Diagnosis in vascular dementia, applying ‘Cochrane diagnosis rules’ to ‘dementia diagnostic tools’

In this issue of Clinical Science, Biesbroek and colleagues describe recent work on magnetic resonance imaging (MRI)-based cerebral lesion location and its association with cognitive decline. The authors conclude that diagnostic neuroimaging in dementia should shift from whole-brain evaluation to focused quantitative analysis of strategic brain areas. This commentary uses the review of lesion location mapping to discuss broader issues around studies of dementia test strategies. We draw upon work completed by the Cochrane Dementia and Cognitive Improvement Group designed to improve design, conduct and reporting of dementia biomarker studies

Local Anesthesia Toxicity

Local anesthesia (LA) provides a way to relieve temporary pain in a small part of the body and has been used for over 100 years (Fencl, 2015). LA also prevents the passage of surgical stimuli into the central nervous system (CNS) making a surgical procedure less painful for the patient (Noble, 2015). According to Noble, “altering the passage of stimuli from smaller diameter neurons in a confined area with lower drug dosages is called LA, such as the injection of LA around a surgical incision” (Noble, 2015, p.325). LA can be used in a variety of settings, such as in dentist/medical offices and in the operating room (OR). LA can be administered via injection, infiltration or topical application with anesthesia professions, surgeons or dentists administering it. When performing LA administration one must be aware of the risk of local anesthetic systemic toxicity (LAST) (Fencl, 2015). It is a very serious and sometimes fatal complication to administration. It can result from the patient’s risk factors, current medications or inadvertent injection directly into the vascular system- resulting in immediate absorption of the anesthetic agent into an exceptionally vascular area (Fencl, 2015). Early response at the first sign of toxicity is pertinent and improves chances of successful treatment. Once the reaction is noticed, immediate supportive care needs to be initiated due to the chance of severe cardiac depression. Advanced Cardiac Life Support (ACLS) should be started immediately and is considered the first-line treatment for this complication (Noble, 2015). Lipid emulsion therapy can also be used to help reduce the toxic plasma levels of LA, ultimately reversing the severe symptoms of LAST. Prevention measures (in a checklist form) have been put in place to help reduce the risk of LAST by The American Society of Regional Anesthesia and Pain Management (ASRA) (Noble, 2015). This is a helpful tool utilized by anesthesia staff to help focus on the immediate needs of the patient and manage cardiac events for someone diagnosed with LAST. By educating all staff, effective management of this emergent situation will help influence a positive patient outcome. Comprehensive training on LAST guidelines and treatment, along with best practice measures for patients receiving LA are essential for optimistic patient outcomes

Redefining and Improving School District Governance

Explores recent research literature and emerging practices concerning the roles and responsibilities of district school boards and the issues impeding or assisting their effectiveness

Opportunities for teaching and studying medicine in medieval Portugal before the foundation of the University of Lisbon (1290)

This paper discusses where Portuguese physicians studied medicine. The careers of two thirteenth-century physicians, Petrus Hispanus and Giles of Santarém, indicate that the Portuguese travelled abroad to study in Montpellier or Paris. But it is also possible that there were opportunities for study in Portugal itself. Particularly significant in this respect is the tradition of medical teaching associated with the Augustinian house of Santa Cruz in Coimbra and the reference to medical texts found in Coimbra archives. From these sources it can be shown that there was a suitable environment for medical study in medieval Portugal, encouraging able students to further their medical interests elsewhere

Opportunities for Teaching and Studying Medicine in Medieval Portugal before the Foundation of the University of Lisbon (1290)

This paper discusses where Portuguese physicians studied medicine. The careers of two thirteenth-century physicians, Petrus Hispanus and Giles of Santarém, indicate that the Portuguese travelled abroad to study in Montpellier or Paris. But it is also possible that there were opportunities for study in Portugal itself. Particularly significant in this respect is the tradition of medical teaching associated with the Augustinian house of Santa Cruz in Coimbra and the reference to medical texts found in Coimbra archives. From these sources it can be shown that there was a suitable environment for medical study in medieval Portugal, encouraging able students to further their medical interests elsewhere