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This systematic investigation of the neurocognitive correlates of complex regional pain syndrome (CRPS) in a single case also reports agnosia for object orientation in the context of persistent CRPS. We report a patient (JW) with severe long-standing CRPS who had no difficulty identifying and naming line drawings of objects presented in 1 of 4 cardinal orientations. In contrast, he was extremely poor at reorienting these objects into the correct upright orientation and in judging whether an object was upright or not. Moreover, JW made orientation errors when copying drawings of objects, and he also showed features of mirror reversal in writing single words and reading single letters. The findings are discussed in relation to accounts of visual processing. Agnosia for object orientation is the term for impaired knowledge of an object's orientation despite good recognition and naming of the same misoriented object. This defect has previously only been reported in patients with major structural brain lesions. The neuroanatomical correlates are discussed. The patient had no structural brain lesion, raising the possibility that nonstructural reorganisation of cortical networks may be responsible for his deficits. Other patients with CRPS may have related neurocognitive defects. [ABSTRACT FROM AUTHOR]

Are you following best practices to prevent errors? Is your facility doing all it should? Read these revealing survey responses for answers. [ABSTRACT FROM AUTHOR]

Learn how adapting processes for prescribing, preparing, and administering can help reduce errors associated with certain high-alert medications. [ABSTRACT FROM AUTHOR]

This article describes OSF Healthcare's recent journey in patient safety. It discusses the involvement of its 6 hospitals in collaboration with each other and the Institute for Healthcare Improvement. OSF focused on a strategy for decreasing adverse drug events (ADEs). They worked on impacting 4 major areas: safety culture, high-risk medication, dispensing of medication, and medication reconciliation. By doing this, OSF decreased its rate of ADEs per 1000 units of medication administered from 3.84 to 1.39 over the course of 20 months. [ABSTRACT FROM AUTHOR]

Read what nurses have to say about making and reporting medication errors and disclosing them to patients -- and learn how you can reduce the risk for your patients and yourself. [ABSTRACT FROM AUTHOR]

Learn the best defense against medication errors -- understanding the roles that human factors and systems play. [ABSTRACT FROM AUTHOR]

BACKGROUND: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES: To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. PARTICIPANTS: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. DESIGN: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. MEASUREMENTS AND MAIN RESULTS: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. CONCLUSIONS: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families. [ABSTRACT FROM AUTHOR]

Background: Ultraporous β-tricalcium phosphate (TCP) synthetic graft material (Vitoss; Orthovita) persists for a year or longer in some cases. In this study, we prospectively examined healing of cavitary defects filled with TCP versus TCP and bone marrow aspirate (TCP/BM) with the hypothesis that bone-marrow aspirate speeds incorporation of bone graft substitute.Methods: Fifty-five patients with a benign bone lesion undergoing surgical curettage were randomized to receive TCP (N = 26; mean duration of follow-up [and standard deviation], 20.2 ± 7.2 months) or TCP/BM (N = 29; mean duration of follow-up, 18.0 ± 7.7 months). There were no significant differences between the groups with regard to demographic or defect parameters. Clinical and radiographic evaluations were done at 1.5, three, six, twelve, eighteen, and twenty-four months, and computed tomography [CT] scans were performed at twelve months. An independent radiographic review was done to evaluate six parameters.Results: There was a significant (p < 0.001) increase in trabeculation through the defect and graft resorption with decreases in the persistence of the graft in both soft tissue and the defect as well as a decreased radiolucent rim around the graft over time. No significant differences were observed between the TCP and TCP/BM groups in terms of any radiographic parameter. No complications related to the graft material or BM were identified.Conclusions: While significant improvements in radiographic parameters were observed in both TCP groups over two years of follow-up, the addition of BM was not found to provide any significant benefit. Results should not be extrapolated to other bone graft substitutes used for this purpose. [ABSTRACT FROM AUTHOR]

Study Design: A descriptive CT study of lumbar facet joint (FJ) arthrosis in general and spinal stenosis populations. Objective: To reveal the prevalence of FJ arthrosis in general and stenosis populations and to establish its relationship to age and sex. Summary Of Background Data: FJ arthrosis is a common radiographic finding and has been suggested as a cause of low back and lower extremity pain. It is also considered a dominant player in the genesis of lumbar spinal stenosis. Although it is well accepted that FJ arthrosis is an age dependent phenomenon, controversies still exist as to its association with sex and its prevalence at different spine levels. In addition, data on FJ arthrosis frequency in spinal stenosis population are missing. Methods: Two groups were studied. The first included 65 individuals with LSS (mean age = 66 ± 10 yr) and the second, 150 individuals (mean age = 52 ± 19 yr) without LSS related symptoms. Both left and right FJ arthrosis for each vertebral level (L3-S1) were evaluated on CT images (Brilliance 64, Philips Medical System, Cleveland, OH). Chi-square, Linear-by-Linear Association and McNemar test were carried out to reveal the correlation between FJ arthrosis and demographic factors (age, sex) and prevalence at different lumbar levels in both stenosis and nonstenosis groups. In addition, a two-way analysis of variance (ANOVA) was used to determine the association between body mass index (BMI) and FJ arthrosis. Results: The rate of FJ arthrosis at L3-L4 and L4-L5 were significantly higher (P < 0.001) in the stenotic group compared to the control. In the control group the prevalence of FJ arthrosis increases cephalocaudally (L3-L4 = 16%, L4-L5 = 28%, L5-S1 = 55%), whereas in the stenotic group there is a sharp increase from L3-L4 (27%) to L4-L5 (58%), but not from L4-L5 to L5-S1 (55%). No association between FJ arthrosis and sex was noted. Although, mean BMI was significantly smaller in the control group compared to the stenotic group, no association between BMI and facet arthrosis was found. In the general population the prevalence of FJ arthrosis at all three levels was greater for the right side; however, significant difference (P = 0.004) was obtained only for L3-L4. In all joints studied, the prevalence of FJ arthrosis increases considerably from the young age cohort (18-39) to the old age cohort (>60). Nevertheless, 10% of the young individuals (18-39) have already manifested FJ arthrosis at L5-S1. No arthrosis at that age was observed at L3-L4. Conclusion: FJ arthrosis is an age-dependent and BMI and sex independent phenomenon. In the general population, the prevalence of FJ arthrosis increases cephalocaudally with the highest frequency at L5-S1. In the stenotic group, the highest frequency was observed at the two caudal levels; L4-L5 and L5-S1. The prevalence of FJ arthrosis was greater for the right side. [ABSTRACT FROM AUTHOR]