Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study.

Background: Central nervous system (CNS) infections are particularly prevalent in the adult neurocritical care patient population and are associated with significant morbidity and mortality. Factors relevant to the nature of CNS infections pose significant challenges to clinicians treating afflicted patients. Intraventricular (IVT) administration of antibiotics may offer several benefits over systemic therapy; however, the outcomes and current practices of such treatments are poorly described in the literature.

Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges.

Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes.

Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review.

Objectives: (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research.

Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013.

Study Selection: Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English.

Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation.

Background: Scapular dyskinesis is an abnormal scapular motion or position during active arm elevation. Dyskinesis is theorized to contribute to impingement syndrome by decreasing the subacromial space. A corrective maneuver of the scapular assistance test (SAT) proposes to increase scapular upward rotation and posterior tilt to increase the subacromial space.

Patient- and clinician-rated outcome measures for clinical decision making in rehabilitation.

Outcome measures can be classified as clinician rated and patient rated. Clinician-rated measures predominantly assess impairments, whereas patient-rated measures, also known as patient-based measures, are designed to evaluate the impact of the injury on a patient's daily activities, work, and recreation. Currently, there is a greater reliance on clinician-rated impairment measures for clinical decision making, specifically with treatment planning and assessing outcomes of care.

Ultrasonographic measures of subacromial space in patients with rotator cuff disease: A systematic review.

Purpose: Recently sonography (US) has been used to measure the subacromial space outlet with a linear measurement of the acromiohumeral distance (AHD). The purpose of this article is to systematically review the literature on the influence of rotator cuff disease (RCD) on AHD using US.

Methods: Computer-aided searches of databases were performed to identify comparative studies that measured US-generated AHD in adults with symptomatic RCD.

Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing.

Healthcare reform 2009 and its implications for pharmacists.

The US healthcare system has been widely criticized by many and praised by others for many reasons that are not mutually exclusive. There is no doubt that, compared with our peer industrialized countries, the US ranks near the bottom in many of the benchmark criteria such as life expectancy, infant mortality, and mortality of the population that is amenable to health care. Despite these shortcomings, the US has been a major innovator in healthcare technology including the development of biological and pharmacological drugs.

Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries.

Object: The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI.

Methods: Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers.

Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity.

Background And Purpose: Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with shoulder pain and functional loss.

Subjects And Methods: Subjects (N=40) with shoulder pain and functional loss were tested by measuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper trapezius, middle trapezius, and serratus anterior muscles.

A hypothesis-generating study to evaluate platelet activity in diabetics with chronic kidney disease.

BACKGROUND: It is well described that diabetes mellitus is a hypercoagulable state. It is also known that patients with renal dysfunction have impaired platelet aggregation and function. It is not well described how renal dysfunction affects the hypercoagulability associated with diabetes.

Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes.

Background: Platelet (PLT) transfusions are administered in cardiac surgery to prevent or treat bleeding, despite appreciation of the risks of blood component transfusion. The current analysis investigates the hypothesis that PLT transfusion is associated with adverse outcomes associated with coronary artery bypass graft surgery (CABG).

Study Design And Methods: Data originally collected during double-blind placebo-controlled phase III trials for licensure of Trasylol (aprotinin injection) were retrospectively analyzed.

Identification of Naegleria fowleri in domestic water sources by nested PCR.

The free-living amoeboflagellate Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis (PAM), a rapidly fatal disease of the central nervous system. In the United States, the disease is generally acquired while swimming and diving in freshwater lakes and ponds. In addition to swimming, exposure to N.

Partial breast brachytherapy after lumpectomy: low-dose-rate and high-dose-rate experience.

Purpose: The use of partial breast brachytherapy (PBB) after lumpectomy for selected patients with early-stage breast cancer reduces the adjuvant radiotherapy treatment time to <1 week. Despite the advantages of accelerated treatment, maintaining an acceptable cosmetic outcome is important. In a cohort of patients who received low-dose-rate (LDR) or high-dose-rate (HDR) PBB after lumpectomy, the clinical characteristics and treatment parameters were analyzed to identify predictors for an unfavorable cosmetic outcome.

Interventions in chronic pain management. 4. Medications in pain management.

Unlabelled: This self-directed learning module, which highlights pharmacologic approaches in the management of chronic pain, focuses on both traditional and nontraditional medications. It is part of the study guide on interventions in chronic pain management in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article highlights medication concepts, including the cyclooxygenase-2 inhibitors, opiate management of chronic pain, and neuropathic pain management; and it reviews some nontraditional approaches such as homeopathy and herbal remedies.

Congenital and acquired brain injury. 2. Brain injury rehabilitation: medical management.

Unlabelled: This self-directed learning module focuses on the importance of developing comprehensive problem lists and treatment plans for the patient with acute brain injury. It is part of the chapter on Congenital and Acquired Brain Injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on general medical management, interpretation of brain injury severity, cranial nerve dysfunction, acute changes in neurologic function, and treatment of spasticity.

Increased vascular endothelial cell production of interleukin-6 in severe preeclampsia.

Objective: The purpose of this study was to determine whether plasma from women with severe preeclampsia stimulates the production of endothelial cell interleukin-6 production and whether vitamin E could inhibit this process.

Study Design: Human umbilical vein endothelial cells were cultured in the presence of 5% plasma from women with severe preeclampsia (n = 12) or healthy pregnant women at term (n = 12), with or without 50 micromol/L vitamin E. Levels of interleukin-6 in plasma and human umbilical vein endothelial cell-conditioned media were measured by enzyme-linked immunosorbent assay.

Interstitial PO(2) determination by phosphorescence quenching microscopy.

Objective: This study introduces the technique of microinjection of phosphor probe into skeletal muscle tissue to determine oxygen tension (PO(2)) in the interstitium by phosphorescence quenching microscopy.

Method: The spinotrapezius muscle of Wistar-Kyoto rats weighing 240-280 g was surgically isolated and underwent the microinjection procedure. We measured the spatial distribution of phosphor probe 10, 30, and 80 minutes after injection; the tissue PO(2) at sites adjacent to arteriolar and venular microvessels; and the decline in tissue PO(2) during a 3-minute period of 8-Hz contraction.

Adjunctive rifampin therapy for central nervous system staphylococcal infections.

Objective: To review the published clinical data assessing the role of adjunctive rifampin therapy for the treatment of staphylococcal central nervous system (CNS) infections.

Data Sources: A MEDLINE search (January 1966-March 2000) of English-language literature pertaining to CNS staphylococcal infections and rifampin was performed; tertiary sources were also used.

Data Extraction: Human data and case reports were included, as no clinical trials have been published.

A review of self-report scales for the assessment of functional limitation and disability of the shoulder.

A shoulder disorder affects a patient's overall quality of life. Self-report outcome measures can be used to assess the effects of shoulder dysfunction in terms of patients' functional limitations and disabilities. Selection of a shoulder-specific scale from the numerous scales available can be overwhelming.