Rogue Regional Medical Center

Primary angiitis of the central nervous system (PACNS) usually presents with symptoms of headache, cognitive impairment, or stroke with a mean age of onset at 50 years. Inflammation of the cerebral vessels can cause narrowing, occlusion, or thrombosis resulting in tissue ischemia and necrosis of the involved vessel territory. Findings can be seen on Magnetic Resonance Imaging (MRI) scans of the brain and serological markers of inflammation are typically within normal limits. The nonspecificity of PACNS presents a challenge for accurate diagnosis and must be differentiated from secondary vasculitis and Reversible Cerebral Vasoconstriction Syndrome (RCVS). Cerebral angiography, even though having low sensitivity and specificity, could sometimes be the only diagnostic tool available.

Premature infants are not prepared developmentally, physically, or cognitively with the multiple survival skills of the typical newborn. To determine whether physical activity generated spontaneously by premature infants stretching against the resistance of "prepod" garments is as effective as exercises provided by therapists in slowing bone density loss. Preterm very low birth weight infants were placed in two nonrandomized parallel groups according to birth age. Infants routinely started in a traditional intense intervention setting and graduated to a special care section with private rooms that allowed parents to remain with their child. Healthy infants without medical complications, born between 28 and 32 wk postmenstrual age. The control group received traditional exercises. The experimental group wore a prepod almost 24 hr a day. Outcomes and Measures: An ultrasound of the tibia was obtained at 31 to 32 wk and 4 wk later. Weight gain, head circumference growth, and length of stay (LOS) were also measured. Although not statistically significant, the ultrasound results showed that the prepod group had less loss of bone density than the traditional therapy exercise group. The desired outcome was for pods to be as effective at reducing bone loss as traditional exercise, so the results exceeded expectations. The unexpected, and more notable, finding was a striking drop in LOS for the prepod group. Spontaneous exercise by premature infants decreases bone loss and LOS. Better bone health and increased developmental maturity increase the chances of a positive developmental outcome and save the hospital significant expense. What This Article Adds: The prepod is a simple, cost-effective, noninvasive treatment tool occupational therapy practitioners can use to support a premature infant's development. This study has considerable potential to affect how infants are served, both developmentally and financially.

The Accreditation Council for Graduate Medical Education Program Requirements (PRs) for Pediatrics require that residents be able to competently perform neonatal endotracheal intubation (NET).1 In this issue of Pediatrics, DeMeo et al2 defined competency as a 75% likelihood of intubation success; only a minority of residents (23%) were able to achieve competency during the study period. Four cumulative NET successes were needed to achieve competency; the median number of NET opportunities for their subjects, however, was 3 (range: 1–13). There are 2 lists of procedures in the current version of the PRs. The first list requires residents to “competently perform,” and the second list requires “competent understanding.” During the PR revision process, the Accreditation Council for Graduate Medical Education Residency Review Committee initially recommended that NET be moved to the second list of procedures. However, feedback from the pediatric community overwhelmingly urged the committee to move NET back to the first list. Advocates for preserving NET as a skill noted that some pediatricians will practice in remote areas, where they could be solely responsible for NET. Responding to the pediatric community, NET was moved … Address correspondence to Joseph Gilhooly, MD, 1900 SW River Dr, Unit 701, Portland, OR 97201. E-mail: gilhooly{at}ohsu.edu

A geriatric patient status post intraabdominal surgery presented with persistent diarrhoea and heavy intestinal methicillin-resistant Staphylococcus aureus (MRSA) growth after multiple courses of antibiotic therapy. Additionally, swab cultures of the anterior nares tested positive for MRSA. In order to impede infection and prevent future complications, the patient received a 10-day course of vancomycin oral solution 250 mg every 6 h, 15-day course of Saccharomyces boulardii 250 mg orally twice daily and a 5-day course of topical mupirocin 2% twice daily intranasally. Diarrhoea ceased during therapy and repeat cultures 11 days after initiating therapy demonstrated negative MRSA growth from the stool and nares. Further repeat cultures 5 months later revealed negative MRSA growth in the stools and minimal MRSA growth in the nares. Overall, enteral vancomycin and probiotics successfully eradicated MRSA infection without intestinal recurrence. Although the results were beneficial treating MRSA diarrhoea for our patient, these agents remain highly controversial.

This study describes and evaluates a structured program for orientation of new graduate registered nurses in a setting that has increased the number of new graduate RNs hired in recent years. It describes the elements of a supportive environment for new RNs and brings attention to the need to develop support and recognition of nurse preceptors, who are noted to be the cornerstone of support for new RNs as they make the transition from student to accomplished professional.

This advanced analysis describes how lumbosacral radiculopathy, lumbosacral spinal stenosis, and other diagnoses featuring low back pain may be determined using electrodiagnostic procedures. The chapter concludes with a list of indications that can help determine when these procedures may be useful, as well as some suggestions for when they may be unnecessary.