Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients: a systematic review.

Patients in Intensive Care Unit (ICU) often require sedatives which commonly include midazolam and the more recently developed α2-receptor agonist, dexmedetomidine. It was our aim to compare the sedative and clinical effectiveness of dexmedetomidine vs midazolam in adults admitted to ICU, using an objective appraisal of randomized control trials. Medline, Embase, SCOPUS, Web of Knowledge, Cinhal, the United States National Library of Medicine, and the Cochrane Database of Systematic Reviews were searched using keywords: 'dexmedetomidine', 'midazolam', and 'intensive care'. These were limited to human studies and adults (>18 yr old). Six randomized controlled trials were found and were critically appraised using a standardized appraisal method. Two papers described the time spent by each intervention group within a specified target sedation range and both found no statistically significant difference between midazolam and dexmedetomidine (P=0.18 and P=0.15). A third paper found no statistically significant difference in the length of time that patients were sedated within a target zone (P=0.445). Two additional pilot studies did not report P values as they were insufficiently statistically powered. A final paper found that, of the eight occasions measured, patients on dexmedetomidine were more often within the target sedation range than patients on midazolam. The sedative benefits of dexmedetomidine vs midazolam remain inconclusive. While some secondary outcomes showed clinical effectiveness of dexmedetomidine, more research is needed to validate the findings of these studies.

Juvenile fibromyalgia syndrome: proposed management using a cognitive-behavioral approach.

In recent years, fibromyalgia has become an increasingly recognized chronic syndrome. Although it occurs more frequently in adults, it is also seen among school-age children and adolescents. In such cases, it is known as juvenile fibromyalgia syndrome (JFS). The widespread pain and other possible symptoms associated with JFS can have a negative impact on the occupational performance and developmental tasks of children and adolescents. As experts in the areas of occupational performance, daily functional skills, and child development, occupational therapists have a potential role to play in the assessment and management of children and adolescents with JFS. To date, however, no occupational therapy management approach for clients with JFS has been documented in the professional literature. In this paper, we outline the clinical features of JFS, pertinent assessment areas, and potential management strategies using a cognitive-behavioral approach.

Replication research: a purposeful occupation worth repeating.

It is common for researchers to request at the end of their published studies, the urgency for further studies to be completed. Unfortunately there are very few published studies that have replicated original studies. The purpose of this article is to provide a framework for understanding issues related to replication research that will assist occupational therapy researchers, clinicians, managers, students and educators to realize the importance of implementing and publishing replication research to establish evidence-based practice. Various areas related to replication research are explored. In addition, a computerized literature search using the search term 'replication' was completed. Only four articles published between 1982-1998 were discovered. This article concludes with recommendations to ensure replication studies are included in the occupational therapy literature and utilized in clinical practice.

Relationship of uterine blood flow to chorionic sac and embryo growth rates.

The embryonic period of development is characterized by marked variability in the rate of embryonic growth and development. Differences in uterine blood flow may explain this variability. We investigated the relationship between uterine artery blood flow volume (VOL), uterine artery pulsatility index (UA-PI), uterine artery resistance index (UA-RI), spiral artery pulsatility index (SA-PI), spiral artery resistance index (SA-RI), chorionic sac diameter (CSD), and crown-rump length (CRL) during 321 first trimester vaginal colour Doppler ultrasound examinations of 94 delivered or continuing pregnancies. After correcting for the confounding effect of gestational age, subject, and serum hormone levels by Analysis of Covariance, CRL was related to UA-PI (P = 0.025) and UA-RI (P < 0.001), but not to VOL, SA-PI, or SA-RI. No relationship was found between CSD and any uterine blood flow variables. Serum oestradiol levels were related to CSD and CRL (P < 0.001). No relationship was found to progesterone, maternal age, parity, or previous abortion. We conclude that differences in uterine blood flow and serum oestradiol explain some of the variability in the rate of embryo growth during the first 12 gestational weeks.

The male minority: Job satisfaction of men in occupational therapy.

Occupational therapy is a female dominated profession: only 3% of all clinicians are men. The purpose of this investigation was to identify variables that affect the job satisfaction of male occupational therapists. Specifically, the study examined five job satisfaction factors (work, pay, coworkers, supervision, and promotional opportunities), work environment traits, community role strain, colleague role strain, patient role strain, role ambiguity, role conflict, role overload, and specific demographic characteristics of male occupational therapists. A mailed survey questionnaire was sent to all male clinicians who were members of the Canadian Association of Occupational Therapists (n = 199) during the 1990-1991 membership year. Eighty-three percent of the sample responded (n = 164). Of these, 74% said they expect to leave the occupational therapy profession within 10 years. Most male occupational therapists reside in Ontario, are 33 years old, work with an adult client case load in a general hospital setting, and spend half their time in direct client care. Respondents indicated that, as a group, they are very dissatisfied with their work, pay, promotional opportunities, supervision, and coworkers. Male occupational therapists rated their work environments as above average in terms of physical comfort, but below average for control. As a group, male occupational therapists experience an average level of community, colleague, and patient role strain. Similarly, they experience an average degree of role conflict and role overload, but reported a low level of role ambiguity. Significant predictors of respondents' global job satisfaction were examined by multiple regression analysis. Five factors were determined to be significant predictors of global job satisfaction: community role strain, number of hours of overtime worked on a weekly basis, involvement, year of graduation from professional training, and colleague role strain. Recommendations for occupational therapy personnel and future research are made based on these results.

Effect of standing on non-pregnant uterine blood flow.

Uterine artery blood flow measurements made solely in the recumbent position may miss physiological changes that occur while patients are upright. We evaluated the effect of standing on the minute blood flow volume of the ascending uterine artery, the pulsatility index (PI), resistance index (RI) and waveforms and on the PI and RI of the myometrial spiral arteries and waveforms at 3-8 and at 9-14 min standing in 74 non-pregnant women. At 9-14 min, the uterine artery blood flow volume had decreased by an average of 34% and the RI had significantly increased in 70% of subjects. Decreased uterine artery blood flow volume was associated with increased distal resistance and with decreased vessel diameter, possibly due to stretching or kinking of the uterine arteries. Changes in the spiral artery PI paralleled changes in the uterine artery PI at 9-14 min, but were less pronounced. Spiral artery PI and RI were not related to the uterine artery blood flow volume while women were recumbent, although they were significantly related while women were standing. The effects of age, uterine mobility and uterine position on uterine artery or spiral artery blood flow were apparent only while women were standing. We conclude that standing as well as recumbent studies are necessary when uterine and myometrial blood flow are evaluated, and that uterine flow volume per minute should be measured whenever possible.

Predictors of burnout for psychiatric occupational therapy personnel.

Burnout is inherent in many health care professions. This research investigation was conducted to determine if burnout existed at significant levels and if a relationship between burnout, work environment factors and demographic characteristics existed among a group of psychiatric occupational therapy personnel. The study design was a descriptive survey format utilizing mailed questionnaires. Eighty-nine respondents completed the Maslach Burnout Inventory, the Work Environment Scale and a demographic questionnaire. A series of regression analyses were performed. The results indicated that the following were significant predictors of burnout: work involvement, a large percentage of clients on one's caseload diagnosed with schizophrenia, work pressure, age, income level, the length of time working in psychiatric occupational therapy, caseload size and the amount of overtime performed on a weekly basis. Implications for psychiatric occupational therapy practice are discussed and recommendations for future research are made.

Personality characteristics of occupational therapy students and clinicians.

Various occupational groups are often viewed as having a set of distinctive personality characteristics. The purpose of this study was to examine the personality traits of five subject groups: occupational therapy students in first, second, third and fourth years (N = 60) at the School of Rehabilitation Therapy at Queen's University, and practicing occupational therapy clinicians from the Kingston area (N = 22). The Personality Research Form-E (PRF-E) was used to collect the data. As a combined group, students and clinicians were not distinguishable from the general population in terms of personality. For students notable correlation scores (p. 01) between the year of study and the obtained PRF-E scores were observed on two scales: endurance (r = -0.31) and nurturance (r = -0.41). Analysis of variance indicated statistically significant differences (p .01 and p .05) between fourth year students and clinicians on certain personality variables. Fourth year students scored higher on the abasement, affiliation, change, nurturance, play and social recognition scales. Clinicians obtained higher scores for endurance and harm avoidance.

Salmonella saint-paul infection in two dairy herds.

An outbreak of salmonellosis due to Salmonella saint-paul in two dairy herds was first detected during routine examination of calves soon after calving; infection reached 100% amongst calves and up to 60% amongst milking cows. Excretion by cows continued for over 12 months and by calves for up to 18 months. The most important factor in controlling the spread of infection was reduction of environmental contamination by removal of carriers, prompt antibiotic treatment of sick calves and reduction in stocking densities.

Salmonella saint-paul infection in calves.

A natural outbreak of Salmonella saint-paul infection in two Institute herds was monitored clinically, bacteriologically and immunologically. This paper describes the findings in calves. Morbidity and mortality became apparent 30 days after S. saint-paul was first isolated on routine sampling of neonatal calf faeces. All heifer calves were treated with a tetracycline or ampicillin preparation when they showed clinical signs of disease, while the effects of intradermal vaccination with heat-killed S. saint-paul were assessed in a proportion of the bull calves. Antibiotic treatment reduced mortality and the number of persistent excretors; vaccination did not affect mortality but, if given during the first week of life, reduced the duration of faecal excretion. Calves which were untreated and unvaccinated, or vaccinated when older than 16 days, excreted S. saint-paul for periods of up to 18 months. Of six 'recovered' calves, which had been negative on faecal culture for 5-8 weeks, four yielded S. saint-paul at necropsy. Agglutinating antibody titres were highest in those unvaccinated calves which were persistent excretors.

Protection of cattle against experimentally induced salmonellosis by intradermal injection of heat-killed Salmonella dublin.

A single intradermal dose (7.5 mg) of heat-killed Salmonella dublin protected two out of three cattle against intravenous challenge with live S dublin. A second dose of 8 mg increased the protection rate to six out of seven. Four of the survivors had transient diarrhoea and S dublin was recovered from the carcases of four killed at four to 21 weeks after infection. Protected animals had elevated serum antibody titres and their serum passively protected rats against intraperitoneal challenge. The resistance of vaccinated cattle, presumably immunological in character, was not associated with leucocyte migration inhibition by salmonella antigen, depression of serum iron levels or haematological changes.

Transmission of Salmonella mbandaka to cattle from contaminated feed.

Salmonella mbandaka was isolated from cattle on three dairy farms. The duration of infection was less than four weeks and none of the animals became clinically ill. The animals had all consumed a diet containing a vegetable fat supplement contaminated with S. mbandaka and this was shown to be the source of the infections. It is significant that a feed containing purely vegetable components was incriminated.

Responses of fluke-infected and fluke-free cattle to experimental reinfection with Salmonella dublin.

Cattle, aged nine to 18 months, were given sublethal doses of Salmonella dublin either intravenously, orally on two occasions, or by contact for 19 to 22 weeks with a persistent excretor. When challenged by intravenous injection of 10(9) S dublin at 10 to 22 weeks after their first exposure to S dublin 22 out of 36 animals survived. All similarly challenged cattle, which had not been previously exposed to S dublin, died. Infection with Fasciola hepatica did not alter the ability of cattle to survive reinfection with S dublin but the bacteria persisted in the tissues and were excreted in the faeces of fluke-infected animals for longer than in fluke-free animals. The ability to survive reinfection and to eliminate S dublin from the tissues was apparently unrelated to agglutinating antibody titres or delayed hypersensitivity.

Crossed immunoelectrophoresis and crossed-line immunoelectrophoresis of Salmonella dublin antigens.

Crossed immunoelectrophoresis and crossed-line immunoelectrophoresis were used to detect 62 antigens in extracts of sonicated Salmonella dublin against an homologous anti-serum. Comparison with six extracts of closely related bacteria showed that all but two of these antigens cross-reacted with at least one other extract.

Antibacterial activity in colostrum and milk associated with protection of piglets against enteric disease caused by K88-positive Escherichia coli.

Piglets suckled by dams that had been vaccinated with K88 antigen were significantly more resistant to deaths caused by neonatal diarrhea after challenge with a large dose of a K88-positive enteropathogenic strain of Escherichia coli than piglets suckled by control dams. The factors most likely to be involved in protection of the piglets were investigated by comparing the antibacterial activities of serum and mammary secretions from the two groups of dams. Vaccination stimulated the production of K88 antibodies, which were associated with anti-adhesive activity directed against the adhesive properties of the K88 antigen, and of O8 antibodies; the latter antibodies were attributed to traces of O8 antigen in the vaccine. Neutralizing activity against heat-labile enterotoxin was present in several dams before vaccination but was not stimulated by bacteriostatic activities were similar in serum and mammary secretions from both groups of dams and appeared to play no significant role in the protective after parturition were atrributed to exposure of the dams to the challenge strain excreted by the piglets. It was concluded that neutralization of the adhesive properties of K88 antigen by K88 antibodies in colostrum and in milk contributed significantly to the protection of piglets from vaccinated dams. However, the contribution of antibacterial activities associated with the greater levels of O8 antibodies in colstrum from the vaccinated group cannot be entirely excluded.