Current trends in paediatric and neonatal ventilatory care – a nationwide survey

Aim: To assess daily practices in paediatric and neonatal ventilatory care in Finland. Methods: All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3‐month prospective survey. Results: A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung‐protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome. Conclusion: Most of the principles of lung‐protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.     

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正Orginal data from clinical investigations clinical trials,preventive or therapeutics studies Basic research,with clinical application Epidemiology Advances in new techniques and knowledge Augmentation and promotion of medical information Clinical review and discussion     

ACAM2000: a newly licensed cell culture-based live vaccinia smallpox vaccine

Importance of the field: Migraine is an episodic, substantially inherited brain disorder affecting 15% of adults in Western Europe and North America, and is one of the commonest reasons for patients to see their physicians. While the World Health Organization considers that severe migraine can be as disabling as quadriplegia, unfortunately the condition remains undertreated. Until the 1990s, specific migraine therapies were limited to ergot derivatives.

Areas covered in this review: The triptans, serotonin 5-HT_1B/1D receptor agonists, revolutionized the acute management of migraine patients. However, although the triptans are generally effective and safe, not all patients can take them and many do not respond especially to oral therapies. Recently, progress has been made on the therapeutic front, particularly with new acute treatments. This review will focus on the therapeutic potential of ADX10059, a metabotropic glutamate receptor 5, negative allosteric modulator (mGluR5 NAM), in migraine. Data from a proof-of-concept study in episodic migraineurs demonstrated a significant improvement following acute treatment. A large European multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study is currently investigating the efficacy, safety and tolerability of the compound for migraine prevention.

What the reader will gain: The reader will have the basic principles of migraine management and the potential for glutamate-targeted approaches.

Take home message: Targeting glutamatergic transmission in migraine may provide a novel preventive therapy that is effective and well-tolerated.     

Mycophenolate Fetal Toxicity and Risk Evaluation and Mitigation Strategies

The mycophenolic acid (MPA) preparations are one of the most commonly used immunosuppressants in the United States. However, these agents carry a black box warning regarding their use during pregnancy due to an association with increased risk of miscarriage and congenital defects. To ensure that the benefits of MPA outweigh the risks, the Food and Drug Administration (FDA) required all manufacturers of MPA products to propose risk evaluation and mitigation strategies (REMS). Four years after initially calling for proposals, the FDA approved a single shared REMS system in September 2012. The elements of the MPA REMS include a medication guide and elements to assure safe use (ETASU). The medication guide, which was previously FDA‐approved in 2008, should continue to be distributed to patients, and the ETASU requires physicians to complete training and obtain patient signatures on the “Patient‐Prescriber Acknowledgement Form.” A single, national, voluntary pregnancy registry is available, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA products among patients and possibly practitioners.     

False memories in patients with mild cognitive impairment and mild Alzheimer’s disease dementia: Can cognitive strategies help?

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that presents predominantly with impairments in learning and memory. Patients with AD are also susceptible to false memories, a clinically relevant memory distortion where a patient remembers an incorrect memory that they believe to be true. The use of cognitive strategies to improve memory performance among patients with AD by reducing false memories has taken on added importance given the lack of disease-modifying agents for AD. However, existing evidence suggests that cognitive strategies to reduce false memories in patients with AD are of limited effectiveness, although these strategies may be useful at earlier stages of the disease. The purpose of this review is to examine experimental findings of false memories and associated memory processes in patients with mild cognitive impairment due to AD and mild AD dementia. Cognitive strategies to reduce false memories in these patient populations are also reviewed. Approaches to clinically relevant future research are suggested and discussed.     

分析外科护理中的潜在风险及应对策略

目的：分析外科护理中的潜在风险及应对策略。方法收集外科的200例患者作为护理组、200例患者作为对照组，总结出外科护理中的潜在风险，并提出相应的安全护理措施。结果实现安全护理措施后，护理组安全意外事件发生率为0.2％，明显低于对照组的0.8%，两组对比差异显著，具有统计意义（P＆lt;0.05）。结论研究外科护理中的潜在风险及应对策略，有利于提高患者及家属对护理的满意度，降低医疗纠纷的发生率。     

Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center

Cerebral palsy (CP) is a set of nonprogressive neuromuscular disorders caused by defects in the developing fetal brain. The aim of this study is to investigate the prevalence and distribution of various dental conditions including dental caries and periodontitis among individuals with CP who receive care at the Rancho Los Amigos National Rehabilitation Center dental clinic. Medical records of 478 patients between the ages of 3 and 78 years were reviewed. Patients were divided into four age groups: 3–20, 21–35, 36–55, and 56 and above year old. Data related to their dental conditions including caries, periodontitis, and other oral diseases were assessed. Statistical analyses were conducted to evaluate the correlations between these oral diseases and age, gender, ethnicity as well as their living conditions (home or group home). The 36–55‐year‐old age group displayed significantly more caries and periodontitis than any other age groups. Individuals aged 3–20 years showed a significantly lower rate of periodontitis and caries. There was no significant association between gender and race with these outcome variables but there was a correlation between these variables and living conditions. Differences in oral health exist among people with CP from different age groups and living conditions. These findings suggest that there is a dire need for more oral hygiene training and education for the care givers. Dental schools should better prepare their graduates to meet the treatment demands of individuals with special healthcare needs.