RN Case Manager Case Consultation

Purpose: Apply the Collaborative Care Management Practice Model to address: Complex transition planning Clinical progression Readmission risk Promote professional growth Increase knowledge of the ACMA Scope and Standards of Practice for RN Case Managers.https://digitalcommons.centracare.com/nursing_posters/1098/thumbnail.jp

Associations between psychopathic traits and brain activity during instructed false responding

Lying is one of the characteristic features of psychopathy, and has been recognized in clinical and diagnostic descriptions of the disorder, yet individuals with psychopathic traits have been found to have reduced neural activity in many of the brain regions that are important for lying. In this study, we examine brain activity in sixteen individuals with varying degrees of psychopathic traits during a task in which they are instructed to falsify information or tell the truth about autobiographical and non-autobiographical facts, some of which was related to criminal behavior. We found that psychopathic traits were primarily associated with increased activity in the anterior cingulate, various regions of the prefrontal cortex, insula, angular gyrus, and the inferior parietal lobe when participants falsified information of any type. Associations tended to be stronger when participants falsified information about criminal behaviors. Although this study was conducted in a small sample of individuals and the task used has limited ecological validity, these findings support a growing body of literature suggesting that in some contexts, individuals with higher levels of psychopathic traits may demonstrate heightened levels of brain activity

Stereoselective Discrimination and Quantification of Arginine and N-Blocked Arginine Enantiomers by Formation and Dissociation of Calcium-Mediated Diastereomeric Trimer Complexes with a Chiral Reference Compound Using Electrospray Ionization-Ion Trap Tandem Mass Spectrometry

Chiral resolution of arginine (Arg) and Arg derivatives is demonstrated using electrospray ionization-tandem mass spectrometry (ESI-MS). Calcium ion (CaII)-mediated trimeric clusters are generated, which incorporate the analyte of interest and an enantiomerically pure reference molecule of similar metal ion affinity. Two methods, one based on the measurement of a competitive-dissociation-based branching ratio (Rchir) by the kinetic method (KM) and one based on the measurement of a chiral recognition ratio (CR) by a similar method, are compared. Incorporating N-blocked Arg derivatives (Z-Arg and Boc-Arg) as chiral references provides chiral resolution greater than that previously reported for Arg enantiomers. In a reciprocal manner, pure Arg enantiomers can be used as references for discriminating enantiomers of these N-blocked Arg derivatives. Condensed-phase and gas-phase CaII ion affinity relative to Arg is also addressed qualitatively for other acidic, basic, and neutral amino acids. In some cases, when only one offspring ion is observed (insufficient for KM analysis), the CR method can be applied as an alternative to obtain a measurable stereoselectivity value for the system. The results of these experiments demonstrate the applicability of, and the difference between, the KM and the CR method for improved quantitative analysis of enantiomeric excess for Arg

Assessment of chronic postsurgical pain after knee replacement : a systematic review

Objective: Approximately 20% of patients experience chronic pain after total knee replacement (TKR), yet there is no consensus about how best to assess such pain. This systematic review aimed to identify measures used to characterise chronic pain after TKR. Methods: MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL databases were searched for research articles published in all languages from January 2002- November 2011. Articles were eligible for inclusion if they assessed knee pain at a minimum of 3-months after TKR, yielding a total of 1,164 articles. Data extracted included study design, country, timings of assessments, and outcome measures containing pain items. Outcome measures were compared with domains recommended by IMMPACT for inclusion in assessment of chronic pain related outcomes within clinical trials. Temporal trends were also explored. Results: The review found use of a wide variety of composite and single-item measures, with the American Knee Society Score most common. Many measures used in published studies do not capture the multi-dimensional nature of pain recommended by IMMPACT; of those commonly used, the WOMAC and Oxford Knee Score are most comprehensive. Geographical trends were evident, with nation-specific preferences for particular measures. A recent reduction in use of some clinically-administered tools was accompanied by increased use of patient-reported outcome measures. Conclusion: There was wide variation in methods of pain assessment alongside nation-specific preferences and changing temporal trends in pain assessment after TKR. Standardisation and improvements in assessment is needed to enhance the quality of research and facilitate the establishment of a core outcome set

Risk stratification for the development of chronic postsurgical pain

Chronic postsurgical pain (CPSP) is a common complication of surgery with important consequences for the individual patient and society as a whole. Risk stratification is best defined as the grouping of patients based on factors measured at baseline (in this context before surgery), to determine an individual's risk of suffering a particular condition and thereby the likely level of need for preventive interventions. Risk factors for CPSP have been identified in the preoperative, intraoperative, and postoperative periods and cover 6 broad domains: genetic, demographic, psychosocial, pain, clinical, and surgical factors. Risk stratification for CPSP enables clinicians to address these risk factors before surgery, to discuss the necessity of surgery or to change the surgical and anaesthetic/analgesic planning

Somatic aphasia: Mismatch of body sensations with autonomic stress reactivity in psychopathy

Background— Although one of the main characteristics of psychopaths is a deficit in emotion, it is unknown whether they show a fundamental impairment in appropriately recognizing their own body sensations during an emotion-inducing task. Method— Skin conductance and heart rate were recorded in 138 males during a social stressor together with subjective reports of body sensations. Psychopathic traits were assessed using the Psychopathy Checklist – Revised (PCL-R) 2nd edition (Hare, 2003). Results— Nonpsychopathic controls who reported higher body sensations showed higher heart rate reactivity, but this verbal-autonomic consistency was not found in psychopathic individuals. This mind-body disconnection is particularly associated with the interpersonal-affective factor of psychopathy. Conclusions— Findings are the first to document this body sensations– autonomic mismatch in psychopaths, and suggest that somatic aphasia the inaccurate identification and recognition of one‘s own somatic states may partly underlie the interpersonal-affective features of psychopaths