[Legal aspects of selling medical products by gynecologists].

PubMed

Urbaniak, Monika; Spaczyński, Robert Z

2013-07-01

Sales and distribution of medical products and drugs in Poland remains under strict regulations, especially legal regulation contained in the Medical and Dental Practitioners Act, that banned sales of medical products by doctors. It needs to be emphasized that currently doctors are allowed to sell drugs and medical products only in rigorously specified situations. Knowledge of current legal regulations concerning sales of medical products by gynecologists allows to conform with the law and to distribute drugs and medical products under special and predefined conditions.

Effects of stimulant medication under varied motivational operations.

PubMed

Mace, F Charles; Prager, Kevin L; Thomas, Karen; Kochy, Jane; Dyer, Tim J; Perry, Lora; Pritchard, Duncan

2009-01-01

We evaluated the evocative effects of four conditions (high- and low-preference activities, low and divided attention) and stimulant medication on the behavior of a 16-year-old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude behaviors, and physical aggression) improved with stimulant medication in most conditions, but undesirable behaviors were not reduced to acceptable levels in all conditions. This finding suggests that stimulant medication may be a valuable adjunct to function-based interventions.

Advances in Medical Analytics Solutions for Autonomous Medical Operations on Long-Duration Missions

NASA Technical Reports Server (NTRS)

Thompson, David E.; Lindsey, Antonia Edward

2017-01-01

A review will be presented on the progress made under STMDGame Changing Development Program Funding towards the development of a Medical Decision Support System for augmenting crew capabilities during long-duration missions, such as Mars Transit. To create an MDSS, initial work requires acquiring images and developing models that analyze and assess the features in such medical biosensor images that support medical assessment of pathologies. For FY17, the project has focused on ultrasound images towards cardiac pathologies: namely, evaluation and assessment of pericardial effusion identification and discrimination from related pneumothorax and even bladder-induced infections that cause inflammation around the heart. This identification is substantially changed due to uncertainty due to conditions of fluid behavior under space-microgravity. This talk will present and discuss the work-to-date in this Project, recognizing conditions under which various machine learning technologies, deep-learning via convolutional neural nets, and statistical learning methods for feature identification and classification can be employed and conditioned to graphical format in preparation for attachment to an inference engine that eventually creates decision support recommendations to remote crew in a triage setting.

Medical Services at an International Summer Camp Event Under Hot and Humid Conditions: Experiences From the 23rd World Scout Jamboree, Japan.

PubMed

Watanabe, Takemasa; Mizutani, Keiji; Iwai, Toshiyasu; Nakashima, Hiroshi

2018-06-01

The 23rd World Scout Jamboree (WSJ) was a 10-day summer camp held in Japan in 2015 under hot and humid conditions. The attendees comprised 33,628 people from 155 countries and territories. The aim of this study was to examine the provision of medical services under such conditions and to identify preventive factors for major diseases among long-term campers. Data were obtained from WSJ medical center records and examined to clarify the effects of age, sex, and period on visit frequencies and rates. Medical records from 3215 patients were examined. Daytime temperatures were 31.5±3.2°C and relative humidity was 61±13% (mean±SD). The initial visit rates among scouts and adults were 72.2 and 77.2 per 1000 persons, respectively. No significant age difference was observed in the initial visit rate; however, it was significantly higher among female patients than male patients. Significant differences were also seen in the adjusted odds ratios by age, sex, and period for disease distributions of initial visit frequencies. In addition, a higher initial visit frequency for heat strain-related diseases was seen among the scouts. Initial visit frequencies for heatstroke and/or dehydration increased just after opening day and persisted until closing day. Our findings suggest the importance of taking effective countermeasures against heat strain, fatigue, and unsanitary conditions at the WSJ. Medical services staff should take attendees' age, sex, and period into consideration to prevent heat strain-related diseases during such camps under hot and humid conditions. Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Molecules, magic and forgetful fruit flies: the supernatural science of medical gas research.

PubMed

Mychaskiw, George

2011-09-06

Medical gas research often involves the study of molecules under extraphysiologic conditions, that is, conditions that do not exist in nature. This "supernatural" nature of medical gas research sometimes produces results that appear to be almost "magic" to those schooled in traditional physiology"Any sufficiently advanced technology is indistinguishable from magic".-Arthur C. Clarke.

29 CFR 825.113 - Serious health condition.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Serious health condition. 825.113 Section 825.113 Labor... AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.113 Serious health condition. (a) For purposes of FMLA, “serious health condition” entitling an employee to FMLA leave means an...

29 CFR 825.113 - Serious health condition.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Serious health condition. 825.113 Section 825.113 Labor... AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.113 Serious health condition. (a) For purposes of FMLA, “serious health condition” entitling an employee to FMLA leave means an...

29 CFR 825.113 - Serious health condition.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Serious health condition. 825.113 Section 825.113 Labor... AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.113 Serious health condition. (a) For purposes of FMLA, “serious health condition” entitling an employee to FMLA leave means an...

38 CFR 17.240 - Sharing specialized medical resources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.240 Sharing specialized medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe...

38 CFR 17.240 - Sharing specialized medical resources.

Code of Federal Regulations, 2010 CFR

2010-07-01

... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.240 Sharing specialized medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe...

42 CFR 408.202 - Conditions for participation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... apply to CMS to enter into an SMI premium surcharge agreement if the following conditions are met: (1) Each individual designated for coverage under the premium surcharge agreement must be enrolled in...

42 CFR 408.202 - Conditions for participation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... apply to CMS to enter into an SMI premium surcharge agreement if the following conditions are met: (1) Each individual designated for coverage under the premium surcharge agreement must be enrolled in...

An investigation into regular recruit wastage from the British Army, 1988.

PubMed

Jefferson, T O

1990-10-01

A study was made of recruit medical discharges in the British Army in 1988 with the aim of ascertaining the number of medical discharges amongst recruits. AFBs 6863 (Notification of Discharge of a Regular Recruit) were used as the source of data. Recruit medical wastage rate for 1988 was 897 cases, or 16.7% of all known discharges. Three types of medical discharges were present. Four hundred and ninety-six Type 1 or concealed discharges, (9.2% of discharges for all reasons) were made up of cases who had not been boarded and had mainly been discharged under QR 9.381 (defect of enlistment). Two hundred and seventy-five Type 2 discharges (5.1% of discharges for all reasons) represented boarded cases discharged under QR 9.385 (ceasing to fulfil medical requirements). One hundred and twenty-six Type 3 discharges (2.3% of all discharges) were boarded cases mainly discharged under QR 9.381 (defect of enlistment). As all discharges under paragraphs other than QR 9.385 are given administrative discharge outflow code, only the 275 Type 2 discharges (or 31.7% of medical discharges) appeared on the Army's own source of medical data, the TRIMEDS database. This had the effect of concealing the majority of those discharges caused by conditions predating enlistment therefore decreasing the number of known false negatives not detected at recruiting medicals. The biggest causes of discharge were conditions of the lower limbs and back (54.5% of medical discharges), a conglomerate of minor categories of pathology (14.6%), asthma (9.6%) and deformities (7.4%). Within each type the bulk of the discharges was concealed in Type 1 discharges especially for conditions predating enlistment.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecules, magic and forgetful fruit flies: the supernatural science of medical gas research

PubMed Central

2011-01-01

Medical gas research often involves the study of molecules under extraphysiologic conditions, that is, conditions that do not exist in nature. This "supernatural" nature of medical gas research sometimes produces results that appear to be almost "magic" to those schooled in traditional physiology "Any sufficiently advanced technology is indistinguishable from magic". -Arthur C. Clarke PMID:22146602

Modeling Approach for Oxygen Exchange in the Human Lung under Hypobaric Conditions

DTIC Science & Technology

2001-06-01

Operational Medical Issues in Hypo-and Hyperbaric Conditions [les Questions medicales a caractere oprationel liees aux conditions hypobares ou hyperbares ] To...under Hypobaric Conditions DISTRIBUTION: Approved for public release, distribution unlimited This paper is part of the following report: TITLE...Approach for Oxygen Exchange in the Human Lung under Hypobaric Conditions Ing J.P.F. Lindhout*, Drs M. van de Graaff*, Ir Drs R.C. van de Graaff*, Dr

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a survey on forces, conditions and jurisdictional control.

PubMed

Kroezen, Marieke; Francke, Anneke L; Groenewegen, Peter P; van Dijk, Liset

2012-08-01

The number of Western European and Anglo-Saxon countries where nurses are legally allowed to prescribe medicines is growing. As the prescribing of medicines has traditionally been the task of the medical profession, nurse prescribing is changing the relationship between the medical and nursing professions. To gain more insight into the forces that led to the introduction of nurse prescribing of medicines in Western European and Anglo-Saxon countries, as well as into the legal, educational and organizational conditions under which nurses prescribe in these countries. Moreover, this study sought to determine which consequences nurse prescribing has for the division of jurisdictional control over prescribing between the nursing and medical professions. International survey. An email survey was sent to 60 stakeholders of professional nursing or medical associations or government bodies, at national, state or provincial level across ten Western European and Anglo-Saxon countries, namely Australia, Canada, Finland, Ireland, the Netherlands, New Zealand, Spain, Sweden, the United Kingdom and the United States of America. The survey addressed the reasons for the introduction of nurse prescribing and the conditions under which nurses are or will be prescribing medicines. The response rate was 65% (n=39). It was shown that a diversity of forces led to the introduction of nurse prescribing, and respondents from nursing and medical associations and government bodies cited different forces as being important for the introduction of nurse prescribing. Representatives of nurses' associations oftentimes emphasized the medication needs of patients living in remote geographical areas, while representatives of medical associations more often pointed to workforce shortages within the health care service. The conditions under which nurses prescribe medicines vary considerably, from countries where nurses prescribe independently to countries in which prescribing by nurses is only allowed under strict conditions and the supervision of physicians. Citing different forces as being important in the introduction of nurse prescribing can be conceived as a professional 'problem construction' in order to gain jurisdiction over the prescribing task. In most countries, nurses prescribe in a subordinate position and the jurisdiction over prescribing remains predominantly with the medical profession. Copyright © 2012 Elsevier Ltd. All rights reserved.

29 CFR 825.213 - Employer recovery of benefit costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., recurrence, or onset of either a serious health condition of the employee or employee's family member, or a... THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical... continuation, recurrence, or onset of either a serious health condition of the employee or the employee's...

32 CFR 564.39 - Medical care benefits.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 3 2013-07-01 2013-07-01 false Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in a...

32 CFR 564.39 - Medical care benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care benefits. 564.39 Section 564.39... REGULATIONS Medical Attendance and Burial § 564.39 Medical care benefits. (a) A member of the ARNG who incurs a disease or injury under the conditions enumerated herein is entitled to medical care, in a...

[Training of medical practitioners of Russian Federation for dealing with dangerous infections in Stavropol Institute for plague control and for working under the conditions of the emergency situation].

PubMed

Efremenko, V I; Kal'noĭ, S M; Shvetsova, N M; Bogdanov, I K; Grizhebovskiĭ, G M; Briukhanova, G D; Onatskaia, T G

2001-01-01

There are no doubts at present concerning the necessity of training medical practitioners in Russia for dealing with specially dangerous infections and for work under the conditions of emergency situations. From the day this institute was founded the training of the corresponding personnel was started: first physicians, then biologists and other specialists, including medical assistants and technicians. Additional programs for training specialists were developed, the State License for conducting the course of special post-diploma training was obtained. Research works on improving the methods of the indication and rapid diagnostics of the causative agents of dangerous infections, reflected in training programs for specialists and practically used in the process of the realization of antiepidemic measures in the zones of emergency situations, were carried out. In training the students the experience of the work of the institute on ensuring the epidemiological safety of the population under the conditions of different emergency situations was taken into consideration.

The professional medical ethics model of decision making under conditions of clinical uncertainty.

PubMed

McCullough, Laurence B

2013-02-01

The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.

Mycobacterium fortuitum and Mycobacterium chelonae biofilm formation under high and low nutrient conditions.

PubMed

Hall-Stoodley, L; Keevil, C W; Lappin-Scott, H M

1998-12-01

The rapidly growing mycobacteria (RGM) are broadly disbursed in the environment. They have been recovered from freshwater, seawater, wastewater and even potable water samples and are increasingly associated with non-tuberculous mycobacterial disease. There is scant evidence that non-tuberculous mycobacteria (NTM) and RGM form biofilms. Therefore, an experimental system was designed to assess the ability of RGM to form biofilms under controlled laboratory conditions. A flat plate reactor flow cell was attached to either a high or low nutrient reservoir and monitored by image analysis over time. Two surfaces were chosen for assessment of biofilm growth: silastic which is commonly used in medical settings and high density polyethylene (HDPE) which is prevalent in water distribution systems. The results show that Mycobacterium fortuitum and M. chelonae formed biofilms under both high and low nutrient conditions on both surfaces studied. These results suggest that RGM may form biofilms under a variety of conditions in industrial and medical environments. 1998 Society of Applied Microbiology.

A Comparison of Expedition Medical Condition List Treatment Directives with Integrated Medical Model Simulation Data Presentation and Briefing Report

NASA Technical Reports Server (NTRS)

Lewis, Robert

2013-01-01

This aerospace medicine clerkship project is under the direction of Dr. Sharmila Watkins and is in cooperation with Dr. Eric Kerstman and Dr. Ronak Shah. The questions of the research project are: 1. What are the main drivers of evacuation and loss of crew life (LOCL) on three Design Reference Missions (DRMs): Near Earth Asteroid (NEA), Lunar Sortie and Lunar Outpost using an inexhaustible International Space Station medical kit 2. What are the treatment designations for these driving medical conditions as listed in Expedition Medical Condition List (EMCL) 3. Do the drivers make sense in the context of the given Design Reference Mission (DRM) 4. Do any EMCL treatment designations need re-assessing.

Gender differences in leadership amongst first-year medical students in the small-group setting.

PubMed

Wayne, Nancy L; Vermillion, Michelle; Uijtdehaage, Sebastian

2010-08-01

To investigate the extent of gender bias in the volunteerism of small-group leaders amongst first-year medical students, and whether bias could be eliminated with special instructions to the students. The gender of leaders in small-group sessions in a real academic setting was monitored under two conditions: control conditions, in which basic instructions were provided to participants, and intervention conditions, in which the same basic instructions were provided plus a brief "pep talk" on the importance of experiencing a leadership role in a safe environment. During the small-group sessions, an observer noted the gender and names of group leaders for later analysis. After a class debriefing, a subset of leaders and nonleaders from both the control and intervention groups were invited to be interviewed about their perceptions of the small-group experience. Interviews were tape recorded and transcribed for analysis. In 2007-2008 and 2008-2009, disproportionately fewer women than men volunteered to become small-group leaders under control conditions. This gender bias was eliminated under intervention conditions. The interviews illustrated how a subtle change in instructions helped some female students take on a leadership role. Gender bias in leadership in the small-group setting amongst medical students-even when women make up half of the class-may persist without targeted intervention. The authors suggest that frequent and consistent intervention during medical school could be an important factor in encouraging women to identify themselves as leaders, promoting confidence to consider leadership roles in medicine.

42 CFR 438.812 - Costs under risk and nonrisk contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Conditions for Federal Financial Participation § 438.812 Costs under risk and nonrisk contracts. (a) Under a risk contract, the total amount the...

Profile of Travelers With Preexisting Medical Conditions Attending a Specialist Travel Medicine Clinic in Ireland.

PubMed

Han, Calvin Teo Jia; Flaherty, Gerard

2015-01-01

Patients with complex medical comorbidities travel for protracted periods to remote destinations, often with limited access to medical care. Few descriptions are available of their preexisting health burden. This study aimed to characterize preexisting medical conditions and medications of travelers seeking pre-travel health advice at a specialized travel medicine clinic. Records of travelers attending the Galway Tropical Medical Bureau clinic between 2008 and 2014 were examined and information relating to past medical history was entered into a database. Data were recorded only where the traveler had a documented medical history and/or was taking medications. Of the 4,817 records available, 56% had a documented medical history and 24% listed medications. The majority of travelers with preexisting conditions were female. The mean age of the cohort was 31.68 years. The mean period remaining before the planned trip was 40 days. Southeast Asia was the most popular single destination, and 17% of travelers with medical conditions were traveling alone. The most frequently reported conditions were allergies (20%), insect bite sensitivity (15%), asthma (11%), psychiatric conditions (4%), and hypertension (3%). Of the 30 diabetic travelers, 14 required insulin; 4.5% of travelers were taking immunosuppressant drugs, including corticosteroids. Half of the female travelers were taking the oral contraceptive pill while 11 travelers were pregnant at the time of their pre-travel consultation. This study provides an insight into the medical profile of travelers attending a travel health clinic. The diverse range of diseases reported highlights the importance of educating physicians and nurses about the specific travel health risks associated with particular conditions. Knowledge of the effects of travel on underlying medical conditions will inform the pre-travel health consultation. © 2015 International Society of Travel Medicine.

Employment of telemedicine in emergency medicine. Clinical requirement analysis, system development and first test results.

PubMed

Czaplik, M; Bergrath, S; Rossaint, R; Thelen, S; Brodziak, T; Valentin, B; Hirsch, F; Beckers, S K; Brokmann, J C

2014-01-01

Demographic change, rising co-morbidity and an increasing number of emergencies are the main challenges that emergency medical services (EMS) in several countries worldwide are facing. In order to improve quality in EMS, highly trained personnel and well-equipped ambulances are essential. However several studies have shown a deficiency in qualified EMS physicians. Telemedicine emerges as a complementary system in EMS that may provide expertise and improve quality of medical treatment on the scene. Hence our aim is to develop and test a specific teleconsultation system. During the development process several use cases were defined and technically specified by medical experts and engineers in the areas of: system administration, start-up of EMS assistance systems, audio communication, data transfer, routine tele-EMS physician activities and research capabilities. Upon completion, technical field tests were performed under realistic conditions to test system properties such as robustness, feasibility and usability, providing end-to-end measurements. Six ambulances were equipped with telemedical facilities based on the results of the requirement analysis and 55 scenarios were tested under realistic conditions in one month. The results indicate that the developed system performed well in terms of usability and robustness. The major challenges were, as expected, mobile communication and data network availability. Third generation networks were only available in 76.4% of the cases. Although 3G (third generation), such as Universal Mobile Telecommunications System (UMTS), provides beneficial conditions for higher bandwidth, system performance for most features was also acceptable under adequate 2G (second generation) test conditions. An innovative concept for the use of telemedicine for medical consultations in EMS was developed. Organisational and technical aspects were considered and practical requirements specified. Since technical feasibility was demonstrated in these technical field tests, the next step would be to prove medical usefulness and technical robustness under real conditions in a clinical trial.

29 CFR 825.213 - Employer recovery of benefit costs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825.213 Employer recovery of benefit costs. (a) In addition to the circumstances discussed... may require medical certification of the employee's or the family member's serious health condition or...

29 CFR 825.207 - Substitution of paid leave.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825... against the employee's FMLA leave entitlement. For example, paid sick leave used for a medical condition... between workers' compensation absences and FMLA leave. (f) Section 7(o) of the Fair Labor Standards Act...

29 CFR 825.207 - Substitution of paid leave.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825... against the employee's FMLA leave entitlement. For example, paid sick leave used for a medical condition... between workers' compensation absences and FMLA leave. (f) Section 7(o) of the Fair Labor Standards Act...

76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

... under section 1903 of the Social Security Act for any amounts expended for providing medical assistance... (the Act) authorizes Federal grants to the States for Medicaid programs to provide medical assistance... all Federal requirements. The Federal government pays its share of medical assistance expenditures to...

Improvement of the Russian system of medical care at the site of space crew landing

NASA Astrophysics Data System (ADS)

Rukavishnikov, Ilya; Bogomolov, Valery; Polyakov, Alexey

The crew members are delivered to ISS and return back to the Earth on the space craft "Soyuz TMA" at present time. The technical means providing the safe landing of space crews are reliable enough. In spite of that the complex of negative factors (long lasting alternating and shock overloads, effects of landing apparatus rotation on vestibular system) affects the crew during landing and can reach the extreme values under the certain conditions. According to this fact there is a possibility of appearance of bodily damages of different weight besides the traditional functional disturbances. The group of search and rescue on the landing site includes the medical specialists appropriately equipped to stop the symptoms of medical contingency (strong vestibule-vegetative reactions, traumas of different weight, etc.) Medical evacuation complex which provides the acceptable conditions for the cosmonauts including the conditions for medical care is delivered to the landing site as well. The long term experience of search and rescue assurance at the landing site have shown that the specialists successfully cope with this task. In some cases it was required to give the medical help which allowed to improve the general condition and physical capacity of crewmembers and provide their evacuation to the places of postflight rehabilitation. At the same time the solution of some of the problems from our point of view could increase the efficacy of medical care for the landing crew. The organization of the training on emergency under the field conditions for medical specialists on the regular basis (not less that once a year) is extremely important. The equipment of medical specialists requires the regular improvement and modernization due to the fast changing medical technologies and standards. Wearable medical sets must provide the first aid performing in accordance to the modern medical requirements. It is also necessary to include in the list of equipment the textbook of methodic describing diagnostics and medical care in case of most probable diseases and traumas which can happen at the landing site. Application of modern telemedicine technologies will allow to increase the possibilities of diagnostics of emergency condition and to get the consultative support necessary for the decision making on first aid and on the ways of evacuation of crewmembers.

45 CFR 144.103 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under the terms of a group health plan because of a relationship to a participant. Eligible individual... this definition. Medical condition or condition means any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury (whether or not the injury is...

45 CFR 144.103 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under the terms of a group health plan because of a relationship to a participant. Eligible individual... this definition. Medical condition or condition means any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury (whether or not the injury is...

45 CFR 144.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... under the terms of a group health plan because of a relationship to a participant. Eligible individual... this definition. Medical condition or condition means any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury (whether or not the injury is...

10 CFR 35.632 - Full calibration measurements on teletherapy units.

Code of Federal Regulations, 2014 CFR

2014-01-01

... use of the unit; and (2) Before medical use under the following conditions: (i) Whenever spot-check...) of this section must be performed by the authorized medical physicist. (g) A licensee shall retain a...

10 CFR 35.632 - Full calibration measurements on teletherapy units.

Code of Federal Regulations, 2012 CFR

2012-01-01

... use of the unit; and (2) Before medical use under the following conditions: (i) Whenever spot-check...) of this section must be performed by the authorized medical physicist. (g) A licensee shall retain a...

10 CFR 35.632 - Full calibration measurements on teletherapy units.

Code of Federal Regulations, 2013 CFR

2013-01-01

... use of the unit; and (2) Before medical use under the following conditions: (i) Whenever spot-check...) of this section must be performed by the authorized medical physicist. (g) A licensee shall retain a...

10 CFR 35.632 - Full calibration measurements on teletherapy units.

Code of Federal Regulations, 2011 CFR

2011-01-01

... use of the unit; and (2) Before medical use under the following conditions: (i) Whenever spot-check...) of this section must be performed by the authorized medical physicist. (g) A licensee shall retain a...

10 CFR 35.632 - Full calibration measurements on teletherapy units.

Code of Federal Regulations, 2010 CFR

2010-01-01

... use of the unit; and (2) Before medical use under the following conditions: (i) Whenever spot-check...) of this section must be performed by the authorized medical physicist. (g) A licensee shall retain a...

29 CFR 825.124 - Needed to care for a family member or covered servicemember.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.124 Needed to care for a family member or covered servicemember. (a) The medical... serious health condition, the family member is unable to care for his or her own basic medical, hygienic...

29 CFR 825.124 - Needed to care for a family member or covered servicemember.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.124 Needed to care for a family member or covered servicemember. (a) The medical... serious health condition, the family member is unable to care for his or her own basic medical, hygienic...

29 CFR 825.124 - Needed to care for a family member or covered servicemember.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.124 Needed to care for a family member or covered servicemember. (a) The medical... serious health condition, the family member is unable to care for his or her own basic medical, hygienic...

Surgical Management of the Constricted or Obliterated Vagina.

PubMed

Gebhart, John B; Schmitt, Jennifer J

2016-08-01

Management of the constricted or obliterated vagina demands an understanding and recognition of the potential etiologies leading to this presentation. A thorough and comprehensive medical and surgical review is required to arrive at an accurate diagnosis, which then will guide medical or surgical intervention. It is paramount to recognize when underlying medical conditions are contributing to these conditions and to begin medical therapy; failure to do so will often yield suboptimal results. When these conditions arise after surgical interventions, compensatory surgical techniques that correct upper and lower vaginal strictures or obliteration include incision through the stricture, vaginal advancement, Z-plasty, skin grafts, perineal flaps, and abdominal flaps and grafts. Postoperative surveillance and dilation are critical to optimize long-term success.

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

29 CFR 825.207 - Substitution of paid leave.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825... against the employee's FMLA leave entitlement. For example, paid sick leave used for a medical condition...' compensation absences and FMLA leave. (f) Section 7(o) of the Fair Labor Standards Act (FLSA) permits public...

29 CFR 825.206 - Interaction with the FLSA.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825....g., leave to care for a grandparent or for a medical condition which does not qualify as a serious...

29 CFR 825.206 - Interaction with the FLSA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825....g., leave to care for a grandparent or for a medical condition which does not qualify as a serious...

29 CFR 825.206 - Interaction with the FLSA.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825....g., leave to care for a grandparent or for a medical condition which does not qualify as a serious...

29 CFR 825.207 - Substitution of paid leave.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825... against the employee's FMLA leave entitlement. For example, paid sick leave used for a medical condition...' compensation absences and FMLA leave. (f) Section 7(o) of the Fair Labor Standards Act (FLSA) permits public...

29 CFR 825.206 - Interaction with the FLSA.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825....g., leave to care for a grandparent or for a medical condition which does not qualify as a serious...

29 CFR 825.206 - Interaction with the FLSA.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825....g., leave to care for a grandparent or for a medical condition which does not qualify as a serious...

Outdoor Air Pollution, Heart Attack and Stroke

EPA Science Inventory

Elevated outdoor ambient air particle pollution triggers heart attacks, strokes, and abnormal heart rhythms and worsens heart failure in individuals at high risk due to underlying medical conditions. Emergency Medical Services in communities are the first responders to these eme...

American Academy of Allergy, Asthma & Immunology membership experience with allergen immunotherapy safety in patients with specific medical conditions.

PubMed

Larenas-Linnemann, Désirée E S; Hauswirth, David W; Calabria, Christopher W; Sher, Lawrence D; Rank, Matthew A

2016-09-01

Little data in the literature exist concerning patients with certain underlying medical conditions who receive allergen subcutaneous immunotherapy (SCIT). To survey allergists' experience with SCIT in patients with medical conditions considered to impose an elevated risk for untoward outcomes. A Web-based survey was conducted among members of the American Academy of Allergy, Asthma & Immunology to query about their experience with SCIT in patients with certain medical conditions. There were 1085 replies (21% response), of whom, 86% were U.S. based, 51% were suburban, 31% were academic, 42% were medium-sized practices, and 54% had >15 years' experience. In responders' opinion, SCIT was "contraindicated" in patients with the following: acquired immune deficiency syndrome (AIDS) (48%), cancer (and still receiving active treatment) (33%), severe asthma (32%), and a history of transplantation (30%). Even so, survey responders collectively gave SCIT to >2400 patients for each of these conditions: severe asthma, coronary artery disease, cancer in remission, and autoimmune disorders; and to ≥5400 patients with hypertension and ≥4100 women who became pregnant. The experience of colleagues with these patients rarely resulted in major problems (i.e., activation of underlying disease, systemic reactions to SCIT, or SCIT discontinuation), with the exception of severe asthma (12.5%), initiation of SCIT during pregnancy (5.4%), and AIDS (4.2%). For most other conditions, it was ≤1.5% (e.g., continue during pregnancy, cancer in remission, history of transplantation, positive human immunodeficiency virus and no AIDS). According to the experience of a large group of practicing allergists, the American Academy of Allergy, Asthma & Immunology members, few medical conditions seemed to pose an elevated risk for untoward outcomes from SCIT. Because these are survey results, prospective research might yield even more solid data.

Consent to treatment by minors attending accident and emergency departments: guidelines.

PubMed Central

Williams, L; Harris, A; Thompson, M; Brayshaw, A

1997-01-01

The absolute right to refuse medical treatment, even if the reasons are irrational, is confined to competent adults. Children under 16 years can give legal consent to treatment in the absence of consent from those with parental responsibility. Children under 18 years do not, however, have an absolute right to consent, or refuse to consent, to treatment. The views of children assume increasing importance with age and maturity. Accident and emergency medical and nursing staff may face difficult decisions when children, or those with parental responsibility, refuse to consent to medical treatment. This paper presents guidelines designed to guide the decision making process in immediately or potentially life threatening conditions and in non-life-threatening conditions. Images Figure 1 Figure 2 p289-a PMID:9315927

Treating Asthma in Children under 5

MedlinePlus

... pieces of information to make a diagnosis. Medical history Your doctor will likely ask a number of ... conditions/childhood-asthma/in-depth/asthma-in-children/ART-20044376 . Mayo Clinic Footer Legal Conditions and Terms ...

[Perioperative use of medical hypnosis. Therapy options for anaesthetists and surgeons].

PubMed

Hermes, D; Trübger, D; Hakim, S G; Sieg, P

2004-04-01

Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.

Association of postmortem blood hemoglobin A1c levels with diabetic conditions in aviation accident pilot fatalities.

DOT National Transportation Integrated Search

2001-07-01

Purpose. The Federal Aviation Administration's (FAA's) Office of Aerospace Medicine evaluates present and proposed medical certification standards for pilots. Under this responsibility, the FAA Civil Aerospace Medical Institute investigates the role ...

Do absorption and realistic distraction influence performance of component task surgical procedure?

PubMed

Pluyter, Jon R; Buzink, Sonja N; Rutkowski, Anne-F; Jakimowicz, Jack J

2010-04-01

Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient.

Medical innovation versus stem cell tourism.

PubMed

Lindvall, Olle; Hyun, Insoo

2009-06-26

Stem cell tourism is criticized on grounds of consumer fraud, blatant lack of scientific justification, and patient safety. However, the issues are complex because they invoke questions concerning the limits of acceptable medical innovation and medical travel. Here we discuss these issues and articulate conditions under which "unproven" therapies may be offered to patients outside of regular clinical trials.

Out-Of-Pocket Prescription Costs Under A Typical Silver Plan Are Twice As High As They Are In The Average Employer Plan.

PubMed

Thorpe, Kenneth E; Allen, Lindsay; Joski, Peter

2015-10-01

The health insurance Marketplaces created under the Affordable Care Act have attracted nearly ten million enrollees, including many people who were previously insured by an employer-sponsored plan. The most popular Marketplace plan--the silver plan--has significantly higher cost sharing than does a typical employer-sponsored plan, which may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions. We estimated the impact of higher cost sharing on drug and medical spending among patients with chronic conditions. Using national data, we compared cost sharing and prescription and medical spending for patients covered by employer-sponsored plans to the spending for those in a typical silver plan in the Marketplaces. Our results show that out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan, resulting in fewer prescriptions filled and refilled and in higher spending on other medical services. Maintaining the use of cost-effective prescription medications might require lower cost sharing for patients with chronic conditions than is currently found in the Marketplaces. Project HOPE—The People-to-People Health Foundation, Inc.

Validation of a computational knee joint model using an alignment method for the knee laxity test and computed tomography.

PubMed

Kang, Kyoung-Tak; Kim, Sung-Hwan; Son, Juhyun; Lee, Young Han; Koh, Yong-Gon

2017-01-01

Computational models have been identified as efficient techniques in the clinical decision-making process. However, computational model was validated using published data in most previous studies, and the kinematic validation of such models still remains a challenge. Recently, studies using medical imaging have provided a more accurate visualization of knee joint kinematics. The purpose of the present study was to perform kinematic validation for the subject-specific computational knee joint model by comparison with subject's medical imaging under identical laxity condition. The laxity test was applied to the anterior-posterior drawer under 90° flexion and the varus-valgus under 20° flexion with a series of stress radiographs, a Telos device, and computed tomography. The loading condition in the computational subject-specific knee joint model was identical to the laxity test condition in the medical image. Our computational model showed knee laxity kinematic trends that were consistent with the computed tomography images, except for negligible differences because of the indirect application of the subject's in vivo material properties. Medical imaging based on computed tomography with the laxity test allowed us to measure not only the precise translation but also the rotation of the knee joint. This methodology will be beneficial in the validation of laxity tests for subject- or patient-specific computational models.

An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

PubMed

Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

2009-09-01

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

A battle over birth "control": legal and legislative employer prescription contraception benefit mandates.

PubMed

Loomis, C Keanin

2002-12-01

Under the Pregnancy Discrimination Act (PDA), employers are prohibited from discriminating against women by treating pregnancy and childbirth different from other medical conditions. Employers who offer medical benefits to their employees have thus been required to cover pregnancy-related medical costs on the same terms as other medical coverage. The cost of prescription contraception, however, has generally not been covered by employer-sponsored medical plans, even while other prescription drugs were. This Note examines the recent case of Erickson v. Bartell Drug Co., which challenged this practice of excluding prescription contraception coverage as discriminatory under the PDA, and argues that further federal legislation is necessary to ensure the equal treatment of women in the workplace.

Liquid-crystal displays for medical imaging: a discussion of monochrome versus color

NASA Astrophysics Data System (ADS)

Wright, Steven L.; Samei, Ehsan

2004-05-01

A common view is that color displays cannot match the performance of monochrome displays, normally used for diagnostic x-ray imaging. This view is based largely on historical experience with cathode-ray tube (CRT) displays, and does not apply in the same way to liquid-crystal displays (LCDs). Recent advances in color LCD technology have considerably narrowed performance differences with monochrome LCDs for medical applications. The most significant performance advantage of monochrome LCDs is higher luminance, a concern for use under bright ambient conditions. LCD luminance is limited primarily by backlight design, yet to be optimized for color LCDs for medical applications. Monochrome LCDs have inherently higher contrast than color LCDs, but this is not a major advantage under most conditions. There is no practical difference in luminance precision between color and monochrome LCDs, with a slight theoretical advantage for color. Color LCDs can provide visualization and productivity enhancement for medical applications, using digital drive from standard commercial graphics cards. The desktop computer market for color LCDs far exceeds the medical monitor market, with an economy of scale. The performance-to-price ratio for color LCDs is much higher than monochrome, and warrants re-evaluation for medical applications.

Management of Tooth Wear: A Holistic, Dental, Medical, and Mental Healthcare Approach.

PubMed

Ahmed, Khaled E

2016-08-01

Tooth wear is a condition that affects a substantial cohort of dental patients. It has a measurable impact on patients' satisfaction, and overall quality of life. Recently, with growing evidence, our understanding of the aetiology, progression, and management of tooth wear has evolved. The paper argues that pathological tooth wear should not be solely considered as a dental condition, but rather a dental manifestation of other mental and medical disorders. As such, successful management of tooth wear, and its underlying aetiology, requires a holistic, multidisciplinary management approach, involving dental, medical, and mental healthcare providers.

Effects of Stimulant Medication under Varied Motivational Operations

ERIC Educational Resources Information Center

Mace, F. Charles; Prager, Kevin L.; Thomas, Karen; Kochy, Jane; Dyer, Tim J.; Perry, Lora; Pritchard, Duncan

2009-01-01

We evaluated the evocative effects of four conditions (high- and low-preference activities, low and divided attention) and stimulant medication on the behavior of a 16-year-old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude…

Use of Observational Learning Enhanced Instruction in Low Language Competency Audiences

ERIC Educational Resources Information Center

Zain-ul-abdin, Khawaja

2013-01-01

This dissertation investigates the use of observational learning enhanced health instruction to mitigate problems of low language competency among learners. Low language competency can cause improper comprehension of medical instruction and health education, resulting in misdiagnosis, reduced recall, under reporting of medical conditions and…

[Medical and sanitary conditions of life activities of sea craft crew (review of literature)].

PubMed

Kubasov, R V; Lupachev, V V; Kubasova, E D

2016-08-01

The article characterizes sea work conditions under which crew-members carry occupational activitie's during the sail. Negative factors influencing health of crew members are listed. Among these factors, the major influence is caused by physical (noise, vibration, mechanical impacts, ionizing radiation varying in frequency), chemical, climate and.geographic, social an psychologic factors. Conclusion is that extreme work conditions of sailing staffers cause overstrain of adaptation systems, disorders of regulation fuctions, worsen health state and induce disablement. Within a system of medical care.for water transport workers, necessity is to have complex accounting of occupational hazards for more qualitative and safe work conditions.

Emergency Medicine and the Underage Athlete

PubMed Central

Martin, David E.

1994-01-01

Most high school and some collegiate athletes are legal minors. In civil matters, the law treats minors (usually individuals under the age of 18 years) uniquely. Limitations exist on a minor's ability to enter into contracts, make determinations regarding medical care, and bear responsibility for personal actions. Medical professionals are often unclear on matters relating to the provision of medical care to minors. The purpose of this discourse is to present selected legal issues in the context of two fictional case studies. Case 1 presents issues regarding the definition of emergency medical conditions and the related emergency medical doctrine. Case 2 provides an example of an acute medical concern which fails to fall under emergency medical classification but rather provides a context for discussing the mature minor doctrine. Both cases are analyzed in light of these doctrines in addition to other pertinent legal considerations. PMID:16558280

10 CFR 1046.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... official of the local DOE field office and authorized by the Director, Office of Health and Safety, to... performance of work under DOE jurisdiction. Field organization. Any organizational component of the DOE... Government property. Medical condition. General health, physical condition, and emotional and mental...

Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

USDA-ARS?s Scientific Manuscript database

The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

21 CFR 558.315 - Levamisole hydrochloride (equivalent).

Code of Federal Regulations, 2010 CFR

2010-04-01

... directed; feed the equivalent of 1 lb. of 0.08 percent worming feed per 100 lbs. of body weight of pigs to... feeding; when medicated feed is consumed, resume normal feeding. Pigs maintained under conditions of... in a short time after medication. If pigs are infected with mature lungworms, coughing and vomiting...

Medical tourism in India.

PubMed

Gupta, Vijay; Das, Poonam

2012-06-01

The term 'medical tourism' is under debate because health care is a serious business and rarely do patients combine the two. India is uniquely placed by virtue of its skilled manpower, common language, diverse medical conditions that doctors deal with, the volume of patients, and a large nonresident Indian population overseas. Medical tourism requires dedicated services to alleviate the anxiety of foreign patients. These include translation, currency conversion, travel, visa, posttreatment care system,and accommodation of patient relatives during and after treatment.

[Various aspects of public health system development under market economy].

PubMed

Polyakov, I V; Uvarov, S A

1995-01-01

Transfer from administrative methods of management to economic relationships in the public health system leads to reevaluation of the regularities in the development of the system of population health protection under conditions of marketing relations. The paper presents the logistic aspects of public health management under new conditions: positive and negative features in the development of medical insurance and offers a concept of introduction of a system of synchronous regulation of material, financial, and information streams in public health.

Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students

PubMed Central

Afrisham, Reza; Sadegh-Nejadi, Sahar; SoliemaniFar, Omid; Kooti, Wesam; Ashtary-Larky, Damoon; Alamiri, Fatima; Najjar-Asl, Sedigheh; Khaneh-Keshi, Ali

2016-01-01

Objective The purpose of this study was to evaluate the salivary testosterone levels under psychological stress and its relationship with rumination and five personality traits in medical students. Methods A total of 58 medical students, who wanted to participate in the final exam, were selected by simple random sampling. Two months before the exam, in the basal conditions, the NEO Inventory short form, and the Emotional Control Questionnaire (ECQ) were completed. Saliva samples were taken from students in both the basal conditions and under exam stress. Salivary testosterone was measured by ELISA. Data was analyzed using multivariate analysis of variance with repeated measures, paired samples t-test, Pearson correlation and stepwise regression analysis. Results Salivary testosterone level of men showed a significant increase under exam stress (p<0.05). However, a non-significant although substantial reduction observed in women. A significant correlation was found between extroversion (r=-0.33) and openness to experience (r=0.30) with salivary testosterone (p<0.05). Extraversion, aggression control and emotional inhibition predicted 28% of variance of salivary testosterone under stress. Conclusion Salivary testosterone reactivity to stress can be determined by sexual differences, personality traits, and emotional control variables which may decrease or increase stress effects on biological responses, especially the salivary testosterone. PMID:27909455

Management of prescription and nonprescription drug use during pregnancy.

PubMed

Morgan, Maria A; Cragan, Janet D; Goldenberg, Robert L; Rasmussen, Sonja A; Schulkin, Jay

2010-08-01

To assess screening and treatment patterns of obstetrician-gynecologists regarding medication use during pregnancy. A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. The response rate was 58%. Most respondents reported always asking pregnant patients about use of over-the-counter (OTC) (86%) and prescription (98%) drugs; 24% reported not always asking about alternative medications. Far fewer reported always asking nonpregnant patients about use of alcohol (67%), illegal drugs (51%) and OTC medications (52%) than pregnant patients. Two-fifths (41%) reported prescribing a medication during pregnancy for which they had insufficient information about potential effects on the fetus; nearly half (47%) reported that there are medical conditions for which they would like to prescribe medications but do not due to insufficient safety information. Physician responses indicate that they are less likely to refer pregnant than nonpregnant patients to a specialist for treatment of certain conditions. These results indicate that obstetrician-gynecologists sometimes prescribe medications for pregnant patients under less than optimal conditions and emphasize the importance of generating up-to-date information on effects of medications during pregnancy and having it readily available to health care providers.

Cardiac medical conditions have become the leading cause of death in children with heart disease.

PubMed

Schlingmann, Tobias R; Thiagarajan, Ravi R; Gauvreau, Kimberlee; Lofgren, Kimberly C; Zaplin, Michael; Connor, Jean A; del Nido, Pedro J; Lock, James E; Jenkins, Kathy J

2012-01-01

Mortality among children with congenital and acquired heart disease has decreased significantly over the past decades. We sought to determine whether the underlying problems leading to death in these patients had changed over the past decade. We reviewed medical records for 100 deaths of cardiac patients in 2004-2005 and 100 deaths in 1995-1996. Demographic, clinical, and procedural data as well as circumstances of death were collected. A consensus committee reviewed each case and sought to identify the condition leading to death. These conditions were classified as predominantly surgical or medical. General patient characteristics (age, gender, cardiac history, comorbidities, proportion of surgical patients) did not change significantly between the two time periods. However, in 1995-1996, 64% of deceased surgical patients had died within 30 days of surgery. This rate was nearly halved to only 38% by 2004-2005 (P= .003). Furthermore, the conditions leading to death changed significantly: 51% of patient deaths in 1995-1996 resulted from a surgical problem, 29% from a medical condition. This ratio was reversed in 2004-2005: Only 31% of patient deaths were due to a surgical problem, while 50% of deaths resulted from a medical condition (P= .005). The most common medical conditions resulting in death were pulmonary vein stenosis, pulmonary arterial hypertension, and primary myocardial failure. The proportion of deaths within 30 days of cardiac surgery decreased significantly over the past decade. While surgical causes accounted for the majority of these deaths in 1995-1996, most patient deaths in 2004-2005 resulted from cardiac medical causes. © 2012 Wiley Periodicals, Inc.

42 CFR 410.55 - Services related to kidney donations: Conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Services related to kidney donations: Conditions... Services § 410.55 Services related to kidney donations: Conditions. Medicare Part B pays for medical and other health services covered under this subpart that are furnished in connection with a kidney donation...

42 CFR 410.55 - Services related to kidney donations: Conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Services related to kidney donations: Conditions... Services § 410.55 Services related to kidney donations: Conditions. Medicare Part B pays for medical and other health services covered under this subpart that are furnished in connection with a kidney donation...

42 CFR 410.55 - Services related to kidney donations: Conditions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Services related to kidney donations: Conditions... Services § 410.55 Services related to kidney donations: Conditions. Medicare Part B pays for medical and other health services covered under this subpart that are furnished in connection with a kidney donation...

42 CFR 410.55 - Services related to kidney donations: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Services related to kidney donations: Conditions... Services § 410.55 Services related to kidney donations: Conditions. Medicare Part B pays for medical and other health services covered under this subpart that are furnished in connection with a kidney donation...

42 CFR 410.55 - Services related to kidney donations: Conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Services related to kidney donations: Conditions... Services § 410.55 Services related to kidney donations: Conditions. Medicare Part B pays for medical and other health services covered under this subpart that are furnished in connection with a kidney donation...

38 CFR 21.266 - Payment of subsistence allowance under special conditions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and... rehabilitation program under Chapter 31 while hospitalized in a VA medical center or in any other hospital at VA... provided under § 21.264 that may be paid to a veteran pursuing a rehabilitation program for any month for...

Slaves of the state - medical internship and community service in South Africa.

PubMed

Erasmus, Nicolette

2012-06-05

Owing to a chronic shortage of medical staff in South Africa, sleep-deprived medical interns and community service doctors work up to 200 hours of overtime per month under the state's commuted overtime policy. Nurses moonlight in circumvention of the Basic Conditions of Employment Act. For trainee doctors, overtime over 80 hours is unpaid, and rendered involuntarily under threat of not qualifying to practise medicine in South Africa. As forced labour, and sleep deprivation amounting to cruel and degrading treatment, it is outlawed in international law. No other professional group in the country is subjected to such levels of exploitation and discrimination by the state. These abuses should be challenged under the Constitution. Solutions include the installation of electronic time-recording in state hospitals, cessation of unpaid overtime, limits on medical intern shifts to a maximum of 16 hours, and an investigation by the Human Rights Commission of South Africa.

[Economic problems in military public health].

PubMed

Petrov, G M; Moretskiĭ, A A

2000-03-01

There are discussed the problems of military treatment and prophylactic institution (TPI) functioning under conditions of market reform of Russian public health. Main marketing concepts in military health are determined and some recommendations on work improvement in TPI of the Armed Forces in the system of obligatory medical insurance are presented, granting population paid medical services. It is necessary to form a new type of director--military and medical manager.

[Problems in organization of medical criminological registration and personality identification for subjects occupationally exposed to life risk].

PubMed

Shcherbakov, V V

2000-01-01

The paper discusses problems in organization of identification studies under conditions of mass deaths as exemplified by forensic medical records of medical criminological identification studies of subjects killed during war conflict in Chechnya. The evolution of the organization model of identification studies is shown transformation of organization philosophy, formation of expert algorithms, formalization and technologic realization of expert solutions.

Severe Trauma Stress Inoculation Training for Combat Medics using High Fidelity Simulation

DTIC Science & Technology

2013-12-01

why several programs have been developed to introduce TC3 principles to military medical providers (Physician Assistants (PA), nurses , and doctors... Practitioner and senior medical Non~Commissioned Officer (NCO) a practical working knowledge of how to deal with the injured patient in a combat...environment and under simulated battlefield conditions. TCMC, on the other hand, provides the Physician Assistant, Physician, Nurse Practitioner and senior

Acute movement disorders in the medical setting.

PubMed

Zawar, Ifrah; Caro, Mario A; Feldman, Lara; Jimenez, Xavier F

2016-07-01

Objective Psychosomatic medicine psychiatrists are often tasked with the evaluation and treatment of complex neuropsychiatric states which may be motoric in phenotype. Little energy has been dedicated to understanding acute movement disorders in the hospital environment. Method Recognizing the importance of frontal-subcortical (corticostriatothalamocortical) circuitry and basal ganglia structures, we present a case series of acute movement disorder phenotypes resulting from underlying medical conditions, commonly-administered medications, or the interaction of both. We organize these scenarios into neurodegenerative disorders, primary psychiatric disorders, neuroinflammation, and polypharmacy, demonstrating a clinical example of each followed by background references on a variety of clinical states and medications contributing to acute movement disorders. In addition, we offer visual illustration of implicated neurocircuitry as well as proposed neurotransmitter imbalances involving glutamate, gamma aminobutyric acid, and dopamine. Furthermore, we review the various clinical syndromes and medications involved in the development of acute movement disorders. Results Acute movement disorder's involve complex interactions between frontal-subcortical circuits and acute events. Given the complexity of interactions, psychopharmacological considerations become critical, as some treatments may alleviate acute movement disorders while others will exacerbate them. Conclusion Integrating underlying medical conditions and acutely administered (or discontinued) pharmacological agents offers an interactional, neuromedical approach to acute movement disorders that is critical to the work of psychosomatic medicine.

American Academy of Asthma, Allergy & Immunology membership experience with venom immunotherapy in chronic medical conditions and pregnancy, and in young children.

PubMed

Calabria, Christopher W; Hauswirth, David W; Rank, Matthew; Sher, Lawrence; Larenas-Linnemann, Desiree

2017-03-01

Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children. A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons." Results were expressed descriptively. A total of 697 of 5123 surveys (14%) were completed: 87% of the respondents were based in the United States, and 28% worked in an academic setting. Most respondents (71%) believed that pregnancy was a contraindication for starting VIT. Most were comfortable continuing VIT (51%) if the woman became pregnant after starting therapy. Of the allergists who treated children, many would give VIT down to age 5 years (42%) or younger, ages 1-4 years (35%). The following list is of the specific medical condition, the number of allergists who used VIT in patients with this condition, and the percentage who reported major problems: severe asthma, 212 (4.2%); hypertension, 287 (1.1%); coronary artery disease, 222 (3.6%); arrhythmias, 136 (3.4%); cerebrovascular disease, 104 (5.1%); cancer in remission, 166 (0%); cancer stable but still under treatment, 44 (7.2%); a history of bone marrow transplantation, 15 (4.9%); a history of solid organ transplantation, 29 (3.6%); human immunodeficiency virus, 53 (1.4%); acquired immunodeficiency syndrome, 24 (6.2%); stable autoimmune disease, 164 (2.8%); mastocytosis, 66 (18.4%); elevated serum tryptase, 101 (10.8%); immunodeficiency 59 (2.5%). Many allergists were comfortable using VIT in young children and continuing but not starting pregnant women on VIT. VIT was commonly used in patients with hypertension, coronary artery disease, arrhythmias, cancer in remission, and stable autoimmune disease. Major problems were most frequently reported in use with mastocytosis, elevated tryptase, and cancer still under treatment.

Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

PubMed

Morton, Laurel M; Phillips, Tania J

2016-04-01

Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Sleep Problems in Children and Adolescents with Common Medical Conditions

PubMed Central

Lewandowski, Amy S.; Ward, Teresa M.; Palermo, Tonya M.

2011-01-01

Synopsis Sleep is critically important to children’s health and well-being. Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared to otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders (e.g., sleep disordered breathing, restless leg syndrome), co-morbid with acute and chronic conditions (e.g., asthma, arthritis, cancer), or secondary to underlying disease-related mechanisms (e.g. airway restriction, inflammation) treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences and promotion of healthy sleep habits and health outcomes. PMID:21600350

29 CFR 825.302 - Employee notice requirements for foreseeable FMLA leave.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and... foster care, planned medical treatment for a serious health condition of the employee or of a family... hospitalized overnight; whether the employee or the employee's family member is under the continuing care of a...

29 CFR 825.302 - Employee notice requirements for foreseeable FMLA leave.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and Obligations Under the Act § 825.302 Employee notice requirements for foreseeable FMLA leave. (a) Timing of... foster care, planned medical treatment for a serious health condition of the employee or of a family...

29 CFR 825.302 - Employee notice requirements for foreseeable FMLA leave.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and Obligations Under the Act § 825.302 Employee notice requirements for foreseeable FMLA leave. (a) Timing of... foster care, planned medical treatment for a serious health condition of the employee or of a family...

29 CFR 825.302 - Employee notice requirements for foreseeable FMLA leave.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and Obligations Under the Act § 825.302 Employee notice requirements for foreseeable FMLA leave. (a) Timing of... foster care, planned medical treatment for a serious health condition of the employee or of a family...

29 CFR 825.302 - Employee notice requirements for foreseeable FMLA leave.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and Obligations Under the Act § 825.302 Employee notice requirements for foreseeable FMLA leave. (a) Timing of... foster care, planned medical treatment for a serious health condition of the employee or of a family...

29 CFR 825.203 - Scheduling of intermittent or reduced schedule leave.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825.203 Scheduling of intermittent or reduced schedule leave. Eligible... the serious health condition of a covered family member or the employee or the serious injury or...

Hypertensive Medications in Competitive Athletes.

PubMed

Pelto, Henry

Hypertension is the most common cardiovascular disease in athletes. It is an important cause of long-term morbidity and mortality, even in a fit, athletic population. Management options to reduce these long-term risks exist that have minimal impact on athletic performance. Identification and management of underlying lifestyle factors and diseases that may lead to secondary hypertension is critical. These include substance abuse, medications, and underlying medical conditions. After evaluation and management of these issues, medications can be used to reduce blood pressure. In the athletic population, first-line medication treatment should include ACE inhibitors, angiotensin II receptor blockers (ARB), and calcium channel blockers (CCB). The response to treatment should be followed closely to ensure adequate blood pressure control. Athletic participation in sports with high dynamic load should be limited in individuals with stage 2 hypertension or stage 1 hypertension with evidence of end organ damage.

Influence of Dopaminergic Medication on Conditioned Pain Modulation in Parkinson's Disease Patients

PubMed Central

Buhmann, Carsten; Forkmann, Katarina; Diedrich, Sabrina; Wesemann, Katharina; Bingel, Ulrike

2015-01-01

Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but little is known about the underlying pathophysiological mechanisms. The susceptibility to pain is known to depend on ascending and descending pathways. Because parts of the descending pain inhibitory system involve dopaminergic pathways, dysregulations in dopaminergic transmission might contribute to altered pain processing in PD. Deficits in endogenous pain inhibition can be assessed using conditioned pain modulation (CPM) paradigms. Methods Applying such a paradigm, we investigated i) whether CPM responses differ between PD patients and healthy controls, ii) whether they are influenced by dopaminergic medication and iii) whether there are effects of disease-specific factors. 25 patients with idiopathic PD and 30 healthy age- and gender-matched controls underwent an established CPM paradigm combining heat pain test stimuli at the forearm and the cold pressor task on the contralateral foot as the conditioning stimulus. PD patients were tested under dopaminergic medication and after at least 12 hours of medication withdrawal. Results No significant differences between CPM responses of PD patients and healthy controls or between PD patients “on” and “off” medication were found. These findings suggest (i) that CPM is insensitive to dopaminergic modulations and (ii) that PD is not related to general deficits in descending pain inhibition beyond the known age-related decline. However, at a trend level, we found differences between PD subtypes (akinetic-rigid, tremor-dominant, mixed) with the strongest impairment of pain inhibition in the akinetic-rigid subtype. Conclusions There were no significant differences between CPM responses of patients compared to healthy controls or between patients “on” and “off” medication. Differences between PD subtypes at a trend level point towards different pathophysiological mechanisms underlying the three PD subtypes which warrant further investigation and potentially differential therapeutic strategies in the future. PMID:26270817

Energy under-reporting in adults with mood disorders: prevalence and associated factors.

PubMed

Davison, Karen M

2013-09-01

Little is known about relationships of energy under-reporting in mental health populations. Using data from a sample of individuals with mood disorders (n = 97), demographic, food intake and body-related, psychological, lifestyle, and condition-specific factors were examined in relationship to energy under-reporting. More than two-thirds (70%) were considered under-reporters based on Goldberg's classifications. Differences were found between energy under-reporters and accurate reporters for diet quality, sex, body mass index (BMI), weight change after taking psychiatric medications, and for those taking mood stabilizers (all p's < 0.05). Regression analyses indicated there was lower prevalence of under-reporting as diet quality improved, if individuals experienced weight change after taking psychiatric medication, or were females (p < 0.05). The prevalence of under-reporting was more than 1.3 times in those taking mood stabilizers versus those not taking this psychiatric medication [Prevalence ratio (PR) = 1.30, 95% CI 1.01-1.66, p < 0.05]. Further research of under-reporting in mental health populations will enable targeted approaches to improve accuracy of diet reporting and inferences made about nutrition and mental health.

The safety of paediatric dentistry procedures under general anaesthesia. A five-year experience of a tertiary care center.

PubMed

Bartella, A K; Lechner, C; Kamal, M; Steegmann, J; Hölzle, F; Lethaus, B

2018-03-01

Frequently general anaesthesia (GA) is used to treat noncompliant children. Especially in children with morbid diseases general anaesthesia can be a challenging procedure for anaesthetists. The aim of this paper was to evaluate the risks and adverse reactions with a special focus on the impact of existing medication conditions and syndromes. and methods Records of children up to 10 years of age, who were admitted for paediatric dentistry procedures under GA from January 2011 to December 2016 at the University Hospital of the University of Aachen (Germany), were reviewed. A special attention was paid to the intra- and perioperative critical adverse reactions and concomitant systemic conditions and their impact on treatment outcome. Two hundred and twenty patients were admitted for dental restorations. Critical adverse reactions occurred in 4% of the treated patients and they were statistically significantly (p=0.004) related to the ASA classification above II. The use of a laryngeal mask airway was significantly associated (p<0.001) with a shorter duration of surgery. Most common concomitant medical conditions were congenital heart disease, mental retardation and inherited syndromes. Although the administration of general anaesthesia in infants and children can be regarded as a safe procedure, clinically significant adverse reactions can occur, especially in patients with an existing medical condition.

47 CFR 2.1204 - Import conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... generations of a particular model under development are considered to be separate devices. (4) The radio... particular model under development are considered to be separate devices. (5) The radio frequency device is... offered for sale or marketed. (9) The radio frequency device is a medical implant transmitter inserted in...

47 CFR 2.1204 - Import conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... generations of a particular model under development are considered to be separate devices. (4) The radio... particular model under development are considered to be separate devices. (5) The radio frequency device is... offered for sale or marketed. (9) The radio frequency device is a medical implant transmitter inserted in...

Comparing deep learning and concept extraction based methods for patient phenotyping from clinical narratives.

PubMed

Gehrmann, Sebastian; Dernoncourt, Franck; Li, Yeran; Carlson, Eric T; Wu, Joy T; Welt, Jonathan; Foote, John; Moseley, Edward T; Grant, David W; Tyler, Patrick D; Celi, Leo A

2018-01-01

In secondary analysis of electronic health records, a crucial task consists in correctly identifying the patient cohort under investigation. In many cases, the most valuable and relevant information for an accurate classification of medical conditions exist only in clinical narratives. Therefore, it is necessary to use natural language processing (NLP) techniques to extract and evaluate these narratives. The most commonly used approach to this problem relies on extracting a number of clinician-defined medical concepts from text and using machine learning techniques to identify whether a particular patient has a certain condition. However, recent advances in deep learning and NLP enable models to learn a rich representation of (medical) language. Convolutional neural networks (CNN) for text classification can augment the existing techniques by leveraging the representation of language to learn which phrases in a text are relevant for a given medical condition. In this work, we compare concept extraction based methods with CNNs and other commonly used models in NLP in ten phenotyping tasks using 1,610 discharge summaries from the MIMIC-III database. We show that CNNs outperform concept extraction based methods in almost all of the tasks, with an improvement in F1-score of up to 26 and up to 7 percentage points in area under the ROC curve (AUC). We additionally assess the interpretability of both approaches by presenting and evaluating methods that calculate and extract the most salient phrases for a prediction. The results indicate that CNNs are a valid alternative to existing approaches in patient phenotyping and cohort identification, and should be further investigated. Moreover, the deep learning approach presented in this paper can be used to assist clinicians during chart review or support the extraction of billing codes from text by identifying and highlighting relevant phrases for various medical conditions.

Burning mouth syndrome

PubMed Central

Gurvits, Grigoriy E; Tan, Amy

2013-01-01

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment. PMID:23429751

Burning mouth syndrome.

PubMed

Gurvits, Grigoriy E; Tan, Amy

2013-02-07

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Associated Medical Disorders and Disabilities in Children with Autistic Disorder: A Population-Based Study

ERIC Educational Resources Information Center

Kielinen, Marko; Rantala, Heikki; Timonen, Eija; Linna, Sirkka-Liisa; Moilanen, Irma

2004-01-01

A population-based survey was conducted among 152,732 Finnish children and adolescents aged under 16 years and living in northern Finland. Diagnoses and associated medical conditions were derived from the hospital and institutional records of this area. One hundred and eighty-seven children with DSM-IV autistic disorder were identified. Associated…

[Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

PubMed

Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

2015-06-01

Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany. © Georg Thieme Verlag Stuttgart · New York.

Determining medical staffing requirements for humanitarian assistance missions.

PubMed

Negus, Tracy L; Brown, Carrie J; Konoske, Paula

2010-01-01

The primary mission of hospital ships is to provide acute medical and surgical services to U.S. forces during military operations. Hospital ships also provide a hospital asset in support of disaster relief and humanitarian assistance (HA) operations. HA missions afford medical care to populations with vastly different sets of medical conditions from combat casualty care, which affects staffing requirements. Information from a variety of sources was reviewed to better understand hospital ship HA missions. Factors such as time on-site and location shape the mission and underlying goals. Patient encounter data from previous HA missions were used to determine expected patient conditions encountered in various HA operations. These data points were used to project the medical staffing required for future missions. Further data collection, along with goal setting, must be performed to accomplish successful future HA missions. Refining staffing requirements allows deployments to accomplish needed HA and effectively reach underserved areas.

28 CFR 541.21 - Conditions of disciplinary segregation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... facility and under the supervision and control of the medical staff. (2) Cell occupancy. The number of... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Conditions of disciplinary segregation... inmate housed in a special housing unit in a cell either alone or with other inmates, separated from the...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met: (a) The emergency services were provided in a hospital emergency department or...

Tribological investigation of a functional medical textile with lubricating drug-delivery finishing.

PubMed

Gerhardt, L-C; Lottenbach, R; Rossi, R M; Derler, S

2013-08-01

Textile-based drug delivery systems have a high potential for innovative medical and gerontechnological applications. In this study, the tribological behaviour and lubrication properties of a novel textile with drug delivery function/finishing was investigated by means of friction experiments that simulated cyclic dynamic contacts with skin under dry and wet conditions. The textile drug delivery system is based on a loadable biopolymer dressing on a polyester (PES) woven fabric. The fabrics were finished with low (LC) and highly cross-linked (HC) polysaccharide dressings and investigated in the unloaded condition as well as loaded with phytotherapeutic substances. The mechanical resistance and possible abrasion of the functional coatings on the textile substrate were assessed by friction measurements and scanning electron microscopical analyses. Under dry contact conditions, all investigated fabrics (PES substrate alone and textiles with loaded and unloaded dressings) showed generally low friction coefficients (0.20-0.26). Under wet conditions, the measured friction coefficients were typically higher (0.34-0.51) by a factor of 1.5-2. In the wet condition, both loaded drug delivery textiles exhibited 7-29% lower friction (0.34-0.41) than the PES fabric with unloaded dressings (0.42-0.51), indicating pronounced lubrication effects. The lubrication effects as well as the abrasion resistance of the studied textiles with drug delivery function depended on the degree of dilution of the phytotherapeutic substances. Lubricating formulations of textile-based drug delivery systems which reduce friction against the skin might be promising candidates for advanced medical textile finishes in connection with skin care and wound (decubitus ulcer) prevention. Copyright © 2013 Elsevier B.V. All rights reserved.

SECONDARY OSTEOPOROSIS: PATHOPHYSIOLOGY AND MANAGEMENT

PubMed Central

Mirza, Faryal; Canalis, Ernesto

2015-01-01

Osteoporosis is a skeletal disorder characterized by decreased bone mineral density and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. This review focuses on some of the common causes of osteoporosis, addressing the underlying mechanisms, diagnostic approach and treatment of low bone mass in the presence of these conditions. PMID:25971649

Gynaecomastia--pathophysiology, diagnosis and treatment.

PubMed

Narula, Harmeet S; Carlson, Harold E

2014-11-01

Gynaecomastia (enlargement of the male breast tissue) is a common finding in the general population. Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited. Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. Estrogens are known to stimulate the growth of breast tissue, whereas androgens inhibit it; most cases of gynaecomastia result from deficient androgen action or excessive estrogen action in the breast tissue. In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.

42 CFR 485.635 - Condition of participation: Provision of services.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... (3) The CAH maintains a list of all services furnished under arrangements or agreements. The list..., biologicals, and intravenous medications must be administered by or under the supervision of a registered..., sex, gender identity, sexual orientation, or disability. (4) Ensure that all visitors enjoy full and...

42 CFR 482.25 - Condition of participation: Pharmaceutical services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... registered pharmacist or a drug storage area under competent supervision. The medical staff is responsible... principles. (1) A full-time, part-time, or consulting pharmacist must be responsible for developing... under the supervision of a pharmacist and performed consistent with State and Federal laws. (2)(i) All...

42 CFR 482.25 - Condition of participation: Pharmaceutical services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... registered pharmacist or a drug storage area under competent supervision. The medical staff is responsible... principles. (1) A full-time, part-time, or consulting pharmacist must be responsible for developing... under the supervision of a pharmacist and performed consistent with State and Federal laws. (2)(i) All...

42 CFR 482.25 - Condition of participation: Pharmaceutical services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... registered pharmacist or a drug storage area under competent supervision. The medical staff is responsible... principles. (1) A full-time, part-time, or consulting pharmacist must be responsible for developing... under the supervision of a pharmacist and performed consistent with State and Federal laws. (2)(i) All...

42 CFR 482.25 - Condition of participation: Pharmaceutical services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... registered pharmacist or a drug storage area under competent supervision. The medical staff is responsible... principles. (1) A full-time, part-time, or consulting pharmacist must be responsible for developing... under the supervision of a pharmacist and performed consistent with State and Federal laws. (2)(i) All...

42 CFR 482.25 - Condition of participation: Pharmaceutical services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... registered pharmacist or a drug storage area under competent supervision. The medical staff is responsible... principles. (1) A full-time, part-time, or consulting pharmacist must be responsible for developing... under the supervision of a pharmacist and performed consistent with State and Federal laws. (2)(i) All...

Effects of medication and subthalamic nucleus deep brain stimulation on tongue movements in speakers with Parkinson's disease using electropalatography: a pilot study.

PubMed

Hartinger, Mariam; Tripoliti, Elina; Hardcastle, William J; Limousin, Patricia

2011-03-01

Parkinson's disease (PD) affects speech in the majority of patients. Subthalamic nucleus deep brain stimulation (STN-DBS) is particularly effective in reducing tremor and rigidity. However, its effect on speech is variable. The aim of this pilot study was to quantify the effects of bilateral STN-DBS and medication on articulation, using electropalatography (EPG). Two patients, PT1 and PT2, were studied under four conditions: on and off medication and ON and OFF stimulation. The EPG protocol consisted of a number of target words with alveolar and velar stops, repeated 10 times in random order. The motor part III of the Unified Parkinson Disease Rating Scale (UPDRS) indicated significantly improved motor scores in the ON stimulation condition in both patients. However, PT1's articulation patterns deteriorated with stimulation whereas PT2 showed improving articulatory accuracy in the same condition. The results revealed different effects of stimulation and medication on articulation particularly with regard to timing. The study quantified less articulatory undershoot for velar stops in comparison to alveolars. Furthermore, the findings provided preliminary evidence that stimulation with medication has a more detrimental effect on articulation than stimulation without medication.

What do UK medical students value most in their careers? A discrete choice experiment.

PubMed

Cleland, Jennifer A; Johnston, Peter; Watson, Verity; Krucien, Nicolas; Skåtun, Diane

2017-08-01

Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors. Our aim was to investigate the strength of UK medical students' preferences for the characteristics of training posts in terms of monetary value. We distributed a paper questionnaire that included a discrete choice experiment (DCE) to final-year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students. Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career-related behaviour. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Severe hyperkalemia requiring hospitalization: predictors of mortality

PubMed Central

2012-01-01

Introduction Severe hyperkalemia, with potassium (K+) levels ≥ 6.5 mEq/L, is a potentially life-threatening electrolyte imbalance. For prompt and effective treatment, it is important to know its risk factors, clinical manifestations, and predictors of mortality. Methods An observational cohort study was performed at 2 medical centers. A total of 923 consecutive Korean patients were analyzed. All were 19 years of age or older and were hospitalized with severe hyperkalemia between August 2007 and July 2010; the diagnosis of severe hyperkalemia was made either at the time of admission to the hospital or during the period of hospitalization. Demographic and baseline clinical characteristics at the time of hyperkalemia diagnosis were assessed, and clinical outcomes such as in-hospital mortality were reviewed, using the institutions' electronic medical record systems. Results Chronic kidney disease (CKD) was the most common underlying medical condition, and the most common precipitating factor of hyperkalemia was metabolic acidosis. Emergent admission was indicated in 68.6% of patients, 36.7% had electrocardiogram findings typical of hyperkalemia, 24.5% had multi-organ failure (MOF) at the time of hyperkalemia diagnosis, and 20.3% were diagnosed with severe hyperkalemia at the time of cardiac arrest. The in-hospital mortality rate was 30.7%; the rate was strongly correlated with the difference between serum K+ levels at admission and at their highest point, and with severe medical conditions such as malignancy, infection, and bleeding. Furthermore, a higher in-hospital mortality rate was significantly associated with the presence of cardiac arrest and/or MOF at the time of diagnosis, emergent admission, and intensive care unit treatment during hospitalization. More importantly, acute kidney injury (AKI) in patients with normal baseline renal function was a strong predictor of mortality, compared with AKI superimposed on CKD. Conclusions Severe hyperkalemia occurs in various medical conditions; the precipitating factors are similarly diverse. The mortality rate is especially high in patients with severe underlying disease, coexisting medical conditions, and those with normal baseline renal function. PMID:23171442

Marijuana: Views on Its Medical Use Recorded at the Slovak Social Network

ERIC Educational Resources Information Center

Kolena, Branislav; Petrovicová, Ida; Trnovec, Tomáš; Pilka, Tomáš; Bicanová, Gabriela

2016-01-01

We describe opinions on medical use of "Cannabis sativa L." under conditions of Slovakia (n = 717). Personal experience with marijuana was detected in 77.42% (n = 553) in age categories younger than 20 years (n = 96) and in 77.06% (n = 457) of adults. Almost 86% of respondents (n = 618) agreed with legal use of marijuana for medical…

[The requirements of standard and conditions of interchangeability of medical articles].

PubMed

Men'shikov, V V; Lukicheva, T I

2013-11-01

The article deals with possibility to apply specific approaches under evaluation of interchangeability of medical articles for laboratory analysis. The development of standardized analytical technologies of laboratory medicine and formulation of requirements of standards addressed to manufacturers of medical articles the clinically validated requirements are to be followed. These requirements include sensitivity and specificity of techniques, accuracy and precision of research results, stability of reagents' quality in particular conditions of their transportation and storage. The validity of requirements formulated in standards and addressed to manufacturers of medical articles can be proved using reference system, which includes master forms and standard samples, reference techniques and reference laboratories. This approach is supported by data of evaluation of testing systems for measurement of level of thyrotrophic hormone, thyroid hormones and glycated hemoglobin HB A1c. The versions of testing systems can be considered as interchangeable only in case of results corresponding to the results of reference technique and comparable with them. In case of absence of functioning reference system the possibilities of the Joined committee of traceability in laboratory medicine make it possible for manufacturers of reagent sets to apply the certified reference materials under development of manufacturing of sets for large listing of analytes.

Risk Adjustment May Lessen Penalties On Hospitals Treating Complex Cardiac Patients Under Medicare's Bundled Payments.

PubMed

Markovitz, Adam A; Ellimoottil, Chandy; Sukul, Devraj; Mullangi, Samyukta; Chen, Lena M; Nallamothu, Brahmajee K; Ryan, Andrew M

2017-12-01

To reduce variation in spending, Medicare has considered implementing a cardiac bundled payment program for acute myocardial infarction and coronary artery bypass graft. Because the proposed program does not account for patient risk factors when calculating hospital penalties or rewards ("reconciliation payments"), it might unfairly penalize certain hospitals. We estimated the impact of adjusting for patients' medical complexity and social risk on reconciliation payments for Medicare beneficiaries hospitalized for the two conditions in the period 2011-13. Average spending per episode was $29,394. Accounting for medical complexity substantially narrowed the gap in reconciliation payments between hospitals with high medical severity (from a penalty of $1,809 to one of $820, or a net reduction of $989), safety-net hospitals (from a penalty of $217 to one of $87, a reduction of $130), and minority-serving hospitals (from a penalty of $70 to a reward of $56, an improvement of $126) and their counterparts. Accounting for social risk alone narrowed these gaps but had minimal incremental effects after medical complexity was accounted for. Risk adjustment may preserve incentives to care for patients with complex conditions under Medicare bundled payment programs.

Overview of Common Sleep Disorders and Intersection with Dermatologic Conditions.

PubMed

Walia, Harneet K; Mehra, Reena

2016-04-30

Sleep disorders are very common, often under-recognized and therefore undertreated, are associated with a myriad of medical conditions and could lead to significant impairment of quality of life. This review provides an up-to-date synopsis of common sleep disorders encompassing insufficient sleep syndrome, insomnia, circadian rhythm disorders and obstructive sleep apnea with a brief overview of epidemiology, screening, diagnostic testing and treatment. We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer.

Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.

PubMed

Jain, Seema; Kamimoto, Laurie; Bramley, Anna M; Schmitz, Ann M; Benoit, Stephen R; Louie, Janice; Sugerman, David E; Druckenmiller, Jean K; Ritger, Kathleen A; Chugh, Rashmi; Jasuja, Supriya; Deutscher, Meredith; Chen, Sanny; Walker, John D; Duchin, Jeffrey S; Lett, Susan; Soliva, Susan; Wells, Eden V; Swerdlow, David; Uyeki, Timothy M; Fiore, Anthony E; Olsen, Sonja J; Fry, Alicia M; Bridges, Carolyn B; Finelli, Lyn

2009-11-12

During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009. Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase-polymerase-chain-reaction assay. Of the 272 patients we studied, 25% were admitted to an intensive care unit and 7% died. Forty-five percent of the patients were children under the age of 18 years, and 5% were 65 years of age or older. Seventy-three percent of the patients had at least one underlying medical condition; these conditions included asthma; diabetes; heart, lung, and neurologic diseases; and pregnancy. Of the 249 patients who underwent chest radiography on admission, 100 (40%) had findings consistent with pneumonia. Of the 268 patients for whom data were available regarding the use of antiviral drugs, such therapy was initiated in 200 patients (75%) at a median of 3 days after the onset of illness. Data suggest that the use of antiviral drugs was beneficial in hospitalized patients, especially when such therapy was initiated early. During the evaluation period, 2009 H1N1 influenza caused severe illness requiring hospitalization, including pneumonia and death. Nearly three quarters of the patients had one or more underlying medical conditions. Few severe illnesses were reported among persons 65 years of age or older. Patients seemed to benefit from antiviral therapy. 2009 Massachusetts Medical Society

Annual Check-up

MedlinePlus

... Guides Quizzes Parents About Us Donate General Health Sexual Health Medical Conditions Nutrition & Fitness Emotional Health Annual Check- ... re under the age of 18. Issues about sexual health, HIV, and STIs will be kept confidential. How ...

78 FR 68714 - Medical Devices; Ophthalmic Devices; Classification of the Scleral Plug

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... the device materials must be performed; (iv) Performance data must demonstrate acceptable mechanical properties under simulated clinical use conditions including insertion and removal of the device; (v...

Ecologic Reformulation of Pediatric Social Illness.

ERIC Educational Resources Information Center

Newberger, Eli H.; Marx, Thomas J.

Members of a group of hospitalized children under 4 years of age (48 under care for child abuse, 97 for accidents, 41 for failure to thrive, and 23 for ingestions) were matched individually on age, social class, and race with controls suffering from comparable acute medical conditions. A structured maternal and paternal interview yielded 63…

42 CFR 23.34 - What other conditions are imposed?

Code of Federal Regulations, 2010 CFR

2010-10-01

..., under section 1842(b)(3)(B)(ii) of the Social Security Act as full payment for all services for which... administers the State plan for medical assistance under title XIX of the Social Security Act to provide... during normal working hours to accounts, documents, and records for the purposes of audit or evaluation...

42 CFR 23.34 - What other conditions are imposed?

Code of Federal Regulations, 2011 CFR

2011-10-01

..., under section 1842(b)(3)(B)(ii) of the Social Security Act as full payment for all services for which... administers the State plan for medical assistance under title XIX of the Social Security Act to provide... during normal working hours to accounts, documents, and records for the purposes of audit or evaluation...

Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 1.

PubMed

Tucci, Veronica Theresa; Moukaddam, Nidal; Alam, Al; Rachal, James

2017-09-01

Patients presenting to the emergency department with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, interdisciplinary consensus on medical clearance is lacking, leading to wide variations in quality of care and, quite often, poor medical care. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach. This article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical or physical examination, and common pitfalls in the medical clearance process. Copyright © 2017 Elsevier Inc. All rights reserved.

Removing Pubic Hair (For Young Men)

MedlinePlus

... Medical Conditions Nutrition & Fitness Emotional Health Removing Pubic Hair Posted under Health Guides . Updated 23 March 2017. + ... Twitter email Print Some guys trim their pubic hair, others prefer to shave or wax, and most ...

42 CFR 485.635 - Condition of participation: Provision of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... biologicals. These rules must provide that there is a drug storage area that is administered in accordance.... (3) All drugs, biologicals, and intravenous medications must be administered by or under the...

Body Odor (For Young Men)

MedlinePlus

... Sexual Health Medical Conditions Nutrition & Fitness Emotional Health Body Odor Posted under Health Guides . Updated 23 March 2017. + ... every guy has to deal with. What causes body odor? During puberty, your sweat glands become much more ...

[Consequences for military medicine of new nuclear weapons developments].

PubMed

Vogler, H

1985-01-15

The development and production of qualitatively new nuclear weapons (e.g. neutron weapons) has consequences also for the medical protection under conditions of war. In the present paper the peculiarities of these new systems of arms as well as the profile of injured persons which is to be expected after use of neutron weapons are analysed and general conclusions for the medical service are drawn.

[The actual approaches to the economic analysis of effectiveness of functioning of multi-profile curative preventive medical institution].

PubMed

Gaĭdarov, G M; Alekseeva, N Iu; Latysheva, E A

2010-01-01

The article deals with the technique of economic analysis of effectiveness of functioning of multi-profile curative preventive medical institution in the conditions of transition to the payment according the completed case of treatment. The necessity of the measures targeted to prevent the financial losses under the new form of payment for hospital care is proved.

Stem Cell Education for Medical Students at Tongji University: Primary Cell Culture and Directional Differentiation of Rat Bone Marrow Mesenchymal Stem Cells

ERIC Educational Resources Information Center

Jin, Caixia; Tian, Haibin; Li, Jiao; Jia, Song; Li, Siguang; Xu, Guo-Tong; Xu, Lei; Lu, Lixia

2018-01-01

Stem cells are cells that can self-renew and differentiate into a variety of cell types under certain conditions. Stem cells have great potential in regenerative medicine and cell therapy for the treatment of certain diseases. To deliver knowledge about this frontier in science and technology to medical undergraduate students, we designed an…

Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study.

PubMed

Brown, H K; Speechley, K N; Macnab, J; Natale, R; Campbell, M K

2016-04-01

Our objectives were: (1) to examine the association between maternal, fetal, and placental phenotypes of preterm delivery and medically indicated early delivery of singletons during the late preterm and early term periods; and (2) to identify the specific maternal, fetal, and placental conditions associated with these early deliveries. Retrospective study. City of London and Middlesex County, Ontario, Canada. Singleton live deliveries, at 34-41 weeks of gestation to women in London and Middlesex. We obtained data from a city-wide perinatal database (2002-2011; n = 25 699). We used multinomial logistic regression for multivariable analyses. The outcome was the occurrence of medically indicated late preterm (34-36 weeks of gestation) and early term (37-38 weeks of gestation) delivery, versus delivery at full term (39-41 weeks of gestation). After controlling for confounding factors, all phenotypes were associated with increased odds of medically indicated late preterm and early term delivery. Within the maternal phenotype, chronic maternal medical conditions were associated with increased odds of medically indicated early term delivery (e.g. for gastrointestinal disease, adjusted odds ratio, aOR 1.72, 95% CI 1.47-2.00; for anaemia, aOR 1.40, 95% CI 1.20-1.63), but not late preterm delivery. The aetiology of medically indicated early delivery close to full term is heterogeneous. Patterns of associations suggest slightly different conditions underlying the late preterm and early term phenotypes, with chronic maternal medical conditions being associated with early term delivery but not with late preterm delivery. These results have implications for the prevention of early delivery as well as the identification of high-risk groups among those born early. The aetiology of medically indicated late preterm and early term delivery is heterogeneous. © 2015 Royal College of Obstetricians and Gynaecologists.

Self-hypnosis for anxiety associated with severe asthma: a case report

PubMed Central

Anbar, Ran D

2003-01-01

Background Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations. Case Presentation The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy. Conclusions This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma. PMID:12875663

Self-hypnosis for anxiety associated with severe asthma: a case report.

PubMed

Anbar, Ran D

2003-07-22

Management of asthma can be complicated by both medical and psychiatric conditions, such as gastroesophageal reflux, chronic sinusitis, and anxiety. When symptoms of asthma are interpreted without regard to such conditions treatment may yield a suboptimal outcome. For example, anxiety-associated dyspnea, tachypnea, and chest tightness can be mistakenly interpreted as resulting from an exacerbation of asthma. Medical treatment directed only for asthma may thus lead to overuse of asthma medications and increased hospitalizations. The described case illustrates how a systemic steroid-dependent patient with asthma benefited from receiving care from a pediatric pulmonologist who also was well versed in the diagnosis and treatment of anxiety. By using self-hypnosis, the patient was able to reduce her dependence on bronchodilators. Following modification of her medical therapy under supervision of the pulmonologist, and regular use of hypnosis, the patient ultimately was weaned off her systemic steroid therapy. This report emphasizes that anxiety must be considered as a comorbid condition in the treatment of asthma. Self-hypnosis can be a useful skill in the treatment of a patient with anxiety and asthma.

An example of extreme cardiology: chest pain on the high seas and helicoptered medical evacuations: the French Navy experience.

PubMed

Vinsonneau, Ulric; Cavel, Christiane; Bombert, Christophe; Lely, Laurent; Paleiron, Nicolas; Vergez-Larrouget, Claude; Cornily, Jean-Christophe; Castellant, Philippe; Gilard, Martine; Paule, Paule; Bronstein, Jean-Ariel

2012-10-01

Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology of acute chest pain in the high seas has been poorly described. Therefore, in this retrospective study, we aimed to assess the prevalence and constraints found in the management of these emergencies. From January 1, 2000, to April 30, 2009, 286 medical evacuations by helicopter were performed, 132 of which were due to traumatological emergencies, and 154 to medical emergencies. Acute chest pain, with 36 missions, was the leading cause of medical evacuation. All evacuated patients were men who were either professional sailors or ferry passengers. The median age was 48 years (range, 26-79). The most common prehospital diagnosis was coronary chest pain in 23 patients (64%), including 11 patients with acute coronary syndrome with ST-segment elevation. Thirty-two patients were airlifted by helicopter. All patients benefited from monitoring, electrocardiogram, peripheral venous catheter, and medical management as soon as the technical conditions allowed it. Copyright © 2012 Elsevier Inc. All rights reserved.

Fatigue Risk Management in Aviation Maintenance: Current Best Practices and Potential Future Countermeasures

DTIC Science & Technology

2011-06-01

consequence of an underlying medical condition, such as insomnia or sleep apnea (Kryger, Roth & Dement, 2005). In these situa- tions, medical attention will...of sleep loss for some mili- tary missions (Caldwell et al., 2009). There have been suggestions that such substances may have potential as fatigue...National Transportation Safety Board PERCLOS----Percentage of Eye Closure SAFTE -------- Sleep Activity Fatigue and Task Effectiveness SMS

42 CFR 422.752 - Basis for imposing intermediate sanctions and civil money penalties.

Code of Federal Regulations, 2013 CFR

2013-10-01

... with the organization whose medical condition or history indicates a need for substantial future... determination that could lead to a contract termination under 422.510(a), CMS may impose the intermediate...

42 CFR 422.752 - Basis for imposing intermediate sanctions and civil money penalties.

Code of Federal Regulations, 2011 CFR

2011-10-01

... with the organization whose medical condition or history indicates a need for substantial future... determination that could lead to a contract termination under 422.510(a), CMS may impose the intermediate...

42 CFR 422.752 - Basis for imposing intermediate sanctions and civil money penalties.

Code of Federal Regulations, 2012 CFR

2012-10-01

... with the organization whose medical condition or history indicates a need for substantial future... determination that could lead to a contract termination under 422.510(a), CMS may impose the intermediate...

Treatment of delirium with risperidone in cancer patients.

PubMed

Kishi, Yasuhiro; Kato, Masashi; Okuyama, Toru; Thurber, Steven

2012-08-01

Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 ± 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 ± 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

Space Shuttle Program: STS-1 Medical Report

NASA Technical Reports Server (NTRS)

1981-01-01

The necessity for developing medical standards addressing individual classes of Shuttle crew positions is discussed. For the U.S. manned program the conclusion of the Apollo era heralded the end of water recovery operations and the introduction of land-based medical operations. This procedural change marked a significant departure from the accepted postflight medical recovery and evaluation techniques. All phases of the missions required careful re-evaluation, identification of potential impact on preexisting medical operational techniques, and development of new methodologies which were carefully evaluated and tested under simulated conditions. Significant coordination was required between the different teams involved in medical operations. Additional dimensions were added to the concepts of medical operations, by the introduction of different toxic substances utilized by the Space Transportation Systems especially during ground operations.

[Evaluation of the efficiency of preventive medical examinations of railway transport workers].

PubMed

Pankova, V B; Golysheva, G V; Khvastunov, R M; Makarov, A A

2006-01-01

The paper reflects the priority role of preliminary and periodic medical examinations in the system of measures implemented by therapeutic-and-prophylactic institutions of the Ministry of Railway of Russia. It gives a comprehensive assessment of the medical, social, and economic aspects of the efficiency of preventive medical examinations. Emphasis is laid on the necessity of elaborating methods to evaluate the economic efficiency of medical measures under the conditions of market economy. At the same time, light is shed on the difficulties available when a full-scale, within the whole industry, economic evaluation of periodic medical examinations is made. The role of a cost-effect analysis is shown as the most flexible existing principle in the evaluation of the efficiency of medical preventive measures.

The effect of conscious control on handwriting in children with attention deficit hyperactivity disorder.

PubMed

Tucha, Oliver; Lange, Klaus W

2005-08-01

Two experiments were performed regarding the effect of conscious control on handwriting fluency in healthy adults and ADHD children. First, 26 healthy students were asked to write a sentence under different conditions. The results indicate that automated handwriting movements are independent from visual feedback. Second, the writing performance of 12 children with ADHD was examined on their usual medication with methylphenidate and under placebo. In comparison to placebo, medication with methylphenidate resulted in a reduced fluency of handwriting. Automated handwriting movements could be elicited in children with ADHD on medication. The results suggest that both visual and mental control of handwriting movements affect the automation of handwriting movements. Furthermore, a simple training procedure was designed and performed in a case study of a boy with ADHD.

Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia.

PubMed

Delfiner, Alexandra; Myers, Aaron; Lumsden, Christie; Chussid, Steve; Yoon, Richard

To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012-2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (p<.001). Common medical comorbidities appear evenly distributed: autism (12%), cardiac anomalies (14%), developmental delay (14%), genetic syndromes/chromosomal disorders (13%), and neurological disorders (12%). Younger age groups (1 to 2 years and 3 to 5 years) had a high percentage of hospitalizations due to the extent and severity of the dental disease (83%) and behavior (77%) (p<0.001). No single comorbidity was seen more often than others in this patient population. The range of medical conditions in this population may be a reflection of the range of pediatric specialty services at Children's Hospital of NewYork-Presbyterian.

Changes in microbial community structures due to varying operational conditions in the anaerobic digestion of oxytetracycline-medicated cow manure.

PubMed

Turker, Gokhan; Aydin, Sevcan; Akyol, Çağrı; Yenigun, Orhan; Ince, Orhan; Ince, Bahar

2016-07-01

Management of manure containing veterinary antibiotics is a major concern in anaerobic treatment systems because of their possible adverse effects on microbial communities. Therefore, the aim of study was to investigate how oxytetracycline (OTC) influences bacteria and acetoclastic and hydrogenotrophic methanogens under varying operational conditions in OTC-medicated and non-medicated anaerobic cow manure digesters. Concentrations of OTC and its metabolites throughout the anaerobic digestion were determined using ultraviolet-high-performance liquid chromatography (UV-HPLC) and tandem liquid chromatography-mass spectrometry (LC/MS/MS), respectively. Fluorescent in situ hybridization, denaturing gradient gel electrophoresis, cloning, and sequencing analyses were used to monitor changes in microbial community structures. According to the results of analytical and molecular approaches, operating conditions highly influence active microbial community dynamics and associate with biogas production and elimination of OTC and its metabolites during anaerobic digestion of cow manure in the presence of an average initial concentration of 2.2 mg OTC/L. The impact of operating conditions has a drastic effect on acetoclastic methanogens than hydrogenotrophic methanogens and bacteria.

Price elasticity and medication use: cost sharing across multiple clinical conditions.

PubMed

Gatwood, Justin; Gibson, Teresa B; Chernew, Michael E; Farr, Amanda M; Vogtmann, Emily; Fendrick, A Mark

2014-11-01

To address the impact that out-of-pocket prices may have on medication use, it is vital to understand how the demand for medications may be affected when patients are faced with changes in the price to acquire treatment and how price responsiveness differs across medication classes.  To examine the impact of cost-sharing changes on the demand for 8 classes of prescription medications. This was a retrospective database analysis of 11,550,363 commercially insured enrollees within the 2005-2009 MarketScan Database. Patient cost sharing, expressed as a price index for each medication class, was the main explanatory variable to examine the price elasticity of demand. Negative binomial fixed effect models were estimated to examine medication fills. The elasticity estimates reflect how use changes over time as a function of changes in copayments. Model estimates revealed that price elasticity of demand ranged from -0.015 to -0.157 within the 8 categories of medications (P  less than  0.01 for 7 of 8 categories). The price elasticity of demand for smoking deterrents was largest (-0.157, P  less than  0.0001), while demand for antiplatelet agents was not responsive to price (P  greater than 0.05). The price elasticity of demand varied considerably by medication class, suggesting that the influence of cost sharing on medication use may be related to characteristics inherent to each medication class or underlying condition.

Combined Racial and Gender Differences in the Long-Term Predictive Role of Education on Depressive Symptoms and Chronic Medical Conditions.

PubMed

Assari, Shervin

2017-06-01

Despite a well-established literature on the protective effect of education on health, less is known about group differences in the mechanisms underlying this association. Using a life course approach and cumulative advantage theory, this study compared Black men, Black women, White men, and White women to assess the long-term gradient (education as a continuous measure) and threshold (>12 years) effects of baseline education on change in chronic medical conditions (CMC) and depressive symptoms (DS) from baseline to 25 years later. Data came from the Americans' Changing Lives Study, 1986-2011. The study followed Black and White respondents for up to 25 years, among whom 1271 individuals who had survived and were under follow-up were interviewed in 2011 and reported their number of chronic medical conditions and depressive symptoms (Center for Epidemiological Studies-Depression; CES-D 11). Multi-group structural equation modeling was used to compare gradient and threshold effects of education on change in chronic medical conditions and depressive symptoms from baseline (1986) to 25 years later (2011) among Black men, Black women, White men, and White women. There were group differences in the long-term association between education measured as a gradient and the change in depressive symptoms and chronic medical conditions during the follow-up, and in the association between education measured at the threshold of 12 years on change in depressive symptoms from baseline to follow-up. However, the association between education measured at this threshold and change in chronic medical conditions did not differ across race-gender groups. With the exception of Black men, who showed a gradient protective effect for baseline education against increase in the number of chronic medical associations (threshold or gradient) with change in chronic medical conditions. Among White men and White women, education had a threshold protective effect against increase in depressive symptoms from baseline to 25 years later. Black men and women showed a gradient protective effect of baseline education against an increase in depressive symptoms over the 25-year follow-up period, but unexpectedly, a threshold effect of education was also found to be associated with an increase in depressive symptoms over the follow-up period among Black men. This finding suggests that although Black men benefit from each incremental increase in education, those who graduated from high school were at an additional risk of depressive symptoms over a 25-year period. Findings suggest that the intersection of race and gender influences how education is associated with long-term changes in physical and mental health of individuals from baseline to 25 years later. As the shape of the association between education and health depends on the intersection of race and gender, these groups may vary for operant mechanisms by which education operates as a main social determinant of health.

[Teenage pregnancies, legal aspects].

PubMed

Rogue, Fanny

2016-01-01

Minor girls are legally considered as incapable, under the authority of their parents. Difficulties can arise when a minor becomes pregnant. The law takes account of this situation: under certain conditions, she can decide by herself to undertake certain actions, medical or otherwise, without the consent of her parents. These include access to contraception, abortion or anonymous birth. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

32 CFR 199.12 - Third party recoveries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... United States has a right to collect under both 10 U.S.C. 1095b and the Federal Medical Care Recovery Act... and conditions of the third-party payer's plan. This is the sole purpose for which patient care... payer to enforce a right of the United States under 10 U.S.C. 1095b and this section. (2) This also...

32 CFR 199.12 - Third party recoveries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... United States has a right to collect under both 10 U.S.C. 1095b and the Federal Medical Care Recovery Act... and conditions of the third-party payer's plan. This is the sole purpose for which patient care... payer to enforce a right of the United States under 10 U.S.C. 1095b and this section. (2) This also...

32 CFR 199.12 - Third party recoveries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... United States has a right to collect under both 10 U.S.C. 1095b and the Federal Medical Care Recovery Act... and conditions of the third-party payer's plan. This is the sole purpose for which patient care... payer to enforce a right of the United States under 10 U.S.C. 1095b and this section. (2) This also...

Medication supply, healthcare outcomes and healthcare expenses: longitudinal analyses of patients with type 2 diabetes and hypertension.

PubMed

Chen, Chi-Chen; Blank, Robert H; Cheng, Shou-Hsia

2014-09-01

Patients with chronic conditions largely depend on proper medications to maintain health. This study aims to examine, for patients with diabetes and hypertension, whether the appropriateness of the quantity of drug obtained is associated with favorable healthcare outcomes and lower expenses. This study utilized a longitudinal design with a seven-year follow-up period from 2002 to 2009 under a universal health insurance program in Taiwan. The patients under study were those aged 18 years or older and newly diagnosed with type 2 diabetes or hypertension in 2002. Generalized estimating equations were performed to examine the relationship between medication supply and health outcomes as well as expenses. The results indicate that while compared with patients with an appropriate medication supply, patients with either an undersupply or an oversupply of medications tended to have poorer healthcare outcomes. The study also found that an excess supply of medications for patients with diabetes or hypertension resulted in higher total healthcare expenses. Either an undersupply or an oversupply of medication was associated with unfavorable healthcare outcomes, and that medication oversupply was associated with the increased consumption of health resources. Our findings suggest that improving appropriate medication supply is beneficial for the healthcare system. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Drilling force and temperature of bone under dry and physiological drilling conditions

NASA Astrophysics Data System (ADS)

Xu, Linlin; Wang, Chengyong; Jiang, Min; He, Huiyu; Song, Yuexian; Chen, Hanyuan; Shen, Jingnan; Zhang, Jiayong

2014-11-01

Many researches on drilling force and temperature have been done with the aim to reduce the labour intensiveness of surgery, avoid unnecessary damage and improve drilling quality. However, there has not been a systematic study of mid- and high-speed drilling under dry and physiological conditions(injection of saline). Furthermore, there is no consensus on optimal drilling parameters. To study these parameters under dry and physiological drilling conditions, pig humerus bones are drilled with medical twist drills operated using a wide range of drilling speeds and feed rates. Drilling force and temperature are measured using a YDZ-II01W dynamometer and a NEC TVS-500EX thermal infrared imager, respectively, to evaluate internal bone damage. To evaluate drilling quality, bone debris and hole morphology are observed by SEM(scanning electron microscopy). Changes in drilling force and temperature give similar results during drilling such that the value of each parameter peaks just before the drill penetrates through the osteon of the compact bone into the trabeculae of the spongy bone. Drilling temperatures under physiological conditions are much lower than those observed under dry conditions, while a larger drilling force occurs under physiological conditions than dry conditions. Drilling speed and feed rate have a significant influence on drilling force, temperature, bone debris and hole morphology. The investigation of the effect of drilling force and temperature on internal bone damage reveals that a drilling speed of 4500 r/min and a feed rate of 50 mm/min are recommended for bone drilling under physiological conditions. Drilling quality peaks under these optimal parameter conditions. This paper proposes the optimal drilling parameters under mid- and high-speed surgical drilling, considering internal bone damage and drilling quality, which can be looked as a reference for surgeons performing orthopedic operations.

42 CFR 423.752 - Basis for imposing intermediate sanctions and civil money penalties.

Code of Federal Regulations, 2011 CFR

2011-10-01

... permitted by this part) by eligible individuals with the organization whose medical condition or history... CMS makes a determination that could lead to a contract termination under 423.509(a), CMS may impose...

42 CFR 423.752 - Basis for imposing intermediate sanctions and civil money penalties.

Code of Federal Regulations, 2014 CFR

2014-10-01

... condition or history indicates a need for substantial future medical services. (5) Misrepresents or... lead to a contract termination under 423.509(a), CMS may impose the intermediate sanctions at 423.750(a...

Human torso phantom for imaging of heart with realistic modes of cardiac and respiratory motion

DOEpatents

Boutchko, Rostyslav; Balakrishnan, Karthikayan; Gullberg, Grant T; O& #x27; Neil, James P

2013-09-17

A human torso phantom and its construction, wherein the phantom mimics respiratory and cardiac cycles in a human allowing acquisition of medical imaging data under conditions simulating patient cardiac and respiratory motion.

Clinical endocannabinoid deficiency (CECD) revisited: can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?

PubMed

Smith, Steele Clarke; Wagner, Mark S

2014-01-01

Ethan B. Russo's paper of December 1, 2003 explored the concept of a clinical endocannabinoid deficiency (CECD) underlying the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome and other functional conditions alleviated by clinical cannabis. Available literature was reviewed, including searches via the National Library of medicine database and other sources. A review of the literature indicates that significant progress has been made since Dr. Ethan B. Russo's landmark paper, just ten years ago (February 2, 2004). Investigation at that time suggested that cannabinoids can block spinal, peripheral and gastrointestional mechanisms that promote pain in headache, fibromyalgia, irritable bowel syndrome and muscle spasm. Subsequent research has confirmed that underlying endocannabinoid deficiencies indeed play a role in migraine, fibromyalgia, irritable bowel syndrome and a growing list of other medical conditions. Clinical experience is bearing this out. Further research and especially, clinical trials will further demonstrate the usefulness of medical cannabis. As legal barriers fall and scientific bias fades this will become more apparent.

The impact of training under different visual-spatial conditions on reverse-alignment laparoscopic skills development.

PubMed

Holznecht, Catherine; Schmidt, Travis; Gould, Jon

2012-01-01

Circumstances may arise during laparoscopic procedures in which alignment of the laparoscope and the instruments is off by 180°, creating a mirror image of the operative field. It has been shown that task performance is degraded under these reverse-alignment conditions, and that the magnitude of performance impairment is directly related to laparoscopic experience and skill. The aim of this study was to determine if reverse-alignment surgical skills could be developed through training. Twenty-two medical students were randomized to train in either reverse- or forward-alignment conditions on a standardized laparoscopic task in a video trainer (peg transfer). Baseline scores were attained for each group under both orientations. Subjects participated in three 1-h training sessions during an 8-week period. Post-training scores were then obtained under both alignment conditions. Pre and post-training scores were compared for users in each study group under both conditions. Post-training assessments in the forward orientation demonstrated that subjects in the forward-training group improved significantly compared to pre-testing, while the performance of subjects in the reverse-training group did not improve. Under reverse-alignment conditions, both groups improved on post-test assessment, with dramatic improvements observed for those in the reverse-training group. Laparoscopic novices can learn to adapt to a sensorimotor discordance in a simulated training environment. While it is possible that skills developed by training under standard forward-alignment conditions can be utilized in situations of extreme visual-spatial discordance, the intentional development of reverse-alignment skills by training under these conditions may prove beneficial to novice surgeons.

Diagnosis and management of patients with hypercalcaemia.

PubMed

Walker, Jennie

2015-05-01

Hypercalcaemia is a common biochemical abnormality in the blood that can be caused by malignancy, hyperparathyroidism, medications or underlying medical conditions. Initial signs and symptoms are often vague, however, if someone has severe hypercalcaemia it is treated as an emergency, requiring prompt management to prevent life-threatening complications such as dehydration, cardiac arrhythmias or coma. Understanding the pathophysiology, signs and symptoms of hypercalcaemia enables effective diagnosis and holistic management of the patient with complex health needs.

Catatonia in the medically ill: Etiology, diagnosis, and treatment. The Academy of Consultation-Liaison Psychiatry Evidence-Based Medicine Subcommittee Monograph.

PubMed

Denysenko, Lex; Sica, Nicole; Penders, Thomas M; Philbrick, Kemuel L; Walker, Audrey; Shaffer, Scott; Zimbrean, Paula; Freudenreich, Oliver; Rex, Nicole; Carroll, Brendan T; Francis, Andrew

2018-05-01

Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. PubMed searches were used to identify relevant articles from 1962 to present. More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic.

PubMed

Marešová, Petra; Peteja, Matus; Lerch, Milan; Zonca, Pavel; Kuca, Kamil

2016-01-01

Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used medical devices and approaches. This article is based on the Drummond and O'Brien methodology, which specifically determines the content of direct and indirect costs in health services. The costs of operations during the period 2010-2014 were specified for a total of 746 patients. The cost details are described for four patients who represent the use of different types of medical devices. The procedure was a laparoscopic surgery in all cases. The total costs of inguinal hernia repairs (as per 2015 currency conversion rate) are €1,248,579; only part is covered from public funds, resulting in a loss of €218,359 for the hospital. The obtained data indicate that this operation is unprofitable for hospitals under the present conditions. The loss in the subject facility amounts to 17% of the total cost, which is the cost incurred by the hospital in the Czech Republic. The study conducted in the Czech Republic refers to different economic results when using various medical device types. So the medical device selection depends on advantages or disadvantages for the patients, as well as on the cost effectiveness for the hospital.

Neural mechanisms associated with treatment decision making: An fMRI study.

PubMed

Abidi, Malek; Bruce, Jared; Le Blanche, Alain; Bruce, Amanda; Jarmolowicz, David P; Csillik, Antonia; Thai, N Jade; Lim, Seung-Lark; Heinzlef, Olivier; de Marco, Giovanni

2018-04-23

Great progress has been made in understanding how people make financial decisions. However, there is little research on how people make health and treatment choices. Our study aimed to examine how participants weigh benefits (reduction in disease progression) and probability of risk (medications' side effects) when making hypothetical treatment decisions, and to identify the neural networks implicated in this process. Fourteen healthy participants were recruited to perform a treatment decision probability discounting task using MRI. Behavioral responses and skin conductance responses (SCRs) were measured. A whole brain analysis were performed to compare activity changes between "mild" and "severe" medications' side effects conditions. Then, orbitofrontal cortex (OFC), ventral striatum (VS), amygdala and insula were chosen for effective connectivity analysis. Behavioral data showed that participants are more likely to refuse medication when side effects are high and efficacy is low. SCRs values were significantly higher when people made medication decisions in the severe compared to mild condition. Functionally, OFC and VS were activated in the mild condition and were associated with increased likehood of choosing to take medication (higher area under the curve "AUC" side effects/efficacy). These regions also demonstrated an increased effective connectivity when participants valued treatment benefits. By contrast, the OFC, insula and amygdala were activated in the severe condition and were associated with and increased likelihood to refuse treatment. These regions showed enhanced effective connectivity when participants were confronted with increased side effects severity. This is the first study to examine the behavioral and neural bases of medical decision making. Copyright © 2018 Elsevier B.V. All rights reserved.

Medical Logistics Lessons Observed During Operations Enduring Freedom and Iraqi Freedom.

PubMed

Dole, Mark J; Kissane, Jonathan M

2016-01-01

Medical Logistics (MEDLOG) is a function of the Army's integrated System for Health that provides the medical products and specialized logistics services required to deliver health protection and care under all operational conditions. In unified land operations, MEDLOG is an inherent function of Health Service Support (HSS), which also includes casualty care and medical evacuation. This paper focuses on a few key lessons observed during Operations Enduring Freedom and Iraqi Freedom with direct implications for the support of HSS in future operations as envisioned in the Army Operating Concept and the Joint Concept for Health Services. It also examines a few key enablers that helped mitigate these challenges that are not yet fully acknowledged in Army Medical Department doctrine, policy, and planning.

Pneumococcal Vaccination Recommendations for Children and Adults by Age and/or Risk Factor

MedlinePlus

... 1 and Adults by Age and/or Risk Factor Routine Recommendations for Pneumococcal Conjugate Vaccine (PCV13) and ... People with Underlying Medical Conditions or Other Risk Factors Risk Group Immuno- competent Functional or anatomic asplenia ...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

Fair market value: taking a proactive approach.

PubMed

Romero, Richard A

2008-04-01

A valuation report assessing the fair market value of a contractual arrangement should include: A description of the company, entity, or circumstance being valued. Analysis of general economic conditions that are expected to affect the enterprise. Evaluation of economic conditions in the medical services industry. Explanation of the various valuation approaches that were considered. Documentation of key underlying assumptions, including revenue and expense projections, projected profit, and ROI.

Life Sciences Research and Development Opportunities During Suborbital Space Flight

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2010-01-01

Suborbital space platforms provide a unique opportunity for Space Life Sciences in the next few years. The opportunities include: physiological characterization of the first few minutes of space flight; evaluation of a wide-variety of medical conditions during periods of hyper and hypo-gravity through physiological monitoring; and evaluation of new biomedical and environmental health technologies under hyper and hypo-gravity conditions

The development and evaluation of a new coding system for medical records.

PubMed

Papazissis, Elias

2014-01-01

The present study aims to develop a simple, reliable and easy tool enabling clinicians to codify the major part of individualized medical details (patient history and findings of physical examination) quickly and easily in routine medical practice, by entering data to a purpose-built software application, using structure data elements and detailed medical illustrations. We studied medical records of 9,320 patients and we extracted individualized medical details. We recorded the majority of symptoms and the majority of findings of physical examination into the system, which was named IMPACT® (Intelligent Medical Patient Record and Coding Tool). Subsequently the system was evaluated by clinicians, based on the examination of 1206 patients. The evaluation results showed that IMPACT® is an efficient tool, easy to use even under time-pressing conditions. IMPACT® seems to be a promising tool for illustration-guided, structured data entry of medical narrative, in electronic patient records.

Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis.

PubMed

Flanagan, Esther; Herron, Katherine A; O'Driscoll, Ciarán; Williams, Amanda C de C

2015-01-01

Classification of vaginal pain within medical or psychiatric diagnostic systems draws mainly on the presumed presence or absence (respectively) of underlying medical etiology. A focus on the experience of pain, rather than etiology, emphasizes common ground in the aims of treatment to improve pain and sexual, emotional, and cognitive experience. Thus, exploring how vaginal pain conditions with varying etiology respond to psychological treatment could cast light on the extent to which they are the same or distinct. To examine the combined and relative efficacy of psychological treatments for vaginal pain conditions. A systematic search of EMBASE, MEDLINE, PsycINFO, and CINAHL was undertaken. Eleven randomized controlled trials were entered into a meta-analysis, and standardized mean differences and odds ratios were calculated. Effect sizes for individual psychological trial arms were also calculated. Main outcome measures were pain and sexual function. Equivalent effects were found for psychological and medical treatments. Effect sizes for psychological treatment arms were comparable across vaginal pain conditions. Effectiveness was equivalent regardless of presumed medical or psychiatric etiology, indicating that presumed etiology may not be helpful in selecting treatment. Research recommendations and clinical implications are discussed. © 2014 International Society for Sexual Medicine.

Health Care Expenditures and Length of Disability Across Medical Conditions.

PubMed

Zaidel, Catherine S; Ethiraj, Rajesh K; Berenji, Manijeh; Gaspar, Fraser W

2018-02-19

To describe the relationship between the length of short-term disability (STD) and health care spending. Medical claims for insured US employees on STD were evaluated to describe the distribution of disability durations and health expenditures across major diagnostic categories and common medical conditions. Correlations between health expenditures and disability durations were examined. The most expensive 10% of cases accounted for more than half of total health spending. The longest 10% of cases accounted for more than one-third of total disability time. Only one-third of the most expensive cases were also among the longest in duration. Disability durations were moderately correlated with medical spending and this relationship was modified by comorbid conditions and age. Psychosocial barriers, in addition to biomedical factors, should be considered to achieve optimal functional outcomes and well-being of patients.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

Minimizing material damage using low temperature irradiation

NASA Astrophysics Data System (ADS)

Craven, E.; Hasanain, F.; Winters, M.

2012-08-01

Scientific advancements in healthcare driven both by technological breakthroughs and an aging and increasingly obese population have lead to a changing medical device market. Complex products and devices are being developed to meet the demands of leading edge medical procedures. Specialized materials in these medical devices, including pharmaceuticals and biologics as well as exotic polymers present a challenge for radiation sterilization as many of these components cannot withstand conventional irradiation methods. The irradiation of materials at dry ice temperatures has emerged as a technique that can be used to decrease the radiation sensitivity of materials. The purpose of this study is to examine the effect of low temperature irradiation on a variety of polymer materials, and over a range of temperatures from 0 °C down to -80 °C. The effectiveness of microbial kill is also investigated under each of these conditions. The results of the study show that the effect of low temperature irradiation is material dependent and can alter the balance between crosslinking and chain scission of the polymer. Low temperatures also increase the dose required to achieve an equivalent microbiological kill, therefore dose setting exercises must be performed under the environmental conditions of use.

Current Treatment Options for Auricular Hematomas.

PubMed

MacPhail, Catriona

2016-07-01

Ear disease, such as otitis externa, resulting in aggressive head shaking or ear scratching, is the most common cause of the development of aural hematomas in dogs and cats. An underlying immunologic cause has also been proposed to explain cartilage and blood vessel fragility. Numerous options exist for management of aural hematomas, from medical management alone with corticosteroids, to simple hematoma centesis, to surgical intervention. Because this condition is usually secondary to another disease process, regardless of mode of treatment, likelihood of recurrence is low if the underlying condition is managed properly. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and validation of a continuous measure of patient condition using the Electronic Medical Record.

PubMed

Rothman, Michael J; Rothman, Steven I; Beals, Joseph

2013-10-01

Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients. A survey of Electronic Medical Record data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single-variable risks. The model's validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals. Outcome validation across hospitals yields an area under the receiver operating characteristic curve(AUC) of ≥0.92 when separating hospice/deceased from all other discharge categories, an AUC of ≥0.93 when predicting 24-h mortality and an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomes reflective of patient condition across the acuity spectrum indicates utility in both medical-surgical units and critical care units. The model output, which we call the Rothman Index, may provide clinicians with a longitudinal view of patient condition to help address known challenges in caregiver communication, continuity of care, and earlier detection of acuity trends. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey.

PubMed

Yang, Juan; Jit, Mark; Leung, Kathy S; Zheng, Ya-Ming; Feng, Lu-Zhao; Wang, Li-Ping; Lau, Eric H Y; Wu, Joseph T; Yu, Hong-Jie

2015-10-06

The seasonal influenza vaccine coverage rate in China is only 1.9 %. There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level, even though this kind of information is important for informing national-level immunization policy decision-making. A retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective. Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013. Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients. The study enrolled 529 outpatients (median age: eight years; interquartile range [IQR]: five to 20 years) and 254 inpatients (median age: four years; IQR: two to seven years). Among the outpatients, 22.1 % (117/529) had underlying diseases and among the inpatients, 52.8 % (134/254) had underlying diseases. The average total costs related to influenza-associated outpatient visits and inpatient visits were US$ 155 (standard deviation, SD US$ 122) and US$ 1,511 (SD US$ 1,465), respectively. Direct medical costs accounted for 45 and 69 % of the total costs related to influenza-associated outpatient and inpatient visits, respectively. For influenza outpatients, the mean cost per episode in children aged below five years (US$ 196) was higher than that in other age groups (US$ 129-153). For influenza inpatients, the mean cost per episode in adults aged over 60 years (US$ 2,735) was much higher than that in those aged below 60 years (US$ 1,417-1,621). Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions (outpatients: US$ 186 vs. US$ 146; inpatients: US$ 1,800 vs. US$ 1,189). In the baseline analysis, inpatients reported costs were 18 % higher than those found in the accounts review (n = 38). The economic burden of influenza-associated outpatient and inpatient visits in China is substantial, particularly for young children, the elderly, and patients with underlying medical conditions. More widespread influenza vaccination would likely alleviate the economic burden of patients. The actual impact and cost-effectiveness analysis of the influenza immunization program in China merits further investigation.

[Advances in clinical study of nocturia].

PubMed

Guan, Zhi-chen

2010-08-18

Nocturia is one of the most common reasons for interrupted sleep in general adult population. The condition affects both men and women, with an incidence that increases dramatically with age. Nocturia has a negative impact on quality of life, affecting both morbidity and mortality. International Continence Society (ICS) issued a report of terminology standardization in 2002, in which nocturia is defined as waking during the night at least once to urinate. Nocturia is a common complaint in elderly population. Although most cases of nocturia are assumed to be caused by urologic problems, the interacting effects of aging and sleep on renal and urinary function, in fact, cause nocturia in the elderly. Effective diagnosis of the condition is dependent on a clear understanding of its underlying etiology. Multiple factors may cause nocturia, such as behavioral or environmental factors and pathologic conditions. In general, the causes of nocturia fall into three categories: diurnal polyuria, nocturnal polyuria, and low bladder capacity. Careful evaluation of medications and underlying medical conditions is essential for the proper management of nocturia. A voiding diary is necessary to diagnose the syndrome of nocturnal polyuria, which is a common cause of nocturia. Addressing any underlying conditions that contribute to nocturia is the first step in treating the condition. Lifestyle and behavioral changes may provide benefit in some individuals, but for many cases, pharmacotherapy is the best option. Antimuscarinic agents are first-line therapies for overactive bladder and are often used in the management of nocturia. Current treatment options also include desmopressin, a synthetic analog of arginine vasopressin, which can increase urinary osmolality and decrease total urinary volume. The desmopressin therefore increases the length of time until the first nocturnal void and decreases the number of nocturnal voids, the NUV voided, and the percentage of urine voided at night.

Medication therapy management and condition care services in a community-based employer setting.

PubMed

Johannigman, Mark J; Leifheit, Michael; Bellman, Nick; Pierce, Tracey; Marriott, Angela; Bishop, Cheryl

2010-08-15

A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical outcomes. A business model in which health-system pharmacists provide MTM and condition care services for company employees has demonstrated successful outcomes in terms of patient satisfaction, cost savings, and clinical benefits.

Correct titration of non-drugs and some other methodological issues.

PubMed

Beneke, M; Rasmus, W; Rød, I S; Fritze, J

1994-01-01

Doctors' prescription and dosing behaviour was investigated using data from 9 clinical trials in 550 patients treated with psychotropics. 7 trials were conducted under double- and 2 under single-blind conditions. In 3 of these trials, oral and i.m. preparations were used demanding a double-dummy design. All patients were evaluated on a weekly or 2-week basis using psychopathological rating scales (i.e. Hamilton Anxiety Scale, Hamilton Depression Scale, Clinical Global Impressions, Simpson and Angus EPS). It was found that (a) oral-medication titration was 3- to 4-fold more broad-ranging than i.m. medication titration, (b) oral placebo was titrated to the same extent as the oral investigational drugs, and (c) the titration schedule did not follow protocol requirements. Moreover, the average doses in all drug and placebo groups were the same. Concomitant medication like sleep inducers was found to be more closely related to doctors' habits than to actual medical need. Independent of trial and investigational drug, 10-33% of all patients received additional sleep inducers.

Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 2: Special Psychiatric Populations and Considerations.

PubMed

Alam, Al; Rachal, James; Tucci, Veronica Theresa; Moukaddam, Nidal

2017-09-01

Patients who present to the emergency department (ED) with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, there are wide variations in quality of care for these individuals. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach to patients. Our group has long advocated a dynamic comanagement approach for medical clearance in the ED, and this article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical/physical examination, and common pitfalls in the medical clearance process. Copyright © 2017 Elsevier Inc. All rights reserved.

42 CFR 417.424 - Denial of enrollment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.424 Denial of... complying with any of the other contract qualifying conditions set forth in subpart J of this part; (3...

A case of coffee-ground emesis in an elderly patient

PubMed Central

De Palma, Giovanni D; Persico, Marcello; Forestieri, Pietro

2014-01-01

Key Clinical Message Black esophagus is an exceeding rare disorder with a multifactorial etiology. Clinical presentation is generally related to upper gastrointestinal bleeding. Diagnosis is based on endoscopic images. Overall mortality is largely related to the underlying medical condition. PMID:25356232

Impact of food intake on the pharmacokinetics of first-line antituberculosis drugs in Taiwanese tuberculosis patients.

PubMed

Lin, Hsien-Chun; Yu, Ming-Chih; Liu, Hsing-Jin; Bai, Kuan-Jen

2014-05-01

Under the directly observed treatment, short course (DOTS) program, antituberculosis (anti-TB) medications were possibly taken at random time, regardless of whether it was prior to or after meals. This study was to evaluate the impact of food intake on pharmacokinetic profiles of first-line TB drugs in Taiwanese TB patients, as well as the relationship between drug levels and pharmacogenetics. This open-label, randomized, cross-over study included newly diagnosed Taiwanese TB patients treated between January 2010 and February 2011 at Taipei Medical University-Wan Fang Hospital. Rifater [a fixed-dose combination formulation of isoniazid (INH), rifampicin (RIF), and pyrazinamide (PZA)] and ethambutol (EMB) were given according to national TB guidelines. Blood samples were collected prior to and 1 hour, 2 hours, 4 hours, 6 hours, and 10 hours after dosing under fasting or postprandial conditions. Pharmacokinetic parameters of the maximum serum concentration (Cmax), time to Cmax, and area under the serum concentration-time curve from the beginning to the 10(th) hour (AUC0-10) were calculated. Sixteen TB patients were included and received anti-TB treatment under the DOTS program after discharge. The overall effects showed that food intake reduced the mean Cmax (INH: 40.6%, RIF: 40.2%, EMB 34.4%, PZA: 24.4%) and AUC0-10 (INH: 21.3%, RIF: 26.4%, EMB: 12.2%, PZA: 12.0%). Meanwhile, food increased the time to Cmax (INH: 78.1%, RIF: 151.3%, EMB: 41.4%, PZA: 148.9%). Significantly lower serum drug concentrations were observed under postprandial conditions than fasting conditions for INH, RIF, and PZA. The impact of taking random anti-TB drugs under the DOTS program instead of taking drugs regularly prior to meals requires further study. Copyright © 2014. Published by Elsevier B.V.

Building integrated mental health and medical programs for vulnerable populations post-disaster: connecting children and families to a medical home.

PubMed

Madrid, Paula A; Sinclair, Heidi; Bankston, Antoinette Q; Overholt, Sarah; Brito, Arturo; Domnitz, Rita; Grant, Roy

2008-01-01

Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and > 200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks ("villages") under the auspices of the [US] Federal Emergency Management Agency (FEMA). The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program ("Operation Assist") to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.

Association of time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected bacteria of patients after solid organ transplantation.

PubMed

Schmalz, G; Berisha, L; Wendorff, H; Widmer, F; Marcinkowski, A; Teschler, H; Sommerwerck, U; Haak, R; Kollmar, O; Ziebolz, D

2018-05-01

Aim of this study was to investigate the association of the time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected periodontal pathogenic bacteria of immunosuppressed patients after solid organ transplantation (SOT). 169 Patients after SOT (lung, liver or kidney) were included and divided into subgroups according their time under (0-1, 1-3, 3-6, 6-10 and >10 years) and form of immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs. combination). Periodontal probing depth (PPD) and clinical attachment loss (CAL) were assessed. Periodontal disease severity was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were investigated for eleven selected potentially periodontal pathogenic bacteria using polymerasechainreaction. The mean PPD and CAL as well as prevalence of Treponema denticola and Capnocytophaga species was shown to be different but heterogeneous depending on time under immunosuppression (p<0.05). Furthermore, only the medication with Cyclosporine was found to show worse periodontal condition compared to patients without Cyclosporine (p<0.05). Prevalence of Porphyromonas gingivalis, Tannerella forsythia and Fusobacterium nucleatum was reduced and prevalence of Parvimonas micra and Capnocytophaga species was increased in patients under immunosuppression with Glucocorticoids, Mycophenolate as well as combination therapy. Time under and form of immunosuppression might have an impact on the clinical periodontal and microbiological parameters of patients after SOT. Patients under Cyclosporine medication should receive increased attention. Differences in subgingival biofilm, but not in clinical parameters were found for Glucocorticoids, Mycophenolate and combination therapy, making the clinical relevance of this finding unclear.

Early life stages of Northern shrimp (Pandalus borealis) are sensitive to fish feed containing the anti-parasitic drug diflubenzuron.

PubMed

Bechmann, Renée Katrin; Lyng, Emily; Westerlund, Stig; Bamber, Shaw; Berry, Mark; Arnberg, Maj; Kringstad, Alfhild; Calosi, Piero; Seear, Paul J

2018-05-01

Increasing use of fish feed containing the chitin synthesis inhibiting anti-parasitic drug diflubenzuron (DFB) in salmon aquaculture has raised concerns over its impact on coastal ecosystems. Larvae of Northern shrimp (Pandalus borealis) were exposed to DFB medicated feed under Control conditions (7.0 °C, pH 8.0) and under Ocean Acidification and Warming conditions (OAW, 9.5 °C and pH 7.6). Two weeks' exposure to DFB medicated feed caused significantly increased mortality. The effect of OAW and DFB on mortality of shrimp larvae was additive; 10% mortality in Control, 35% in OAW, 66% in DFB and 92% in OAW + DFB. In OAW + DFB feeding and swimming activity were reduced for stage II larvae and none of the surviving larvae developed to stage IV. Two genes involved in feeding (GAPDH and PRLP) and one gene involved in moulting (DD9B) were significantly downregulated in larvae exposed to OAW + DFB relative to the Control. Due to a shorter intermoult period under OAW conditions, the OAW + DFB larvae were exposed throughout two instead of one critical pre-moult period. This may explain the more serious sub-lethal effects for OAW + DFB than DFB larvae. A single day exposure at 4 days after hatching did not affect DFB larvae, but high mortality was observed for OAW + DFB larvae, possibly because they were exposed closer to moulting. High mortality of shrimp larvae exposed to DFB medicated feed, indicates that the use of DFB in salmon aquaculture is a threat to crustacean zooplankton. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Comparison of the release behaviors of di (2-ethylhexyl) phthalate and tri(2-ethylhexyl) trimellitate from the polyvinyl-chloride infusion set into pharmaceutical solutions.

PubMed

Zhang, Hong; Yang, Fengmin; Shen, Gang; Yang, Yueyang; Tang, Yalin

2015-05-01

Polyvinyl-chloride (PVC) with plasticizers of di(2-ethylhexyl) phthalate (DEHP) and tris(2-ethyl- hexyl) trimellitate (TOTM) is widely used in medical and paramedical appliances. However, such plasticizers can leach from PVC products into contact solutions. The aim of this study is to investigate the release behaviors of DEHP and TOTM from the PVC intravenous infusion set into various pharmaceutical solutions under the simulated clinical conditions, such as the lipophilic substances (paclitaxel) , parenteral nutrition (fat emulsion injection) , acid and alkali pharmaceutical solution (levofloxacin hydrochloride injection, pH 3.0-5.0 and furosemide, pH 8.0-9.0). A simple and rapid high-performance liquid chromatographic method with UV detection (HPLC-UV) for the determination of DEHP or TOTM released from PVC medical devices into the above intravenous preparations was developed. The cumulative amounts of DEHP or TOTM released in 24 h were in the same following order: paclitaxel > fat emulsion injection levofloxacin hydrochloride > furosemide solution. From a comparison of the cumulative amounts of released DEHP and TOTM from the above solutions, we found that the cumulative amount of TOTM is far less than that of DEHP, under the same conditions. The cumulative amount of the DEHP released in 24 h in the paclitaxel solution was 21. 14 mg, while under the same conditions, the cumulative amount of TOTM was only 0. 078 mg. The cumulative amount of DEHP is assumed to be about 270 times that of the released TOTM. Thus TOTM could be a superior alternative to DEHP for use in medical devices because of its potential lower leachability.

Material Logistic Support of the Hospital Ships

DTIC Science & Technology

1986-12-01

Codeine Sulfate Tablets 6505-00-132-6904 Isoniazid Tablets 6505-00-165-6545 Cephalexin Capsules 6505-00-165-6575 Rifampin Capsules 6505-00-400-2054...35 4. CONSUMPTION RATE FOR MEDICAL CONSUMABLE ITEM FOR SPECIFIC CONDITION UNDER SCENARIO A 38 5. CONTRIBUTION FACTOR FOR BISACODYL TABLETS FOR SCENARIO...probability that patient condition 249 will require Bisacodyl. If the probability was twenty percent, then the amount of Bisacodyl needed would be two tablets

[MRI diagnostics of bone marrow oedema and its significance for the forensic medical evaluation of the injuries to bones and articulations].

PubMed

Fetisov, V A; Kulinkovich, K Yu

The objective of the present study was the analysis of the publications in the literature dealing with radiological methods employed for the diagnostics of injuries to and diseases of the bones and articulations as well as the role of bone marrow oedema in the development of these conditions in the specific context of the problems facing forensic medical expertise. The main results of the domestic and foreign authors concerning MRI-based investigations into the nature of injuries and other pathological changes in bones and articulations during different periods after their development are discussed with the major emphasis placed on diagnostics of bone marrow oedema. Magnetic resonance visualization of this diagnostic feature and the related manifestations of the above conditions in many cases provides an indisputable evidence of the damage whereas the discovery of its distribution to and localization in the bone structures makes it possible to elucidate the sources of this condition, such as a blow, torsional stress, stretching, etc., and its underlying mechanisms. The character and the mode of distribution of the signal from a bone marrow oedema under various conditions of visualization allow to carry out differential diagnostics of the damage prescription period of up to 1.5 months.

Medical merchants: conflict of interest, office product sales and notifiable conduct.

PubMed

Parker, Malcolm H; Wardle, Jon L; Weir, Michael; Stewart, Cameron L

2011-01-03

Professional ethical codes identify the issue of conflict of interest, which can distort doctors' objective judgements concerning the best interests of patients. Legal fiduciary duties may be owed by doctors to patients in situations of potential conflict of interest. Prescribing and dispensing functions have been largely legally separated to prevent conflicts of interest arising. The advent of integrative medicine has been accompanied by an apparent growth of in-house selling of therapeutic products. Medical merchandising constitutes a prima-facie conflict of interest and may amount to notifiable conduct under the Health Practitioner Regulation National Law provisions. We believe that doctors who sell therapeutic products should adhere to strict conditions to avoid significantly departing from accepted professional standards. Doctors who have a reasonable belief that a colleague is failing to comply with these conditions could consider notifying the Medical Board of Australia.

Catatonia in DSM-5.

PubMed

Tandon, Rajiv; Heckers, Stephan; Bustillo, Juan; Barch, Deanna M; Gaebel, Wolfgang; Gur, Raquel E; Malaspina, Dolores; Owen, Michael J; Schultz, Susan; Tsuang, Ming; van Os, Jim; Carpenter, William

2013-10-01

Although catatonia has historically been associated with schizophrenia and is listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. Consequently, catatonia secondary to a general medical condition was included as a new condition and catatonia was added as an episode specifier of major mood disorders in DSM-IV. Different sets of criteria are utilized to diagnose catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions in DSM-IV, however, and catatonia is a codable subtype of schizophrenia but a specifier for major mood disorders without coding. In part because of this discrepant treatment across the DSM-IV manual, catatonia is frequently not recognized by clinicians. Additionally, catatonia is known to occur in several conditions other than schizophrenia, major mood disorders, or secondary to a general medical condition. Four changes are therefore made in the treatment of catatonia in DSM-5. A single set of criteria will be utilized to diagnose catatonia across the diagnostic manual and catatonia will be a specifier for both schizophrenia and major mood disorders. Additionally, catatonia will also be a specifier for other psychotic disorders, including schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, and substance-induced psychotic disorder. A new residual category of catatonia not otherwise specified will be added to allow for the rapid diagnosis and specific treatment of catatonia in severely ill patients for whom the underlying diagnosis is not immediately available. These changes should improve the consistent recognition of catatonia across the range of psychiatric disorders and facilitate its specific treatment. Published by Elsevier B.V.

Horizontal gaze nystagmus: a review of vision science and application issues.

PubMed

Rubenzer, Steven J; Stevenson, Scott B

2010-03-01

The Horizontal Gaze Nystagmus (HGN) test is one component of the Standardized Field Sobriety Test battery. This article reviews the literature on smooth pursuit eye movement and gaze nystagmus with a focus on normative responses, the influence of alcohol on these behaviors, and stimulus conditions similar to those used in the HGN sobriety test. Factors such as age, stimulus and background conditions, medical conditions, prescription medications, and psychiatric disorder were found to affect the smooth pursuit phase of HGN. Much less literature is available for gaze nystagmus, but onset of nystagmus may occur in some sober subjects at 45 degrees or less. We conclude that HGN is limited by large variability in the underlying normative behavior, from methods and testing environments that are often poorly controlled, and from a lack of rigorous validation in laboratory settings.

Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

PubMed

Tuladhar, H; Risal, A

2010-06-01

World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

42 CFR 442.14 - Effect of change of ownership.

Code of Federal Regulations, 2010 CFR

2010-10-01

....14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... agreement is subject to all applicable statutes and regulations and to the terms and conditions under which...

[Current status and trends in the health of the Moscow population].

PubMed

Tishuk, E A; Plavunov, N F; Soboleva, N P

1997-01-01

Based on vast comprehensive medical statistical database, the authors analyze the health status of the population and the efficacy of public health service in Moscow. The pre-crisis tendencies and the modern status of public health under modern socioeconomic conditions are noted.

38 CFR 21.3305 - “Interrupted” status.

Code of Federal Regulations, 2014 CFR

2014-07-01

... provided for each eligible person, including training during the summer, except where, because of his or... necessary under the following conditions: (1) During summer vacations or periods when no instruction is given before and after summer sessions. (2) During a prolonged period of illness or medical...

38 CFR 21.3305 - “Interrupted” status.

Code of Federal Regulations, 2013 CFR

2013-07-01

... provided for each eligible person, including training during the summer, except where, because of his or... necessary under the following conditions: (1) During summer vacations or periods when no instruction is given before and after summer sessions. (2) During a prolonged period of illness or medical...

Early recognition of growth abnormalities permitting early intervention

USDA-ARS?s Scientific Manuscript database

Normal growth is a sign of good health. Monitoring for growth disturbances is fundamental to children's health care. Early detection and diagnosis of the causes of short stature allows management of underlying medical conditions, optimizing attainment of good health and normal adult height. This rev...

Critical parts are stored and shipped in environmentally controlled reusable container

NASA Technical Reports Server (NTRS)

Kummerfeld, K. R.

1966-01-01

Environmentally controlled, hermetically sealed, reusable metal cabinet with storage drawers is used to ship and store sensitive electronic, pneumatic, or hydraulic parts or medical supplies under extreme weather or handling conditions. This container is compatible with on-site and transportation handling facilities.

Eye Injuries (For Parents)

MedlinePlus

... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español First Aid: Eye ... a speck of dirt under the eyelid. Others, like those that happen during sports activities, can be serious and require medical attention. ...

48 CFR 245.7310-5 - Controlled substances.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (Bureau of Narcotics and Dangerous Drugs) to buy controlled substances as a medical practitioner, dealer... hallucinogenic drugs, shall be subject to the following special conditions: (a) Controlled Substances. Bids will... represents and warrants that it is registered under The Comprehensive Drug Abuse Prevention and Control Act...

Queues and care: how medical residents organize their work in a busy clinic.

PubMed

Finlay, W; Mutran, E J; Zeitler, R R; Randall, C S

1990-09-01

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.

Invasive Disease Due to Nontypeable Haemophilus influenzae among Children in Arkansas

PubMed Central

O'Neill, Joshua M.; St. Geme III, Joseph W.; Cutter, David; Adderson, Elisabeth E.; Anyanwu, Juliana; Jacobs, Richard F.; Schutze, Gordon E.

2003-01-01

In this study, we reviewed cases of invasive disease due to nontypeable Haemophilus influenzae among children hospitalized at Arkansas Children's Hospital from 1993 to 2001. A total of 28 cases were examined, including 21 associated with bacteremia and 4 associated with meningitis. Of the patients examined, 86% were ≤4 years of age, and 68% had underlying medical conditions. Characterization of the bacterial isolates by multilocus sequence type genotyping revealed significant overall genetic diversity, similar to the diversity in the general population structure for nontypeable H. influenzae. However, four separate pairs of isolates were closely related genetically, a relationship confirmed by pulsed-field gel electrophoresis and Southern hybridization studies using probes for the major H. influenzae adhesin genes. These results suggest that selected strains of nontypeable H. influenzae may have more invasive potential, especially in young children and patients with underlying medical conditions. At this point, the specific factors that contribute to enhanced virulence remain unclear. PMID:12843045

Modulation of Endothelial Glycocalyx Structure under Inflammatory Conditions

PubMed Central

Kolářová, Hana; Ambrůzová, Barbora; Švihálková Šindlerová, Lenka; Klinke, Anna; Kubala, Lukáš

2014-01-01

The glycocalyx of the endothelium is an intravascular compartment that creates a barrier between circulating blood and the vessel wall. The glycocalyx is suggested to play an important role in numerous physiological processes including the regulation of vascular permeability, the prevention of the margination of blood cells to the vessel wall, and the transmission of shear stress. Various theoretical models and experimental approaches provide data about changes to the structure and functions of the glycocalyx under various types of inflammatory conditions. These alterations are suggested to promote inflammatory processes in vessels and contribute to the pathogenesis of number of diseases. In this review we summarize current knowledge about the modulation of the glycocalyx under inflammatory conditions and the consequences for the course of inflammation in vessels. The structure and functions of endothelial glycocalyx are briefly discussed in the context of methodological approaches regarding the determination of endothelial glycocalyx and the uncertainty and challenges involved in glycocalyx structure determination. In addition, the modulation of glycocalyx structure under inflammatory conditions and the possible consequences for pathogenesis of selected diseases and medical conditions (in particular, diabetes, atherosclerosis, ischemia/reperfusion, and sepsis) are summarized. Finally, therapeutic strategies to ameliorate glycocalyx dysfunction suggested by various authors are discussed. PMID:24803742

Drowning fatalities in childhood: the role of pre-existing medical conditions.

PubMed

Franklin, Richard C; Pearn, John H; Peden, Amy E

2017-10-01

This study is an analysis of the contribution of pre-existing medical conditions to unintentional fatal child (0-14 years) drowning and a of critique prevention stratagems, with an exploration of issues of equity in recreation. This study is a total population, cross-sectional audit of all demographic, forensic and on-site situational details surrounding unintentional fatal drowning of children 0-14 years in Australia for the period of 1 July 2002 to 30 June 2012. Data were sourced from the National (Australia) Coronial Information System. Age-specific disease patterns in the general population were obtained from the Australian Institute of Health and Welfare. Four hundred and sixty-eight children drowned during the study period. Fifty-three (11.3%) had a pre-existing medical condition, of whom 19 suffered from epilepsy, 13 from autism and 5 with non-specific intellectual disabilities. Epilepsy is a risk factor in childhood drowning deaths, with a prevalence of 4.1% of drowning fatalities, compared with 0.7%-1.7% among the general 0-14 years population (relative risk: 2.4-5.8). Epilepsy was deemed to be contributory in 16 of 19 cases (84.2% of epilepsy cases) with a median age of 8 years. Asthma and intellectual disabilities were under-represented in the drowning cohort. Except for epilepsy, this research has indicated that the risks of drowning while undertaking aquatic activities are not increased in children with pre-existing medical conditions. Children with pre-existing medical conditions can enjoy aquatic activities when appropriately supervised. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A hierarchical, ontology-driven Bayesian concept for ubiquitous medical environments--a case study for pulmonary diseases.

PubMed

Maragoudakis, Manolis; Lymberopoulos, Dimitrios; Fakotakis, Nikos; Spiropoulos, Kostas

2008-01-01

The present paper extends work on an existing computer-based Decision Support System (DSS) that aims to provide assistance to physicians as regards to pulmonary diseases. The extension deals with allowing for a hierarchical decomposition of the task, at different levels of domain granularity, using a novel approach, i.e. Hierarchical Bayesian Networks. The proposed framework uses data from various networking appliances such as mobile phones and wireless medical sensors to establish a ubiquitous environment for medical treatment of pulmonary diseases. Domain knowledge is encoded at the upper levels of the hierarchy, thus making the process of generalization easier to accomplish. The experimental results were carried out under the Pulmonary Department, University Regional Hospital Patras, Patras, Greece. They have supported our initial beliefs about the ability of Bayesian networks to provide an effective, yet semantically-oriented, means of prognosis and reasoning under conditions of uncertainty.

A model-based approach for the evaluation of vagal and sympathetic activities in a newborn lamb.

PubMed

Le Rolle, Virginie; Ojeda, David; Beuchée, Alain; Praud, Jean-Paul; Pladys, Patrick; Hernández, Alfredo I

2013-01-01

This paper proposes a baroreflex model and a recursive identification method to estimate the time-varying vagal and sympathetic contributions to heart rate variability during autonomic maneuvers. The baroreflex model includes baroreceptors, cardiovascular control center, parasympathetic and sympathetic pathways. The gains of the global afferent sympathetic and vagal pathways are identified recursively. The method has been validated on data from newborn lambs, which have been acquired during the application of an autonomic maneuver, without medication and under beta-blockers. Results show a close match between experimental and simulated signals under both conditions. The vagal and sympathetic contributions have been simulated and, as expected, it is possible to observe different baroreflex responses under beta-blockers compared to baseline conditions.

Effect of shear stress on platelet adhesion to expanded polytetrafluoroethylene, a silicone sheet, and an endothelial cell monolayer.

PubMed

Furukawa, K S; Ushida, T; Sugano, H; Tamaki, T; Ohshima, N; Tateishi, T

2000-01-01

We visualized in real-time platelets adhering to the surface of three representative biomaterials, by using an apparatus consisting of a modified cone and plate rheometer combined with an upright epifluorescence microscope under two shear flows (0.1 and 5.0 dyne/cm2). The materials were expanded polytetrafluoroethylene (ePTFE), silicone sheet, and a monolayer of bovine endothelial cells (ECs) formed on glass, all of which are opaque materials used for artificial blood vessels and medical devices. According to quantitative analysis, the monolayer of ECs formed on glass had better blood compatibility than did either the ePTFE or the silicone sheet under shear flow conditions. Under a shear flow condition of 0.1 dyne/cm2, platelet adhesion was silicone sheet > ePTFE. In contrast, under a shear flow condition of 5.0 dyne/cm2, ePTFE > silicone sheet. These results indicate that the intensity of shear stress could modify the order of hemocompatibility of the materials. Therefore, direct observation of platelet adhesion under shear flow conditions is indispensable for testing and screening biomaterials and for providing a precise quantitative evaluation of platelet adhesion.

Agreement between patient interview data on prescription medication use and pharmacy records in those aged older than 50 years varied by therapeutic group and reporting of indicated health conditions.

PubMed

Richardson, Kathryn; Kenny, Rose Anne; Peklar, Jure; Bennett, Kathleen

2013-11-01

To estimate the agreement between interview-ascertained medication use and pharmacy records among the population aged older than 50 years, and to identify patient-level predictors of discordance. The Irish Longitudinal study on Ageing is representative of community-dwelling adults aged 50 years and older in Ireland. Interview-ascertained medication data from 2,621 participants were linked to pharmacy dispensing records. The kappa statistics measured the agreement between the two sources for 19 therapeutic classes. Logistic regression assessed the effect of patient-level characteristics on survey under- and overreporting of regularly dispensed medications. Agreement was good or very good (κ=0.64-0.86) for 15 medication classes, and moderate or poor for antiinflammatory and antirheumatic products (κ=0.54), analgesics (κ=0.50), psycholeptics (κ=0.59), and ophthalmologicals (κ=0.37). Not reporting an indicated health condition, less frequent dispensing, older age, and more medications regularly dispensed were associated with survey underreporting, but results varied by therapeutic class. Memory and cognition were not associated with discordance. Ascertaining medication use via patient interview seems a valid method for most medication classes and also captures nonprescription and supplement use. However, medications applied topically and as needed may be underreported. The source of medication data should be carefully considered when performing pharmacoepidemiological studies. Copyright © 2013 Elsevier Inc. All rights reserved.

Lung function requirements in flying duty the problem of bronchial hyperresponsiveness in military aircrew.

PubMed

Hartmann, C M; Steinhoff-Lankes, D; Maya-Pelzer, P

1999-09-09

Uncompromised lung function is essential for fitness to fly. Under hypobaric conditions there is an increased risk of hypoxemia. G-forces, positive pressure breathing and anti-G maneuvers cause physical stress to the lung tissue and altered pulmonary blood flow. Breathing with pure oxygen, dry cabin air and ozone can cause airway irritation. Chemically and physically by irritating agents may be present. Emergencies such as smoke in the cockpit or inhalation of tear gas can rapidly compromise the pulmonary system in susceptible persons. Sudden incapacitation may occur. Trapped gases may cause overinflation and lung rupture in rapid decompression. Applicants for military duty have to pass basic lung function tests routinely. Preselection of aircrew candidates tends to be even stricter. Asthma and obstructive lung disease are disqualifying. Trained aircrew with late onset of pulmonary problems can be waived under certain restrictions in many cases. Some national regulations exclude even applicants with allergies. Due to aeromedical experience we should always be aware of the latent unspecific bronchial hyperresponsiveness (BHR). BHR is one of the characteristics of asthma bronchiale. If BHR exists there is an increased risk of later development of asthma bronchiale, especially together with perennial allergies such as against house dust mite. Under certain conditions BHR can become symptomatic and aeromedically relevant. In some cases we saw an exacerbation under medication, mostly under beta-receptor-blockers. In one case even under betablocker-containing eye drops. In the Gulf War 1991 a number of allied military personnel had to be withdrawn because of bronchospastic symptoms. This can be explained among others by medication with physostigmine. Physostigmine is a systemically active cholinergic drug which is prophylactically used under threat of chemically warfare agents. In individuals with latent BHR physostigmine will lower the threshold for bronchial reactions considerably and even cause manifest bronchospasm. We recommend an unspecific bronchial challenge test in the selection of personnel for duties where uncompromised lung function under all environmental conditions is essential.

Preparations for Severe Winter Conditions by Emergency Health Personnel in Turkey.

PubMed

Calışkan, Cüneyt; Algan, Aysun; Koçak, Hüseyin; Biçer, Burcu Küçük; Sengelen, Meltem; Cakir, Banu

2014-04-23

Emergency and core ambulance personnel work under all environmental conditions, including severe weather condtions. We evaluated emergency medical personnel in Çanakkale, Turkey, for their degree of preparedness. A descriptive study was conducted in Çanakkale, Turkey, within 112 emergency service units and their 17 district stations. Surveys were developed to measure the level of preparedness for serious winter conditions that individual workers made for themselves, their homes, and their cars. Of the 167 survey participants, the mean age was 29.8 ± 7.9 years; 52.7% were women; more than half (54.75%) were emergency medical technicians; and 53.3% were married. Only 10.4% of those who heated their homes with natural gas had carbon monoxide detectors. Scores relating to household and individual preparation for severe winter conditions increased by participants' age (P < .003), being married (P < .000) and working in the city center (P < .021); and for men whose cars were equipped with tow ropes, extra clothing, and snow tires (P < .05). Absenteeism was higher for central-city personnel than district workers because they were less prepared for harsh winter conditions (P = .016). Many of the surveyed emergency health personel demonstrated insufficient preparations for serious winter conditions. To increase the safety and efficiency of emergency medical personnel, educational training programs should be rountinely conducted. (Disaster Med Public Health Preparedness. 2014;0:1-4).

Medical costs and lost productivity from health conditions at volatile organic compound-contaminated Superfund sites

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lybarger, J.A.; Spengler, R.F.; Brown, D.R.

1998-10-01

This paper estimates the health costs at Superfund sites for conditions associated with volatile organic compounds (VOCs) in drinking water. Health conditions were identified from published literature and registry information as occurring at excess rates in VOC-exposed populations. These health conditions were: (1) some categories of birth defects, (2) urinary tract disorders, (3) diabetes, (4) eczema and skin conditions, (5) anemia, (6) speech and hearing impairments in children under 10 years of age, and (7) stroke. Excess rates were used to estimate the excess number of cases occurring among the total population living within one-half mile of 258 Superfund sites.more » These sites had evidence of completed human exposure pathways for VOCs in drinking water. For each type of medical condition, an individual`s expected medical costs, long-term care costs, and lost work time due to illness or premature mortality were estimated. Costs were calculated to be approximately $330 million per year, in the absence of any remediation or public health intervention programs. The results indicate the general magnitude of the economic burden associated with a limited number of contaminants at a portion of all Superfund sites, thus suggesting that the burden would be greater than that estimated in this study if all contaminants at all Superfund sites could be taken into account.« less

Accuracy of self-reported medical problems in patients with alcohol dependence and co-occurring schizophrenia or schizoaffective disorder.

PubMed

Meszaros, Zsuzsa Szombathyne; Dimmock, Jacqueline A; Ploutz-Snyder, Robert; Chauhan, Sumerendra Vir Singh; Abdul-Malak, Ynesse; Middleton, Frank A; Batki, Steven L

2011-11-01

Schizophrenia and alcohol dependence (AD) are both major risk factors for a variety of medical problems, yet little is known about the medical status of patients in whom both conditions coexist. The objectives of this study are to assess accuracy of self-reported medical problems and to compare the accuracy reports in patients with schizophrenia or schizoaffective disorder and co-occurring AD compared to patients with AD only and to controls. Our hypothesis was that medical problems are under-reported in patients with co-occurring disorders, possibly due to the combination of alcohol use and symptoms of schizophrenia. Self-reported medical diagnoses were recorded and compared to medical records obtained from all area hospitals in 42 patients with schizophrenia and AD, 44 patients with schizoaffective disorder and AD, 41 patients with AD only, and 15 control subjects. Patients underwent medical history, physical examination, and review of medical records. Patients with schizophrenia or schizoaffective disorder and co-occurring AD underreported their medical problems significantly more than patients with AD only and controls. Accuracy of self report was significantly lower in patients with schizophrenia-spectrum disorders plus co-occurring alcohol dependence than in AD alone or in controls. The most commonly underreported diagnoses included coronary artery disease, chronic renal failure, seizure disorder, hyperlipidemia, asthma and hypertension. In order to detect potentially unreported medical conditions in patients with co-occurring schizophrenia/schizoaffective disorder and alcohol dependence, the use of targeted screening questionnaires is recommended in addition to physical examination and thorough review of medical records. Copyright © 2011 Elsevier B.V. All rights reserved.

Early Lessons on Bundled Payment at an Academic Medical Center.

PubMed

Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

2017-09-01

Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate. Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.

42 CFR 417.404 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.404 General requirements. (a) In order to contract with CMS under the Medicare program, an entity must— (1) Be determined by CMS to be an HMO or CMP...

Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care

PubMed Central

Gyedu, Adam; Agbedinu, Kwabena; Dalwai, Mohammed; Osei-Ampofo, Maxwell; Nakua, Emmanuel Kweku; Oteng, Rockefeller; Stewart, Barclay

2016-01-01

Introduction The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Methods Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Results Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Conclusion Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative. PMID:28154649

Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care.

PubMed

Gyedu, Adam; Agbedinu, Kwabena; Dalwai, Mohammed; Osei-Ampofo, Maxwell; Nakua, Emmanuel Kweku; Oteng, Rockefeller; Stewart, Barclay

2016-01-01

The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49-59; house officers: 55%, 95% CI 48-60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most 'emergency' level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.

Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780).

PubMed

Neuderth, Silke; Schwarz, Betje; Gerlich, Christian; Schuler, Michael; Markus, Miriam; Bethge, Matthias

2016-08-17

Musculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved. The cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients' discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies. This study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders. German Clinical Trials Register ( DRKS00009780 , February 10, 2016).

The Two-Stage Examination: A Method to Assess Individual Competence and Collaborative Problem Solving in Medical Students

PubMed Central

Morton, David A.; Pippitt, Karly; Lamb, Sara; Colbert-Getz, Jorie M.

2016-01-01

Problem Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments. Approach Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1. In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2. Outcomes Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17). Next Steps Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts. PMID:27049544

A secure mobile multimedia system to assist emergency response teams.

PubMed

Belala, Yacine; Issa, Omneya; Gregoire, Jean-Charles; Wong, James

2008-08-01

Long wait times after injury and greater distances to travel between accident scenes and medical facilities contribute to increased, possibly unnecessary deaths. This paper describes a mobile emergency system aimed at reducing mortality by improving the readiness of hospital personnel, therefore allowing for more efficient treatment procedures to be performed when the victim arrives. The system is designed to provide a secure transmission of voice, medical data, and video in real-time over third-generation cellular networks. Test results obtained on a commercial network under real-life conditions demonstrate the ability to effectively transmit medical data over 3G networks, making them a viable option available to healthcare professionals.

[Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

PubMed

Poliakov, B A; Kizeev, M V

2010-01-01

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

Technology: quality at what cost

NASA Astrophysics Data System (ADS)

Fitzmaurice, J. M.

1994-12-01

Although medical technology appears to be the driving force behind the rate of increase of real national health expenditures, market imperfections are of greater concern. The market falls short of efficiently allocating health services because of perverse financial incentives and a lack of consumer and physician understanding of the value of many medical services. Making the best use of new and old technology requires better-informed health care decisions, which can help to counter the market imperfections. Cost-effectiveness analysis is presented as one way to assist decisions that must consider the effect of limited resources. Another approach-- medical effectiveness--derives from the lack of knowledge about the impact on patient outcomes of many treatments delivered for specific conditions under the average conditions of care in the community. This lack of knowledge led to the development of the medical treatment effectiveness and technology research activities of the Agency for Health Care Policy and Research. The treatment of medical technologies proposed by health reform legislation and by the National Information Infrastructure initiative is briefly discussed. The paper concludes that wise evaluation of new and old technologies--including information systems--is required to improve our patient outcomes, productivity, and enjoyment of life.

[Discussion of the implementation of MIMIC database in emergency medical study].

PubMed

Li, Kaiyuan; Feng, Cong; Jia, Lijing; Chen, Li; Pan, Fei; Li, Tanshi

2018-05-01

To introduce Medical Information Mart for Intensive Care (MIMIC) database and elaborate the approach of critically emergent research with big data based on the feature of MIMIC and updated studies both domestic and overseas, we put forward the feasibility and necessity of introducing medical big data to research in emergency. Then we discuss the role of MIMIC database in emergency clinical study, as well as the principles and key notes of experimental design and implementation under the medical big data circumstance. The implementation of MIMIC database in emergency medical research provides a brand new field for the early diagnosis, risk warning and prognosis of critical illness, however there are also limitations. To meet the era of big data, emergency medical database which is in accordance with our national condition is needed, which will provide new energy to the development of emergency medicine.

Standards on medical fitness examinations for Navy divers.

PubMed

Weiss, Michael

2003-01-01

The German Navy employs approximately 480 divers in their primary and secondary role. Before entering diving training, every diver has to pass an intensive physical examination programme at the German Naval Medical Institute (NMI) in Kiel-Kronshagen. Annual follow-ups ensure the currency of the medical findings. Criteria of medical fitness for diving reflect industrial medical standards for hyperbaric workers as well as the general medical guidelines for NATO divers. A diving examination consists of the individual medical history, a physical examination including the neurological status and the assessment of the cardiovascular fitness by ECG and bicycle ergometry. The respiratory system is screened by regular chest x-rays and spirometry or body plethysmography. Blood and urine samples are taken to look for abnormal haematological and metabolic conditions as well as disorders of the genito-urinary system. In order to determine visual fitness, diver's visual acuity, colour vision and stereopsis as well as eye fundi are examined by an eye specialist. Also the ENT examination involves a speciality consultant and consists of audiometry, inspection of the external ear and tympanic membrane and functional tests. To ensure a high standard of dental fitness, screening by a dental officer is part of the annual check-up. Every routine diving medical examination at the NMI includes a pressure test in the hyperbaric chamber. Divers who use nitrox or oxygen-rebreather devices have to pass successfully an oxygen tolerance test under hyperbaric conditions. The annual routine diving medical examination contributes to minimize the risk of accidents in military diving operations.

Multimorbidity in bipolar disorder and undertreatment of cardiovascular disease: a cross sectional study.

PubMed

Smith, Daniel J; Martin, Daniel; McLean, Gary; Langan, Julie; Guthrie, Bruce; Mercer, Stewart W

2013-12-23

Individuals with serious mental disorders experience poor physical health, especially increased rates of cardiometabolic morbidity and premature morbidity. Recent evidence suggests that individuals with schizophrenia have numerous comorbid physical conditions that may be under-recorded and undertreated, but to date very few studies have explored this issue for bipolar disorder. We conducted a cross-sectional analysis of a dataset of 1,751,841 registered patients within 314 primary care practices in Scotland, UK. Bipolar disorder was identified using Read Codes recorded within electronic medical records. Data on 32 common chronic physical conditions were also assessed. Potential prescribing inequalities were evaluated by analysing prescribing data for coronary heart disease (CHD) and hypertension. Compared to controls, individuals with bipolar disorder were significantly less likely to have no recorded physical conditions (OR 0.59, 95% CI 0.54 to 0.63) and significantly more likely to have one physical condition (OR 1.27, 95% CI 1.16 to 1.39), two physical conditions (OR 1.45, 95% CI 1.30 to 1.62) and three or more physical conditions (OR 1.44, 95% CI 1.30 to 1.64). People with bipolar disorder also had higher rates of thyroid disorders, chronic kidney disease, chronic pain, chronic obstructive airways disease and diabetes but, surprisingly, lower recorded rates of hypertension and atrial fibrillation. People with bipolar disorder and comorbid CHD or hypertension were significantly more likely to be prescribed no antihypertensive or cholesterol-lowering medications compared to controls, and bipolar individuals with CHD or hypertension were significantly less likely to be on two or more antihypertensive agents. Individuals with bipolar disorder are similar to individuals with schizophrenia in having a wide range of comorbid and multiple physical health conditions. They are also less likely than controls to have a primary-care record of cardiovascular conditions such as hypertension and atrial fibrillation. Those with a recorded diagnosis of CHD or hypertension were less likely to be treated with cardiovascular medications and were treated less intensively. This study highlights the high physical healthcare needs of people with bipolar disorder, and provides evidence for a systematic under-recognition and undertreatment of cardiovascular disease in this group.

Smart information system for gachon university gil hospital.

PubMed

Park, Dong Kyun; Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-03-01

In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Smart Information System for Gachon University Gil Hospital

PubMed Central

Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-01-01

Objectives In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. Methods This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. Results The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Conclusions Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future. PMID:22509476

Regulatory science based approach in development of novel medical devices.

PubMed

Sakuma, Ichiro

2015-08-01

For development rational evaluation method for medical devices' safety and efficacy, regulatory science studies are important. Studies on regulatory affairs related to a medical device under development should be conducted as well as its technological development. Clinical performance of a medical device is influenced by performance of the device, medical doctors' skill, pathological condition of a patient, and so on. Thus it is sometimes difficult to demonstrate superiority of the device in terms of clinical outcome although its efficacy as a medical device is accepted. Setting of appropriate end points is required to evaluate a medical device appropriately. Risk assessment and risk management are the basis of medical device safety assurance. In case of medical device software, there are difficulties in identifying the risk due to its complexity of user environment and different design and manufacturing procedure compared with conventional hardware based medical devices. Recent technological advancement such as information and communication technologies (ICT) for medical devices and wireless network has raised new issue on risk management: cybersecurity. We have to watch closely the progress of safety standard development.

An under-diagnosed cause of leg swelling

PubMed Central

Goodliffe, James M; Ormerod, Julian O M; Beale, Andrew; Ramcharitar, Steve

2013-01-01

A grossly obese woman was wrongly diagnosed throughout her adult life of having lymphoedema. Her condition was subsequently confirmed as lipoedema, an entirely different condition, which is noted in medical text books but is seldom taught to medical students or to general practitioners. The condition is caused by abnormal deposition of adipose tissue in the extremities (usually the lower limbs) and almost exclusively affects women. It often starts at puberty or may occur after pregnancy. The exact aetiology is not yet understood but genetic and hormonal factors may be implicated. The problem is that misdiagnosis leads to inappropriate tests and improper treatment to the patient. When recognised it is often too late to do anything for the patient and they become highly dependent on social care. This case describes how the diagnosis can be confirmed through an ultrasound image and illustrates the need for early recognition to facilitate specialist care. PMID:23709549

Catatonia among adolescents with Down syndrome: a review and 2 case reports.

PubMed

Jap, Shannon N; Ghaziuddin, Neera

2011-12-01

Catatonia is a relatively common condition with an estimated prevalence of 0.6% to 17% among youth with psychiatric disorders. Certain patient groups, such as those with autism, may be at a particularly high risk for catatonia. Most of the youth with catatonia are males with a diagnosis of a bipolar disorder. We describe here 2 adolescent females, both with Down syndrome, who presented with catatonia not accompanied by significant affective or psychotic symptoms or with a general medical condition. Both patients had functioned well until the onset of catatonic symptoms. In the current classification system used in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, catatonia is described in association with schizophrenia, as a specifier of affective disorders or secondary to general medical conditions. The cases described here highlight the problem with this classification system when patients fail to meet any of the 3 diagnostic categories under which catatonia is currently described.

Identification and Management of Eating Disorders in Integrated Primary Care: Recommendations for Psychologists in Integrated Care Settings.

PubMed

Buchholz, Laura J; King, Paul R; Wray, Laura O

2017-06-01

Eating disorders are associated with deleterious health consequences, increased risk of mortality, and psychosocial impairment. Although individuals with eating disorders are likely to seek treatment in general medical settings such as primary care (PC), these conditions are often under-detected by PC providers. However, psychologists in integrated PC settings are likely to see patients with eating disorders because of the mental health comorbidities associated with these conditions. Further, due to their training in identifying risk factors associated with eating disorders (i.e., comorbid mental health and medical disorders) and opportunities for collaboration with PC providers, psychologists are well-positioned to improve the detection and management of eating disorders in PC. This paper provides a brief overview of eating disorders and practical guidance for psychologists working in integrated PC settings to facilitate the identification and management of these conditions.

Framing effect debiasing in medical decision making.

PubMed

Almashat, Sammy; Ayotte, Brian; Edelstein, Barry; Margrett, Jennifer

2008-04-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts. The present study investigated the effects of a debiasing procedure designed to prevent the framing effect for young adults who made decisions based on hypothetical medical decision-making vignettes. The debiasing technique involved participants listing advantages and disadvantages of each treatment prior to making a choice. One hundred and two undergraduate students read a set of three medical treatment vignettes that presented information in terms of different outcome probabilities under either debiasing or control conditions. The framing effect was demonstrated by the control group in two of the three vignettes. The debiasing group successfully avoided the framing effect for both of these vignettes. These results further support previous findings of the framing effect as well as an effective debiasing technique. This study improved upon previous framing debiasing studies by including a control group and personal medical scenarios, as well as demonstrating debiasing in a framing condition in which the framing effect was demonstrated without a debiasing procedure. The findings suggest a relatively simple manipulation may circumvent the use of decision-making heuristics in patients.

76 FR 41063 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE: Inclusion of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... years, registered pharmacists have played an increasing role in providing clinical services through the retail pharmacy venue. In 50 states, registered pharmacists are authorized to administer vaccines in a... are responsible for the training, oversight, and stipulating the conditions under which a pharmacist...

32 CFR 728.71 - Ex-service maternity care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of pregnancy, or separated from the service under honorable conditions and found to have been... certified by medical authorities that the pregnancy existed prior to entry into service (EPTE), maternity benefits are not authorized. (1) Former women members of the Army, Air Force, Navy, and Marine Corps. (2...

29 CFR 825.305 - Certification, general rule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee and Employer Rights and Obligations Under the Act § 825.305... employee's covered family member with a serious health condition, or due to the employee's own serious...

Early Intervention for Abused and Neglected Infants and Toddlers

ERIC Educational Resources Information Center

Zero to Three (J), 2006

2006-01-01

Children who suffer abuse or neglect, or have parents who suffer from mental health problems (especially maternal depression), substance abuse, or family violence, have as high a probability of experiencing developmental delays as do children with medical conditions that are automatically eligible for Part C services under the Individuals with…

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2014 CFR

2014-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2012 CFR

2012-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2013 CFR

2013-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 456.128 - Initial continued stay review date.

Code of Federal Regulations, 2010 CFR

2010-10-01

... norms to assign the initial continued stay review date, the number of days between the individual's... and criteria required to be described under § 456.129; (2) The individual's condition; and (3) The individual's projected discharge date; (c)(1) The committee uses any available appropriate regional medical...

Ultrasonic Drilling and Coring

NASA Technical Reports Server (NTRS)

Bar-Cohen, Yoseph

1998-01-01

A novel drilling and coring device, driven by a combination, of sonic and ultrasonic vibration, was developed. The device is applicable to soft and hard objects using low axial load and potentially operational under extreme conditions. The device has numerous potential planetary applications. Significant potential for commercialization in construction, demining, drilling and medical technologies.

TOTAL RESPIRATORY TRACT DEPOSITION OF FINE MICRON-SIZED PARTICLES IN HEALTHY ADULTS: EMPIRICIAL EQUATIONS FOR GENDER AND BREATHING PATTERN

EPA Science Inventory

An accurate dose estimation under various inhalation conditions is important for assessing both the potential health effects of pollutant particles and the therapeutic efficacy of medical aerosols. We measured total deposition fraction (TDF) of monodisperse micron-sized particles...

[Use of medical treatment data outside of the patient supply: best way pseudonymisation].

PubMed

Schütze, B

2012-04-01

The use of data pending during the patient supply to research, quality assurance as also to education is desirable. However, this use is not allowed in every German federal land without approval of the patient. Just in the case of retrospective research an approval of the patient is often not to be received. For the use of medical routine data for the research the pseudonymisation is good therefore. Pseudonymisation is a procedure by which all person-related data within a data record is replaced by one artificial identifier. Therefore pseudonymisation facilitates the linking of medical data and the data identifying the patient only under certain, before defined and controllable conditions. Through that medical data can be passed on to third party without this third party being able to identify the person who the medical data belong to. Under consideration of the present possibilities of the information technology as also the available technical preparations for the use of the pseudonymisation and the advantages being inherent in the pseudonymisation the pseudonymisation represents the method of choice during the use of data of the patient supply to the research, quality assurance as well as education. © Georg Thieme Verlag KG Stuttgart · New York.

Anticipatory nausea and vomiting due to chemotherapy.

PubMed

Kamen, Charles; Tejani, Mohamedtaki A; Chandwani, Kavita; Janelsins, Michelle; Peoples, Anita R; Roscoe, Joseph A; Morrow, Gary R

2014-01-05

As a specific variation of chemotherapy-induced nausea and vomiting, anticipatory nausea and vomiting (ANV) appears particularly linked to psychological processes. The three predominant factors related to ANV are classical conditioning; demographic and treatment-related factors; and anxiety or negative expectancies. Laboratory models have provided some support for these underlying mechanisms for ANV. ANV may be treated with medical or pharmacological interventions, including benzodiazepines and other psychotropic medications. However, behavioral treatments, including systematic desensitization, remain first line options for addressing ANV. Some complementary treatment approaches have shown promise in reducing ANV symptoms. Additional research into these approaches is needed. This review will address the underlying models of ANV and provide a discussion of these various treatment options. © 2013 Published by Elsevier B.V.

NASA Laboratory Analysis for Manned Exploration Missions

NASA Technical Reports Server (NTRS)

Krihak, Michael (Editor); Shaw, Tianna

2014-01-01

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability Element under the NASA Human Research Program. ELA instrumentation is identified as an essential capability for future exploration missions to diagnose and treat evidence-based medical conditions. However, mission architecture limits the medical equipment, consumables, and procedures that will be available to treat medical conditions during human exploration missions. Allocated resources such as mass, power, volume, and crew time must be used efficiently to optimize the delivery of in-flight medical care. Although commercial instruments can provide the blood and urine based measurements required for exploration missions, these commercial-off-the-shelf devices are prohibitive for deployment in the space environment. The objective of the ELA project is to close the technology gap of current minimally invasive laboratory capabilities and analytical measurements in a manner that the mission architecture constraints impose on exploration missions. Besides micro gravity and radiation tolerances, other principal issues that generally fail to meet NASA requirements include excessive mass, volume, power and consumables, and nominal reagent shelf-life. Though manned exploration missions will not occur for nearly a decade, NASA has already taken strides towards meeting the development of ELA medical diagnostics by developing mission requirements and concepts of operations that are coupled with strategic investments and partnerships towards meeting these challenges. This paper focuses on the remote environment, its challenges, biomedical diagnostics requirements and candidate technologies that may lead to successful blood/urine chemistry and biomolecular measurements in future space exploration missions. SUMMARY The NASA Exploration Laboratory Analysis project seeks to develop capability to diagnose anticipated space exploration medical conditions on future manned missions. To achieve this goal, NASA will leverage existing point-of-care technology to provide clinical laboratory measurements in space. This approach will place the project on a path to minimize sample, reagent consumption, mass, volume and power. For successful use in the space environment, NASA specific conditions such as micro gravity and radiation, for example, will also need to be addressed.

Gene, Immune and Cellular Responses to Single and Combined Space Flight Conditions-B (TripleLux-B):

NASA Image and Video Library

2015-03-31

ISS043E070945 (03/31/2015) --- ESA (European Space Agency) astronaut Samantha Cristoforetti, Expedition 43 flight engineer aboard the International Space Station, is seen working on a science experiment that includes photographic documentation of Cellular Responses to Single and Combined Space Flight Conditions. Some effects of the space environment level appear to act at the cellular level and it is important to understand the underlying mechanisms of these effects. This science project uses invertebrate hemocytes to focus on two aspects of cellular function which may have medical importance. The synergy between the effects of the space radiation environment and microgravity on cellular function is the goal of this experiment along with studying the impairment of immune functions under spaceflight conditions.

Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

PubMed

Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

2018-01-27

With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder.

PubMed

Suehs, Brandon T; Davis, Cralen; Ng, Daniel B; Gooch, Katherine

2017-07-01

Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB). A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined. Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p < 0.001). The incremental net cost associated with potentially inappropriate use of antimuscarinic medication was higher under the 2012 Beers Criteria than under the 2015 Beers Criteria. In this cohort of patients newly initiated on antimuscarinic OAB treatment, substantial overlap of patients identified with PIM based on the 2015 Beers Criteria compared with the 2012 Beers Criteria was observed. In addition, the findings suggest that, when applied to antimuscarinic initiators, the 2015 Beers Criteria result in a greater prevalence of PIM and the identification of patients with less overall medical morbidity than the 2012 Beers Criteria.

The Near Earth Asteroid Medical Conditions List

NASA Technical Reports Server (NTRS)

Barr, Yael R.; Watkins, S. D.

2011-01-01

Purpose: The Exploration Medical Capability (ExMC) element is one of six elements within NASA s Human Research Program (HRP) and is responsible for addressing the risk of "the inability to adequately recognize or treat an ill or injured crewmember" for exploration-class missions. The Near Earth Asteroid (NEA) Medical Conditions List, constructed by ExMC, is the first step in addressing the above-mentioned risk for the 13-month long NEA mission. The NEA mission is being designed by NASA's Human Space Flight Architecture Team (HAT). The purpose of the conditions list is to serve as an evidence-based foundation for determining which medical conditions could affect a crewmember during the NEA mission, which of those conditions would be of concern and require treatment, and for which conditions a gap in knowledge or technology development exists. This information is used to focus research efforts and technology development to ensure that the appropriate medical capabilities are available for exploration-class missions. Scope and Approach: The NEA Medical Conditions List is part of a broader Space Medicine Exploration Medical Conditions List (SMEMCL), which incorporates various exploration-class design reference missions (DRMs). The conditions list contains 85 medical conditions which could occur during space flight and which are derived from several sources: Long-Term Surveillance of Astronaut Health (LSAH) in-flight occurrence data, The Space Shuttle (STS) Medical Checklist, The International Space Station (ISS) Medical Checklist, and subject matter expert opinion. Each medical condition listed has been assigned a clinical priority and a clinical priority rationale based on incidence, consequence, and mitigation capability. Implementation: The conditions list is a "living document" and as such, new conditions can be added to the list, and the priority of conditions on the list can be adjusted as the DRM changes, and as screening, diagnosis, or treatment capabilities change. The NEA medical conditions list was used recently as the basis for identifying gaps in in-flight medical evaluation (screening) capabilities. Learning Objectives: The audience will become familiar with the approach taken by NASA's Exploration Medical Capability element in addressing the risk of inability to recognize and treat medical conditions in the setting of a Near Earth Asteroid mission. Which one of the following statements is incorrect? a) The Near Earth Asteroid (NEA) medical conditions list includes 85 medical conditions which could occur during space flight. b) Each condition on the NEA medical conditions list has been assigned a clinical priority and a clinical priority rationale. c) The NEA medical conditions list targets a mission to Mars. d) The NEA medical conditions list should be viewed as a "living document" where new conditions can be added and clinical priorities adjusted to address changes in the design reference mission or medical capabilities. The incorrect answer is c). The NEA medical conditions list targets a mission to a Near Earth Asteroid.

Ethical and epistemic issues in direct-to-consumer drug advertising: where is patient agency?

PubMed

Womack, Catherine A

2013-05-01

Arguments for and against direct-to-consumer drug advertising (DTCA) center on two issues: (1) the epistemic effects on patients through access to information provided by the ads; and (2) the effects of such information on patients' abilities to make good choices in the healthcare marketplace. Advocates argue that DTCA provides useful information for patients as consumers, including information connecting symptoms to particular medical conditions, information about new drug therapies for those conditions. Opponents of DTCA point out substantial omissions in information provided by the ads and argue that the framing of the ads may mislead patients about the indications, uses, and effectiveness of the drugs advertised. They also suggest that DTCA has a number of potentially negative effects on the doctor-patient relationship. The standard arguments appear to assume a simplistic correlation-more information means more agency for patients. However, empirical studies on medical decision making suggest that this relationship is much more complex and nuanced. I examine recent research on ways in which patients are vulnerable with respect to DTCA. In order to address the complex issues of information acquisition and consumer decision-making in the health care marketplace, the focus should not be simply on what information patients need in order to make medical decisions, but also on the conditions under which patients actually are able to make medical decisions requiring complex medication information. This requires examining both the cognitive limitations of patients with respect to drug information and investigating patients' preferences and needs in a variety of medical contexts.

Police officer response to the injured officer: a survey-based analysis of medical care decisions.

PubMed

Sztajnkrycer, Matthew D; Callaway, David W; Baez, Amado Alejandro

2007-01-01

No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat. The purpose of this study was to assess medical decision-making capabilities of law enforcement personnel under these circumstances. Web-based surveys were administered to all sworn officers within the county jurisdiction. Thirty-eight key actions were predetermined for nine injured officer scenarios, with each correct action worth one point. Descriptive statistics and t-tests were used to analyze results. Ninety-seven officers (65.1% response rate) responded to the survey. The majority of officers (68.0%) were trained to the first-responder level. Overall mean score for the scenarios was 15.5 +/- 3.6 (range 7-25). A higher level of medical training (EMT-B/P versus first responder) was associated with a higher mean score (16.6 +/- 3.4, p = 0.05 vs. 15.0 +/- 3.6, p = 0.05). Tactical unit assignment was associated with a lower score compared with non-assigned officers (13.5 +/- 2.9 vs. 16.0 +/- 3.6, p = 0.0085). No difference was noted based upon previous military experience. Ninety-two percent of respondents expressed interest in a law enforcement-oriented advanced first-aid course. Tactical medical decision-making capability, as assessed through the nine scenarios, was sub-optimal. In this post 9/11 era, development of law enforcement-specific medical training appears appropriate.

Diagnostic profile of young and middle-aged memory clinic patients.

PubMed

Vraamark Elberling, Tina; Stokholm, Jette; Høgh, Peter; Waldemar, Gunhild

2002-10-22

With the objective of characterizing the underlying conditions in younger patients with cognitive symptoms, 314 consecutive patients were studied, aged <60 years, referred to a multidisciplinary memory clinic over a period of 54 months. Fifteen percent of the patients fulfilled Diagnostic and Statistical Manual IV criteria for dementia, 17% had selective cognitive deficits, and 55% had no cognitive deficits. Cognitive symptoms in younger patients rarely reflect dementia but more often other medical and psychiatric conditions.

Hospitalizations for severe lower respiratory tract infections.

PubMed

Greenbaum, Adena H; Chen, Jufu; Reed, Carrie; Beavers, Suzanne; Callahan, David; Christensen, Deborah; Finelli, Lyn; Fry, Alicia M

2014-09-01

Hospitalization for lower respiratory tract infections (LRTIs) among children have been well characterized. We characterized hospitalizations for severe LRTI among children. We analyzed claims data from commercial and Medicaid insurance enrollees (MarketScan) ages 0 to 18 years from 2007 to 2011. LRTI hospitalizations were identified by the first 2 listed International Classification of Diseases, Ninth Revision discharge codes; those with ICU admission and/or receiving mechanical ventilation were defined as severe LRTI. Underlying conditions were determined from out- and inpatient discharge codes in the preceding year. We report insurance specific and combined rates that used both commercial and Medicaid rates and adjusted for age and insurance status. During 2007-2011, we identified 16797 and 12053 severe LRTI hospitalizations among commercial and Medicaid enrollees, respectively. The rates of severe LRTI hospitalizations per 100000 person-years were highest in children aged <1 year (commercial: 244; Medicaid: 372, respectively), and decreased with age. Among commercial enrollees, ≥ 1 condition increased the risk for severe LRTI (1 condition: adjusted relative risk, 2.68; 95% confidence interval, 2.58-2.78; 3 conditions: adjusted relative risk, 4.85; 95% confidence interval, 4.65-5.07) compared with children with no medical conditions. Using commercial/Medicaid combined rates, an estimated 31289 hospitalizations for severe LRTI occurred each year in children in the United States. Among children, the burden of hospitalization for severe LRTI is greatest among children aged <1 year. Children with underlying medical conditions are at greatest risk for severe LRTI hospitalization. Copyright © 2014 by the American Academy of Pediatrics.

Clinical prediction and the idea of a population.

PubMed

Armstrong, David

2017-04-01

Using an analysis of the British Medical Journal over the past 170 years, this article describes how changes in the idea of a population have informed new technologies of medical prediction. These approaches have largely replaced older ideas of clinical prognosis based on understanding the natural histories of the underlying pathologies. The 19 th -century idea of a population, which provided a denominator for medical events such as births and deaths, was constrained in its predictive power by its method of enumerating individual bodies. During the 20 th century, populations were increasingly constructed through inferential techniques based on patient groups and samples seen to possess variable characteristics. The emergence of these new virtual populations created the conditions for the emergence of predictive algorithms that are used to foretell our medical futures.

Incidence and prevalence of hyperhidrosis.

PubMed

Moraites, Eleni; Vaughn, Olushola Akinshemoyin; Hill, Samantha

2014-10-01

Hyperhidrosis is a skin disorder characterized by excessive sweating that often causes significant impairment in social, occupational, and emotional wellbeing. Hyperhidrosis is thought to affect 2.8% of the US population and can be of primary or secondary origin. Primary hyperhidrosis is usually bilateral, symmetric, and focal. The most common focal sites include, but are not limited to, the palms, soles, and axillae. Secondary hyperhidrosis is usually caused by an underlying medical condition or medication. Secondary hyperhidrosis must be ruled out before a diagnosis of primary hyperhidrosis is made. Copyright © 2014 Elsevier Inc. All rights reserved.

Body Mass Measurement - Skylab Experiment M172

NASA Technical Reports Server (NTRS)

1972-01-01

This chart provides details on Skylab's Body Mass Measurement experiment (M172). The M172 experiment was a medical study to determine the body mass of each crew member and observe changes in body masses during flight. Knowledge of exact body mass variations throughout the flight aided significantly in the correlation of other medical data obtained during the flight. Mass measurements under zero-gravity conditions were achieved by the application of Newton's second law (force equals mass times acceleration). The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

Outcomes after asystole events occurring during wearable defibrillator-cardioverter use.

PubMed

Liang, Jackson J; Bianco, Nicole R; Muser, Daniele; Enriquez, Andres; Santangeli, Pasquale; D'Souza, Benjamin A

2018-04-26

To examine whether wearable cardioverter defibrillator (WCD) alarms for asystole improve patient outcomes and survival. All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a database of device and medical record documentation and customer call reports. Events were classified as asystole episodes if initial presenting arrhythmia was asystole (< 10 beats/minor ≥ 5 s pause). Survival was defined as recovery at the scene or arrival to a medical facility alive, or not requiring immediate medical attention. Episodes occurring in hospitals, nursing homes, or ambulances were considered to be under medical care. Serious asystole episodes were defined as resulting in unconsciousness, hospital transfer, or death. Of the total 51933 patients having worn the WCD in 2013, there were 257 patients (0.5%) who had asystole episodes and comprised the study cohort. Among the 257 patients (74% male, median age 69 years), there were 264 asystole episodes. Overall patient survival was 42%. Most asystoles were considered "serious" ( n = 201 in 201 patients, 76%), with a 26% survival rate. All 56 patients with "non-serious" asystole episodes survived. Being under medical care was associated with worse survival of serious asystoles. Among acute survivors, 20% later died during WCD use (a median 4 days post asystole episode). Of the 86 living patients at the end of WCD use period, 48 (56%) received ICD/pacemaker and 17 (20%) improved their condition. Survival rates after asystole in patients with WCD are higher than historically reported survival rates. Those under medical care at time of asystole exhibited lower survival.

Adrenergic Receptor Stimulation Prevents Radiation-Induced DNA Strand Breaks, Apoptosis and Gene Expression in Simulated Microgravity

NASA Technical Reports Server (NTRS)

Moreno-Villanueva, Maria; Krieger, Stephanie; Feiveson, Alan; Kovach, Annie Marie; Buerkle, Alexander; Wu, Honglu

2017-01-01

Under Earth gravity conditions cellular damage can be counteracted by activation of the physiological defense mechanisms or through medical interventions. The mode of action of both, physiological response and medical interventions can be affected by microgravity leading to failure in repairing the damage. There are many studies reporting the effects of microgravity and/or radiation on cellular functions. However, little is known about the synergistic effects on cellular response to radiation when other endogenous cellular stress-response pathways are previously activated. Here, we investigated whether previous stimulation of the adrenergic receptor, which modulates immune response, affects radiation-induced apoptosis in immune cells under simulated microgravity conditions. Peripheral blood mononuclear cells (PBMCs) were stimulated with isoproterenol (a sympathomimetic drug) and exposed to 0.8 or 2Gy gamma-radiation in simulated microgravity versus Earth gravity. Expression of genes involved in adrenergic receptor pathways, DNA repair and apoptosis as well as the number of apoptotic cells and DNA strand breaks were determined. Our results showed that, under simulated microgravity conditions, previous treatment with isoproterenol prevented radiation-induced i) gene down regulation, ii) DNA strand breaks formation and iii) apoptosis induction. Interestedly, we found a radiation-induced increase of adrenergic receptor gene expression, which was also abolished in simulated microgravity. Understanding the mechanisms of isoproterenol-mediated radioprotection in simulated microgravity can help to develop countermeasures for space-associated health risks as well as radio-sensitizers for cancer therapy.

RBE and OER within the spread-out Bragg peak for proton beam therapy: in vitro study at the Proton Medical Research Center at the University of Tsukuba

PubMed Central

Kanemoto, Ayae; Hirayama, Ryoichi; Moritake, Takashi; Furusawa, Yoshiya; Sun, Lue; Sakae, Takeji; Kuno, Akihiro; Terunuma, Toshiyuki; Yasuoka, Kiyoshi; Mori, Yutaro; Tsuboi, Koji; Sakurai, Hideyuki

2014-01-01

There are few reports on the biological homogeneity within the spread-out Bragg peak (SOBP) of proton beams. Therefore, to evaluate the relative biological effectiveness (RBE) and the oxygen enhancement ratio (OER), human salivary gland tumor (HSG) cells were irradiated at the plateau position (position A) and three different positions within a 6-cm-wide SOBP (position B, 26 mm proximal to the middle; position C, middle; position D, 26 mm distal to the middle) using 155-MeV/n proton beams under both normoxic and hypoxic conditions at the Proton Medical Research Center, University of Tsukuba, Japan. The RBE to the plateau region (RBEplateau) and the OER value were calculated from the doses corresponding to 10% survival data. Under the normoxic condition, the RBEplateau was 1.00, 0.99 and 1.09 for positions B, C and D, respectively. Under the hypoxic condition, the RBEplateau was 1.10, 1.06 and 1.12 for positions B, C and D, respectively. The OER was 2.84, 2.60, 2.63 and 2.76 for positions A, B, C and D, respectively. There were no significant differences in either the RBEplateau or the OER between these three positions within the SOBP. In conclusion, biological homogeneity need not necessarily be taken into account for treatment planning for proton beam therapy at the University of Tsukuba. PMID:24876271

Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder.

PubMed

Chung, Eric; Lee, Dominic; Gani, Johan; Gillman, Michael; Maher, Christopher; Brennan, Janelle; Johns Putra, Lydia; Ahmad, Laura; Chan, Lewis Lw

2018-01-15

Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.

Status Epilepticus and Refractory Status Epilepticus Management

PubMed Central

Abend, Nicholas S.; Bearden, David; Helbig, Ingo; McGuire, Jennifer; Narula, Sona; Panzer, Jessica A.; Topjian, Alexis; Dlugos, Dennis J.

2014-01-01

Status epilepticus (SE) describes persistent or recurring seizures without a return to baseline mental status, and is a common neurologic emergency. SE can occur in the context of epilepsy or may be symptomatic of a wide range of underlying etiologies. The clinician’s aim is to rapidly institute care that simultaneously stabilizes the patient medically, identifies and manages any precipitant conditions, and terminates seizures. Seizure management involves “emergent” treatment with benzodiazepines followed by “urgent” therapy with other anti-seizure medications. If seizures persist then refractory SE is diagnosed and management options include additional anti-seizure medications or infusions of midazolam or pentobarbital. This paper reviews the management of pediatric SE and RSE. PMID:25727508

[Pecularities of organisation and health care delivery to military servicemen under conditions of mid- and high mountains].

PubMed

Khalimov, Yu Sh; Vetryakov, O V; Makiev, R G; Kuzmich, V G

2016-01-01

The authors present an analysis of adverse climatic factors mid- and high mountains, which have a significant negative impact on fighting facility and capacity for work in military servicemen that may cause an acute mountain sickness and severe complications (high altitude pulmonary edema and high-altitude cerebral edema). Complicated mechanisms of organism disorder are shown. Sophisticated medical and tactical factors of mountain theatre of war, defining the nature of actions of troops, require special approaches to organisation of medical support. One of the major tasks of the medical service and the commanders is the timely prevention of health disorders troops in mountainous terrain.

Exploration Medical System Demonstration (EMSD) Project

NASA Technical Reports Server (NTRS)

Chin, Duane

2012-01-01

The Exploration Medical System Demonstration (EMSD) is a project under the Exploration Medical Capability (ExMC) element managed by the Human Research Program (HRP). The vision for the EMSD is to utilize ISS as a test bed to show that several medical technologies needed for an exploration mission and medical informatics tools for managing evidence and decision making can be integrated into a single system and used by the on-orbit crew in an efficient and meaningful manner. Objectives: a) Reduce and even possibly eliminate the time required for on-orbit crew and ground personnel (which include Surgeon, Biomedical Engineer (BME) Flight Controller, and Medical Operations Data Specialist) to access and move medical data from one application to another. b) Demonstrate that the on-orbit crew has the ability to access medical data/information using an intuitive and crew-friendly software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management framework and architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities.

Thoracic radiology of infections emerging after natural disasters.

PubMed

Ketai, Loren; Currie, Bart J; Alva Lopez, Luis Felipe

2006-11-01

When natural disasters demolish shelter, destroy sources of clean drinking water, and disrupt the availability of medical care, vast numbers of people are placed at increased risk of disease. The infectious diseases that propagate under these conditions are usually common ones. Occasionally, a natural disaster alters the local environment in ways that markedly increase the prevalence of a disease that is endemic to a geographic region, occurring only as isolated cases under normal conditions. Many of these infections may affect the thorax. In this article, we discuss the radiologic findings of 4 infectious diseases, coccidioidomycosis, leptospirosis, melioidosis, and Chagas disease, which may flourish after natural disasters strike areas where they are endemic.

Empowered citizen 'health hackers' who are not waiting.

PubMed

Omer, Timothy

2016-08-17

Due to the easier access to information, the availability of low cost technologies and the involvement of well educated, passionate patients, a group of citizen 'Health Hackers', who are building their own medical systems to help them overcome the unmet needs of their conditions, is emerging. This has recently been the case in the type 1 diabetes community, under the movement #WeAreNotWaiting, with innovative use of current medical devices hacked to access data and Open-Source code producing solutions ranging from remote monitoring of diabetic children to producing an Artificial Pancreas System to automate the management and monitoring of a patient's condition. Timothy Omer is working with the community to utilise the technology already in his pocket to build a mobile- and smartwatch-based Artificial Pancreas System.

Interprofessional Learning of Physiotherapists under Conditions of Higher Education in Great Britain

ERIC Educational Resources Information Center

Guk, Svitlana

2014-01-01

The problems of implementing interprofessional training of physiotherapists in universities and at the bases of the practical training of students in Great Britain have been analyzed. The role of physiotherapists in issues of medical education and practical assistance within their own profession has been defined. The list of leading training bases…

20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

Code of Federal Regulations, 2011 CFR

2011-04-01

... Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES... records, death certificates, x-rays, magnetic resonance images or reports, computer axial tomography or...

20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

Code of Federal Regulations, 2014 CFR

2014-04-01

...' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL... certificates, x-rays, magnetic resonance images or reports, computer axial tomography or other imaging reports...

20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

Code of Federal Regulations, 2013 CFR

2013-04-01

...' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL... certificates, x-rays, magnetic resonance images or reports, computer axial tomography or other imaging reports...

20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES... records, death certificates, x-rays, magnetic resonance images or reports, computer axial tomography or...

20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

Code of Federal Regulations, 2012 CFR

2012-04-01

... Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES... records, death certificates, x-rays, magnetic resonance images or reports, computer axial tomography or...

Two cases of paralitic ileus in onco-hematologic patients

PubMed Central

Carraro, Francesca; Rivetti, Elisa; Romano, Erica; Fagioli, Franca

2012-01-01

Paralytic ileus is a severe complication resulting from a variety of disorders. It occurs most commonly in patients with serious underlying medical or surgical conditions. Prompt diagnosis and appropriate management may improve the outcome. We describe 2 cases of onco-hematologic patients who presented this complication after intensive chemotherapy. PMID:22690309

The Effect of Disability Insurance on Health Investment: Evidence from the Veterans Benefits Administration's Disability Compensation Program

ERIC Educational Resources Information Center

Singleton, Perry

2009-01-01

I examine whether individuals respond to monetary incentives to detect latent medical conditions. The effect is identified by a policy that deemed diabetes associated with herbicide exposure a compensable disability under the Veterans Benefits Administration's Disability Compensation program. Since a diagnosis is a requisite for benefit…

Chondriotin sulfate disaccharides as a bioactive compound modified the murine gut microbiome under healthy and stressed conditions

USDA-ARS?s Scientific Manuscript database

Chondriotin sulfate (CS) has been widely used for medical and nutraceutical purposes due to its roles in maintaining tissue structural integrity. We investigated if CS disaccharides may act as a bioactive compound and modulate gut microbial composition in mice. Our data show that CS disaccharides su...

38 CFR 51.43 - Per diem and drugs and medicines-principles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... medicines-principles. 51.43 Section 51.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... Per diem and drugs and medicines—principles. (a) As a condition for receiving payment of per diem... drugs and medicines under this part, the State must submit to the VA medical center of jurisdiction a...

Being born under adverse economic conditions leads to a higher cardiovascular mortality rate later in life: evidence based on individuals born at different stages of the business cycle.

PubMed

van den Berg, Gerard J; Doblhammer-Reiter, Gabriele; Christensen, Kaare

2011-05-01

We connect the recent medical and economic literatures on the long-run effects of early-life conditions by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life, we use the state of the business cycle around birth. We find significant negative effects of economic conditions around birth on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions, we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.

Payment or reimbursement for certain medical expenses for Camp Lejeune family members. Interim final rule.

PubMed

2014-09-24

The Department of Veterans Affairs (VA) is promulgating regulations to implement statutory authority to provide payment or reimbursement for hospital care and medical services provided to certain veterans' family members who resided at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. Under this rule, VA will reimburse family members, or pay providers, for medical expenses incurred as a result of certain illnesses and conditions that may be attributed to exposure to contaminated drinking water at Camp Lejeune during this time period. Payment or reimbursement will be made within the limitations set forth in statute and Camp Lejeune family members will receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans.

Medical foods for Alzheimer's disease.

PubMed

Shah, Raj C

2011-06-01

Alzheimer's disease (AD) is a neurodegenerative condition associated with cognitive loss, behavioural changes, functional ability decline and caregiver burden. Given the worldwide public health impact of AD, novel interventions to reduce suffering experienced by AD patients need to be developed. Foods may offer a mechanism for intervention complementary to drugs, devices, biologicals and vaccines. Apart from foods with health claims (including dietary supplements), medical foods are also being explored as an intervention option. The purpose of this article is to describe how medical foods may complement other interventions for AD patients by: (i) defining what a medical food is; (ii) discussing whether AD is a condition amenable to medical food intervention; (iii) reviewing current clinical trial data on medical foods used in participants with AD; and (iv) highlighting steps needed to establish a more comprehensive framework for developing medical foods for AD. While medical foods may be defined differently in other countries, the US Orphan Drug Act of 1998 defined a medical food as a food formulated for enteral intake, taken under physician supervision, and intended to meet the distinctive nutritional requirements identified for a disease or condition. For AD to be amenable to medical food intervention, it must: (i) result in limited or impaired capacity to ingest, digest, absorb or metabolize ordinary foodstuff or certain nutrients; or (ii) have unique, medically determined nutrient requirements; and (iii) require dietary management that cannot be achieved by modification of the normal diet alone. While these criteria are most likely met in advanced AD, identifying unique nutritional requirements in early AD that cannot be met by normal diet modification requires a better understanding of AD pathophysiology. A PubMed search using the terms 'medical food' and 'Alzheimer', limited to clinical trials published in English with human participants with AD aged >65 years and supplemented by other articles known to meet the inclusion criteria, revealed that only two medical foods, AC-1202 and Souvenaid® with Fortasyn Connect™, have clinical trial results available for discussion. As medical food development for AD is a relatively new endeavour, a window of opportunity exists for all stakeholders to develop a comprehensive framework for assuring that medical food interventions for AD achieve the highest possible scientific and ethical standards to warrant commercialization.

Sex differences in reinstatement of cocaine-seeking with combination treatments of progesterone and atomoxetine.

PubMed

Swalve, Natashia; Smethells, John R; Zlebnik, Natalie E; Carroll, Marilyn E

2016-06-01

Two repurposed medications have been proposed to treat cocaine abuse. Progesterone, a gonadal hormone, and atomoxetine, a medication commonly used to treat attention deficit/hyperactivity disorder, have both been separately shown to reduce cocaine self-administration and reinstatement (i.e., relapse). The goal of the present study was to examine sex differences in the individual effects of PRO and ATO as well as the combination PRO+ATO treatment on cocaine (COC), caffeine (CAF), and/or cue-primed reinstatement of cocaine-seeking. Adult male and female Wistar rats lever-pressed under a FR 1 schedule for cocaine infusions (0.4mg/kg/inf). After 14 sessions of stable responding in daily 2-h sessions, rats underwent a 21-day extinction period when no drug or drug-related stimuli were present. Rats were then separated into four groups that received PRO (0.5mg/kg) alone (PRO+SAL), ATO (1.5mg/kg) alone (VEH+ATO), control (VEH+SAL) or combination (PRO+ATO) treatments prior to the reinstatement condition. Reinstatement of cocaine-seeking to cues and/or drug injections of cocaine or caffeine was tested after extinction. During maintenance, females self-administered more cocaine than males, but no sex differences were seen during extinction. Females showed greater cocaine-seeking than males after a CAF priming injection. Individual treatment with ATO did not decrease reinstatement under any priming condition; however, the combination treatment decreased cocaine-seeking under the COC+CUES priming condition in males, and both PRO alone and the combination treatment decreased cocaine-seeking in the CAF+CUES condition in females. Overall, PRO alone was only effective in reducing reinstatement in females, while the combination treatment was consistently effective in reducing reinstatement in both sexes. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical and Immunological Benefits of OM-85 Bacterial Lysate in Patients with Allergic Rhinitis, Asthma, and COPD and Recurrent Respiratory Infections.

PubMed

Koatz, Ana M; Coe, Noemí A; Cicerán, Alberto; Alter, Adriana J

2016-08-01

The aim of this study was to evaluate the efficacy of OM-85 in reducing the incidence of respiratory tract infections (RTIs) in patients with allergic rhinitis, asthma, or chronic obstructive pulmonary disease (COPD), and its effect on immunological parameters, namely serum and secretory IgA levels. This was an open-label, prospective, sequential study which included 84 consecutive patients aged 16-65 years, who presented with recurrent (three or more) respiratory infections during the year prior to study entry. In the first year of the study, patients received standard optimized care (SOC), according to their underlying disease condition (asthma, allergic rhinitis, or COPD). In the following year, patients received treatment with OM-85 oral bacterial lysate (one 7 mg capsule daily for ten consecutive days per month, for 3 months), with a 6-month follow-up. Medical history, clinical symptoms, serum, and secretory IgA levels, and the number of infections and exacerbations were evaluated before and after treatment. There was a decrease in the total number of RTIs before the OM-85 treatment period (SOC only) compared to the year before the study start [69/266 (corresponding to a 74 % reduction)] and an additional decrease [38/69 (corresponding to a 45 % reduction)] after OM-85 treatment; p < 0.05. There was also a significant reduction in the total number of exacerbations related to the patients' underlying medical conditions, which decreased from 55 to 35 during OM-85 (+SOC) treatment, corresponding to a reduction of 36 %. In addition, an increase in serum and secretory IgA levels which coincided with the administration of OM-85 was observed. Our results showed the clinical benefits of OM-85 in reducing RTIs and exacerbations of the underlying medical condition, in patients with allergic rhinitis, asthma, or COPD.

The bactericidal effect of surface micro-discharge plasma under different ambient conditions

NASA Astrophysics Data System (ADS)

Shimizu, T.; Zimmermann, J. L.; Morfill, G. E.

2011-02-01

A series of experiments on the bactericidal properties of plasmas using a surface micro-discharge (SMD) device in an atmosphere under different ambient temperatures and humidities was carried out. This plasma dispenser was developed for use as a disinfection system in private and public places (hospitals, medical practices, etc). The bactericidal effect is due to the interplay of the plasma and the chemical products produced via interactions with O2/N2 and H2O vapour in air. To use this device in different countries and therefore under various ambient conditions, it is important to understand its behaviour and efficiency, especially with respect to air temperature and humidity. The experimental results obtained in this study show that the bactericidal properties of the SMD plasma dispenser are not sensitive to the different temperatures and humidities.

Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness.

PubMed

Moore, Andrew J; Richardson, Jane C; Bernard, Miriam; Sim, Julius

2018-02-26

Medical science and other sources, such as the media, increasingly inform the general public's understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper - based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis - we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs' use of medical images and models can inform patients' understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients' orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively. Implications for Rehabilitation Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease. An individual's understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care. Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively. Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients' activity levels and return to social participation.

Physician Satisfaction in Treating Medically Unexplained Symptoms.

PubMed

Brauer, Simon G; Yoon, John D; Curlin, Farr A

2017-05-01

To determine whether treating conditions having medically unexplained symptoms is associated with lower physician satisfaction and higher ascribed patient responsibility, and to determine whether higher ascribed patient responsibility is associated with lower physician satisfaction in treating a given condition. We surveyed a nationally representative sample of 1504 US primary care physicians. Respondents were asked how responsible patients are for two conditions with more-developed medical explanations (depression and anxiety) and two conditions with less-developed medical explanations (chronic back pain and fibromyalgia), and how much satisfaction they experienced in treating each condition. We used Wald tests to compare mean satisfaction and ascribed patient responsibility between medically explained conditions and medically unexplained conditions. We conducted single-level and multilevel ordinal logistic models to test the relation between ascribed patient responsibility and physician satisfaction. Treating medically unexplained conditions elicited less satisfaction than treating medically explained conditions (Wald P < 0.001). Physicians attribute significantly more patient responsibility to the former (Wald P < 0.005), although the magnitude of the difference is small. Across all four conditions, physicians reported experiencing less satisfaction when treating symptoms that result from choices for which patients are responsible (multilevel odds ratio 0.57, P = 0.000). Physicians experience less satisfaction in treating conditions characterized by medically unexplained conditions and in treating conditions for which they believe the patient is responsible.

Infrared Spectroscopy of Blood for Disease Identification

NASA Astrophysics Data System (ADS)

Pichardo, J. L.; Huerta-Franco, R.; Álvarez, R. R.; Bernal, J.; Gutiérrez-Juárez, G.; Palomares-Anda, P.

2003-09-01

Total reflectance attenuated infrared Fourier transform spectroscopy was used to analyze blood samples. Plasma and red blood cells were separated by centrifugation. The spectra were recorded from 200 to 4000 cm-1 under the same conditions for all samples. Samples of healthy donors were compared with those patients with different diseases (polycythemia and high blood pressure). Patients were under medical control at the time of the study. However, the preliminary results reveal that blood samples from healthy subjects had different infrared spectra compared to the non healthy patients.

Dyslipidemia prevalence, treatment, control, and awareness in the Canadian Health Measures Survey.

PubMed

Joffres, Michel; Shields, Margot; Tremblay, Mark S; Connor Gorber, Sarah

2013-04-24

The most recent Canadian population-level data on lipid levels are from 1992. This study presents current estimates of Canadians with dyslipidemia, the proportion aware of their condition, and the proportion being treated and below target values. The Canadian Health Measures Survey (2007-2009) assessed the prevalence, awareness and treatment of dyslipidemia. Dyslipidemia was defined as TC/HDL-C ratio ≥5; measured LDL-C ≥3.5 mmol/L; or taking lipid-modifying medications. The 2009 guidelines for the diagnosis and treatment of dyslipidemia were used to define low, moderate or high cardiovascular disease (CVD) risk and treatment initiation and targets. Forty-five percent of Canadians aged 18-79 years have dyslipidemia. Fifty-seven percent of respondents were not aware of their condition. Lipid-modifying therapy was initiated in individuals where treatment would be recommended in 49%, 20% and 54% of those at high, moderate, and low risk levels, respectively. The majority (81%) of those taking medication had their lipid levels under desirable levels, however, only 24% of those with dyslipidemia reported medication use. Overall, only 19% of those with dyslipidemia had their lipids under recommended levels. Only 41% of those taking lipid-modifying medication reached a recommended target of LDL-C <2 mmol/L or ApoB <0.8 g/L. There is still a high proportion of Canadians at high risk of CVD, with dyslipidemia, who are not being treated to recommended levels. These data need to be integrated into CVD reduction recommendations and represent an important baseline for assessing progress.

Attitudes of medical students to induced abortion.

PubMed

Buga, G A B

2002-05-01

Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can only be offered under conditions where legislation has been passed for legal termination of unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the attitudes of doctors and other healthcare workers to induced abortion. Medical students as future doctors may have attitudes to abortion that will affect the provision of safe abortion. Little is known about the attitudes of South African medical students to abortion. To assess sexual practices and attitudes of medical students to induced abortion and to determine some of the factors that may influence these attitudes. A cross-sectional analytic study involving the self-administration of an anonymous questionnaire. The questionnaire was administered to medical students at a small, but growing, medical school situated in rural South Africa. Demographic data, sexual practices and attitudes to induced abortion. Two hundred and forty seven out of 300 (82.3%) medical students responded. Their mean age was 21.81 +/- 3.36 (SD) years, and 78.8% were Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single, 68.6% were already sexually experienced, and their mean age at coitarche was 17.24+/-3.14 (SD) years. Although overall 61.2% of the respondents felt abortion is murder either at conception or later, the majority (87.2%) would perform or refer a woman for abortion under certain circumstances. These circumstances, in descending order of frequency, include: threat to mother's life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to mother's mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents would perform or refer for abortion on demand, 12.8% would neither perform nor refer for abortion under any circumstances. Religious affiliation and service attendance significantly influenced some of these attitudes and beliefs. Although many of the medical students personally felt abortion is murder, the majority are likely to perform or refer patients for abortion under certain circumstances; only about a tenth are likely to perform or refer patients for abortion on demand.

Effects of Two Years of Exercise on Gait Impairment in People with Parkinson’s Disease: The PRET-PD Randomized Trial

PubMed Central

Rafferty, Miriam R.; Prodoehl, Janey; Robichaud, Julie A.; David, Fabian J.; Poon, Cynthia; Goelz, Lisa C.; Vaillancourt, David E.; Kohrt, Wendy M.; Comella, Cynthia L.; Corcos, Daniel M.

2016-01-01

Background and Purpose This study presents a secondary analysis from the Progressive Resistance Exercise Training in Parkinson disease (PRET-PD) trial investigating the effects of progressive resistance exercise (PRE) and a PD-specific multimodal exercise program, modified Fitness Counts (mFC), on spatial, temporal, and stability-related gait impairments in people with Parkinson disease (PD). Methods Forty-eight people with PD were randomized to participate in PRE or mFC 2×/week for 24 months; 38 completed the study. Gait velocity, stride length, cadence, and double support time were measured under 4 walking conditions (off/on medication, comfortable/fast speed). Ankle strength was also measured off and on medication. Twenty-four healthy controls provided comparison data at one time point. Results At 24 months, there were no significant differences between exercise groups. Both groups improved fast gait velocity off medication, cadence in all conditions, and plantarflexion strength off/on medication. Both groups with PD had more gait measures that approximated the heathy controls at 24 months than at baseline. Plantarflexion strength was significantly associated with gait velocity and stride length in people with PD at baseline and 24 months, but changes in strength were not associated with changes in gait. Discussion and Conclusions Twenty-four months of PRE and mFC were associated with improved off medication fast gait velocity and improved cadence in all conditions, which is important because temporal gait measures can be resistant to medications. Spatial and stability-related measures were resistant to long-term improvements, but did not decline over 24 months. Strength gains did not appear to transfer to gait. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1). PMID:27977518

Cross-standard user description in mobile, medical oriented virtual collaborative environments

NASA Astrophysics Data System (ADS)

Ganji, Rama Rao; Mitrea, Mihai; Joveski, Bojan; Chammem, Afef

2015-03-01

By combining four different open standards belonging to the ISO/IEC JTC1/SC29 WG11 (a.k.a. MPEG) and W3C, this paper advances an architecture for mobile, medical oriented virtual collaborative environments. The various users are represented according to MPEG-UD (MPEG User Description) while the security issues are dealt with by deploying the WebID principles. On the server side, irrespective of their elementary types (text, image, video, 3D, …), the medical data are aggregated into hierarchical, interactive multimedia scenes which are alternatively represented into MPEG-4 BiFS or HTML5 standards. This way, each type of content can be optimally encoded according to its particular constraints (semantic, medical practice, network conditions, etc.). The mobile device should ensure only the displaying of the content (inside an MPEG player or an HTML5 browser) and the capturing of the user interaction. The overall architecture is implemented and tested under the framework of the MEDUSA European project, in partnership with medical institutions. The testbed considers a server emulated by a PC and heterogeneous user devices (tablets, smartphones, laptops) running under iOS, Android and Windows operating systems. The connection between the users and the server is alternatively ensured by WiFi and 3G/4G networks.

Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities

PubMed Central

Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

2018-01-01

Background: With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, “‘medically under-served” patients continue to experience significant inequalities around access to healthcare services. Aim: This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Method: Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals (n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Results: Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. Discussion: This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual’s needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements. PMID:29382062

[Practice guidelines for pain management in Mexico].

PubMed

Guevara-López, Uriah; Covarrubias-Gómez, Alfredo; Rodríguez-Cabrera, Rafael; Carrasco-Rojas, Antonio; Aragón, Griselda; Ayón-Villanueva, Hortensia

2007-01-01

It has been documented that pain, in its diverse modalities, is the most common cause of medical attention in Mexico. Due to the increased frequency, pain management has been under consideration in health programs. On the other hand, inadequate pain management can cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has been no agreement to establish better diagnostic and therapeutic methods. Three consensus groups were reunited in different times; those were integrated by medical experts from private and public institutions and form diverse states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of painful conditions. Following the methodology used for other consensus groups, diverse meetings were held to review medical evidence about the assessment and treatment of acute, perioperative and cancer pain. A series of recommendations were obtained and classified according to their methodological strength. As a result of these meetings, a series of recommendations based on the medical evidence were obtained. These recommendations are outlined in three practice guidelines that are intended to allow Mexican practitioners to provide optimal management for painful conditions.

Mitigation of Tracheobronchomalacia with 3D-Printed Personalized Medical Devices in Pediatric Patients

PubMed Central

Morrison, Robert J.; Hollister, Scott J.; Niedner, Matthew F.; Mahani, Maryam Ghadimi; Park, Albert H.; Mehta, Deepak K.; Ohye, Richard G.; Green, Glenn E.

2015-01-01

Three-dimensional (3D) printing offers the potential for rapid customization of medical devices. The advent of 3D-printable biomaterials has created the potential for device control in the fourth dimension: 3D-printed objects that exhibit a designed shape change under tissue growth and resorption conditions over time. Tracheobronchomalacia (TBM) is a condition of excessive collapse of the airways during respiration that can lead to life-threatening cardiopulmonary arrests. Here we demonstrate the successful application of 3D printing technology to produce a personalized medical device for treatment of TBM, designed to accommodate airway growth while preventing external compression over a pre-determined time period before bioresorption. We implanted patient-specific 3D-printed external airway splints in three infants with severe TBM. At the time of publication, these infants no longer exhibited life-threatening airway disease and had demonstrated resolution of both pulmonary and extra-pulmonary complications of their TBM. Long-term data show continued growth of the primary airways. This process has broad application for medical manufacturing of patient-specific 3D-printed devices that adjust to tissue growth through designed mechanical and degradation behaviors over time. PMID:25925683

Job of the Bible: leprosy or scabies?

PubMed

Appelboom, Thierry; Cogan, Elie; Klastersky, Jean

2007-04-01

Proposing a medical diagnosis a posteriori of a person who died a long time ago is not as impossible as it sounds if sufficient medical history is available.A whole book of the Bible is devoted to Job and his trials. The diagnosis of leprosy has been generally accepted by medieval commentators because the verses of the Book speak of ulcers disseminated over the skin, and also because leprosy is an exemplary sanction imposed by way of example by God to punish those who have committed a sin. In this paper, we have taken the different verses with a medical content from the Book of Job, and reconstructed the clinical picture as if the patient had turned up in the 21st century in order to see if the diagnosis of leprosy may be called into question, and to discuss the limits of the medico-historic approach. The clinical picture of the disease consists of deterioration in the general condition, with widespread pain, confusion, skin eruptions, bilious vomiting, and so on. Under these conditions, if Job did exist, and if the retrospective medical history is reliable, the most likely diagnosis is that of scabies rather than leprosy. Copyright (c) 2007 Mount Sinai School of Medicine.

The burden of premature ejaculation: the patient's perspective.

PubMed

Sotomayor, Mariano

2005-05-01

Premature ejaculation (PE) remains an underdetected and under-treated condition, despite the advances in available treatment options. Men with PE often feel stigmatized by the condition and embarrassment is a key barrier to discussing the problem with healthcare professionals. Men with PE perceive themselves as having little control over ejaculation and this lack of control is mirrored in diminished satisfaction with sexual intercourse. The burden of PE is both emotional and physical. Premature ejaculation is associated with low self-esteem, anxiety, and feelings of shame and inferiority. In some studies there is an association with depression. Premature ejaculation places a significant burden on the patient-partner relationship and there is evidence to suggest that there is a higher prevalence of female sexual dysfunction associated with PE. Patients with PE often view the condition as purely psychological or as a problem that will resolve with time and many are unaware that medical treatment could be of benefit. This endorses the particularly important role of healthcare professionals in recognizing the barriers to patient diagnosis and promoting the view that PE is not only a common but also a treatable medical condition.

Understanding Neurophobia: Reasons behind Impaired Understanding and Learning of Neuroanatomy in Cross-Disciplinary Healthcare Students

ERIC Educational Resources Information Center

Javaid, Muhammad Asim; Chakraborty, Shelly; Cryan, John F.; Schellekens, Harriët; Toulouse, André

2018-01-01

Recent studies have highlighted a fear or difficulty with the study and understanding of neuroanatomy among medical and healthcare students. This has been linked with a diminished confidence of clinical practitioners and students to manage patients with neurological conditions. The underlying reasons for this difficulty have been queried among a…

3 CFR 8843 - Proclamation 8843 of July 26, 2012. Anniversary of the Americans With Disabilities Act, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... President of the United States of America A Proclamation Since our earliest days, America has measured its.... Under this landmark law, America became the first Nation to comprehensively declare equality for its... conditions, medical history, or genetic information—a provision that will be extended to all Americans in...

The british military hospitals in macedonia during the first world war.

PubMed

Cvetkovski, Vladimir

The paper focusses its attention to the medical work of the British Military hospitals stationed in Macedonia during the First World War, the surgical work carried out under very heavy conditions in improvised operating theatres as well as the treatment of the wounded and sick solders brought from the battlefields on the Macedonian Front.

How and What Do Medical Students Learn in Clerkships? Experience Based Learning (ExBL)

ERIC Educational Resources Information Center

Dornan, Tim; Tan, Naomi; Boshuizen, Henny; Gick, Rachel; Isba, Rachel; Mann, Karen; Scherpbier, Albert; Spencer, John; Timmins, Elizabeth

2014-01-01

Clerkship education has been called a "black box" because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links…

Haloperidol Treatment with Chronically Medicated Residents: Dose Effects on Clinical Behavior and Reinforcement Contingencies.

ERIC Educational Resources Information Center

Aman, Michael G.; And Others

1989-01-01

The study of effects of haloperidol drug therapy with 20 institutionalized mentally retarded persons found clinical changes confined to a slight reduction in stereotypic behavior and an increase in gross motor activity under the high dose condition. Subjects with high initial levels of stereotypy showed the best response to the drug. (Author/DB)

42 CFR 410.19 - Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Ultrasound screening for abdominal aortic aneurysms... (SMI) BENEFITS Medical and Other Health Services § 410.19 Ultrasound screening for abdominal aortic... ultrasound screening for an abdominal aortic aneurysm under Medicare program; and (2) Is included in at least...

CME, Physicians, and Pavlov: Can We Change What Happens When Industry Rings the Bell?

PubMed Central

Lichter, Paul R.

2008-01-01

Purpose To show how physicians’ conditioned response to “keeping up” has helped industry’s opportunistic funding of continuing medical education (CME) and to propose ways to counter the conditioned response to the benefit of patients and the public. Methods Review of the literature and commentary on it. Results The pharmaceutical and device industries (hereafter referred to as industry) have a long history of bribing physicians to prescribe and use their products. Increasing pressure from Congress and the public has been brought to bear on industry gifting. This pressure, coinciding with increasing financial problems for the providers of CME, provided industry with reason and opportunity to expand its role in the financing of CME. Industry’s incentive to make its CME funding appear to be an arm’s-length transaction has spawned medical education service supplier (MESS) companies. Industry makes “unrestricted grants” to the MESS, and the MESS puts on the CME program. Helped by these CME programs, industry is able to subtly “buy” physicians one at a time, so that under the cover of “education” they and their academic institutions and medical organizations lose sight of being CME pawns in industry’s sole objective: profit. Conclusions Despite a vast literature showing how physician integrity is easy prey to industry, the medical profession continues to allow industry to have a detrimental influence on the practice of medicine and on physician respectability. It will take resolute action to change the medical profession’s conditioned response to industry’s CME bell and its negative effect on patients and the public. PMID:19277219

Pilot Domain Task Experience in Night Fatal Helicopter Emergency Medical Service Accidents.

PubMed

Aherne, Bryan B; Zhang, Chrystal; Newman, David G

2016-06-01

In the United States, accident and fatality rates in helicopter emergency medical service (HEMS) operations increase significantly under nighttime environmentally hazardous operational conditions. Other studies have found pilots' total flight hours unrelated to HEMS accident outcomes. Many factors affect pilots' decision making, including their experience. This study seeks to investigate whether pilot domain task experience (DTE) in HEMS plays a role against likelihood of accidents at night when hazardous operational conditions are entered. There were 32 flights with single pilot nighttime fatal HEMS accidents between 1995 and 2013 with findings of controlled flight into terrain (CFIT) and loss of control (LCTRL) due to spatial disorientation (SD) identified. The HEMS DTE of the pilots were compared with industry survey data. Of the pilots, 56% had ≤2 yr of HEMS experience and 9% had >10 yr of HEMS experience. There were 21 (66%) accidents that occurred in non-visual flight rules (VFR) conditions despite all flights being required to be conducted under VFR. There was a statistically significant increase in accident rates in pilots with <2 and <4 yr HEMS DTE and a statistically significant decrease in accident rates in pilots with >10 yr HEMS DTE. HEMS DTE plays a preventive role against the likelihood of a night operational accident. Pilots with limited HEMS DTE are more likely to make a poor assessment of hazardous conditions at night, and this will place HEMS flight crew at high risk in the VFR night domain.

Forms of war.

PubMed

Vogel, H; Bartelt, D

2007-08-01

Under war conditions, employed weapons can be identified on radiographs obtained in X-ray diagnostic. The analysis of such X-ray films allows concluding that there are additional information about the conditions of transport and treatment; it shall be shown that there are X-ray findings which are typical and characteristic for certain forms of warfare. The radiograms have been collected during thirty years; they come from hospitals, where war casualties had been treated, and personal collections. The material is selected, because in war X-ray diagnostic will be limited and the interest of the opposing parties influence the access to the material; furthermore the possibilities to publish or to communicate facts and thoughts are different. Citizens of the USA, GB, France, or Israel will have easier access to journals than those of Vietnam, Chad, and Zimbabwe. Under war conditions, poor countries, like North Vietnam may develop own concepts of medical care. There are X-ray findings which are typical or even characteristic for air warfare, guerrilla warfare, gas war, desert warfare, conventional warfare, and annihilation warfare, and city guerrilla warfare/civil war. The examples demonstrate that weapons and the conditions of transport and treatment can be recognized by X-ray findings. The radiogram can be read like a document. In War, there are differences between a treatment and imaging diagnostic in countries, which control the air space and in those who do not. Medical care of the poor, i.e. in countries (in general those opposing the western nations) will hardly be published, and poverty has no advocate.

What is the definition of a poisoning?

PubMed

Uges, D R

2001-03-01

New insights in medicine and acceptable treatments necessitates an adjustment of the existing definition of clinical or forensic poisoning to: 'An individual's medical or social unacceptable condition as a consequence of being under influence of an exogenous substance in a dose too high for the person concerned'. For medical and legal purposes it is important to know how the victim became poisoned. In general, there are three ways of causing medical poisoning: accidental poisoning, including iatrogenic poisoning, experimental and intentional poisoning. Nowadays iatrogenic intoxication, poisoning caused by the Münchhausen's syndrome (by proxy) and experimental poisoning (designer drugs) have a major place in contemporary toxicology. Although some toxicologists use the word 'intoxication' only overdoses with central effects, in this article 'intoxication' and 'poisoning' are considered to be synonymous.

Successful medical management of a neonate with spontaneous splenic rupture and severe hemophilia A.

PubMed

Badawy, Sherif M; Rossoff, Jenna; Yallapragada, Sushmita; Liem, Robert I; Sharathkumar, Anjali A

2017-03-01

Splenic rupture in neonates is a rare event, usually occurring in the setting of underlying predisposing conditions. Here, we present the case of a term neonate who presented with worsening anemia in the setting of known hemolytic disease during the newborn period and was later found to have a spontaneous splenic rupture. He was subsequently diagnosed with severe hemophilia A, and was managed medically with recombinant factor VIII replacement therapy without any surgical intervention. This is the first reported case of a neonate who had spontaneous splenic rupture and severe hemophilia A, and underwent successful medical treatment without any surgical intervention. Copyright © 2016 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. All rights reserved.

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders

PubMed Central

Fife, Terry D.; Moawad, Heidi; Moschonas, Constantine; Hammond, Nancy

2015-01-01

Summary The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time. PMID:26336632

[Medicine behind bars. Illness is usual not grounds for modifying imprisonment].

PubMed

Schwarzkopf, A; Zenker, M

2002-05-16

The article describes the possibilities of medical care in prison as exemplified by the Kassel 1 prison with its attached central hospital facility. The main areas of medical care covered there are the treatment of wounds, conservative treatment of fractures, ophthalmology, ENT, urology, dentistry and, via external consultant physicians, also internal medicine, pneumology, dermatology and gynecology. Such infections as hepatitis B and C, syphilis, and tuberculosis have a greater prevalence among prisoners--in contrast to other infections afflicting people housed under similar living conditions, such as in communal living facilities, which show no such increased prevalence. Furthermore, there is a relatively high percentage of injuries, including those that are self-inflicted. The problem of certifying a prisoner medically unfit to tolerate imprisonment is discussed.

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.

PubMed

Fife, Terry D; Moawad, Heidi; Moschonas, Constantine; Shepard, Katie; Hammond, Nancy

2015-08-01

The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana ( Cannabis sativa ) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time.

Role of Inflammation in Human Fatigue: Relevance of Multidimensional Assessments and Potential Neuronal Mechanisms

PubMed Central

Karshikoff, Bianka; Sundelin, Tina; Lasselin, Julie

2017-01-01

Fatigue is a highly disabling symptom in various medical conditions. While inflammation has been suggested as a potential contributor to the development of fatigue, underlying mechanisms remain poorly understood. In this review, we propose that a better assessment of central fatigue, taking into account its multidimensional features, could help elucidate the role and mechanisms of inflammation in fatigue development. A description of the features of central fatigue is provided, and the current evidence describing the association between inflammation and fatigue in various medical conditions is reviewed. Additionally, the effect of inflammation on specific neuronal processes that may be involved in distinct fatigue dimensions is described. We suggest that the multidimensional aspects of fatigue should be assessed in future studies of inflammation-induced fatigue and that this would benefit the development of effective therapeutic interventions. PMID:28163706

Military nephrology—what a civilian doctor should know

PubMed Central

2011-01-01

This article provides some background on military nephrology in the UK. The primary objective of the Defence Medical Services is the maintenance of operational capability of military personnel. This includes exclusion of nephrological diseases that might reduce renal reserve to a critical level under field conditions, increasing susceptibility to trauma, burns, infection and adverse environmental conditions and increasing the need for renal support. Renal failure potentially compromises not only the patient but also his comrades through reduced staffing and inability to execute the military mission. Safety of weapon systems for which the patient is responsible may be reduced. At forward locations, need for evacuation may put aircraft or vehicles and their crew with medical attendants at unnecessary risk. Regular follow-up and continuity of care are difficult owing to the demands of military life that include frequent postings and deployments. PMID:25984145

Soldiers as subjects of medical research: Comments on Hassidim et al. on ethical standards of the Israel Defense Force.

PubMed

Kasher, Asa

2017-01-01

In 2008 a group of former soldiers of the Israel Defense Force (IDF) sued the Ministry of Defense and others, claiming they had suffered from medical problems that resulted from an IDF medical experiment in which they had participated in the 1970s. There was no compelling medical evidence with respect to causal relationships between their participation in the experiment and their later medical problems. The President of the District Court, Justice Hila Gerstl, appointed me, with the consent of the parties, to write a deposition with respect to the ethical aspects of the case. My comments in the sequel rest on my deposition, applying not only to the case that had been under discussion but also to each and every case of experimentation. My arguments, strictly confined to the ethical aspects of the case, as opposed to the legal aspects and the debated facts, were not in favor of either party. As a result the state and the former soldiers reached an agreement approved by the court. One of the major points made in that deposition is that the Nuremberg and Helsinki principles follow from those of medical ethics in general, except for the requirement to have an Institutional Review Board (IRB). A second major point is that under very strict conditions, more than what is usually required, soldiers may participate in medical experiments administered by their military force. However, new conscripts during their first months of their service should not take part in medical experimentation within their military force.

[Evaluation and management of hyperhidrosis].

PubMed

Menzinger, Sébastien; Quenan, Sandrine

2017-03-29

Hyperhidrosis is excessive sweating beyond what is expected for thermoregulatory needs. Nearly 3 % of the population has hyperhidrosis. It may be primary or secondary to medications or general medical conditions, including diabetes mellitus, hyperthyroidism, Parkinson disease, etc. History taking and clinical examination are essential to differentiate primary from secondary origins. Blood tests and a consultation with a specialist (endocrinologist, neurologist) is sometimes necessary to establish the diagnosis. The management of secondary hyperhidrosis involves the treatment of the underlying cause. For primary hyperhidrosis, it depends on its severity and the sites affected. This article will review the treatments for primary hyperhidrosis.

Firearms, mental illness, dementia and the clinician.

PubMed

Wand, Anne P F; Peisah, Carmelle; Strukovski, Julie-Anne; Brodaty, Henry

2014-12-11

Clinicians have an obligation to report to state or territory police any concerns about risk of harm from patients with access to firearms. Dementia is an under-recognised medical problem which may increase the risk of firearm injury or violence in those with such access. There are no guidelines for clinicians regarding mandatory screening for access to firearms, and currently the onus is on the firearm licence holder to declare any relevant medical conditions. We propose that clinicians should screen patients for firearm possession and use a combined capacity and risk assessment approach to evaluating fitness for firearm licences.

Challenges of self-reported medical conditions and electronic medical records among members of a large military cohort

PubMed Central

Smith, Besa; Chu, Laura K; Smith, Tyler C; Amoroso, Paul J; Boyko, Edward J; Hooper, Tomoko I; Gackstetter, Gary D; Ryan, Margaret AK

2008-01-01

Background Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medical record diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the "health literacy" of the patient. Methods The US Department of Defense military health system offers a unique opportunity to evaluate electronic medical records with near complete ascertainment while on active duty. This study compared 38 self-reported medical conditions to electronic medical record data in a large population-based US military cohort. The objective of this study was to better understand challenges and strengths in self-reporting of medical conditions. Results Using positive and negative agreement statistics for less-prevalent conditions, near-perfect negative agreement and moderate positive agreement were found for the 38 diagnoses. Conclusion This report highlights the challenges of using self-reported medical data and electronic medical records data, but illustrates that agreement between the two data sources increases with increased surveillance period of medical records. Self-reported medical data may be sufficient for ruling out history of a particular condition whereas prevalence studies may be best served by using an objective measure of medical conditions found in electronic healthcare records. Defining medical conditions from multiple sources in large, long-term prospective cohorts will reinforce the value of the study, particularly during the initial years when prevalence for many conditions may still be low. PMID:18644098

[The influence of the climatic and weather conditions on the mechanisms underlying the formation of enhanced meteosensitivity (a literature review)].

PubMed

Uyanaeva, A I; Tupitsyna, Yu Yu; Rassulova, M A; Turova, E A; Lvova, N V; Ajrapetova, N S

The present review concerns the problem of the influence of the climatic conditions on the human body, the creation of the medical weather forecast service, the development of non-pharmacological methods for the correction of meteopathic disorders, and the reduction of the risk of the complications provoked by the unfavourable weather conditions. The literature data are used to analyse the influence of climatic and weather factors on the formation of enhanced meteosensitivity and the development of exacerbations of chronic non-communicable diseases under the influence of weather conditions. It is concluded that marked changes of the weather may lead to an increased frequency of exacerbations of the chronic non-communicable diseases. The influence of weather and climate on human health is becoming an increasingly important factor under the current conditions bearing in mind the modern tendency toward variations of the global climatic conditions and their specific regional manifestations. The authors emphasize the necessity of the identification and evaluation of the predictors of the development of high meteosensitivity for the prognostication of the risks of the meteopathic reactions and the complications associated with the changes in weather conditions as well as the importance of the improvement of the existing and the development of new methods for the non-pharmacological prevention and correction of enhanced meteosensitivity with the application of the natural and preformed physical factors.

Conditioned pharmacotherapeutic effects: a preliminary study.

PubMed

Ader, Robert; Mercurio, Mary Gail; Walton, James; James, Deborra; Davis, Michael; Ojha, Valerie; Kimball, Alexa Boer; Fiorentino, David

2010-02-01

To test the hypothesize that psoriasis patients treated under a partial schedule of pharmacologic (corticosteroid) reinforcement would show less severe symptoms and relapse than those given the same amount of drug under standard conditions. Behavioral conditioning as an inherent component of many pharmacotherapeutic protocols has never been examined. A double-blind, simple randomization intervention was conducted with 46 patients from California and New York. Initially, lesions were treated with 0.1% acetonide triamcinolone under standard treatment conditions. Thereafter, a Standard Therapy group continued on continuous reinforcement (active drug every treatment) with 100% of the initial dose; Partial Reinforcement patients received a full dose 25% to 50% of the time and placebo medication other times; Dose Control patients received continuous reinforcement with 25% to 50% of the initial dose. Severity of disease scores in California neither supported nor refuted the hypothesis. In New York, where there was no difference between Partial Reinforcement and Dose Control groups at baseline, partial reinforcement effected a greater reduction in lesion severity than Dose Control conditions and did not differ from Standard Therapy patients receiving two to four times more drug. For the entire population, the frequency of relapse under partial reinforcement (26.7%) was lower than in Dose Control patients (61.5%) and did not differ from full-dose treatment (22.2%). A partial schedule of pharmacotherapeutic reinforcement could maintain psoriasis patients with a cumulative amount of corticosteroid that was relatively ineffective when administered under standard treatment conditions. Conceivably, corticosteroid administration only one quarter or half as frequently as currently prescribed is sufficient to treat psoriasis. We posit, however, that these preliminary observations implicate conditioning processes in-and for the design of-regimens of pharmacotherapy.

CobraPLA Insertion by anesthetists and non-anesthetists wearing unconventional protective gear: a prospective study in humans.

PubMed

Ben-Abraham, Ron; Flaishon, Ron; Sotman, Alexander; Ekstein, Perla; Ezri, Tiberiu; Ogorek, Daniel; Weinbroum, Avi A

2008-07-01

The threat of a mass casualty unconventional attack has challenged the medical community to devise means for providing rapid and reliable emergent airway control under chaotic conditions by inexperienced medical personnel dressed in self protective gear. Since endotracheal intubation may not be feasible under those conditions, other extraglottic devices should be considered. We assessed the performance of anesthesia and non-anesthesia residents in inserting the CobraPLA, a supraglottic airway device, on consecutive anesthetized patients, to assess its potential use under simulated conditions. Anesthesia and non-anesthesia residents wearing either surgical scrubs or complete anti-chemical gear inserted the CobraPLA in anesthetized patients. If post-trial positive pressure ventilation via the CobraPLA was unsuccessful, an LMA or endotracheal tube was inserted in its stead. It took anesthesia residents 57+/-23 sec and 43+/-13 sec (P<0.05) to place the CobraPLA while wearing anti-chemical gear and surgical scrubs, respectively. Non-anesthesia residents wearing anti-chemical gear performed worse than anesthetists in their first insertion (73+/-9 sec, P<0.05), but after the brief training period they performed as well as their colleagues anesthetists (58+/-10 sec, P=NS). Post-trial, twenty-one CobraPLA (42%) leaked, preventing adequate positive-pressure ventilation: 13 devices (26% of the total) required replacements. Anti-chemical protective gear slowed the insertion of the CobraPLA by anesthetists, and more so by other residents inexperienced in airway management. In 26% of the cases CobraPLA was inadequate for positive pressure ventilation.

Evaluation of macrocytosis in routine hemograms.

PubMed

Veda, P

2013-03-01

Macrocytosis, a condition in which erythrocytes are larger than normal manifests as an increase in mean corpuscular volume (MCV) more than 100 fl. The aim of this study was to identify the underlying causes of macrocytosis, detected in routine hemograms and to evaluate the hematological features in different etiologies. This study included 178 adult patients whose detailed medical history was recorded, and Vitamin B12 assay, folate assay, thyroid function tests, liver function tests, complete blood counts and peripheral smear evaluation was performed. Alcoholism was identified as the etiological factor in 65 cases (36.5%), Vitamin B12 deficiency in 43 cases (24.1%) and drug related in 23 cases (12.9%). These three conditions accounted for 73.6% of macrocytosis. Other causes identified were folate deficiency, liver disease, Myelodysplastic syndrome, chronic renal failure and Aplastic anemia. In 41 cases, the cause of macrocytosis could not be explained. Anemia was observed in 95 cases (53.3%) being most common in Vitamin B12 deficiency. 9 cases (20.9%) of Vitamin B12 deficiency presented with isolated macrocytosis without anemia. It was observed that mean hemoglobin was lower and red cell distribution width (RDW) higher in megaloblastic conditions. Peripheral smear revealed hypersegmented neutrophils in 86% and macro-ovalocytes in 72% of the megaloblastic cases. Complete medical history, red cell parameters and peripheral blood smear are simple, inexpensive tools which assist in identifying the underlying cause of macrocytosis, particularly in resource limited settings. Macrocytosis needs to be evaluated even in the absence of anemia, as it may be the first clue to an underlying pathology.

Short- and long-term health consequences of sleep disruption.

PubMed

Medic, Goran; Wille, Micheline; Hemels, Michiel Eh

2017-01-01

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption.

Short- and long-term health consequences of sleep disruption

PubMed Central

Medic, Goran; Wille, Micheline; Hemels, Michiel EH

2017-01-01

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption. PMID:28579842

[The history of medicine in the ancient time].

PubMed

Tesarová, Drahomíra

2012-01-01

This article deals with the history of medicine in the ancient Greece; from the cult of the God Asklepios, to the founder of the scientific rational medicine, Hippokrates. The humoral theory of Hippokrates is explained (the human body consists from four liquids) and his ideal of a physician's approach to a patient is emphasized. In the Hellenistic period the medical development continued in the Alexandria Medical School (Herofilos and Erasistratos). At first, not much attention was given to medicine and scientific health prevention in ancient Rome. Only 293 AD have physicians from Greece first been invited to Rome--e.g. Asklepiades. During the reign of C. lulius Caesar, foreigners, who engaged in medical practice, were granted Roman citizenship and thanks to a number of benefits the medical condition in Roman Empire blossomed. Medical clinics (iatreia), infirmaries (valetudinaria) and, under the influence of Christianity, hospitals were established. In the 2nd century AD ancient medicine reached its climax with physician Galenos, who created the entire system of medical science and became the most significant, but also last medical figure of ancient Rome.

CONFLICT OF INTERESTS AS A PROBLEM OF EVIDENCE-BASED MEDICINE.

PubMed

Arpent'eva, M P

The role of ideology (principles) of evidence-based medicine in prophylaxis and correction of con?flict of interests in various spheres of medicine and socio-medical assistance is considered. Professional ethics formed in the course of education and undergoing modification under conditions of real practical work is a main sphere of medical and related edological practices associated with conflicts of interests. Of special importance are principles of bioethics based on the requiremnents of evidence- based medicine. The role of evidence-based medicine in prophylaxis and resolution of conflicts of interests is related to the training and re-training of specialists, prevention and correction of their professional degradation and deformation in the course ofpractical clinical work. Analysis of prima, y and secondary motives underlying occupational out. activities and their role in the formation of the conflict of interests was carried.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

PubMed Central

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

PubMed

Dionne-Odom, J Nicholas; Willis, Danny G; Bakitas, Marie; Crandall, Beth; Grace, Pamela J

2015-01-01

Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU. Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews. The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition. The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs. Copyright © 2015 Elsevier Inc. All rights reserved.

Conditions for excellence in teaching in medical education: The Frankfurt Model to ensure quality in teaching and learning.

PubMed

Giesler, Marianne; Karsten, Gudrun; Ochsendorf, Falk; Breckwoldt, Jan

2017-01-01

Background: There is general consensus that the organizational and administrative aspects of academic study programs exert an important influence on teaching and learning. Despite this, no comprehensive framework currently exists to describe the conditions that affect the quality of teaching and learning in medical education. The aim of this paper is to systematically and comprehensively identify these factors to offer academic administrators and decision makers interested in improving teaching a theory-based and, to an extent, empirically founded framework on the basis of which improvements in teaching quality can be identified and implemented. Method: Primarily, the issue was addressed by combining a theory-driven deductive approach with an experience based, "best evidence" one during the course of two workshops held by the GMA Committee on Personnel and Organizational Development in Academic Teaching (POiL) in Munich (2013) and Frankfurt (2014). Two models describing the conditions relevant to teaching and learning (Euler/Hahn and Rindermann) were critically appraised and synthesized into a new third model. Practical examples of teaching strategies that promote or hinder learning were compiled and added to the categories of this model and, to the extent possible, supported with empirical evidence. Based on this, a checklist with recommendations for optimizing general academic conditions was formulated. Results: The Frankfurt Model of conditions to ensure Quality in Teaching and Learning covers six categories: organizational structure/medical school culture, regulatory frameworks, curricular requirements, time constraints, material and personnel resources, and qualification of teaching staff. These categories have been supplemented by the interests, motives and abilities of the actual teachers and students in this particular setting. The categories of this model provide the structure for a checklist in which recommendations for optimizing teaching are given. Conclusions: The checklist derived from the Frankfurt Model for ensuring quality in teaching and learning can be used for quality assurance and to improve the conditions under which teaching and learning take place in medical schools.

Effects of disease severity and medication state on postural control asymmetry during challenging postural tasks in individuals with Parkinson's disease.

PubMed

Barbieri, Fabio A; Polastri, Paula F; Baptista, André M; Lirani-Silva, Ellen; Simieli, Lucas; Orcioli-Silva, Diego; Beretta, Victor S; Gobbi, Lilian T B

2016-04-01

The aim of this study was to investigate the effects of disease severity and medication state on postural control asymmetry during challenging tasks in individuals with Parkinson's disease (PD). Nineteen people with PD and 11 neurologically healthy individuals performed three standing task conditions: bipedal standing, tandem and unipedal adapted standing; the individuals with PD performed the tasks in ON and OFF medication state. The participants with PD were distributed into 2 groups according to disease severity: unilateral group (n=8) and bilateral group (n=11). The two PD groups performed the evaluations both under and without the medication. Two force plates were used to analyze the posture. The symmetric index was calculated for various of center of pressure. ANOVA one-way (groups) and two-way (PD groups×medication), with repeated measures for medication, were calculated. For main effects of group, the bilateral group was more asymmetric than CG. For main effects of medication, only unipedal adapted standing presented effects of PD medication. There was PD groups×medication interaction. Under the effects of medication, the unilateral group presented lower asymmetry of RMS in anterior-posterior direction and area than the bilateral group in unipedal adapted standing. In addition, the unilateral group presented lower asymmetry of mean velocity, RMS in anterior-posterior direction and area in unipedal standing and area in tandem adapted standing after a medication dose. Postural control asymmetry during challenging postural tasks was dependent on disease severity and medication state in people with PD. The bilateral group presented higher postural control asymmetry than the control and unilateral groups in challenging postural tasks. Finally, the medication dose was able to reduce postural control asymmetry in the unilateral group during challenging postural tasks. Copyright © 2015 Elsevier B.V. All rights reserved.

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand.

PubMed

Suriyawongpaisal, Paibul; Aekplakorn, Wichai; Srithamrongsawat, Samrit; Srithongchai, Chaisit; Prasitsiriphon, Orawan; Tansirisithikul, Rassamee

2016-10-21

Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider's practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

Painful Medical Conditions and Alcohol Use: A Prospective Study Among Older Adults

PubMed Central

Brennan, Penny L.; Schutte, Kathleen K.; SooHoo, Sonya; Moos, Rudolf H.

2011-01-01

Objective To determine associations between older adults’ baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations. Method At baseline, then 1, 4, and 10 years later, late-middle-aged community residents (M=61 years; n=1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships. Results At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems. Conclusions Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men. PMID:21668742

COMPLICATIONS OF ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANESTHESIA IN TUBE-FED CHILDREN: A RETROSPECTIVE ANALYSIS.

PubMed

Nguyen, Trang D; Freilich, Marshall M; Macpherson, Bruce A

2016-06-01

To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding. A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events. During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s. Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.

Exploration Laboratory Analysis FY13

NASA Technical Reports Server (NTRS)

Krihak, Michael; Perusek, Gail P.; Fung, Paul P.; Shaw, Tianna, L.

2013-01-01

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, which is stated as the Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL), and to perform human research studies on the International Space Station (ISS) that are supported by the Human Health and Countermeasures (HHC) element. Since there are significant similarities in the research and medical operational requirements, ELA hardware development has emerged as a joint effort between ExMC and HHC. In 2012, four significant accomplishments were achieved towards the development of exploration laboratory analysis for medical diagnostics. These achievements included (i) the development of high priority analytes for research and medical operations, (ii) the development of Level 1 functional requirements and concept of operations documentation, (iii) the selection and head-to-head competition of in-flight laboratory analysis instrumentation, and (iv) the phase one completion of the Small Business Innovation Research (SBIR) projects under the topic Smart Phone Driven Blood-Based Diagnostics. To utilize resources efficiently, the associated documentation and advanced technologies were integrated into a single ELA plan that encompasses ExMC and HHC development efforts. The requirements and high priority analytes was used in the selection of the four in-flight laboratory analysis performers. Based upon the competition results, a down select process will be performed in the upcoming year. Looking ahead, this unified effort has positioned each element for an in-flight lab analysis demonstration of select diagnostics measurements in the 2015 timeframe.

42 CFR 416.45 - Condition for coverage-Medical staff.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Condition for coverage-Medical staff. 416.45....45 Condition for coverage—Medical staff. The medical staff of the ASC must be accountable to the governing body. (a) Standard: Membership and clinical privileges. Members of the medical staff must be...

42 CFR 416.45 - Condition for coverage-Medical staff.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Condition for coverage-Medical staff. 416.45....45 Condition for coverage—Medical staff. The medical staff of the ASC must be accountable to the governing body. (a) Standard: Membership and clinical privileges. Members of the medical staff must be...

NASA Laboratory Analysis for Manned Exploration Missions

NASA Technical Reports Server (NTRS)

Krihak, Michael K.; Shaw, Tianna E.

2014-01-01

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability Element under the NASA Human Research Program. ELA instrumentation is identified as an essential capability for future exploration missions to diagnose and treat evidence-based medical conditions. However, mission architecture limits the medical equipment, consumables, and procedures that will be available to treat medical conditions during human exploration missions. Allocated resources such as mass, power, volume, and crew time must be used efficiently to optimize the delivery of in-flight medical care. Although commercial instruments can provide the blood and urine based measurements required for exploration missions, these commercial-off-the-shelf devices are prohibitive for deployment in the space environment. The objective of the ELA project is to close the technology gap of current minimally invasive laboratory capabilities and analytical measurements in a manner that the mission architecture constraints impose on exploration missions. Besides micro gravity and radiation tolerances, other principal issues that generally fail to meet NASA requirements include excessive mass, volume, power and consumables, and nominal reagent shelf-life. Though manned exploration missions will not occur for nearly a decade, NASA has already taken strides towards meeting the development of ELA medical diagnostics by developing mission requirements and concepts of operations that are coupled with strategic investments and partnerships towards meeting these challenges. This paper focuses on the remote environment, its challenges, biomedical diagnostics requirements and candidate technologies that may lead to successful blood-urine chemistry and biomolecular measurements in future space exploration missions.

A smart spirometry device for asthma diagnosis.

PubMed

Kassem, A; Hamad, M; El Moucary, C

2015-08-01

In this paper an innovative prototype for smart asthma spirometry device to be used by doctors and asthma patients is presented. The novelty in this prototype relies in the fact that it is destined to subtend not only adults but offers an efficient and attractive manner to accommodate children patients as well thus, making it efficient for doctors, patients and parents to detect and monitor such intricate cases at stages as early as six years old. Moreover, the apparatus used enables us to integrate a vital parameter representing the Forced Expiratory Volume to the final diagnosis. Besides, the presented device will automatically diagnose those patients, assess their asthma condition, and schedule their medication process without excessive visits to medical centers whilst providing doctors with accurate and pertinent and comprehensive medical data in a chronological fashion. Zooming into under the hood of the device, a fully reliable hardware digital system lies along with a flowmeter detector and a Bluetooth emitter to interface with a user-friendly GUI-based application installed on smartphones which incorporates appealing animated graphics to encourage children to take the test. Furthermore, the device offers the capability of storing chronological data and a relevant resourceful display for accurate tracking of patients' medical record, the evolvement of their asthma condition, and the administered medication. Finally, the entire device is aligned with the medical requirements as per doctors' and telemedicine specialists' recommendations; the experiments carried out demonstrated the effectiveness and sustainable use of such device.

Nanobacteria: Fact or Fiction? Characteristics, Detection and Medical Importance of Novel Self-Replicating, Calcifying Nanoparticles

NASA Technical Reports Server (NTRS)

Ciftcioglu, Neva; Mckay, David S.; Mathew, Grace; Kajander, E. Olavi

2006-01-01

There is some debate in microbiology as to whether Nanobacteria (NB) are alive. This paper reviews some aspects of NB. In summary, Nanobacteria is a perfect model for studying biogenic mineralization/calcification because NB a) are self-replicating particles and have less complicated metabolic pathways b) accumulate calcium and phosphate under physiological conditions, c)produce a calcium phosphate mineral similar to bone, d) exist in physical conditions (pH, gravity, temperature, etc) that are easy to manipulate, and which can be replicated for the physiological model.

Parkinsonian gait improves with bilateral subthalamic nucleus deep brain stimulation during cognitive multi-tasking.

PubMed

Chenji, Gaurav; Wright, Melissa L; Chou, Kelvin L; Seidler, Rachael D; Patil, Parag G

2017-05-01

Gait impairment in Parkinson's disease reduces mobility and increases fall risk, particularly during cognitive multi-tasking. Studies suggest that bilateral subthalamic deep brain stimulation, a common surgical therapy, degrades motor performance under cognitive dual-task conditions, compared to unilateral stimulation. To measure the impact of bilateral versus unilateral subthalamic deep brain stimulation on walking kinematics with and without cognitive dual-tasking. Gait kinematics of seventeen patients with advanced Parkinson's disease who had undergone bilateral subthalamic deep brain stimulation were examined off medication under three stimulation states (bilateral, unilateral left, unilateral right) with and without a cognitive challenge, using an instrumented walkway system. Consistent with earlier studies, gait performance declined for all six measured parameters under cognitive dual-task conditions, independent of stimulation state. However, bilateral stimulation produced greater improvements in step length and double-limb support time than unilateral stimulation, and achieved similar performance for other gait parameters. Contrary to expectations from earlier studies of dual-task motor performance, bilateral subthalamic deep brain stimulation may assist in maintaining temporal and spatial gait performance under cognitive dual-task conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Weight gain, metabolic disturbances, and physical health care in a Brazilian sample of outpatients with schizophrenia

PubMed Central

Gordon, Pedro Caldana; Xavier, Josefa Cynara; Louzã, Mario Rodrigues

2013-01-01

Background In the last few decades, a large number of studies have produced compelling evidence that patients with schizophrenia are at increased risk for developing several medical conditions and diseases, including obesity, metabolic disturbances, and cardiovascular diseases. Several protocols have been designed with the aim of reducing such risk. Objective: To investigate current physical health status in a population of outpatients with schizophrenia. Methods: A cross-sectional study was conducted in our outpatient clinic, selecting subjects who met DSM-IV diagnosis criteria for schizophrenia. Data were collected regarding clinical characteristics, lifestyle, medication in use, and biometric and laboratory parameters. Results: A total of 261 patients were included. We found a high prevalence of elevated body mass index (BMI . 25) (70%), dyslipidemia (73.2%), and metabolic syndrome (28.7%). Patients’ ages were associated with worsened lipid profiles, but other variables, such as disorder duration or type of antipsychotic in use, were not associated with any metabolic disturbance. Despite the increased prevalence of these conditions, only a small portion of the sample was under regular medical treatment. Conclusion: Outpatients with schizophrenia show signs of poor physical health conditions. These findings reinforce the need for an intensive and appropriate approach to assure that these patients receive adequate clinical referral and treatment. PMID:23355783

CareTrack Kids—part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review

PubMed Central

Hooper, Tamara D; Hibbert, Peter D; Mealing, Nicole; Wiles, Louise K; Jaffe, Adam; White, Les; Cowell, Christopher T; Runciman, William B; Goldstein, Stan; Hallahan, Andrew R; Wakefield, John G; Murphy, Elisabeth; Lau, Annie; Wheaton, Gavin; Williams, Helena M; Hughes, Clifford; Braithwaite, Jeffrey

2015-01-01

Introduction Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. Methods and analysis A random sample of 6000–8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged <16 years who presented with at least one of the study conditions during 2012 and 2013 will be reviewed. Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service and Women's and Children's Hospital Network (South Australia). An application is under review for the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and offer oral presentations to researchers, clinicians and policymakers at national and international conferences. PMID:25854977

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.

PubMed

Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

2016-12-21

To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

PubMed Central

Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

2016-01-01

AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. RESULTS Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. CONCLUSION Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients. PMID:28058017

Modeling and simulation for space medicine operations: preliminary requirements considered

NASA Technical Reports Server (NTRS)

Dawson, D. L.; Billica, R. D.; McDonald, P. V.

2001-01-01

The NASA Space Medicine program is now developing plans for more extensive use of high-fidelity medical simulation systems. The use of simulation is seen as means to more effectively use the limited time available for astronaut medical training. Training systems should be adaptable for use in a variety of training environments, including classrooms or laboratories, space vehicle mockups, analog environments, and in microgravity. Modeling and simulation can also provide the space medicine development program a mechanism for evaluation of other medical technologies under operationally realistic conditions. Systems and procedures need preflight verification with ground-based testing. Traditionally, component testing has been accomplished, but practical means for "human in the loop" verification of patient care systems have been lacking. Medical modeling and simulation technology offer potential means to accomplish such validation work. Initial considerations in the development of functional requirements and design standards for simulation systems for space medicine are discussed.

Requirements for Modeling and Simulation for Space Medicine Operations: Preliminary Considerations

NASA Technical Reports Server (NTRS)

Dawson, David L.; Billica, Roger D.; Logan, James; McDonald, P. Vernon

2001-01-01

The NASA Space Medicine program is now developing plans for more extensive use of high-fidelity medical Simulation systems. The use of simulation is seen as means to more effectively use the limited time available for astronaut medical training. Training systems should be adaptable for use in a variety of training environments, including classrooms or laboratories, space vehicle mockups, analog environments, and in microgravity. Modeling and simulation can also provide the space medicine development program a mechanism for evaluation of other medical technologies under operationally realistic conditions. Systems and procedures need preflight verification with ground-based testing. Traditionally, component testing has been accomplished, but practical means for "human in the loop" verification of patient care systems have been lacking. Medical modeling and simulation technology offer potential means to accomplish such validation work. Initial considerations in the development of functional requirements and design standards for simulation systems for space medicine are discussed.

Religious Involvement and Marijuana Use for Medical and Recreational Purposes

PubMed Central

Burdette, Amy M.; Webb, Noah S.; Hill, Terrence D.; Haynes, Stacy Hoskins; Ford, Jason A.

2018-01-01

In this article, we use data from the 2016 National Survey on Drug Use and Health (NSDUH) to examine the association between religious involvement and marijuana use for medical and recreational purposes in U.S. adults (N = 41,517). We also consider whether the association between religious involvement and marijuana use varies according to personal health status. Our results show that adults who attend religious services more frequently and hold more salient religious beliefs tend to exhibit lower rates of medical and recreational marijuana use. We also find that these “protective effects” are less pronounced for adults in poor health. Although our findings confirm previous studies of recreational marijuana use, we are the first to examine the association between religious involvement and medical marijuana use. Our moderation analyses suggest that the morality and social control functions of religious involvement may be offset under the conditions of poor health. PMID:29899577

Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block

PubMed Central

Jeon, Younghoon; Kim, Saeyoung

2017-01-01

Abstract Rationale: The great auricular nerve can be damaged by the neck surgery, tumor, and long-time pressure on the neck. But, great auricular neuralgia is very rare condition. It was managed by several medication and landmark-based great auricular nerve block with poor prognosis. Patient concerns: A 25-year-old man presented with a pain in the left lateral neck and auricle. Diagnosis: He was diagnosed with great auricular neuralgia. Interventions: His pain was not reduced by medication. Therefore, the great auricular nerve block with local anesthetics and steroid was performed under ultrasound guidance. Outcomes: Ultrasound guided great auricular nerve block alleviated great auricular neuralgia. Lessons: This medication-resistant great auricular neuralgia was treated by the ultrasound guided great auricular nerve block with local anesthetic agent and steroid. Therefore, great auricular nerve block can be a good treatment option of medication resistant great auricular neuralgia. PMID:28328811

[Methods of data selection from the French medical information system program for trauma patient's analysis: Burns and traumatic brain injuries].

PubMed

Paget, L-M; Dupont, A; Pédrono, G; Lasbeur, L; Thélot, B

2017-10-01

Data from the French medical information system program in medicine, surgery, obstetrics and dentistry can be adapted in some cases and under certain conditions, to account for hospitalizations for injuries. Two areas have been explored: burn and traumatic brain injury victims. An algorithm selecting data from the Medical information system program was established and implemented for several years for the study of burn victims. The methods of selection of stays for traumatic brain injuries, which are the subject of a more recent exploration, are described. Production of results in routine on the hospitalization for burns. Expected production of results on the hospitalization for traumatic brain injuries. In both cases, the knowledge obtained from these utilizations of the Medical information system program contributes to epidemiological surveillance and prevention and are useful for health care organization. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Differences between dietary supplement and prescription drug omega-3 fatty acid formulations: a legislative and regulatory perspective.

PubMed

Collins, Nancy; Tighe, Ann P; Brunton, Stephen A; Kris-Etherton, Penny M

2008-12-01

The medical management of many diseases and conditions can include either restriction or provision of specific essential nutrients. When such nutrients are needed, there are often both prescription and nonprescription products available, as in the case of nicotinic acid or omega-3 fatty acids. Although they may seem to contain similar ingredients, there may be important differences between the prescription and dietary-supplement preparations. The manufacturing of prescription pharmaceutical products is regulated by the US Food and Drug Administration (FDA), which mandates standards for consistency and quality assurance. Dietary supplements are available to consumers under the provisions of the Dietary Supplement Health and Education Act of 1994, for which the FDA has the burden of proving a dietary supplement is harmful rather than requiring the manufacturer prove that the supplement is safe. Consumers and medical professionals should be aware of the important qualitative and quantitative differences between the FDA-approved prescription formulations and dietary supplements, particularly when an essential nutrient is part of the medical management of a disease or condition.

Special Medical Conditions Associated with Catatonia in the Internal Medicine Setting: Hyponatremia-Inducing Psychosis and Subsequent Catatonia

PubMed Central

Novac, Andrei A; Bota, Daniela; Witkowski, Joanne; Lipiz, Jorge; Bota, Robert G

2014-01-01

Diagnosis and treatment of catatonia in the psychiatry consultation service is not infrequent. Usually, the patient either presents to the Emergency Department or develops catatonia on the medical floor. This condition manifests with significant behavioral changes (from mildly decreased speech output to complete mutism) that interfere with the ability to communicate. After structural brain disorders are excluded, one of the diagnoses that always should be considered is catatonia. However, the causes of catatonia are numerous, ranging from psychiatric causes to a plethora of medical illnesses. Therefore, it is not surprising that there are many proposed underlying mechanisms of catatonia and that controversy persists about the etiology of specific cases. There are only 6 reports of hyponatremia-induced catatonia and psychosis in the literature. Here, we present the case of a 30-year-old woman with catatonia and psychosis induced by hyponatremia, and we use this report to exemplify the multitude of biologic causes of catatonia and to propose a new way to look at the neuroanatomical basis of processing, particularly the vertical processing systems we believe are involved in catatonia. PMID:25102520

A review of data on laboratory colonies of bed bugs (Cimicidae), an insect of emerging medical relevance.

PubMed

Cannet, Arnaud; Akhoundi, Mohammad; Berenger, Jean-Michel; Michel, Gregory; Marty, Pierre; Delaunay, Pascal

2015-01-01

Cimicidae are hematophagous Heteroptera, feeding on human blood, that have been the subject of significant medical investigation. In particular, they have been colonized under laboratory conditions to study their medical relevance. Laboratory colonization of these bugs is a multifactorial phenomenon. Our goal was to conduct a comparative literature review to classify the published data, demonstrating preferred bed bug colony conditions. We show that physical factors including temperature, relative humidity and photoperiod, and physiological factors such as type and frequency of blood meals play important roles in laboratory colonies. Any change in these factors produces changes in life-cycle duration. Temperature and blood meal are the most important factors, with a marked impact on the life-cycle of laboratory populations, depending on the species. A wide range of temperatures (15-34 °C) and relative humidity (46-75%) with an average of 25 °C and 59% were found for these colonies. Two widely used blood sources for the colonies were rabbits and humans. © A. Cannet et al., published by EDP Sciences, 2015.

How far can Foucault take us?: an analysis of the changing discourses and limitations of the medical treatment of apoplexy and stroke.

PubMed

Daneski, Katharine; Higgs, Paul; Morgan, Myfanwy

2011-07-01

This article examines the conditions under which epistemological shifts in medicine have shaped the history of apoplexy and stroke. Our intention is to understand how stroke medicine as a distinct branch of bio-medicine has emerged in its current form. In doing so, we draw on aspects of the work of Michel Foucault as they relate to fabrication of biomedical discourses. The past 300 years of the transformation of the condition is examined using Michel Foucault's analysis of medical history as instances of the changing spatialization of disease. While the adoption of this approach helped explain how medical practice was shaped by changing interpretations of the causes of apoplexy and stroke over the past few centuries, we also found that there were certain limitations to such an approach. Overall, however, we hope to show that an examination of the history of stroke medicine through a Foucauldian influenced lens can provide a useful understanding of its current circumstances as well as throw light on gaps in Foucauldian approaches themselves.

Enterococcus faecium and Enterococcus durans isolated from cheese: Survival in the presence of medications under simulated gastrointestinal conditions and adhesion properties.

PubMed

Amaral, Daniel M F; Silva, Luana F; Casarotti, Sabrina N; Nascimento, Liane Caroline Sousa; Penna, Ana Lúcia B

2017-02-01

In this study, we evaluated the survival of Enterococcus faecium and Enterococcus durans, isolated from cheese, in the presence of medications and under simulated in vitro gastrointestinal conditions. The presence of genes encoding virulence factors, the susceptibility to antimicrobial agents, and adhesion properties were also assessed. Enterococcus faecium and E. durans both exhibited resistance to most of the tested medications but showed a large sensitivity to analgesics and antihypertensives; they also showed wide susceptibility to antimicrobial agents. Enterococcus durans SJRP29 had greater resistance to the presence of medications in comparison with the probiotic Lactobacillus acidophilus La-5. The strains, except for E. durans SJRP05, did not harbor virulence genes. Enterococcus durans SJRP14, SJRP17, and SJRP26 were sensitive to all tested antimicrobial agents. Enterococcus faecium was more stable during the simulation of gastrointestinal tract and showed greater viability. At the end of the assay, except for E. durans SJRP17, all strains showed high viability (>7 log cfu/mL). Enterococcus durans SJRP29 stood out from the other strains and was selected for further evaluation; it tolerated up to 3.0% NaCl at 30 and 37°C, besides having good adhesion properties (high values of auto-aggregation, co-aggregation, and hydrophobicity). Additionally, the microorganism did not show bile salt hydrolase activity or mucin degradation. These results encourage carrying out additional tests to evaluate the probiotic features by using in vitro dynamic models and in vivo tests before applying these strains to a food system. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Declaration of the Chilean Academy of Medicine of Law 20.850 "On clinical trials of pharmaceutical products and medical devices" and of the bylaw that will regulate its application].

PubMed

López, Gloría; Valdés, Gloría; Roessler, Emilio; Valdivieso, Vicente

2017-04-01

In Chile, high cost treatments required by selected medical conditions are financed by the State, according to Law 20.850. A bylaw under discussion by the Senate regulates clinical trials, posing complex issues that will endanger local interest in front-line research: 1) The exclusive and mandatory control bestowed to the Institute of Public Health during all stages of the trials and also the surveillance of institutions performing clinical trials, overriding their Clinical Research Review Boards; 2) The 10 year period during which any adverse event is assumed to have been caused by the medication or devise evaluated by the trial, unless the contrary is proven in a judicial process; 3) Individuals submitted to the trials are entitled to free post trial access to the treatment received during the study, financed by the trial supporting entities and as long as the drug or devise is considered to be useful. While agreeing with the need to have a National Registry of Clinical Trials, we predict that the mentioned critical issues in the bylaw will lead to difficulties and unnecessary judicial processes, thus limiting clinicians' interest in performing research. We propose to modify the bylaw, excluding responsibilities on events associated with the natural evolution of the medical condition, with patients' ageing or with comorbidities and clinical events considered unpredictable when the protocol was accepted. We recommend that the free post trial access should be a joint decision involving the patient and the attending physician, taking in consideration that the volunteer has been exposed to risks and burdens, or when discontinuation of treatment entails a vital risk until the treatment under study has been approved and becomes available in the national market.

Code of Practice for Scientific Diving: Principles for the Safe Practice of Scientific Diving in Different Environments. Unesco Technical Papers in Marine Science 53.

ERIC Educational Resources Information Center

Flemming, N. C., Ed.; Max, M. D., Ed.

This publication has been prepared to provide scientific divers with guidance on safe practice under varying experimental and environmental conditions. The Code offers advice and recommendations on administrative practices, insurance, terms of employment, medical standards, training standards, dive planning, safety with different breathing gases…

Let's Talk about the Needs of African American Children with Sickle Cell Disease: A Recognized "Other Health Impairment."

ERIC Educational Resources Information Center

Dooley, Elizabeth A.; Perkins, Nechelle

Children who inherit sickle cell disease, primarily African Americans and Hispanics, are at risk for serious medical conditions and require special care both at home and in school. Sickle cell disease is recognized as an "Other Health Impairment" and identified students may be eligible for special education services under the Individuals…

Impact of surface chemistry

PubMed Central

Somorjai, Gabor A.; Li, Yimin

2011-01-01

The applications of molecular surface chemistry in heterogeneous catalyst technology, semiconductor-based technology, medical technology, anticorrosion and lubricant technology, and nanotechnology are highlighted in this perspective. The evolution of surface chemistry at the molecular level is reviewed, and the key roles of surface instrumentation developments for in situ studies of the gas–solid, liquid–solid, and solid–solid interfaces under reaction conditions are emphasized. PMID:20880833

TRIAGE of Irradiated Personnel

DTIC Science & Technology

1996-09-25

Vivo Electron Paramagnetic Resonance, Electron Spin Resonance (EPR, ESR) for In Vivo Dosimetry Under Field Conditions Dr. Harold M. Swartz Dartmouth...Force Medical Center Andrews Air Force Base, MD • Status and Limitations of Physical Dosimetry in the Field Environment David A. Schauer, LCDR, MSC...USN Naval Dosimetry Center Navy Environmental Health Center Detachment Bethesda, MD • NATO Policy and Guidance on Antiemetic Usage Robert Kehlet

Comparison Study of Judged Clinical Skills Competence from Standard Setting Ratings Generated under Different Administration Conditions

ERIC Educational Resources Information Center

Roberts, William L.; Boulet, John; Sandella, Jeanne

2017-01-01

When the safety of the public is at stake, it is particularly relevant for licensing and credentialing exam agencies to use defensible standard setting methods to categorize candidates into competence categories (e.g., pass/fail). The aim of this study was to gather evidence to support change to the Comprehensive Osteopathic Medical Licensing-USA…

JPRS Report Soviet Union Political Affairs.

DTIC Science & Technology

1990-07-27

consciousness. Under these conditions the unresolved state of many social, political, and national problems acquired a special urgency . Meanwhile, the...whole. These errors consist entirely of crude distortions of party policy guidelines. And the tragic mistakes of recent years represent depar - tures...kolkhozes, medical institutions and even the soccer team. And so, there is a great discrepancy between words and actions with respect to mutual

[Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: Feasibility study in a German army field hospital in Afghanistan].

PubMed

Braun, T; Kunz, U; Schulz, C; Lieber, A; Willy, C

2015-08-01

Traumatic brain injury (TBI) is one of the most common causes of death in ordinary accidents, natural disasters, or warfare. The gold standard for diagnosis of TBI is the CT scan; a delay of diagnostics or medical care is the strongest independent predictor of mortality of TBI patients--particularly in the case of a surgically treatable intracranial hematoma. The proper classification of these patients is of major importance in situations where a CT is not accessible. A portable screening device that uses near-infrared spectroscopy (NIRS) technology allows a preliminary estimate of an intracranial hematoma. This study assessing practicability shows that the use of the device in a military medical rescue center (Kunduz, Afghanistan) is easy to learn and can be repeatedly used even under emergency room conditions. The technique can be applied in penetrating and blunt TBIs in the absence of an immediately available CT scan in rural areas, preclinically, under mass casualty conditions (e.g., in disaster situations) as well as in humanitarian crises or war zones. Nevertheless, further studies to assess the validity of this device are necessary.

Labeling of Medication and Placebo Alters the Outcome of Episodic Migraine Attacks

PubMed Central

Kam-Hansen, Slavenka; Jakubowski, Moshe; Kelley, John M.; Kirsch, Irving; Hoaglin, David C.; Kaptchuk, Ted J.; Burstein, Rami

2014-01-01

Information provided to patients is thought to influence placebo and drug effects. We investigated the potential relationship between treatment labeling and its outcome in a prospective, within-subjects, repeated measures study of episodic migraine. A cohort of 66 participants documented 7 separate migraine attack: one untreated attack, followed by six attacks that were randomly assigned for either rizatriptan (10 mg Maxalt) or placebo treatments, each of which labeled once as ‘Maxalt’, once as ‘Placebo’, and once as ‘Maxalt or Placebo’ (459 documented attacks). Data were analyzed using generalized linear mixed model statistics. While Maxalt was generally superior to placebo, the placebo effect, and to a lesser extent Maxalt efficacy, increased monotonically with treatment labeling as follows: ‘Placebo’ label < ‘Maxalt or placebo’ label ≤ ‘Maxalt’ label. Efficacy of Maxalt mislabeled as placebo was not significantly different from the efficacy of placebo mislabeled as Maxalt. The placebo effect was significant under each labeling condition relative to no treatment, amounting in magnitude to >50% of Maxalt effect under the corresponding labeling condition. Thus, incremental “positive” information yielded incremental efficacy of placebo and medication during migraine attacks. PMID:24401940

Local sustainability and scaling up for user fee exemptions: medical NGOs vis-à-vis health systems.

PubMed

Olivier de Sardan, Jean-Pierre; Diarra, Aïssa; Koné, Félix Yaouaga; Yaogo, Maurice; Zerbo, Roger

2015-01-01

Free healthcare obviously works when a partner from abroad supplies a health centre or a health district with medicines and funding on a regular basis, provides medical, administrative and managerial training, and gives incentive bonuses and daily subsistence allowances to staff. The experiments by three international NGO in Burkina Faso, Mali and Niger have all been success stories. But withdrawing NGO support means that health centres that have enjoyed a time of plenty under NGO management will return to the fold of health centres run by the state in its present condition and the health system in its present condition, with the everyday consequences of late reimbursements and stock shortages. The local support given by international NGOs has more often than not an effect of triggering an addiction to aid instead of inducing local sustainability without infusion. In the same way, scaling up to the entire country a local pilot experiment conducted under an NGO involves its insertion into a national bureaucratic machine with its multiple levels, all of which are potential bottlenecks. Only experiments carried out under the "ordinary" management of the state are capable of laying bare the problems associated with this process. Without reformers 'on the inside' (within the health system itself and among health workers), no real reform of the health system induced by reformers 'from the outside' can succeed.

Preventive and invasive treatment in special needs patients: a German retrospective study.

PubMed

Rothmaier, Katrin; Bücher, Katharina; Metz, Isabel; Pitchika, Vinay; Hickel, Reinhard; Heinrich-Weltzien, Roswitha; Kühnisch, Jan

2017-05-01

Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d 3/4 mft/0.9 D 3/4 MFT) than in ODC (2.5 d 3/4 mft /0.9 D 3/4 MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Medical students' medication communication skills regarding drug prescription-a qualitative analysis of simulated physician-patient consultations.

PubMed

Hauser, Katarina; Matthes, Jan

2017-04-01

Poor medication communication of physicians to patients is detrimental, e.g. for medication adherence. Reasons for physicians' deficits in medication communication may be unfavourable conditions in daily practice or already insufficient training during their (undergraduate) medical studies. We explored medical students' communication on new medications in simulated physician-patient conversations to identify actual deficits indicating apparent educational needs. Fifth year medical students attending a mandatory course at the University of Cologne had simulated physician-patient consultations aiming at drug prescription. In 2015, 21 consultations were recorded, transcribed and subjected to qualitative content analysis based on the method of inductive coding. Even essential information on drug therapy was often lacking (e.g. adverse effects, drug administration). Some aspects were addressed more frequently than others. This seemed to differ depending on the diagnosis underlying the particular treatment (acute event vs. chronic disease). The extent of information on drug treatments given in simulated physician-patient consultations varied significantly between students. Fifth year medical students showed appreciable deficits in communicating drug prescriptions to patients though there were remarkable inter-individual differences. Our findings suggest that communication on drug therapy to patients is no self-evolving skill. Thus, there is obviously a need for emphasizing medication communication in the training of medical students. Communication aids specifically aiming at medication communication might facilitate learning of adequate medication communication skills.

42 CFR 416.45 - Condition for coverage-Medical staff.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Condition for coverage-Medical staff. 416.45... Coverage § 416.45 Condition for coverage—Medical staff. The medical staff of the ASC must be accountable to the governing body. (a) Standard: Membership and clinical privileges. Members of the medical staff...

42 CFR 416.45 - Condition for coverage-Medical staff.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Condition for coverage-Medical staff. 416.45... Coverage § 416.45 Condition for coverage—Medical staff. The medical staff of the ASC must be accountable to the governing body. (a) Standard: Membership and clinical privileges. Members of the medical staff...

42 CFR 416.45 - Condition for coverage-Medical staff.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Condition for coverage-Medical staff. 416.45... Coverage § 416.45 Condition for coverage—Medical staff. The medical staff of the ASC must be accountable to the governing body. (a) Standard: Membership and clinical privileges. Members of the medical staff...

Teens and Preventive Care Use: Implications for EPSDT Outreach.

PubMed

Larson, Anita M; Selameab, Tehout; Bushyhead, Beverly

2015-01-01

Teens have low overall preventive care utilization compared to other age groups. Low health care use by teens is a result of a variety of complex economic, social, and cultural factors. This study, completed by one local community health board responsible for the administration of the Early Periodic Screening Diagnosis and Treatment (EPSDT) program, produced findings that enhanced outreach to teens and supported the medical providers who serve them. More than 800 teens and young adults from a variety of cultures and communities across an urban Minnesota county were surveyed to understand the conditions under which they do and do not seek medical care. Findings suggest teens with structural barriers associated with poverty such as lack of insurance and transportation to clinics could benefit from intentional connections to medical programs. Psychosocial barriers, revolving around trust, relationships with providers, communication, and privacy, might be ameliorated through enhanced education and targeted outreach to clinics and teens, activities appropriate under the objectives and program activities of EPSDT. This study could be replicated in any community to gather data unique to local populations being served.

Influenza in hospitalized children in Ireland in the pandemic period and the 2010/2011 season: risk factors for paediatric intensive-care-unit admission.

PubMed

Rebolledo, J; Igoe, D; O'Donnell, J; Domegan, L; Boland, M; Freyne, B; McNAMARA, A; Molloy, E; Callaghan, M; Ryan, A; O'Flanagan, D

2014-09-01

Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.

Water deficit affected flavonoid accumulation by regulating hormone metabolism in Scutellaria baicalensis Georgi roots.

PubMed

Yuan, Yuan; Liu, Yunjun; Wu, Chong; Chen, Shunqin; Wang, Zhouyong; Yang, Zhaochun; Qin, Shuangshuang; Huang, Luqi

2012-01-01

The content of flavonoids especially baicalin and baicalein determined the medical quality of Scutellaria baicalensis which is a Chinese traditional medicinal plant. Here, we investigated the mechanism responsible for the content and composition of flavonoids in S. baicalensis under water deficit condition. The transcription levels of several genes which are involved in flavonoid biosynthesis were stimulated by water deficit. Under water deficit condition, fifteen up-regulated proteins, three down-regulated proteins and other six proteins were detected by proteomic analysis. The identified proteins include three gibberellin (GA)- or indoleacetic acid (IAA)-related proteins. Decreased endogenous GAs level and increased IAA level were observed in leaves of S. baicalensis which was treated with water deficit. Exogenous application of GA or α-naphthalene acelic acid (NAA) to plants grown under water deficit conditions led to the increase of endogenous GAs and the decrease of IAA and flavonoids, respectively. When the synthesis pathway of GA or IAA in plants was inhibited by application with the inhibitors, flavonoid levels were recovered. These results indicate that water deficit affected flavonoid accumulation might through regulating hormone metabolism in S. baicalensis Georgi.

Evaluating the Risks of High Altitude Travel in Chronic Liver Disease Patients.

PubMed

Luks, Andrew M; Swenson, Erik R

2015-06-01

Luks, Andrew M., and Erik R. Swenson. Clinician's Corner: Evaluating the risks of high altitude travel in chronic liver disease patients. High Alt Med Biol 16:80-88, 2015.--With improvements in the quality of health care, people with chronic medical conditions are experiencing better quality of life and increasingly participating in a wider array of activities, including travel to high altitude. Whenever people with chronic diseases travel to this environment, it is important to consider whether the physiologic responses to hypobaric hypoxia will interact with the underlying medical condition such that the risk of acute altitude illness is increased or the medical condition itself may worsen. This review considers these questions as they pertain to patients with chronic liver disease. While the limited available evidence suggests there is no evidence of liver injury or dysfunction in normal individuals traveling as high as 5000 m, there is reason to suspect that two groups of cirrhosis patients are at increased risk for problems, hepatopulmonary syndrome patients, who are at risk for severe hypoxemia following ascent, and portopulmonary hypertension patients who may be at risk for high altitude pulmonary edema and acute right ventricular dysfunction. While liver transplant patients may tolerate high altitude exposure without difficulty, no information is available regarding the risks of long-term residence at altitude with chronic liver disease. All travelers with cirrhosis require careful pre-travel evaluation to identify conditions that might predispose to problems at altitude and develop risk mitigation strategies for these issues. Patients also require detailed counseling about recognition, prevention, and treatment of acute altitude illness and may require different medication regimens to prevent or treat altitude illness than used in healthy individuals.

Enhanced risk prediction model for emergency department use and hospitalizations in patients in a primary care medical home.

PubMed

Takahashi, Paul Y; Heien, Herbert C; Sangaralingham, Lindsey R; Shah, Nilay D; Naessens, James M

2016-07-01

With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011. Data were randomly split into development and validation data sets. We compared the enhanced model containing the additional risk predictors with the Minnesota medical tiering model. The study was conducted in the primary care practice of an integrated delivery system at an academic medical center in Rochester, Minnesota. The study focus was primary care medical home patients in 2010 and 2011 (n = 84,752), with the primary outcome of subsequent hospitalization or ED visit. A total of 42,384 individuals derived the enhanced risk-prediction model and 42,368 individuals validated the model. Predictors included Adjusted Clinical Groups-based Minnesota medical tiering, patient demographics, insurance status, and prior year healthcare utilization. Additional variables included specific mental and medical conditions, use of high-risk medications, and body mass index. The area under the curve in the enhanced model was 0.705 (95% CI, 0.698-0.712) compared with 0.662 (95% CI, 0.656-0.669) in the Minnesota medical tiering-only model. New high-risk patients in the enhanced model were more likely to have lack of health insurance, presence of Medicaid, diagnosed depression, and prior ED utilization. An enhanced model including additional healthcare-related factors improved the prediction of risk of hospitalization or ED visit.

Menopause, only for women? The social construction of menopause as an exclusively female condition.

PubMed

Oudshoorn, N E

1997-06-01

Over the last three decades the menopause has continued to interest the medical profession, the pharmaceutical industry and the mass media. Although there exist many different views on the menopause, there is one common denominator. Menopause is depicted as an exclusively female condition. The medical discourse on menopause seems to exclude men. However, a closer look at the history of the medical sciences reveals that there have been and still are, attempts to classify symptoms of ageing men as male menopause or climacterium. Despite these attempts to put men on the menopausal agenda, most attention is focused on women. How can we understand this almost exclusive focus on female bodies? Why does there exist such an emphasis on the medicalization of the third age of women rather than of men? Maybe we might be inclined to think of a male conspiracy, as has been suggested by feminists: women take the pills, while men cash the bills. We might consider the enormous profits of the pharmaceutical industry. This paper is concerned with finding an alternative explanation for the almost exclusive attention for the female menopause. Based on historical data and more recent discussions in medical journals, the paper shows that the medicalization of the female menopause and the relative silence around the male climacterium can be understood in terms of the social and cultural processes that underly the classification of health problems as specific diseases. The imbalance in medical treatment of climacteric health problems in women and men is not simply rooted in biological sex differences, but can be ascribed to men's attitudes towards health problems and organizational infrastructures of the medical institutions.

[Evolution of China's rural cooperative medical care system.].

PubMed

Cai, Tian-Xin

2009-11-01

The rural cooperative medical care system of our country originated from the beginning of the 50s of the 20(th) century, which developed abnormally due to leftist ideology during the period of the Cultural Revolution. An institutional reform of the rural cooperative medical care system had began after the reform and opening up in China, but with the development of rural productivity and rapid transformation of economic structure, the traditional cooperative medical care system declined rapidly due to incompatibility with the new model of economic and social development. At the beginning of the 90s of the 20(th) century, exploring the developmental path of rural cooperative medical service, under the conditions of market economy and adopting the approach of "main individual investment with partial collective and appropriate government support", to try to establish rural cooperative medical funds, so that the rural cooperative medical system could bottom out gradually, but still failed to achieve the expected goal of universal access to health care in 2000. However, the promotion and establishment of a new rural cooperative medical care and aid system could become a major achievement aim in the 21(st) century.

Physicians' exodus: why medical graduates leave Austria or do not work in clinical practice.

PubMed

Scharer, Sebastian; Freitag, Andreas

2015-05-01

Austria has the highest number of medical graduates of all Organisation for Economic Co-operation and Development (OECD) countries in relation to its population size, but over 30% choose not to pursue a career as physicians in the country. This article describes under- and postgraduate medical education in Austria and analyses reasons for the exodus of physicians. In Austria, medicine is a 5- or 6-year degree offered at four public and two private medical schools. Medical graduates have to complete training in general medicine or a speciality to attain a licence to practice. While not compulsory for speciality training, board certification in general medicine has often been regarded as a prerequisite for access to speciality training posts. Unstructured postgraduate training curricula, large amounts of administrative tasks, low basic salaries and long working hours present for incentives for medical graduates to move abroad or to work in a non-clinical setting. The scope of current reforms, such as the establishment of a new medical faculty and the implementation of a common trunk, is possibly insufficient in addressing the issue. Extensive reforms regarding occupational conditions and the structure of postgraduate medical education are necessary to avoid a further exodus of junior doctors.

[The Jewish Hospital in Budapest under the Nazi occupation (1944-1945)].

PubMed

Weisskopf, Varda

2008-01-01

On March 19, 1944 the German army invaded and occupied Hungary. The Waffen-SS soldiers captured the buildings of the Jewish community in Budapest, including the famous and important Jewish hospital on Szabolcs Street, founded in 1802. The Jewish hospital moved into a school belonging to the Jewish community on 44 Wesselényi Street. The hospital personnel managed to smuggle out medical equipment, and operating rooms were transferred into this central, temporary medical location. Other hospitals were founded, some inside the ghetto, others outside. The Judenrat supplied these hospitals with medical equipment obtained through contributions from Jews. The temporary hospitals admitted sick patients and a great number of those injured as a result of the war in Budapest. These hospitals operated with poor equipment. Surgeries were sometimes performed on kitchen tables, and medical equipment was sterilized by burning the synagogue's benches and library books. As of December 1944, there was no electricity in the hospitals. Thus doctors were forced to operate by the light of candles and flashlights. Nevertheless, they managed to save numerous lives. In spite of the terrible conditions under which the medical staff worked, they were committed to their mission, and their courage deserves appreciation. Ghetto Budapest was liberated by the Red army on 18th January, 1945. Thousands of Jews were released from the temporary hospitals.

Reinforcement and Stimulant Medication Ameliorate Deficient Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder.

PubMed

Rosch, Keri S; Fosco, Whitney D; Pelham, William E; Waxmonsky, James G; Bubnik, Michelle G; Hawk, Larry W

2016-02-01

This study examined the degree to which reinforcement, stimulant medication, and their combination impact response inhibition in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Across three studies, participants with ADHD (n = 111, 25 girls) and typically-developing (TD) controls (n = 33, 6 girls) completed a standard version of the stop signal task (SST) and/or a reinforcement-manipulation SST with performance-contingent points. In two of these studies, these tasks were performed under placebo or 0.3 and 0.6 mg/kg methylphenidate (MPH) conditions. Cross-study comparisons were conducted to test hypotheses regarding the separate and combined effects of reinforcement and methylphenidate on response inhibition among children with ADHD relative to TD controls. Baseline response inhibition was worse among children with ADHD compared to controls. MPH produced dose-related improvements in response inhibition in children with ADHD; compared to non-medicated TD controls, 0.3 mg/kg MPH normalized deficient response inhibition, and 0.6 mg/kg MPH resulted in better inhibition in children with ADHD. Reinforcement improved response inhibition to a greater extent for children with ADHD than for TD children, normalizing response inhibition. The combination of MPH and reinforcement improved response inhibition among children with ADHD compared to reinforcement alone and MPH alone, also resulting in normalization of response inhibition despite repeated task exposure. Deficient response inhibition commonly observed in children with ADHD is significantly improved with MPH and/or reinforcement, normalizing inhibition relative to TD children tested under standard conditions.

Reinforcement and stimulant medication ameliorate deficient response inhibition in children with Attention-Deficit/Hyperactivity Disorder

PubMed Central

Rosch, Keri S.; Fosco, Whitney D.; Pelham, William E.; Waxmonsky, James G.; Bubnik, Michelle G.; Hawk, Larry W.

2015-01-01

This study examined the degree to which reinforcement, stimulant medication, and their combination impact response inhibition in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Across three studies, participants with ADHD (n=111, 25 girls) and typically-developing (TD) controls (n=33, 6 girls) completed a standard version of the stop signal task (SST) and/or a reinforcement-manipulation SST with performance-contingent points. In two of these studies, these tasks were performed under placebo or 0.3 and 0.6 mg/kg methylphenidate (MPH) conditions. Cross-study comparisons were conducted to test hypotheses regarding the separate and combined effects of reinforcement and methylphenidate on response inhibition among children with ADHD relative to TD controls. Baseline response inhibition was worse among children with ADHD compared to controls. MPH produced dose-related improvements in response inhibition in children with ADHD; compared to non-medicated TD controls, 0.3 mg/kg MPH normalized deficient response inhibition, and 0.6 mg/kg MPH resulted in better inhibition in children with ADHD. Reinforcement improved response inhibition to a greater extent for children with ADHD than for TD children, normalizing response inhibition. The combination of MPH and reinforcement improved response inhibition among children with ADHD compared to reinforcement alone and MPH alone, also resulting in normalization of response inhibition despite repeated task exposure. Deficient response inhibition commonly observed in children with ADHD is significantly improved with MPH and/or reinforcement, normalizing inhibition relative to TD children tested under standard conditions. PMID:25985978

Safeguarding the Health of the NASA Astronaut Community: the Need for Expanded Medical Monitoring for Former NASA Astronauts Under the Astronaut Occupational Health Program

NASA Technical Reports Server (NTRS)

Rossi, Meredith; Lee, Lesley; Wear, Mary; Van Baalen, Mary; Rhodes, Bradley

2016-01-01

The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential latent health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging communities are necessary for astronauts to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography), as opposed to conditions resulting directly from the astronaut occupation; and increased breadth of monitoring services will improve the understanding of occupational health risks and longitudinal health of the astronaut community, past, present, and future. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding existing medical monitoring under the Astronaut Occupational Health program for former NASA astronauts.

Boosting medical diagnostics by pooling independent judgments

PubMed Central

Kurvers, Ralf H. J. M.; Herzog, Stefan M.; Hertwig, Ralph; Krause, Jens; Carney, Patricia A.; Bogart, Andy; Argenziano, Giuseppe; Zalaudek, Iris; Wolf, Max

2016-01-01

Collective intelligence refers to the ability of groups to outperform individual decision makers when solving complex cognitive problems. Despite its potential to revolutionize decision making in a wide range of domains, including medical, economic, and political decision making, at present, little is known about the conditions underlying collective intelligence in real-world contexts. We here focus on two key areas of medical diagnostics, breast and skin cancer detection. Using a simulation study that draws on large real-world datasets, involving more than 140 doctors making more than 20,000 diagnoses, we investigate when combining the independent judgments of multiple doctors outperforms the best doctor in a group. We find that similarity in diagnostic accuracy is a key condition for collective intelligence: Aggregating the independent judgments of doctors outperforms the best doctor in a group whenever the diagnostic accuracy of doctors is relatively similar, but not when doctors’ diagnostic accuracy differs too much. This intriguingly simple result is highly robust and holds across different group sizes, performance levels of the best doctor, and collective intelligence rules. The enabling role of similarity, in turn, is explained by its systematic effects on the number of correct and incorrect decisions of the best doctor that are overruled by the collective. By identifying a key factor underlying collective intelligence in two important real-world contexts, our findings pave the way for innovative and more effective approaches to complex real-world decision making, and to the scientific analyses of those approaches. PMID:27432950

The Pharmacological Basis of Cannabis Therapy for Epilepsy.

PubMed

Reddy, Doodipala Samba; Golub, Victoria M

2016-04-01

Recently, cannabis has been suggested as a potential alternative therapy for refractory epilepsy, which affects 30% of epilepsy, both adults and children, who do not respond to current medications. There is a large unmet medical need for new antiepileptics that would not interfere with normal function in patients with refractory epilepsy and conditions associated with refractory seizures. The two chief cannabinoids are Δ-9-tetrahyrdrocannabinol, the major psychoactive component of marijuana, and cannabidiol (CBD), the major nonpsychoactive component of marijuana. Claims of clinical efficacy in epilepsy of CBD-predominant cannabis or medical marijuana come mostly from limited studies, surveys, or case reports. However, the mechanisms underlying the antiepileptic efficacy of cannabis remain unclear. This article highlights the pharmacological basis of cannabis therapy, with an emphasis on the endocannabinoid mechanisms underlying the emerging neurotherapeutics of CBD in epilepsy. CBD is anticonvulsant, but it has a low affinity for the cannabinoid receptors CB1 and CB2; therefore the exact mechanism by which it affects seizures remains poorly understood. A rigorous clinical evaluation of pharmaceutical CBD products is needed to establish the safety and efficacy of their use in the treatment of epilepsy. Identification of mechanisms underlying the anticonvulsant efficacy of CBD is also critical for identifying other potential treatment options. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

[Treatment of recurrent neurocardiogenic syncope with cardiac inhibitors with ipratropium bromide].

PubMed

Friederich, H-C; Michaelsen, J; Hesse, C; Schellberg, D; Schwab, M; Herzog, W

2004-06-01

Pharmacological approaches for the treatment of cardioinhibitory vasovagal syncope are controversially discussed in the literature. In acute treatment of neurocardiogenic syncope, anticholinergics (atropine) are used effectively. Randomised and placebo-controlled clinical trials evaluating the preventive significance of anticholinergic agents in the therapy of cardioinhibitory vasovagal syncope are still missing. We report the case of an 18-year-old male patient with recurrent convulsive, cardioinhibitory neurocardiogenic syncope. Vasovagal syncope occurred predominantly as centrally induced syncope triggered by negative emotions such as fear or by seeing blood. Under resting conditions, the patient revealed increased parasympathetic tone with nocturnal bradycardia of 38 beats/min. In the course of head-up tilt table testing a cardioinhibitory syncope with an asystolic pause of 10 seconds occurred without any prodromes after 10 minutes of upright positioning. In order to inhibit parasympathetic tone, medication with ipratropiumbromide was initiated. Time-variant analysis of heart rate variability (autoregressive model) during head-up tilt table testing showed under the medication with ipratropiumbromide a vagal mediated cardioinhibition to 56 beats/min, but no further sinus arrest. Throughout clinical follow-up of 6 months the patient remained syncope-free under the medication. The usefulness of ipratropiumbromide in inhibiting vagal mediated cardioinhibition will be discussed referring to the case report and to studies evaluating anticholinergic agents in the treatment of neurocardiogenic syncope.

Cost-Benefit Performance of Robotic Surgery Compared with Video-Assisted Thoracoscopic Surgery under the Japanese National Health Insurance System.

PubMed

Kajiwara, Naohiro; Patrick Barron, James; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2015-01-01

Medical economics have significant impact on the entire country. The explosion in surgical techniques has been accompanied by questions regarding actual improvements in outcome and cost-effectiveness, such as the da Vinci(®) Surgical System (dVS) compared with conventional video-assisted thoracic surgery (VATS). To establish a medical fee system for robot-assisted thoracic surgery (RATS), which is a system not yet firmly established in Japan. This study examines the cost benefit performance (CBP) based on medical fees compared with VATS and RATS under the Japanese National Health Insurance System (JNHIS) introduced in 2012. The projected (but as yet undecided) price in the JNHIS would be insufficient if institutions have less than even 200 dVS cases per year. Only institutions which perform more than 300 dVS operations per year would obtain a positive CBP with the projected JNHIS reimbursement. Thus, under the present conditions, it is necessary to perform at least 300 dVS operations per year in each institution with a dVS system to avoid financial deficit with current robotic surgical management. This may hopefully encourage a downward price revision of the dVS equipment by the manufacture which would result in a decrease in the cost per procedure.

Medical condition and care of undocumented migrants in ambulatory clinics in Tel Aviv, Israel: assessing unmet needs.

PubMed

Mor, Zohar; Raveh, Yuval; Lurie, Ido; Leventhal, Alex; Gamzu, Roni; Davidovitch, Nadav; Benari, Orel; Grotto, Itamar

2017-07-14

Approximately 150,000 undocumented migrants (UM) who are medically uninsured reside in Israel, including ~50,000 originating from the horn of Africa (MHA). Free medical-care is provided by two walk-in clinics in Tel-Aviv. This study aims to compare the medical complaints of UM from different origins, define their community health needs and assess gaps between medical needs and available services. This cross-sectional study included a random sample of 610 UM aged 18-64 years, who were treated in these community clinics between 2008 and 2011. The study compared UM who had complex medical conditions which necessitated referral to more equipped medical settings with UM having mild/simple medical conditions, who were treated at the clinics. MHA were younger, unemployed and more commonly males compared with UM originating from other countries. MHA also had longer referral-delays and visited the clinics less frequently. UM with complex medical conditions were more commonly females, had chronic diseases and demonstrated longer referral-delays than those who had mild/simple medical conditions. The latter more commonly presented with complained of respiratory, muscular and skeletal discomfort. In multivariate analysis, the variables which predicted complex medical conditions included female gender, chronic illnes and self-referral to the clinics. The ambulatory clinics were capable of responding to mild/simple medical conditions. Yet, the health needs of women and migrants suffering from complex medical conditions and chronic diseases necessitated referrals to secondary/tertiary medical settings, while jeopardizing the continuity of care. The health gaps can be addressed by a more holistic social approach, which includes integration of UM in universal health insurance.

Tamper-Resistant Mobile Health Using Blockchain Technology

PubMed Central

2017-01-01

Background Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. Objective The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. Methods We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. Results Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. Conclusions Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization. PMID:28747296

Physician responsibility for the cost of unnecessary medical services.

PubMed

Eisenberg, J M; Rosoff, A J

1978-07-13

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

What to do when patients with epilepsy cannot take their usual oral medications.

PubMed

Bank, Anna M; Lee, Jong Woo; Krause, Patricia; Berkowitz, Aaron L

2017-01-01

When people with epilepsy are hospitalised for medical or surgical conditions, they may be unable to take their home antiepileptic drugs (AEDs). Such 'nil by mouth' people with epilepsy require alternative AED regimens to prevent breakthrough seizures. Here, we describe several strategies for maintaining seizure control in patients with epilepsy who have medical or surgical contraindications to their home oral regimens. These strategies include using non-pill oral formulations, using an intravenous formulation of the patient's home AED(s), using a benzodiazepine bridge and/or using alternative intravenous AED(s) when there are no intravenous formulations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Bluetooth Communication for Battery Powered Medical Devices

NASA Astrophysics Data System (ADS)

Babušiak, Branko; Borik, Štefan

2016-01-01

wireless communication eliminates obtrusive cables associated with wearable sensors and considerably increases patient comfort during measurement and collection of medical data. Wireless communication is very popular in recent years and plays a significant role in telemedicine and homecare applications. Bluetooth technology is one of the most commonly used wireless communication types in medicine. This paper describes the design of a universal wireless communication device with excellent price/performance ratio. The said device is based on the low-cost RN4020 Bluetooth module with Microchip Low-energy Data Profile (MLDP) and due to low-power consumption is especially suitable for the transmission of biological signals (ECG, EMG, PPG, etc.) from wearable medical/personal health devices. A unique USB dongle adaptor was developed for wireless communication via UART interface and power consumption was evaluated under various conditions.

[Central sleep apnea syndrome].

PubMed

Sanner, B; Schäfer, T

2008-04-01

Central sleep apnea (CSA) is characterized by a lack of drive to inspire for at least 10 sec. In the CSA-syndrome accompanying arousals and desaturations of the arterial blood cause sleep disturbances and sympathetic nerve activations which lead to excessive daytime sleepiness and increase the risk for cardiovascular morbidity. There are six manifestations of CSA: a rare primary or idiopathic form, often in hypocapnic patients with an increased hypercapnic ventilatory drive; Cheyne-Stokes respiration, characterised by periodic CSA and a crescendo/decrescendo breathing pattern, often in patients with severe cardiac or neurological diseases; high altitude-induced periodic breathing (above 4000 m), CSA due to medical or neurological conditions; CSA due to drug or substance use; and primary sleep apnea of infancy. Besides the consequent treatment of the underlying medical conditions therapeutic options include the use of drugs, e. g. acetacolamide or oxygen, as well as non-invasive ventilation, e. g. continuous positive airway pressure (CPAP) or adaptive servo-ventilation.

Physician involvement in disease management as part of the CCM.

PubMed

Wallace, Paul J

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I.

Physician Involvement in Disease Management as Part of the CCM

PubMed Central

Wallace, Paul J.

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

Catatonia Update.

PubMed

Brar, Kanwarjeet; Kaushik, Sachin S; Lippmann, Steven

2017-10-26

Catatonia is a neuropsychiatric condition characterized by physical presentations ranging from profound immobility to excessive motor activity. Emotional aspects of catatonia vary clinically between psychomotor retardation and extreme excitability. In the past, catatonia was considered to be a variant of schizophrenia. However, the disorder actually occurs as a clinical expression of many different psychiatric, neurologic, or medical diagnoses. A prompt diagnostic evaluation should identify any underlying diseases with consideration of somatic pathologies, especially those affecting central nervous system function. The workup focuses on a range of metabolic, traumatic, infectious, degenerative, autoimmune, drug-related, or other possible conditions, including psychiatric etiologies. Appropriate interventions should be instituted as quickly as possible to avoid complications like dehydration or deep vein thromboses. Symptomatic treatment commonly includes various pharmaceuticals or electroconvulsive therapy. Benzodiazepine drugs are, and have long been, the most preferred pharmacotherapy. These medications are usually fast acting and effective, are safe, and remain the catatonia treatment of choice. © Copyright 2017 Physicians Postgraduate Press, Inc.

Testing for EMC (electromagnetic compatibility) in the clinical environment.

PubMed

Paperman, D; David, Y; Martinez, M

1996-01-01

Testing for electromagnetic compatibility (EMC) in the clinical environment introduces a host of complex conditions not normally encountered under laboratory conditions. In the clinical environment, various radio-frequency (RF) sources of electromagnetic interference (EMI) may be present throughout the entire spectrum of interest. Isolating and analyzing the impact from the sources of interference to medical devices involves a multidisciplinary approach based on training in, and knowledge of, the following: operation of medical devices and their susceptibility to EMI; RF propagation modalities and interaction theory; spectrum analysis systems and techniques (preferably with signature analysis capabilities) and calibrated antennas; the investigation methodology of suspected EMC problems, and testing protocols and standards. Using combinations of standard test procedures adapted for the clinical environment with personnel that have an understanding of radio-frequency behavior increases the probability of controlling, proactively, EMI in the clinical environment, thus providing for a safe and more effective patient care environment.

Improved education in musculoskeletal conditions is necessary for all doctors.

PubMed Central

Akesson, Kristina; Dreinhöfer, Karsten E.; Woolf, A. D.

2003-01-01

It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals' quality of life but also, importantly, on people's ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels--and the resulting competence and confidence of many doctors--do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system. PMID:14710510

Miniaturization as a key factor to the development and application of advanced metrology systems

NASA Astrophysics Data System (ADS)

Furlong, Cosme; Dobrev, Ivo; Harrington, Ellery; Hefti, Peter; Khaleghi, Morteza

2012-10-01

Recent technological advances of miniaturization engineering are enabling the realization of components and systems with unprecedented capabilities. Such capabilities, which are significantly beneficial to scientific and engineering applications, are impacting the development and the application of optical metrology systems for investigations under complex boundary, loading, and operating conditions. In this paper, and overview of metrology systems that we are developing is presented. Systems are being developed and applied to high-speed and high-resolution measurements of shape and deformations under actual operating conditions for such applications as sustainability, health, medical diagnosis, security, and urban infrastructure. Systems take advantage of recent developments in light sources and modulators, detectors, microelectromechanical (MEMS) sensors and actuators, kinematic positioners, rapid prototyping fabrication technologies, as well as software engineering.

The contingency of patient preferences for involvement in health decision making.

PubMed

Ryan, John; Sysko, James

2007-01-01

Studies indicate that better patient compliance and higher patient satisfaction result when agreement exists between the physician and the patient regarding the medical problem and its treatment. This study will extend previous work by investigating (1) under what conditions patients prefer to be actively involved in their treatment decisions, (2) the underlying theoretical reasons that may account for patient decision-making preferences, and (3) what medical decision-making model can guide physicians and medical policy makers when adapting their medical decision-making styles. A total of 2,765 individuals were surveyed by the National Opinion Research Center as part of the 2002 General Social Survey (GSS). This survey included a one-time topical module on "Doctors and Patients," which incorporated questions on patient preferences concerning the physician-patient relationship. Demographic information (e.g., age, education, and sex) was analyzed against patient preferences for medical decision making. Results support patient preferences for participatory medical decision making, and this is especially true for younger, more educated, and female patients. Common prudence would suggest that the best way to determine a patient's preference for participating in medical decision making is to simply ask them. However, the very asking of this straightforward question is based on the assumption that patients do wish to be actively involved. Results of this study support such an assumption. In the absence of all other knowledge, the results of this national survey support the health care practitioner's belief that U.S. patients, in general, have a preference for being actively involved in medical decision making and that this preference is truer for younger, female, and more educated patients.

A critical theory of medical discourse: how patients and health professionals deal with social problems.

PubMed

Waitzkin, H; Britt, T

1989-01-01

Criticism of social context does not generally appear in medical encounters. When contextual issues arise in medical discourse, messages of ideology and social control may become apparent, usually without the conscious awareness of the participants. By easing the physical or psychological impact of contextual difficulties, or by encouraging patients' conformity to mainstream expectations of desirable behavior, encounters with doctors can help win patients' consent to troubling social conditions. Seen in this light, doctor-patient encounters become micropolitical situations that do not typically encourage explicit statements or actions by health professionals to change contextual sources of their patients' difficulties. A critical theory influenced by structuralism suggests that the surface meanings of signs in medical discourse prove less important than their structural relationships. In addition, a theoretical approach adopting elements of post-structuralism and Marxist literary criticism emphasizes the marginal, absent, or excluded elements of medical discourse. Contextual features that shape a text include social class, sex, age, and race. Through the underlying structure of medical discourse, contextual problems are expressed, marginalized, and managed.

A light on medical practice in 19th-century Canada: the medical manuscripts of Dr. John Mackieson of Charlottetown

PubMed Central

Shephard, D A

1998-01-01

During his long career as a physician in Charlottetown, Dr. John Mackieson (1795-1885) compiled 4 medical manuscripts: 2 sets of case records, a synopsis of the medical conditions that were common in his day and a formulary. As primary sources, these documents provide information about medicine in 19th-century Canada and augment our knowledge of the problems of medical practice in that era. They illustrate aspects of the work of Dr. Mackieson, a generalist with interests in surgery and obstetrics, and they facilitate an understanding of the rationale underlying the treatments that he and his contemporaries used. Although 150 years old, the case records can be appreciated for their relevance to the art of medicine. Two excerpts from the case records, presented in this article, provide a sense of Dr. Mackieson's writings and introduce a discussion on the significance of these manuscripts in relation to the ideas on disease and treatment that governed medical practice, both in Prince Edward Island and elsewhere in Canada, in the 19th century. PMID:9724982

Debates about assisted suicide in Switzerland.

PubMed

Burkhardt, Sandra; La Harpe, Romano

2012-12-01

Assisted suicide is allowed in 3 states of the United States (Oregon, Washington, Montana) but only if performed by a physician.On the opposite, in Switzerland, at the beginning of the 20th century, the Swiss Penal Code referred to assisted suicide in the context of honor or an unhappy love affair. It was only in 1985 that Exit Deutsche Schweiz (Exit for German-speaking Switzerland) "medically" assisted the first patient to end his life.Even if authorized by the Swiss law upon certain conditions, assisted suicide is subject to debates for ethical reasons. The Swiss Academy of Medical Sciences described directives to guide physicians on this difficult subject.Different studies showed an increase in the number of medical-assisted suicide in Switzerland since the 1990s. Now, this number seems to be quite stable. Assisted suicide is authorized in a few hospitals under strict conditions (especially when returning home is impossible).Thus, according to the Swiss law, any person could perform assisted suicide; this is essentially performed by 3 main associations, using pentobarbital on medical prescription as lethal substance.Generally speaking, the Swiss population is rather in favor of assisted suicide. Among politics, the debate has been tough until 2010, when the Federal Council decided not to modify the Swiss Penal Code concerning assisted suicide.

Performance Analysis of IEEE 802.15.6 CSMA/CA Protocol for WBAN Medical Scenario through DTMC Model.

PubMed

Kumar, Vivek; Gupta, Bharat

2016-12-01

The newly drafted IEEE 802.15.6 standard for Wireless Body Area Networks (WBAN) has been concentrating on a numerous medical and non-medical applications. Such short range wireless communication standard offers ultra-low power consumption with variable data rates from few Kbps to Mbps in, on or around the proximity of the human body. In this paper, the performance analysis of carrier sense multiple access with collision avoidance (CSMA/CA) scheme based on IEEE 802.15.6 standard in terms of throughput, reliability, clear channel assessment (CCA) failure probability, packet drop probability, and end-to-end delay has been presented. We have developed a discrete-time Markov chain (DTMC) to significantly evaluate the performances of IEEE 802.15.6 CSMA/CA under non-ideal channel condition having saturated traffic condition including node wait time and service time. We also visualize that, as soon as the payload length increases the CCA failure probability increases, which results in lower node's reliability. Also, we have calculated the end-to-end delay in order to prioritize the node wait time cause by backoff and retransmission. The user priority (UP) wise DTMC analysis has been performed to show the importance of the standard especially for medical scenario.

Race and Ethnic Group Differences in Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Chronic Medical Conditions.

PubMed

Watkins, Daphne C; Assari, Shervin; Johnson-Lawrence, Vicki

2015-09-01

This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups.

20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

Code of Federal Regulations, 2014 CFR

2014-04-01

... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP in...

20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

Code of Federal Regulations, 2012 CFR

2012-04-01

... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP in...

20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

Code of Federal Regulations, 2013 CFR

2013-04-01

... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP in...

20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

Code of Federal Regulations, 2011 CFR

2011-04-01

... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP in...

Robust Machine Learning Variable Importance Analyses of Medical Conditions for Health Care Spending.

PubMed

Rose, Sherri

2018-03-11

To propose nonparametric double robust machine learning in variable importance analyses of medical conditions for health spending. 2011-2012 Truven MarketScan database. I evaluate how much more, on average, commercially insured enrollees with each of 26 of the most prevalent medical conditions cost per year after controlling for demographics and other medical conditions. This is accomplished within the nonparametric targeted learning framework, which incorporates ensemble machine learning. Previous literature studying the impact of medical conditions on health care spending has almost exclusively focused on parametric risk adjustment; thus, I compare my approach to parametric regression. My results demonstrate that multiple sclerosis, congestive heart failure, severe cancers, major depression and bipolar disorders, and chronic hepatitis are the most costly medical conditions on average per individual. These findings differed from those obtained using parametric regression. The literature may be underestimating the spending contributions of several medical conditions, which is a potentially critical oversight. If current methods are not capturing the true incremental effect of medical conditions, undesirable incentives related to care may remain. Further work is needed to directly study these issues in the context of federal formulas. © Health Research and Educational Trust.

Pulmonary Vascular Complications of Liver Disease

PubMed Central

Fritz, Jason S.; Fallon, Michael B.

2013-01-01

Hepatopulmonary syndrome and portopulmonary hypertension are two pulmonary vascular complications of liver disease. The pathophysiology underlying each disorder is distinct, but patients with either condition may be limited by dyspnea. A careful evaluation of concomitant symptoms, the physical examination, pulmonary function testing and arterial blood gas analysis, and echocardiographic, imaging, and hemodynamic studies is crucial to establishing (and distinguishing) these diagnoses. Our understanding of the pathobiology, natural history, and treatment of these disorders has advanced considerably over the past decade; however, the presence of either still increases the risk of morbidity and mortality in patients with underlying liver disease. There is no effective medical treatment for hepatopulmonary syndrome. Although liver transplantation can resolve hepatopulmonary syndrome, there appears to be worse survival even with transplantation. Liver transplantation poses a very high risk of death in those with significant portopulmonary hypertension, where targeted medical therapies may improve functional status and allow successful transplantation in a small number of select patients. PMID:23155142

Corrosion performance of Cr3C2-NiCr+0.2%Zr coated super alloys under actual medical waste incinerator environment

NASA Astrophysics Data System (ADS)

Ahuja, Lalit; Mudgal, Deepa; Singh, Surendra; Prakash, Satya

2018-03-01

Incineration techniques are widely used to dispose of various types of waste which lead to formation of very corrosive environment. Such corrosive environment leads to the degradation of the alloys used in these areas. To obviate this problem, zirconium modified Cr3C2-(NiCr) coating powder has been deposited on three superalloys namely Superni 718, Superni 600 and Superco 605 using Detonation gun technique. Corrosion test was conducted in actual medical waste incinerator environment. The samples were hung inside the secondary chamber operated at 1050°C for 1000h under cyclic condition. Corrosion kinetics was monitored using the weight gain measurements and thickness loss. Corrosion products were characterized using scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction technique. It was observed that coating is found to be successful in impeding the corrosion problem in superalloys.

Assessment of the viscoelastic mechanical properties of polycarbonate urethane for medical devices.

PubMed

Beckmann, Agnes; Heider, Yousef; Stoffel, Marcus; Markert, Bernd

2018-06-01

The underlying research work introduces a study of the mechanical properties of polycarbonate urethane (PCU), used in the construction of various medical devices. This comprises the discussion of a suitable material model, the application of elemental experiments to identify the related parameters and the numerical simulation of the applied experiments in order to calibrate and validate the mathematical model. In particular, the model of choice for the simulation of PCU response is the non-linear viscoelastic Bergström-Boyce material model, applied in the finite-element (FE) package Abaqus®. For the parameter identification, uniaxial tension and unconfined compression tests under in-laboratory physiological conditions were carried out. The geometry of the samples together with the applied loadings were simulated in Abaqus®, to insure the suitability of the modelling approach. The obtained parameters show a very good agreement between the numerical and the experimental results. Copyright © 2018 Elsevier Ltd. All rights reserved.

Medical, Psychophysiological, and Human Performance Problems During Extended EVA

NASA Technical Reports Server (NTRS)

1997-01-01

In this session, Session JP1, the discussion focuses on the following topics: New Developments in the Assessment of the Risk of Decompression Sickness in Null Gravity During Extravehicular Activity; The Dynamic of Physiological Reactions of Cosmonauts Under the Influence of Repeated EVA Workouts, The Russian Experience; Medical Emergencies in Space; The Evolution from 'Physiological Adequacy' to 'Physiological Tuning'; Five Zones of Symmetrical and Asymmetrical Conflicting Temperatures on the Human Body, Physiological Consequences; Human Performance and Subjective Perception in Nonuniform Thermal Conditions; The Hand as a Control System, Implications for Hand-Finger Dexterity During Extended EVA; and Understanding the Skill of Extravehicular Mass Handling.

Lessons learned from a colocation model using psychiatrists in urban primary care settings.

PubMed

Weiss, Meredith; Schwartz, Bruce J

2013-07-01

Comorbid psychiatric illness has been identified as a major driver of health care costs. The colocation of psychiatrists in primary care practices has been proposed as a model to improve mental health and medical care as well as a model to reduce health care costs. Financial models were developed to determine the sustainability of colocation. We found that the population studied had substantial psychiatric and medical burdens, and multiple practice logistical issues were identified. The providers found the experience highly rewarding and colocation was financially sustainable under certain conditions. The colocation model was effective in identifying and treating psychiatric comorbidities.

Sleep and the Cardiovascular System in Children.

PubMed

Paul, Grace R; Pinto, Swaroop

2017-06-01

Subspecialty pediatric practice provides comprehensive medical care for a range of ages, from premature infants to children, and often includes adults with complex medical and surgical issues that warrant multidisciplinary care. Normal physiologic variations involving different body systems occur during sleep and these vary with age, stage of sleep, and underlying health conditions. This article is a concise review of the cardiovascular (CV) physiology and pathophysiology in children, sleep-disordered breathing (SDB) contributing to CV morbidity, congenital and acquired CV pathology resulting in SDB, and the relationship between SDB and CV morbidity in different clinical syndromes and systemic diseases in the expanded pediatric population. Copyright © 2017 Elsevier Inc. All rights reserved.

[Forensic medical characteristic of the thermal injury caused by inflammation of combustible fluids].

PubMed

Khushkadamov, Z K; Iskhizova, L N; Gornostaev, D V

2012-01-01

The diagnostics of thermal injuries caused by inflammation of combustible fluids should be based on the comprehensive assessment of the results of examination of the scene of the accident, autopsy studies, forensic chemical expertise, and analysis of the circumstances of the case and/or medical documentation. Special attention should be given to the choice of adequate methods for taking samples to be used in forensic chemical studies. The assessment of thermal injuries caused by inflammation of combustible fluids must take into consideration the time and conditions under which they were inflicted (e.g. closed or open space, vertical or horizontal position, etc.).

X-ray versus gamma irradiation effects on polymers

NASA Astrophysics Data System (ADS)

Croonenborghs, B.; Smith, M. A.; Strain, P.

2007-11-01

Today, the most common methods used for medical device sterilisation are by gaseous ethylene oxide and by electron beam or gamma irradiation. With X-ray sterilisation about to enter the market, its material compatibility needs to be assessed at doses typically encountered during a sterilisation process. This paper reports on a study that compares the effects of exposing different types of plastics that are commonly used in medical devices to 60Co or to 5 MeV X-rays. The dose rate for both irradiation modalities was of the same order of magnitude. Under these conditions, both types of radiation are found to have similar effects on polymer properties.

[Work capacity evaluation in nonspecific lung diseases in a polyclinic section for lung diseases and tuberculosis].

PubMed

Herlík, J; Kos, S

1991-01-01

Describing the structure of a chest clinic in a large city requirements for a high level on the field of medical assessing in patients with non-specific lung diseases are formulated. 1. It must be sure, that all patients suffering from lung diseases are referred to a pneumologist. 2. Opportunities for optimal diagnosis must be given (knowledge and experiences of physicians and nurses; medical equipments of a high technical standard). 3. A scientific-based treatment must be guaranteed. Under optimal conditions it is possible to shorten the duration of disablement and to avoid the hospitalization in some cases.

[The notion of occupational skin disease. Medical and legal aspects].

PubMed

Elsner, P; Schliemann, S

2015-03-01

The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers, dermatologists should be familiar not only with the medical definition, but also with these different legal definitions of skin disease.

Hypertensive crisis.

PubMed

Rodriguez, Maria Alexandra; Kumar, Siva K; De Caro, Matthew

2010-01-01

Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.

42 CFR 494.170 - Condition: Medical records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Medical records. 494.170 Section 494.170... Administration § 494.170 Condition: Medical records. The dialysis facility must maintain complete, accurate, and...: Completion of patient records and centralization of clinical information. (1) Current medical records and...

42 CFR 494.170 - Condition: Medical records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Medical records. 494.170 Section 494.170... Administration § 494.170 Condition: Medical records. The dialysis facility must maintain complete, accurate, and...: Completion of patient records and centralization of clinical information. (1) Current medical records and...

42 CFR 494.170 - Condition: Medical records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Medical records. 494.170 Section 494.170... Administration § 494.170 Condition: Medical records. The dialysis facility must maintain complete, accurate, and...: Completion of patient records and centralization of clinical information. (1) Current medical records and...

Lifesource XL-18 pedometer for measuring steps under controlled and free-living conditions.

PubMed

Liu, Sam; Brooks, Dina; Thomas, Scott; Eysenbach, Gunther; Nolan, Robert Peter

2015-01-01

The primary aim was to examine the criterion and construct validity and test-retest reliability of the Lifesource XL-18 pedometer (A&D Medical, Toronto, ON, Canada) for measuring steps under controlled and free-living activities. The influence of body mass index, waist size and walking speed on the criterion validity of XL-18 was also explored. Forty adults (35-74 years) performed a 6-min walk test in the controlled condition, and the criterion validity of XL-18 was assessed by comparing it to steps counted manually. Thirty-five adults participated in the free-living condition and the construct validity of XL-18 was assessed by comparing it to Yamax SW-200 (YAMAX Health & Sports, Inc., San Antonio, TX, USA). During the controlled condition, XL-18 did not significantly differ from criterion (P > 0.05) and no systematic error was found using Bland-Altman analysis. The accuracy of XL-18 decreased with slower walking speed (P = 0.001). During the free-living condition, Bland-Altman analysis revealed that XL-18 overestimated daily steps by 327 ± 118 than Yamax (P = 0.004). However, the absolute percent error (APE) (6.5 ± 0.58%) was still within an acceptable range. XL-18 did not differ statistically between pant pockets. XL-18 is suitable for measuring steps in controlled and free-living conditions. However, caution may be required when interpreting the steps recorded under slower speeds and free-living conditions.

Medical Conditions and Medication Use in Adults with Down Syndrome: A Descriptive Analysis

ERIC Educational Resources Information Center

Kerins, Gerard; Petrovic, Kimberly; Bruder, Mary Beth; Gruman, Cynthia

2008-01-01

Background: We examined the presence of medical conditions and medication use within a sample of adults with Down syndrome. Methods: Retrospective chart review using a sample of 141 adults with Down syndrome and age range of 30 to 65 years. Results: We identify 23 categories of commonly occurring medical conditions and 24 categories of medications…

Pediatric liver transplant outcome using severe hypernatremic donors.

PubMed

Uribe, M; Alba, A; González, G; Hunter, B; Heine, C; Iñiguez, R; Cavallieri, S; Flores, L; Soto, P; Auad, H; Zuleta, R; Acuña, C

2013-01-01

Pediatric liver transplantation is limited by donation. In the last 5 years, urgent conditions have forced transplant teams to accept donors with minor suboptimal conditions, termed "extended donor criteria." Among those, the risk of using severe hypernatremic donors (SHD) for liver transplant is not yet well established. The aim of this study is to report the outcome of pediatric patients receiving grafts from SHD. Clinical records of patients transplanted in the last 3 years at Hospital Luis Calvo Mackenna, Santiago, Chile, were reviewed. Outcome was evaluated in terms of patient and graft survival and complications potentially associated to the donor condition. Five of 33 deceased donor transplants presented with SHD. All recipients were waiting transplant in an acute condition, one of them in acute liver failure (ALF). No living related donor was available. Donors' serum sodium was 169 to 193 mEq/L before medical management and between 157 and 172 mEq/L at procurement. One patient died from sepsis related to biliary complications, and the patient suffering ALF developed primary graft nonfunction, received a second transplant 2 weeks later, and recovered to stable medical condition. No other complication was registered in these patients. Our findings allow us to postulate that hypernatremic deceased donors may be used for pediatric liver transplant under special circumstances. Copyright © 2013 Elsevier Inc. All rights reserved.

Concurrent medical conditions among pregnant women - ignore at their peril: report from an antenatal anesthesia clinic.

PubMed

Weiniger, Carolyn F; Einav, Sharon; Elchalal, Uriel; Ozerski, Vladislav; Shatalin, Daniel; Ioscovich, Alexander; Ginosar, Yehuda

2018-03-19

Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, followed by anesthesia related concerns 20%, neurologic conditions 19%, and cardiac conditions 15%. Women were provided plans that were deliberated carefully rather than being concocted during labor. A wide range of concurrent medical conditions was seen in the antenatal anesthesia clinic, however fewer women attended the clinic than expected according to known population frequencies of concurrent medical conditions. Women with concurrent medical conditions should have labor and anesthesia plans considered during the nine months of pregnancy, prior to delivery, and hospitals should have a means of obtaining this information in a timely manner. Finally, there is a need to develop additional antenatal anesthesia clinics.

Vision Screening by Color Photography

NASA Technical Reports Server (NTRS)

Jayroe, R.; Richardson, J. R.; Kerr, J.; Hay, S.; Mcbride, R.

1985-01-01

Screening test developed for detecting a range of vision defects in eye, including common precursors to amblyopia. Test noninvasive, safe, and administered easily in field by operator with no medical training. Only minimal momentary cooperation of subject required: Thus, test shows promise for use with very young children. Test produces color-slide images of retinas of eyes under specially-controlled lighting conditions. Trained observer screens five children per minute.

Computational Study of Thrombus Formation and Clotting Factor Effects under Venous Flow Conditions

DTIC Science & Technology

2016-04-26

Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, MarylandABSTRACT A comprehensive... experimental study. The model allowed us to identify the distinct patterns character- izing the spatial distributions of thrombin, platelets, and fibrin...time, elevated fibrinogen levels may contribute to the development of thrombosis (4,6,12). Quantitative knowledge about the interactions between fibrin

42 CFR 484.34 - Condition of participation: Medical social services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant...

42 CFR 484.34 - Condition of participation: Medical social services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant...

42 CFR 484.34 - Condition of participation: Medical social services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant...

42 CFR 484.34 - Condition of participation: Medical social services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant...

42 CFR 484.34 - Condition of participation: Medical social services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant...

Strengthening training in rural practice in Germany: new approach for undergraduate medical curriculum towards sustaining rural health care.

PubMed

Holst, Jens; Normann, Oliver; Herrmann, Markus

2015-01-01

After decades of providing a dense network of quality medical care, Germany is facing an increasing shortage of medical doctors in rural areas. Current graduation rates of generalists do not counterbalance the loss due to retirement. Informed by international evidence, different strategies to ensure rural medical care are under debate, including innovative teaching approaches during undergraduate training. The University of Magdeburg in Saxony-Anhalt was the first medical school in Germany to offer a rural elective for graduate students. During the 2014 summer semester, 14 medical students attended a two-weekend program in a small village in Northern Saxony-Anhalt that allowed them to become more familiar with a rural community and rural health issues. The elective course raised a series of relevant topics for setting up rural practice and provided students with helpful insight into living and working conditions in rural practice. Preliminary evaluations indicate that the rural medicine course allowed medical students to reduce pre-existing concerns and had positive impact on their willingness to set up a rural medical office after graduation. Even short-term courses in rural practice can help reduce training-related barriers that prevent young physicians from working in rural areas. Undergraduate medical training is promising to attenuate the emerging undersupply in rural areas.

Evaluation of accelerated stability test conditions for medicated chewing gums.

PubMed

Maggi, Lauretta; Conte, Ubaldo; Nhamias, Alain; Grenier, Pascal; Vergnault, Guy

2013-10-01

The overall stability of medicated chewing gums is investigated under different storage conditions. Active substances with different chemical stabilities in solid state are chosen as model drugs. The dosage form is a three layer tablet obtained by direct compression. The gum core contains the active ingredient while the external layers are formulated to prevent gum adhesion to the punches of the tableting machine. Two accelerated test conditions (40°C/75% RH and 30°C/65% RH) are performed for 6 months. Furthermore, a long-term stability test at room conditions is conducted to verify the predictability of the results obtained from the stress tests. Some drugs are stable in all the conditions tested, but other drugs, generally considered stable in solid dosage forms, have shown relevant stability problems particularly when stress test conditions are applied to this particular semi-solid dosage forms. For less stable drugs, the stress conditions of 40°C/75% RH are not always predictable of chewing gum stability at room temperature and may produce false negative; intermediate conditions, 30°C/65% RH, are more predictive for this purpose, the results of drug content found after 6 months at intermediate stress conditions and 12 months at room conditions are generally comparable. But the results obtained show that only long-term conditions stability tests gave consistent results. During aging, the semi solid nature of the gum base itself, may also influence the drug delivery rate during chewing and great attention should be given also to the dissolution stability.

[What Psychiatrists Should Know about the Medical Documentation They Issue: Admission for Medical Care and Protection, Medical Treatment for Persons with Disabilities, Mental Health Disability Certification, etc].

PubMed

Yamasaki, Masao

2015-01-01

Psychiatrists issue a wide variety of documentation, among which are torms such as Registration of Admission for Medical Care and Protection, Periodic Report of Condition, Certification of Medical Treatment for Persons with Disabilities, and Mental Health Disability Certification, which are required under laws such as the Act on Mental Health and Welfare for the Mentally Disabled. These documents are important in that they are related to protecting the human rights of people with mental disorders, as well as securing appropriate medical and welfare services for them. However, in the course of reviewing and evaluating documentation at our Mental Health and Welfare Center, we encounter forms which are incomplete, or which contain inappropriate content. In order to protect the human rights of people with mental disorders, and to ensure the provision of appropriate medical and welfare services for them, I call on psychiatrists to issue carefully written and appropriate documentation. In this talk I will focus primarily on what psychiatrists should know when filling in forms in the course of their day-to-day clinical work.

PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions.

PubMed

Brooks, Benjamin Rix; Crumpacker, David; Fellus, Jonathan; Kantor, Daniel; Kaye, Randall E

2013-01-01

Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. Although PBA occurs secondary to many neurological conditions, with an estimated United States (US) prevalence of up to 2 million persons, it is thought to be under-recognized and undertreated. The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. Participating clinicians were asked to enroll ≥20 consenting patients with any of 6 conditions: Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson's disease (PD), stroke, or traumatic brain injury (TBI). Patients (or their caregivers) completed the Center for Neurologic Study-Lability Scale (CNS-LS) and an 11-point scale measuring impact of the neurological condition on the patient's quality of life (QOL). Presence of PBA symptoms was defined as a CNS-LS score ≥13. Demographic data and current use of antidepressant or antipsychotic medications were also recorded. PRISM enrolled 5290 patients. More than one third of patients (n = 1944; 36.7%) had a CNS-LS score ≥13, suggesting PBA symptoms. The mean (SD) score measuring impact of neurological condition on QOL was significantly higher (worse) in patients with CNS-LS ≥13 vs <13 (6.7 [2.5] vs. 4.7 [3.1], respectively; P<0.0001 two-sample t-test). A greater percentage of patients with CNS-LS ≥13 versus <13 were using antidepressant/antipsychotic medications (53.0% vs 35.4%, respectively; P<0.0001, chi-square test). Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. Higher CNS-LS scores were associated with impaired QOL and greater use of antipsychotic/antidepressant medications. These data underscore a need for greater awareness, recognition, and diagnosis of PBA.

Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children.

PubMed

Alexeeff, Stacey E; Yau, Vincent; Qian, Yinge; Davignon, Meghan; Lynch, Frances; Crawford, Phillip; Davis, Robert; Croen, Lisa A

2017-07-01

This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest associations (ORs 2.0-23.3). Moderately strong associations were observed for nutrition, genetic, ear nose and throat, and sleep conditions (ORs 2.1-3.2). Using machine learning methods, we clustered children based on their medical conditions prior to ASD diagnosis and demonstrated ASD risk stratification. Our findings provide new evidence indicating that children with ASD have a disproportionate burden of certain medical conditions preceding ASD diagnosis.

Venous thromboembolism in medical outpatients - a cross-sectional survey of risk assessment and prophylaxis.

PubMed

Lawall, Holger; Matthiessen, Andreas; Hohmann, Volker; Bramlage, Peter; Haas, Sylvia; Schellong, Sebastian

2011-01-01

The degree of thromboprophylaxis in medical outpatients is low despite a substantial risk for venous thromboembolism (VTE). This may be attributable to difficulties in assessing risk. Assessment tools like the Haas' scorecard aid in determining the need for thromboprophylaxis. We aimed at evaluating how the use of this tool may aid physicians in appropriately using anticoagulants. This was an epidemiological, cross-sectional survey of acute medically ill patients with limited mobility treated by general practitioners and internists. Risk assessment for VTE by the treating physician was compared to calculated risk. Of 8,123 patients evaluated between August 2006 and April 2008, 7,271 fulfilled the in- and exclusion criteria. Mean age was 69.4 ± 13.6 years, and 45.2% were male. Of these 82.8% were high risk based on their acute medical condition, 37.9% based on their underlying chronic condition. Immobilisation, heart failure, pneumonia, age, obesity, and major varicosis were the most frequently encountered risk factors. The agreement between the Haas' scorecard and physician indicated risk was high. At least 94.1% of patients with high risk received adequate anticoagulation mostly as low molecular weight heparins for a mean duration of 15.1 ± 30.5 days. There is a substantial risk for VTE in medical outpatients. Using a simple structured scorecard resulted in an overall appropriate risk assessment and high degree of anticoagulation. The scorecard may provide a tool to improve the overall awareness for VTE risk in medical outpatients, substantially improving the degree of prophylaxis in a patient population with largely underestimated risk.

An (un)desirable trade of harms? How elite athletes might react to medically supervised 'doping' and their considerations of side-effects in this situation.

PubMed

Overbye, Marie

2018-05-01

The zero-tolerance approach to doping in sport has long been criticised. Legalising 'doping' under medical supervision has been proposed as a better way of protecting both athletes' health and fair competition. This paper investigates how elite athletes might react if specific doping substances were permitted under medical supervision and explore athletes' considerations about side-effects in this situation. The results are interpreted using a framework, which views elite sport as an exceptional and risky working environment. 775 elite athletes (mean age: 21.73, SD = 5.52) representing forty sports completed a web-based questionnaire (response rate: 51%) presenting a scenario of legalised, medically supervised 'doping'. 58% of athletes reported an interest in one or more of the 13 proposed substances/methods. Athletes' interest in a specific product was linked to its capacity to enhance performance levels in the athletes' particular sport and depended on gender and age. 23% showed interest in either one or more of erythropoietin (EPO), anabolic-androgenic steroids (AAS), blood transfusions and/or Growth Hormone if permitted and provided under qualified medical supervision. Male speed and power sports athletes of increasing age had the highest likelihood of being interested in AAS (41%, age 36), female motor-skill sports athletes had the lowest (<1%, age 16). 59% feared side-effects. This fear kept 39% of all athletes from being interested in specific substances/methods whereas 18% declared their interest despite fearing the side-effects. Interpreting results with the understanding of sport as an exceptional and risky working environment suggests that legalising certain 'doping' substances under medical supervision would create other/new types of harms, and this 'trade-off of harms and benefits' would be undesirable considering the occupational health, working conditions and well-being of most athletes. Assessing the risks and harms produced/reduced by specific drugs when considering sport as a precarious occupation may prove useful in composing the Prohibited List and reducing drug-related harm in sport. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

A pre-therapeutic coating for medical devices that prevents the attachment of Candida albicans.

PubMed

Vargas-Blanco, Diego; Lynn, Aung; Rosch, Jonah; Noreldin, Rony; Salerni, Anthony; Lambert, Christopher; Rao, Reeta P

2017-05-19

Hospital acquired fungal infections are defined as "never events"-medical errors that should never have happened. Systemic Candida albicans infections results in 30-50% mortality rates. Typically, adhesion to abiotic medical devices and implants initiates such infections. Efficient adhesion initiates formation of aggressive biofilms that are difficult to treat. Therefore, inhibitors of adhesion are important for drug development and likely to have a broad spectrum efficacy against many fungal pathogens. In this study we further the development of a small molecule, Filastatin, capable of preventing C. albicans adhesion. We explored the potential of Filastatin as a pre-therapeutic coating of a diverse range of biomaterials. Filastatin was applied on various biomaterials, specifically bioactive glass (cochlear implants, subcutaneous drug delivery devices and prosthetics); silicone (catheters and other implanted devices) and dental resin (dentures and dental implants). Adhesion to biomaterials was evaluated by direct visualization of wild type C. albicans or a non-adherent mutant edt1 -/- that were stained or fluorescently tagged. Strains grown overnight at 30 °C were harvested, allowed to attach to surfaces for 4 h and washed prior to visualization. The adhesion force of C. albicans cells attached to surfaces treated with Filastatin was measured using Atomic Force Microscopy. Effectiveness of Filastatin was also demonstrated under dynamic conditions using a flow cell bioreactor. The effect of Filastatin under microfluidic flow conditions was quantified using electrochemical impedance spectroscopy. Experiments were typically performed in triplicate. Treatment with Filastatin significantly inhibited the ability of C. albicans to adhere to bioactive glass (by 99.06%), silicone (by 77.27%), and dental resin (by 60.43%). Atomic force microcopy indicated that treatment with Filastatin decreased the adhesion force of C. albicans from 0.23 to 0.017 nN. Electrochemical Impedance Spectroscopy in a microfluidic device that mimic physiological flow conditions in vivo showed lower impedance for C. albicans when treated with Filastatin as compared to untreated control cells, suggesting decreased attachment. The anti-adhesive properties were maintained when Filastatin was included in the preparation of silicone materials. We demonstrate that Filastatin treated medical devices prevented adhesion of Candida, thereby reducing nosocomial infections.

Op HERRICK primary care casualties: the forgotten many.

PubMed

Nelson, T G; Wall, C; Driver, J; Simpson, R

2012-09-01

The number of battle casualties generated during war is far outnumbered by non-battle casualties. Each year the current conflict in Afghanistan sees hundreds of service personnel medically evacuated direct from the front line to the care of their home units' primary care facility. To date these casualties remain undiscovered by medical research. This is the first study to look at the care pathway of primary care casualties from Operation HERRICK using information from the Defence Patient Tracking System (DPTS). Information relating to all casualties from Afghanistan discharged at the airhead between 1 January 2009 and 31 December 2010 was collected from the DPTS. Common conditions were identified and information relating to the follow up care extracted to provide an overview of the care pathway. 387 aeromedical evacuations were identified as primary care casualties. The three commonest conditions were musculoskeletal (183 cases), mental health (29) and noise-induced hearing loss (26). 205 (53%) were not seen outside of primary care for the tracked condition. 166 (81%) of those that remained under primary care had two or less consultations during the time period of the study. The mean time frame between the 1st and 2nd consultation was 5.4 weeks. A significant number of aeromedical evacuations from Afghanistan are for primary care casualties. The DPTS can be used to provide a basic overview of the care pathway of repatriated personnel. Little contact with the medical services would appear to occur for these types of casualties. There is a significant gap in military medical research looking at primary care casualties repatriated from operations.

42 CFR 436.308 - Medically needy coverage of individuals under age 21.

Code of Federal Regulations, 2010 CFR

2010-10-01

... THE VIRGIN ISLANDS Optional Coverage of the Medically Needy § 436.308 Medically needy coverage of... (b) of this section: (1) Who would not be covered under the mandatory medically needy group of... nursing facility services are provided under the plan to individuals within the age group selected under...

[Medical professionalism-on social responsibilities viewed from historical perspective].

PubMed

Kim, Jang Han

2015-03-01

What is medical professionalism and does it matter to the patients? Medical professionals take responsibility for their judgements and the consequences that ensue. Traditionally medical professionalism is defined as a set of values, behaviors, and relationships which support the trust the public has in doctors. The public is well aware that absence of professionalism is harmful to their interests. However, the exercise of medical professionalism is endangered by the political and cultural environment. The values of professionalism have been changed throughout the medical history and the meaning of it was also changed according to social theories. Traditional medical professionalism was based on the virtue of autonomy, self-regulation and competency etc. However, in the new millenium era, the meaning of professionalism has changed under the concept of responsibility which includes the classical virtues. The meaning of professionalism nowadays is only based on the structure and conflicting theories which cannot solve all the issues surrounding professionalism in medical practice. The conditions of medical practice are critical determinants for the future of professionalism. The interaction between doctor and patient is central to the medical care, and medical professionalism has roots in almost every aspect of medical care. I argue that doctors have responsibility to act according to the values which have been determined by the medical profession, history and surrounding society. The new millennium medical professionalism which based on the responsibility could initiate a public dialogue about the role of the doctor in creating a fairer society.

Synthesis of polymer ion-exchange hydrogels under γ - irradiation 60Co

NASA Astrophysics Data System (ADS)

Le, V. M.; Zhevnyak, V. D.; Pak, V. Kh; Ananev, V. A.; Borodin, U. V.

2015-04-01

We have reported earlier about the modification of ion-exchange hydrogel under the influence of gamma radiation. The optimal absorbed dose of irradiation had been choosen for radiation modification of polymer hydrogels by ionits to produce products with a high content of the gel - fractions and sufficient mechanical properties. The dependence of the static exchange capacity of hydrogels on the type of ionit and its fractional composition had been studied. The dependence of the static exchange capacity of the quantitative composition of the ionit in the volume of the hydrogel had been investigated. The ion-exchange medical eye lenses had been made under selected conditions of synthesis. Their sorption properties had been studied.

The prevalence and incidence of medical conditions in healthy pharmaceutical company employees who volunteer to participate in medical research

PubMed Central

Singh, S D; Williams, A J

1999-01-01

Aims Although clinical research in healthy volunteers is commonly performed there have been few studies of the value of the medical screening of subjects. The aim of this study was to investigate the prevalence and incidence of medical conditions found during the medical screening of ‘healthy’ subjects employed in a pharmaceutical company who volunteered to participate in medical research. Methods This was a retrospective study of the medical notes of all the subjects who volunteered for membership of the Zeneca Clinical Pharmacology Unit’s healthy volunteer panel over a 4 year period from 1990 to 1994. The prevalence of medical conditions found at presentation was determined. The incidence of medical conditions during the 4 year observation period was also ascertained. Medical screening included a full medical history and examination, clinical chemistry, haematology and urinalysis screens, pulmonary function tests, ECGs, 24 h ambulatory cardiac monitoring and a request for information from the volunteer’s General Practitioner. Results Prevalence-1293 subjects volunteered to join the panel of which 156 subjects (12%) were not accepted at presentation including 141 (10.9%) for medical reasons. The most medical common reasons were; previously diagnosed medical conditions (3.3%), cardiovascular abnormalities (1.9%), abnormal liver function tests (1.9%), anaemia (1.2%), hyperlipidaemia (1.1%), excess alcohol intake (0.6%) and thyroid disease (0.5%). Incidence—36 of the 1137 volunteers (0.8% per year) accepted onto the panel subsequently developed medical conditions of which the most common were; anaemia (0.29% per year), cardiovascular abnormalities (0.13% per year) and vasovagal syncope (0.13% per year). Conclusions This study demonstrates the importance of medical screening before healthy volunteers participate in clinical research. PMID:10383556

Methicillin Resistant Staphylococcus Aureus Biofilm Formation Over A Separated Flow Region Under Steady And Pulsatile Flow Conditions

NASA Astrophysics Data System (ADS)

Salek, M. Mehdi; Martinuzzi, Robert

2012-02-01

Several researchers have observed that the formation, morphology and susceptibility of bacterial biofilms are affected by the local hydrodynamic condition and, in particular, shear stresses acting on the fluid-biofilm interface. A backwards facing step (BFS) experimental model has been widely utilized as an in vitro model to examine and characterize the effect of flow separation and recirculation zones comparable to those present within various medical devices as well as those observed in vivo. The specific geometry of BFS covers a vide range of flow features observed in physiological or environmental conditions. The hypothesis of this study is that the flow behavior and structures can effectively contribute to the transport and attachment of cells and affecting the morphology of adhered colonies as well as suspended structures (i.e. biofilm streamers). Hence, the formation of the recirculation region occurring within a backward facing step (BFS) under steady and pulsatile conditions as well as three-dimensional flow structures arising close to the side walls are investigated to correlate to biofilms behavior. This hypothesis is investigated using a backward facing step incorporated into a flow cell under steady and pulsatile flow regimes to study the growth of methicillin resistant Staphylococcus aureus (MRSA) UC18 as the study microorganism.

Preflight screening techniques for centrifuge-simulated suborbital spaceflight.

PubMed

Pattarini, James M; Blue, Rebecca S; Castleberry, Tarah L; Vanderploeg, James M

2014-12-01

Historically, space has been the venue of the healthy individual. With the advent of commercial spaceflight, we face the novel prospect of routinely exposing spaceflight participants (SPFs) with multiple comorbidities to the space environment. Preflight screening procedures must be developed to identify those individuals at increased risk during flight. We examined the responses of volunteers to centrifuge accelerations mimicking commercial suborbital spaceflight profiles to evaluate how potential SFPs might tolerate such forces. We evaluated our screening process for medical approval of subjects for centrifuge participation for applicability to commercial spaceflight operations. All registered subjects completed a medical questionnaire, physical examination, and electrocardiogram. Subjects with identified concerns including cardiopulmonary disease, hypertension, and diabetes were required to provide documentation of their conditions. There were 335 subjects who registered for the study, 124 who completed all prescreening, and 86 subjects who participated in centrifuge trials. Due to prior medical history, five subjects were disqualified, most commonly for psychiatric reasons or uncontrolled medical conditions. Of the subjects approved, four individuals experienced abnormal physiological responses to centrifuge profiles, including one back strain and three with anxiety reactions. The screening methods used were judged to be sufficient to identify individuals physically capable of tolerating simulated suborbital flight. Improved methods will be needed to identify susceptibility to anxiety reactions. While severe or uncontrolled disease was excluded, many subjects successfully participated in centrifuge trials despite medical histories of disease that are disqualifying under historical spaceflight screening regimes. Such screening techniques are applicable for use in future commercial spaceflight operations.

Medical Treatment of Aortic Aneurysms in Marfan Syndrome and other Heritable Conditions

PubMed Central

Jost, Christine H. Attenhofer; Greutmann, Matthias; Connolly, Heidi M.; Weber, Roland; Rohrbach, Marianne; Oxenius, Angela; Kretschmar, Oliver; Luscher, Thomas F.; Matyas, Gabor

2014-01-01

Thoracic aortic aneurysms can be triggered by genetic disorders such as Marfan syndrome (MFS) and related aortic diseases as well as by inflammatory disorders such as giant cell arteritis or atherosclerosis. In all these conditions, cardiovascular risk factors, such as systemic arterial hypertension, may contribute to faster rate of aneurysm progression. Optimal medical management to prevent progressive aortic dilatation and aortic dissection is unknown. β-blockers have been the mainstay of medical treatment for many years despite limited evidence of beneficial effects. Recently, losartan, an angiotensin II type I receptor antagonist (ARB), has shown promising results in a mouse model of MFS and subsequently in humans with MFS and hence is increasingly used. Several ongoing trials comparing losartan to β-blockers and/or placebo will better define the role of ARBs in the near future. In addition, other medications, such as statins and tetracyclines have demonstrated potential benefit in experimental aortic aneurysm studies. Given the advances in our understanding of molecular mechanisms triggering aortic dilatation and dissection, individualized management tailored to the underlying genetic defect may be on the horizon of individualized medicine. We anticipate that ongoing research will address the question whether such genotype/pathogenesis-driven treatments can replace current phenotype/syndrome-driven strategies and whether other forms of aortopathies should be treated similarly. In this work, we review currently used and promising medical treatment options for patients with heritable aortic aneurysmal disorders. PMID:24527681

Medicalising short children with growth hormone? Ethical considerations of the underlying sociocultural aspects.

PubMed

Murano, Maria Cristina

2018-06-01

In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by means of a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: (1) the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; (2) the analysis of the goals of medicine should be broadened to include justifications for the treatment; (3) the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation.

Communication in acute ambulatory care.

PubMed

Dean, Marleah; Oetzel, John; Sklar, David P

2014-12-01

Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.

[EVALUATION OF THE EFFECTIVENESS OF ADDITIONAL PROFESSIONAL EDUCATION ON THE BASIS OF HEALTH CARE FACILITY].

PubMed

Bohomaz, V M; Rymarenko, P V

2014-01-01

In this study we tested methods of facility learning of health care workers as part of a modern model of quality management of medical services. The statistical and qualitative analysis of the effectiveness of additional training in emergency medical care at the health facility using an adapted curriculum and special mannequins. Under the guidance of a certified instructor focus group of 53 doctors and junior medical specialists studied 22 hours. According to a survey of employees trained their level of selfassessment of knowledge and skills sigificantly increased. Also significantly increased the proportion of correct answers in a formalized testing both categories of workers. Using androgological learning model, mannequins simulators and training in small groups at work create the most favorable conditions for effective individual and group practical skills of emergency medicine.

A novel strategy for load balancing of distributed medical applications.

PubMed

Logeswaran, Rajasvaran; Chen, Li-Choo

2012-04-01

Current trends in medicine, specifically in the electronic handling of medical applications, ranging from digital imaging, paperless hospital administration and electronic medical records, telemedicine, to computer-aided diagnosis, creates a burden on the network. Distributed Service Architectures, such as Intelligent Network (IN), Telecommunication Information Networking Architecture (TINA) and Open Service Access (OSA), are able to meet this new challenge. Distribution enables computational tasks to be spread among multiple processors; hence, performance is an important issue. This paper proposes a novel approach in load balancing, the Random Sender Initiated Algorithm, for distribution of tasks among several nodes sharing the same computational object (CO) instances in Distributed Service Architectures. Simulations illustrate that the proposed algorithm produces better network performance than the benchmark load balancing algorithms-the Random Node Selection Algorithm and the Shortest Queue Algorithm, especially under medium and heavily loaded conditions.

[The Military Medical Academy during the Great Patriotic War].

PubMed

Elizarev, S V; Lemeshkin, R N; Klyuchnkov, P B

2015-05-01

The article is devoted to the 70th anniversary of Victory in the Great Patriotic War of 1941-1945. Presented the contribution of the"Military Medical Academy. Examined the activities of the academy and the fulfillment of its employees on the eve of the war, the conditions under which employees had to work in the first months of the war in Leningrad. Described the evacuation of the Academy to the rear of the' country and especially educational, scientific and practical activities of employees Academy in Samarkand; activities clinics Academy remaining in the besieged Leningrad; radical reorganization of the Academy during the war. Presented briefly the history of creation of command and the Medical Faculty. Paying tribute to the faculty of the Academy in the field of research, teaching activities and practical work in the army.

The evaluation of readiness of medical personnel to act under conditions of chemical contamination.

PubMed

Szarpak, Łukasz; Kurowski, Andrzej

2014-08-01

We evaluated the knowledge of physicians, nurses, and paramedics in Poland about the procedures in a chemical contamination. An anonymous survey was mailed to 600 randomly selected physicians, nurses, and paramedics. The survey included questions concerning the process of decontamination, knowledge of toxidromes, and the use of selected antidotes. Completed surveys were received from 510 respondents (85%). A very low level of knowledge was observed regarding decontamination techniques (from 8.3% to 34.2%), use of antidotes (from 13.7% to 61%), and knowledge of toxidromes (from 10.2% to 22.7%). Our findings showed that for all aspects of chemical rescue procedures queried, the knowledge of medical personnel was not satisfactory. Both practical and theoretical training of medical personnel is urgently needed for life-saving procedures during a chemical contamination.

A joint inventory policy under permissible delay in payment and stochastic demand (Case study: Pharmacy Department of Pariaman Hospital)

NASA Astrophysics Data System (ADS)

Jonrinaldi, Primadi, M. Yugo; Hadiguna, Rika Ampuh

2017-11-01

Inventory cannot be avoided by organizations. One of them is a hospital which has a functional unit to manage the drugs and other medical supplies such as disposable and laboratory material. The unit is called Pharmacy Department which is responsible to do all of pharmacy services in the hospital. The current problem in Pharmacy Department is that the level of drugs and medical supplies inventory is too high. Inventory is needed to keep the service level to customers but at the same time it increases the cost of holding the items, so there should be a policy to keep the inventory on an optimal condition. To solve such problem, this paper proposes an inventory policy in Pharmacy Department of Pariaman Hospital. The inventory policy is determined by using Economic Order Quantity (EOQ) model under condition of permissible delay in payment for multiple products considering safety stock to anticipate stochastic demand. This policy is developed based on the actual condition of the system studied where suppliers provided a certain period to Pharmacy Department to complete the payment of the order. Based on implementation using software Lingo 13.0, total inventory cost of proposed policy of IDR 137,334,815.34 is 37.4% lower than the total inventory cost of current policy of IDR 219,511,519.45. Therefore, the proposed inventory policy is applicable to the system to minimize the total inventory cost.

The Acute Gastrointestinal Syndrome in High-Dose Irradiated Mice

PubMed Central

Booth, Catherine; Tudor, Gregory; Tudor, Julie; Katz, Barry P; MacVittie, Thomas

2012-01-01

The most detailed reports of the response of the gastrointestinal system to high dose acute radiation have focused mainly on understanding the histopathology. However, to enable medical countermeasure assessment under the animal rule criteria, it is necessary to have a robust model in which the relationship between radiation dose and intestinal radiation syndrome incidence, timing and severity are established and correlated with histopathology. Although many mortality studies have been published, they have used a variety of mouse strains, ages, radiation sources and husbandry conditions, all of which influence the dose response. Further, it is clear that the level of bone marrow irradiation and supportive care can influence endpoints. In order to create robust baseline data we have generated dose response data in adult male mice, maintained under identical conditions, and exposed to either total or partial-body irradiation. Partial-body irradiation includes both extensive (40%) and minimal (5%) bone marrow sparing models, the latter designed to correlate with an established primate model and allow assessment of effects of any medical countermeasure on all three major radiation syndromes (intestinal, bone marrow and lung) in the surviving mice. Lethal dose (LD30, LD50 and LD70) data are described in the various models, along with the impact of enteric flora and response to supportive care. Correlation with diarrhea severity and histopathology are also described. This data can be used to aid the design of good laboratory practice (GLP) compliant Animal Rule studies that are reflective of the conditions following accidental radiation exposure. PMID:23091876

Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site.

PubMed

Aggarwal, Neil K; Desilva, Ravi; Nicasio, Andel V; Boiler, Marit; Lewis-Fernández, Roberto

2015-01-01

Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility. Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.

Does the Cultural Formulation Interview (CFI) for the Fifth Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site

PubMed Central

Aggarwal, Neil K.; DeSilva, Ravi; Nicasio, Andel V.; Boiler, Marit; Lewis-Fernández, Roberto

2014-01-01

Objectives Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. Design We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n=64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. Results Despite racial, ethnic, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient’s perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but 2 codes fell under the implementation outcome of clinical utility, 2 fell under acceptability, and none fell under feasibility. Conclusion Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition. PMID:25372242

The Effects of Medical Conditions on Driving Performance

DOT National Transportation Integrated Search

2017-08-01

This project investigated the effect of selected medical conditions on the exposure and performance of older drivers. A review of recent literature, followed by a panel meeting with driving safety experts, prioritized four medical conditions for furt...

Evaluating drivers licensed with medical conditions in Utah, 1992-1996

DOT National Transportation Integrated Search

1999-06-01

The Utah Driver License Division has implemented a program since 1979 that restricts drivers with medical conditions by functional ability category (medical condition) according to their functional ability level. This study compares the citation, all...

Medications and Older Adults

MedlinePlus

... Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide ... Expert Search Search AAAAI Breadcrumb navigation Home ▸ Conditions & Treatments ▸ Library ▸ Allergy Library ▸ Medications and older adults Share | Medications and ...

Electromechanical fatigue in IPMC under dynamic energy harvesting conditions

NASA Astrophysics Data System (ADS)

Krishnaswamy, Arvind; Roy Mahapatra, D.

2011-04-01

Ionic polymer-metal composites (IPMCs) are an interesting subset of smart, multi-functional materials that have shown promises in energy conversion technologies. Being electromechanically coupled, IPMCs can function as dynamic actuators and sensors, transducers for energy conversion and harvesting, as well as artificial muscles for medical and industrial applications. Like all natural materials, even IPMCs undergo fatigue under dynamic load conditions. Here, we investigate the electromechanical fatigue induced in the IPMCs due to the application of cyclic mechanical bending deformation under hydrodynamic energy harvesting condition. Considering the viscoelastic nature of the IPMC, we employ an analytical approach to modeling electromechanical fatigue primarily under the cyclic stresses induced in the membrane. The polymer-metal composite undergoes cyclic softening throughout the fatigue life without attaining a saturated state of charge migration. However, it results in (1) degradation of electromechanical performance; (2) nucleation and growth of microscopic cracks in the metal electrodes; (3) delamination of metal electrodes at the polymer-electrode interface. To understand these processes, we employ a phenomenological approach based on experimentally measured relaxation properties of the IPMC membrane. Electromechanical performance improves significantly with self-healing like properties for a certain range of relaxation time. This is due to reorientation of the backbone polymer chains which eventually leads to a regenerative process with increased charge transport.

Reduced-Intensity Stem Cell Transplantation: "...whereof a little More than a little is by much too much." King Henry IV, part 1, I, 2.

PubMed

Antin, Joseph H

2007-01-01

The recognition that the immune system can play a major role in the control and cure of transplantable disorders led to the development of reduced-intensity allogeneic transplantation. The notion is that a compromise can be made between the intensity of conditioning and the fostering of graft-versus-host disease/ graft-versus-leukemia (GVHD/GVL), allowing the use of less intense conditioning with concomitantly less intense immediate toxicity. Reduced-intensity conditioning regimens have allowed the application of transplantation to older patients and to patients with underlying medical problems that preclude full-dose transplantation. Clearly, in some settings in which dose intensity is important, reduced-intensity regimens are less useful. However, for diseases that are either indolent, highly susceptible to GVL, or under good control before entering transplantation, this approach appears to have substantial benefits. Although the therapy appears to be valuable, concerns about delayed immune reconstitution and GVHD remain.

[Treatment of hyperhidrosis (excessive sweating)].

PubMed

Salava, Alexander; Jousimaa, Jukkapekka

2016-01-01

Hyperhidrosis can be localized or generalized and may cause the patient significant discomfort. Localized hyperhidrosis is usually primary, often begins in adolescence and is partly based on genetic dispositions. As a rule it does not necessitate investigations for secondary causes (e.g. endocrine or neurologic conditions). Generalized hyperhidrosis is commonly associated with environmental or lifestyle factors, and sometimes physiological factors. In new-onset generalized sweating of unclear origin, it may be appropriate to consider secondary causes (underlying diseases, medications, infections). Relatively effective symptomatic treatments are available in localized hyperhidrosis. The treatment of generalized hyperhidrosis is almost always directed against the underlying factors.

Medical home services for children with behavioral health conditions.

PubMed

Sheldrick, Radley C; Perrin, Ellen C

2010-01-01

Whether medical services received by children and youth with behavioral health conditions are consistent with a Medical Home has not been systematically studied. The objectives of this study were to examine the variation among four behavioral health conditions in regard to services related to the Medical Home. Cross-sectional analyses of the 2003 National Survey of Children's Health were conducted. Multiple logistic regression analyses tested the impact of behavioral health conditions on medical needs, on Medical Home components, and on likelihood of having a Medical Home overall. Autism, Depression/Anxiety, and Behavior/Conduct problems were associated with reduced likelihood of having a Medical Home, whereas Attention-Deficit Hyperactivity Disorder was associated with increased likelihood. All health conditions predicted increased access to a primary care physician (PCP) and a preventive visit in the past year. However, all were also associated with higher needs for specialty care and all behavioral health conditions except Attention-Deficit Hyperactivity Disorder were associated with difficulties accessing this care. A detailed examination of the receipt of services among children and youth with behavioral health conditions reveals two primary reasons why such care is less likely to be consistent with a Medical Home model: (1) parents are more likely to report needing specialty care; and (2) these needs are less likely to be met. These data suggest that the reason why services received by children and youth with behavioral health conditions are not consistent with the Medical Home has more to do with difficulty accessing specialty care than with problems accessing quality primary care.

[Amiodarone-induced thyrotoxicosis].

PubMed

Bogazzi, Fausto; Tomisti, Luca; Di Bello, Vitantonio; Martino, Enio

2017-03-01

Amiodarone-induced thyroid dysfunction occurs in about 15-20% of patients under amiodarone therapy. Amiodarone-induced hypothyroidism (AIH) can develop in patients with an apparently normal thyroid gland or in those with an underlying chronic autoimmune thyroiditis. On a clinical ground, AIH is not challenging and can be easily treated with L-thyroxine therapy. Amiodarone-induced thyrotoxicosis (AIT) can occur in patients with (AIT 1) or without (AIT 2) an underlying thyroid disease. AIT 1 is a true iodine-induced hyperthyroidism occurring in patients with an underlying thyroid autonomy while AIT 2 is a drug-induced destructive thyroiditis. According to the different pathogenetic mechanism, AIT 2 is treated with glucocorticoids while AIT 1 usually responds to thionamides. Thyroidectomy should be considered when AIT represents an imminent risk for cardiac conditions, when patients require a prompt resolution of thyrotoxicosis or when they do not respond to the medical therapy. An effective collaboration between cardiologists and endocrinologists is crucial in each part of the management of AIT patients, including the evaluation of cardiological conditions with regard to thyroid hormone excess and whether, or not, it is necessary to continue amiodarone therapy.

A biphasic model for bleeding in soft tissue

NASA Astrophysics Data System (ADS)

Chang, Yi-Jui; Chong, Kwitae; Eldredge, Jeff D.; Teran, Joseph; Benharash, Peyman; Dutson, Erik

2017-11-01

The modeling of blood passing through soft tissues in the body is important for medical applications. The current study aims to capture the effect of tissue swelling and the transport of blood under bleeding or hemorrhaging conditions. The soft tissue is considered as a non-static poro-hyperelastic material with liquid-filled voids. A biphasic formulation effectively, a generalization of Darcy's law-is utilized, treating the phases as occupying fractions of the same volume. The interaction between phases is captured through a Stokes-like friction force on their relative velocities and a pressure that penalizes deviations from volume fractions summing to unity. The soft tissue is modeled as a hyperelastic material with a typical J-shaped stress-strain curve, while blood is considered as a Newtonian fluid. The method of Smoothed Particle Hydrodynamics is used to discretize the conservation equations based on the ease of treating free surfaces in the liquid. Simulations of swelling under acute hemorrhage and of draining under gravity and compression will be demonstrated. Ongoing progress in modeling of organ tissues under injuries and surgical conditions will be discussed.

Bilateral Femoral Neck Fatigue Fracture due to Osteomalacia Secondary to Celiac Disease: Report of Three Cases.

PubMed

Selek, Ozgur; Memisoglu, Kaya; Selek, Alev

2015-08-01

Bilateral non traumatic femoral neck fatigue fracture is a rare condition usually occurring secondary to medical conditions such as pregnancy, pelvic irradiation, corticosteroid exposure, chronic renal failure and osteomalacia. In this report, we present three young female patients with bilateral femoral neck fracture secondary to osteomalacia. The underlying cause of osteomalacia was Celiac disease in all patients. The patients were treated with closed reduction and internal fixation with cannulated lag screws. They were free of pain and full weight bearing was achieved at three months. There were no complications, avascular necrosis and nonunion during the follow up period. In patients with bone pain, non traumatic fractures and muscle weakness, osteomalacia should be kept in mind and proper diagnostic work-up should be performed to identify the underlying cause of osteomalacia such as celiac disease.