We found no increase in the number of adverse events with morphine pretreatment in ketamine sedations for children. Prospective studies to validate these findings, including an effect of timing of analgesia administration, are warranted.
Resilience refers to the adaptability of a person – an ability to “bounce-back” from stressors. We question if resilience can be strengthened, potentially to decrease the risk of stress-related disorders. Unfortunately, the molecular origins of resilience are complicated and not yet well understood. In this review, we examine the various physiological biomarkers of resilience, including the associated genes, epigenetic changes, and protein biomarkers associated with resilient phenotypes. In addition to assessing biomarkers that may indicate higher levels of resilience, we also review at length the many biomarkers that confer lower levels of resilience and may lead to disorders of low resilience, such as anxiety and depression. This large and encompassing review may help to identify the possible therapeutic targets of resilience. Hopefully these studies will lead to a future where stress-related disorders can be prevented, rather than treated.
Objective: Clinical guidelines place considerable emphasis on early swallow screening, as it has significant impact on patient outcomes. This study aims to examine perspectives and practices of speech and language therapists (SLTs) in the Republic of Ireland on swallow screening, exploring challenges in screening methods to improve practice and facilitate research. Methods: An 18-item web-based survey was devised targeting SLTs working in dysphagia in Republic of Ireland. Perspectives were sought on definitions of screening, models of practice, tests used, and factors influencing decision-making. Results: Fifty-eight SLTs responded, representing a cross section of clinical settings, populations, and experience. Screening tests most frequently employed were personal screening tests (80%). Important considerations reported in test selection were patient safety (100%), ease of use (97%), staffing (97.5%), and diagnostic accuracy (97.5%). Perceived challenges were staff training associated with screening. Conclusions: It is concerning that while diagnostic accuracy was recognised as important, most respondents used tests lacking in diagnostic accuracy. While the survey response rate was low, it is hypothesised that findings reflect practice. There is a need for SLTs to equip themselves with the skills to discern which screening test is most diagnostically accurate for clinical populations with further research to improve practice.
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