Methylphenidate in the treatment of an adolescent female with obsessive-compulsive disorder and attention deficit hyperactivity disorder: a case report.

OBJECTIVES: We describe a case whereby a 15-year-old female with treatment-resistant obsessive-compulsive disorder (OCD) was treated with methylphenidate for co-morbid attention deficit hyperactivity disorder (ADHD). The ADHD-OCD co-morbidity has often been overlooked clinically due to conflicting opinions about their underlying neurobiology and treatment options. CONCLUSIONS: In this adolescent with co-morbid ADHD and OCD, we observed that the adjunctive use of methylphenidate resulted in enhanced treatment response to both psychological and pharmacological interventions for OCD. This case highlights the need to identify and treat co-morbid ADHD in OCD cases where progress has stalled.

Emergency department staff can effectively resuscitate in level C personal protective equipment.

OBJECTIVE: ED staff are expected to perform resuscitation of trauma victims of chemical, biological and radiation incidents while wearing level C personal protective equipment (PPE). The present project assessed the subjective discomfort, physiological impact and performance of staff wearing PPE. METHODS: A paired intervention study of ED staff in a resuscitation scenario comparing task performance wearing gown and gloves with PPE. Data were collected using a structured self-administered questionnaire and by objective and subjective measurements. RESULTS: Seven ED doctors and 11 ED nurses were enrolled. Nine had previous PPE training although only one had used PPE clinically. Overall, ED staff felt that PPE did not affect their ability to perform trauma resuscitation. For individual tasks, staff felt that PPE impaired assessment of pulse, i.v. cannulation, i.v. line attachment, use of a mini-jet, bag and mask ventilation, and communication. However, the only objective difference in task performance was time to control haemorrhage (increase from 38 to 47 s, P = 0.02). PPE was well tolerated, with minimal physiological or psychological impact. Staff wore PPE for a median of 37 min (interquartile range: 33-38) and estimated that PPE could be worn for a further 30 min if required. CONCLUSIONS: ED staff are able to perform resuscitation procedures in PPE without adverse physiological effects or impact on performance. Subjective concerns regarding task performance were not reflected in objective measurements. This might indicate that appropriate training and feedback could reduce the negative impression associated with activities undertaken while wearing PPE.