The Flip Side of the Coin: Giftedness in Pediatric Acute-Onset Neuropsychiatric Syndrome.

Individuals with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), an immune-modulated disorder, experience exacerbation-related neuropsychiatric symptoms, functional impairments, and high rates of developmental diagnosis. The literature describes links between giftedness and mental illness, and giftedness and autoimmune disorders. We sought to explore rates of giftedness among children with PANS as perceived by their caregivers, and to examine whether giftedness was related to PANS symptom severity, persistence, or duration.

The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial.

Importance: Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs).

Objective: To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy.

Design, Setting, And Participants: This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020.

Surgically generated aerosol and mitigation strategies: combined use of irrigation, respirators and suction massively reduces particulate matter aerosol.

Background: Aerosol is a health risk to theatre staff. This laboratory study quantifies the reduction in particulate matter aerosol concentrations produced by electrocautery and drilling when using mitigation strategies such as irrigation, respirator filtration and suction in a lab environment to prepare for future work under live OR conditions.

Methods: We combined one aerosol-generating procedure (monopolar cutting or coagulating diathermy or high-speed diamond- or steel-tipped drilling of cadaveric porcine tissue) with one or multiple mitigation strategies (instrument irrigation, plume suction and filtration using an FFP3 respirator filter) and using an optical particle counter to measure particulate matter aerosol size and concentrations.

The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care.

Objectives: Polypharmacy is common, costly, and harmful for hospitalized older adults. Scalable strategies to reduce the burden of potentially inappropriate medications (PIMs) are needed. We sought to leverage medication reconciliation in hospitalized older adults by pairing with MedSafer, an electronic decision support tool for deprescribing.

Facet joint degeneration adversely affects ultrasound imaging of the lumbar spine.

Aim: Ultrasound of neuraxis can be used to identify the best possible inter-spinous space to perform neuraxial block. The aim of this study was to assess the anatomical correlation between neuraxial ultrasound and magnetic resonance imaging (MRI).

Material And Method: Twenty-one patients who underwent MRI of the lumbar spine had ultrasound of lumbar neuraxis performed by an experienced operator.

A pilot study of a Medication Rationalization (MERA) intervention.

Background: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications.

Methods: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity.

Residual Kidney Function and Peritoneal Dialysis-Associated Peritonitis Treatment Outcomes.

Background And Objectives: Residual kidney function contributes to the clearance of antibiotics excreted by the kidneys, lowering the antibiotic concentration, which may adversely affect the treatment of peritoneal dialysis-associated peritonitis. The objective of our study was to examine the relationship between residual kidneyfunction and peritonitis treatment outcomes.

Design, Setting, Participants, & Measurements: Our study included 181 participants who experienced 339 episodes of Gram-positive, Gram-negative, and culture-negative peritoneal dialysis-associated peritonitis at a single centerfrom 2003 to 2010.

Preparation of the Dräger Fabius GS workstation for malignant hyperthermia-susceptible patients.

Purpose: In order to establish guidelines for the preparation of the Dräger Fabius GS premium anesthetic workstation for malignant hyperthermia-susceptible patients, the authors evaluated the effect of the workstation's exchangeable and autoclavable components on the washout of isoflurane.

Methods: A Dräger Fabius GS workstation was primed with 1.5% isoflurane, and exchangeable components were replaced as follows: Group 1: no replacement (control); Group 2: autoclaved ventilator diaphragm and ventilator hose; Group 3: flushed ventilator diaphragm and ventilator hose; Group 4: autoclaved compact breathing system.

Identification of the lumbar interspinous spaces: palpation versus ultrasound.

Background: Palpation has been shown to be inaccurate at identifying lumbar interspinous spaces. Our goal in this study was to compare ultrasound imaging of the region to palpation.

Methods: Using ultrasound in the postpartum period, we estimated the interspinous level used for obstetric neuraxial anesthesia in 121 women and compared this estimation with the level estimated by palpation and documented in the chart by the anesthesiologist.

Determination of the ED95 for intrathecal plain bupivacaine combined with fentanyl in active labor.

Background: Combined spinal-epidural (CSE) analgesia is an effective technique for pain control in labor and is particularly useful in the active phase. Excessive doses of intrathecal bupivacaine may be associated with adverse effects. This study is designed to estimate the ED95 for intrathecal plain bupivacaine with fentanyl 15 microg in labor.

Complications of neuraxial anesthesia in an extreme morbidly obese patient for Cesarean section.

A morbidly obese patient presented for elective cesarean section. This case demonstrates the technical difficulties and potentially life-threatening complications encountered in attempting to locate an epidural space at a distance of over 11 cm from the skin. Ultrasound was used to aid in locating the space.

Influence of posture on the incidence of vein cannulation during epidural catheter placement.

Background And Objective: Epidural vein cannulation has long been recognized as a problem in parturients due to distension of epidural veins. Epidural vein engorgement is maximal when the pregnant woman is in the supine position and minimal in the lateral position. Following an initial observation of an apparently high incidence of epidural vein cannulation in the sitting position, a randomized trial was conducted to document whether such an association existed.