SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers.

Background: Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports.

Medical student perceptions of an initial collaborative immersion experience.

Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration.

Multiorgan eosinophilic infiltration after initiation of clozapine therapy: a case report.

Background: The eosinophilic response to clozapine is well described in the literature, causing a variety of responses, from serositis to colitis. However, there are not case reports describing a clozapine-induced marked eosinophilia resulting in multiorgan dysfunction.

Case Presentation: In this case report, we describe a 24 year old Caucasian male who presented with severe systemic eosinophilia resulting in eosinophilic GI tract infiltration, myocarditis, pericardial and pleural effusions with dramatic improvement following drug withdrawal.

The Interprofessional Clinical Experience: Introduction to Interprofessional Education Through Early Immersion in Health Care Teams.

Introduction: The ability to collaborate as a member of interprofessional teams is essential for patient care and a core competency for students in health professions education. We developed a yearlong course, the Interprofessional Clinical Experience (ICE), to introduce first-year medical students to team-based aspects of the health care environment and provide them with a foundation upon which later experiences can grow.

Methods: The course uses experiential learning and critical reflection through reflective writing to orient students to working with care teams.

Iodine Deficiency and Hypothyroidism From Voluntary Diet Restrictions in the US: Case Reports.

Iodine deficiency is rare in the United States today, and this is largely due to the effectiveness of iodization in the general food supply. Recent trends among specific populations of children in the United States include adopting food restrictions, such casein-free and gluten-free diets. Although the effect of these types of diets on overall nutrition status and certain micronutrients has been studied in children with autism spectrum disorder, the effect of these limitations on iodine levels in children has not been assessed.

Assessing the validity evidence of an objective structured assessment tool of technical skills for neonatal lumbar punctures.

Background: The lumbar puncture (LP) is a procedural competency deemed necessary by the Accreditation Council for Graduate Medical Education and the Emergency Medicine and Pediatric Residency Review Committees. The emergency department (ED) is a primary site for residents to be evaluated performing neonatal LPs. Current evaluation methods lack validity evidence as assessment tools.

Management of brachial plexus injuries.

Most brachial plexus lesions are traction injuries sustained during birth, but in adolescents and older people they are usually caused by traffic accidents or following a fall in the home. A minority are the result of penetrating injury after civilian assault or trauma encountered during wartime. Birth palsy cases (obstetric brachial plexus palsy) and the remaining cases (traumatic briachial plexus palsy) are viewed differently with regard to treatment and outcome and so these two groups are usually discussed in separate chapters.

Motor evoked potentials after transcranial magnetic stimulation support hypothesis of coexisting central mechanism in obstetric brachial palsy.

Six infants with obstetric brachial palsy, ranging from 4 to 7 months of age, were investigated. One was suspected of having extensive brachial plexus lesions and five were suspected of having a unilateral lesion of both roots C5 and C6. All were referred to our center to investigate the possibility for reconstructive surgery.

The role of electromyography in the management of the brachial plexus palsy of the newborn.

Despite being the foremost examination in the management of traumatic nerve damage electromyography (EMG) has an uncertain and ill-defined role in the investigation of brachial plexus palsy of the newborn (BPPN). This may be because EMG, which is used most commonly several months after birth, fails to answer adequately two of the most important questions posed by this condition: its aetiology and the likely prognosis. In this review, we contend that EMG has important contributions to the solution of both of these questions but only if the timing of the investigation is altered.

Results of carpal tunnel release.

We evaluated, by means of a prospective study, the results of carpal tunnel release both clinically and electrophysiologically in 188 patients with a carpal tunnel syndrome. A questionnaire was completed by patient and surgeon pre- and post-operatively (6 and 12 months after operation), when physical examination, electromyography and nerve conduction tests were also performed. Full pre- and post-operative results were available for 136 patients and 82% of the patients were satisfied with the results of the operation.

Dysfunction at the motor end-plate and axon membrane in Guillain-Barré syndrome: a single-fiber EMG study.

In nine patients with Guillain-Barré syndrome (GBS), stimulation single-fiber electromyography (SFEMG) and serological studies were performed in the acute stage of the illness. Increased jitter and intermittent blocking of muscle fiber action potentials occurred to a varying degree in all patients. Five patients had elevated titers of antiganglioside antibodies.

Extensive somatosensory innervation in infants with obstetric brachial palsy.

In the pre-operative screening of infants with obstetric brachial palsy (OBP), the results of routine electromyography are often overly optimistic when compared to the peri-operative findings. This prompted us to include investigation of the sensory innervation of these infants using the N20 (the first cortical response to a peripheral stimulation) of the somatosensory evoked potentials (SSEP). Three to seven months after birth, SSEP were recorded at the skull after stimulation of the thumb and middle finger in infants with obstetric rupture of the upper trunk or avulsion of roots C5, C6, or C7, and in whom no clinical improvement of motor function was observed in the biceps brachii and deltoid muscles.

Visual cortex excitability in migraine before and after valproate prophylaxis: a pilot study using TMS.

We examined the effect of standard migraine prophylaxis with sodium valproate on repeated measures of occipital excitability using transcranial magnetic stimulation (TMS). We predicted that, comparing pre- and post-treatment assessments, a reduction in clinical migraine parameters would be paralleled by a decrease in excitability measurements.A total of 31 migraine patients enrolled in the study, for assessment prior to and 1 month after commencement of sodium valproate prophylaxis.

Visual cortex excitability in migraine with and without aura.

Objectives: Previous research using transcranial magnetic stimulation has produced equivocal findings concerning thresholds for the generation of visual phosphenes in migraine with aura. These studies were methodologically varied and did not systematically address cortical excitability in migraine without aura. We therefore studied magnetophosphene thresholds in both migraine with aura and migraine without aura compared with headache-free controls.

Non-invasive assessment of local arterial pulse pressure: comparison of applanation tonometry and echo-tracking.

Objectives: Pulse pressure is not constant throughout the arterial tree. Use of pulse pressure at one arterial site as surrogate for pulse pressure at another arterial site may be erroneous. The present study compares three non-invasive techniques to measure local pulse pressure: (i) internally calibrated readings from applanation tonometry, (ii) alternative calibration of pressure waves obtained with applanation tonometry and (iii) alternative calibration of arterial distension waves obtained with echo-tracking.

Validation of an electromyography and nerve conduction study protocol for the analysis of brachial plexus lesions in 184 consecutive patients with traumatic lesions.

Objectives: To validate a concentric needle electromyography (EMG) and nerve conduction study (NCS) protocol for the preoperative analysis of brachial plexus lesions.METHODS. 184 consecutive patients with traumatic brachial plexus lesions were analyzed.

Suppression of perception in migraine: evidence for reduced inhibition in the visual cortex.

Background: Results from transcranial magnetic stimulation (TMS) studies of visual cortex have confirmed visual cortical hyperexcitability in patients with migraine. It has been speculated that this may be due to deficient intracortical inhibitory tone. However, the TMS induction of phosphenes relies on the reporting of a subjective experience, and may thus be subject to bias.

The findings in paediatric obstetric brachial palsy differ from those in older patients: a suggested explanation.

An EMG and nerve-conduction-study protocol has been developed and used in all patients with brachial plexus lesions since 1985. The findings of EMG and nerve-conduction studies in obstetric brachial palsy (OBP) mostly suggest a falsely optimistic prognosis. To analyse this, all subjects were selected with complete avulsion of both roots C5 and C6 and/or complete rupture of the upper trunk verified during operation from a group of 162 infants with OBP (aged 4 to 14 months) and a group of 184 child and adult patients (aged 6 to 74 years) with a traumatic brachial plexus lesion.