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April 2, 2003

Nurses' Working Conditions and the Nursing Shortage

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(13):1633-1635. doi:10.1001/jama.289.13.1633-a

In Reply: We agree with Dr Latronico that the occurrence of simultaneous axon and muscle involvement in critical illness neuromuscular abnormalities (CINMA) is not novel. This finding has been previously identified in 2 prospective cohort studies of ICU patients with systematic electrophysiological and muscle histological examination.1,2 In our study, electrophysiological examination and muscle biopsy were only performed in patients with clinical paresis at awakening after the acute phase of their illness, which confirmed that clinical weakness was associated with both axonal and muscle involvement.

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