Similar erythrocyte sedimentation rate and C-reactive protein sensitivities at the onset of septic arthritis, osteomyelitis, acute rheumatic fever

The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are employed in the evaluation of patients with suspected septic arthritis, osteomyelitis, and acute rheumatic fever. The purpose of this study is to determine if one test has greater sensitivity (rises earlier) than the other. Laboratory data were retrieved for pediatric patients hospitalized with one of the above three conditions, who had both ESR and CRP tests done on or shortly prior to admission. Sensitivity calculations were performed for mild, moderate, and severe degrees of ESR and CRP elevation. Microcytic erythrocytes, as defined by mean corpuscular volume (MCV) <80 µL, were identified to see if this affects the ESR. ESR or CRP sensitivities depend on the cutoff value (threshold) chosen as a positive test. The sensitivities were similar for similar degrees of elevation. ESR and CRP discordance was not significantly related to MCV. We concluded that the CRP does not rise earlier than the ESR (their sensitivities are similar). Previously published conclusions are dependent on arbitrary thresholds. We could not find any evidence that MCV affects the ESR

Malpract ice Risk Assessm ent Among Different Approac hes For Informed Consent

Abstract Introduction: The standards for obtahing Thformed consent, set forth by the Hawaii Revised Statutes, establish that it is the physician&apos;s duty to disclose what a reasonable person objectively needs to hear in order to make an informed decision. It is the purpose of this study to report the opinions of medical malpractice attorneys to survey their opinion whether full or limited disclosure of alternative treat ments in informed consent is viewed as having a lower malpractice risk. Methods: Hawaii medical malpractice attorneys viewed a com pilation of arguments forand against both full and limited disclosure, and completed an opinion survey after reading samples of disclo sure statements h two different case scenarios: 1) a pediatric emergency department case involving a febrile child at risk for occult bacteremia, and 2) an obstetrics case Thvolving a woman with a postdate pregnancy. Results: A vast majority of respondents believe that, in general and in the obstetrics case, full disclosure results in less liability. In the pediatrics ED case, 46% chose full disclosure as having less liability, 38% believe that the same liability exists with both full and limited disclosure, and 15% believe that limited disclosure is asso ciated with less liability in this case. Conclusions: Hawaii attorneys with medical malpractice experi ence overwhelmingly agree that, in general, full disclosure is asso ciated will less medical legal liability. Full disclosure was also the option selected as associated with less liability by a majority of attorneys ha sample obstetrical case. Opinions were more diverse in the pediatrics ED case. Many attorneys stressed thatjudging the risk of liability in general is difficult, and should be done on a case by case basis

Mechanical Bonds and Topological Effects in Radical Dimer Stabilization

While mechanical bonding stabilizes tetrathiafulvalene (TTF) radical dimers, the question arises: what role does topology play in catenanes containing TTF units? Here, we report how topology, together with mechanical bonding, in isomeric [3]- and doubly interlocked [2]catenanes controls the formation of TTF radical dimers within their structural frameworks, including a ring-in-ring complex (formed between an organoplatinum square and a {2+2} macrocyclic polyether containing two 1,5-dioxynaphthalene (DNP) and two TTF units) that is topologically isomeric with the doubly interlocked [2]catenane. The separate TTF units in the two {1+1} macrocycles (each containing also one DNP unit) of the isomeric [3]catenane exhibit slightly different redox properties compared with those in the {2+2} macrocycle present in the [2]catenane, while comparison with its topological isomer reveals substantially different redox behavior. Although the stabilities of the mixed-valence (TTF2)^(•+) dimers are similar in the two catenanes, the radical cationic (TTF^(•+))_2 dimer in the [2]catenane occurs only fleetingly compared with its prominent existence in the [3]catenane, while both dimers are absent altogether in the ring-in-ring complex. The electrochemical behavior of these three radically configurable isomers demonstrates that a fundamental relationship exists between topology and redox properties

Malpractice risk assessment among different approaches for informed consent.

INTRODUCTION: The standards for obtaining informed consent, set forth by the Hawaii Revised Statutes, establish that it is the physician's duty to disclose what a reasonable person objectively needs to hear in order to make an informed decision. It is the purpose of this study to report the opinions of medical malpractice attorneys to survey their opinion whether full or limited disclosure of alternative treatments in informed consent is viewed as having a lower malpractice risk. METHODS: Hawaii medical malpractice attorneys viewed a compilation of arguments for and against both full and limited disclosure, and completed an opinion survey after reading samples of disclosure statements in two different case scenarios: 1) a pediatric emergency department case involving a febrile child at risk for occult bacteremia, and 2) an obstetrics case involving a woman with a postdate pregnancy. RESULTS: A vast majority of respondents believe that, in general and in the obstetrics case, full disclosure results in less liability. In the pediatrics ED case, 46% chose full disclosure as having less liability, 38% believe that the same liability exists with both full and limited disclosure, and 15% believe that limited disclosure is associated with less liability in this case. CONCLUSIONS: Hawaii attorneys with medical malpractice experience overwhelmingly agree that, in general, full disclosure is associated will less medical legal liability. Full disclosure was also the option selected as associated with less liability by a majority of attorneys in a sample obstetrical case. Opinions were more diverse in the pediatrics ED case. Many attorneys stressed that judging the risk of liability in general is difficult, and should be done on a case by case basis

Teaching suturing in a workshop setting: a comparison of several models.

OBJECTIVES: Suturing is taught in workshops using a variety of models. The purpose of this study is to compare the resemblance to human skin of four models commonly used to teach suturing: pig skin, beef tongue, hot dog and latex glove. METHODS: 5 centimeter biconvex incisions were made in each of the models and closed by 50 physician study volunteers comprised of 33 board-certified physicians and 17 resident physicians. They rated each model on a scale of 1 to 4, where 4 closely resembles human skin and 1 does not resemble human skin. RESULTS: The following mean ratings were given by study volunteers: beef tongue 3.5 +/- 0.5, pig skin 3.2 +/- 0.8, latex glove 1.6 +/- 0.7, hot dog 1.4 +/- 0.6. CONCLUSION: Beef tongue and pig skin were rated highest by study volunteers. However, pig skin is much cheaper than beef tongue. Pig skin is the best inexpensive model for teaching skin suturing of the four models studied

Propofol's EEG Fast Activity is Dose-Dependent

Introduction: For patients with a first-time suspected seizure, electroencephalograms (EEG) are part of the initial evaluation. Most sedatives result in EEG artifact “fast activity” (FA), making the EEG difficult to read. During propofol-sedated EEGs, we noticed that FA would diminish when the propofol infusion rate was low. The purpose of this study is to investigate propofol dosing and its relationship to EEG FA artifact. Methods: This study involved retrospective chart reviews of a pediatric database for sedated EEG encounters in patients under 7 years of age. Data was collected from a total of 55 charts. Total doses of propofol (mg/kg/hr) were calculated for the first half and second half. The actual EEGs were reviewed by a pediatric neurologist study investigator, to classify the degree of FA as: none, mild, moderate, severe. We then examined whether total doses of propofol given during the EEG (mg/kg/hr) halves affected the severity of FA using ordinal logistic regression. Results: The results are summarized in Table 1, which shows that propofol doses (paired T-test, p<0.001) and EEG FA (Bowker’s test of symmetry, p=0.002) were higher in the first half compared to the second half. Figure 1 graphs each data point independently, which shows via linear and ordinal logistic regression a positive relationship between propofol dosing and FA severity (p=0.0014, OR=1.20, 95% CI=1.08-1.34, respectively). Conclusion: Fast activity due to propofol appears to be dose-dependent. Lower doses of propofol resulted in less FA on EEG, suggesting that reducing the dose can reduce the FA artifact