Source: Medicine Science | International Medical Journal
Ergenekon Karagoz, Umit Savasci.
In this study, our aim was to review the data of adult patients followed due to a measles diagnosis and the reasons for the measles cases, which has shown an increase because of the events of recent forced migration in our country. Adult patients who referred to the outpatient clinic of infectious diseases and clinical microbiology of our hospital between January and April 2013 and who were diagnosed with measles were retrospectively studied. Patients were diagnosed with measles in accordance with the presence of symptoms described by the World Health Organization (WHO) and in combination with the determination of measles IgM positivity by Enzyme Linked Immunosorbent Assay (ELISA). 16 patients did not have any information about their measles vaccination background. Only one patient reported that he received a single dose vaccination one year previously. Measles IgM positivity by ELISA was determined for all patients. When laboratory findings were assessed we found that leukopenia and thrombocytopenia developed respectively, in 4 and 4 patients. In addition, hepatitis developed in 4 patients, otitis media in 2 patients, pneumonia in 3 patients and a sinusitis complication in 2 patients. Measles is a very contagious disease with a high contagion rate but can be kept under control by maintaining vaccination rates high in the community. However, we must not forget that vaccinations may only provide 95% protection. Measles may become epidemic when sensitive individuals are present in the community at a certain ratio. Therefore, immunity rates must be accelerated in young adults in the community by vaccination campaigns (catch-up) while existing rates of childhood vaccinations are maintained. Especially when the population shows a tendency to increase, due to reasons such as migration or war, it is essential to comply with the mentioned precautions.
Τρίτη, 6 Δεκεμβρίου 2016
Assessment of adult measles cases followed at a military hospital during a measles epidemic: does forced migration increase infectious diseases such as measles that may affect public health?
Source: Medicine Science | International Medical Journal
Alparslan Ersoy, Canan Ersoy.
Different disturbances of thyroid hormones in the absence of concurrent thyroid disease have been reported in patients on maintenance hemodialysis. After a successful kidney transplant, thyroid hormone metabolism normalizes. Although increased frequency of goiter and thyroid adenomas have been observed, hyperthyroidism is very rare. Herein, we report two kidney transplant recipients under immunosuppressive therapy that presents with hyperthyroidism.
The effect of preanalytical mechanical mixing time on complete blood cell count parameters in the emergency laboratory
Source: Medicine Science | International Medical Journal
Cigdem Yucel, Turan Turhan, Esin Calci.
Complete blood count (CBC) is one of the most common laboratory tests. Preanalytical factors like specimen homogenization affect the CBC test results. In the emergency laboratory, test time is a ciritcal parameter. Optimization of test procedures is of critical importance to give more accurate results in a shorter time period. This study was designed to evaluate the effects of preanalytical mechanical mixing times on CBC parameters and to optimize the mechanical mixing time for the analysis. Mechanical mixing time of 1 and 5 minutes (t= 1 and t=5 respectively) with a rotary type mixer and automatic mixing performed by the Coulter LH 780 (t=0) prior to complete blood count analysis were evaluated. Between t=0 and t=1 minutes of mechanical mixing, only a significant change in MPV values were obtained (p
Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach.
Fatigue in an adult attention deficit hyperactivity disorder population: A trans-diagnostic approach.
Br J Clin Psychol. 2016 Dec 05;:
Authors: Rogers DC, Dittner AJ, Rimes KA, Chalder T
OBJECTIVES: Trans-diagnostic approaches suggest that key cognitive and behavioural processes maintain symptoms across a wide range of mental health disorders. Fatigue is a common clinical feature of attention deficit hyperactivity disorder (ADHD) in adulthood; however, empirical data supporting its prevalence are lacking. This study aimed to collate outcomes from outpatient services to (1) investigate the prevalence of fatigue in adults with ADHD, (2) examine symptoms of ADHD in adults with chronic fatigue syndrome (CFS), and (3) consider secondary clinical characteristics common to both disorder groups.
METHODS: Measures of self-reported fatigue were compared across groups of adults with ADHD (N = 243), CFS (N = 86), and healthy controls (HC) (N = 211) using a between-subjects cross-sectional design. Groups were also compared on secondary clinical measures of functional impairment, mood, anxiety, sleep, self-efficacy, and their beliefs about the acceptability of expressing emotions.
RESULTS: The ADHD group were significantly more fatigued than HC with 62% meeting criteria for fatigue caseness. ADHD symptoms were significantly greater in the CFS group than in HC. ADHD and CFS groups did not differ significantly on measures of functional impairment, mood, and self-efficacy. No significant differences were detected on measures of anxiety when items relating to physical restlessness were removed from the analysis.
CONCLUSIONS: Adults with ADHD experience greater fatigue than HC. Adults with CFS and ADHD share many trans-diagnostic clinical characteristics, including difficulties with low mood, anxiety, and reduced self-efficacy, which impact upon their overall functioning. Further research is required to investigate extraneous factors mediating fatigue severity in these clinical groups.
PRACTITIONER POINTS: Fatigue is a common clinical feature of attention deficit hyperactivity disorder (ADHD) in adulthood. Evidence-based interventions for chronic fatigue syndrome could be adapted to address fatigue in ADHD in adults.
PMID: 27918087 [PubMed - as supplied by publisher]
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Results of bronchoscopic excision in typical carcinoid tumors of the lung in Turkey.
Med Glas (Zenica). 2017 Feb 01;14(1):
Authors: Boyacı H, Çörtük M, Gül Ş, Tanrıverdi E, Özgül MA, Dinçer HE, Çetinkaya E
Aim Carcinoid tumors of the lung are the tumors originating from the neuroendocrine cells. Surgical excision remains the gold standard for the treatment. Treatment with interventional bronchoscopic excision has also been reported as an alternative option in typical carcinoid tumors of the lung. The aim of this study was to present results and outcomes in patients who were bronchoscopically treated and followed-up. Methods Data of 14 patients, who had undergone bronchoscopic excision due to typical carcinoid tumor of the lung between April 2008 and July 2015 were retrospectively evaluated. Bronchoscopic excision procedures were performed under general anesthesia, while control bronchoscopies were carried out with flexible bronchoscopy. Time between the first and last bronchoscopies was accepted as the follow-up duration. Results A total of 14 patients was evaluated with eight (57.1%) males. Mean age was 43.57±14.07 (23-68) years. The most common symptoms were shortness of breath and coughing. Mean of 5.69±3.35 (2-12) bronchoscopy procedures were performed in the patients during the diagnosis, treatment and follow-up. Mean follow-up duration was 32.0±19.22 months. At the long-term follow-up, two patients developed 50% stenosis and one patient developed granulation tissue in the endobronchial treatment site. None of the patients developed recurrence during the mean.
PMID: 27917852 [PubMed - as supplied by publisher]
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Sleep Quality Differs Between Athletes and Non-athletes.
Clin Invest Med. 2016 Dec 01;39(6):27525
Authors: Demirel H
PURPOSE: Sufficient sleep or sleep of sufficient quality is essential for the health of children, adolescents and adults, as sleep influences almost all dimensions of life. The purpose of this study was to investigate the possible positive effects of sportsmanship on sleep quality and to assess the possible differences in sleep quality between athletes and non-athletes.
METHODS: Sedentary or non-athletes subjects (n=103) and athletes (n=93) participated in this study. The Turkish version of Pittsburg Sleep Quality Index was used to assess the points associated with sleep quality of participants before and one month after wet cupping therapy.
RESULTS: Athletes had statistically significantly higher Pittsburg Sleep Quality Index parameters compared with non-athletes.
CONCLUSIONS: Long-term exercise or physical fitness is advised for better health and a life without stress, anxiety and depression and also for the normal brain function and emotional stability.
PMID: 27917815 [PubMed - in process]
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Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit.
Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit.
Int Psychogeriatr. 2016 Dec 05;:1-11
Authors: Abengaña J, Chong MS, Tay L
BACKGROUND: Overlap between neuropsychiatric symptoms of dementia and delirium complicates diagnosis of delirium superimposed on dementia (DSD). This study sought to examine differences in delirium presentation and outcomes between DSD patients with and without pre-existing behavioral and psychological symptoms of dementia (BPSD).
METHODS: This was a prospective cohort study of older adults with DSD admitted to a specialized delirium unit (December 2010-August 2012). We collected data on demographics, comorbidities, illness severity, delirium precipitants, and cognitive and functional scores. Delirium severity was assessed using Delirium Rating Scale Revised-98 (DRS-R-98) and Cognitive Assessment Method severity score (CAM-sev). Patients were categorized as DSD-BPSD+ and DSD-BPSD- based on elicited behavioral and psychological disturbances.
RESULTS: We recruited 174 patients with DSD (84.4 +/-7.4 years) with 37 (21.3%) having BPSD. At presentation, delirium severity and symptom frequency on DRS-R98 were similar, but DSD-BPSD+ more often required only a single precipitant (40.5% vs. 21.9%, p = 0.07), and had significantly longer delirium duration (median days: 7 vs. 5, p < 0.01). At delirium resolution, DSD-BPSD+ exhibited significant improvement in sleep-wake disturbances (89.2% vs. 54.1%, p < 0.01), affect lability (81.1% vs. 56.8%, p = 0.05), and motor agitation (73% vs. 40.5%, p < 0.01), while all non-cognitive symptoms except motor retardation were improved in DSD-BPSD-. Pharmacological restraint was more prevalent (62.2% vs. 40.1%, p = 0.03), and at higher doses (chlorpromazine equivalents 0.95 +/-1.8 vs. 0.40 +/-1.2, p < 0.01) in DSD-BPSD+.
CONCLUSIONS: BPSD may increase vulnerability of dementia patients to delirium, with subsequent slower delirium recovery. Aggravation of sleep disturbance, labile affect, and motor agitation should raise suspicion for delirium among these patients.
PMID: 27917740 [PubMed - as supplied by publisher]
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[Insomnia and habits to help to fall asleep among adults].
Orv Hetil. 2016 Dec;157(49):1955-1959
Authors: Fusz K, Faludi B, Pusztai D, Sebők N, Oláh A
INTRODUCTION: The quality of sleep can be influenced by several factors, insomnia in turn has an effect on the state of health.
AIM: The aim of our survey is to measure the effects of insomnia, furthermore, the sleep affecting agents and habits to help to fall asleep among adults.
METHOD: We collected the online nationwide and the written datas from the South-Transdanubia region, 455 adults filled the questionnaire which contains the Athens Insomnia Scale.
RESULTS: 13.4% of participants has insomnia, it is influenced by the quality of diet (p<0.001), comsumption of coffee (p = 0.045) and the physical activity (p = 0.011), what is more in correlation with the prevalency of chronic deseases (p = 0.001) and psychosomatic symptoms (p<0.001). The most frequent causes of sleep disorders are: work-related stress (35.6%), personal-life stress (35.4%) and pain (24.2%). In case of dormition problems most of the participants watch television (52.1%) and read (33%); 7.5% and 11.4% of the responders use sleeping pills and tisane.
CONCLUSIONS: We attract attention to the prevalency and effects of insomnia, and the habits to help to fall asleep. Orv. Hetil., 2016, 157(49), 1955-1959.
PMID: 27917672 [PubMed - in process]
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Mannitol challenge testing for asthma in a community cohort of young adults.
Respirology. 2016 Dec 05;:
Authors: White EC, de Klerk N, Hantos Z, Priston M, Hollams EM, James A, Sly PD, Holt PG, Hall GL
BACKGROUND AND OBJECTIVE: Mannitol challenge testing is an established tool for clinical asthma diagnosis, and can be performed outside of specialized respiratory laboratories. Despite applicability in both clinical and non-clinical populations, with different pre-test asthma probabilities, differences in diagnostic properties have not been well explored. This study aimed to quantify the diagnostic utility of mannitol challenge testing for asthma in a community cohort and a symptomatic wheezing subset of this cohort.
METHODS: During the 22-year follow-up of the Western Australian Pregnancy (Raine) Cohort, 772 participants (384 males) completed mannitol challenge and skin prick testing and respiratory health questionnaires, of whom 148 reporting wheeze in the past 12 months were included in a wheezing subset.
RESULTS: Responsiveness to mannitol had low sensitivity (19%) and high specificity (97%) to identify current asthma in the complete cohort, with positive and negative predictive values (PPV and NPV) of 45% and 92%, respectively. Within the wheezing subset, sensitivity (19%) and specificity (94%) remained similar, but PPV increased to 79%, and NPV decreased to 52%.
CONCLUSION: Our findings support previously reported high specificity and good PPV for mannitol challenge testing in symptomatic wheezing populations, and highlight the need for caution when interpreting mannitol test results in non-clinical populations.
PMID: 27917572 [PubMed - as supplied by publisher]
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The aim of this study was to investigate whether physicians who felt strongly for or against a treatment, in this case a moderately life prolonging non-curative cancer treatment, differed in their estimation of medical indication for this treatment as compared to physicians who had no such sentiment. A further aim was to investigate how the notion of medical indication was conceptualised.Methods
A random sample of GPs, oncologists and pulmonologists (n = 646) comprised the study group. Respondents were randomised to receive either version of a case presentation; in one version, the patient had smoked and in the other version she had never smoked. The physicians were labelled value-neutral (65%) and value-influenced (35%) on the basis of their attitude towards the treatment.Results
In the ‘value-influenced’ group, there was a significant difference in the estimation of medical indication for treatment depending upon whether the patient had smoked (50% (95% CI: 41–59) or never smoked (67% (95% CI: 58–76) (Chi-2 = 5.8, df = 1; p = 0.016)). There was no such difference in the ‘value-neutral’ group.Conclusion
This study shows that compared to value-neutral physicians, value-influenced physicians are more likely to base decisions of medical indication on medically irrelevant factors (in this case: the patient’s smoking status). Moreover, medical indication is used in an ambiguous manner. Hence, we recommend that the usage of ‘medical indication’ be disciplined.
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Vaccinate-or-mask: Ethical duties and rights of health care providers in obtaining or refusing the influenza vaccination
There is much controversy over the effectiveness of the influenza vaccination; yet, globally, many health institutions are implementing policies that require health providers to either receive the influenza vaccination or wear a surgical mask. This vaccinate-or-mask policy has caused great hullabaloo among health care providers and the institutions wherein they work. In light of the limitations to best practice evidence, we conducted an analysis of the policy and its implications based first on the bioethical principles of beneficence, nonmaleficience, respect for autonomy, and justice and then on the ethical theories of Immanuel Kant and John Stuart Mill. The most important ethical issue was threat to patient safety and welfare in the event of receiving care from a health provider who chose to forego the influenza vaccination and surgical mask requirement. We concluded that policies requiring health care providers to receive the influenza vaccination or wear a surgical mask are only partially supported by the bioethical principle approach; however, they are clearly justified from a deontological standpoint. That is, Kant would argue the rightness of the policy as a moral imperative for health care providers to not impose a health risk to those they serve and for health care institutions to ensure professional care giver vaccination. In further considering the vaccinate-or-mask policy in terms of the utilitarian "greatest good for the greatest number", we determined that Mill would argue that this type of policy is ethically right and just, but also that policies solely requiring immunization would be ethical as public well-being is promoted.
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The compliance of Iraqi pharmacists with ethical principles in applying the pharmaceutical care for diabetic patients
Pharmacists play a central role in caring of diabetic patients. During patient-centered care, important ethical issues and conflicts may arise, which makes ethical skills for pharmacist important toward conflict-resolution so this study aimed to assess compliance of Iraqi pharmacists with ethical principles while providing their care to diabetic patients. A cross sectional study by a validated questionnaire format was given to a convenient sample of 95 community pharmacists in Baghdad—Iraq. The questionnaire assesses the ethical practices of each pharmacist by using indirect questions through a simulated case which is commonly encountered in private pharmacies in Iraq. Most participated pharmacists failed to respect patient autonomy and they are not encouraging their patients to participate in decision making about their treatment. Participated pharmacists also failed in applying ethical principle of veracity during educating the patient about serious drug side effects. Furthermore most pharmacists had financial conflict of interests that undermine the pharmacist ability to fulfill the primary professional and ethical obligation to ensure patient's beneficence, justice and autonomy. Meanwhile most participated pharmacist may be good in maintaining their professional competence, yet the majority failed to develop their competence by keeping their knowledge up to-dated. In conclusion pharmacists failed to apply ethical principles during their usual care for diabetic patients.
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Administrative staff, including principal investigators, administrative managers, and elected officials, have a crucial role in ensuring the ethical conduct of the clinical research that occurs in their organisations. However, only few studies have focused on their perspectives.Aim
This study describes the ethical aspects of clinical research from the perspectives of the administrative staff at university hospitals in Finland.Methods
Qualitative data were collected with semi-structured face-to-face interviews (n = 31), and subjected to content analysis.Results
Four core perspectives emerged: human subject autonomy and its acknowledgement in clinical practice, increased tension between the regulations and practice of clinical research, concerns about a changing research environment, and factors that promote ethical research conduct in hospitals.Conclusion
Ethics always extends beyond the law. Therefore it is important to strengthen researchers’ ethical sensitivity through education. Furthermore, we should reinforce elements such as organisational culture, cooperation, and a workable research infrastructure that support good research ethics in hospitals.
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Kings College London Student Clinical Ethics Committee case discussion: An elderly patient wants to go home following inpatient treatment, but it is thought she may be at risk in her own home and her discharge is delayed
The Student Clinical Ethics Committee considered the case of an elderly woman who remained in hospital for 2 months after treatment, despite being considered medically fit for discharge, causing her great distress. The committee considered the justifications for keeping the patient on the ward in order to determine whether she was fit to be discharged to her home. The case study summarises the reflections of the committee and focuses on the capacity of the patient to make the decision to go home, the potential risks and consequences of discharging her, the concerns of the health care teams and their responsibility to make a decision.
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Culturally competent clinical ethics: Case study response: Response to case study: A family requests that their grandmother, who does not speak English, is not informed of her terminal diagnosis
The case study: a family requests that their grandmother, who does not speak English, is not informed of her terminal diagnosis focusses mostly on the issues of autonomy of patient and truth telling but fails to highlight the most ethically salient feature of the case; the clinician did not talk to the patient. The case study notes that the patient spoke a dialect of Cantonese and felt that translation services might not have been readily available. This is unacceptable practice given the easy availability of professional telephone interpreters. In addition, it rendered the rest of the discussion academic as without a professional interpreter the clinician had no idea exactly what the family member who was interpreting was saying to their grandmother. This is an excellent case to discuss the ethics of the care of culturally and linguistically diverse people and the importance of interpreter use in patients with limited English proficiency. This case is also a good illustration of a limitation of Clinical Ethics Committees. A common norm is that there is no patient involvement in the deliberations of the committee. Without any patient involvement, it is very difficult to understand the patient’s position (well illustrated in this case) and impossible to engage in dialogue to find an agreed management plan.
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The ‘SLICE’ model for Structured Learning in Clinical Ethics provides a template to help medical professionals identify their own "moral compass" to provide guidance in complex ethical areas. The model has five domains – Conscience, Compliance, Concurrence, Conversation and Conversion.
The use of ‘SLICE’ model as a tool for ethics education has been described in various undergraduate and postgraduate settings. These include teaching ethical aspects of transplantation; legislation for undergraduates and consent in paediatric anaesthesia. Its use as tool for teaching reflective ethical practice has been recently described demonstrating the potential of the SLICE model for supporting appraisal and professional development.
In this article, we explore the suitability of the SLICE model to provide a general framework encompassing all the requirements for Ethical Clinical practice in anaesthesia. Good Medical Practice guidance produced by the General Medical Council and guidance provided jointly by the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland is used as the foundation for developing this framework.
The Good Practice Guide for anaesthetic departments provides a solid ethical frame work for interpreting and applying Good Medical Practice guidance by the General Medical Council. Tools such as the SLICE model complement the guides produced by the professional organisations by providing a choice of different methods to facilitate education, decision making and reflective practice.
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Despite the fact that the criteria for allocation of donated livers have been laid down for years, these criteria may not help to select a potential recipient from those with the same medical requirements. This study used conjoint analysis method to determine the importance of certain non-medical factors from the public’s point of view. Through a population based study, a sample of 899 randomly selected persons filled a questionnaire where in each question the respondents had to choose one out of two hypothetical patients as the recipients of a donor liver considering their expressed characteristics. The collected data were analyzed by means of conjoint analysis method, and the importance of each characteristic was determined. According to the respondents the important criteria for allocation of donated livers included younger age, being married or breadwinner of the family, more than 3-year survival after transplantation, and having no role in causing the illness. Among the selected criteria, financial ability to pay post-operation costs had the least value on the selection. The findings of this study indicate that the public may values certain social and individual factors in case of multiple potential recipients with equal medical need for liver transplant.
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Pre-mortem interventions for donation after circulatory death and overall benefit: A qualitative study
This article explores how the type of consent given for organ donation should affect the judgement of a patient's overall benefit with regards to donation of their organs and the pre-mortem interventions required to facilitate this. The findings of a qualitative study of the views of 10 healthcare professionals, combined with a philosophical analysis inform the conclusion that how consent to organ donation is given is a reliable indicator only of the strength of evidence about views on donation and subsequent willingness to undergo pre-mortem interventions. It is not an indicator of the strength of actual desire to donate. Clinical management of living patients prior to donation after circulatory death must therefore respect the values, wishes and beliefs of the potential donation after circulatory death donor. Our participants, however, suggested that the information currently provided is sufficient to authorise donation and that this consent, however provided, was sufficient to proceed with pre-mortem interventions. Respect for autonomy underpinned this ‘all or nothing’ approach. Although the legal requirements for donation authorisation and the protection of patients without capacity are clear, practice and policy regarding consent in donation after circulatory death may be based on donation following brainstem death where the patient is already dead when the family is approached. Custom and practice in donation after circulatory death may need to be revised to protect the interests of the dying potential donor.
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Considerations and values in decision making regarding mechanical ventilation for older patients with severe to very severe COPD
The different considerations involved in decisions regarding whether or not to initiate mechanical ventilation for patients with severe chronic obstructive pulmonary disease (COPD) are challenging for health professionals.Aim
To investigate the considerations and values that influences decision-making regarding mechanical ventilation in older patients (≥65-years-old) with severe to very severe COPD. Furthermore, it aims to elucidate how physicians involve their patient in decision-making process.Participants and setting
Seven intensive care physicians and seven physicians working in the respiratory units at two university hospitals and two district hospitals in Norway.Methods
This study had a qualitative design consisting of focus group interviews with 14 physicians. The data was analysed according to the interpretative contexts: self-understanding, critical common-sense understanding and theoretical understanding.Results
Decisions regarding mechanical ventilation were mainly based on the physicians' own experiences, their perceptions of the patients' situation, and biomedical data. The patients were not involved in the decision-making and such decisions were only occasionally made in a multi-professional context.Conclusion
To decide whether older patients with severe COPD should be treated with mechanical ventilation is both medically and ethically challenging for physicians. Decision making in this context seems to be mainly driven by a paternalistic attitude, since the physicians interviewed in our study, in general, make such decisions without involving either the patient, their next of kin or the nurses. There is a need for broader cooperation between health professional and for the involvement of patients in the decision-making process regarding mechanical ventilation in cases of late stage COPD.
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Current organ procurement policies in the UK include ante-mortem interventions to facilitate organ donation. However, a clear and unambiguous legal framework for these procedures does not currently exist. The Human Tissue Act (HTA) 2004 does not provide authority for donor optimisation procedures before death, and there are a number of difficulties in encompassing these procedures within the Mental Capacity Act (MCA) 2005 provisions on best interests. This article proposes a system of specific advance consent to enable best interests to take on its ascribed role as the legal justification for donor optimisation procedures.
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An empirical ethical analysis of community treatment orders within mental health services in England
Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances.
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Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physician–patient relationship ("bedside rationing") is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physician–patient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of his argument yet build on his genuine insights. In our analysis, Wyller’s critique of bedside rationing is instructive both for harbouring some very common misconceptions that must be exposed and refuted, but also for offering important words of caution. In particular, bedside rationing must be performed in ways that do not harm the physician–patient relationship. Read irenically, Wyller’s critique is a reminder of what must not be lost in our painful endeavour to update the ethics of medicine to encompass the unavoidability of rationing.
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Deep brain stimulation has emerged as a "last resort" therapy for patients with prolonged disorders of consciousness. The latter encompasses a range of conditions including minimal conscious state and persistent vegetative state. Functional neuroimaging studies have shown that minimal conscious state and persistent vegetative state have different patterns of residual brain function and may therefore respond differently to deep brain stimulation. The failure to distinguish between the two conditions in this context can give rise to false expectation, misunderstanding and ill-guided treatment. As a halfway technology for prolonged disorders of consciousness, deep brain stimulation could also produce improvement in awareness that is in fact harm, and its impact may involve a wide range of public interests. This paper will discuss related ethical and legal issues with an emphasis on the distinction between minimal conscious state and persistent vegetative state in the application of deep brain stimulation.
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There have been only few attempts to explore the relationship between emotional intelligence (EI) and religiosity. However, none of them included measures of ability EI. In two studies, we investigated the potential associations between various aspects of religious belief and ability and trait EI. In Study 1 (N = 240), we found that ability EI was positively associated with general level of religious belief. Study 2, conducted among Polish Christians (N = 159), replicated the previous result on the connection between ability EI and religion. Moreover, both trait and ability EI were negatively correlated with extrinsic religious orientation and negative religious coping. Additional analysis showed that extrinsic orientation mediated the relationship between ability EI and religiosity.
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Happiness is a feeling that is desired by every human being. To achieve happiness, human try various routes like, to gain financial superiority, fame, entertainment, assets and so on. But on the contrary, religiosity is claimed to be a technique to attain purpose in life, mental health, physical well-being and internal peace, which ultimately leads to happiness in life. This study analyses the studies conducted in last two decades toward understanding the relationship between religiousness and happiness. These studies have been organised in terms of the religions, geographic locations, scales and significance. The study shows that the claim has proven to be true by a vast majority of the surveys irrespective of religion, gender, nationality or race. Although Muslims seems to be the happiest, it requires further verification.
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Exploring instructors’ technology readiness, attitudes and behavioral intentions towards e-learning technologies in Egypt and United Arab Emirates
This paper explores the association between technology readiness, (a meta-construct consisting of optimism, innovativeness, discomfort, and insecurity), attitude, and behavioral intention towards e-learning technologies adoption within an education institution context. The empirical study data is collected at two private universities located in Egypt and UAE. The research explores the role of instructors’ technology readiness level, in shaping their attitudes, preference to human interaction and ultimately behavioral intentions towards adopting e-learning technologies. Analysis of the data (Mann-Whitney U non-parametric test) shows no significant differences between instructors at the two universities in terms of technology readiness, attitudes, behavioral intentions, and preference to human interaction. The exploratory results provide evidence for the relationship between instructors’ technology, attitude, and behavioral intentions to adopt e-learning technologies. The study finds that preference to human interaction is equally important in Egypt and UAE with a strong potential to affect instructor’s behavioral intentions for adopting e-learning technologies. The research results provide initial insights to education managers on the nature and mechanisms of the relationship among the research variables, which would improve the ability of educational institutions to introduce and adopt e-learning technologies. An additional contribution is the validity and reliability tests for Technology Readiness (TR) scale, which shows its viability as a meaningful measurement instrument for use in an educational setting.
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Reframing the principle of specialisation in legitimation code theory: A blended learning perspective
This study argues that in developing a robust framework for students in a blended learning environment, Structural Alignment (SA) becomes the third principle of specialisation in addition to Epistemic Relation (ER) and Social Relation (SR). We provide an extended code: (ER+/−, SR+/−, SA+/−) that present strong classification and framing to the architecture of blended learning while defining the impact of structural alignment in the trajectory. The subjects in this study were 500 undergraduate students drawn from three faculties in a university. Using a Structural Equation Model (SEM), we show that SR, ER and SA redefine the principle of specialisation in Legitimation Code Theory (LCT) which is necessary in enhancing blended learning. We conclude that whereas epistemic and social relations define the knower and knowledge code, structural alignment explains the infrastructure and policy framework that supports knowledge acquisition in a blended learning environment.
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Higher education is moving towards digitalized learning. The rapid development of technological resources, devices and wireless networks enables more flexible opportunities to study and learn in innovative learning environments. New technologies enable combining of authentic and virtual learning spaces and digital resources as multifunctional learning platforms. In the development process it is important to ensure that the quality of environment and the pedagogical suitability are high in relation to the intended learning outcome. The quality of the learning environment can be assessed, for example, from students’ levels of satisfaction. In this study a satisfaction is proposed by following aspects: instruction and feedback, pedagogical and technological methods, perceived enjoyment and self-motivation. The aim of this study was to compare the students’ satisfaction with a ubiquitous learning environment based on 360o–technology and a traditional web-based online learning environment. A comparative, quasi-experimental study design was used. 115 students assigned on clinical histology and histotechnology course and voluntarily to the study, 61 students were assigned to an experimental group and 54 to a control group. The experimental group studied via a 360o–ubiquitous learning environment (ULE) and the control group via a web-based online course (WLE). Satisfaction was assessed at the end of studies by using an instrument developed for this study. The instrument measured aspects affecting the perceived satisfaction by 25 items (Likert 1–5) and 2 open-ended questions. The data was analysed by using the Mann Whitney U-test and with an inductive content analysis. Students in both groups were highly satisfied in the use of the learning environments. Used pedagogical and technological methods were assessed as high. The environments were assessed as easy to use and re-use. Diverse, interesting and clear learning content was seen as highly positive. Statistically significant difference between groups were seen in aspect concerning instruction and feedback. Other significant differences were not seen between groups. Developmental needs were seen in instruction and feedback aspect. More structured course planning, more supportive supervision and technical support were pointed out. The results suggest that ubiquitous learning environments should be used as supportive in histology and histotechnology studies. The results also indicated that the further development and optimisation of the learning environment should be done.
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Detection and identification of pathogenic bacteria responsible for postoperative pneumonia after esophagectomy
Surgical complications occur frequently after radical esophagectomy and one of its most serious complications is postoperative pneumonia. Preoperative or postoperative bacteriological assessment may be useful in predicting, preventing, and managing postoperative pneumonia.
One hundred and five consecutive patients undergoing any procedure that included subtotal esophagectomy from October 2009 to March 2011 were the subject of this study. Culture materials (pharyngeal swab, nasal swab, dental plaque, tongue coating, gastric juice, and sputum) retrieved from the 105 esophageal cancer patients before, during, and after the surgery were comprehensively investigated for an association with postoperative pneumonia.
Twenty-one patients out of 105 (20%) were retrospectively diagnosed with postoperative pneumonia. The investigated culture studies were associated with the occurrence of postoperative pneumonia in only one respect: positive detection of pathogens in postoperative endotracheal sputum was associated with marginally increased pneumonia (P = 0.053). Among the 21 pneumonia patients, pathogens were frequently detected in gastric juice retrieved on the first postoperative day (8 out of 14) and postoperative endotracheal sputum (13 out of 17). The putative pathogens of postoperative pneumonia were detected in 7 out of 8 gastric juice specimens and 9 out of 11 in sputum.
Postoperative pneumonia could not be predicted by either preoperative or postoperative bacteriological studies. In the patients with postoperative pneumonia, the postoperative bacterial culture of the gastric juice and sputum may be useful in identifying the causative organisms of postoperative pneumonia and, thus, in selecting appropriate antibiotics.
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Use of self-expandable plastic stents (SEPS) in management of refractory benign esophageal strictures: a single center experience
Benign esophageal stricture is a common cause for dysphagia in adults. It can negatively affect the quality of patient’s life and may cause many complications. Benign esophageal strictures are caused by different procedures and disorders, such as gastroesophageal reflux disease, post-surgery anastomotic stricture, radiation, ablative therapy or caustic ingestion. The aim of the study was to assess the efficacy of Polyflex stent insertion in refractory benign esophageal strictures in patients admitted to the endoscopy unit of the Medical Research Institute hospital, Alexandria University, Alexandria, Egypt.
Patients and methods
Polyflex, self-expandable plastic stent, were inserted in nine patients with refractory benign esophageal strictures with follow-up for 1 year.
Dysphagia was significantly improved in 88% of patients, after insertion of Polyflex stents. Complications reported were one patient with stent migration and 2 patients with esophageal ulceration.
The use of Polyflex stents in the management of benign refractory esophageal strictures appears to be promising with high clinical success rate and few manageable complications.
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Phlegmonous esophagitis is a rare and sometimes fatal condition. Cases surgically treated have been reported previously; however, surgical approaches may be risky in the elderly. An 86-year-old woman presented with a sore throat and high fever after eating fish. She was first diagnosed with a deep cervical abscess, and conservative treatment was initially selected. However, her respiratory failure worsened, so emergent tracheostomy and surgical drainage were performed. Computed tomography showed intramural low-density lesions along the entire length of the esophagus and she was diagnosed with phlegmonous esophagitis. To avoid surgical intervention, endoscopic drainage was first attempted. Mucosal incision was made on the lower esophagus guided by endoscopic ultrasonography, using the insulated-tip electrosurgical knife. After the endoscopic drainage, her general health status improved, and the esophageal wall thickness was reduced. While some cases have recovered with conservative treatment, endoscopic drainage may be useful in certain patients.
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Relaxing incision of the diaphragm for esophageal hiatal closure for giant paraesophageal hiatal hernia
Between December 1994 and December 2015, we performed 500 laparoscopic antireflux surgeries (LARS) in our clinic. Among them, we experienced 4 cases (0.8%) who had giant paraesophageal hiatal hernias (GPEH) with markedly enlarged esophageal hiatuses that made suturing of the right and left crus of the diaphragm difficult during crural repair. Therefore, we developed a procedure that allows crural repair without applying excessive tension after making a relaxing incision on the crus. This technique was applied in 5 cases in the current study. The mean surgical time and loss of bleeding volume were 280.2 ± 45.7 (227–339) min and 46.0 ± 87.1 (0–200) mL, respectively. No adverse events were observed during surgery, and no patients were converted to open surgery. No recurrent case has been observed after three sutures were added for fixation of the stomach and abdominal walls. This technique could be a safe and effective procedure for closure of the crural defect in GPEH.
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Effects of acotiamide on esophageal motility in healthy subjects: a randomized, double-blind, placebo-controlled crossover study
Acotiamide is a new drug that exhibits prokinetic activity by enhancing the release of acetylcholine. However, its effects on esophageal motility currently remain unknown. Therefore, we herein investigated the effects of acotiamide on esophageal motility in healthy, asymptomatic subjects.
Thirty healthy subjects received 100 mg of acotiamide or placebo three times a day for 7 days separated by a 28-day washout period in a randomized, double-blind, placebo-controlled crossover study. On the seventh day of treatment, esophagogastric junction pressure, integrated relaxation pressure, and primary peristalsis were assessed using high-resolution manometry.
Esophagogastric junction pressure was significantly higher in the acotiamide group (median 28.2 mmHg) than in the placebo group (24.0 mmHg), whereas no significant differences were observed in integrated relaxation pressure, the distal contractile integral, or contraction patterns between the two groups. Among 13 healthy subjects with peristaltic abnormalities, no significant differences were noted in integrated relaxation pressure or the distal contractile integral between the acotiamide and placebo groups; however, the esophagogastric junction pressure (acotiamide 23.4 mmHg; placebo 21.7 mmHg) significantly increased, the contraction pattern significantly improved, and the frequency of esophageal peristaltic abnormalities significantly decreased in the acotiamide group.
Acotiamide improves the peristaltic pattern in patients with peristaltic abnormalities by decreasing weak peristalsis with a small break.
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Clinical audit and national survey on the assessment of collateral circulation before radial forearm free flap harvest
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The starting point for bisphosphonate-related osteonecrosis of the jaw: alveolar bone or oral mucosa? A randomized, controlled experimental study
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Chimzeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection
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What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor? A large systematic review and meta-analysis
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Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap
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Response to Comments on "Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy".
Response to Comments on "Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy".
Otolaryngol Head Neck Surg. 2016 Dec;155(6):1069-1070
Authors: Damar M
PMID: 27909206 [PubMed - in process]
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"Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy".
Otolaryngol Head Neck Surg. 2016 Dec;155(6):1069
Authors: Bakshi SS
PMID: 27909205 [PubMed - in process]
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Highlights from the Current Issue: December 2016.
Otolaryngol Head Neck Surg. 2016 Dec;155(6):891-892
Authors: Krouse JH
PMID: 27909204 [PubMed - in process]
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A study of waist circumference, waist-hip ratio as markers of type 2 diabetes mellitus and their correlation with family history of diabetes
Source: International Journal of Research in Medical Sciences
Vijayashree S. Gokhale, Nilesh Jagdale, Tanvi Batra, Shipra Gulati.
Background: Type 2 Diabetes, is almost an epidemic in India. A lot has to be done to prevent or at least postpone its onset. Hence finding bio-markers is important to warn people and create awareness. In India people pay a lot of importance to Family History, and though a positive family history, may predict Diabetes, we wanted to study its correlation to other bio-markers. Methods: Waist circumference, Waist hip ratio was measured in 184 Type 2 Diabetes patients .And history of Diabetes in mother, father or both was recorded .Data tabulated and subjected to statistical analysis. Results: Of the total number (n=184) type 2 diabetes patients studied, males were 93, females 91. 74.2 % males and 83.5 % females had a waist circumference above cut-off (90 cms for males and 80cms for females). 35 males and 42 females had a family history of diabetes. Of these, Father was diabetic in 16 males and 16 females, while mother was diabetic in 19 males and 26 females. Conclusions: Waist circumference and waist hip ratio above cut-off values emerged as common positive findings in majority of type 2 diabetic patients. Family history, individually as Paternal or Maternal Diabetes did not show statistically significant correlation with waist circumference or Waist-hip ratio.
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Mitigating risk of aldosterone in diabetic kidney disease Purpose of review Diabetic kidney disease... Mitigating risk of aldosterone in dia...
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High lymphocyte count during neoadjuvant chemoradiotherapy is associated with improved pathologic complete response in esophageal cancerPublication date: Available online 9 March 2018 Source: Radiotherapy and Oncology Author(s): Penny Fang, Wen Jiang, Rajayogesh Davulur...
Medicine by Alexandros G. Sfakianakis National Update on Measles Cases and Outbreaks — United States, January 1–October 1, 2019 Manisha... ...