Articles: adult.
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⋯ Where there is no evidence of frank spondylolisthesis or displacement and pain does not radiate below the knee, we recommend direct repair of the pars interarticularis fracture, especially in young active adults. We describe a modified form of the Buck screw procedure with a minimally invasive, image-guided method of pars interarticularis fixation. The use of image guidance simplifies the otherwise difficult visualization required for pars interarticularis screw placement and allows minimal skin and muscle dissection, which may translate into a more rapid postoperative recovery.
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Anesthesiology clinics · Dec 2011
Delirium: an emerging frontier in the management of critically ill children.
Delirium is a syndrome of acute brain dysfunction that commonly occurs in critically ill adults and most certainly is prevalent in critically ill children all over the world. The dearth of information about the incidence, prevalence, and severity of pediatric delirium stems from the simple fact that there have not been well-validated instruments for routine delirium diagnosis at the bedside. ⋯ In adults, delirium is responsible for significant increases in both morbidity and mortality in critically ill patients. The advent of new tools for use in critically ill children will allow the epidemiology of this form of acute brain dysfunction to be studied adequately, will allow clinical management algorithms to be developed and implemented following testing, and will present the necessary incorporation of delirium as an outcome measure for future clinical trials in pediatric critical care medicine.
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Evaluating the extent to which groups or subgroups of individuals differ with respect to primary healthcare experience depends on first ruling out the possibility of bias. ⋯ Differential item functioning does not bias or invalidate French/English comparisons on subscales, but additional development is required to make French and English items equivalent. These instruments are relatively robust by educational status and geography, but results suggest potential differences in the underlying construct in low-education and rural respondents.
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To review the evidence for the effectiveness of topical nitroglycerin in treating acute and chronic tendinopathies among adults. ⋯ Topical nitroglycerin relieved pain intensity in activities of daily living among patients with chronic or acute tendinopathies. There was little evidence for effectiveness on other outcomes. The incidence of headache was increased by nitroglycerin.
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Identifying fever can influence management of the emergency department (ED) patient, including diagnostic testing, treatment, and disposition. We set out to determine how well oral and tympanic membrane (TM) temperatures compared with rectal measurements. ⋯ The oral and tympanic temperature readings are not equivalent to rectal thermometry readings. Oral thermometry frequently underestimates the temperature relative to rectal readings, and TM values can either under- or overestimate the rectal temperature. The clinician needs to be aware of the varying relationship between oral, TM, and rectal temperatures when interpreting readings.