Likely CAM cases were younger, and more often prescribed additional antipsychotics, specifically quetiapine. Seven (78%) of 9 patients diagnosed with CAM met published CAM definition. In 14 undiagnosed potential cases, 10 (71%) did not have timely testing to exclude CAM. CONCLUSIONS Maintaining a high index of suspicion, clinical monitoring and timely testing is important to supplement CAM screening protocols. More research is needed to identify those that can be safely rechallenged or even continue clozapine treatment with monitoring.PURPOSE/BACKGROUND In addition to clozapine, other atypical antipsychotic drugs pharmacologically similar to clozapine, for example, olanzapine, risperidone, and melperone, are also effective in a similar proportion of treatment-resistant schizophrenia (TRS) patients, ~40%. The major goal of this study was to compare 2 doses of lurasidone, another atypical antipsychotic drug, and time to improvement in psychopathology and cognition during a 6-month trial in TRS patients. METHODS/PROCEDURES The diagnosis of TRS was based on clinical history and lack of improvement in psychopathology during a 6-week open trial of lurasidone 80 mg/d (phase 1). This was followed by a randomized, double-blind, 24-week trial of lurasidone, comparing 80- and 240-mg/d doses (phase 2). FINDINGS/RESULTS Significant non-dose-related improvement in the Positive and Negative Syndrome Scale-Total and subscales and in 2 of 7 cognitive domains, speed of processing and executive function, were noted. Twenty-eight (41.8%) of 67 patients in the combined sample improved ≥20% in the Positive and Negative Syndrome Scale-Total. Of the 28 responders, 19 (67.9%) first reached ≥20% improvement between weeks 6 and 24 during phase 2, including some who had previously failed to respond to clozapine. IMPLICATIONS/CONCLUSIONS Improvement with lurasidone is comparable with those previously reported for clozapine, melperone, olanzapine, and risperidone in TRS patients. In addition, this study demonstrated that 80 mg/d lurasidone, an effective and tolerable dose for non-TRS patients, was also effective in TRS patients but required longer duration of treatment. Direct comparison of lurasidone with clozapine in TRS patients is indicated.PURPOSE/BACKGROUND Alzheimer disease (AD) is a public health issue because of the low number of symptomatic drugs and the difficulty to diagnose it at the prodromal stage. The need to develop new treatments and to validate sensitive tests for early diagnosis could be met by developing a challenge model reproducing cognitive impairments of AD. Therefore, we implemented a 24-hour sleep deprivation (SD) design on healthy volunteers in a randomized, double-blind, placebo-controlled, crossover study on 36 healthy volunteers. METHODS/PROCEDURE To validate the SD model, cognitive tests were chosen to assess a transient worsening of cognitive functions after SD and a restoration under modafinil as positive control (one dose of 200 mg). Then, the same evaluations were replicated after 15 days of donepezil (5 mg/d) or memantine (10 mg/d). The working memory (WM) function was assessed by the N-back task and the rapid visual processing (RVP) task. FINDINGS/RESULTS The accuracy of the N-back task and the reaction time of SD, and the expected drug effect should be carefully considered.OBJECTIVE To determine the vestibulo-ocular reflex (VOR) performance during the attacks of Menière’s disease (MD) using video head-impulse tests (video-HITs) according to each ictal phase. STUDY DESIGN Retrospective case series review. METHODS We analyzed the results of video-HITs in 24 patients with unilateral definite MD during and between the attacks. RESULTS The head impulse gain of the VOR was usually normal (81%, 39 of the 48 semicircular canals [SCCs] in 16 patients) in the affected ear during the irritative or recovery phase, and did not differ from that for each SCC between the attacks (horizontal [HCs], p = 0.412; anterior [ACs], p = 0.920; posterior canals [PCs], p = 0.477). During the paretic phase, however, the head impulse gains of the VOR were equally normal (22/42, 52%) or decreased (20/42, 48%) for the affected ear (42 SCCs in 14 patients). The gains for the HCs were lower during the paretic phase than those between the attacks in the affected ear, while those for the ACs and PCs did not differ (HCs, p = 0.001; ACs, p = 0.158, PCs, p = 0.401). Covert saccades were more frequently observed even in the presence of normal VOR gains during the paretic phase as well. CONCLUSION During the attacks of MD, HITs are usually normal during the irritative/recovery phases, but become positive in more than a half of the patients during the paretic phase. This evolution in the ictal findings of HITs may reflect characteristic ictal vestibular discharges in MD and should be considered in evaluating patients with MD according to each ictal phase during the attacks.OBJECTIVE To determine the incidence of hearing loss (HL) as well as differences in wages and labor force participation rates between individuals with and without HL. STUDY DESIGN Retrospective ecological study. 2-APV in vitro PATIENTS 1% of the US population including individuals with and without HL from the public use micro data sample (PUMS) of the 2011 to 2016 American Community Survey (ACS) was analyzed. MAIN OUTCOME MEASURE ACS census data on individual age, self-reported hearing loss, labor force participation, and monetary earnings between 2011 and 2016. RESULTS HL incidence rates were 13.4, 0.4, 3.8, 18.1, and 117.1 per 10,000 people among 0 to 2, 3 to 17, 18 to 44, 45 to 64, and 65+ years old, respectively. HL 18 to 44, 45 to 64, and 65+ years old participated in the labor force at 86, 81, and 61% of the rate of hearing individuals. HL 18 to 44, 45 to 64, and 65+ years old earned 78, 73, and 72% of the wages earned by non-HL individuals. CONCLUSIONS Calculated HL incidence and labor force participation rates were higher than previously published in literature analyzing 1991 census data. The changes may be due to the methodology used in this study but may also reflect improvements in diagnosis, access to technology, and the implementation of the Americans with Disabilities Act (ADA) of 1990.OBJECTIVE To mark the centenary of Adam Politzer’s death by investigating and celebrating the legacy he left to otology. Politzer is arguably one of the greatest otologists of the last 200 years and his textbook on otological history is undoubtedly the seminal work on the subject. The aim of this paper is twofold. Not only do the authors hope to find out if he is still remembered by otolaryngologists, but also what has been the greatest legacy which he has bequeathed to them. METHODOLOGY Extensive review of available academic literature mentioning the name Politzer. RESULTS Politzer’s celebrated tome, History of Otology was not only the first comprehensive book on the subject, but it has stood the test of time and still remains unsurpassed as the “Gold Standard” reference work. CONCLUSION The considered opinion of the authors (both otolaryngologists and academic historians) is that the name of Politzer certainly lives on and that this book is probably his most enduring legacy to posterity. It can justifiably be said that Adam Politzer was the first otologist to prove the concept that the past is the key of the present, which opens the future.OBJECTIVE To assess factors predicting vestibular neuritis (VN) prognosis at an early stage. STUDY DESIGN Retrospective chart review. SETTING University hospital. PATIENTS Sixty-five patients with VN, between 2014 and 2018. INTERVENTIONS Bithermal caloric test, rotatory chair test, subjective visual horizontal and vertical, cervical visual myogenic evoked potential test, and visual head impulse test (vHIT). MAIN OUTCOME MEASURES Hospitalization duration. RESULTS The mean hospitalization duration was 4.6 ± 1.4 days. Mean caloric weakness was 65.5 ± 20.6%. For the vHIT, gain in both anterior and horizontal semicircular canal (SCC) was statistically significantly different between the lesion and intact sides (p  less then  0.001). Backward conditional regression analysis revealed that a higher degree of spontaneous nystagmus (SN) (EXP[B] = 1.104, 95% confidence interval [CI] = 1.012-1.204, p = 0.026), and a lower caloric paresis (CP) value (EXP(B) = 1.033, 95% CI = 1.000-1.075, p = 0.047) were associated with 5 days or more of hospitalization. The cut-off value of SN was 12.05 degrees/s for increased hospital stay. Four weeks after discharge from hospital, five patients (8.9%) had persistent SN, and 19 (33.9%) and 28 (50.0%) had a positive HIT and nystagmus during head-shaking, respectively. Patients with persistent nystagmus at 1 month had more severe initial SN (p  less then  0.05). CONCLUSION Only the degree of SN at the initial evaluation affected both the hospitalization period and the bed-side examination results at 1 month after discharge in patients with VN.Prior studies have reported inconsistent findings regarding the relationship between nurse staffing and nosocomial infections in very low-birth-weight (VLBW) infants. Little is known about whether similar associations occur in Korea. The purpose of this study was to identify the nurse staffing of neonatal intensive care units (NICUs) in Korea and to verify the association between nurse staffing and nosocomial infections among VLBW infants in NICUs. We selected 4654 VLBW infants admitted to 52 hospitals. Nosocomial infections were defined as incidence of bloodstream infection, urinary tract infection (UTI), or rotavirus infection. The average number of NICU patients per nurse was 4.51(minimum-maximum 2.38-8.16). Hospitals with a higher number of patients per nurse exhibited a significant increased UTI rate (P = .005) and rotavirus infection rate (P = .025) in the univariate analysis. After adjusting for all patient and hospital characteristics, UTI significantly increased with increasing number of patients per nurse (odds ratio [OR] = 1.79; 95% confidence interval, 1.29-2.47), while bloodstream infection (OR = 0.93; 95% confidence interval, 0.79-1.09) and rotavirus infection (OR = 1.14; 95% confidence interval, 0.92-1.41) were not significant. These findings revealed that a nurse staffing in NICUs is an important factor for preventing UTI among VLBW infants.The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH.