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Summary: Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia. Introduction: Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms. During chronic hyponatremia, arginine-vasopressin secretion can result from hypovolemia or from syndrome of inappropriate anti-diuresis (SIAD) that leads to a slightly volemic expansion. Since volemia determines renal calcium excretion and balance, we evaluated calcium homeostasis in patients with chronic hyponatremia, related to SIAD or to hypovolemia. Methods: We retrospectively included all patients referred to our Department between May 2006 and May 2014 for hyponatremia, resulting from SIAD or chronic hypovolemia. None had edema, cirrhosis, cardiac, or renal insufficiency. Exploration included estimation of volemia, extracellular fluid volume (ECFV) measurement with inulin, and calcium homeostasis. Results: In total, the SIAD and hypovolemic groups included 22 and 7 patients, respectively. The SIAD group exhibited signs of increased volemia: higher glomerular filtration rate, higher fractional excretion of uric acid, and lower plasma renin. ECFV exceeded that of the hypovolemic group and was above usual values. There was no difference between the two groups regarding plasma calcium, PTH, and vitamin D. However, in the SIAD group, calciuria was higher than in the hypovolemic group, reaching levels of hypercalciuria. Furthermore, there was a positive correlation between calciuria and markers of volemia. Conclusions: Our results show that SIAD results in a volemic expansion tendency that is associated with a decrease in renal calcium reabsorption and thus hypercalciuria, whereas in the hypovolemic group, calciuria was not increased. Therefore, renal loss of calcium and bone demineralization in SIAD patients could be partly induced by volemic expansion. [ABSTRACT FROM AUTHOR]

Background: A wide range of neuropsychological development outcomes in children are currently measured in a large number of birth cohort and child cohort studies. Methods: We summarized neuropsychological development assessment protocols from a number of birth cohort studies, reviews and specific books on child neuropsychology into a unifying conceptual framework. Results: We suggest that neuropsychological development can be differentiated into two levels, i.e. functional and clinical. The functional level includes the skills, abilities, capacities and knowledge acquired during maturation of the brain as a result of the development of neural networks. It can be further divided into cognitive, psychomotor and social-emotional development subdomains. The clinical level includes the assessment of neurodevelopmental disorders or the presence of symptoms (subclinical symptomatology) of these disorders in populations under investigation in environmental epidemiology studies. Conclusions: Through explicit recognition of these levels of outcomes, and in using this framework, epidemiologists will be better able to design research through the informed selection of individual levels of outcomes. The framework also serves to standardize disparate terminologies across this field and allows for pooling of epidemiological data on neuropsychological endpoints where essentially similar levels of outcomes have been analyzed using different tests. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Accessible summary • Applying pragmatic risk management procedures to facilitate the sharing of clinical knowledge in and across mental health teams. Zoning: focused support is pragmatic risk management support procedure that enhances adherence to operational policies, provides a forum in which staff can receive support and visually facilitates the sharing of clinical knowledge. This paper presents a 3-year multi-method management project that sought to introduce zoning principles into all teams of an inner city Mental Health NHS Trust. By changing the language and culture of the organization findings indicate that there has been a positive attitudinal shift in how the approach is perceived. It is considered to be of value to staff, service users and their families and 73% of teams are now using it routinely. [ABSTRACT FROM AUTHOR]