Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.

CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE: To explore the effectiveness of IND for procedural distress in children. DATA SOURCES: We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION: We included randomized trials of IND for procedures in children. DATA EXTRACTION: Methodologic quality of evidence was evaluated by using the Cochrane Collaboration\u27s risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS: Among 19 trials ( LIMITATIONS: The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS: Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects

A cross-sectional study examining convergent validity of a frailty index based on electronic medical records in a Canadian primary care program

Background An electronic frailty index (eFI) has been developed and validated in the UK; it uses data from primary care electronic medical records (EMR) for effective frailty case-finding in primary care. This project examined the convergent validity of the eFI from Canadian primary care EMR data with a validated frailty index based on comprehensive geriatric assessment (FI-CGA), in order to understand its potential use in the Canadian context. Methods A cross-sectional validation study, using data from an integrated primary care research program for seniors living with frailty in Edmonton, AB. Eighty-five patients 65 years of age and older from six primary care physicians’ practices were recruited. Patients were excluded if they were under 65 years of age, did not provide consent to participate in the program, or were living in a long term care facility at the time of enrolment. We used scatter plots to assess linearity and Pearson correlation coefficients to examine correlations. Results Results indicate a strong statistically significant correlation between the eFI and FI-CGA (r = 0.72, 95% CI 0.60–0.81, p < 0.001). A simple linear regression showed good ability of the eFI scores to predict FI-CGA scores (F (1,83) = 89.06, p < .0001, R2 = 0.51). Both indices were also correlated with age, number of chronic conditions and number of medications. Conclusions The study findings support the convergent validity of the eFI, which further justifies implementation of a case-finding tool that uses routinely collected primary care data in the Canadian context

Aboveground Biomass Accumulation in a Tropical Wet Forest in Nicaragua Following a Catastrophic Hurricane Disturbance 1

Among their effects on forest structure and carbon dynamics, hurricanes frequently create large-scale canopy gaps that promote secondary growth. To measure the accumulation of aboveground biomass (AGBM) in a hurricane damaged forest, we established permanent plots 4 mo after the landfall of Hurricane Joan on the Atlantic coast of Nicaragua in October 1988. We quantified AGBM accumulation in these plots by correlating diameter measurements to AGBM values using a published allometric regression equation for tropical wet forests. In the first measurement year following the storm, AGBM in hurricane-affected plots was quite variable, ranging from 26 to 153 Mg/ha, with a mean of 78 (±15) Mg/ha. AGBM was substantially lower than in two control plots several kilometers outside the hurricane's path (331 ±15 Mg/ha). Biomass accumulation was slow (5.36 ± 0.74 Mg/ha/yr), relative to previous studies of forest regeneration following another hurricane (Hugo) and agricultural activity. We suggest that large-scale, homogenous canopy damage caused by Hurricane Joan impeded the dispersal and establishment of pioneer trees and led to a secondary forest dominated by late successional species that resprouted and survived the disturbance. With the relatively slow rate of biomass accumulation, any tightening in disturbance interval could reduce the maximum capacity of the living biomass to store carbon.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73646/1/j.1744-7429.2005.00077.x.pd