Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Agitation

  • emergence agitation
  • mechanical agitation
  • psychomotor agitation
  • ultrasonic agitation

  • Terms modified by Agitation

  • agitation inventory
  • agitation rate
  • agitation speed

  • Selected Abstracts


    Julio Leey MD
    No abstract is available for this article. [source]

    Management of Acute Undifferentiated Agitation in the Emergency Department

    William J. Holubek MD
    No abstract is available for this article. [source]

    Metastable zone determination of lipid systems: Ultrasound velocity versus optical back-reflectance measurements

    Kesarin Chaleepa
    Abstract The metastable zone width (MZW) of a multi-component system as influenced by the process parameters cooling rate, agitation speed, and additive concentration was determined via ultrasound velocity measurements. The results were compared with those obtained by optical back-reflectance measurements (ORM) using coconut oil as a model substance. Increasing the cooling rate led to the shift of the nucleation point to lower temperatures. This tendency was better visualized by the ultrasonic curves while a significant disturbance of the ORM signal could be observed. Agitation led to an increase of the nucleation temperature and hence a narrower metastable zone. The influence of an additive on the MZW was found to strongly depend on its concentration. The MZW detected by the ultrasound technique was narrower compared to that obtained by the ORM method, indicating the faster response to the phase transition of the ultrasound technique. Another advantage of the ultrasound technique was the in situ evaluation of the experimental data, while ORM needed a linear fitting to estimate the saturation temperature. Furthermore, ultrasound velocity measurements are based on density determination of the medium whereas the ORM sensor is able to detect only particles that are located within the measuring zone and possess a well-defined size. Practical applications: MZW is one of the most important parameters that determine the characteristics of crystalline products. However, a proper technique that can be used in MZW detection in fat systems has rarely been reported, due to the difficulties in dealing with natural fats. The findings of this study can greatly help those who are involved in the field of fat crystallization from both the academic and the practical point of view. This is due to the fact that new and promising techniques for the online and in situ determination of the MZW of fats, with high accuracy, and reproducibility, under most process conditions, were clarified in this work. The readers can easily follow the procedure developed in this paper. Also information about the influence of process parameters and additives on the MZW is included. [source]

    Agitation and despair in relation to parents: activating emotional suffering in transference

    Inga Reznik
    Abstract Affect and motivation are known to arise in the social-cognitive process transference, which occurs when a new person minimally resembles a significant other, implicitly activating the mental representation of this significant other (Andersen, Reznik, & Manzella, 1996) and indirectly, the relational self (i.e. Andersen & Chen, 2002). Triggering the significant-other representation should also indirectly activate any self-discrepancy held from this other's perspective, resulting in shifts in discrete affect and self-regulation. Participants (n,=,110; 34 men, 76 women) with an actual-ideal or actual-ought self-discrepancy from their parent's perspective (Higgins, 1987) learned about a new person who did or did not minimally resemble this parent. As predicted, this evoked positive evaluation of the new person, that is, a positive transference, and yet, as a function of self-discrepancy, also increased discrete negative mood with ideal-discrepant individuals becoming more dejected and ought-discrepant individuals more hostile and less calm. Self-regulatory focus shifted as well in terms of motivation to avoid emotional closeness. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    Agitation in the morning: symptom of depression in dementia?

    Anna-Katharina Theison
    Abstract Objective To investigate the possible correlations between depression in dementia and agitation in the morning by a prospective naturalistic study. Methods Data were collected from three independent nursing homes in an urban setting. Trained nursing home staff pre-selected 110 demented and agitated patients with a minimum age of 60 years. Three main groups were formed based on agitation peak either: in the morning, evening or none. Each is respectively: ,sunrisers', ,sundowners' and ,constants'. Agitation was assessed by the same staff twice a day for a 2-week timeframe using the CMAI (Cohen-Mansfield Agitation Inventory); MMSE (Mini-Mental State Examination) for dementia re-evaluation and staging; CSDD (Cornell Score for Depression in Dementia) for depression screening. Results Sixty-three (60%) of all patients were depressive but only 16 patients of them were treated with antidepressants. Forty-four patients were classified as belonging to the ,sunriser' group, 38 to the ,sundowners' and 23 to the ,constants'. There were no significant differences in depression between the three groups: p,=,0.798 for the difference in proportion of depressed or not depressed people; p,=,0.272 for the difference in raw Cornell-score between agitation in the morning and evening. Conclusion ,Sunrising' appears to play an important role in dementia. In our population agitation was slightly more common in the morning than in the evening, but peak of agitation does not seem to be related to depression in dementia. Our data supports that the diagnosis of depression is still often overlooked in demented and agitated persons. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients

    Andrea S. Schreiner
    Abstract Background The present study reports on the first translation and use of the Cornell Scale for Depression in Dementia (CSDD) (Alexopoulos, Abrams, Young, & Shamoian, 1988) among poststroke patients (n,=,101) in Japan. Objectives The study had three main purposes: 1. To examine the factor structure of the CSDD among Japanese poststroke patients; 2. To compare this with the factor structure identified for Anglo-American Alzheimer's (AD) patients; and 3. To examine the prevalence and covariates of depressive symptoms among the Japanese stroke survivors. Methods Poststroke patients and their caregivers (n,=,202), at a random sample of neurological hospitals in western Japan, were interviewed using the study instruments. Data was also collected from patient charts. All subjects at each site who met the study criteria participated in the study. Results The four-factor solution for poststroke subjects was analogous to that found among AD patients with 2 main exceptions. In contrast to AD patients: 1. Physical complaints were unrelated to depressed mood in stroke patients; and 2. Agitation and psychosis loaded with depressed mood in stroke patients rather than as a separate unique factor as in AD patients. However, in the exploratory 5-factor model, agitation and suicidal ideation comprised a unique factor. Using standard cutoff scores for the CSDD, 58.2% of poststroke patients had scores suggesting possible depression. CSDD scores were not related to functional ability, or stroke characteristics such as aphasia or right or left-sided paralysis. However, scores were significantly higher among subjects,2 years poststroke. Feelings of irritability, anxiety, sadness, and sleep problems were most prevalent. Discussion Despite the prevalence of depressive symptoms, none of the subjects were currently receiving any mental health treatment. Findings suggest that symptoms differ by poststroke duration, which may necessitate different treatment approaches. Copyright © 2002 John Wiley & Sons, Ltd. [source]

    Physical and chemical restraints in acute care: Their potential impact on the rehabilitation of older people

    Sarah Mott RN PhD FRCNA
    Agitation is a major problem for older people and is present in over half of the hospitalizations for people > 65 years of age. In a previous study by the authors, results indicated that nursing actions often did not meet best-practice standards in the care of older, agitated patients. This paper builds on these results by reviewing the literature pertaining to the use of restraints and contributes to the body of knowledge surrounding the impact of the acute-care experience on rehabilitation outcomes. Successful rehabilitation relies on the improvement of functional health outcomes and, for this to happen, physical and emotional well-being are important. The sequelae of restraint use in acute care have the potential to alter peoples' ability to participate fully in a rehabilitation programme, thereby placing their future placement at risk. This paper explores the outcomes of restraint use in the acute-care setting and presents the argument that their effects are likely to be detrimental to rehabilitation outcomes. [source]

    Effect of Person-Centered Showering and the Towel Bath on Bathing-Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled Trial

    Philip D. Sloane MD
    Objectives: To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap). Design: A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover. Setting: Nine skilled nursing facilities in Oregon and six in North Carolina. Participants: Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them. Measurements: Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora. Results: All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans. Conclusion: Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia. [source]

    Predictive Value of Nonspecific Symptoms for Acute Illness in Nursing Home Residents

    Kenneth S. Boockvar MD
    OBJECTIVES: To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents. DESIGN: Prospective, observational study. SETTING: Academic nursing home located in an urban setting. PARTICIPANTS: Two hundred two newly admitted residents. MEASUREMENTS: Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae. RESULTS: Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91. CONCLUSION: Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness. [source]

    Agitation and mobilization of thixotropic liquids

    AICHE JOURNAL, Issue 9 2010
    J. J. Derksen
    Abstract Direct numerical simulations of transitional and turbulent flows of purely viscous thixotropic liquids in stirred tanks have been performed. The simple thixotropy model used is based on the notion of a network in the liquid with an integrity that builds up with finite rate under quiescent conditions, and breaks down under liquid deformation. We solve a transport equation for the network integrity which is two-way coupled to the lattice-Boltzmann-based flow solver. The liquid's time scale characterized by the dimensionless Deborah number shows a profound impact on the level of mobilization and the flow patterns in the mixing tanks, especially if the time scale of the liquid is of the same order as the circulation time in the tank. It is also demonstrated to what extent increasing the impeller speed improves mobilization and mixing. © 2010 American Institute of Chemical Engineers AIChE J, 2010 [source]

    Agitation and weight loss in an autistic boy

    Rachel Conyers
    Abstract: An 11 year old boy with autism presented with a 2-month history of agitated behaviour with associated weight loss. On examination he was wasted and distressed. He had severe hypoalbuminaemia. Gastrointestinal imaging revealed a gastric bezoar. At operation a large phytobezoar extending into the jejunum was identified and removed. Postoperatively he required intensive nutritional resuscitation and support, including treatment of multiple micronutrient deficiencies. Malnutrition is common in children with developmental disabilities, with a number of possible contributing factors. Gastric bezoar is a rare cause, which should be considered in mobile children who may engage in pica. [source]

    Characterization of antibody aggregation: Role of buried, unpaired cysteines in particle formation

    Stephen R. Brych
    Abstract Proteins are susceptible to degradation upon exposure to a variety of stresses during product manufacturing, transportation and storage. In this study, we investigated the aggregation properties of a monoclonal antibody during agitation stress. Agitation exclusively led to insoluble aggregates, or particle formation. Removal or modification of the air,liquid interface with a surfactant (e.g., polysorbate) abrogated particle formation. The supernatant postagitation was analyzed using SE-HPLC, FTIR, and AUC analyses and revealed no changes in conformation and aggregation profile when compared to the nonagitated antibody sample. The antibody particles were comprised of a combination of nonnative intermolecular disulfide-linked covalent as well as noncovalent interactions. Analysis of the antibody's unpaired cysteines revealed that the nonnative intermolecular disulfide bonds were formed through buried cysteines, which suggested at least partial unfolding of the antibody domains. FTIR analysis indicated that the particulated antibody maintained significant native-like secondary structure suggesting that particle formation led to minimal structure changes, but capable of exposing free cysteines to solvent to form the nonnative intermolecular disulfide bonds. The results presented in this study indicate the importance of the interactions between the antibody and the air,liquid interface during agitation in the formation of particles and suggests that reduced disulfide bonds may play a significant role in the particulation reaction. This phenomenon can be applicable to other proteins with similar free cysteine and structural characteristics. © 2009 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:764,781, 2010 [source]

    Why do captive tufted capuchins (Cebus apella) urine wash?

    Kimran E. Miller
    Abstract Urine washing (UW) has been observed in numerous species of prosimians and New World monkeys. The functional significance of UW in Cebidae, specifically, Cebus apella, has not been determined. The objective of our study was to test two major hypotheses related to the function of UW: (1) UW functions as a thermoregulatory mechanism, and (2) UW functions as a means of social communication related to (a) territoriality, (b) sexual encounters, or (c) intragroup aggression/agitation. We collected focal data on a captive group of 28 tufted capuchins (C. apella; July,October 2004 and February,July 2005). We found no significant correlation between UW rates and temperature, at a constant, moderate humidity level. Rates of UW were significantly greater outdoors (no conspecific neighbors) vs. indoors (conspecific neighbors). Qualitative evidence suggests a relationship between UW by the alpha male and sexual solicitations from females. UW rates associated with aggression received were significantly higher than UW rates associated with aggression given and UW rates associated with potential fear/stress. There was also a significant negative correlation between cortisol measures and UW frequencies. Our results suggest that UW does not function in thermoregulation or in territorial communication. Alternatively, our results suggest that UW may be associated with sexual encounters and receiving aggression. Additionally, further investigation is warranted to determine whether UW is used as an appeasement mechanism or as a stress reliever or as both. Am. J. Primatol. 70:119,126, 2008. © 2007 Wiley-Liss, Inc. [source]

    Clarithromycin-induced hypomania in a child , a case report

    W. J. Baranowski
    Baranowski WJ. Clarithromycin-induced hypomania in a child , a case report. Objective:, We report here a child developing hypomania while treated with clarithromycin. Method:, Case report. Results:, A 3-year-old boy was treated for pneumonia with oral clarithromycin in monotherapy. The boy became somewhat hyperactive and irritable after the second dose. After the third dose he presented with psychomotor agitation, pressured speech, irritability, aggressive behaviour and insomnia. The antibiotic was identified as the only possible cause of the described clinical picture and was discontinued immediately. The hypomanic symptoms subsided gradually over 36 h. Conclusion:, Commonly-used medications can produce uncommon adverse reactions. Clinicians, especially general practitioners, pediatricians, as well as child and adolescent psychiatrists ought to be aware of such a possibility when evaluating a child with suddenly changed behaviour. [source]

    Psychotic and behavioural symptoms in a population-based sample of the very elderly subjects

    S. Östling
    Objective:, The aim was to elucidate the relationship between psychotic and behavioural symptoms in the elderly. Method:, A representative sample of 85 year old subjects living in Gothenburg, Sweden (n = 451) was assessed with neuropsychiatric examinations, key informant interviews and record reviews. Results:, Fourteen percent of these very elderly subjects had paranoid symptoms with concomitant anxious agitation and/or irritability/anger. Hallucinations and paranoid symptoms were both associated with a pattern of behavioural symptoms including both anxious agitation and irritability/anger simultaneously in both demented [hallucinations, Odds ratio (OR) 2.8, Confidence interval (CI) 1.2,6.7, paranoid symptoms OR 5.6 CI 2.2,14.2] and non-demented (hallucinations OR 3.2 CI 1.2,8.3, paranoid symptoms OR 4.8 CI 2.0,11.8). Conclusion:, Psychotic symptoms are associated with behavioural symptoms regardless of dementia status. Since these symptoms lead to decreased ability to function in daily life and increased caregiver burden, it is important for health professionals to identify and treat these symptoms also in non-demented. [source]

    A cognitive and affective pattern in posterior fossa strokes in children: a case series

    Aim, Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits. Method, In a retrospective study, we included all cases of posterior fossa strokes in children occurring at a single centre between 2005 and 2007, and investigated cognitive and affective deficits. Results, Five males aged 3 to 14 years met the inclusion criteria. They all presented very early with mood disturbances: outbursts of laughter and/or crying and alternating agitation or prostration that disappeared spontaneously within a few days. Persistent cognitive deficits were also diagnosed in all five: initial mutism, then anomia, followed by comprehension deficiency and deficiencies of planning ability, visual,spatial organization, and attention. Despite early and intensive rehabilitation, recovery from these cognitive deficits was slow and sometimes incomplete, and on follow-up they proved to be more disabling than the motor symptoms. Interpretation, These findings are similar to the cerebellar cognitive affective syndrome described in adults, and quite similar to the language and affective deficits observed in children after surgery for posterior fossa tumour. This is consistent with the role of the cerebellum and brainstem in affective and cognitive processes from early development. [source]

    Neuroleptic malignant syndrome during olanzapine and levomepromazine treatment

    K. Järventausta
    Objective: To date only five reports of neuroleptic malignant syndrome (NMS) related to olanzapine exist. The first case report was published in November 1998. Method: We report the case of a 78-year-old woman suffering from chronic schizophrenia who developed a NMS while being treated with olanzapine and levomepromazine. Before this her medication had been unchanged for more than 2 years. Results: When treated with olanzapine and levomepromazine, the patient had a fulminant NMS which was complicated with pneumonia. When the neuroleptic drug treatment was discontinued, the patient recovered. However, when this combination was restarted later due to severe agitation and hallucinations, the symptoms of NMS reappeared. Conclusion: This case report shows that the neuroleptic malignant syndrome can occur during olanzapine treatment as well as during treatment with conventional neuroleptics. This syndrome may develop even after a long and stable neuroleptic treatment. [source]

    Correlation between attenuated psychotic experiences and depressive symptoms among Japanese students

    Hiroyuki Kobayashi
    Abstract Aims: To examine the emergence of attenuated psychotic experiences, self-disturbance or affective symptoms among younger subjects in the general population and to investigate the intergroup differences on each symptom between adolescents and post-adolescents. Methods: A total of 781 participants, 496 university students (mean age: 19.3 ± 1.1 years) and 285 high school students (mean age: 16.0 ± 0.3 years), were administered self-reported questionnaires. Psychotic prodromal symptoms were evaluated using the PRIME Screen-Revised (PS-R), a 12-item self-reported questionnaire. To measure the cognitive, emotional and physical symptoms associated with depression, the Zung Self-rating Depression Scale (ZSDS), a 20-item self-reported questionnaire, was administered. Results: There were no intergroup differences on the factor score of the PS-R, except the self-demarcation factor (post-adolescents > adolescents), whereas there were significant differences in the factor score of the ZSDS, except for the anxiety factor. Among the post-adolescents, the factors of the PS-R showed a moderate correlation to the cognitive factor on the ZSDS; among the adolescents, the PS-R factors showed a greater correlation to the anxiety factor on the ZSDS than other factors. There were no differences in the distribution of each item of the PS-R between the two groups. Conclusions: The disturbance of self results in difficulty to precisely objectify, especially among adolescents, which would induce more primitive reactions such as agitation, irritability or anxiety; probably, the self disturbance would become an explicit symptom from an implicit experience with advancing age of the subject. Although these data are only preliminary, they could explain the pathway of progression prior to the onset of psychosis, from disturbance within the self to exaggerated self-absorption. [source]

    Mephentermine dependence without psychosis: a Brazilian case report

    ADDICTION, Issue 6 2010
    Henrique Faria De Sousa
    ABSTRACT Background Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. Case description The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. Conclusions Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs. [source]

    Direct chiral analysis of primary amine drugs in human urine by single drop microextraction in-line coupled to CE

    ELECTROPHORESIS, Issue 16 2009
    Kihwan Choi
    Abstract Three-phase single drop microextraction (SDME) was in-line coupled to chiral CE of weakly basic amine compounds including amphetamine. SDME was used for the matrix isolation and sample preconcentration in order to directly analyze urine samples with the minimal pretreatment of adding NaOH. A small drop of an acidic aqueous acceptor phase covered with a thin layer of octanol was formed at the tip of a capillary by simple manipulation of the liquid handling functions of a commercial CE instrument. While the saline matrix of the urine sample was blocked by the octanol layer, the basic analytes in a basic aqueous donor phase were concentrated into the acidic acceptor drop through the octanol layer by the driving force of the pH difference between the two aqueous phases. The enantiomers of the enriched amines were resolved by using (+)-(18-crown-6)-tetracarboxylic acid as a chiral selector for the subsequent CE separation. From 10,min SDME with the agitation of the donor phase by a small stirrer retrofit to the CE instrument, enrichment factors were about a 1000-fold, yielding the LOD of 0.5,ng/mL for amphetamine. This low LOD value as well as the convenience of in-line coupled SDME make the proposed scheme well suited for the demanding chiral analysis of amphetamine-type stimulants. [source]

    Measurement of specific radioactivity in proteins separated by two-dimensional gel electrophoresis

    ELECTROPHORESIS, Issue 5-6 2006
    Shaobo Zhou
    Abstract We report a method to quantify the specific radioactivity of proteins that have been separated by 2-DE. Gels are stained with SyproRuby, and protein spots are excised. The SyproRuby dye is extracted from each spot using DMSO, and the fluorescence is quantified automatically using a plate reader. The extracted gel piece is then dissolved in hydrogen peroxide and radioactivity is quantified by liquid scintillation counting. Gentle agitation with DMSO for 24,h was found to extract all the SyproRuby dye from gel fragments. The fluorescence of the extract was linearly related to the amount of BSA loaded onto a series of 1-D gels. When rat muscle samples were run on 2-DE gels, the fluorescence extracted from 54,protein spots showed a good correlation (r = 0.79, p < 0.001) with the corresponding spot intensity measured by conventional scanning and image analysis. DMSO extraction was found not to affect the amount of radioactive protein left in the gel. When a series of BSA solutions of known specific radioactivity were run on 2-DE gels, the specific radioactivity measured by the new method showed a good correlation (r = 0.98, p < 0.01, n = 5) with the specific radioactivity measured directly before loading. Reproducibility of the method was measured in a series of 2-DE gels containing proteins from the livers of rats and mice that had been injected with [35S]methionine. Variability tended to increase when the amount of radioactivity in the protein spot was low, but for samples containing at least 10,dpm above background the CV was around 30%, which is comparable to that obtained when measuring protein expression by conventional image analysis of SyproRuby-stained 2-DE gels. Similar results were obtained whether spots were excised manually or using a spot excision robot. This method offers a high-throughput, cost-effective and reliable method of quantifying the specific radioactivity of proteins from metabolic labelling experiments carried out in,vivo, so long as sufficient quantities of radioactive tracer are used. [source]

    What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?

    Greg Treston
    Abstract Objective: Ketamine has become the drug most favoured by emergency physicians for sedation of children in the ED. Some emergency physicians do not use ketamine for paediatric procedural sedation (PPS) because of concern about emergence delirium on recovery. The present study set out to determine the true incidence and nature of this phenomenon. Methods: Prospective data relating to any emergence agitation, crying, hallucinations, dreams, altered perceptions, delirium and necessary interventions were recorded in consecutive cases of ketamine PPS from March 2002 to June 2007, and analysed. Standard inclusion and exclusion criteria for the use of ketamine were followed. Results: A total of 745 prospective data collection records were available for analysis over the 5 year period. Of all, 93 (12.5%) children cried on awakening when recovering from PPS, 291 (39%) experienced pleasant altered perceptions and 16 (2.1%) experienced what was called ,emergence delirium'. None required any active treatment and all except one settled within 20 min. There was no evidence of an increased rate of nightmares on telephone follow up in the weeks post procedure. Conclusion: The belief that ketamine, in the doses used for ED PPS, causes frequent emergence delirium is flawed. A pleasant emergence phenomenon is common, but is not distressing for the child, and has no long-term (up to 30 days) negative sequelae. Rarely, there is anxiety or distress on awakening from ketamine sedation, which settles spontaneously. This should not deter emergency physicians from using ketamine for PPS. [source]

    Epidemiology of unarmed threats in the emergency department

    Jonathan C Knott
    Abstract Objective:, To evaluate the precipitants, subject characteristics, nature and outcomes of unarmed threats in the ED. Methods:, A 12 month prospective survey of security codes precipitated by an unarmed threat (Code Grey). Results:, Data were collected on 151 subjects. The Code Grey rate was 3.2/1000 ED presentations. They were most frequent on Saturday and in the late evening/early morning. There were verbal or physical threats of violence made to staff on 104 occasions (69%, 95% confidence interval [CI] 61,76) and a perceived threat of patient self-harm on 114 occasions (76%, 95% CI 68,82). Median time to be seen by a doctor was 8 min (interquartile range [IQR]: 2,21 min) and median time from presentation to Code was 59 min (IQR: 5,222 min). Sixteen subjects (11%, 95% CI 6,17) had a history of violence, 45 (30%, 95% CI 23,38) were affected by alcohol, 25 (17%, 95% CI 11,24) had used illicit drugs and 79 (52%, 95% CI 44,60) had a significant mental illness contributing to the Code Grey. Seventy-one patients (47%, 95% CI 39,55) required psychiatric admission, 49 (79%, 95% CI 66,88) involuntarily. Conclusion:, Acutely agitated subjects pose a threat to themselves and the staff caring for them. The reason for the agitation is multifactorial and the majority arrive in a behaviourally disturbed state requiring early intervention. The times most likely to result in a Code Grey coincide with least available resources: ED and hospital risk management policies must account for this. A coherent approach by ED to this population is required to optimize patient and staff outcomes. [source]

    De novo epileptic confusion in the elderly: A 1-year prospective study

    EPILEPSIA, Issue 6 2010
    Olivier Veran
    Summary Purpose:, Nonconvulsive status epilepticus (NCSE) is clinically difficult to diagnose, especially in old patients without epilepsy, and requires electroencephalography (EEG) for diagnosis. Its incidence among elderly patients with confusion of unknown origin (CUO) remains undetermined. Methods:, A 1-year prospective study was conducted in patients aged 60 years or older, for whom EEG was requested because of confusion considered to be of unknown origin after initial clinical, biologic, and imaging investigations. Diagnosis criteria included a validated clinical assessment scale to confirm confusion. Results:, Of 44 patients with confirmed CUO, 7 presented with de novo NCSE. NCSE population had a mean age of 76 years (range, 60,97 years). No statistically significant differences were found between NCSE patients and others for age, drugs, presence of myoclonia, eyelid myoclonia, tachycardia, or agitation. In contrast, an acute onset (<24 h), gender (100% female among NCSE patients), and lack of clinical response to simple commands were significantly associated with NCSE. No differences between the two groups were evidenced for mortality and morbidity (length of hospitalization, social outcome, and so on). Discussion:, Almost 16% of patients aged 60 or older with confusion of unknown origin had NCSE, according to this first prospective study. Female patients with rapid onset (<24 h) of symptoms and lack of response to simple commands were at a higher risk of presenting with NCSE. [source]

    Intravenous and intratracheal administration of trimetoquinol, a fast-acting short-lived bronchodilator in horses with ,heaves'

    Summary Reason for performing study: Trimetoquinol (TMQ) is a potent ,-adrenoceptor agonist bronchodilator used in human medicine but has not been evaluated for potential use as a therapeutic agent for horses with ,heaves'. Objectives: To assess the pharmacodynamics of TMQ in horses with ,heaves' to determine potential therapeutic effects. Methods: Increasing doses of TMQ were administered to horses with ,heaves' by i.v. and intratracheal (i.t.) routes. Doses ranged 0.001,0.2 ,g/kg bwt i.v. and 0.01,2 ,g/kg bwt i.t. Cardiac and airways effects were assessed by measurement of heart rate (HR) and maximal change in pleural pressure (,Pplmax), respectively. Side effects of sweating, agitation and muscle trembling were scored subjectively. Duration of action to i.v. (0.2 ,g/kg bwt) and i.t. (2 ,g/kg bwt) TMQ was evaluated over 6 h. Results: Intravenous TMQ was an exceptionally potent cardiac stimulant. Heart rate increased at 0.01 ,g/kg bwt, and was still increasing after administration of highest dose, 0.2 ,g/kg bwt. Airway bronchodilation, measured as a decrease in ,Pplmax, also commenced at 0.01 ,g/kg bwt. By the i.t. route, TMQ was 50,100-fold less potent than by i.v. Side effects included sweating, agitation and muscle trembling. Overall, the onset of HR and bronchodilator effects was rapid, within about 3 min, but effects were over at 2 h. Conclusion: When administered i.v. and i.t., TMQ is a highly potent cardiac stimulant and a modest bronchodilator. It may not be an appropriate pharmacological agent by i.v. and i.t. routes for the alleviation of signs in horses with ,heaves'. Further studies of TMQ by oral and aerosol routes are necessary. Potential relevance: In horses, TMQ is a fast-acting bronchodilator with a short duration of action. It could be used as a rescue agent during an episode of ,heaves'. The i.v. and i.t. administration of TMQ is associated with side effects, similar to those reported for all other ,-agonists. However, other routes, such as aerosol and oral, may prove useful and safe for the alleviation of bronchoconstriction typical of ,heaves'. [source]

    Population-based case,control study of morale in Parkinson's disease

    J. Benito-León
    Background:, Parkinson's disease (PD) is associated with cognitive, psychiatric, and motor features. Each could contribute to a poor sense of well-being and low morale. A systematic study of morale in community-dwelling PD cases has not been performed. Methods:, A total of 52 PD cases and 260 matched controls from three Spanish communities were assessed using the Philadelphia Geriatric Center Morale Scale (PGCMS) (range = 0[low morale],17). The PGCMS includes three dimensions of psychological well-being: agitation, lonely dissatisfaction, and attitude toward own aging. Results:, The PGCMS score was lower in PD cases than controls (8.71 ± 3.64 vs. 11.03 ± 2.77, P < 0.001), as were the agitation subscore (3.36 ± 1.91 vs. 4.07 ± 1.59, P < 0.05), lonely dissatisfaction subscore (3.48 ± 1.36 vs. 4.11 ± 1.12, P < 0.01), and attitude toward own aging subscore (1.86 ± 1.37 vs. 2.85 ± 1.13, P < 0.001). In a linear regression analysis that adjusted for depressive symptoms and other covariates, PD cases had a lower PGCMS score than controls (P < 0.001). Conclusions:, Morale was significantly lower in community-dwelling PD cases than matched controls. The detection and possible treatment of this problem may improve the psychological well-being of patients with this disease. [source]

    Monitoring of CBFV and time characteristics of oxygen-induced acute CNS toxicity in humans

    A. E. Koch
    Background:, Hyperbaric oxygen can cause central nervous system (CNS) toxicity with seizures. We tested the hypothesis that CNS toxicity could be predictable by cerebral blood flow velocity (CBFV) monitoring. Method:, We monitored 369 mandatory oxygen tolerance tests (30 min, 280 kPa O2) by video-documentation and since May 2005 by additional CBFV registration (n = 61). Results:, The onset of early manifestations of CNS toxicity was documented in 11 of 369 tests within 22 ± 3 min. These included twitches and/or agitation, 6 of 11 and tonic,clonic seizures in 5 of 11 cases. In both cases with CBFV monitoring, an increase in CBFV preceded symptom onset, once followed by seizure, once without seizure after timely oxygen reduction. Conclusions:, During exposure to 280 kPa oxygen at rest a constant delay of approximately 20 min precedes the onset of central nervous oxygen toxicity. An increase in CBFV may indicate the impending seizure. [source]

    Effect of post-space treatment on retention of fiber posts in different root regions using two self-etching systems

    Ling Zhang
    The effect of post-space treatment on the retention of fiber posts in different root regions was evaluated using two self-etching systems. Post spaces were prepared in extracted premolars and then the root canals were subjected to one of the following post-space treatments: (i) water irrigation (control); (ii) etching with 35% phosphoric acid for 30 s; (iii) irrigation with 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); and (iv) ultrasonic agitation associated with 17% EDTA and 5.25% NaOCl irrigating solutions. The dentin surfaces were examined under scanning electron microscopy (SEM) after different post-space treatments. Fiber posts were then luted in the treated roots using resin cement with either Clearfil SE Bond or Clearfil DC Bond, and the thin-slice push-out test was performed. Scanning electron microscopy showed that all the post-space treatments tested were effective in removal of the smear layer of debris, or sealer/gutta-percha remnants, on the root canal. The apical push-out strength was affected by post-space treatment. Both 35% phosphoric acid etching and ultrasonic agitation in combination with EDTA/NaOCl irrigation improved the apical push-out strength of the fiber post, regardless of the type of self-etching system. A solo irrigation with an EDTA/NaOCl solution resulted in a lower apical push-out strength compared with the other two experimental groups. [source]

    The impact of regulatory focus on affective responses to social discrimination

    Kai Sassenberg
    The impact of individuals' regulatory focus and the domain of outcomes (non-gains vs. losses) on the target's affective responses to social discrimination were tested. Based on regulatory focus theory (Higgins, 1997), it was predicted that a prevention focus would lead to more anger and agitation after social discrimination, because experiencing social discrimination is similar to experiencing failure. This pattern was predicted to be more pronounced when social discrimination was based on losses than when social discrimination was based on non-gains (i.e., when the in-group was evaluated more negatively vs. less positively compared to the out-group). The results of three studies using chronic and situationally induced regulatory focus confirmed these predictions. No effect was found for the promotion focus. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    The possible adaptive advantages of terrestrial egg deposition in some fluvial diadromous galaxiid fishes (Teleostei: Galaxiidae)

    FISH AND FISHERIES, Issue 3 2006
    RM McDowall
    Abstract Several diadromous New Zealand and Australian species of Galaxias are now known, or suspected, to deposit their eggs amongst riparian vegetation or substrates either supratidally in estuaries or in forested streams in locations that are only temporarily submerged by elevated water levels. The eggs develop in a humid atmosphere and hatch when the egg deposition sites are resubmerged; a significant role for agitation in stimulating hatching seeming likely. There are risks from the eggs becoming dehydrated, and also from a failure by water to resubmerge the eggs before they have exhausted their energy resources. Hatching is triggered by elevated flows, perhaps being an outcome of agitation of the eggs. Elevated flows may also increase the rate of downstream transport of the larvae, facilitating survival during dispersal to sea from spawning sites in streams that may be long distances inland. Hatching during flood events may favour survival of the larvae because turbid flows may provide ,cover' for the larvae as they emigrate to sea. Risks from egg predation by aquatic predators may be replaced by risks from terrestrial predators. [source]