutaneous rash during the short-term post-surgical period.

Results

Of a total of 195 patients, 8 (0.02 %) developed acute skin reactions during the first 3 months. Case 1 was compatible with reticulated papillomatosis. Case 2 was diagnosed as recurrent angioedema. Cases 3, 4, and 7 presented a cutaneous drug reaction to vitamin supplementation. Cases 5, 6, and 8 seemed to be secondary to xerosis and responded to lubrication.

Conclusion

Acute cutaneous skin reactions after bariatric surgery are unusual. When they do occur, they appear to be benign conditions.