Background: The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF).
Methods: In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement.
Visual pursuit (VP) and visual fixation (VF) have been recognized as the first signs of emerging consciousness and, therefore, are considered indicative of the minimally conscious state (MCS). However, debate exists about their status as they are considered either conscious reactions or reflexes. The aim of this study is to review the evidence of the definition, operationalization, and assessment of VP and VF in unconscious patients.
View Article and Find Full Text PDFBackground: Transmission of MRSA from livestock to humans is rare, but it is advisable to remain alert.
Case Study: Following 2 hospital admissions within a month and a half, a 73-year-old patient was found to have become infected with MRSA. The MRSA type was livestock-related.
We describe the clinical course of a 51-year-old woman in a vegetative state and of a 63-year-old woman in a minimally conscious state. The difference between these two states is an important one, as clinical course, prognosis and medical-ethical considerations of both are different. In practice it is difficult to distinguish between a vegetative state and a minimally conscious state, but the use of a Post-Acute Level of Consciousness scale helps to illustrate the differences.
View Article and Find Full Text PDFTo reduce the access times of an endoscopy department, we developed an iterative combination of Discrete Event simulation and Integer Linear Programming. We developed the method in the Endoscopy Department of the Academic Medical Center in Amsterdam and compared different scenarios to reduce the access times for the department. The results show that by a more effective allocation of the current capacity, all procedure types will meet their corresponding performance targets in contrast to the current situation.
View Article and Find Full Text PDFThe sural/radial nerve amplitude ratio (SRAR) has been proposed as a sensitive indicator of early-stage axonal polyneuropathy. However, previous studies did not take into account the effect of sex differences or different calculating methods. To obtain reference values and information on the variability of the SRAR in daily practice, we measured amplitudes of sural and superficial radial sensory nerve action potentials in 106 healthy adults, correlated them with epidemiological variables, and calculated the SRAR in several ways.
View Article and Find Full Text PDFA 42-year-old, previously healthy cattle inspector presented with a 7-day history of fever, a painful left knee, malaise and muscular pain. He did not suffer from an underlying disease, nor was he immunocompromised. After 12 days of hospitalization, a unilocular abscess in the left psoas muscle was diagnosed.
View Article and Find Full Text PDFAntibiotic use in The Netherlands during the period 1994-1999 is described in relation to the resistance of routine isolates of Streptococcus pneumoniae. The average antibiotic use in the study period was 3.4 defined daily doses per 1000 persons per day (DDD/1000/day) penicillins, 0.
View Article and Find Full Text PDFObjective: To determine the basic sensitivity of Escherichia coli in the province of Friesland, the Netherlands, to antimicrobial agents used by general practitioners to treat urinary tract infections.
Design: Inventory.
Method: Fifty general practitioners in the province were asked in 1999 to have faeces submitted by patients who had not been using antibiotics for at least one month.
Prosthet Orthot Int
April 2000
This paper describes the experience with a trans-tibial amputation due to reflex sympathetic dystrophy. Because of lack of information about postoperative management in these cases, the medical history is provided together with a description of early mobilisation and technical information about prosthetic equipment.
View Article and Find Full Text PDFEur J Clin Microbiol Infect Dis
December 1994
To assess the efficacy of single-dose antibiotic prophylaxis in coronary artery bypass grafting, 1,016 consecutive patients were prospectively randomized to receive either a single dose or a three-day course of cefuroxime. Nine patients (0.9%) died within seven days; no death was caused by infection.
View Article and Find Full Text PDFObjective: To determine whether polymerase chain reaction (PCR) fingerprinting can be used to gain insight into the epidemiology of methicillin resistant Staphylococcus aureus (MRSA).
Design: Retrospective DNA analysis of MRSA strains. BACTERIAL STRAINS: MRSA strains were collected in two Dutch and one Belgian hospital (Reinier de Graaf Gasthuis, Delft; St.
A case of symptomatic Actinobacillus actinomycetemcomitans bacteremia in a patient with an implanted pacemaker is presented. Attacks of fever occurred for at least 1 year. Oral examination revealed a mild form of periodontitis.
View Article and Find Full Text PDFGlycocalyx (or slime), which is an important virulence factor of many pathogenic bacteria, was isolated from Bacteroides fragilis, Bacteroides thetaiotaomicron and Staphylococcus epidermidis. Organisms were grown for 24 h in a chemically defined, dialysable liquid medium. Bacteria were centrifuged and the supernatant was concentrated and dialysed against distilled water.
View Article and Find Full Text PDFRecovery from gram-negative septicemia depends on the successful joint action of antibiotics and host defense mechanisms. The possible enhancement of host defense with either immunotherapy or antibiotic treatment has been the subject of numerous investigations. Because of the great similarity of core epitopes within different species of Enterobacteriaceae, most studies have focused on the development of cross-reactive and/or cross-protective antibodies to these common epitopes.
View Article and Find Full Text PDFWe have studied the effect of sub-minimal inhibitory concentrations (sub-MIC) of ciprofloxacin and fleroxacin on capsulated (K+) and non-capsulated (K-) Gram-negative bacilli (Escherichia coli O1:K1, O7:K1, O1:K-, O7:K-, and Klebsiella oxytoca) as well as on Staphylococcus aureus and we investigated the interaction of antibiotic pretreated bacteria with human serum and polymorphonuclear leukocytes (PMN). Following overnight growth in the presence of 1/2 MIC of the antibiotics, bacteria were opsonized in human serum and incubated with PMN. Opsonophagocytosis was quantified as the ratio of uptake by PMN of radioactively labeled bacteria.
View Article and Find Full Text PDFThe murine immune response to Escherichia coli exposed to subminimal inhibitory concentrations of four antibiotics was investigated. Groups of mice were injected for 8 weeks with formalin-killed bacteria and subsequently challenged with 10 x LD50 of viable E. coli.
View Article and Find Full Text PDFThe efficacy and safety of ofloxacin 400 mg once daily and amoxycillin/clavulanic acid 500/125 mg three times daily were compared in a double-blind manner in patients with an acute exacerbation of chronic bronchitis. Of 102 patients enrolled, 95 (93%) could be assessed for effectiveness. Treatment success was achieved in 41 (84%) of 49 patients in the ofloxacin group compared with 41 (89%) of 46 patients in the amoxycillin/clavulanic acid group.
View Article and Find Full Text PDFThe influence of five antibiotics (netilmicin, ceftriaxone, cefepime, fleroxacin, and ciprofloxacin) on capsular polysaccharide distribution and on opsonophagocytosis by human polymorphonuclear leukocytes of unencapsulated and encapsulated Escherichia coli strains was studied. Unencapsulated E. coli strains were readily opsonized in serum and easily ingested by polymorphonuclear leukocytes, and antibiotics did not further enhance the phagocytosis rates.
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