Wearable devices for tracking physical activity in the community after an acquired brain injury: A systematic review.

OBJECTIVE: The application of wearable devices in individuals with acquired brain injury (ABI) resulting from stroke or traumatic brain injury (TBI) for monitoring physical activity (PA) has been relatively recent. The current systematic review aims to provide insights into the adaption of these devices, the outcome metrics, and their transition from the laboratory to the community for PA monitoring of individuals with ABI. LITERATURE SURVEY: The PubMed and Google Scholar databases were systematically reviewed using appropriate search terms. A total of 20 articles were reviewed from the last 15 years. METHODOLOGY: Articles were classified into three categories: PA measurement studies, PA classification studies, and validation studies. The quality of studies was assessed using a quality appraisal checklist. SYNTHESIS: It was found that the transition of wearable devices from in-lab to community-based studies in individuals with stroke has started but is not widespread. The transition of wearable devices in the community has not yet started for individuals with TBI. Accelerometer-based devices were more frequently chosen than pedometers and inertial measurement units. No consensus on a preferred wearable device (make or model) or wear location could be identified, although step count was the most common outcome metric. The accuracy and validity of most outcome metrics used in the community were not reported for many studies. CONCLUSIONS: To facilitate future studies using wearable devices for PA measurement in the community, we recommend that researchers provide details on the accuracy and validity of the outcome metrics specific to the study environment. Once the accuracy and validity are established for a specific population, wearable devices and their derived outcomes can provide objective information on mobility impairment as well as the effect of rehabilitation in the community.

Streptococcus Gordonii Empyema: A Case Report and Review of Empyema.

Streptococcus gordonii (S. gordonii) is a pioneer oral bacteria that is recognized as an agent of bacterial endocarditis. However, an extensive review of the literature revealed no reported case of S. gordonii causing empyema. We present a case of a 65-year-old male who presented with respiratory distress. Physical examination revealed several dental caries with decreased breath sounds in the bibasilar regions. A computed tomography (CT) scan of the chest and abdomen demonstrated left-sided pleural effusion and a 4.3 cm x 2.8 cm splenic abscess. He received intravenous (IV) antibiotics, and his blood cultures remained negative. Drainage of the splenic abscess grew S. gordonii. A CT-guided thoracentesis yielded 450 ml of exudative fluid. Pleural fluid cultures grew S. gordonii. A CT scan of the head and neck ruled out an intra-oral abscess. He received six weeks of IV penicillin with a follow-up CT scan showing resolution of both the splenic abscess and the left parapneumonic effusion.

Nontuberculous Mycobacteria Lymphadenitis: A Case Report.

Atypical mycobacteria, also known as nontuberculous mycobacteria (NTM) includes acid-fast bacteria other than Mycobacterium tuberculosis. NTM can be isolated from a variety of environmental sources including water, food products, domestic animals, and soil; human exposure is typically from soil to the oral cavity and respiratory tract. Diagnosis of NTM is suspected in children less than five years old with subacute, unilateral, non-tender cervicofacial lymphadenitis in combination with a history of water exposure, penetrating injection, as well as negative routine cultures or response to antistaphylococcal and antistreptococcal antibiotics. The course of the disease is variable and can involve eruption of the lymph node and tract formation with drainage. Management of nontuberculous mycobacteria can include surgical and antimycobacterial therapy. We present a case of a two-year-old African American girl who presented to the clinic with anterior ear lobe and submandibular lymphadenitis due to suspected NTM.

A Case of Umbilical Endometriosis: Villar's Nodule.

Umbilical endometriosis is a fairly rare clinical entity with unclear pathogenesis. We report the case of a 27-year-old woman who presented with a painful umbilical mass and discharge. Imaging performed was inconclusive, and surgical excision of the site with margins revealed endometriosis on microscopic examination. The incidence of umbilical endometriosis, its pathogenesis, clinical manifestations, workup, and management are discussed.

Reduced GABAergic inhibition of kidney-related PVN neurons in streptozotocin-treated type 1 diabetic mouse.

Activity of presympathetic neurons in the paraventricular nucleus (PVN) of the hypothalamus is known to play an important role in the regulation of sympathetic outflow. Sympathetic overactivity is associated with many pathophysiological conditions such as diabetes mellitus and hypertension; however, the underlying synaptic mechanisms are poorly understood. In this study, we examined the GABAergic inhibitory synaptic control of kidney-related presympathetic PVN neurons in the streptozotocin-treated type 1 diabetic mouse model, using patch-clamp slice electrophysiology in combination with retrograde labeling. Type 1 diabetes resulted in decreased frequency of miniature inhibitory postsynaptic currents (mIPSCs). Our data also demonstrated a reduction of mIPSC amplitude and mean inhibitory current without alteration of input resistance. Furthermore, our data revealed decreased tonic GABAergic inhibition of kidney-related PVN neurons in diabetic conditions, which was consistent with the observed increased excitability of the presympathetic PVN neurons. In summary, our data demonstrated decreased phasic and tonic inhibitory control of kidney-related presympathetic PVN neurons that suggest altered sympathetic circuitry in type 1 diabetes.

Are pediatric interns prepared to perform infant lumbar punctures? A multi-institutional descriptive study.

BACKGROUND: There are few data describing pediatric interns' experiences, knowledge, attitudes, and skills related to common procedures. This information would help guide supervisors' decisions about interns' preparedness and training needs. OBJECTIVES: This study aimed to describe pediatric interns' medical school experiences, knowledge, attitudes, and skills with regard to infant lumbar punctures (LPs) and to describe the impact of these factors on interns' infant LP skills. METHODS: This prospective cross-sectional descriptive study was conducted at 21 academic medical centers participating during 2010. Participants answered 8 knowledge questions, 3 attitude questions, and 6 experience questions online. Skills were assessed on an infant LP simulator using a 15-item subcomponent checklist and a 4-point global assessment. RESULTS: Eligible interns numbered 493, with 422 (86%) completing surveys and 362 (73%) completing skills assessments. The majority 287/422 (68%) had never performed an infant LP; however, 306 (73%) had observed an infant LP during school. The mean (SD) knowledge score was 63% (±21%). The mean (SD) subcomponent skills checklist score was 73% (±21%). On the global skills assessment, 225 (62%) interns were rated as beginner, and 137 (38%) were rated as competent, proficient, or expert. Independent predictors of an above-beginner simulator performance included infant LP experience on a patient (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.4-3.5), a knowledge score greater than 65% (OR, 2.4; 95% CI, 1.5-3.7), or self-reported confidence (OR, 3.5; 95% CI, 1.9-6.4). CONCLUSIONS: At the start of residency, the majority of pediatric interns have little experience, poor knowledge, and low confidence and are not prepared to perform infant LPs.

Interns' success with clinical procedures in infants after simulation training.

BACKGROUND AND OBJECTIVE: Simulation-based medical education (SBME) is used to teach residents. However, few studies have evaluated its clinical impact. The goal of this study was to evaluate the impact of an SBME session on pediatric interns' clinical procedural success. METHODS: This randomized trial was conducted at 10 academic medical centers. Interns were surveyed on infant lumbar puncture (ILP) and child intravenous line placement (CIV) knowledge and watched audiovisual expert modeling of both procedures. Participants were randomized to SBME mastery learning for ILP or CIV and for 6 succeeding months reported clinical performance for both procedures. ILP success was defined as obtaining a sample on the first attempt with <1000 red blood cells per high-power field or fluid described as clear. CIV success was defined as placement of a functioning catheter on the first try. Each group served as the control group for the procedure for which they did not receive the intervention. RESULTS: Two-hundred interns participated (104 in the ILP group and 96 in the CIV group). Together, they reported 409 procedures. ILP success rates were 34% (31 of 91) for interns who received ILP mastery learning and 34% (25 of 73) for controls (difference: 0.2% [95% confidence interval: -0.1 to 0.1]). The CIV success rate was 54% (62 of 115) for interns who received CIV mastery learning compared with 50% (58 of 115) for controls (difference: 3% [95% confidence interval: -10 to 17]). CONCLUSIONS: Participation in a single SBME mastery learning session was insufficient to affect pediatric interns' subsequent procedural success.

Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department.

OBJECTIVE: The objective of this study was to investigate the impact of wound packing versus no wound packing on short-term failure rates and long-term recurrences after incision and drainage (I&D) of a simple cutaneous abscess. METHODS: In this randomized, single-blind, prospective study, subjects between the ages 1 and 25 years with skin abscesses needing an I&D were enrolled consecutively and randomized to be packed or not packed following the procedure. Treatment failure was assessed at a 48-hour follow-up visit by a masked observer who rated the need for a major intervention (repeat I&D or re-exploration) or minor intervention (antibiotics initiated or changed, need for packing, or repeat visit). Pain scores were assessed using color analog scales before and after the procedure and repeated at the 48-hour follow-up visit. Healing and abscess recurrence were assessed via telephone interview at 1 week and 1 month. RESULTS: Fifty-seven subjects were enrolled over a 15-month period. Overall failure rates were similar between the groups, with 19 (70%) of 27 subjects in the packed group needing an intervention by 48 hours compared with 13 (59%) of 22 subjects in the nonpacked group who needed an intervention (difference, 11%; 95% confidence interval, -15% to 36%). Major and minor intervention rates were also similar. Pain scores did not significantly differ between groups. CONCLUSIONS: Wound packing does not appear to significantly impact the failure or recurrence rates after simple I&D. Larger studies are needed to better validate the equivalency of these 2 strategies.