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Selected Abstracts4 A Multimedia Web-based Interactive Quiz Module for the Education of Emergency Medical PersonnelACADEMIC EMERGENCY MEDICINE, Issue 2008James D'Agostino A dynamic database-driven website was introduced in 2002. This site has served successfully as a learning tool with its annual update and addition of interactive case and quiz modules. To extend web-based learning as an educational tool, we developed a multimedia web-based module for emergency medicine, with video and audio enhancements to simulate patient encounters in the emergency ward setting. Central to the web-module development is the creation of a relational database. We use FileMaker Pro with search, storage, retrieval, image, video and audio incorporation functions, and a built-in interface that allows display of database contents in web templates. Initially the patient's history and presentation are presented with a 30,60 second video followed by key physical findings. The diagnostic studies and management of the patient are then available through sequential interactive quizzes and feedback replies, presented in audio-, video- and image-oriented formats. The format of the quizzes themselves simulates medical board questions. Initial feedback has been favorable. The majority of emergency medicine personnel feel that this module complements and enhances regular lecture sessions. In addition, it enables preservation of interesting and/or infrequently encountered cases for viewing by all residents in Emergency Medicine. [source] Practice Guidelines for Evaluation of Fever in Returning Travelers and MigrantsJOURNAL OF TRAVEL MEDICINE, Issue 2003Valérie D'Acremont Background Fever upon return from tropical or subtropical regions can be caused by diseases that are rapidly fatal if left untreated. The differential diagnosis is wide. Physicians often lack the necessary knowledge to appropriately take care of such patients. Objective To develop practice guidelines for the initial evaluation of patients presenting with fever upon return from a tropical or subtropical country in order to reduce delays and potential fatal outcomes and to improve knowledge of physicians. Target audience Medical personnel, usually physicians, who see the returning patients, primarily in an ambulatory setting or in an emergency department of a hospital and specialists in internal medicine, infectious diseases, and travel medicine. Method A systematic review of the literature,mainly extracted from the National Library of Medicine database,was performed between May 2000 and April 2001, using the keywords fever and/or travel and/or migrant and/or guidelines. Eventually, 250 articles were reviewed. The relevant elements of evidence were used in combination with expert knowledge to construct an algorithm with arborescence flagging the level of specialization required to deal with each situation. The proposed diagnoses and treatment plans are restricted to tropical or subtropical diseases (nonautochthonous diseases). The decision chart is accompanied with a detailed document that provides for each level of the tree the degree of evidence and the grade of recommendation as well as the key points of debate. Participants and consensus process Besides the 4 authors (2 specialists in travel/tropical medicine, 1 clinical epidemiologist, and 1 resident physician), a panel of 11 European physicians with different levels of expertise on travel medicine reviewed the guidelines. Thereafter, each point of the proposed recommendations was discussed with 15 experts in travel/tropical medicine from various continents. A final version was produced and submitted for evaluation to all participants. Conclusion Although the quality of evidence was limited by the paucity of clinical studies, these guidelines established with the support of a large and highly experienced panel should help physicians to deal with patients coming back from the Tropics with fever. [source] Has the education of professional caregivers and lay people in dental trauma care failed?DENTAL TRAUMATOLOGY, Issue 1 2009Ulf Glendor This situation could seriously affect the outcome of TDIs, especially a complicated TDI. The overall aim of this study was to present a review of dental trauma care with focus on treatment and dentists and lay persons' lack of knowledge on how to manage a TDI. A further aim is to introduce the actors involved and the outcome of their education. Material and method:, The databases Medline, Cochrane, SSCI, SCI and CINAHL from the year 1995 to the present were used. Focus was on treatment need, inadequate care, lack of knowledge and poor organization of emergency care. Result:, Studies from different countries demonstrated that treatment needs were not properly met despite the fact that not all untreated teeth needed treatment. Treatment in emergency dental care was often inadequate or inappropriate. With the exception of lay people, teachers, medical personnel and even dentists performed inadequate care. Furthermore, information to the public was insufficient. Despite a low level of knowledge, lay people expressed a strong interest in helping someone with a TDI. Conclusion:, The conclusion from this review is that consideration must be given the problematic results from different studies on education or information about dental trauma care. Despite that the studies reviewed were from different countries and groups of people, the results seem to be consistent, i.e. that a large part of the educational process of professional caregivers and lay people has failed. Too much hope seems to be put on lay people to handle difficult cases such as tooth avulsion. Education of caregivers and lay people is a field where much remains to be explored. [source] A Pilot Study of the Clinical Impact of Hand-Carried Cardiac Ultrasound in the Medical ClinicECHOCARDIOGRAPHY, Issue 6 2006Lori B. Croft M.D. Background: Small, hand-carried ultrasound devices have become widely available, making point-of-care echocardiograms (echos) accessible to all medical personnel as a means to augment and improve the increasingly inefficient physical examination. This study was designed to determine the clinical utility of hand-carried echo by medical residents in clinical decision making. Methods: Nine residents underwent brief, practical echo training to perform and interpret a limited hand-carried echo as an integral component of their office examination. The residents' hand-carried echo consisting of four basic views to define left ventricular (LV) function and wall thickness, valvular disease, and any pericardial effusions was compared to one performed by a level III echocardiographer. Results: Seventy-two consecutive medical clinic patients were enrolled with an average image acquisition time of 4.45 minutes. Residents obtained diagnostic images in 94% of the cases and interpreted them correctly 93% of the time. They correctly identified 92% of the major echo findings and 78% of the minor findings. Their diagnosis of LV dysfunction, valvular disease, and LV hypertrophy improved by 19%, 39%, and 14% with hand-carried echo compared to history and physical alone. Management decisions were reinforced in 76% and changed in 40% of patients with the use of hand-carried echo. Conclusion: This study demonstrates that it is possible to train medical residents to perform an effective and reasonably accurate hand-carried echo during their physical examination, which can impact clinical management. [source] Information Technology and Emergency Medical Care during DisastersACADEMIC EMERGENCY MEDICINE, Issue 11 2004Theodore C. Chan MD Abstract Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims. [source] Targeting Chemical and Biological Warfare Agents at the Molecular LevelELECTROANALYSIS, Issue 14 2003Omowunmi Abstract After the September,11 tragedies of 2001, scientists and law-enforcement agencies have shown increasing concern that terrorist organizations and their "rogue" foreign government-backers may resort to the use of chemical and/or biological agents against U.S. military or civilian targets. In addition to the right mix of policies, including security measures, intelligence gathering and training for medical personnel on how to recognize symptoms of biochemical warfare agents, the major success in combating terrorism lies in how best to respond to an attack using reliable analytical sensors. The public and regulatory agencies expect sensing methodologies and devices for homeland security to be very reliable. Quality data can only be generated by using analytical sensors that are validated and proven to be under strict design criteria, development and manufacturing controls. Electrochemical devices are ideally suited for obtaining the desired analytical information in a faster, simpler, and cheaper manner compared to traditional (lab-based) assays and hence for meeting the requirements of decentralized biodefense applications. This articler presents a review of the major trends in monitoring technologies for chemical and biological warfare (CBW) agents. It focuses on research and development of sensors (particularly electrochemical ones), discusses how advances in molecular recognition might be used to design new multimission networked sensors (MULNETS) for homeland security. Decision flow-charts for choosing particular analytical techniques for CBW agents are presented. Finally, the paths to designing sensors to meet the needs of today's measurement criteria are analyzed. [source] Intracutaneous injection of the macrophage-activating lipopeptide-2 (MALP-2) which accelerates wound healing in mice , a phase I trial in 12 patientsEXPERIMENTAL DERMATOLOGY, Issue 12 2008Margarete Niebuhr Abstract:, Chronic skin ulcers, such as leg ulcers, pressure sores and diabetic foot ulcers, are a challenge to physicians and medical personnel and a cause of tremendous discomfort and ensuing loss of quality of life to the patients. Wound healing involves production and action of various growth factors. A novel approach, distinct from the application of single growth factors, is the administration of the macrophage stimulator macrophage-activating lipopeptide-2 (MALP-2). The rationale is based on the finding that macrophages are the main source of several growth factors required for wound healing, which are sequentially released during this process. MALP-2 has previously been shown to be effective in an established animal model with diabetic mice. The purpose of the present phase I study was to establish tolerability of MALP-2 when applied into small cutaneous wounds in human beings. Twelve patients (six females and six males; mean age 66.8 years; range 52,87 years) with different diagnoses were enrolled into the study. An artificial wound was created with a 2-mm diameter skin biopsy punch and a volume of 30 ,l MALP-2 (0.125,1 ,g) or vehicle control, respectively, was injected intracutaneously into the wound and closed with a water-resistant transparent adhesive. Photos were taken daily from every patient up to 6 days, and skin biopsies were performed after 1 week from six patients. We could show in the present study for the first time that MALP-2 caused a transient erythema and was tolerated without any systemic side effects up to a dose of 1 ,g per wound in human beings. In healthy as well as in diabetic patients, MALP-2 induced local inflammation that faded after 48 h. The effectiveness of MALP-2 in the healing of chronic wounds in humans, e.g. in chronic skin ulcers, such as leg ulcers, pressure sores and diabetic foot ulcers, could now be addressed in further studies. [source] Prison health care: is contracting out healthy?HEALTH ECONOMICS, Issue 11 2009Kelly Bedard Abstract US prison health care has recently been in the news and in the courts. A particular issue is whether prisons should contract out for health care. Contracting out has been growing over the past few decades. The stated motivation for this change ranges from a desire to improve the prison healthcare system, sometimes in response to a court mandate, to a desire to reduce costs. This study is a first attempt to quantify the impact of this change on inmate health. As morbidity measures are not readily obtainable, we focus on mortality. More specifically, we use a panel of state prisons from 1979 to 1990 and a fixed effects Poisson model to estimate the change in mortality associated with increase in the percentage of medical personnel employed under contract. In contrast to the first stated aim of contracting, we find that a 13% increase in percentage of medical personnel employed under contract increases mortality by 1.3%. Copyright © 2009 John Wiley & Sons, Ltd. [source] Pain on injection from propofol may be avoided by changing its formulationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010J. A. ALDRETE Background: After using propofol for a decade, pain on injection had been considered routine by patients and medical personnel. When given propofol from a different manufacturer, patients did not complain. Two preparations of propofol were compared. Methods: A comparative, double-blind, randomized study was conducted in 22 adult patients undergoing pain relief procedures; they received sedation by an intravenous injection of 1.7 mg/kg of propofol and then were treated with paravertebral injections. Pain on injection was assessed by verbal complaint, movement of the extremity, of the whole body and recollection of pain at induction, when discharged. Propofol from Baxter Laboratories, mixed with either 5 ml of 2% lidocaine or 5 ml of NaCl 0.9%, was compared with propofol Laboratorios Gray, which was similarly mixed. Injections were randomly administered four times, blindly, to each of 22 patients. Statistical analysis was conducted using the analysis of variance method. Results: A total of 352 propofol injections were given. Each of the four propofol solutions was administered 88 times; of patients receiving Baxter propofol+saline, 74 (84%) had pain; when mixed with 2% lidocaine 45 (50.2%) complained. After propofol Gray with NaCl 0.9% was given, two patients (2.2%) experienced pain. Propofol Gray with 2% lidocaine produced no pain. None of the latter group remembered having pain, whereas, those given propofol Baxter 54 (61.3%) and 26 (29.5%) remembered experiencing pain at injection. Pain on injection was prevented and statistically reduced (<0.01) with the propofol from Laboratorios Gray. Conclusions: By changing the formulation (size of molecules and their dispersion) of propofol, pain on injection was avoided. [source] Investigation into possible DNA damaging effects of ultrasound in occupationally exposed medical personnel , the alkaline comet assay studyJOURNAL OF APPLIED TOXICOLOGY, Issue 3 2005Verica Garaj-Vrhovac Abstract In the present paper the possible DNA damaging effects of ultrasound in occupationally exposed medical personnel were investigated using the alkaline comet assay. The extent of DNA migration in peripheral blood leucocytes was measured. Parameters of the comet assay were studied in 30 medical workers occupationally exposed to ultrasound and in 30 corresponding unexposed control subjects. It was found that the subjects who were occupationally exposed to ultrasound for various periods of time showed a highly significant increase in levels of DNA damage compared with the control. The results obtained have confirmed the usefulness of the alkaline comet assay as a sensitive biodosimetric method, reflecting the current level of DNA damage and[sol ]or repair in peripheral blood leucocytes of ultrasound-exposed subjects. In spite of their limitations, the results of the present investigation indicate that individuals occupationally exposed to ultrasound may experience an increased genotoxic risk, emphasizing the need for more research into the nature and extent of the biological consequences to medical personnel working with ultrasonic equipment. Copyright © 2005 John Wiley & Sons, Ltd. [source] Our genes are not our destiny: incorporating molecular medicine into clinical practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2008Stephen J. Genuis MD FRCSC DABOG DABEM FAAEM Abstract In many developed nations, the state of publicly administered health care is increasingly precarious as a result of escalating numbers of chronically ill patients, inadequate medical personnel and hospital facilities, as well as sparse funding for ongoing upgrades to state-of-the-art diagnostic and therapeutic technology , an increased emphasis on aetiology-centred medicine should be considered in order to achieve improved health for patients and populations. Medical practice patterns which are designed to provide quick and effective amelioration of signs and symptoms are frequently not an enduring solution to many health afflictions and chronic disease states. Recent scientific discovery has rendered the drug-oriented algorithmic paradigm commonly found in contemporary evidence-based medicine to be a reductionist approach to clinical practice. Unfolding evidence appears to support a genetic predisposition model of health and illness rather than a fatalistic predestination construct , modifiable epigenetic and environmental factors have enormous potential to influence clinical outcomes. By understanding and applying fundamental clinical principles relating to the emerging fields of molecular medicine, nutrigenomics and human exposure assessment, doctors will be empowered to address causality of affliction when possible and achieve sustained reprieve for many suffering patients. [source] Corporal punishment: Mother's disciplinary behavior and child's psychological profile in Alexandria, EgyptJOURNAL OF FORENSIC NURSING, Issue 1 2009Mostafa A. Abolfotouh Abstract Although all professionals oppose abusive physical punishment, nonabusive physical punishment is still controversial. The aim of the present study was (i) to determine parents' behavior regarding the discipline of their children using corporal punishment or other alternative disciplinary methods, (ii) to identify the different associated factors for corporal punishment, and (iii) to determine the association between exposure of the child to corporal punishment and his or her psychosocial well-being. A representative sample of 400 fifth-grade primary school children and their mothers were subjected to a cross-sectional survey. Mothers were subjected to a questionnaire to assess their behavior on corporal punishment and other disciplinary methods. The children were subjected to Coopersmith Self-Esteem Inventory to assess their self-esteem, and a questionnaire to assess their relationship with others. About three-quarter of children (76.3%) were corporally punished, and about half of them (46.2%) were punished on sites other than the extremities or buttocks. In 59.3% of them the frequency of the punishment ranged from once or twice/week to more than once/day, and it left marks in about 20%. Other disciplinary methods used by mothers were yelling/insulting (43.5%), taking away a toy or privilege (39.3%), discussing/explaining (9.5%), and time out (2.8%). The significant predictors of mothers' use of corporal punishment were male gender of the child (p < 0.01), rural origin of the father (p= 0.02), the mother's bad history of rearing experience (p < 0.01), and poor interparental relationship (p= 0.02). The relation between corporal punishment of children and their self-esteem was not statistically significant; however, corporally punished children scored lower on their relationship with others than noncorporally punished ones (Z= 2.60, p < 0.05). Corporal punishment is a widespread disciplinary method in Alexandria. The use of corporal punishment could have adverse effects on the child especially on his or her relationship with others. Planning an awareness-raising educational program for current and expectant parents is recommended, to promote positive nonviolent methods of child rearing, via the media and campaigns, and encouragement of political, community, and religious leaders; medical personnel; journalists; and sports and entertainment figures to share in these campaigns [source] An outbreak of HBV and HCV infection in a paediatric oncology ward: Epidemiological investigations and prevention of further spreadJOURNAL OF MEDICAL VIROLOGY, Issue 3 2003Uga Dumpis Abstract Hospital-acquired hepatitis B (HBV) and C virus (HCV) infections continue to occur despite increased awareness of this problem among the medical community. One hundred six patients were infected in a haematology oncology ward for children, over the time period 1996 to 2000. Serum samples from 45 such patients and 3 from infected medical personnel were used for nucleic acid amplification. HBV core, as well as HCV core and hypervariable region 1 (HVR1) nucleotide sequences, were analysed by phylogenetic tree analysis, in order to characterise the epidemiological pattern of viral transmission on the ward. Samples from 32 patients were positive for HBV-DNA or HCV-RNA by PCR. Ten patients were positive for both markers. Seventeen out of twenty-three HCV core gene sequences were found to be evolutionarily related and clustered separately from other local sequences in the phylogenetic tree, indicating nosocomial transmission. This was confirmed by analysis of HVR1 gene sequences. One nurse and one physician from the ward were HCV RNA positive, but their HCV sequences were not related evolutionarily to those of the patient cluster. Fifteen out of nineteen HBV core gene sequences were also clustered together and were positioned separately in the relevant tree. Epidemiological investigation excluded a common source infection and indicated that spread of infection was most likely due to inappropriate infection control measures on the ward. No obvious risk factors for transmission were identified during the retrospective survey in patients with related sequences, except use of multidose vials for saline and poor staff compliance with routine hand hygiene procedures. The preventive measures that were introduced reduced the incidence of infection significantly. No new cases of HBV infection and only three anti-HCV seroconversions occurred over a period of 19 months. The introduction and maintenance of strict prevention measures over a 2 year period, combined with HBV vaccination, reduced significantly the incidence of new HCV and HBV infections. J. Med. Virol. 69:331,338, 2003. © 2003 Wiley-Liss, Inc. [source] Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patientJOURNAL OF MEDICAL VIROLOGY, Issue 4 2002R. Stefan Ross Abstract During recent years, a controversial discussion has emerged in the medical community on the real number and possible public health implications of hepatitis C virus (HCV) transmissions from infected medical staff to susceptible patients. We report here on molecular virological and epidemiological analyses involving 229 patients who underwent exposure-prone operations by an HCV-infected orthopedic surgeon. Of the 229 individuals affected, 207 could be tested. Three were positive for HCV antibodies. Molecular and epidemiological investigation revealed that two of them were not infected by the surgeon. The third patient, a 50-year-old man, underwent complicated total hip arthroplasty with trochanteric osteotomy. He harbored an HCV 2b isolate that in phylogenetic analysis of the hypervariable region 1 (HVR 1) was closely related to the HCV strain recovered from the infected surgeon, indicating that HCV-provider-to-patient transmission occurred intraoperatively. To our knowledge, this is the first documented case of HCV transmission by an orthopedic surgeon. The recorded transmission rate of 0.48% (95% confidence interval: 0.09,2.68%) was within the same range reported previously for the spread of hepatitis B virus during orthopedic procedures. Since the result of our investigation sustains the notion that patients may contract HCV from infected health-care workers during exposure-prone procedures, a series of further retrospective exercises is needed to assess more precisely the risk of HCV provider-to-patient transmission and to delineate from these studies recommendations for the guidance and management of HCV-infected medical personnel. J. Med. Virol. 66:461,467, 2002. © 2002 Wiley-Liss, Inc. [source] Early Adolescents Perceptions of Health and Health Literacy,JOURNAL OF SCHOOL HEALTH, Issue 1 2007Stephen L. Brown PhD ABSTRACT Background:, Health illiteracy is a societal issue that, if addressed successfully, may help to reduce health disparities. It has been associated with increased rates of hospital admission, health care expenditures, and poor health outcomes. Because of this, much of the research in the United States has focused on adults in the health care system. This study investigated the effect of aspects of health literacy on the motivation to practice health-enhancing behaviors among early adolescents. Methods:, Measures were generally based on 3 National Health Education Standards for grades 5-8. Data were obtained from 1178 9- to 13-year-old students visiting 11 health education centers in 7 states. Students responded via individual electronic keypads. Results:, Multivariate logistic regression revealed that, in addition to age, difficulty understanding health information and belief that kids can do little to affect their future health, decreased the likelihood for interest in and desire to follow what they were taught about health. Further, low interest independently decreased motivation to follow what was taught. Girls were more likely to turn to school, parents, and medical personnel for health information. Older students were more likely to turn to school and to the Internet. Conclusions:, Programs and curricula should be designed to increase student interest in health issues and their self-efficacy in controlling their own health destinies. Educators should also teach students to more effectively use nonconventional health information sources such as the Internet, parents, and medical professionals. [source] Concurrence of hepatitis B surface antibodies and surface antigen: implications for postvaccination control of health care workersJOURNAL OF VIRAL HEPATITIS, Issue 2 2002H. L. Zaaijer Among 1081 persons testing positive for hepatitis B surface antigen, 106 (10%) tested positive for antibodies to surface antigen (anti-HBs) in the same blood sample. Thirty of these persons were studied in detail: seven tested positive for hepatitis B e-antigen, nine were apparently healthy blood donors, and in 14 chronic infection could be demonstrated in follow-up samples. Frozen samples of 14 persons were available for additional quantitative anti-HBs testing using another anti-HBs assay: three showed no anti-HBs reactivity, seven showed borderline anti-HBs levels (1,5 IU/L), and anti-HBs titres ranged from 23 to 66 IU/L in four HBsAg-positive persons, including an apparently healthy blood donor. Thus, after hepatitis B vaccination of medical personnel, presence of anti-HBs may erroneously suggest immunity, while in fact chronic infection with hepatitis B virus is present. [source] Lupine, a source of new as well as hidden food allergensMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 1 2010Uta Jappe Abstract The present review summarizes current knowledge about lupine allergy, potential sensitization routes, cross-reactions between lupine and other legumes, and the respective IgE-binding proteins. Since the 1990s, lupine flour is used as a substitute for or additive to other flours, mostly wheat flour, in several countries of the EU. In 1994, the first case of an immediate-type allergy after ingestion of lupine flour-containing pasta was reported. Since then, the number of published incidents following ingestion or inhalation of lupine flour is rising. So far, the Lupinus angustifolius ,-conglutin has been designated as the allergen Lup an 1 by the International Union of Immunological Societies Allergen Nomenclature Subcommittee. Initially, publications focussed on the fact that peanut-allergic patients were at risk to develop anaphylaxis to lupine due to cross-reactivity between peanut and lupine. At present, however, the ratio between cases of pre-existing legume allergy (mostly peanut allergy) to de novo sensitization to lupine seed is nearly 1:1. Although in December 2006, lupine and products thereof were included in the EU foodstuff allergen list according to the Commission Directive 2006/142/EC amending Annex IIIA of Directive 2000/13/EC in order to prevent severe reactions caused by "hidden food allergens", the majority of patients and medical personnel are still not aware of raw lupine seed as potentially dangerous food allergen. [source] Study of subjectivity in the perception of cesarean birthNURSING & HEALTH SCIENCES, Issue 1 2005Chai Soon Park rn Abstract This study defined the structural patterns of subjectivity in the perception of cesarean birth. Q methodology was used on 71 statements collected through interviews with seven persons and a literature review followed. Twenty-nine Q samples were selected and administered to 22 persons, and four types of subjectivity were revealed by the QUANL PC Program. Type 1, or the ,naturalist', is characterized by a passive tendency and dislikes artificial methods, feeling that they are performed for hospital income and the trend for social preference. Type 2, ,logical thinker', thinks that cesarean birth should be selected if there are obstetric complications and severe anxiety about labor, even though it results in low intimacy with the baby. Type 3, ,maternal instinctivism', values the maternal-baby relationship and the sense of accomplishment from childbirth. Type 4, ,egocentric', thinks that cesarean section should be chosen when the woman has severe anxiety about labor or when the obstetric condition becomes dangerous. Before commencement of the patient's labor pains, the nurses and medical personnel who are participating in the delivery should assess the structural pattern on parturient woman's subjectivity in the perception of cesarean section. As a further step, they should encourage the woman and her family to participate in the decision-making process for considering the type of delivery the mother wants. [source] Cardiac arrest in a child with cerebral palsy undergoing sevoflurane induction of anesthesia after preoperative clonidinePEDIATRIC ANESTHESIA, Issue 3 2007MARK M. GOLDFINGER MD Summary Clonidine is a frequently administered ,2-adrenergic agonist which can decrease heart rate and blood pressure. We present a case of a 5-year-old child with cerebral palsy and seizure disorder, receiving clonidine for restlessness, who presented for placement of a baclofen pump. Without the knowledge of the medical personnel, the patient's mother administered three doses of clonidine during the evening before and morning of surgery to reduce anxiety. During induction of anesthesia, the patient developed bradycardia and hypotension requiring cardiac resuscitation. There are no previous reports of clonidine-associated cardiac arrest in a child undergoing induction of anesthesia. [source] Achieving super-resolution X-ray imaging with mobile C-arm devicesTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 3 2009C. Bodensteiner Abstract Background The term super-resolution refers to the process of combining a set of low-resolution images into a high-resolution image using image processing methods. This work is concerned with the reconstruction of high-resolution X-ray images. Specifically, we address the problem of acquiring X-ray images from multiple, very close view points. Methods We propose to use a novel experimental robotic C-arm device to create high-resolution X-ray images. For this purpose, we suggest different strategies for acquiring multiple low-resolution images, and we provide the steps to achieve acquisition-error compensation. Compared to visible light images, X-ray images have the particularity that parallax effects render super-resolution very difficult. Using the acquired multi-frame data, we evaluate recent well-known super-resolution reconstruction algorithms. The same algorithms are evaluated based on synthetic 3D phantom data and real X-ray images. Results In experiments with both synthetic and real projection data, we successfully reconstruct up to four times higher-resolution images. These images reveal structures and details which are not perceivable in the low-resolution images. Conclusions The advantage of super-resolution techniques for X-ray is the potential reduction of radiation dose for patients and medical personnel. Potential medical applications include the diagnosis of early-stage osteoporosis and the detection of very small calcifications. Copyright © 2009 John Wiley & Sons, Ltd. [source] Medical Ethics at Guantanamo Bay and Abu Ghraib: The Problem of Dual LoyaltyTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2006Peter A. Clark S.J., Ph.D. Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism. [source] Tracheal intubation following training with the GlideScope® compared to direct laryngoscopyANAESTHESIA, Issue 7 2010C. M. Ayoub Summary Tracheal intubation using direct laryngoscopy has a high failure rate when performed by untrained medical personnel. This study compares tracheal intubation following direct laryngoscopy by inexperienced medical students when initially trained by using either the GlideScope®, a video assisted laryngoscope, or a rigid (Macintosh) laryngoscope. Forty-two medical students with no previous experience in tracheal intubation were randomly divided into two equal groups to receive training with the GlideScope or with direct laryngoscopy. Subsequently, each medical student performed three consecutive intubations on patients with normal airways that were observed by a anaesthetist who was blinded to the training method. The rates of successful intubation were significantly higher in the Glidescope group after the first (48%), second (62%), and third (81%) intubations compared with the Macintosh group (14%, 14% and 33%; p = 0.043, 0.004 and 0.004, respectively). The mean (SD) times for the first, second, and third successful tracheal intubations were significantly shorter in the Glidescope group (59.3 (4.4) s, 56.6 (7.1) s and 50.1 (4.0) s) than the Macintosh group (70.7 (7.5) s, 73.7 (7.3) s and 67.6 (2.0) s; p = 0.006, 0.003 and 0.0001, respectively). Training with a video-assisted device such as the GlideScope improves the success rate and time for tracheal intubation in patients with normal airways when this is performed by inexperienced individuals following a short training programme. [source] LMA SupremeTM insertion by novices in manikins and patientsANAESTHESIA, Issue 4 2010B. W. Howes Summary The LMA SupremeÔ has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non-anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. Fifty airway novices inserted the LMA Supreme in anaesthetised patients undergoing elective surgery. First time insertion success rate was 86% and overall insertion success rate was 100%. Mechanical ventilation was successful in all cases. Median (IQR [range]) time to establish an airway was 34 s (26-40 [18,145] s). Median (IQR [range]) pharyngeal seal pressure was 23 cmH2O (19-28 [13,40] cmH2O). There were no important complications. Results are consistent with previous studies of use of the LMA Supreme by airway experts. We conclude that the LMA supreme is suitable for use by airway novices. Further research is needed before it may be recommended for cardiopulmonary resuscitation and emergency airway use. [source] | ||||||||||||||||