The beneficial effect of probiotics as an adjuvant treatment in childhood drug resistant epilepsy: A prospective pilot study.

Background: One of the most common long-term neurological disorders affecting children is epilepsy. Even with effective antiseizure medications, one-third of epileptic patients develop drug-resistant epilepsy (DRE). Numerous treatments have been offered to these DRE patients, though with varying degrees of effectiveness.

Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation.

Background: Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist-driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU.

Canadian guidance for diagnosis and management of acute hepatic porphyrias.

Acute hepatic porphyrias (AHP) comprise four rare monogenic autosomal conditions. Each is linked to a deficiency of heme metabolizing enzymes. Common manifestations include severe abdominal pain, nausea, confusion, hyponatremia, hypertension, tachycardia, and neuropathy.

Effective stewardship strategies to enhance appropriateness of refer-out test requests in a Canadian tertiary centre laboratory.

Objectives: Specialized testing conducted in reference laboratories is costly and often not optimally directed. Since 2016, our institution has worked to ensure the appropriateness of refer-out (RO) tests. We examine the impact of utilization initiatives on the patterns of requests and completed tests.

Comparisons between dual-energy X-ray absorptiometry and bioimpedance devices for appendicular lean mass and muscle quality in Hispanic adults.

The purpose of this study was to compare single- and multi-frequency bioimpedance (BIA) devices against dual-energy X-ray absorptiometry (DXA) for appendicular lean mass (ALM) and muscle quality index (MQI) metrics in Hispanic adults. One hundred thirty-one Hispanic adults (18-55 years) participated in this study. ALM was measured with single-frequency bioimpedance analysis (SFBIA), multi-frequency bioimpedance analysis (MFBIA) and DXA.

Off-road vehicle crashes: dangers of alcohol and drug impairment.

Background: Impaired driving is a public health issue, yet little is known concerning the prevalence of substance use in drivers involved in off-road vehicle crashes. The goal of the present study was to describe the demographics and prevalence of alcohol and drug use in drivers of off-road vehicle crashes.

Methods: In this observational substudy, we collected clinical and toxicological data on all moderately or severely injured off-road vehicle drivers who had blood samples obtained within 6 h of the crash.

A modular microfluidic platform to study how fluid shear stress alters estrogen receptor phenotype in ER breast cancer cells.

Metastatic breast cancer leads to poor prognoses and worse outcomes in patients due to its invasive behavior and poor response to therapy. It is still unclear what biophysical and biochemical factors drive this more aggressive phenotype in metastatic cancer; however recent studies have suggested that exposure to fluid shear stress in the vasculature could cause this. In this study a modular microfluidic platform capable of mimicking the magnitude of fluid shear stress (FSS) found in human vasculature was designed and fabricated.

A modular microfluidic platform to study how fluid shear stress alters estrogen receptor phenotype in ER breast cancer cells.

Metastatic breast cancer leads to poor prognoses and worse outcomes in patients due to its invasive behavior and poor response to therapy. It is still unclear what biophysical and biochemical factors drive this more aggressive phenotype in metastatic cancer; however recent studies have suggested that exposure to fluid shear stress in the vasculature could cause this. In this study a modular microfluidic platform capable of mimicking the magnitude of fluid shear stress (FSS) found in human vasculature was designed and fabricated.

Evaluation of a Rapid Four-Compartment Model and Stand-Alone Methods in Hispanic Adults.

Background: A rapid 4-compartment (4C) model integrates dual-energy x-ray absorptiometry (DXA) and multi-frequency bioimpedance analysis (MFBIA), which may be useful for clinical and research settings seeking to employ a multi-compartment model.

Objectives: This study aimed to determine the added benefit of a rapid 4C model over stand-alone DXA and MFBIA when estimating body composition.

Methods: One hundred and thirty participants (n = 60 male; n = 70 female) of Hispanic descent were included in the present analysis.

Capnography for Monitoring of the Critically Ill Patient.

Capnography has been widely adopted in multiple clinical areas. The capnogram and end-tidal carbon dioxide offer a wealth of information, in the right clinical setting, and when properly interpreted. In this article, the authors aim to review the most common clinical scenarios during which capnography has been shown to be of benefit.

Central venous-to-arterial PCO difference as a marker to identify fluid responsiveness in septic shock.

Defining the hemodynamic response to volume therapy is integral to managing critically ill patients with acute circulatory failure, especially in the absence of cardiac index (CI) measurement. This study aimed at investigating whether changes in central venous-to-arterial CO difference (Δ-ΔPCO) and central venous oxygen saturation (ΔScvO) induced by volume expansion (VE) are reliable parameters to define fluid responsiveness in sedated and mechanically ventilated septic patients. We prospectively studied 49 critically ill septic patients in whom VE was indicated because of circulatory failure and clinical indices.

The analytical performance of six urine drug screens on cobas 6000 and ARCHITECT i2000 compared to LC-MS/MS gold standard.

Background: Immunoassays provide a rapid tool for the screening of drugs-of-abuse (DOA). However, results are presumptive and confirmatory testing is warranted. To reduce associated cost and delay, laboratories should employ assays with high positive and negative predictive values (PPVs and NPVs).

A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound.

Objectives: To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners.

Setting: The University of Iowa Hospitals and Clinics.

Subjects: Twenty-four subjects (23 first-year medical students and one first-year physician assistant student).

Usefulness of venous-to-arterial partial pressure of CO difference to assess oxygen supply to demand adequacy: effects of dobutamine.

The central venous O saturation value and lactic acid levels are part of the diagnostic and therapeutic work up of patients in shock. These usual indicators of tissue hypoxia don't fully describe the adequacy of tissue perfusion. There is ample evidence that supplementing this data with the venous-to-arterial partial pressure of CO (PCO) difference (ΔPCO) complements the clinician's tools when treating patients with shock.

Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures?

The arterial partial pressure of carbon dioxide (Pa) is an important parameter in critically ill, mechanically ventilated patients. To limit invasive procedures or for more continuous monitoring of Pa, clinicians often rely on venous blood gases, capnography, or transcutaneous monitoring. Each of these has advantages and limitations.

Improving CPR Performance.

Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. CPR is a complex set of interventions requiring leadership, coordination, and best practices. Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations.

Multiple pre- and post-analytical lean approaches to the improvement of the laboratory turnaround time in a large core laboratory.

Background: Core laboratory (CL), as a new business model, facilitates consolidation and integration of laboratory services to enhance efficiency and reduce costs. This study evaluates the impact of total laboratory automation system (TLA), electric track vehicle (ETV) system and auto-verification (AV) of results on overall turnaround time (TAT) (phlebotomy to reporting TAT: PR-TAT) within a CL setting.

Methods: Mean, median and percentage of outlier (OP) for PR-TAT were compared for pre- and post-CL eras using five representative tests based on different request priorities.

Using electronic medical record notes to measure ICU telemedicine utilization.

Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered.