Accuracy and Precision of the SynchroMed II Pump.

OBJECTIVE: The objective of this study was to evaluate the accuracy and precision of SynchroMed II programmable infusion pumps for delivery of intrathecal baclofen to treat severe spasticity. DESIGN: Retrospective chart review study. SETTING: Urban academic rehabilitation clinic. PATIENTS (OR PARTICIPANTS): Patients with spasticity treated with intrathecal baclofen. METHODS OR INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS): A retrospective chart review of 149 patients inclusive of 755 individual patient encounters more than a 2.5-year span for baclofen pump refills was performed. MAIN OUTCOME MEASUREMENTS: Charts were reviewed to obtain data on the concentration and dose of intrathecal baclofen, aspirated and residual volumes, age of the pump, and reservoir volume of the pump. Flow rate (mL/day) was calculated for each chronological visit. Flow rates from clinical data were used to calculate the accuracy and precision based on the manufacturer's specifications for both the 20 mL and 40 mL pumps. RESULTS: The infused volume accuracy and precision of both the 20 mL pumps and 40 mL pumps remained within manufacturer's specifications while delivering drug at a rate slightly lower than predicted. There were no cases of pump over-infusion. There is a statistically significant decrease in flow rate accuracy over the lifespan of the pump. CONCLUSIONS: SynchroMed II pumps infuse at slightly less than their predicted rate while remaining within the manufacturer's specifications. No pump over-infusions were noted. Pump flow rate declines over time. Further study is warranted to assess the impact of this flow rate decrease on patient treatment and safety.

A Cross-Sectional Study of Pain Among U.S. College Music Students and Faculty.

OBJECTIVES: Studies over recent decades have demonstrated significant performance-related pain among professional musicians. However, there have been no largescale studies to evaluate pain among college musicians. The aim of this study was to determine the prevalence and anatomical locations of performance-related pain among students and faculty at the college level and learn what musicians do when they have pain. METHODS: Cross-sectional data were collected using an online survey distributed to colleges across the United States. Data were analyzed using REDCap electronic data capture tools and Microsoft Excel. RESULTS: We received 1,007 survey responses and found that 67% of musicians at colleges experienced performance-related pain. The highest prevalence of pain was in woodwind musicians, with 83% reporting performance-related pain. The most common locations of pain were upper back (27%), lower back (26%), and fingers of the right hand (25%). Many student musicians with pain seek help from their teacher, but almost as many do not seek help at all. Less than 25% see a medical professional. CONCLUSIONS: Most musicians at colleges experience performance-related pain in a variety of anatomical locations depending upon instrument/voice. Performing arts health organizations can increase awareness of treatment options for musicians suffering from performance-related pain, which may lead to improved quality of life and increased career longevity for college musicians.

Growth characteristics in cerebral palsy subtypes: a comparative assessment.

AIM: Children with quadriplegic cerebral palsy (CP) have been found to have growth rates that differ from those of children with typical development. Little research has been performed to distinguish whether growth patterns in hemiplegic, diplegic, and quadriplegic CP differ from one another. The purpose of this study was to compare growth of children with quadriplegic, hemiplegic, and diplegic CP. METHOD: Retrospective data were collected from the electronic medical record of patients with CP at an outpatient center. Linear mixed models were used to examine growth by diagnosis, using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 343.0 (diplegia), 343.1 (hemiplegia), and 343.2 (quadriplegia). RESULTS: Heights and weights of children with quadriplegic CP were consistently lower than those with hemiplegic or diplegic CP. Children with hemiplegic CP had greater heights and weights than other CP subtypes. There were statistically significant differences in weight gain curves among the three diagnoses for males (p<0.05). INTERPRETATION: Our study reveals differences in growth rates between hemiplegic, diplegic, and quadriplegic CP subtypes.

Prevalence of Injuries during Brazilian Jiu-Jitsu Training.

Brazilian jiu-jitsu (BJJ) is a martial art that focuses on groundwork, joint locks, and chokeholds. The purpose of this study is to determine the prevalence of injuries sustained during BJJ training. A 27-question research survey was e-mailed to 166 BJJ gyms in the United States. Demographic information, belt level, weight class, training hours, competition experience, and injury prevalence data were collected. The majority of respondents were Caucasian (n = 96) males (n = 121) with an average age of 30.3 years. Overall, the most common injury locations were to the hand and fingers (n = 70), foot and toes (n = 52), and arm and elbow (n = 51). The most common medically diagnosed conditions were skin infections (n = 38), injuries to the knee (n =26), and foot and toes (n = 19). The most common non-medically diagnosed injuries occurred to the hand and fingers (n = 56), arm and elbow (n = 40), and foot and toes (n = 33). In general, athletes were more likely to sustain distal rather than proximal injuries. Athletes reported more frequent medically diagnosed injuries to the lower extremity and more frequent self-diagnosed injuries to the upper extremity. Upper extremity injuries appear to be more frequent but less severe than lower extremity injuries with the opposite being true for lower extremity injuries.

Quality of intrathecal baclofen from different sources.

OBJECTIVE: To compare the quality of intrathecal baclofen obtained from a national compounding pharmacy (AnazaoHealth) with the manufactured product (Lioresal) with regard to accuracy and precision of baclofen concentration, and the content of the baclofen degradation product, 4-(4-chlorophenyl)-2-pyrrolidinone (PYR). DESIGN: Samples of baclofen used for refilling intrathecal pumps were placed in 1.2-mL silicone gasket-sealed cryogenic vials and stored at or lower than -25°C. Each sample was a different lot number (Lioresal) or prescription number (AnazaoHealth). The laboratory was blinded to the source of the solutions. Coupled with electrospray ionization-mass spectrometry analyte confirmation, quantitation of baclofen and PYR in each sample was performed in duplicate by using high-performance liquid chromatography with ultraviolet detection via a photodiode array detector. SETTING: Outpatient clinic. PARTICIPANTS: Patients with intrathecal baclofen pumps. MAIN OUTCOME MEASURES: Accuracy and precision of baclofen concentration, and concentration of PYR. RESULTS: The difference of mean concentrations from expected concentrations of 500 and 2000 µg/mL were significantly greater for samples from AnazaoHealth compared with Lioresal. Values are shown as mean (± standard error), with n the number samples, for AnazaoHealth compared with Lioresal: (537.1 ± 6.7 µg/mL [n = 8] versus 515.6 ± 0.82 µg/mL [n = 5]; P = .034, respectively) and (2211.4 ± 21.6 µg/mL [n = 12] versus 2055.3 ± 8.7 µg/mL [n = 4]; P = .004, respectively). AnazaoHealth samples with expected concentration of 4000 µg/mL were 3987.7 ± 79.9 µg/mL, n = 7. All 9 Lioresal samples were within 5% of the expected concentration. Of 27 AnazaoHealth samples, 22 were more than 5%, and 8 were more than 10% different from the expected concentration. No PYR was detected in any sample from AnazaoHealth. All samples of Lioresal contained PYR, but all solutions contained less PYR than 1% of the baclofen concentration. CONCLUSIONS: Lioresal was more accurate in concentration and more precise among batches than compounded intrathecal baclofen but had higher levels of PYR.