Omega-3 Levels in Prenatal Supplements.

Objective:  This study aimed to systematically document the reported omega-3 levels in commercially available prenatal supplements in the United States and Canada, and compare these levels to recommended intakes in pregnancy.

Study Design:  Commercial prenatal supplements were identified using the Dietary Supplement Label Database ( = 50) and the Licensed Natural Health Products Database ( = 18). Mean omega-3 levels and the proportion of products meeting recommendations for pregnant women were tabulated.

Utilizing Community Procedure Clinics to Enhance Resident Procedural Education.

Introduction: Procedure training in family medicine residency is important for future full-spectrum practice. Some residency programs have cited difficulty providing adequate procedure education. Residency collaboration with nonfaculty attending physicians working at community nonresidency clinics may help programs increase resident exposure to procedures.

Fatigue in Adults: Evaluation and Management.

Fatigue is among the top 10 reasons patients visit primary care offices, and it significantly affects patients' well-being and occupational safety. A comprehensive history and cardiopulmonary, neurologic, and skin examinations help guide the workup and diagnosis. Fatigue can be classified as physiologic, secondary, or chronic.

Improving Prediction of Postoperative Myocardial Infarction With High-Sensitivity Cardiac Troponin T and NT-proBNP.

Background: This study sought to determine whether preoperatively measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) improve cardiac risk prediction in patients undergoing major noncardiac surgery compared with the standard risk indices.

Methods: In this ancillary study to the Vitamins in Nitrous Oxide trial, patients were included who had preoperative hs-cTnT and NT-proBNP measured (n = 572). Study outcome was the incidence of postoperative myocardial infarction (MI) within the first 3 postoperative days.

Resident Perceptions of Giving and Receiving Peer-to-Peer Feedback.

Background: Peer feedback is increasingly being used by residency programs to provide an added dimension to the assessment process. Studies show that peer feedback is useful, uniquely informative, and reliable compared to other types of assessments. Potential barriers to implementation include insufficient training/preparation, negative consequences for working relationships, and a perceived lack of benefit.

Nitrous Oxide for Treatment-Resistant Major Depression: A Proof-of-Concept Trial.

Background: N-methyl-D-aspartate receptor antagonists, such as ketamine, have rapid antidepressant effects in patients with treatment-resistant depression (TRD). We hypothesized that nitrous oxide, an inhalational general anesthetic and N-methyl-D-aspartate receptor antagonist, may also be a rapidly acting treatment for TRD.

Methods: In this blinded, placebo-controlled crossover trial, 20 patients with TRD were randomly assigned to 1-hour inhalation of 50% nitrous oxide/50% oxygen or 50% nitrogen/50% oxygen (placebo control).

Using the Guidelines for Adolescent Preventive Services to estimate adolescent depressive symptoms in school-based health centers.

Background And Objectives: The study objective was to understand the relationship between depressive symptoms and demographic, behavioral, and environmental risk variables among adolescents attending school-based health centers (SBHCs) using the Guidelines for Adolescent Preventive Services (GAPS) questionnaires.

Methods: Using GAPS questionnaires, we conducted a retrospective medical record review of 672 adolescents attending two Detroit-area school-based health clinics. Bivariate and multivariate analyses were conducted to determine which factors were associated with depressive symptoms while adjusting for other relevant factors.

Effect of bone cement viscosity and set time on mantle area in total knee arthroplasty.

To assess the impact of bone cement viscosity on total knee arthroplasty, we compared 1 high-viscosity and 2 medium-viscosity cements with respect to mantle area and zone-specific intrusion depths into the tibial plateau. We analyzed postoperative radiographs to determine penetration area and depth in 72 consecutive patients (79 knees) in whom DePuy II (n = 11), Endurance (n = 34), or Simplex-P (n = 34) cement was used. Penetration into the tibial plateau (anteroposterior zones 1-4) was significantly reduced with use of the high-viscosity DePuy II cement but did not differ significantly between the 2 medium-viscosity cements, Endurance and Simplex-P.

Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty.

Background: Gun pressurization in total knee arthroplasty (TKA) may result in better cement penetration than hand packing, leading to fewer tibial plate failures. We compared cement intrusion characteristics between vacuum mixing and gun pressurization versus hand mixing and packing in the proximal tibia among patients undergoing TKA.

Methods: We analyzed 6-week radiographs from 77 consecutive patients for cement area and zone-specific intrusion using computer-assisted image analysis.

Component version in modular total hip revision.

Morphologic changes of the proximal femur make revision total hip arthroplasty challenging. Metaphyseal retroversion and diaphyseal varus are common in this scenario. Twenty-one total hip revisions using a modular femoral prosthesis were examined by obtaining three radiographs (A/P, surgical lateral, and true lateral of the femur) to assemble CAD models for determining the range of modular component positioning.

Electrode placement during stimulus evoked electromyographic monitoring of iliosacral screw insertion: a finite element model.

Stimulus evoked electromyography is currently used during surgery to prevent nerve root injury during iliosacral screw insertion. In order to evaluate the importance of anode location in this procedure, a three dimensional finite element model was constructed from computed tomography data to evaluate the effectiveness of five electrode locations. Three anode locations (CASIS, dorsal midline and ventral midline) performed well, including the one most commonly used clinically (ventral midline).