Access-Site Complications in Mechanical Thrombectomy for Acute Ischemic Stroke: A Review of Prospective Trials.

BACKGROUND: A shift has occurred in interventional cardiology from transfemoral to transradial access due to a 70%-80% decrease in complications. This shift has not yet taken place in other interventional specialties, perhaps owing to the lack of generalizability of findings in the cardiology data. PURPOSE: Our aim was to assess data from the recent mechanical thrombectomy prospective trials to better understand the access-site complication rate. DATA SOURCES: Articles were systematically sourced from the National Center for Biotechnology Information PubMed archive. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, prospective, randomized controlled trials published after 2008 with mention of major and/or minor femoral access-site complications in neuroendovascular mechanical thrombectomies were included. DATA ANALYSIS: Major and minor femoral access-site complications were extracted. A total complication rate was calculated with major access-site complications alone and combined with minor access-site complications. DATA SYNTHESIS: Seven prospective studies of 339 total screened met the inclusion criteria. Eleven major access-site complications were identified in of 660 total interventions, revealing a major access-site complication rate of 1.67% for patients undergoing mechanical thrombectomy with transfemoral access. If minor access-site complications were included, 35 total incidents were detected in 763 interventions, resulting in a total complication rate of 4.59%. LIMITATIONS: Multiple unspecified vessel and procedure-related complications were mentioned in the studies. CONCLUSIONS: The overall rate of major access-site complications was 1.67% in this review, which is not low and poses a risk to patients. We suggest further investigation into the feasibility and complication rates of alternative access sites for neurointerventional procedures.

Protection, participation and protection through participation: young people with intellectual disabilities and decision making in the family context.

BACKGROUND: Research suggests that persons with intellectual disabilities (ID) are expected to be more compliant than persons without disabilities and that expectations for compliance begin in childhood. No study, however, seems yet to have included a primary focus on the participatory rights, or rights to express opinions, desires and preferences and to be heard and taken seriously in decision making among young people with ID who are not yet considered legally adult. The purpose of the two current studies was to explore how the right to participation is negotiated for young people with ID in a family context and to determine family members' recommendations for strategies to facilitate the participation of young people with ID. METHOD: In the first study, four young people with ID, their mothers and two siblings from four families took part in semi-structured interviews about decision making in the family context. In the second study, a mother and daughter from the first study discussed and developed strategies to promote participation for young people with ID. RESULTS: In the first study, all participants communicated that young people with ID follow an age-typical yet restricted pattern of participation in decisions about their lives. Young people's participation was consistently framed by familial norms and values as well as their families' desire to protect them. In the second study, both participants suggested communication about the outcomes of real or imagined decisions would help young family members rehearse decision-making strategies that would facilitate their autonomy while remaining within the bounds of familial norms, values and perceptions of safety. CONCLUSIONS: Although young people with ID may make fewer independent decisions about their lives than typically developing peers, support in decision making can enable both increased protection and independence.

Spatial and temporal variations in Pb concentrations and isotopic composition in road dust, farmland soil and vegetation in proximity to roads since cessation of use of leaded petrol in the UK.

Results are presented for a study of spatial distributions and temporal trends in concentrations of lead (Pb) from different sources in soil and vegetation of an arable farm in central Scotland in the decade since the use of leaded petrol was terminated. Isotopic analyses revealed that in all of the samples analysed, the Pb conformed to a binary mixture of petrol Pb and Pb from industrial or indigenous geological sources and that locally enhanced levels of petrol Pb were restricted to within 10 m of a motorway and 3 m of a minor road. Overall, the dominant source of Pb was historical emissions from nearby industrial areas. There was no discernible change in concentration or isotopic composition of Pb in surface soil or vegetation over the decade since the ban on the sale of leaded petrol. There was an order of magnitude decrease in Pb concentrations in road dust over the study period, but petrol Pb persisted at up to 43% of the total Pb concentration in 2010. Similar concentrations and spatial distributions of petrol Pb and non petrol Pb in vegetation in both 2001 and 2010, with enhanced concentrations near roads, suggested that redistribution of previously deposited material has operated continuously over that period, maintaining a transfer pathway of Pb into the biosphere. The results for vegetation and soil transects near minor roads provided evidence of a non petrol Pb source associated with roads/traffic, but surface soil samples from the vicinity of a motorway failed to show evidence of such a source.

Process dissociation of sight vocabulary and phonetic decoding in reading: a new perspective on surface and phonological dyslexias.

Recent research on developmental dyslexia has suggested a phonological core deficit hypothesis (e.g., Manis, Seidenberg, Doi, McBride-Chang, & Peterson, 1996; Stanovich, Siegel, & Gottardo, 1997) whereby pure cases of developmental phonological dyslexia (dysfunctional phonetic decoding processing but normal sight vocabulary processing) can exist, but pure cases of developmental surface dyslexia (dysfunctional sight vocabulary processing but normal phonetic decoding processing) should not. By applying Jacoby's (1991) and Lindsay and Jacoby's (1994) process dissociation procedure to the reading of regular and exception words, we present a method that serves to estimate readers' reliance on sight vocabulary and phonetic decoding during real word recognition. These reliance estimates are then used in Castles and Coltheart's (1993) regression-based approach to identify normal readers and developmental dyslexics. This new method: (1) allows one to explore normal reading acquisition and both the delay and deviance accounts of developmental dyslexia, (2) provides an alternative to matching dyslexics to both chronological-age and reading-age control groups, and (3) uses only real words. We present evidence that pure cases of developmental surface dyslexia can be obtained with both Castles and Coltheart's measure as well as our own, and that developmental surface dyslexia is not simply a delayed reading deficit. The theoretical importance and utility of estimates of reliance on sight vocabulary and phonetic decoding is discussed.

Preparing medical students for the changing healthcare environment in United States.

Future graduates of medical schools in the United States will practice in healthcare environments increasingly predominated by managed care. Thus allopathic and osteopathic undergraduate and postgraduate residency training programs should begin to revise their respective curricula and conduct training in managed healthcare environments to prepare graduates for practice in managed care settings. The demand for curricular revision in medicine comes not only from prospective employers and government agencies, but from students and graduates. Educators, clinicians, and government officials have recently defined core competencies that are requisite to the education and preparation of future physicians through the work of the Council on Graduate Medical Education (COGME). This article discusses these core competencies and suggests strategies by which to implement them in undergraduate and graduate medical education.

First-language acquisition in adolescence: evidence for a critical period for verbal language development.

It has been hypothesized that there is a critical period for first-language acquisition that extends into late childhood and possibly until puberty. The hypothesis is difficult to test directly because cases of linguistic deprivation during childhood are fortunately rare. We present here the case of E.M., a young man who has been profoundly deaf since birth and grew up in a rural area where he received no formal education and had no contact with the deaf community. At the age of 15, E.M. was fitted with hearing aids that corrected his hearing loss to 35 dB, and he began to learn verbal Spanish. We describe his language development over the 4-year period since his acquisition of hearing aids and conclude that the demonstrates severe deficits in verbal comprehension and production that support the critical period hypothesis.

Motivations and practice-area preferences of pharmacists interested in pursuing a Pharm.D. degree through a nontraditional program.

Pharmacists' interest in a proposed nontraditional Pharm.D. program, motivations for wanting to pursue a Pharm.D. degree, and practice-area preferences were surveyed. Questionnaires were mailed to 12,621 pharmacists in Illinois and Arizona. Information sought included current position and practice area, number of job and career changes, preferred practice area, and interest in enrolling in a proposed nontraditional Pharm.D. program described in a cover letter. For pharmacists indicating an interest, information was sought on motivations for wanting to pursue a Pharm.D. degree expected support from employers, and preferred practice areas after obtaining a Pharm.D. degree. The response rate was 28.8%. A total of 1119 respondents (31.9%) indicated that they would or probably would enroll in the proposed Pharm.D. program. These pharmacists gave improving their clinical skills and improving the quality of their work as reasons for wanting to enroll, and half indicated that their current practice area would be their preferred area after they completed a Pharm.D. degree. Almost three quarters (72%) of hospital pharmacists; more than 60% of home health care or consultant independent, and managed care pharmacists; and 21% of pharmacists in chain pharmacies stated a preference to stay in their current practice area after obtaining a Pharm.D. degree. Eight variables were useful in predicting whether respondents would prefer to remain in their current practice area, including tuition assistance or reimbursement from employers, satisfaction with current position, and number of years in current position. Respondents who were interested in pursuing a Pharm.D. degree through the nontraditional program described to them were motivated by a desire to improve their clinical skills and the quality of their work and the opportunity to open doors to new careers.

How a collaborative task force can assist in managing biotechnology products.

The rapid expansion of biotechnology-derived pharmaceuticals into the health care system presents new challenges and concerns in formulary selection, development of usage guidelines, and budgeting. A DUE/QA pharmacy network and a hospital association in a metropolitan area formed a Biotechnology Task Force, whose goals included: developing a forum for practitioners and administrators to exchange information; applying a strategy for evaluating and predicting usage patterns; promoting educational endeavors; and developing database technology to assist institutions with usage monitoring. The task force successfully educated health care professionals and administrators about the ramifications of biopharmaceuticals. Having this process defined will prove beneficial for future evaluation of other biopharmaceuticals.

Computer-based patient simulations: hospital pharmacists' performance and opinions.

The performance of pharmacists in using an interactive computer-based patient simulation program and their attitudes toward the simulations are reported. The Institutional Patient Medication Simulation program is designed to enhance and evaluate the medication problem-solving skills of pharmacists. Each simulation consists of patient data-gathering, case question, and therapy decision modules with initial assessment and monitoring nodes. Five simulations were tested: gout, urinary-tract infection, congestive heart failure, antimicrobial prophylaxis in surgery, and hypertension. Pharmacists from nine hospitals were recruited for the study. Participants were asked to perform the simulations within a specified period and to complete attitudinal questionnaires. Of the 91 pharmacists who volunteered, 72 (79%) completed the simulations and the questionnaires. The practitioners indicated that the simulations adequately tested their knowledge and that they would recommend them to colleagues. Performance scores for data gathering were less than 70%, with no significant differences among the simulations. Case question scores exceeded 80% and again were consistent among simulations, whereas therapy decision scores were more variable, with the lowest scores being recorded for antimicrobial-related simulations. Pharmacists with more hospital experience tended to perform better. Pharmacists completing a patient simulation program found the simulations to be worthwhile. Performance scores indicated some difficulty in gathering patient data and showed that correct therapeutic decisions may not always occur even if adequate information is obtained.

Method comparison--a different approach.

The commonly accepted method of analysing data from method comparison studies is regression analysis, a method which has limitations. This study illustrates the use of a graphical presentation of data, the difference plot, which can be used as an alternative to least squares regression analysis. The data from comparison studies performed on five methods were analysed both by Deming's regression analysis, with calculation of the correlation coefficient, and by the difference plot. The results show that in most cases much more relevant information was obtained from the difference plot.

Induction of beta-1,3-glucanase in barley in response to infection by fungal pathogens.

The sequence of a partial cDNA clone corresponding to an mRNA induced in leaves of barley (Hordeum vulgare) by infection with fungal pathogens matched almost perfectly with that of a cDNA clone coding for beta-1,-3-glucanase isolated from the scutellum of barley. Western blot analysis of intercellular proteins from near-isogenic barley lines inoculated with the powdery mildew fungus (Erysiphe graminis f. sp. hordei) showed a strong induction of glucanase in all inoculated lines but was most pronounced in two resistant lines. These data were confirmed by beta-1,3-glucanase assays. The barley cDNA was used as a hybridization probe to detect mRNAs in barley, wheat (Triticum aestivum), rice (oryza sativus), and sorghum (Sorghum bicolor), which are induced by infection with the necrotrophic pathogen Bipolaris sorokiniana. These results demonstrate that activation of beta-1,3-glucanase genes may be a general response of cereals to infection by fungal pathogens.