Articles: cations.
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This article offers a new neural network framework for understanding both the transients and the asymptotes of operant (instrumental) learning. The theory shows that interplay between simple short and long-term memory mechanisms is sufficient to explain a large number of operant phenomena. It describes short- and long-term effects of reinforcement and how these effects modulate the operant response, how novel events are detected and processed, and how their consequences also modulate the operant response. ⋯ Implications of the present theory for other operant conditioning phenomena, classical conditioning, and avoidance behavior are suggested. Copyright 1997 Elsevier Science Ltd. All Rights Reserved.
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To review the effect of enteral nutrition on nosocomial pneumonia in critically ill patients as summarized in randomized clinical trials. STUDY IDENTIFICATION AND SELECTION: Studies were identified through MEDLINE, SCISEARCH, EMBASE, the Cochrane Library, bibliographies of primary and review articles, and personal files. Through duplicate independent review, we selected randomized trials evaluating approaches to nutrition and their relation to nosocomial pneumonia. DATA ABSTRACTION: In duplicate, independently, we abstracted key data on the design features, population, intervention and outcomes of the studies. ⋯ Nutritional interventions in critically ill patients appear to have a modest and inconsistent effect on nosocomial pneumonia. This body of evidence neither supports nor refutes the gastropulmonary route of infection.
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Randomized Controlled Trial Clinical Trial
Comparison of topical anaesthesia methods for venous cannulation in adults.
A prospective, randomized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation. The study was double-blinded to the degree that the methodologies allowed. One hundred and fifty healthy adults undergoing elective surgery were allocated at random to five groups: EMLA cream, ethyl chloride spray, intracutaneous infiltration with 2% lidocaine, placebo cream and no treatment. ⋯ Spray did not significantly lower puncture pain (26.5) and, in addition, was associated with discomfort (10.5). In adults, EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation. Local lidocaine infiltration is impaired by applicational pain, whereas spraying the puncture site with ethyl chloride has no analgesic benefit.
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The European Federation of Neurological Societies (EFNS) Scientific Panel on Neurorehabilitation established a Task Force on standards in neurological rehabilitation in June 1996. The remit for the Task Force was to: (1) produce a report on the state of neurological rehabilitation across Europe; and (2) recommend standards for the provision of neurological services for disabled people. The main conclusions of the Task Force were as follows:(1) A questionnaire circulated to each European member country has indicated a significant lack of adequate neurological rehabilitation facilities across Europe. ⋯ Such investment should produce benefits for disabled people and their carers and in the long term benefits for the national economy.(7) The Task Force realizes that neurological rehabilitation is poorly developed both in Europe and the world as a whole. We firmly endorse international co-operation in this field and are happy to co-operate with any international organization in order to develop such links for clinical, educational or research initiatives.(8) The Task Force encourages individual countries to produce a document summarizing their own situation with regard to these standards and to produce a timetable for action to improve their situation. The EFNS Task Force would be pleased to assist in the publication of such deliberations or to act as a focus for international education and research or for sharing of examples of good practice.
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The purpose of this study was to evaluate the effect of altering the use of the protocol for brain death determination in traumatically injured patients, on time to brain death determination, medical complication rates, organ procurement rates and charges for care rendered during brain death determination. A retrospective chart review of trauma patients with lethal brain injuries at an urban tertiary care trauma center was performed. Two groups of trauma patients with lethal head injuries were compared. Group I consisted of patients pronounced brain dead using a protocol requiring two brain examinations, and group II contained patients evaluated using a protocol requiring one brain examination in conjunction with a nuclear medicine brain flow scan. ⋯ Medical complications are universal in the traumatized patient awaiting the determination of brain death. These complications necessitate aggressive and costly care in the intensive care unit in order to optimize organ function in preparation for possible transplantation. In our institution, the determination of brain death using a single clinical examination and a nuclear medicine flow study significantly shortened the brain death stay and reduced associated charges accrued during this period. The complication and organ procurement rates were not affected in this small, preliminary report sample.