[Routine written intervention asserting the advantages of multiple blood cultures increases their order rate among doctors].

PURPOSE: Obtaining two or more blood culture sets is important for achieving good sensitivity and for detecting contamination. However, many doctors still only order one set for their laboratory testing. We wished to determine if routine written intervention to these doctors could increase the number of multiple blood cultures they ordered. MATERIALS AND METHODS: On November 11, 2011 at Tokyo Teishin Hospital, we began sending letters asserting the advantages of using multiple blood culture sets to doctors who only ordered solitary blood cultures. The effect of the intervention was determined by measuring the order rate of multiple blood culture sets at the hospital. We compared the order rate one year before intervention with that of one year after. We used a chi-square test (without Yates correction) to analyze the data, and p values less than 0.05 were considered to be statistically significant; all tests were two-tailed. RESULTS: Before written intervention, the order rate of multiple blood cultures was 41%. This increased significantly to 68% after intervention (p < 0.001). The latter figure was 1.7 times greater than the former (relative risk, 1.7; 95% confidence interval, 1.5-1.8). CONCLUSION: Routine written educational intervention asserting the advantage of multiple blood cultures led to an increase in their order rate by doctors. While this is a significant increase, it is still insufficient. Therefore, we propose the need for internal policies requiring at least two blood culture sets to ensure better sensitivity and detection of contamination. To enforce these policies, hospital personnel should be allowed to routinely intervene by either sending warning letters to the doctors or displaying this information on the patient's electronic chart.

[The effect of prophylactic therapy with valproate sodium and phenobarbital in two patients with cyclic vomiting syndrome].

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting, and other symptoms, separated by intervals of comparative wellness. Associated symptoms include nausea, abdominal pain, headache, and motion sickness. Recently, CVS was categorized as a migraine. Case 1 was a girl aged 4 years and 11 months, who had frequent and severe episodes of vomiting since she was 3 years old. The diagnosis of CVS was established on the basis of clinical symptoms and laboratory data. Her electroencephalogram was normal. Prophylactic therapy using a single drug such as amitriptyline, carbamazepine, phenytoin, cyproheptadine, valproate sodium or phenobarbital was not effective. However, her recurring vomiting disappeared with prophylactic therapy using valproate sodium and phenobarbital. Case 2 was a boy aged 10 years and 7 months, who had frequent episodes of vomiting since he was 1 year and 10 months old. He had been receiving intravenous hyperalimentation therapy at home since infancy because of frequent vomiting and failure to thrive. His electroencephalogram showed no abnormality. Prophylactic therapy using a single drug such as diazepam, phenytoin, valproate sodium or phenobarbital was not effective. However, his recurring vomiting disappeared with prophylactic therapy using valproate sodium and phenobarbital. There were no adverse effects in both patients. The combination therapy with valproate sodium (20 - 26 mg/kg/day) and phenobarbital (4 - 5 mg/kg/day) was effective as a prophylactic therapy in these two patients. The combination therapy with valproate sodium and phanobarbital for prophylaxis of vomiting may be helpful in patients with intractable CVS.

Emotions surrounding friendships of adolescents with autism spectrum disorder in Japan: A qualitative interview study.

Emotions are embedded in culture and play a pivotal role in making friends and interacting with peers. To support the social participation of students with autism spectrum disorders (ASD) it is essential to understand their emotional life in the context of ethnic and school cultures. We are particularly interested in how anxiety and loneliness are experienced in developing and maintaining friendships in the daily encounters of adolescents with ASD in the specific context of Japanese schools, because these emotions could serve either as facilitators or barriers to social interaction, depending on how individuals manage them. The present qualitative study investigated perceptions of emotions related to friendship in the everyday school life of 11 adolescents with ASD in Japan. Data were collected by means of semi-structured individual interviews, which revealed a wide range of motivations for socialization, limited future prospects to deepen friendships, robust self-awareness of one's own social challenges, and conscious efforts to cope with these challenges. An inductive approach to data analysis resulted in four themes: social motivation, loneliness, anxiety, and distress. To our knowledge this is the first study to uncover the rich emotional life of adolescents with ASD in the context of their friendships in an Asian culture.

Executive function predicts the visuospatial working memory in autism spectrum disorder and attention-deficit/hyperactivity disorder.

Children with autism spectrum disorder (ASD) and those with attention deficit/hyperactivity disorder (ADHD) always show working memory deficits. However, research findings on the factors that affected the working memory in ASD and ADHD were inconsistent. Thus, we developed the present study to investigate the association of executive function (EF) with the visuospatial working memory (VSWM) in ASD and ADHD. Three groups of participants were examined: 21 children with ASD, 28 children with ADHD and 28 typically developing (TD) children as the controls. All participants completed two tests: the Wisconsin Card Sorting Test (WCST) and the Corsi Block Tapping Test for measuring EF and VSWM, respectively. The WCST included four domains: categories achieved (CA), perseverative errors (PE), failures to maintain set (FMS), and total errors (TE). The findings indicated that (1) the ASD group showed poorer performance in VSWM than the ADHD and TD groups; (2) for the ASD group, VSWM was positively correlated with CA, and was negatively correlated with PE and TE; (3) for the ADHD group, FMS showed a negative relationship with VSWM; and (4) TE predicted the performance of VSWM in ASD group, while FMS predicted VSWM in ADHD group. The study results suggested that VSWM was impaired in ASD but not in ADHD. Also, the EF domains were differently correlated with the VSWM performance in ASD and ADHD. Our study suggests that we should consider different intervention targets of working memory and EF contributions in improving the cognitive capacity of ASD and ADHD. Autism Res 2018, 11: 1148-1156. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present study compared the visuospatial working memory (VSWM) in three groups of children: autism (ASD), attention deficit/hyperactivity disorder (ADHD), and typically developed children (TD). The ASD group showed poorer VSWM than the ADHD and TD groups. The total error of executive function predicted the performance of VSWM in ASD, while failures to maintain set predicted VSWM in ADHD . These findings suggested that we should consider the different working memory and executive function training targets to increase cognitive capacity of ASD and ADHD.

Wisconsin card sorting test in children with temporal lobe epilepsy.

To search for the origin of frontal lobe dysfunction identified by the Wisconsin card sorting test (WCST) in temporal lobe epilepsy (TLE) patients, we investigated the WCST performance among 19 children with TLE (with hippocampal atrophy (HA group N=12), without structural lesions (NSL group N=7)), 15 patients with frontal lobe epilepsy (FLE group), and age-matched normal controls (N group). The paired verbal association learning test (PVALT) and Benton visual retention test (BVRT) were also performed. HA group and FLE groups achieved significantly fewer categories and demonstrated more perseverative errors on the WCST than NSL and N groups. In addition, category achievement in WCST showed significant inverse correlation to age at the initial status convulsivus in the HA group (P<0.05). The achievement on PVALT and BVRT did not show any significant differences between HA and FLE groups (P>0.05). Thus, the frontal lobe dysfunction in the HA group is found to exist as early as 7 years old, when they seem to have only a short seizure history or to receive a little electrical interference from the temporal lobe focus to the frontal region. These facts would underscore the importance of prefrontal dysfunction persisting from the early insults and only becoming apparent after maturation of the prefrontal region in patients with mesial TLE.

Superior fluid intelligence in children with Asperger's disorder.

Asperger's disorder is one of autistic spectrum disorders; sharing clinical features with autism, but without developmental delay in language acquisition. There have been some studies of intellectual functioning in autism so far, but very few in Asperger's disorder. In the present study, we investigated abstract reasoning ability, whose form of intelligence has been labeled fluid intelligence in the theory of Cattell [Cattell, R. B. (1963). Theory of fluid and crystallized intelligence: A critical experiment. Journal of Educational Psychology, 54, 1-22.], in children with Asperger's disorder. A test of fluid intelligence, the Raven's Standard Progressive Matrices Test, was administered to 17 children with Asperger's disorder and 17 age-, gender-, and FIQ-matched normal children. The results showed that children with Asperger's disorder outperformed on the test of fluid reasoning than typically developing children. We suggest that individuals with Asperger's disorder have higher fluid reasoning ability than normal individuals, highlighting superior fluid intelligence.