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Michalczyk K.,Memorial Hospital | Sullivan J.E.,University of Louisville | Berkenbosch J.W.,University of Louisville
Pediatric Critical Care Medicine | Year: 2013

Objective: Ketamine has a long history of use during pediatric procedural sedation. Concerns about raising intracranial pressure may limit use in certain situations. Whereas some data suggest that benzodiazepine coadministration may blunt this response, pediatric data during procedural sedation do not exist. We evaluated the effects of midazolam pretreatment on intracranial pressure during ketamine sedation in children. Design: Prospective, randomized clinical study. Setting: Outpatient Medical Observation unit at Kosair Children's Hospital. Patients: A total of 25 oncology patients in whom sedated lumbar puncture was scheduled. Interventions: Patients alternated between sedation in Group A (midazolam/ketamine prior to lumbar puncture) or Group B (ketamine only prior to lumbar puncture). Opening pressure, medication doses, sedation depth, and complications were recorded. A control group of non-ketamine-sedated patients (Group C) was added to differentiate drug vs. disease-specific opening pressure changes. Between-group differences were compared by linear mixed effects model or contingency table with p < 0.05 considered significant. Measurements and Main Results: Twenty-five patients aged 82 ± 49 months were sedated 84 times. Thirty-five sedations were in Group A, 39 in Group B, and 10 in Group C. Mean (95% confidence interval) adjusted opening pressure in Group A (22.0 [12.3, 22.2] cm H2O) was lower than Group B (26.5 [24.0, 29.2] cm H2O, p = 0.013). Opening pressure in Group C (17.3 [12.3, 22.2] cm H2O) was lower than in Group B (p = 0.002) but not in Group A (p = 0.096). Ketamine doses were similar between Groups A and B (1.4 ± 0.6 mg/kg vs. 1.4 ± 0.4 mg/kg, p = NS). Mean midazolam pretreatment dose was 0.09 ± 0.02 mg/kg and did not correlate with measured opening pressure. Four patients, all in Group B, experienced significant emergence reactions. Conclusion: While pretreatment with midazolam is associated with a reduction in intracranial pressure compared with sedation with ketamine alone, ketamine-containing regimens are associated with higher opening pressures than non-ketamine-containing regimens. © 2013 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Source

Curtice M.J.,Hollyhill Unit | Exworthy T.,Memorial Hospital
Psychiatrist | Year: 2010

The introduction of the Human Rights Act 1998 in the UK has not led to widespread knowledge and understanding in patient and carer groups, healthcare professionals or at an organisational level. This knowledge deficit has been recognised by government bodies and other agencies, which has led to the introduction of a bottom-up human rights-based approach that can be used by individuals and organisations alike in everyday practice. It avoids the need to have technical knowledge of the Human Rights Act and associated case law and is based upon concepts that underpin all the articles of the Act. The human rights-based approach is the process by which human rights can be protected by adherence to underlying core values of fairness, respect, equality, dignity and autonomy, or FREDA. Source

Van Manen M.D.,Memorial Hospital | Nace J.,Rubin Institute for Advanced Orthopedics | Mont M.A.,Rubin Institute for Advanced Orthopedics
Journal of the American Osteopathic Association | Year: 2012

Osteoarthritis (OA) of the knee, one of the most common causes of disability, continues to increase in prevalence as the older adult and obese populations grow. Often, the general practitioner is the first to evaluate a patient with a painful knee that has arthritis. Evidence-based evaluation and treatment guidelines recommend the use of nonoperative treatments before surgical treatment options such as total knee arthroplasty (TKA) are considered. Understanding available nonoperative treatment options is critical for physicians who first encounter patients with OA of the knee. The authors provide an overview of nonoperative treatment options for patients with OA, including weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. The authors also discuss operative treatment options to be considered before TKA and review indications for TKA when other treatment options have been exhausted. Source

Ewing J.,Memorial Hospital
Clinical Orthopaedics and Related Research | Year: 2012

This Classic Article is a reprint of the original work by J. Ewing, The Bulkley Lecture: The Modern Attitude Toward Traumatic Cancer. An accompanying biographical sketch of J. Ewing is available at DOI 10.1007/s11999-011-2234-y . The Classic Article is ©1935 and is reprinted courtesy of the New York Academy of Medicine from Ewing J. The Bulkley Lecture: The Modern Attitude Toward Traumatic Cancer. © 2012 The Association of Bone and Joint Surgeons® Bibliography:. Source

Euba R.,Memorial Hospital
Journal of ECT | Year: 2012

Studies on ECT and race show that ECT clinics treat predominantly white patients. It has been suggested that certain ethnic groups are less likely to receive a diagnosis of an affective disorder and are therefore less likely to be referred to the ECT clinic. In the United States, inequalities in access to health care between the different ethnic groups may be a contributory factor. In the United Kingdom, there is a mistaken predominant perception that ECT is given mainly to members of ethnic minorities; instead, there is a need to ensure that nonwhites have equal access to this effective treatment. Copyright © 2012 by Lippincott Williams & Wilkins. Source

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