Andrew J. Bush

Quantitative criteria for insomnia

Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (> or =3 nights a week) and duration (> or =6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) > or =31 min; (b) occurring > or =3 nights a week; (c) for > or =6 months are the most defensible quantitative criteria for insomnia.

Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections Results From the Trial to Reduce Antimicrobial Prophylaxis Errors

Objective:The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). Summary Background Data:National AMP guidelines should be supported by evidence from large contemporary data sets. Methods:Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). Results:One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98–3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74–12.90), but only when the preoperative dose was given correctly. Conclusions:These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.

Targeted chemoradiation for advanced head and neck cancer: Analysis of 213 patients

To determine the survival results, patterns of relapse, and organ preservation effects of a targeted chemoradiation protocol for patients with advanced (stage III–IV) carcinoma of the head and neck.

Relationship of hippocampal sclerosis to duration and age of onset of epilepsy, and childhood febrile seizures in temporal lobectomy patients

Controversy exists as to whether hippocampal sclerosis (HS) is a preexisting cause or a consequence of seizures. We investigated 122 consecutive patients who underwent anterior temporal lobectomy for intractable epilepsy between 1989 and 1992. MRI scans were normal apart from evidence of HS in 5 cases. The degree of HS was graded from 0 to 4. There was a significant inverse correlation between age of seizure onset and grade of HS (P < 0.0001), and a positive correlation between duration of epilepsy and grade of HS (P < 0.001). Using a dichotomous grouping of HS (HPSC - for grades 0 and 1 [no/mild HS], and HPSC + for grades 3 and 4 [moderate/marked HS]), there was a positive correlation between HPSC + and a history of childhood febrile seizures (CFS) (P = 0.003), earlier age of onset of epilepsy (P < 0.001) and longer duration of epilepsy (P < 0.001). There was no correlation with history of particularly prolonged individual seizures. Partial correlations after controlling for age at onset of epilepsy showed that there was no longer a significant relationship between HPSC + and duration of epilepsy. After controlling for duration of epilepsy, the relationship between HPSC + and age of onset remained significant (P < 0.001). The correlation between HPSC + and CFS, controlling for age at onset, was not significant. A series of logistic regression analyses showed age at onset to be the only predictor of HPSC +. It is concluded that this is supportive evidence for preexisting HS being a cause of temporal lobe epilepsy and not a consequence of seizures.

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

Summary: Purpose: To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming.

Respiratory Syncytial Virus Load, Viral Dynamics, and Disease Severity in Previously Healthy Naturally Infected Children

BACKGROUND Respiratory syncytial virus (RSV) disease severity was thought to be a result of host immunopathology but alternatively may be driven by high-level viral replication. The relationships between RSV load, viral clearance dynamics, and disease severity have not been carefully evaluated. METHODS Previously healthy RSV-infected children <2 years old were recruited. RSV load was measured in respiratory secretions by fresh quantitative culture over 3 hospital days. Measures of disease severity were hospital admission, duration of hospitalization, requirement for intensive care, and respiratory failure. RESULTS Multivariate logistic regression models revealed independent predictors of increased duration of hospitalization: male sex, lower weight, and higher viral load on any day. Viral loads at day 3 were more significantly associated with requirement for intensive care and respiratory failure than were viral loads at earlier time points. Faster RSV clearance was independently associated with shorter hospitalization. DISCUSSION These observations challenge the immunopathology-based pathogenesis paradigm. They also have major therapeutic implications, suggesting that application of antiviral agents early in the disease course, even at a time when viral replication is at its highest, might improve subsequent morbidity by significantly lowering viral load and direct viral cytopathic effects, and aborting the potential downstream immunopathology.

Epidemiology of Sleep : Age, Gender, and Ethnicity

Contents: Goals and Distinctive Characteristics of This Survey. A Review of Epidemiological Studies of Insomnia and Sleep. Methods of This Survey. An Archive of Normal Sleep. An Archive of Insomnia. An Archive of the Sleep of African Americans. Summary of Main Findings. Appendix: Alphabetical Listing of Abbreviations and Acronyms.

Socioeconomic status and insomnia

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.

Nasal quantity of respiratory syncytial virus correlates with disease severity in hospitalized infants.

Objective. To evaluate the relationship between nasal quantity of respiratory syncytial virus (RSV) and disease severity in hospitalized infants without underlying cardiopulmonary disease or immunodeficiency. Methods. Nasal aspirates were obtained from hospitalized infants <24 months of age with recently identified RSV infection and evaluated for RSV quantity by a standard plaque assay on HEp‐2 cell monolayers. Subjects were classified as having “severe” disease if they required mechanical ventilation at the time of sample collection and as having “nonsevere” disease if they did not. Linear modeling was used to determine the relationship between nasal RSV quantity and various independent variables, including disease severity. Results. Nasal aspirates from 39 patients were evaluated. Age, gender and mean duration of time from symptom onset to sample acquisition (5 days) were similar between the severe (n = 15) and nonsevere (n = 24) groups. Significantly more infants were born at <35 weeks gestation in the severe disease group (7 of 15 vs. 3 of 24, P = 0.017), and infants born at <35 weeks gestation were significantly more likely to be of non‐Caucasian ethnicity than were infants born at ≥35 weeks gestation (8 of 10 vs. 12 of 29, P = 0.035). The linear model found that higher nasal RSV quantities were associated with severe disease [mean ± SEM, 5.06 ± 0.34 log plaque‐forming units (pfu)/ml vs. 3.91 ± 0.35 log pfu/ml, P = 0.022], gestational age ≥35 weeks (5.44 ± 0.27 log pfu/ml vs. 3.52 ± 0.45 log pfu/ml, P = 0.002) and non‐Caucasian ethnicity (5.16 ± 0.30 log pfu/ml vs. 3.80 ± 0.37 log pfu/ml, P = 0.006). Conclusions. Nasal RSV quantity correlates with disease severity in hospitalized infants with recently identified RSV infection.

Prediction of Verbal Memory Loss in Individuals After Anterior Temporal Lobectomy

Summary: Purpose: Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre‐to postoperative memory decline using only information available preoperatively.