Do animals dream?

The understanding of biological functions of sleep has improved recently, including an understanding of the deep evolutionary roots of sleep among animals. However, dreaming as an element of sleep may be particularly difficult to address in non-human animals because in humans dreaming involves a non-wakeful form of awareness typically identified through verbal report. Here, we argue that parallels that exist between the phenomenology, physiology, and sleep behaviors during human dreaming provide an avenue to investigate dreaming in non-human animals. We review three alternative measurements of human dreaming - neural correlates of dreaming, 'replay' of newly-acquired memories, and dream-enacting behaviors - and consider how these may be applied to non-human animal models. We suggest that while animals close in brain structure to humans (such as mammals and birds) may be optimal models for the first two of these measurements, cephalopods, especially octopuses, may be particularly good candidates for the third.

Dreams reflect nocturnal cognitive processes: Early-night dreams are more continuous with waking life, and late-night dreams are more emotional and hyperassociative

Contributions of specific sleep stages to cognitive processes are increasingly understood. Non-REM sleep is particularly implicated in episodic memory consolidation, whilst REM sleep preferentially consolidates and regulates emotional information, and gives rise to creativity and insight. Dream content reflects these processes: non-REM dreams are more likely to picture episodic memories, whereas REM dreams are more emotional and bizarre. However, across-the-night differences in the memory sources of dream content, as opposed to sleep stage differences, are less well understood. In the present study, 68 participants were awoken from sleep in the early and late night and recorded their dreams and waking-life activities. Early-night dreams were more clearly relatable to (or continuous with) waking life than late-night dreams. Late-night dreams were more emotional-important, more time orientation varied, and more hyperassociative, than early-night dreams. These dream content differences may underlie the mental content that accompanies sleep processes like memory consolidation, emotion-processing, and creativity.

Impact of a Pharmacy Resident on Hospital Length of Stay and Drug-Related Costs

Background:

The impact of pharmacy residents' interventions on medical rounds has not been well evaluated.

Objective:

To assess the impact of a resident's interventions on hospital length of stay, describe the types of interventions, and assess drug-related cost savings.

Methods:

Using a matched control design, we conducted an evaluative study of adults admitted to a general internal medicine unit over one month. The study group consisted of patients admitted to the service of a medical team that included a pharmacy resident and medical residents. The pharmacy resident prospectively collected data on patient demographics and interventions made during patient admission and follow-up rounds. The control group consisted of patients admitted to the service of a team consisting of medical residents only, over the same period. The medical records of the control group were retrospectively evaluated for potential interventions.

Results:

Forty patients were enrolled in each group (aged 63 ± 17 y, mean ± SD). In the study group, 250 of 271 interventions were accepted and fulfilled. In the control group, 321 potential interventions were identified. The mean length of stay of the study group was significantly lower than that of the control group (7.9 ± 7.2 days vs 10.9 ± 7.9 days, respectively; p = 0.008). In the study group and the control group, the total interventions were related to prescribing errors (51.3% vs 45.4%), preventable adverse drug events (32.9% vs 42.3%), patient monitoring (14% vs 7%), and drug interactions (1.8% vs 5.3%). In the study group, the net drug-related cost savings totaled $2087.

Conclusions:

Our study demonstrates the positive impact of a pharmacy resident on reducing the hospital length of stay and producing drug-related cost savings. Most interventions prevented adverse drug events and prescribing errors.

Does the handling time of unrefrigerated human fecal specimens impact the detection of Clostridium difficile toxins in a hospital setting?

BACKGROUND

The stability of Clostridium difficile toxins is an important factor in determining the accuracy of the enzyme immunoassay (EIA). The Centers for Disease Control has stated that C. difficile toxins may become undetectable in unrefrigerated stool specimens within 2 h after collection.

PURPOSE

The purpose of our study was to determine how the unrefrigerated handling time of human fecal specimens affects the results of C. difficile infection (CDI) testing.

METHODS

A retrospective review of CDI testing with Premier™ Toxins A and B kit was conducted in northern New Jersey, USA. Stool collection times and receiving times were recorded for each specimen. The unrefrigerated handling time was calculated for each.

RESULTS

A total of 1126 fecal specimens were submitted. We excluded 72 fecal specimens due to incomplete documentation. We included 1054 fecal specimens collected from 636 hospitalized patients. A total of 132 out of 1054 specimens (12.5%) tested positive for C. difficile toxins. Nine hundred and fifty-four specimens were unrefrigerated for 13 h or less, of which 127 (13.3%) tested positive. Five (5%) of the 100 specimens that were unrefrigerated for more than 13 h tested positive (p = 0.02).

CONCLUSION

C. difficile toxins can still be detected up to 13 h after collection in unrefrigerated human fecal specimens. However, fecal specimens should be processed according to the current recommendations to ensure the reliability of EIA testing until the results of our study are confirmed with prospective studies.

Impact of patient education on quality of bowel preparation in outpatient colonoscopies

BACKGROUND

High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions. Limited literature exists on evaluating educational intervention as a means of improving the quality of bowel preparation prior to outpatient colonoscopy.

OBJECTIVE

Our objective was to determine the effect of an educational intervention on the quality of outpatient colonoscopy preparation. The secondary objective was to determine whether the quality of bowel preparation improves overall colonoscopy outcomes as measured by rate of polyp detection and caecal intubation time.

METHODS

A single-blinded, prospective, randomised, controlled trial was conducted in two inner-city gastroenterology clinics in the USA. One hundred and sixty-four subjects were enrolled and randomly assigned to one of two groups. The control group subjects received verbal and written instructions for colonoscopy. The intervention group subjects received the same instructions and were then asked to answer a questionnaire. The subjects' responses were reviewed and an additional explanation of the preparation process provided. An attending gastroenterologist determined the quality of each bowel preparation at the time of colonoscopy using the Universal Preparation Assessment Scale.

RESULTS

The educational intervention had no impact on the overall quality of bowel preparation (P=0.12). However, the type of food (liquid vs solid) consumed during the 24 hours prior to the procedure (P=0.04) and the time since the last solid meal (P=0.03) did have an impact on preparation quality. Other significant factors included elapsed time to first bowel movement from the initiation of bowel preparation (P=0.05) and age younger than 55 (P=0.02). Adequate bowel preparation was associated with shorter total procedure (P=0.001) and caecal intubation (P=0.01) times.

CONCLUSION

Our study failed to demonstrate any effect of an educational intervention on the quality of colonoscopy preparation. However, adherence to simple dietary instructions did have a significant impact on the quality of bowel preparation. Adequate bowel preparation was associated with shorter procedure time and caecal intubation time.

Brain serotonin and epileptic seizures in mice: a pharmacological and biochemical study

5-Hydroxytryptophan (5-HTP) reduced the intensity of both audiogenic and pentylenetrazol seizures. p-Chlorophenylalanine reduced audiogenic seizure (AGS) susceptibility but failed to change the pentylenetetrazol seizure (PTS). Drugs blocking brain serotonin (5-HT) receptors suppressed AGS but caused no clear effects upon PTS. Pentylenetetraziol-induced shock increased brain 5-hydroxyindoleacetic acid (5hiaa) concentrations and decreased 5-HT levels. Single audiogenic shock decreased the acumulation of 5-HT and 5-HIAA in the brains of mice pretreated with 5-HTP. On the other hand PTS increased the accumulation of 5-HT and 5-HIAA in the brains of mice pretreated with 5-HTP. It is suggested that AGS decrease brain 5-HT turnover whilst PTS cause an opposite effect.