On intimate relationships between healthcare professionals and patients: a nationwide cohort analysis of medical tribunal decisions in the Netherlands.

Background: We examine the incidence of medical tribunal decisions and disciplinary actions (DAs) against healthcare professionals (HCPs). In addition, we studied whether an intimate relationship between an HCP and patient as part of the medical tribunal decision is associated with an increased likelihood of disciplinary actions.

Methods: We conducted a nationwide cohort analysis on the downloadable medical tribunal decisions from a medical disciplinary tribunal in the Netherlands from 2010 to 2017.

Disturbance history can increase functional stability in the face of both repeated disturbances of the same type and novel disturbances.

Climate change is expected to increase the incidences of extremes in environmental conditions. To investigate how repeated disturbances affect microbial ecosystem resistance, natural lake bacterioplankton communities were subjected to repeated temperature disturbances of two intensities (25 °C and 35 °C), and subsequently to an acidification event. We measured functional parameters (bacterial production, abundance, extracellular enzyme activities) and community composition parameters (richness, evenness, niche width) and found that, compared to undisturbed control communities, the 35 °C treatment was strongly affected in all parameters, while the 25 °C treatment did not significantly differ from the control.

A quantitative framework for assessing ecological resilience.

Quantitative approaches to measure and assess resilience are needed to bridge gaps between science, policy and management. In this paper, we revisit definitions of resilience and suggest a quantitative framework for assessing ecological resilience sensu Holling (1973). Ecological resilience as an emergent ecosystem phenomenon can be decomposed into complementary attributes (scales, adaptive capacity, thresholds and alternative regimes) that embrace the complexity inherent to ecosystems.

Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review.

Given the fast development and increasing clinical relevance of ultrasound guidance for thoracic paravertebral blockade, this review article strives (1) to provide comprehensive information on thoracic paravertebral space anatomy, tailored to the needs of a regional anesthesia practitioner, (2) to interpret ultrasound images of the thoracic paravertebral space using cross-sectional anatomical images that are matched in location and plane, and (3) to briefly describe and discuss different ultrasound-guided approaches to thoracic paravertebral blockade. To illustrate the pertinent anatomy, high-resolution photographs of anatomical cross-sections are used. By using voxel anatomy, it is possible to visualize the needle pathway of different approaches in the same human specimen.

Initial findings from the implementation of a community-based sentinel surveillance system to assess the health effects of climate change in Alaska.

Background: This report describes the results of a study to determine whether a community-based sentinel surveillance system can be developed and implemented to assess the health effects of climate change, and to contribute to local discussions to mitigate these health effects. The purpose of this report is to describe the process and outcomes of this innovative approach to identifying priority areas for adaptation investment. This report can be used to assist local, state and federal governments in determining how to develop actions and policies to promote adaptation to climate change.

Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort.

Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy.

Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.

Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate.

Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral block at T2-3. One patient also developed an ipsilateral hemidiaphragmatic paresis, an adverse effect that has not been reported before.

Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function.

Background And Objectives: This study was performed to determine the minimum effective volume of ropivacaine 0.75% required to produce effective shoulder analgesia for an ultrasound (US)-guided block at the C7 root level with assessment of pulmonary function.

Methods: Using the Dixon and Massey up-and-down method study design, 20 patients scheduled for elective open shoulder surgery under combined general anesthesia and continuous interscalene brachial plexus block were included.

Ultrasound-guided continuous phrenic nerve block for persistent hiccups.

Background: Phrenic nerve block can be performed and repeated if necessary for persistent hiccups, when conservative and pharmacological treatment is unsuccessful. We report the first description of an in-plane ultrasound (US)-guided phrenic nerve block (PhNB) with a catheter, after US investigation of the bilateral diaphragm, to treat hiccups while avoiding repeated PhNBs.

Case: A 36-year-old man had persistent postoperative hiccups not responding to conservative and pharmacological treatment.

In-plane ultrasound-guided thoracic paravertebral block: a preliminary report of 36 cases with radiologic confirmation of catheter position.

Background And Objectives: Thoracic paravertebral block (TPVB) can be used for unilateral surgical procedures. Modifications of the classic approach have been proposed to minimize the risk of pleural puncture. In this study, we evaluated the feasibility and success rate of a transverse in-plane ultrasound (US)-guided TPVB with radiologic confirmation of catheter position.

Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis.

Background And Objectives: Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis.

Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.

Background And Objectives: Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis.

Vertical infraclavicular brachial plexus block: needle redirection after elicitation of elbow flexion.

Background: In vertical infraclavicular brachial plexus block, success depends on distal flexion or extension response. Initially, elbow flexion (lateral cord) is generally observed. However, specific knowledge about how to reach the medial or posterior cord is lacking.

A simplified approach to vertical infraclavicular brachial plexus blockade using hand-held Doppler.

In this observational study, we used Doppler ultrasound during the performance of vertical infraclavicular brachial plexus blockade. The success rate at inserting the needle at the point where the sound of the subclavian artery via Doppler reached its maximum audibility was compared with that of the classical insertion point. In 89 of the 100 patients, the medial or posterior cord was found at first needle pass.

Great minds don't always think alike: the challenges of conducting substance abuse prevention research in public schools.

Prevention researchers and school personnel lack a common understanding concerning the opportunities and burdens of school-based drug prevention research. In this article, we review issues related to researching substance abuse prevention programs in school settings, and assess challenges related to recruitment, communication, research design, surveying, and ensuring program fidelity. We conclude that before any school is enrolled, there must be a mutual understanding as to the nature and extent of the study's requirements and what adjustments a school will have to make to support a successful collaboration.

Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study.

The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made.