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General Medical Practice

Jing Xu, Reilley Paige Mathena, Shreya Singh, Jieun Kim, Jane J Long, Qun Li, Sue Junn, Ebony Blaize, Cyrus David Mintz
There is a large body of preclinical literature suggesting that exposure to general anesthetic agents during early life may have harmful effects on brain development. Patients in intensive care settings are often treated for prolonged periods with sedative medications, many of which have mechanisms of action that are similar to general anesthetics. Using in vivo studies of the mouse hippocampus and an in vitro rat cortical neuron model we asked whether there is evidence that repeated, long duration exposure to midazolam, a commonly used sedative in pediatric intensive care practice, has the potential to cause lasting harm to the developing brain...
January 2019: Journal of Neurosurgical Anesthesiology
Uy Hoang, Anthony C James, Harshana Liyanage, Simon Jones, Mark Joy, Mitch Blair, Michael Rigby, Simon de Lusignan
Early recognition, identification and treatment of children with attention deficit hyperactivity disorder (ADHD) can reduce detrimental outcomes and redirect their developmental trajectory. We aimed to describe variations in age of ADHD diagnosis and stimulant prescribing among general practitioner practices in a nationwide network and identify child, parental, household and general practice factors that might account for these variations. Cross-sectional study of children aged under 19 years registered within a general practice in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network in 2016, RCGP RSC has a household key allowing parent and child details to be linked...
February 14, 2019: BMJ evidence-based medicine
Mirjam Simoons, Henricus G Ruhé, Eric N van Roon, Robert A Schoevers, Richard Bruggeman, Daniëlle C Cath, Diny Muis, Johan Arends, Bennard Doornbos, Hans Mulder
BACKGROUND: At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Therefore it is unclear to which extent the drugs used by psychiatric outpatients are prescribed effectively and safely. These issues warrant structured monitoring of medication use, (pre-existing) co-morbidities, effectiveness and side effects during psychiatric outpatient treatment. Improvement of monitoring practices provides an opportunity to ensure that somatic complications and adverse drug effects are detected and dealt with in a timely manner...
February 14, 2019: BMC Health Services Research
Jie Shi, Yalin Wang
Shape space is an active research topic in computer vision and medical imaging fields. The distance defined in a shape space may provide a simple and refined index to represent a unique shape. This work studies the Wasserstein space and proposes a novel framework to compute the Wasserstein distance between general topological surfaces by integrating hyperbolic Ricci flow, hyperbolic harmonic map, and hyperbolic power Voronoi diagram algorithms. The resulting hyperbolic Wasserstein distance can intrinsically measure the similarity between general topological surfaces...
February 8, 2019: IEEE Transactions on Pattern Analysis and Machine Intelligence
Jonas Nordquist, Ming-Ka Chan, Jerry Maniate, David Cook, Cathal Kelly, Allan McDougall
Medical education has traditionally focused on the learners, the educators, and the curriculum, while tending to overlook the role of the designed environment. Experience indicates, however, that processes and outcomes of medical education are sensitive to the qualities and disposition of the spaces in which it occurs. This includes the clinical education within the patient care environment, termed the clinical learning environment (CLE). Recognition of this has informed the design of some new clinical learning spaces for the past decade...
February 14, 2019: Medical Teacher
Samantha Ruff, Sadia Ilyas, Seth M Steinberg, Zaria Tatalovich, Sarah A McLaughlin, Michael D'Angelica, Chandrajit P Raut, Keith A Delman, Jonathan M Hernandez, Jeremy L Davis
BACKGROUND: Despite burgeoning interest in Complex General Surgical Oncology (CGSO) fellowship training, little is reported about postgraduate employment. The goal of this study was to characterize CGSO graduates' first employment and to identify factors that influenced this decision. METHODS: The National Cancer Institute (NCI) and Society of Surgical Oncology developed and distributed an electronic survey to CGSO fellows who graduated from 2005 to 2016. RESULTS: The survey response rate was 47% (237/509)...
February 13, 2019: Annals of Surgical Oncology
Matej Stuhec, Katja Gorenc, Erika Zelko
BACKGROUND: The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A collaborative care approach, such as providing medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care...
February 13, 2019: BMC Health Services Research
Danielle Weiss, Sarah Ostrowski-Delahanty, Jason Van Allen, Paige Seegan, Meghan L Marsac
PURPOSE: Nurses are at the forefront of children's postinjury recovery; this unique role provides an opportunity for nurses to recognize and screen for symptoms that may interfere with children's quality of life (QOL). As such, aims of the present investigation were to explore selected variables (e.g., posttraumatic stress symptoms [PTSS], hope) that have the potential to impact QOL after pediatric injury, with a larger goal of contributing to recommendations for nursing practice to support children's full (physical and emotional) recovery during the peritrauma period following injury...
February 13, 2019: Journal for Specialists in Pediatric Nursing: JSPN
Nathan Emmerich, Bert Gordijn
With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment...
February 13, 2019: Theoretical Medicine and Bioethics
Danielle L Terry, Christopher P Terry
Behavioral health issues like anxiety and depression negatively impact numerous aspects of primary care, including medical regimen adherence, communication, physical well-being, and engagement in beneficial health behaviors. This study aimed to examine internal and family medicine residents': (1) patterns of addressing mental health concerns (e.g., frequency of referral for psychotherapy and/or medication), (2) self-perceptions of competency in assessment and treatment of specific mental health disorders, and (3) frequency of utilization of efficacious therapeutic strategies during clinical encounters...
February 13, 2019: Journal of Clinical Psychology in Medical Settings
Carlos Federico Davrieux, Mariano Palermo, Edgardo Serra, Eduardo Javier Houghton, Pablo Agustín Acquafresca, Caetano Finger, Mariano Eduardo Giménez
BACKGROUND: The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications...
February 7, 2019: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Jiaqian Li, Yuxin Song, Huanxi Zheng, Shile Feng, Wanghai Xu, Zuankai Wang
Just as the innovation of electronic diodes that allow the current to flow in one direction provides a foundation for the development of digital technologies, the engineering of surfaces or devices that allow the directional and spontaneous transport of fluids, termed liquid diodes, is highly desired in a wide spectrum of applications ranging from medical microfluidics, advanced printing, heat management and water collection to oil-water separation. Recent advances in manufacturing, visualization techniques, and biomimetics have led to exciting progress in the design of various liquid diodes...
February 13, 2019: Soft Matter
Douglas Redd, Yijun Shao, Yan Cheng, Qing Zeng-Treitler
Medical treatments change over time for multiple reasons, including introduction of new treatments, availability of new scientific evidence, change in institutional guidelines, and market efforts by pharmaceutical and medical device companies. Monitoring and analyzing these secular trends will also inform the evaluation of evidence based practice as well as outcome research. Using a large national clinical dataset from the United States Veterans Health Administration (VHA), we measured the change in prevalence of all diseases, medications, and procedures by year from 2001 to 2014...
February 12, 2019: Journal of Medical Systems
Shereen Nabhani-Gebara, Simon Fletcher, Atif Shamim, Leanne May, Nabiha Butt, Sunita Chagger, Thuy Mason, Kunal Patel, Finlay Royle, Scott Reeves
BACKGROUND: A number of key publications in recent years have advocated a more integrated vision of UK primary care involving increased multi-professional communication and understanding. This has resulted in a marked change in the roles being undertaken by pharmacists. Community pharmacists have traditionally provided a medicine supply function and treated minor ailments in addition to delivering a suite of locally commissioned services; however these functions have not necessarily been part of a programme of care involving the other clinicians associated with the patient...
February 1, 2019: Research in Social & Administrative Pharmacy: RSAP
Alexander Wutzler, Christos Krogias, Anna Grau, Roland Veltkamp, Peter U Heuschmann, Karl Georg Haeusler
BACKGROUND: Atrial fibrillation (AF) is present in 15-20% of patients with acute ischemic stroke. Oral anticoagulation reduces the risk of AF-related recurrent stroke but clinical guideline recommendations are rather vague regarding its use in the acute phase of stroke. We aimed to assess the current clinical practice of medical stroke prevention in AF patients during the acute phase of ischemic stroke. METHODS: In April 2017, a standardized anonymous questionnaire was sent to clinical leads of all 298 certified stroke units in Germany...
February 12, 2019: BMC Neurology
Solveig Carmienke, Anne-Kathrin Geier, Tobias Deutsch, Franz Maximilian Rasche, Thomas Frese
BACKGROUND AND AIMS: Comprehensive geriatric assessments are established tools for the identification of health problems in the elderly. So far, little is known about tailoring and targeting to facilitate their application. As a starting point for a tailored assessment of patients with diabetes, a highly prevalent health condition, we aimed to assess if the Standardized Assessment of Elderly People (STEP) is able to identify relevant differences in self-reported health problems between diabetic and non-diabetic patients...
February 12, 2019: Experimental and Clinical Endocrinology & Diabetes
Barbara J Zarowitz, James E Tisdale
BACKGROUND: The exponential increase in the number of medications associated with clinically important prolongation of the heart rate-corrected QT interval (QTc) places older adults at increased risk of arrhythmias including life-threatening torsade de pointes (TdP) and sudden death. Risk factors, other than age older than 65 years and female sex, include multiple concurrent drugs that prolong QTc and a variety of underlying predisposing conditions. Although electronic medical records and pharmacy dispensing systems can alert clinicians to the risk of QTc-prolonging therapy, more than 95% of safety alerts are overridden, and many systems have deactivated QTc drug interaction alerts...
February 12, 2019: Journal of the American Geriatrics Society
Amanda W Cai, Marian H Taylor, Bhavadharini Ramu
PURPOSE OF REVIEW: The number of cancer survivors is increasing, and cardiovascular events are a significant cause of morbidity and mortality in these patients. Preexisting cardiovascular conditions as well as the development of cancer therapeutics-related cardiac dysfunction (CTRCD), in particular left ventricular dysfunction and heart failure, limit the options for cancer therapies for these patients and contribute to reduced cancer survival. RECENT FINDINGS: Recent guidelines and position statements from various cardiology and oncology societies provide an outline for the practicing physician for the management of CTRCD...
February 11, 2019: Current Opinion in Cardiology
Stacey Bennis, Monica Rho
BACKGROUND: Musculoskeletal Women's Health (MSK WH) is a niche subspecialty within Physical Medicine & Rehabilitation (PM&R). Women make up 50.7% of the United States population but are burdened with higher rates of musculoskeletal disease compared to men. MSK WH topics are not included in PM&R or Primary Care Accreditation Council for Graduate Medical Education (ACGME) program requirements. Given PM&R's comprehensive training, physiatrists are ideal candidates to diagnose, treat and provide education on MSK WH conditions...
February 11, 2019: PM & R: the Journal of Injury, Function, and Rehabilitation
Mohamed Hsairi, Faouzi Mehdi, Ridha Bellaaj, Mondher Kassis
BACKGROUND: The aim of screening is to improve individual health through an early detection of diseases at a stage where the prognosis of disease could be significantly. However, this kind of intervention is costly and it's necessary to respect criteria in selection of targeted diseases and screening tests. OBJECTIVE: The objective of this study was to describe public health screening policy in the Maghreb countries in order to identify the main barriers to the development of this type of intervention...
October 2018: La Tunisie Médicale
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