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Journal of the American Academy of... Sep 2023For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular... (Review)
Review
For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.
Topics: Humans; Child; Names; Pelvis; Acetabulum; Orthopedic Surgeons; Orthopedics
PubMed: 37734040
DOI: 10.5435/JAAOSGlobal-D-23-00120 -
AANA Journal Jun 2024Aging leads to anatomic and physiologic changes in the brain, making it more sensitive to the depressant effects of anesthetic medications and increasing the risk of... (Review)
Review
Aging leads to anatomic and physiologic changes in the brain, making it more sensitive to the depressant effects of anesthetic medications and increasing the risk of postoperative neurocognitive complications such as postoperative delirium and postoperative cognitive dysfunction. This article explores the implications of anesthesia on elderly patients' brain health, emphasizing the heightened risk of postoperative neurocognitive disorders, and describes the BIS™ Monitoring System as a neuromonitoring tool for anesthesia professionals to assess the depth of anesthesia. The integration of the BIS Monitoring System into clinical practice can contribute to a more tailored and patient-centered approach to anesthesia management, ultimately improving perioperative outcomes and safety.
Topics: Humans; Aged; Nurse Anesthetists; Aged, 80 and over; Anesthesia; Monitoring, Intraoperative; Consciousness Monitors
PubMed: 38758719
DOI: No ID Found -
BMJ (Clinical Research Ed.) Feb 2024In 1863 the MP William Ewart suggested that "it might be practicable... to have inscribed on those houses in London which have been inhabited by celebrated persons, the...
In 1863 the MP William Ewart suggested that "it might be practicable... to have inscribed on those houses in London which have been inhabited by celebrated persons, the names of such persons." Accordingly, in 1867 the first such inscriptions, which came to be known as blue plaques, were put up by the Society of Arts, commemorating Lord Byron and Napoleon III at places in London where they had lived. The society put up 35 such plaques over the next 35 years when the scheme was taken over by the London County Council, which gave way to the Greater London Council in 1965 and finally English Heritage, in 1986. Among London's 1000 or so blue plaques several medical men and women, doctors, nurses, and other healthcare workers, are commemorated. They include Cecil Belfield-Clarke, Hannah Billig, Richard Bright, Edith Louisa Cavell, Henry Hallett Dale, Charles Darwin, Henry Havelock Ellis, Elizabeth Garrett Anderson, Thomas Hodgkin, William Hunter and his brother John, Joseph Lister, James Mackenzie, Rachel McMillan and her sister Margaret, William Marsden, Florence Nightingale, Ronald Ross, Mary Seacole, Hans Sloane, and George Frederick Still.
Topics: Humans; Female; Animals; London; Chickens; Cognition
PubMed: 38365279
DOI: 10.1136/bmj.q421 -
JAMA Network Open Nov 2023Communication failures in perioperative areas are common and have negative outcomes for both patients and clinicians. Names and roles of teammates are difficult to...
IMPORTANCE
Communication failures in perioperative areas are common and have negative outcomes for both patients and clinicians. Names and roles of teammates are difficult to remember or discern contributing to suboptimal communication, yet the utility of labeled surgical caps with names and roles for enhancing perceived teamwork and connection is not well studied.
OBJECTIVE
To evaluate the use of labeled surgical caps in name use and role recognition, as well as teamwork and connection, among interprofessional perioperative teammates.
DESIGN, SETTING, AND PARTICIPANTS
In this quality improvement study, caps labeled with names and roles were distributed to 967 interprofessional perioperative clinicians, along with preimplementation and 6-month postimplementation surveys. Conducted between July 8, 2021, and June 25, 2022, at a single large, academic, quaternary health care center in the US, the study comprised surgeons, anesthesiologists, trainees, and all interprofessional hospital staff who work in adult general surgery perioperative areas.
INTERVENTION
Labeled surgical caps were offered cost-free, although not mandatory, to each interested clinician.
MAIN OUTCOME AND MEASURE
Quantitative survey of self-reported frequency for name use and role recognition as well as postimplementation sense of teamwork and connection. The surveys also elicited free response comments.
RESULTS
Of the 1483 eligible perioperative clinicians, 967 (65%; 387 physicians and 580 nonphysician staff; 58% female) completed preimplementation surveys and received labeled caps, and 243 of these individuals (51% of physicians and 8% of staff) completed postimplementation surveys. Pre-post results were limited to physicians, due to the low postsurvey staff response rate. The odds of participants reporting that they were often called by their name increased after receiving a labeled cap (adjusted odds ratio [AOR], 13.37; 95% CI, 8.18-21.86). On postsurveys, participants reported that caps with names and roles substantially improved teamwork (80%) and connection (79%) with teammates. Participants who reported an increased frequency of being called by their name had higher odds for reporting improved teamwork (AOR, 3.46; 95% CI, 1.91-6.26) and connection with teammates (AOR, 3.21; 95% CI, 1.76-5.84). Free response comments supported the quantitative data that labeled caps facilitated knowing teammates' names and roles and fostered a climate of wellness, teamwork, inclusion, and patient safety.
CONCLUSIONS AND RELEVANCE
The findings of this quality improvement study performed with interprofessional teammates suggest that organizationally sponsored labeled surgical caps was associated with improved teamwork, indicated by increased name use and role recognition in perioperative areas.
Topics: Adult; Humans; Female; Male; Surveys and Questionnaires; Physicians; Communication; Self Report
PubMed: 37976068
DOI: 10.1001/jamanetworkopen.2023.41182 -
Seizure Nov 2023To describe the evolution in use and cost of antiseizure medications (ASM) in the United States of America (USA).
OBJECTIVE
To describe the evolution in use and cost of antiseizure medications (ASM) in the United States of America (USA).
METHODS
Retrospective descriptive study using the IBM MarketScan Commercial Database (data of privately-insured patients) for the years 2006 to 2021. We identified patients with epilepsy who were on ASM. We adjusted cost for inflation with the Gross Domestic Product Implicit Price Deflator.
RESULTS
We evaluated 347,158 patients (46.9 % males; median (p-p) age: 33 (17-49) years; 28 % with pediatric-onset epilepsy and 72 % with adult-onset epilepsy) with a total of 1,385,382 person-years and 588,285,065 ASM prescription days. The most commonly prescribed (as percentage of prescription days) ASMs in 2006 were valproate (18 %) and lamotrigine (17 %) in pediatric-onset epilepsy and phenytoin (21 %) and carbamazepine (17 %) in adult-onset epilepsy, but starting in the 2010s, levetiracetam and lamotrigine became the most commonly prescribed ASMs in both pediatric-onset (in 2021, levetiracetam 25 %, lamotrigine 16 %) and adult-onset (in 2021, levetiracetam 27 %, lamotrigine 20 %) epilepsy. The proportion of generic ASM use increased 3.6-fold: from 23 % of prescription days in 2006 to 83 % of prescription days in 2021. The median (p-p) average wholesale price (AWP) per person-year increased by 102 % from $2,684 ($990-$5,509) in 2006 to $5,417 ($2,858-$12,310) in 2021. The increases were greater in absolute terms for brand-name ASMs by 419 %: $3,109 ($1,564-$5,068 in 2006 and $16,149 ($12,950-$23,377) in 2021 than for generic ASMs by 462 %: $699 ($457-$1,678) in 2006 and $3,931 ($2,618-$6,081) in 2021. The costs directly borne by the patient (copay, coinsurance, deductibles, and pharmacy processing fees) increased by 69 % for brand-name ASMs from $393 ($246-$570) in 2006 to $665 ($335-$1,308) in 2021, but decreased by 37 % for generic ASMs from $147 ($98-$213) in 2006 to $92 ($51-$141) in 2021.
CONCLUSIONS
The median cost of ASMs per person-year approximately doubled from 2006 to 2021. The increase in use of generic ASMs probably helped buffer the growing costs of ASMs. However, generic ASMs already represent 83 % of prescription days in 2021, with limited room to further contain costs by just increasing the proportion of generics.
Topics: Adult; Male; Child; Humans; Female; Lamotrigine; Levetiracetam; Retrospective Studies; Phenytoin; Drugs, Generic; Epilepsy; Anticonvulsants
PubMed: 37832279
DOI: 10.1016/j.seizure.2023.10.005 -
Journal of Ethnopharmacology May 2024Witches in Western Europe are associated with the use of medicinal, abortifacient, hallucinogenic, and toxic plants. Curiously, these associations are not backed up by...
ETHNOPHARMACOLOGICAL RELEVANCE
Witches in Western Europe are associated with the use of medicinal, abortifacient, hallucinogenic, and toxic plants. Curiously, these associations are not backed up by first-hand evidence and historians are unconvinced that people convicted as witches were herbalists. Local plant names provide an untapped source for analysing witchcraft-plant relationships.
AIM OF THE STUDY
We analysed vernacular plant names indicating an association with witches and devils to find out why these species and witchcraft were linked.
MATERIALS AND METHODS
We constructed a database with vernacular names containing the terms witch and devil in related north-west European languages. The devil was added because of its association with witchcraft. The plant species' characteristics (e.g., medicinal use, toxicity) were assessed to determine if there were non-random associations between these traits and their names.
RESULTS
We encountered 1263 unique vernacular name-taxa combinations (425 plant taxa; 97 families). Most species named after witches and/or devils were found within the Asteraceae, Ranunculaceae, and Rosaceae. For Dutch, German and English we confirmed associations between witchcraft names and toxicity. Hallucinogenic plants do not appear to be associated with witch-names. For Dutch, we found significant associations between plant names and medicinal and apotropaic uses, although we did not find any association with abortifacient qualities.
CONCLUSIONS
This study demonstrates that there is a wide variety of plants associated with witches and the devil in north-western Europe. Plant names with the terms witch and devil were likely used in a pejorative manner to name toxic and weedy plants, and functioned as a warning for their harmful properties. Our study provides novel insights for research into the history of witchcraft and its associated plant species.
Topics: Humans; Plants, Medicinal; Europe; Asteraceae; Plant Weeds; Abortifacient Agents; Ethnobotany
PubMed: 38307353
DOI: 10.1016/j.jep.2024.117804 -
Journal of the History of the... 2023In 1949, William Stewart Alexander (1919-2013), a young pathologist from New Zealand working in London, reported the neuropathological findings in a 15-month-old boy who...
In 1949, William Stewart Alexander (1919-2013), a young pathologist from New Zealand working in London, reported the neuropathological findings in a 15-month-old boy who had developed normally until the age of seven months, but thereafter had progressive enlargement of his head and severe developmental delay. The most striking neuropathological abnormality was the presence of numerous Rosenthal fibers in the brain. The distribution of these fibers suggested to Alexander that the primary pathological change involved astrocytes. In the next 15 years, five similar patients were reported, and in 1964 Friede recognized these cases reflected a single disease process and coined the eponym "Alexander's disease" to describe the disorder. In the 1960s, electron microscopy confirmed that Rosenthal fibers were localized to astrocytes. In 2001, it was shown that Alexander disease is caused by mutations in the gene encoding glial fibrillary acidic protein, the major intermediate filament protein in astrocytes. Although the clinical, imaging, and pathological manifestations of Alexander disease are now well known, few people are familiar with Alexander's career. Although he did not make a further contribution to the literature on Alexander disease, his observations and accurate interpretation of the neuropathology have justified the continued use of the eponym "Alexander disease."
Topics: Male; Humans; Infant; Alexander Disease; Eponyms; Brain; Mutation; Astrocytes
PubMed: 37000960
DOI: 10.1080/0964704X.2023.2190354 -
Oral and Maxillofacial Surgery Jun 2024Sublingual varicose veins are a common vascular lesion with different names, such as caviar tongue or vascular malformations. This study aimed to investigate whether...
PURPOSE
Sublingual varicose veins are a common vascular lesion with different names, such as caviar tongue or vascular malformations. This study aimed to investigate whether there is an association between sublingual varicose veins and cardiovascular diseases by observing arterial hypertension, diabetes, thrombosis, and infarction. In addition, to evaluate a series of thrombi that affected the oral cavity and to analyze their clinical aspects and relate them to possible systemic alterations.
METHODS
This is a cross-sectional study consisting of a sample of 134 varicosities, 23 vascular malformations, and 4 thrombosis.
RESULTS
Lingual varicosities are more frequently observed in women aged 57.4 ± 16.4 years. Hypertension was present in lingual varicosities (n = 73), as well as diabetes (n = 107), reports of thrombosis (n = 41), and infarction (n = 45). Arterial hypertension was decompensated (n = 12). The most frequent underlying diseases were diabetes (p < 0.001), infarction (p = 0.012), and thrombosis (p = 0.004), and the most commonly used drug was losartan.
CONCLUSION
It can be inferred from the present study that lingual varicosities are related to cardiovascular diseases and can serve as a parameter to measure their decompensation.
Topics: Humans; Varicose Veins; Cross-Sectional Studies; Female; Middle Aged; Male; Hypertension; Aged; Adult; Thrombosis; Mouth Floor; Tongue; Aged, 80 and over
PubMed: 38112971
DOI: 10.1007/s10006-023-01202-1 -
Epilepsy & Behavior : E&B Feb 2024Epilepsy is a complex condition and seizures are only one part of this disease. The move from pediatric to adult healthcare system proves difficult for many adolescents...
RATIONALE
Epilepsy is a complex condition and seizures are only one part of this disease. The move from pediatric to adult healthcare system proves difficult for many adolescents with epilepsy and their families. The challenges increase when patients have epilepsies associated with intellectual and/or developmental disabilities, autism spectrum disorder, and motor disorders. Knowledge and system gaps may exist between the two systems, adding to the challenges. The main goal of this study is to understand the perception of patients with epilepsy and their families who were preparing to move from pediatric to adult healthcare system or had already moved.
METHODS
A survey was distributed to patients/caregivers of patients with epilepsy through patient support groups in North America and in-person through the 2019 Epilepsy Awareness Day at Disneyland. Patients were required to be 12 years or older at the time of the survey and were divided into two groups: those between 12 and 17 years and those 18 years or older. Caregivers answered on behalf of patients who were unable to respond (e.g., intellectual disability). Major components of the survey included demographics, epilepsy details, quality and access to care received in pediatric and adult years, and questions regarding transition and readiness.
RESULTS
Responses were received from 58 patients/caregivers of patients with epilepsy from Canada and the United States. In group A (patients between 12 and 17 years), none of the 17-year-old patients were spoken to about transition. Patients (caregivers) with epilepsy and intellectual and/or developmental disabilities (IDD) had less time to discuss important things during the transition/transfer phase than patients with normal intelligence. Finally, there was a statistically significant difference observed in access to specialty care reported in the adult years, compared to the years in the pediatric system. In the group B (patients 18 years and older) a) 35 % still visit their family doctor for epilepsy related treatment despite the majority being on 2 or more antiseizure medications (ASMs); b) 27 % of patients in this group were still being followed by their pediatric neurologist; c) one patient received care only through visits to the emergency department; d) only 4 % felt that they received clear instructions during transfer of care such as knowing the name of the adult healthcare practitioner and/or the name of the care institution they were being transferred to.
CONCLUSIONS
This study highlights the lack of appropriate transition to adult healthcare system (AHCS) amongst an unselected group of patients with epilepsy in Canada and United States. An overwhelming majority of patients followed in the community and in academy centers were simply "transferred" to an adult health practitioner, or they remained under the care of pediatricians. Finally, most patients lack access to significant social and medical support after moving to the AHCS.
Topics: Humans; Child; Adult; Adolescent; Pilot Projects; Autism Spectrum Disorder; Epilepsy; Delivery of Health Care; Neurologists
PubMed: 38219605
DOI: 10.1016/j.yebeh.2024.109624