Design of an Evidence-Based "Second Victim" Curriculum for Nurse Anesthetists.

The "second victim" phenomenon--when a healthcare provider experiences adverse events because of the adverse events of a patient--is not well known or understood among healthcare professionals, including Certified Registered Nurse Anesthetists (CRNAs). No published research is currently available on the impact of second victim specifically in CRNAs, but it is known that second victim poses major challenges for healthcare professionals. Therefore, it is important to acknowledge its occurrence and to develop an educational curriculum based on the available evidence in order to promote peer and organizational support infrastructures. A comprehensive literature review was conducted, 6 educational domains on second victim were developed, and an expert panel validated the content.

Investigation of the anti-inflammatory, antinociceptive effect of ellagic acid as measured by digital paw pressure via the Randall-Selitto meter in male Sprague-Dawley rats.

Ellagic acid (EA), a dietary supplement, is purported to have anti-inflammatory, antinociceptive properties via cyclooxygenase (COX) inhibition. We measured the antinociceptive efficacy of EA alone and in combination with a nonselective COX inhibitor and a selective COX-2 inhibitor. We assigned 54 male Sprague-Dawley rats to 1 of 6 groups to be given the following compounds: (1) vehicle, (2) ketorolac (nonselective COX inhibitor), (3) meloxicam (selective COX-2 inhibitor), (4) EA, (5) EA plus ketorolac, and (6) EA plus meloxicam. Inflammatory pain was induced in the right hind paw by injecting carrageenan. Rats were given study compounds via intraperitoneal injection 30 minutes after paw injections. Pain tolerance was assessed using the Randall-Selitto instrument at 30 minutes and 4, 8, 12, and 24 hours. The highest pressure tolerated was recorded in grams. The analysis of variance suggested a significant difference (F = 2.44; P = .048). The least significant difference post hoc analysis suggested that at 8 hours, EA plus ketorolac provided greater antinociception than all other compounds (P = .04). Furthermore the combination of EA plus ketorolac provided longer antinociception than all other compounds (P = .03) such that EA plus ketorolac was effective at 24 hours.

Natalizumab therapy for moderate to severe Crohn disease in adolescents.

OBJECTIVES: This study evaluated the safety, tolerability, and efficacy of natalizumab, a humanized monoclonal immunoglobulin-G4 antibody to [alpha]4 integrin, in adolescent patients with moderately to severely active Crohn disease (CD). PATIENTS AND METHODS: In a single-arm study, 38 adolescent patients (ages 12-17 y) with active CD (Pediatric Crohn Disease Activity Index [PCDAI] >30) received 3 intravenous infusions of natalizumab (3 mg/kg) at 0, 4 and 8 weeks. The primary analysis was safety, assessed by adverse events, laboratory results, and vital signs. Pharmacokinetic and pharmacodynamic measurements and formation of anti-natalizumab antibodies also were analyzed. Efficacy outcomes were assessed by changes in PCDAI, quality of life (IMPACT III), and levels of C-reactive protein and serum albumin. RESULTS: Thirty-one patients (82%) received 3 natalizumab infusions. The most common adverse events were headache (26%), pyrexia (21%) and CD exacerbation (24%). Clinical response (> or =15-point decrease from baseline PCDAI) and remission (PCDAI < or =10) rates were greatest at week 10 (55% and 29%, respectively). Three patients (8%) tested positive for anti-natalizumab antibodies. The peak level (61.0 and 66.3 microg/mL) and half-life (92.3 and 96.3 h) of natalizumab were comparable after the first and third infusions. Mean [alpha]4 integrin receptor saturation was 93% at 2 hours and <40% at 4 weeks after the first and third infusions. Increase from baseline in circulating lymphocytes ranged from 106% to 122% at 2 weeks and 45% to 65% at 4 weeks after each infusion. CONCLUSION: Natalizumab (3 mg/kg) was well tolerated in these adolescent patients with active CD, with a safety and efficacy profile similar to that of adult natalizumab-treated CD patients. Future studies should evaluate long-term safety and efficacy.