What doctors should look for in patients presenting with erectile dysfunction

Click on the link to view the commentary.S Afr Psychiatry Rev 2003;6:29-3

Blood Pressure During Endovascular Treatment Under Conscious Sedation or Local Anesthesia

OBJECTIVE: To evaluate the role of blood pressure (BP) as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after endovascular treatment (EVT). METHODS: Patients treated in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP), and procedural BP trend, compared to LA. Second, we assessed the association between BP and functional outcome (modified Rankin Scale [mRS]) with multivariable regression. Lastly, we evaluated whether BP explained the effect of CS on mRS. RESULTS: In 440 patients with available BP data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%), and a more negative BP trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common odds ratio [acOR] per 10% drop 0.87, 95% confidence interval [CI] 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95% CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95% CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95% CI 0.42-0.92). CONCLUSIONS: Large BP drops are associated with worse functional outcome. However, BP drops do not explain the worse outcomes in the CS group

Best Practices for the Mentally Ill in the Criminal Justice System

This timely brief resource introduces a new evidence-based model for treatment of mentally ill individuals in jails, with emphasis on community-based options. Forensic mental health experts review police alternatives to arresting mentally ill persons in confrontations, the efficacy of problem-solving courts, and continuity of care between jail and community. The book\u27s best-practices approach extends to frequently related issues such as addiction, domestic violence, juvenile considerations, and trauma and describes successful programs coordinating judicial and clinical systems. These guidelines for decriminalizing non-violent behaviors and making appropriate services available to those with mental problems should also help address issues affecting the justice system, such as overcrowding. Included in the coverage: The Best Practices Model. Best practices in law enforcement crisis interventions with the mentally ill. Problem-solving courts and therapeutic jurisprudence. Competency restoration programs. A review of best practices for the treatment of persons with mental illness in jail. Conclusions, recommendations, and helpful appendices. With its practical vision for systemic improvement, Best Practices Model for Intervention with the Mentally Ill in the Criminal Justice System is progressive reading for practitioners in the mental health field, especially practitioners working with inmates, as well as for stakeholders in the law enforcement and justice systems.https://nsuworks.nova.edu/cps_facbooks/1199/thumbnail.jp

Country data on AMR in Turkiye in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

Background: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action

Is FGF13 a major contributor to genetic epilepsy with febrile seizures plus?

Mutation of fibroblast growth factor 13 (FGF13) has recently been implicated in genetic epilepsy with febrile seizures plus (GEFS+) in a single family segregating a balanced translocation with a breakpoint in this X chromosome gene, predicting a partial knockout involving 3 of 5 known FGF13 isoforms. Investigation of a mouse model of complete Fgf13 knock-out revealed increased susceptibility to hyperthermia-induced seizures and epilepsy. Here we investigated whether mutation of FGF13 would explain other cases of GEFS+ compatible with X-linked inheritance. We screened the coding and splice site regions of the FGF13 gene in a sample of 45 unrelated probands where GEFS+ segregated in an X-linked pattern. We subsequently identified a de novo FGF13 missense variant in an additional patient with febrile seizures and facial edema. Our data suggests FGF13 is not a common cause of GEFS+

Blood Pressure During Endovascular Treatment Under Conscious Sedation or Local Anesthesia

OBJECTIVE: To evaluate the role of blood pressure as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after EVT. METHODS: Patients treated in MR CLEAN Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP) and procedural blood pressure trend, compared to LA. Second, we assessed the association between blood pressure and functional outcome (modified Rankin Scale, mRS) with multivariable regression. Lastly, we evaluated whether blood pressure explained the effect of CS on mRS. RESULTS: In 440 patients with available blood pressure data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%) and a more negative blood pressure trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common OR (acOR) per 10%-drop 0.87, 95%CI 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95%CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95%CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95%CI0.42-0.92). CONCLUSIONS: Large blood pressure drops are associated with worse functional outcome. However, blood pressure drops do not explain the worse outcomes in the CS group

Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out

BACKGROUND: Widespread restructuring of health delivery systems is underway in the US to reduce costs and improve the quality of healthcare. OBJECTIVE: To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US healthcare, defined as the balance between quality and cost. RESEARCH DESIGN: We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. SUBJECTS: We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. MEASURES: Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. RESULTS: Thirty reports of 28 interventions were included. Interventions included patient-centered medical home (PCMH) implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear or mixed results. Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. CONCLUSIONS: On balance the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in outcome quality measures. Standardized measures of value would facilitate assessment of the impact of interventions across studies and better estimates of the broad impact of system change