Report on Special Investigation of Selected Accounts at Kennedy High School, Cedar Rapids Community School District, For the Period June 1, 2003 through May 31, 2006

Community School District Audit Report - Special Investigation

Therapeutic play in preparing for surgery: behavior of preschool children during the perioperative period

Objective:to describe the behavior of children during the instructional session of therapeutic play (ITP) in the preoperative period and to verify the behavior presented by them during the perioperative period. Methods: Exploratory descriptive study with a quantitative approach, developed in a large private hospital in Sao Paulo, in which the behaviors presented by 30 children between three and five years old, undergoing minor surgery were seen at the hospital during the session of TP and in the surgical center, from admission to awaken from anesthesia. Results: Most children participated in the ITP session (21; 70%), entered the surgical room spontaneously (22; 73.3%) without resisting mother separation (24; 80%), collaborating with the anesthetic procedure (16; 53.3%) and quietly awakening from anesthesia (26; 87%). Conclusion: The use of ITP led the child to understand the surgical procedure, making it less traumatic.


Calcium antagonists as first-line therapy in hypertension: results of the Swiss Isradipine Study. Swiss Hypertension Society

In this study of the efficacy and safety of isradipine as first-line therapy in hypertension, 1,647 patients enrolled; 1,472 completed the 4-week placebo run-in period and began treatment with isradipine at 2.5 mg twice daily for 4 weeks. During placebo, 11% (n = 175) of the 1,647 patients withdrew because of normalization of blood pressure, side effects, noncompliance, violation of the study protocol, side effects from concomitant therapy, or other reasons. During isradipine therapy (n = 1,376), blood pressure decreased from 168 +/- 18/102 +/- 8 mm Hg at the end of the placebo period to 155 +/- 17/94 +/- 9 mm Hg after 2 weeks (p less than 0.001) and 151 +/- 16/92 +/- 9 mm Hg after 4 weeks (p less than 0.001). During active treatment, 6.4% (n = 94) were withdrawn because of flushing, headache, edema, palpitations, gastrointestinal side effects, skin rashes, or other side effects, and two patients because of lack of efficacy. The side effect score in the remaining patients worsened for flushing, remained unchanged for edema, but significantly improved for palpitations, fatigue, dizziness, headache, and nervousness. After 4 weeks, 60% of patients had diastolic blood pressures of less than or equal to 90 mm Hg. Thus, isradipine is effective and safe as first-line therapy in patients with primary hypertension as seen in general practice.

Long-term outcome after cognitive and behavioral regression in non-lesional epilepsy with CSWS

Purpose: To present the long-term outcome (LTO) of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to non-lesional focal, mainly frontal epilepsy with continuous spike-waves during slow wave sleep (CSWS). Method: Past medical and EEG data of all patients were reviewed and neuropsychological tests exploring main cognitive functions were administered. Result: After a mean duration of follow-up of 15.6 years (range 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders that were so disturbing during the active period (AP) resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the AP disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. LTO correlated best with duration of CSWS. Conclusion: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence as reported in adults with destructive lesions of the frontal lobes during childhood. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Development of a Safety protocol for Management Thirst in the Immediate Postoperative Period

Objective To develop a safety protocol for the management of thirst in the immediate postoperative period. Method Quantitative, methodological, and applied study conducted in April-August 2012. An extensive literature search and expert consultation was carried out to develop the protocol and its operating manual. Theoretical and semantic analyzes were carried out by experts. Results Assessment of level of consciousness, reflexes of protection of the airways (cough and swallowing), and absence of nausea and vomiting were selected as safety criteria. These criteria were grouped and formatted in a graph algorithm, which indicates the need to interrupt the procedure if a security criterion does not reach the expected standard. Conclusion The protocol was elaborated to fill in the gap in the literature of a specific model concerning nursing actions in the safe management of thirst in the immediate postoperative period.

Report on Special Investigation of the City of Sandyville, For the Period July 1, 1999 through April 28, 2006

City Audit Report - Special Investigation

Special Investigation of the Central Iowa Fair, For the Period July 1, 2004 through September 30, 2006

Other Audit Reports - Special Investigation

Reaudit report on the Lake Park Municipal Utilities for the period July 1, 2004 through June 30, 2005

Reaudit report on the Lake Park Municipal Utilities for the period July 1, 2004 through June 30, 2005

Avancées thérapeutiques dans les epilepsies réfractaires de l'enfant [Therapeutic advances in refractory epilepsies in children].

Epilepsy concerns several thousands of children in Switzerland, and is refractory to classic antiepileptic drugs in an important proportion of cases. This percentage has remained stable, despite a constant production of new antiepileptic molecules. To alleviate this problem, several alternative approaches have been developed these last years. In this article, we present three children who suffer from different forms of pharmacoresistant epilepsy, managed with immunomodulatory or neurosurgical treatments, and we summarize the current knowledge about these therapeutic options.

Polyfunctional HCV-specific T-cell responses are associated with effective control of HCV replication

Rapport de synthèse : L'infection par le virus de l'hépatite C (VHC) a une évolution sévère chez les patients co-infectés par VIH/VHC, de même que chez les patients transplantés hépatiques. Toutefois, les mécanismes impliqués dans cette évolution restent peu clairs. Dans ce travail, nous étudions le profil fonctionnel des cellules T spécifiques dirigées contre le virus de l'hépatite C chez 86 patients mono-infectés par VHC, 48 patients co-infectés par VIH/VHC et 42 patients ayant bénéficié d'une transplantation hépatique. La production d'IFN-Y et d'IL-2 et la capacité de proliférer des cellules T CD4+ et CD8+ sont évaluées après stimulation par des peptides dérivés du VHC. Chez les patients mono-infectés par le VHC, les cellules T spécifiques au VHC sont polyfonctionnelles du point de vue de la sécrétion de cytokines, avec trois profils de sécrétion pour les cellules T CD4+: sécrétion uniquement de IL-2, sécrétion de IL-2 et IFN-y et sécrétion uniquement de IFN-gamma, et de deux profils pour les cellules T CD8+: sécrétion de IL-2 et IFN-y et sécrétion uniquement de IFN-gamma. En revanche, les cellules T spécifiques au VHC chez les individus coinfectés par VIH/VHC et chez les patients transplantés hépatiques ont un profil de sécrétions de cytokines marqué par l'absence de cellules CD4+ sécrétant uniquement l'Il-2 et l'absence de cellules CD8+ sécrétant à la fois IL-2 et IFN-gamma. De plus, la prolifération de cellules T CD4+ et CD8+ spécifiques au VHC est considérablement réduite chez les patients co-infectés par VIH/VHC, comme chez les transplantés hépatiques. La présence de cellules T effectrices uniquement (définies par l'absence de cellules T CD4+ sécrétants uniquement de l'IL-2 et l'absence de cellules T CD8+ sécrétant à la fois IL-2 et IFN-gamma et altération de la capacité proliférative) est associée avec une charge virale VHC significativement plus élevée et une fibrose hépatique plus sévère. Par conséquent, les présents résultats suggèrent la participation de mécanismes immunitaires dans l'évolution accélérée de l'hépatite C chez les patients co-infectés par VIH-1 et chez les patients greffés hépatiques.

Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: a prospective population-based cohort study.

OBJECTIVE: The effect of minor orthopaedic day surgery (MiODS) on patient's mood. METHODS: A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of general anaesthesia (GA) were included. The Medical Outcomes Study - Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and post-operatively. RESULTS: The mean physical component score of SF-36 before surgery was 45.3 (SD=+/-10.1) and 8 weeks following surgery was 44.9 (SD=+/-11.04) [n=148, p=0.51, 95% CI=(-1.03 to 1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov=69.44) corresponded to a correlation coefficient, r=0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with chi(2) (df=1)=0.86 for which p=0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected. CONCLUSIONS: MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.

Report on the Grow Iowa Values Fund (GIVF) for the period July 1, 2003 through June 30, 2006.

Report on the Grow Iowa Values Fund (GIVF) for the period July 1, 2003 through June 30, 2006.

Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. DESIGN: Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in our chronic obstructive pulmonary disease database during a 5-yr period. SETTING: The medical intensive care unit (ICU) of a university hospital. PATIENTS: Eighty-seven patients with chronic obstructive pulmonary disease. Fifteen patients had chronic obstructive pulmonary disease that required mechanical ventilation for acute exacerbation of their disease (study year), and 72 were patients with chronic obstructive pulmonary disease from the previously collected data. INTERVENTIONS: The ICU course (duration of mechanical ventilation, mortality) was recorded, as well as several respiratory parameters (pulmonary function tests and arterial blood gases in stable conditions, and nutritional status), and they were compared with an "index of nursing." MEASUREMENTS AND MAIN RESULTS: We developed an "index of nursing", comparing the effective workforce of the nurses (number and qualifications) with the ideal workforce required by the number of patients and the severity of their diseases. A value of 1.0 represented a perfect match between the needed and the effectively present nurses, whereas a lesser value signified a diminished available workforce. This index was compared with the complications and duration of weaning from mechanical ventilation. During the first 5 yrs, the duration of mechanical ventilation increased progressively from 7.3 +/- 8.0 to 38.2 +/- 25.8 days (p = .006). A significant inverse correlation between the duration of mechanical ventilation and the nursing index (p = .025) was found. In the sixth comparative year, the number of nurses increased (nursing index = 1.05) and the duration of mechanical ventilation decreased to 9.9 +/- 13 days (p < .001, yr 5 vs. yr 6). CONCLUSIONS: The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. Below a threshold in the available workforce of ICU nurses, the weaning duration of patients with chronic obstructive pulmonary disease increases dramatically. Therefore, very close attention should be given to the education and number of ICU nurses.

Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

Audit report on a review of selected general and application controls over the University of Northern Iowa’s Modern Executive Management Financial Information System (MEMFIS) human resources and payroll modules for the period May 22, 2006 through June 12, 2006.

Audit report on a review of selected general and application controls over the University of Northern Iowa’s Modern Executive Management Financial Information System (MEMFIS) human resources and payroll modules for the period May 22, 2006 through June 12, 2006.