BACKGROUND AND PURPOSEBrain death determination (BDD) is primarily a clinical diagnosis, where death is defined as the permanent loss of brainstem function. In scenarios where clinical examinations are inaccurate, ancillary imaging tests are required. The choice of ancillary imaging test is variable, but the common denominator for all of them is to establish a lack of cerebral blood flow. The purpose of this study was to compare the diagnostic accuracy and interrater reliability of different ancillary imaging tests used for BDD.METHODSArchival data were retrospectively analyzed for all patients who underwent any ancillary imaging test for BDD at our institution. The results of ancillary imaging tests were compared with, the reference standard, the clinical checklist for declaration of brain death. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different ancillary imaging tests for BDD were performed. Interobserver agreement between two observers was measured using kappa statistics for each of the imaging modalities.RESULTSA total of 74 patients underwent 41 computer tomography perfusion (CTP), 54 CT angiogram, 15 radionuclide scans, 1 cerebral angiogram, 3 magnetic resonance imaging, and 71 nonenhanced CT (NECT) head for BDD. All ancillary tests (except NECT head) showed 100% specificity and PPV. CTP had the highest sensitivity and NPV. All ancillary imaging tests demonstrated very high interrater reliability.CONCLUSIONSThe uses of ancillary imaging tests for BDD are increasing. Within this study's limitations, CTP followed by radionuclide scan were found to be the most accurate and reliable ancillary imaging test for BDD.

Lower postoperative hematocrit was associated with increased fluid retention, lower perfusion pressure, and worse cerebrovascular injury following deep hypothermic circulatory arrest. Postoperative hematocrit management may have profound systemic and cerebral effects after deep hypothermic circulatory arrest and merits further investigation.

ObjectiveTo explore the health literacy of children diagnosed with Acute Lymphoblastic Leukemia (ALL) through their knowledge of their medications.MethodsWithin the Basic Interpretive approach to qualitative research, semi-structured interviews were conducted with children from ages 6 to18 years (n=16) between May and September 2009 to determine their knowledge of medication properties, medication habits and medication teaching. REB approval was obtained.ResultsThe younger children (mean age 7.5 years) correctly answered, on average, 51% of the questions on colour, 26% of the questions on name, 25% of the questions on frequency, and 8% of the questions on the purposes of their medications. The older children (mean age 16 years) scored at least 35% higher for each characteristic. All of the younger children reported that physicians consistently directed medication education to parents only, and that the younger children were rarely present during these sessions. 13 of the 16 children stated that they want to learn more about and be more involved in education sessions addressing their medications.ConclusionsChildren with ALL at the IWK Health Centre do not have a good knowledge of their medications, however most children expressed that they want to know more about their medications.

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We examined the covariation of stereotyped behaviour and engagement in persons with profound intellectual and physical disabilities. Data are presented on the rates of stereotyped behaviour and engagement immediately prior to, during, and immediately after training sessions aimed at increasing manipulation of entertainment materials such as toys. The results indicated that (a) training was successful in achieving increased engagement, (b) stereotyped behaviour decreased when the level of engagement increased, even though stereotyped behaviour was not incompatible with engagement, and (c) after training ceased, stereotyped behaviour increased to higher levels than baseline and engagement decreased to below baseline levels.