The results of thirty-five joint (hip or knee) replacements in nineteen patients who had an organ transplantation were retrospectively reviewed. The patients received a standard immunosuppressive ...induction regimen at the time of the transplantation and were maintained on a combination of prednisone, azathioprine, and cyclosporine A. All patients received antibiotics perioperatively, but antibiotic-impregnated bone cement was not used for any procedure. Six joint replacements, in three patients who were an average of 48.2 years old at the time of the arthroplasty, were performed before a renal transplantation. Twenty-four joint replacements, in fourteen patients who were an average of 40.9 years old at the time of the arthroplasty, were performed after an organ transplantation. Two patients, who were an average of 53.8 years old at the time of the arthroplasty, each had a joint replacement both before and after a liver transplantation (a total of five joint replacements). The average duration of follow-up from the first joint replacement was 8.8 years (range, one to twenty-three years). The Harris hip score or The Hospital for Special Surgery knee score was determined at the time of the latest follow-up examination. An infection developed around the implant in five patients who had had the joint replacement after a transplantation. The average interval from implantation of the prosthesis until detection of the infection was 3.4 years (range, one to six years). One patient who had a liver transplant was infected with Pseudomonas aeruginosa and another one was infected with Escherichia coli. One patient who had a renal transplant was infected with Staphylococcus epidermidis; one, with Enterococcus; and one, with Serratia marcescens. We found that patients who had a joint replacement after an organ transplantation had a very high risk of devastating infection. The rate of such infection was 19 per cent (five of twenty-seven joint replacements in sixteen patients).
Implicit Puritanism in American moral cognition Uhlmann, Eric Luis; Poehlman, T. Andrew; Tannenbaum, David ...
Journal of experimental social psychology,
March 2011, 2011-03-00, 20110301, 2011-03, Letnik:
47, Številka:
2
Journal Article
Recenzirano
Three studies provide evidence that the judgments and behaviors of contemporary Americans are implicitly influenced by traditional Puritan-Protestant values regarding work and sex. American ...participants were less likely to display traditional values regarding sexuality when implicitly primed to deliberate, as opposed to intuition and neutral primes. British participants made judgments reflecting comparatively liberal sexual values regardless of prime condition (Study 1). Implicitly priming words related to divine salvation led Americans, but not Canadians, to work harder on an assigned task (Study 2). Moreover, work and sex values appear linked in an overarching American ethos. Asian-Americans responded to an implicit work prime by rejecting revealing clothing and sexually charged dancing, but only when their American cultural identity was first made salient (Study 3). These effects were observed not only among devout American Protestants, but also non-Protestant and less religious Americans.
Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients ...with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/kg · d; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%–85%) of 97 cefixime recipients. At 10–14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.
The purpose of this study was to test predicted relationships between adult attachment and stress using subjective and physiological measures.
Sixty-seven healthy adults completed measures of adult ...attachment and perceived chronic stress. Subjective stress and the high-frequency (HF) and low-frequency (LF) spectral bandwidths of heart rate variability (HRV) were measured during a standardized stress protocol.
Attachment anxiety is associated with between-subject differences in chronic perceived stress (
P=.001) and subjective acute stress (
P=.01). There is a main effect of attachment avoidance on between-subject differences in HF HRV (
P=.004). Attachment avoidance is inversely associated with HF HRV, independent of age and variability in respiration.
Attachment anxiety is associated with self-reported distress. Attachment avoidance is inversely associated with HF HRV, a marker of vagal influence on cardiac activity, but is not associated with subjective stress.
Opportunities for residents in a family medicine program to experience continuity of care with a group of patients and to be immersed in the role of a family physician were thought by faculty to be ...insufficient.
To enhance residents' experience of continuity of care with a group of patients; to create a model for training that better simulates clinical practice; and to position core family medicine experiences as the central and continuing focus of the residency program.
The new curriculum replaces block rotations in family medicine with "horizontal" experiences comprising 3 half-days of patient care and 1 half-day seminar each week for all residents through both years of the program. The remaining time in first year is spent on the major disciplines--medicine, pediatrics, emergency, and obstetrics--for which a horizontal family medicine-centred experience has also been introduced. The second-year curriculum is flexible and largely self-directed. Initial evaluations indicate improved continuity of care of family practice patients and broadened clinical exposure for residents. The program has been fully accredited by the College.
A horizontal curriculum in family medicine, designed to address perceived deficiencies in the traditional block rotational model of training, can be developed and implemented in an urban teaching hospital.
To evaluate performance of optical coherence tomography (OCT) for detection of early glaucoma.
Observational case-control study.
Setting: University-based tertiary care center. Study Population: One ...eye from 50 normals, 42 glaucoma suspects, and 59 early glaucoma patients meeting the following criteria: visual field (VF) mean deviation ≥−6.00 dB, age ≥40 years, spherical refractive error ≤5 diopters, astigmatism ≤3 diopters, and visual acuity ≥20/30. Observation Procedure: Early glaucoma by VF (EGVF) was described as repeatable abnormal achromatic VFs based on predefined criteria. Glaucoma suspects (GS) were defined as presence of glaucomatous disk appearance with normal achromatic VFs. Outcome Measures: Average nerve fiber layer thickness (NFLT) and NFLT in each of four quadrants and 12 clock-hour sectors. Receiver operating characteristic curves and sensitivity and specificity were used to assess the performance of OCT.
Average NFLT was 128.4 ± 15.4, 102.0 ± 25.4, and 86.5 ± 31.5 μm in normal, GS, and EGVF eyes, respectively. Normal eyes were different from both glaucoma groups (P < .001); NFLT in the superior quadrant and at the 11 o'clock position had the highest area under the receiver operating characteristic curve (.840 and .933) in the GS and EGVF groups (P = .03). The sensitivity of the OCT for detection of glaucoma was 71% and 85% for the GS and EGVF groups with specificity fixed at 90%.
The OCT discriminates well between eyes with early perimetric glaucoma and normal eyes. However, its performance is less adequate in eyes with suspicious disk and normal VFs.
This uncontrolled study evaluates the efficacy of a combined treatment of medications (for the majority of patients) and a closed group, intensive (two-week) cognitive-behaviour therapy programme for ...heterogeneous groups of psychiatric patients. Five hundred and thirty-one patients at a private psychiatric clinic were included in the study. Self-report measures of depression, anxiety, self-esteem and “locus of control’ were administered before and after treatment and at intervals up to one year later. Statistically and clinically significant improvements were found in all measures and these improvements were maintained up to one year. The results provide support for the efficacy of the treatment.
Recent research about chronic benzodiazepine therapy leading to an increased risk of Alzheimer disease prompts a discussion about benzodiazepine cessation. Benzodiazepines and other types of ...sedative-hypnotics, such as Z-drugs, are no longer recommended for treating insomnia in older adults and are considered inappropriate. In addition to causing memory impairment, falls, fractures and motor vehicle accidents, data now show that sedative-hypnotics account for a substantial number of avoidable emergency department visits and hospital admissions. Even episodic use is associated with harm. Cognitive behavioural therapy is effective for treating chronic insomnia and facilitating benzodiazepine tapering in older adults. Maintaining good sleep hygiene and using a sleep diary to monitor sleep efficiency during or after benzodiazepine withdrawal can be helpful. Patients are often reassured by the knowledge that normal sleep architecture changes with age and that older adults can be expected to sleep for fewer hours each night and experience more awakenings but still feel restored and rested in the morning.
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