 | | Major Adverse Cardiovascular Events Following Partial Nephrectomy | Major Adverse Cardiovascular Events Following Partial Nephrectomy
Major Adverse Cardiovascular Events Following Partial Nephrectomy
Overview
Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.
The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index.
This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection. | 3 | | R465.00 |  |
| | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study. | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Overview
Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy.
Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates.
Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates. | 3 | | R425.00 | |
| | Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis | Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis
Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis
Extensive studies indicate that severe acute respiratory syndrome coronavirus (SARS-CoV-2) involves human sensory systems. A lack of discussion, however, exists given the auditory–vestibular system involvement in CoV disease 2019 (COVID-19). The present systematic review and meta-analysis were performed to determine the event rate (ER) of hearing loss, tinnitus, and dizziness caused by SARS-CoV-2.
Databases (PubMed, ScienceDirect, Wiley) and World Health Organization updates were searched using combined keywords: ‘COVID-19,’ ‘SARS-CoV-2,’ ‘pandemic,’ ‘auditory dysfunction,’ ‘hearing loss,’ ‘tinnitus,’ ‘vestibular dysfunction,’ ‘dizziness,’ ‘vertigo,’ and ‘otologic symptoms.’ Twelve papers met the eligibility criteria and were included in the study. These papers were single group prospective, cross-sectional, or retrospective studies on otolaryngologic, neurologic, or general clinical symptoms of COVID-19 and had used subjective assessments for data collection (case histories/medical records). The results of the meta-analysis demonstrate that the ER of hearing loss (3.1%, CIs: 0.01–0.09), tinnitus (4.5%, CIs: 0.012–0.153), and dizziness (12.2%, CIs: 0.070–0.204) is statistically significant in patients with COVID-19 (Z = -4.469, p = 0.001).
Journal
The Canadian Journal of Neurological Sciences Inc. | 3 | | R465.00 | |
| | Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine | Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine
Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine
Key to achieving better population-based outcomes for patients with lung cancer is the improvement of medical imaging and nuclear medicine infrastructure globally. This paper aims to outline why and spark relevant health systems strengthening. The paper synthesizes the global lung cancer landscape, imaging referral guidelines (including resource-stratified ones), the reliance of TNM staging upon imaging, relevant multinational health technology assessments, and precisely how treatment selection and in turn patient outcomes hinge upon imaging findings. The final discussion presents data on current global gaps in both diagnostics (including imaging) and therapies and how, informed by such data, improved population-based outcomes are tangible through strategic planning.
Imaging findings are central to appropriate lung cancer patient management and can variably lead to life-prolonging interventions and/or to life-enhancing palliative measures. Early-stage lung cancer can be treated with curative intent but, unfortunately, most patients with lung cancer still present at advanced stages and many patients lack access to both diagnostics and therapies. Furthermore, half of lung cancer cases occur in low- and middle-income countries. The role of medical imaging and nuclear medicine in lung cancer management, as outlined herein, may help inform strategic planning.
Journal JCO Global Oncology | 3 | | R420.00 | |
| | Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study | Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study
Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study
Overview
Muscle cramp is fundamentally a medical problem but also a sociological and an economic one. Muscle cramps which characterized by the painful, involuntary, and paroxysmal contraction of a muscle are common and can occur in a wide range of settings and are a highly distressing condition.
The symptoms lead to a decrease in the quality of life for patients and sometimes disturb the proper functioning of the entire body, stimulating the development of several complications and comorbidities.
The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD.
It was concluded that the ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.
Journal
Hindawi BioMed Research International
| 3 | | R425.00 | |
| | Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly | Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly
Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly
Overview
As old population is dramatically growing, the detection of early cognitive deficit will become increasingly crucial. Effective cognitive screening test with quick and convenient merits will ensure recognition of early cognitive deficit and timely intervention. This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly.
The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated.
Many screening tools are currently available, but no tools meet the four important requirements for widespread use in clinical practice or large-scale epidemiological studies — that is, capture a clinically acceptable range of cognitive domains, take short time to administrate (around 5 minutes), have high accuracy for detecting cognitive impairment, and incorporate visual recall, which is the earliest deficits in Alzheimer’s disease (AD) patients. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.
Journal
JKL International LLC Aging and Disease Volume 10, Number 6 URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844584/pdf/ad-10-6-1258.pdf | 3 | | R425.00 | |
| | Mixed reality applications in urology: Requirements and future potential | Mixed reality applications in urology: Requirements and future potential
Mixed reality applications in urology: Requirements and future potential
Overview Mixed reality (MR), the computer-supported augmentation of a real environment with virtual elements, becomes ever more relevant in the medical domain, especially in urology, ranging from education and training over surgeries. This study aimed to review existing MR technologies and their applications in urology. A non-systematic review of current literature was performed using the PubMed-Medline database using the medical subject headings (MeSH) term “mixed reality”, combined with one of the following terms: “virtual reality”, “augmented reality”, ‘’urology’’ and “augmented virtuality”. The relevant studies were utilized. It was found that medical students, urology residents and inexperienced urologists can gain experience thanks to MR technologies. MR applications are also used in patient education before interventions. For surgical support, the achievable accuracy is often not sufficient. The main challenges are the non-rigid nature of the genitourinary organs, intraoperative data acquisition, online and multimodal registration and calibration of devices. However, the progress made in recent years is tremendous in all respects and the gap is constantly shrinking.
Authors Gerd Reis, Mehmet Yilmaz, Jason Rambach, Alain Pagani, Rodrigo Suarez-Ibarrola, Arkadiusz Miernik, Paul Lesur, Nareg Minaskan
| 3 | | R400.00 | |
| | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Overview The purpose of this study is to state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early-stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. It was concluded that SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease. Authors Scott J. Genshaft, MD, Robert D. Suh, MD, Fereidoun Abtin, MD, Mark O. Baerlocher, MD, Albert J. Chang, MD, Sean R. Dariushnia, MD, A. Michael Devane, MD, Salomao Faintuch, MD, MS, Elizabeth A. Himes, BS, Aaron Lisberg, MD, Siddharth Padia, MD, Sheena Patel, MPH, Alda L. Tam, MD, MBA, and Jane Yanagawa, MD Journal J Vasc Interv Radiol
| 3 | | R420.00 | |
| | Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization | Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization
Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization
Overview Prostatic artery embolization (PAE) is a promising alternative to traditional surgical options for treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). However, as with any developing area of investigation, there is a need to assemble consistent high-quality data that clarify the role of that therapy and allow for systematic analyses of multiple studies.
The objective of this Reporting Standards document is to define a consistent nomenclature and terminology with which investigators can communicate the results of PAE trials to facilitate subsequent comparisons of published techniques, embolic materials, patient populations, and outcomes. The intent is to systematize the reporting of PAE data so that higher levels of evidence can be sought. Reporting Standards are not intended to validate or recommend technical aspects of PAE, but to promote transparent, detailed, and uniform reporting of relevant data.
Authors Andre B. Uflacker, MD, Ziv J Haskal, MD, Mark O. Baerlocher, MD, Shivank S. Bhatia, MD, Francisco C. Carnevale, MD, PhD, Sean R. Dariushnia, MD, Salomao Faintuch, MD, MS, Ron C. Gaba, MD, MS, Jafar Golzarian, MD, Mehran Midia, MD, Boris Nikolic, MD, MBA, Marc R. Sapoval, MD, PhD, and T. Gregory Walker, MD
Journal J Vasc Interv Radiol | 3 | | R465.00 | |
| | Advisor high-definition HD Grid catheter for mapping accessory pathways in pediatrics | Advisor high-definition HD Grid catheter for mapping accessory pathways in pediatrics
Advisor high-definition HD Grid catheter for mapping accessory pathways in pediatrics
Overview Intracardiac mapping of accessory pathways has continued to evolve and contribute to high success rates for catheter ablations in pediatrics, ranging from 78% to 98%. Pediatric accessory pathways are common and historically have had a high cure rate with ablation. There are new techniques and technologies being developed to potentially increase efficacy of ablation with improved mapping. With 3-dimensional electroanatomic mapping, increasing point density improves the accuracy of substrate prediction and modeling, particularly as the course of atrioventricular (AV) accessory pathways can be variable, with oblique atrial and ventricular insertion sites or multiple pathways that make accurate mapping challenging. There may be a role in utilizing open-window mapping and the HD Grid catheter (Abbott Laboratories, Abbott Park, IL) to delineate difficult or refractory accessory pathways in pediatric. The Advisor high-density HD Grid catheter (Abbott Laboratories, Abbott Park, IL) allows for bipolar recordings on 2 orthogonal planes among 18 electrodes to facilitate both the identification of small-amplitude high-frequency electrical impulses and the direction of impulse propagation. Although several adult studies have shown the utility of the HD Grid for mapping arrhythmia substrate including accessory pathways, there is no knowledge of studies showing the utilization of the HD Grid for mapping accessory pathways in pediatrics. In this case series, the initial experience utilizing the HD Grid for mapping accessory pathways in the pediatric population is described and finds that the new technology allowing for bipolar orthogonal electrograms can be safely used in the pediatric population.
Authors Michael Nguyen, DO, Johannes C. von Alvensleben, MD, Martin Runciman, MD, FHRS,Kathryn K. Collins Journal Heart Rhythm Case Reports | 3 | | R420.00 | |
| | COVID-19 in Pediatrics | COVID-19 in Pediatrics
Overview In 2019, a novel coronavirus emerged called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). Initially identified in Wuhan, China, COVID-19 spread internationally and became a global pandemic. Most pediatric COVID-19 cases were milder than in adults, but in the early Spring of 2020, a new inflammatory syndrome emerged in children who had evidence of prior SARS CoV-2 infection, called Multisystem Inflammatory Syndrome in Children (MIS-C). As of March 2021, there were approximately 2,592,619 cases of COVID-19 in people under 18 in the United States and 300 deaths. Of all American cases, 2.1% were in children aged 0 to 4 years old, and another 10.2% were in those aged 5 to 17. Prevalence varies by age, with estimates ranging from 17% for children under 2 years old to 25% of children ages 6 to 10 years old, and 23% in 10 to 14 years old. The severity of the disease is generally lower for children, with only 1% to 5% of pediatric cases qualifying as severe versus to 10% to 20% in adults. This finding is thought to reflect the lower levels of angiotensin-converting enzyme 2 expression in alveolar cells, which is the mechanism by which SARS-CoV-2 enters cells. Being older than 12 years and having a high initial C-reactive protein (CRP) are risk factors for admission to a pediatric intensive care unit, and high CRP, leukocytosis, and thrombocytopenia are risk factors for organ dysfunction. Viral load and young age, specifically children under 1 year of age, are other risk factors for more severe disease. This study describes the features, diagnosis, and treatment of pediatric COVID-19 and MIS-C based on the data available at the time of publication.
Authors Case SM, Son MB
Journal Rheumatic Disease Clinics of North America | 3 | | R435.00 | |
| | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Overview The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. This study aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. A national cohort study was conducted in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Patients were excluded if they did not have a neurological consultation or neurological investigations or both or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR or respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall.
Authors Stephen T J Ray et al
Journal The Lancet Child & Adolescent Health | 3 | | R410.00 | |
| | Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons | Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
Overview The importance of routine follow-up of several relatively simple stable injuries (SSIs) is questionable. Multiple studies show that direct discharge (DD) of patients with SSIs from the Emergency Department results in patient outcomes and experiences comparable to ‘standard care’ with outpatient follow-up. The purpose of this study was to evaluate to which extent DD of SSIs has been adopted amongst trauma and orthopaedic surgeons internationally, and to assess the variation in the management of these common injuries. An online survey was sent to members of an international trauma- and orthopaedic surgery collaboration. Participants, all trauma- or orthopaedic surgeons, were presented with eleven hypothetical cases of patients with simple stable injuries in which they were asked to outline their treatment plan regarding number of follow-up appointments and radiographs, physiotherapy and when to start functional movement. Clinical agreement regarding number of appointments and when to start functional movement was not reached for any of the injuries. There was clinical agreement on number of radiographs for one injury and for four injuries regarding routine referral to a physiotherapist. Despite available evidence, DD of SSIs has not been widely adopted worldwide. Practice variation still exists even for these common injuries. This variation suggests inefficiency and consequently unnecessarily high healthcare costs. (Orthopaedic) trauma surgeons are encouraged to evaluate their cur- rent treatment protocols of SSIs.
Authors T.H. Geerdink, B.A. Uijterwijk, D.T. Meijer, I.N. Sierevelt, W.H. Mallee, R.N. van Veen, J.C. Goslings, R. Haverlag, Trauma Platform Study Collaborative Journal Injury International Journal of the Care of the Inured
| 3 | | R420.00 | |
| | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Overview To understand the motivations of rural-practicing primary care clinicians who participate in an intensive multiyear pragmatic randomized behavioural obesity intervention trial, Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER).
Structured interviews were conducted with 21 family medicine clinicians who were study leads at participating rural practices. Themes emerged through an analysis of transcripts and interview notes by using the constant comparative method.
The analysis revealed 3 main themes. First, primary care clinicians participated in RE-POWER because it provided a concrete plan to address their recurring clinical care need for effective obesity treatment and management. Second, participation offered help to frustrated physicians who felt a deep professional duty to care for all their patients’ problems but were dissatisfied with current obesity management. Third, participation was also attractive to rural primary care clinicians because it provided a visible and sustainable way to demonstrate their commitment to improving the health of patients and the broader community.
The findings show that clinicians are motivated to try solutions for a clinical problem— in this case obesity—when that clinical problem is also closely connected to a particularly frustrating area of clinical care that challenges their professional identity. Our data suggest that a motivation to close the gap between ideal and real practice can become such a high priority that clinicians are sometimes willing to try potential solutions, such as engagement in research, that they otherwise would not consider.
Authors Joanna Veazey Brooks, PhD, MBE, Kim S. Kimminau, PhD, Stacy McCrea-Robertson, MS, and Christie Befort, PhD Journal Journal of the American Board of Family Medicine | 3 | | R455.00 | |
| | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Overview Women physicians continue to comprise the minority of leadership roles in Academic Family Medicine (AFM) faculty across North American medical schools. This study quantified the current state of gender disparity by analysing academic position, leadership ranking, and research productivity.
A database for 6,746 AFM faculty members was generated. Gender and academic profiles were obtained for 2,892 academic ranks and 1,706 leadership roles by searching faculty listings enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS).
The results indicated that women hold 46.11% (3,110/6,746) of faculty positions. The proportional composition decreased with increasing academic ranking (49.84% assistant, 46.78% associate, and 41.5% full professor). The same decreasing trend was demonstrated with leadership rank (57.14% minor leadership, 47.65% second-in-command, and 36.61 first-in command). Compared to their gender counterparts, women in AFM demonstrated lower publication productivity as measured by citation number (p=0.04) and years of study (p=0.008).
In conclusion it was found that the composition of academic family medicine faculty members included in this study demonstrated gender disparity. Inclusivity initiatives and policies to tackle the issue of female retention, promotion, and recruitment need to be further explored.
Authors Szu-Yu Tina Chen, Sabeena Jalal, Maryam Ahmadi, Kiran Khurshid, Nizar Bhulani, Ateeq U. Rehman, Aftab Ahmad, Jeffrey Ding, Terri-Leigh R. Aldred, Faisal Khosa
Journal Cureus
| 3 | | R410.00 | |
| | An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture | An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture
An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture
Overview Although the meaning of Integrative Medicine differs by individual patients, their demand for a more inclusive and integrative approach to care that utilizes both conventional and complementary medicine modalities has been increasing. Integrative medicine is an attempt to fulfil this growing demand for more holistic approaches to healthcare. One advantage of establishing a system that encourages more MCPs is that it allows patients to receive conventional and complementary medical care from one individual, but the time and expense of producing these MCPs poses a significant challenge in creating a pipeline of these individuals. If collaboration among clinicians was facilitated to provide patients with an integrative approach to their health care, this would allow the clinician to specialize in their area of focus; however, differing opinions and perspectives about how to care for the patient may pose significant communication challenges in the delivery of effective integrative care. Both approaches have the potential to create more access to integrative medicine for patients. Generous funding sources that create platforms for integrative medicine healthcare, such as The Bernard Osher Foundation’s support for Integrative Medicine, allow university–based community healthcare systems to generate research data that support evidence-based systemic change.
Authors Iman Majd, Paul S. Amieuxb, Sierra V. Cortes, Masa Sasagawa Journal Advances in Integrative Medicine 7 | 3 | | R410.00 | |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike | 3 | | R425.00 | |
| | Hypertension Part 3 | Hypertension Part 3
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Hypertension Part 2 | Hypertension Part 2
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike | 3 | | R410.00 | |
| | Amebiasis | Amebiasis
Overview Amebiasis is caused by Entamoeba histolytica, a protozoan that is found worldwide. The highest prevalence of amebiasis is in developing countries where barriers between human faeces and food and water supplies are inadequate.
Although most cases of amebiasis are asymptomatic, dysentery and invasive extraintestinal disease can occur. Amebic liver abscess is the most common manifestation of invasive amebiasis, but other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. In developed countries, amebiasis primarily affects migrants from and travellers to endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals.
The National Institute of Allergy and Infectious Diseases (NIAID) has classified E histolytica as a category B biodefense pathogen because of its low infectious dose, environmental stability, resistance to chlorine, and ease of dissemination through contamination of food and water supplies.
E histolytica is transmitted via ingestion of the cystic form (infective stage) of the protozoa. Viable in the environment for weeks to months, cysts can be found in soil contaminated with faecal, fertilizer, or water or on the contaminated hands of food handlers. Faecal-oral transmission can also occur in the setting of anal sexual practices or direct rectal inoculation through colonic irrigation devices.
Author Sharespike
| 3 | | R425.00 | |
| | Asthma Exacerbation Part 2 | Asthma Exacerbation Part 2
Asthma Exacerbation Part 2
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents.
Author Sharespike | 3 | | R465.00 | |
| | Asthma Exacerbation Part 1 | Asthma Exacerbation Part 1
Asthma Exacerbation Part 1
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents. Author Sharespike | 3 | | R465.00 | |
| | Acute Leukemia Part 2 | Acute Leukemia Part 2
Overview There are various forms of acute Leukemia of which most of these are discussed in Parts 1 and 2 of this study. In Part 2 Acute Lymphoblastic Leukemia (ALL) is disccused. Acute lymphoblastic leukemia (acute lymphocytic leukemia, ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Acute lymphoblastic leukemia (ALL) is the most common type of cancer and leukemia in children in the United States. Median age at diagnosis is 16 years. ALL accounts for 74% of pediatric leukemia cases. Historically, patients with ALL were divided into three prognostic groups: good risk, intermediate risk, and poor risk.
In adults, ALL is less common than acute myeloid leukemia (AML). The American Cancer Society estimates that 6150 cases of ALL (adult and pediatric) will occur in the United States in 2020, resulting in 1520 deaths. The estimated 5-year survival is 68.6%. The favourable survival rate is due to the high cure rate of ALL in children. Prognosis declines with increasing age, and the median age at death is 56 years. Only 20-40% of adults with acute lymphoblastic leukemia (ALL) are cured with current treatment regimens.
The diagnosis, treatment and effects of Leukemia are addressed here in Part 2.
Author Sharespike | 3 | | R425.00 | |
| | Acute Leukemia Part 1 | Acute Leukemia Part 1
Overview There are various forms of acute Leukemia of which most of these are discussed in Parts 1 and 2 of this study. In Part 1 Acute Lymphoblastic Leukemia is disccused. This is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. A proposed mechanism for some cases of childhood ALL is a two-step process of genetic mutation and exposure to infection. In contrast, most adults with ALL have no identifiable risk factors.
Acute promyelocytic leukemia (APL) is a unique subtype of acute leukemia characterized by abnormal proliferation of promyelocytes, life-threatening coagulopathy, and the chromosome translocation. The discovery and elucidation of the molecular pathogenesis for APL has led to the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) therapies, which improved the prognosis of APL patients significantly.
The diagnosis, treatment and effects of these types of Leukemia are addressed.
Author Sharespike
| 3 | | R425.00 | |
| | Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients | Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients
Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients
Overview Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. This study investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture. A cross-sectional study was conducted to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019. The behaviour of physicians and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment is documented in this study.
Authors Masashi Yamori, Mitsumasa Tamura, Masaki Mikami, Toshio Mori, Masaharu Noi, Yoshisato Machida, Shinya Koshinuma, Gaku Yamamoto Journal International Dental Journal | 3 | | R420.00 | |
| | Ischemic Stroke Part 2 | Ischemic Stroke Part 2
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Ischemic Stroke Part 1 | Ischemic Stroke Part 1
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Vertigo, DIzziness and Imbalance | Vertigo, DIzziness and Imbalance
Vertigo, DIzziness and Imbalance
Overview
Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems.
Mild hearing loss is the most common disability worldwide. The incidence of hearing loss is 25% in people younger than 25 years, and it reaches 40% in persons older than 40 years. About 25% of the population report tinnitus.
Primary care physicians evaluate most cases of dizziness and related symptoms. Their role and that of neurologists in this setting has increased over the past decade. This article outlines the clinical approach to dizziness with emphasis on differentiating peripheral from central dizziness and on office management of the most common diseases. It also addresses indications for referral to an otolaryngologist or neuro-otologist and for specialized auditory and vestibular testing.
To diagnose dizziness, physicians must use the essential tools of history, clinical examination, and follow-up. The etiology in most of these patients mainly involves a vestibular disorder, such as BPPV, Ménière disease, or bilateral vestibular hypofunction. Appropriate management and follow-up are necessary to improve the well-being of these patients.
Authors
Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 2 | Ventricular Tachycardia Part 2
Ventricular Tachycardia Part 2
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 1 | Ventricular Tachycardia Part 1
Ventricular Tachycardia Part 1
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
Overview:
Considering the high socio-economic costs related to the increasing number of dementia patients and their poor quality of life and that of their families, it is important to identify the condition early on and provide an appropriate intervention. This study organized a recollection-based occupational therapy program: a nonpharmacological intervention consisting of five categories of activities (physical, horticultural, musical, art, and instrumental activity of daily living; IADL) and applied it to those having a mild stage of Alzheimer’s disease. The experimental group participated in a total of 24 sessions––five times per week for one hour per session––while the control group took part in regular activities offered by the existing facilities. The experimental group presented improved cognitive functions, reduced depression, and enhanced quality of life; the two groups showed a statistically significant difference in every category. This study is meaningful in that it made a cognitive stimulation program concerning five different categories, implemented it for people suffering mild dementia, and confirmed positive outcomes. If a systemic version of the program is offered in dementia care facilities, it is expected to make a considerable contribution to the care of dementia patients.
Acknowledgements:
Authors: DeokJu Kim
Journal: Occupational Therapy International | 3 | | R435.00 | |
| | Wide Complex Tachycardia | Wide Complex Tachycardia
Overview
Correct diagnosis of wide complex tachycardia (WCTs) can be challenging. With EMS providers' ever-expanding scope of practice, it is no longer safe to label any rhythm that is wide and fast as ventricular tachycardia (VT). Though many paramedic curricula do not address advanced cardiac dysrhythmias and treatments, several EMS departments have protocols that require advanced training in 12-lead ECG interpretation and treatment of specific cardiac dysrhythmias. One must possess the proper diagnostic tools and knowledge to decide whether a WCT is VT or SVT with aberrant conduction. EMS providers should be able to differentiate VT and SVT with aberrant conduction with confidence and a high degree of certainty. In order to understand the visual differences between VT and SVT with aberrant conduction, one must first understand the basic pathophysiology behind the two dysrhythmias. The first steps are maintenance of the patient’s airway with assisted breathing if necessary, cardiac monitoring to identify the heart rhythm, monitoring of blood pressure and oximetry, and establishing intravenous access. In the emergency setting, a wide-complex tachycardia always should be considered as ventricular tachycardia unless proven otherwise, as treatment must be initiated immediately to avoid degeneration into ventricular fibrillation.
| 3 | | R425.00 | |
| | Unstable Angina | Unstable Angina
Overview
Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie, cardiac biomarkers of myocardial necrosis —such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
With unstable angina, symptoms may (1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitro-glycerine. Symptoms of unstable angina are similar to those of myocardial infarction (MI).
The traditional term unstable angina was meant to signify the intermediate state between myocardial infarction (MI) and the more chronic state of stable angina. The old term pre-infarction angina conveys the clinical intent of intervening to attenuate the risk of MI or death. Patients with this condition have also been categorized by presentation, diagnostic test results, or course over time; these categories include new-onset angina, accelerating angina, rest angina, early postinfarct angina, and early post-revascularization angina.
This course deals with the causes and management of unstable angina.
| 3 | | R425.00 | |
| | Severe Distress – COVID 19 | Severe Distress – COVID 19
Severe Distress – COVID 19
Overview
Since the emergence of the 2019 novel coronavirus (SARS-CoV-2) infection in December 2019, the coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. The clinical spectrum of patients with COVID-19 ranges from asymptomatic or mild symptoms to critical disease with a high risk of mortality.
Coronavirus disease 2019 (COVID-19) is the illness associated with the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was initially noted during an outbreak of respiratory illness in the population of Wuhan, the capital of Hubei province, China. The first cases were seen in November 2019, with COVID-19 quickly spreading throughout the city. The World Health Organization (WHO) was notified of the outbreak on December 31, 2019. The cases continued to spread outside of the area and then across the world. COVID-19 was reported as a global health emergency by the end of January 2020. As the worldwide case numbers increased, the WHO declared on March 11, 2020, that COVID-19 had reached the pandemic stage. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
| 3 | | R425.00 | |
| | Sceptic Shock Part 2 | Sceptic Shock Part 2
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Sceptic Shock Part 1 | Sceptic Shock Part 1
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Respiratory Distress Syndrome | Respiratory Distress Syndrome
Respiratory Distress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike
| 3 | | R425.00 | |
| | Preeclampsia for MD's | Preeclampsia for MD's
Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema.
Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.).
In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia.
Eclampsia is defined as seizures that cannot be attributable to other causes in a woman with preeclampsia. HELLP syndrome (haemolysis, elevated liver enzyme, low platelets) may complicate severe preeclampsia.
Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing preeclampsia may not be straightforward. Preeclampsia without severe features may be asymptomatic. Many cases are detected through routine prenatal screening.
Authors
Sharespike
| 3 | | R380.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions. The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities. Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R420.00 | |
| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R435.00 | |
| | Hypertension Part 1 | Hypertension Part 1
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Sleep and the athlete: narrative review and 2021 expert consensus recommendations | Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Overview An ever-growing volume of peer-reviewed Publications speaks to the recent and rapid growth in scope and understanding of sleep for optimal athlete health and performance.
Herein, a panel of international experts review the current knowledge on sleep and the athlete, briefly covering the background, exploring continued controversies, highlighting fruitful avenues for future research and providing practical recommendations. The introduction section covers the need for sleep, including sleep architecture and the restorative benefits of sleep for the brain and body.
Pitfalls and challenges measuring athlete sleep are reviewed, and practical recommendations provided. The following section, entitled sleep and the athlete, covers the influence of sleep inadequacy and sleep extension on athletic performance. This article reviews the evidence that elite athletes are particularly susceptible to sleep inadequacy, for example, during intensified training and in those reporting symptoms of over-reaching and overtraining. The final section, entitled strategies to improve sleep, provides practical recommendations to alleviate the symptoms of jet lag, nutritional strategies to enhance sleep and a toolbox for practitioners to manage and optimise athlete sleep.
Authors Neil P Walsh et al.
Journal British Journal Sports Med 2020
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| | Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection | Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection
Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection
Overview
Cranio-cervical artery dissection (CAD) refers to a tear in the artery lining, resulting in an intramural hematoma toward the intima or the adventitia of the internal carotid artery or vertebral artery. CAD is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. CAD can affect the cranial or cervical portion of the internal carotid artery or vertebral artery. The predisposing factors, clinical presentation, radiological imaging, and outcome may differ between ICAD and VAD.
We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. It was found that the distribution of cervical and intracranial artery dissections was different between ICAD and VAD. The frequencies of radiological features such as double lumen, intimal flap, and dissecting aneurysms also differed in patients with ICAD and VAD.
Authors Yongjun Wu, Hongbin Chen, Shihui Xing, Shuangquan Tan, Xinran Chen, Yan Tan, Jinsheng Zeng and Jian Zhang
| 3 | | R390.00 | |
| | Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial | Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial
Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial
Overview
The effects of osteopathic manipulative treatment (OMT) on functional brain connectivity in healthy adults is missing in the literature. The main advantage for patients is the effective relief of acute and chronic pain. Indeed, OMT was proved effective on conditions and disorders beyond the sensory and motor system, including the reduction of hospitalization length in a large population of preterm infants, effects in anxiety and fatigue in people with Multiple Sclerosis and on autonomic and neuroendocrine responses. The neurophysiological effects underlying clinical improvements are still under debate. Although models explaining the therapeutic effects of OMT include potential brain mechanisms, few studies have been carried out to investigate brain mechanism changes after OMT. Magnetic resonance imaging (MRI) research includes several different approaches to estimate cortical functions. Several of these approaches have demonstrated functional brain changes associated with OMT. Using Arterial Spin Labeling MRI, we recently demonstrated that the treatment of somatic dysfunctions induces cerebral perfusion changes in asymptomatic young participants. This research provides the first preliminary evidence of brain network connectivity changes due to OMT, opening further insights into potential effects of OMT on brain functional activity. Moreover, it suggests future investigations in this unexplored field, particularly on symptomatic subjects.
Authors Marco Tramontano, Francesco Cerritelli, Federica Piras, Barbara Spanò, Federica Tamburella, Fabrizio Piras, Carlo Caltagirone, and Tommaso Gili Journal Brain Sci. 2020 Dec; 10(12): 969. | 3 | | R410.00 | |
| | Desmoid fibromatosis of the pancreas: A case report with radiologic-pathologic correlation | Desmoid fibromatosis of the pancreas: A case report with radiologic-pathologic correlation
Desmoid fibromatosis of the pancreas: A case report with radiologic-pathologic correlation
Overview Pancreas is an exceptionally rare location for desmoid tumours. There are very few case reports of pancreatic fibromatosis in the English radiology literature. This article presents a case of a 45-year-old male with a mixed solid and cystic desmoid tumour of the pancreas which was surgically resected and was followed by recurrence in the mesentery. This will be the first case report of pancreatic desmoid with documented recurrence of fibromatosis in the mesentery which was also surgically resected and confirmed on pathology. In this case report, this entity’s radiological findings with pathology correlation, clinical findings and management were discussed along with literature review.
Authors Kanika Khanna, Fatemeh Abdollahi Mofakham, Darshan Gandhi, Nitin Jain
Journal Radiology Case Reports 15 (2020) 2324 – 2328
| 3 | | R440.00 | |
| | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
Overview Despite evidence demonstrating that medications for opioid use disorder (OUD) reduce morbidity and mortality, most patients do not receive treatment. The National Academies of Science call for more research exploring the patient’s perspective of treatment modalities to increase access to individualized, patient-centred care. The aim of this article is to build on existing literature by describing patient experiences treated for OUD in a rural family medicine setting. Participants’ experiences with OBOT were generally positive and shaped by societal structures and institutions, their life before treatment, their treatment history, and the kind of care they received in OBOT. Patients identified accessibility and privacy as advantages to receiving OBOT in primary care. This research identifies ways providers can provide individualized and effective OUD treatment within the family medicine setting.
Authors Claire Kane, BA, Catherine Leiner, Chase Harless, Kathleen A. Foley, E. Blake Fagan, and Courtenay Gilmore Wilson
Journal J Am Board Fam Med: first published as 10.3122/jabfm.2020.04.190389 on 16 July 2020
| 3 | | R385.00 | |
| | Delayed 18F FDG PET/CT Imaging in the Assessment of Residual Tumours after Transurethral Resection of Bladder Cancer | Delayed 18F FDG PET/CT Imaging in the Assessment of Residual Tumours after Transurethral Resection of Bladder Cancer
Delayed 18F FDG PET/CT Imaging in the Assessment of Residual Tumours after Transurethral Resection of Bladder Cancer
Overview This study is to determine the diagnostic performance of delayed 18F FDG PET/CT in the differentiation of residual tumours from postoperative inflammatory reactions in patients with bladder cancer after initial transurethral resection of bladder tumour (TURBT).
A retrospective clinical study between January 2015 and April 2018 was performed in 79 patients with bladder cancer who had undergone 18F FDG PET/CT within 1 month after initial TURBT. After PET/CT, all patients underwent a second surgery within 2 weeks to confirm the histologic nature of the suspicious lesion and to remove residual tumours. Uni- and multivariable analysis were used to identify predictive factors for residual bladder tumours.
It was concluded that the use of fluorine 18 fluorodeoxyglucose PET/CT to differentiate lesions after transurethral resection of bladder tumour indicates that higher mean standardized uptake values and greater lesion thickness are predictive factors for residual tumours in patients with bladder cancer after oncologic treatment.
Authors Hui Yan, Xiang Zhou, Xiaoyan Wang, Rui Li, Yiping Shi, Qian Xia, Liangrong Wan, Gang Huang, Jianjun Liu.
Journal Radiology Volume 293 Issue 1 | 3 | | R435.00 | |
| | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Overview To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centres and nursing homes in the Healthcare Area of León (Spain). The work centre, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.
Authors: V. Martín, T. Fernández-Villa, M. Lamuedra Gil de Gomez, O. Mencía-Ares, A. Rivero Rodríguez, S. Reguero Celada, M. Montoro Gómez, M.T. Nuevo Guisado, C. Villa Aller, C. Díez Flecha, A. Carvajal, J.P. Fernández Vázquez
Journal: Semergen. 2020;46(S1):42---46 | 3 | | R400.00 | |
| | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Overview Prevention of infectious diseases through immunisation of the growing ageing adult population is essential to improve healthy ageing. However, many licenced and recommended vaccines for this age group show signs of waning of the protective effect due to declining immune responses (immunosenescence) and decreasing vaccine uptake. Today’s major challenge is to improve vaccine effectiveness and uptake and to deploy efficient vaccination strategies for this age group. The Vaccines and Infectious diseases in the Ageing population (VITAL) project, with partners from 17 academic & research groups and public institutes as well as seven industry collaborators, aims to address this challenge. The ambition is to provide evidence-based knowledge to local decision makers. Using a holistic and multidisciplinary approach and novel analytical methods, VITAL will provide tools that allow the development of targeted immunisation programs for ageing adults in European countries. The project is based on four pillars focussing on the assessment of the burden of vaccine-preventable diseases in ageing adults, the dissection of the mechanisms underlying immuno-senescence, the analysis of the clinical and economic public health impact of vaccination strategies and the development of educational resources for healthcare professionals.
Authors Debbie Van Baarle, Kaatje Bollaerts, Giuseppe Del Giudice, Stephen Lockhart, Christine Luxemburger, Maarten J. Postma, Aura Timen, Baudouin Standaert
Journal Vaccine 38 (2020) 5896–5904 https://doi.org/10.1016/j.vaccine.2020.07.005
URL https://www.sciencedirect.com/science/article/pii/S0264410X20309051?via%3Dihub | 3 | | R425.00 | |
| | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Overview
Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease.
To deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs’ hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective.
This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs’ coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability.
Author S. Bae
Journal Journal of Hospital Infection 106 (2020) 107e114 https://doi.org/10.1016/j.jhin.2020.06.022
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308774/pdf/main.pdf | 3 | | R420.00 | |
| | Probiotics and Protection of the Stomach | Probiotics and Protection of the Stomach
Probiotics and Protection of the Stomach
Overview Probiotics are living organisms and have beneficial effects when they colonize the body, assuming they can stay alive long enough to do so. Probiotic treatments are packed with bacteria, but once swallowed, their numbers are dramatically diminished by the stomach's acidity, lowering the chances of therapeutic effect. Probiotics can live or die under a variety of circumstances. One such circumstance is time. Some bacteria make spores which can live for many years and then blossom and grow. Most probiotics do not make spores, so they gradually die off if they do not find a comfortable place to grow, meaning a moist, warm friendly environment like the colon. Stomach acid is extraordinarily strong. It does and will kill most bacteria that get into the stomach each day. Antibiotics can also kill the bacteria in your body. So, how do you protect the probiotic bacteria you take, from this bacteria execution chamber which everyone has inside them?
Acknowledgements Du Pont Dinesco Capsugel R&D Team and Dr Keith Hutchison Elsevier – LWT Food Science and Technology | 2 | | R299.00 | |
| | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection | Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Total robotic surgery for pancreaticoduodenectomy combined with rectal cancer anterior resection
Overview
Synchronous double malignancies, including carcinoma of the ampulla of Vater and rectal carcinoma, are generally uncommon occurrences in the gastrointestinal tract. The present study reports a case of a 37-year-old man who was incidentally found to suffer from carcinoma of the ampulla of Vater and rectal carcinoma. The duodenoscopy was performed and revealed an ulcerated and bulky ampulla of Vater, the biopsy from which revealed a moderate-differentiated adenocarcinoma, A local hospital colonoscopy confirmed a tumour located in rectal 7cm from the anal margin and biopsy-confirmed poorly differentiated adenocarcinoma.
About such patient treatment, both open and laparoscopic surgery are restricted because of operation complexity, large injury, and poor cosmetic effect. surgery performed using Da Vinci robotic surgical system (DVSS). No evidence of recurrence or relapses was found in the first year after surgery. Although sporadic double malignancies are uncommon, they should be considered when evaluating cancer patients. Complex surgery performed by robotic surgery may became surgeon’s preferred treatment modality.
Acknowledgement
Authors QunGuang Jiang, TaiYuan Li, DongNing Liu and Cheng Tang,
Journal Medicine Volume 97 Issue 19
Publisher Wolters Kluwer Health, Inc
| 3 | | R389.00 | |
| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004).
The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis.
Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R410.00 | |
| | Tuberculosis Part 2 | Tuberculosis Part 2
Overview
Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors:
Thomas E Herchline,Thomas E Herchline, Judith K Amorosa, Judith K Amorosa. | 3 | | R420.00 | |
| | Tuberculosis Part 1 | Tuberculosis Part 1
Overview Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors: Thomas E Herchline and Judith K Amorosa | 3 | | R420.00 | |
| | Clinical Practice Guidelines: Respiratory | Clinical Practice Guidelines: Respiratory
Clinical Practice Guidelines: Respiratory
Overview
Asthma is a common condition which produces a significant workload for general practice, hospital outpatient clinics and inpatient admissions. Much of this morbidity relates to poor management (British Thoracic Society, 2014). Chronic obstructive pulmonary disease (COPD) is a group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible. COPD should be distinguished from asthma because it is a progressive, disabling disease with increasingly serious complications and exacerbations. The symptoms, signs and physiology of these conditions can overlap with asthma and differentiation can be difficult, particularly in middle-aged smokers presenting with breathlessness and cough. This difficulty is compounded by the fact that most COPD patients exhibit some degree of reversibility with bronchodilators. Patients with severe chronic asthma, chronic bronchiolitis, bronchiectasis and cystic fibrosis may also present with a similar clinical pattern and partially reversible airflow limitation (The Thoracic Society of Australia and New Zealand, 2002). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R410.00 | |
| | Clinical Practice Guidelines: Seizures | Clinical Practice Guidelines: Seizures
Clinical Practice Guidelines: Seizures
Overview
Paediatric and adult seizures are managed in essentially the same way, with the focus on identification, injury prevention, rapid termination and prevention of ongoing seizures; ongoing attention must be paid to reversal of the cause of the seizure. Important differences in children relate to febrile seizures (covered in section 3: Fever & Sepsis) and easily correctable causes such as hypoglycaemia. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R410.00 | |
| | Clinical Practice Guidelines: Trauma Part 1 | Clinical Practice Guidelines: Trauma Part 1
Clinical Practice Guidelines: Trauma Part 1
Overview
“Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa Clinical Practice Guidelines: Trauma Part 1 | 3 | | R410.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
| 3 | | R420.00 | |
| | Diabetes Mellitus Part 3 | Diabetes Mellitus Part 3
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori
| 3 | | R420.00 | |
| | Diabetes Mellitus Part 2 | Diabetes Mellitus Part 2
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Diabetes Mellitus Part 1 | Diabetes Mellitus Part 1
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R440.00 | |
| | Hyperglycemia | Hyperglycemia
Overview:
Hyperglycemia (also spelled hyperglycaemia or hyperglycæmia), is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/l (~250–300 mg/dl). For diabetics, glucose levels that are too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death. A feeling of hunger, sweating, shakiness and weakness may also be present. Symptoms typically come on quickly. The most common cause of hypoglycemia is medications used to treat diabetes mellitus such as insulin and sulfonylureas. Risk is greater in diabetics who have eaten less than usual, exercised more than usual or drunk alcohol. Other causes of hypoglycemia include kidney failure, certain tumours (such as insulinoma), liver disease, hypothyroidism, starvation, inborn error of metabolism, severe infections, reactive hypoglycemia and several drugs including alcohol. Low blood sugar may occur in otherwise healthy babies who have not eaten for a few hours.
Acknowledgements:
Author:
Jasvinder Chawla
| 3 | | R410.00 | |
| | Idiopathic sudden sensorineural hearing loss in dialysis patients | Idiopathic sudden sensorineural hearing loss in dialysis patients
Idiopathic sudden sensorineural hearing loss in dialysis patients
Overview
Although sudden sensorineural hearing loss (SSNHL) affects chronic kidney disease (CKD) patients more frequently than non-CKD patients, few reports have described SSNHL in dialysis patients. We aimed to review the characteristics of SSNHL in chronic dialysis patients and evaluate treatment responses to steroid therapy. End-stage renal disease was most frequently caused by diabetic nephropathy, chronic glomerulonephritis and unknown factors. Common accompanying symptoms included tinnitus, ear fullness and vertigo. The mean pure tone audiometry threshold at the initial presentation was 82.6 ± 22.4 dB.
Although the exact incidence of SSNHL has also not been determined in CKD patients, Charlene et al. reported a 1.57-fold higher incidence among CKD patients relative to non-CKD controls. Although we could not identify the specific cause of SSNHL in this population, our relatively large case series elucidates the precise clinical features of SSNHL in this population and demonstrates the outcomes of steroid treatment. A prospective study will be required to clarify the effects of treatment and the relationship between sudden hearing loss and chronic renal failure.
Acknowledgement
Authors Sun-Myoung Kang, Hyun Woo Lim and Hoon Yu
Journal Renal Failure
| 3 | | R425.00 | |
| | Prognostic significance of leukopenia during the induction phase in adult B cell acute lymphoblastic leukemia | Prognostic significance of leukopenia during the induction phase in adult B cell acute lymphoblastic leukemia
Prognostic significance of leukopenia during the induction phase in adult B cell acute lymphoblastic leukemia
Overview
The association between chemotherapy-induced leukopenia and clinical outcome has been reported for several types of cancer. The objective of the current study was to evaluate the association of chemotherapy-induced leukopenia during the induction phase with the clinical outcome of adult B cell acute lymphoblastic leukemia (B-ALL). Fifty-one cases of B-ALL, age =14 years, were reviewed.
The variables under consideration included age, sex, the initial white blood cell (WBC) count (WBC-0), as well as the WBC counts on days 8 (WBC-8), 15 (WBC-15), and 22 (WBC-22) during induction therapy, early bone marrow responses on day 15 during induction therapy, immunophenotype, and cytogenetics. Univariate analysis revealed that WBC-15 =0.40×109/L was significantly associated with inferior event-free survival (EFS) (hazard ratio [HR]=2.95, P=0.004) and overall survival (OS) (HR=2.92, P=0.015).
On multivariate analysis, high WBC-15 (=0.40×109/L) remained an independent prognostic factor for EFS (HR=3.29, P=0.014) and OS (HR=3.29, P=0.038). Our results suggested that WBC-15 may contribute to refinements in the current risk stratification algorithms for adult B-ALL.
Acknowledgement
Authors Chongyun Xing, Bin Liang, Junqing Wu, Qianqian Yang, Gang Hu, Ye Yan, Yu Zhang, Songfu Jiang, Kang Yu and Jianhua Feng
Journal Cancer Management and Research
| 3 | | R400.00 | |
| | Protocol for the systematic review of the reporting of transoral robotic surgery | Protocol for the systematic review of the reporting of transoral robotic surgery
Protocol for the systematic review of the reporting of transoral robotic surgery
Overview
This will be a comprehensive review of transoral robotic surgery and will track its innovative evolution since first published description to present day. Inclusion of all study types will allow identification of good and poor examples of the descriptions of innovative invasive procedures. The methods described are applicable to reviews of any innovative surgical or other invasive procedure.
Transoral robotic surgery (TORS) has been adopted in some parts of the world as an innovative approach to the resection of oropharyngeal tumours. The development, details and outcomes of early-to-later phase evaluation of this technique and the quality of evidence to support its adoption into practice have hitherto not been summarised. The aim of this review is to identify and summarise the early and later phase studies of, and evidence for, TORS and to understand how early phase studies report intervention development, governance procedures and selection and reporting of outcomes to optimise methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence based practice. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.
Acknowledgement
Authors Barry G Main, Natalie S Blencowe, Noah Howes, Sian Cousins, Kerry N L Avery, Alexander Gormley, Phil Radford, Daisy Elliott, Benjamin Byrne, Nicholas Wilson, Robert Hinchliffe, Jane M Blazeby,
Journal
BMJ Open
| 3 | | R420.00 | |
| | Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis | Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis
Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis
Overview
Rheumatoid arthritis (RA) is a chronic, autoimmune, and systemic inflammatory disease of unknown etiology, which mainly affects joints and is characterized by symmetrical synovial inflammation, resulting in destruction of joint cartilage, significant pain, and severe disability. This study will evaluate the effectiveness and the safety of steroid and non-steroidal anti-inflammatory drugs for the treatment of patients with rheumatoid arthritis. Randomized clinical trials eligible for our systematic review will enrol adults with rheumatoid arthritis treated with anti-inflammatory drugs compared with a control group (placebo or active control) at any dose, duration, and route of administration and double blind studies.
Dichotomous data will be summarized as risk ratios; continuous data will be given as standard average differences with 95% confidence intervals. The evidence derived by this study will increase awareness of the effectiveness and safety of steroid and non-steroidal anti-inflammatory drugs for the treatment of rheumatoid arthritis. The results could guide patients and healthcare practitioners and help facilitate evidence-based shared care decision making.
Acknowledgement Author Mariana Del Grossi Moura, Luciane Cruz Lopes, Marcus Tolentino Silva, Sílvio Barberato-Filho, Rogério Heládio Lopes Motta and Cristiane de Cássia Bergamaschi,
Journal Medicine Baltimore 2018
| 3 | | R420.00 | |
| | Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? | Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Overview
Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006).
In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. In conclusion, short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon
Acknowledgement
Authors Cristina B. Barra, Maria Jussara F. Fontes, Marco Túlio G. Cintra, Renata C. Cruz, Janaína A. G. Rocha, Maíla Cristina C. Guimarães and Ivani Novato Silva
Journal Revista Da Associação Médica Brasileira
| 3 | | R420.00 | |
| | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer | Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer
Overview
Cervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intra-operative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC. A comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Seventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH. the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intra-operative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intra-operative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions.
Acknowledgement
Authors Yue-Mei Jin, Shan-Shan Liu, Jun Chen, Yan-Nan Chen and Chen-Chen Ren
Journal PLoS ONE
| 3 | | R415.00 | |
| | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Overview
The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH.
The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up. RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.
Acknowledgement
Authors Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Ya-Ling Lin, Hwa-Koon Wu, Shu-Hsin Pai, Dar-Ren Chen and Shou-Jen Kuo,
Journal
Medicine Baltimore
Publisher Wolters Kluwer Health, Inc.
| 3 | | R420.00 | |
| | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy
Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy
Overview
Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH.
This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or non-barbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion.
Vaginal cuff dehiscence is a morbid, potentially fatal complication that can occur after total hysterectomy from any approach. During the 20th century, very few cases were reported, and 95% occurred after total abdominal or vaginal hysterectomy, before the advent of laparoscopic hysterectomy1
Acknowledgement
Authors Benjamin D. Beran, MD, Marie Shockley, MD, Pamela Frazzini Padilla, MD, Sara Farag, MD, Pedro Escobar, MD, Stephen Zimberg, MD, Michael L. Sprague, MD
Journal JSLS (Journal of the Society of Laparoendoscopic Surgeons) Volume 22 Issue 2 | 3 | | R460.00 | |
| | Mortality effects of timing alternatives for hip fracture surgery | Mortality effects of timing alternatives for hip fracture surgery
Mortality effects of timing alternatives for hip fracture surgery
Overview:
The appropriate timing of hip fracture surgery remains a matter of debate. It was sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.
We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.
Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
Acknowledgement
Authors:
Boris Sobolev PhD, Pierre Guy MD, Katie Jane Sheehan PhD, Lisa Kuramoto MSc, Jason M. Sutherland PhD, Adrian R. Levy PhD, James A. Blair MD, Eric Bohm MD, Jason D. Kim MPH, Edward J. Harvey MD, Suzanne N. Morin MD, Lauren Beaupre PhD, Michael Dunbar MD, Susan Jaglal PhD, James Waddell MD; for the Canadian Collaborative Study of Hip Fractures
Journal:
CMAJ Group Volume 190 Issue 31
Publisher:
National Centre for Biotechnology Information | 3 | | R460.00 | |
| | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Overview
Understanding determinants of community mobility disability is critical for developing interventions aimed at preventing or delaying disability in older adults. To understand these determinants, capturing and measuring community mobility has become a key factor. The objectives of this paper are to present and illustrate the signal processing workflow and outcomes that can be extracted from an activity and community mobility measurement approach based on GPS and accelerometer sensor data and 2) to explore the construct validity of the proposed measurement approach using data collected from healthy older adults in free-living conditions.
Wearability and usability of the devices used to capture free-living community mobility impact participant compliance and the quality of the data. The construct validity of the proposed approach appears promising but requires further studies directed at populations with mobility impairments.
Acknowledgement
Author Patrick Boissy, Margaux Blamoutier, Simon Brière and Christian Duval Journal Frontiers in Public Health Volume 6 Article 216 | 3 | | R395.00 | |
| | Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry | Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry
Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry
Overview
Pneumonia and meningitis continue to present an enormous public health burden and pose a major threat to young children. Among the causative organisms of pneumonia and meningitis, bacteria are the most common causes of serious disease and deaths. It is challenging to accurately and rapidly identify these agents.
Using the BP-MS method, we could accurately identify the expected bacteria without cross-reactivity with other pathogens. For the 11 target bacterial pathogens, the analytical sensitivity of the BP-MS method was as low as 10 copies/reaction. To further evaluate the clinical effectiveness of this method, 204 nasopharyngeal swabs from hospitalized children with suspected pneumonia were tested using this method.
We used real-time PCR and nested PCR to confirm positive results, with identical results obtained for 81.4% (136/167) of the samples. The BP-MS method is a sensitive and specific molecular detection technique in a multiplex format and with high sample throughput. Therefore, it will be a powerful tool for pathogen screening and antibiotic selection at an early stage of disease.
Acknowledgements
Authors Chi Zhang, Leshan Xiu, Yan Xiao, Zhengde Xie, Lili Ren and Junping Peng
Journal Frontiers in Cellular and Infection Microbiology Volume 8
Publisher Cross Mark
| 3 | | R460.00 | |
| | The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery | The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery
The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery
Overview
Bariatric surgery is considered an effective treatment for individuals with severe and complex obesity. Besides reducing weight and improving obesity related comorbidities such as diabetes, bariatric surgery could improve patients' health-related quality of life. However, the frequently used instrument to measure quality of life, the EQ-5D has not been validated for use in bariatric surgery, which is a major limitation to its use in this clinical context. Our study undertook a psychometric validation of the 5 level EQ-5D (EQ-5D-5L) using clinical trial data to measure health-related quality of life in patients with severe and complex obesity undergoing bariatric surgery.
The most common types of bariatric surgery are laparoscopic Roux-en-Y gastric bypass, adjustable gastric band surgery and laparoscopic sleeve gastrectomy, with each having its respective benefits and risks. The Roux-en-Y gastric bypass restricts the volume of food eaten by creating a small thumb-sized pouch from the upper stomach and a bypass of the remaining stomach. Bypass alters physiology and anatomy in such a way as to achieve early and generally rapid weight loss but carries risks of serious early morbidity [4, 5]. Longer-term complications include the need for re-operation because of the development of internal hernias or intestinal obstruction and nutritional deficiencies
Acknowledgement
Authors Jilles M. Fermont1, Jane M. Blazeby, Chris A. Rogers, Sarah Wordsworth, on behalf of the By-Band-Sleeve Study Management Group
Journal PLoS One | 3 | | R460.00 | |
| | Cancer and Heart Failure: Understanding the Intersection. | Cancer and Heart Failure: Understanding the Intersection.
Cancer and Heart Failure: Understanding the Intersection.
Overview
Cancer and cardiovascular disease account for nearly half of all deaths in the US. The majority of cancer therapies are known to cause potential cardiac toxicity in some form. Patients with underlying cardiac disease are at a particularly increased risk for worse outcomes following cancer therapy.
Cardiac risk factors include but are not limited to age, female gender, history of myocardial infarction or LVD and tachycardia, as this may be an early sign of cardiac damage.44 Cardiac biomarkers may provide an additive role in this setting. For patients considered to be at higher risk for the development of cardiotoxicity, a cardio-oncology consultation should be offered.
Whether patients with pre-existing cardiovascular disease require cancer therapy with potentially cardiotoxic agents or previously healthy patients develop cardiac complications from cancer therapy, a collaborative patient-centred approach between the cardiologist and oncologist is essential to successful patient care.
Most alarming is the potential for heart failure as a result of cancer treatment, which may lead to early disruption or withdrawal of life-saving cancer therapies and can potentially increase cardiovascular mortality. A multi-disciplinary cardio-oncology approach can improve outcomes through early surveillance, prevention and treatment strategies. Acknowledgement
Author Carine E Hamo and Michelle W Bloo Journal Cardiac Failure Review
Publisher Radcliffe Cardiology 2017
| 3 | | R425.00 | |
| | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Overview
South Africa faces a complex burden of disease consisting of infectious and non–communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. Objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north–east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality.
The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting.
Acknowledgement
Authors Nitya Hullur, Lucia D’Ambruoso, Kerstin Edin, Ryan G Wagner, Sizzy Ngobeni Kathleen Kahn, Stephen Tollman, Peter Byass
Journal Global Health Action Volume 6 Issue 1
| 3 | | R460.00 | |
| | Commensal bacteria produce GPCR ligands that mimic human signalling molecules | Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Overview
Commensal bacteria are believed to play important roles in human health. The mechanisms by which they affect mammalian physiology are poorly understood; however, bacterial metabolites are likely to be key components of host interactions. Here, we use bioinformatics and synthetic biology to mine the human microbiota for N-acyl amides that interact with G-protein-coupled receptors. GPR119 is most highly expressed in the pancreas and duodenum, S1PR4 in the spleen and lymph node, G2A in the lymph node and appendix, PTGIR in the lung and appendix and PTGER4 in the bone marrow and small intestine.
Commensal GPR119 agonists regulate metabolic hormones and glucose homeostasis as efficiently as human ligands although future studies are needed to define their potential physiologic role in humans. This work suggests that chemical mimicry of eukaryotic signaling molecules may be common among commensal bacteria and that manipulation of microbiota genes encoding metabolites that elicit host cellular responses represents a new small molecule therapeutic modality.
Acknowledgement
Author Louis J. Cohen, Daria Esterhazy, Seong-Hwan Kim, Christophe Lemetre, Rhiannon R. Aguilar, Emma A. Gordon, Amanda J. Pickard, Justin R. Cross, Ana B. Emiliano, Sun M. Han1, John Chu, Xavier Vila-Farres, Jeremy Kaplitt, Aneta Rogoz, Paula Y. Calle, Craig Hunter, J. Kipchirchir Bitok, and Sean F. Brady
Journal Nature
Publisher Department of Health & Human Services – USA
| 3 | | R395.00 | |
| | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
Overview
Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumours. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass.
Primary cardiac angiosarcomas in all age groups mostly occur in the right atrium. The most common complaints presented are dyspnea and chest pain, usually related to a malignant cardiac effusion. The pericardium is frequently involved with a right sided angiosarcoma; cardiac tamponade and pericardial effusion are common complications. Our patient had a massive pericardial effusion and malignant cells were seen in cytologic examination.
The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl. Acknowledgement
Authors Elvan Caglar Citak, MD, PhD; Murat Ozeren, MD; M. Kerem Karaca, MD; Derya Karpuz, MD; Feryal Karahan, MD; Eda , Bengi Yilmaz, MD; Yuksel Balci, MD; Pelin Ozcan Kara, MD; Rabia Bozdogan Arpaci, MD Journal Brazilian Journal of Cardiovascular Surgery
| 3 | | R460.00 | |
| | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
Overview
Life-threatening arrhythmia may be induced by corrected QT (QTc) interval prolongation. Several antimicrobial drugs have been associated with QTc interval prolongation. Favipiravir is an inhibitor of the RNA-dependent RNA polymerase of many RNA viruses, including influenza viruses, arenaviruses, phleboviruses, hantaviruses, flaviviruses, enteroviruses, and noroviruses. Favipiravir has also been used in the recent epidemic of Ebolavirus (EBOV) in West Africa. To date, no significant effects of favipiravir on the QT/QTc interval have been detected. We report a case of QTc interval prolongation during favipiravir therapy in an EBOV-infected patient treated at our institution.
In conclusion, we suggest that favipiravir administered at high doses, together with the cofactors discussed above, may have contributed to inducing a QTc interval prolongation in our EBOV patient. If feasible, ECG monitoring could be advisable during high-dose favipiravir therapy, especially when patients experience electrolyte disturbances and concomitant use of drugs with QTc-prolonging potential. Encephalitis or central nervous system (CNS) pathology may have a role in prolonging QT interval. Acknowledgement
Authors Pierangelo Chinello, Nicola Petrosillo, Silvia Pittalis, Gianluigi Biava, Giuseppe Ippolito, Emanuele Nicastri, on behalf of the INMI Ebola Team
Journal PLoS Neglected Tropical Diseases
Publisher Cross Mark
| 3 | | R390.00 | |
| | Ebolaviruses: New roles for old proteins | Ebolaviruses: New roles for old proteins
Ebolaviruses: New roles for old proteins
Overview
In 2014, the world witnessed the largest Ebolavirus outbreak in recorded history. The subsequent humanitarian effort spurred extensive research, significantly enhancing our understanding of ebolavirus replication and pathogenicity. The main functions of each ebolavirus protein have been studied extensively since the discovery of the virus in 1976; however, the recent expansion of ebolavirus research has led to the discovery of new protein functions. The international containment effort spurred extensive research that is enhancing.
These newly discovered roles are revealing new mechanisms of virus replication and pathogenicity, whilst enhancing our understanding of the broad functions of each ebolavirus viral protein (VP). Many of these new functions appear to be unrelated to the protein's primary function during virus replication. Such new functions range from bystander T-lymphocyte death caused by VP40-secreted exosomes to new roles for VP24 in viral particle formation. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity.
Acknowledgement Authors Diego Cantoni and Jeremy S. Rossman Journal PLoS Neglected Tropical Diseases Publisher Cross Mark | 3 | | R420.00 | |
| | Comparison of qPCR versus culture for the detection and quantification of Clostridium difficile environmental contamination | Comparison of qPCR versus culture for the detection and quantification of Clostridium difficile environmental contamination
Comparison of qPCR versus culture for the detection and quantification of Clostridium difficile environmental contamination
Overview
Contaminated surfaces serve as an important reservoir for Clostridium difficile transmission. Current strategies to detect environmental contamination of C. difficile rely heavily on culture, and often only indicate presence versus absence of spores. The goal of this study was to compare quantitative PCR (qPCR) to culture for the detection and quantification of C. Difficile from inert surfaces. First, we compared the limit of detection (LOD) of a 16S rRNA gene and toxin B gene qPCR assay for detection of C. difficile in solution. Second, we compared the LODs of 16S rRNA gene qPCR versus culture for detection of C. difficile from surfaces.
Solution experiments were performed by direct seeding of spores into neutralizing broth, whereas surface experiments involved seeding of spores onto plastic test surfaces, and recovery using sponge swabs. Both experiments were conducted using spores expressing short (NAP1) and long (NAP4) hair lengths. Future work attempting to measure the presence of C. difficile on environmental surfaces should consider using qPCR.
Acknowledgement
Author Laura K. MacDougall, George Broukhanski, Andrew Simor, Jennie Johnstone, Samira Mubareka, Allison McGeer, Nick Daneman, Gary Garber and Kevin A. Brown
Journal PLoS ONE Publisher Cross Mark
| 3 | | R480.00 | |
| | Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network | Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Overview
Following the introduction of 7-valent pneumo-coccal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumo-coccal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, para-pneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015.
The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
Acknowledgement
Author
Tahereh Haji , Adam Byrne and Tom KovesiD
Journal
Children (Basel)
Publisher Basel, Switzerland 2018
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867495/pdf/children-05-00036.pdf
| 3 | | R450.00 | |
| | More than kin, less than kind: one family and the many faces of diabetes in youth | More than kin, less than kind: one family and the many faces of diabetes in youth
More than kin, less than kind: one family and the many faces of diabetes in youth
More than kin, less than kind: one family and the many faces of diabetes in youth
Overview
Identification of the correct etiology of diabetes brings important implications for clinical management. In this report, we describe a case of a 4-year old asymptomatic girl with diabetes since age 2, along with several individuals in her family with different etiologies for hyperglycemia identified in youth. Genetic analyses were made by Sanger sequencing, laboratory measurements included HbA1c, lipid profile, fasting C-peptide, pancreatic auto-antibodies. We found a Gly178Ala substitution in exon 5 of GCK gene in three individuals co-segregating with diabetes, and type 1 diabetes was identified in two other individuals based on clinical and laboratory data. One individual with previous gestational diabetes and other with pre-diabetes were also described.
We discuss difficulties in defining etiology of hyperglycemia in youth in clinical practice, especially monogenic forms of diabetes, in spite of the availability of several genetic, laboratory, and clinical tools. In conclusion, the accurate molecular and clinical diagnosis has significant impact on clinical management of a multifaceted disease such as diabetes, especially when running on the same family.
Acknowledgement
Authors Luciana F. Franco, Renata Peixoto-Barbosa, Renata P. Dotto, José Gilberto H. Vieira, Magnus R. Dias-da-Silva, Luiz Carlos F. Reis, Fernando M. A. Giuffrida, and Andre F. Reis
Journal Arch Endocrinol Metab.
| 3 | | R390.00 | |
| | Postural Tremor and Ataxia Progression in Spino-cerebellar Ataxias | Postural Tremor and Ataxia Progression in Spino-cerebellar Ataxias
Postural Tremor and Ataxia Progression in Spino-cerebellar Ataxias
Postural Tremor and Ataxia Progression in Spino-cerebellar Ataxias
Overview
Postural tremor can sometimes occur in spino-cerebellar ataxias (SCAs). However, the prevalence and clinical characteristics of postural tremor in SCAs are poorly understood, and whether SCA patients with postural tremor have different ataxia progression is not known. Postural tremor could be a clinical feature of SCAs, and the presence of postural tremor could be associated with different rates of ataxia progression. Genetic interactions between ataxia genes might influence the brain circuitry and thus affect the clinical presentation of postural tremor.
In conclusion, our study indicates that postural tremor could be present in the four most common SCAs and that SCA patients with postural tremor might have a different rate of ataxia progression. Genetic interactions between ataxia genes might influence the brain circuitry involved and thus affect the clinical presentation of postural tremor.
Acknowledgement
Author
Shi-Rui Gan, Jie Wang, Karla P. Figuero, Stefan M. Pulst, Darya Tomishon, Danielle Lee, Susan Perlman, George Wilmot, Christopher M. Gomez, Jeremy Schmahmann, Henry Paaulson, Vikram G. Shakkottai, Sarah H. Ying, Theresa Zesiewicz, Khalaf Bushara, Michael D. Geschwind, Guangbin Xia, S. H. Subramony Tetsuo Ashizawa and Sheng-Han Kuo.
Journal Tremor Other Hyperkinet Movement (NY) URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647398/pdf/tre-07-492-7522-1.pdf Disciplines: Neurology, Surgeons, Physicians
| 3 | | R465.00 | |
| | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Overview
There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group.
No effect of training was seen on cerebral N-acetylaspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuro-protective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.
Acknowledgement
S Matura, J Fleckenstein, R Deichmann, T Engeroff, E Füzéki, E Hattingen, R Hellweg, B Lienerth, U Pilatus, S Schwarz, VA Tesky, L Vogt, W Banzer and J Pantel.
Journal Nature Translational Psychiatry (2017) 7, e1172
Publisher Unknown Creative Commons, Open Access doi:10.1038/tp.2017.135
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538117/pdf/tp2017135a.pdf
| 3 | | R445.00 | |
| | A Qualitative Exploration of Chronic Pain and Opioid Treatment | A Qualitative Exploration of Chronic Pain and Opioid Treatment
A Qualitative Exploration of Chronic Pain and Opioid Treatment
A Qualitative Exploration of Chronic Pain and Opioid Treatment
Overview
The study explored high risk participants’ experiences with pain management regarding clinical access to and use of prescription opioids. First, participants perceived providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers’ surveillance of participants’ pain treatment regimen contributed to distress surrounding pain management.
Secondly, study centered on participants’ pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
Acknowledgement
Author Sarina R. Isenberg, Allysha C. Maragh-Bass, Kathleen Ridgeway, Mary Catherine Beach and Amy R. Knowlton.
Journal J Opioid Manag.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560049/pdf/nihms871159.pdf
| 3 | | R455.00 | |
| | Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s). | Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Overview
Gastrointestinal (GI) bleeding is a leading cause of death in dengue. This study aims to identify predictors for GI bleeding in adult dengue patients, emphasizing the impact of existing co-morbid disease(s). Of 1300 adults with dengue virus infection, 175 (mean age, 56.5±13.7 years) patients with GI bleeding and 1,125 (mean age, 49.2±15.6 years) without GI bleeding (controls) were retrospectively analyzed.
Our study is the first to disclose that end stage renal disease and previous stroke, with additional co-morbidities, were strongly significant associated with the risk of GI bleeding in patients with dengue virus infection. Identification of these risk factors can be incorporated into the patient assessment and management protocol of dengue virus infection to reduce its mortality. Our study emphasizes that, in addition to older age and thrombocytopenia , end stage renal disease and previous stroke, with additional co-morbidities, are important clinical predictor of GI bleeding in adult patients with DENV infection. More studies, particularly prospective studies are required to validate these findings for better generalization of their clinical utility.
Acknowledgement
Author Wen-Chi Huang, Ing-Kit Lee, Yi-Chun Chen, Ching-Yen Tsai and Jien-Wei Liu.
Journal PLoS ONE Volume 13 Issue 2
Publisher Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819790/pdf/pone.0192919.pdf
| 3 | | R470.00 | |
| | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
Overview
Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of post-surgical infections.
PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0ng/mL at first or second day after surgery and >0.5ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients. In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.
Acknowledgement
Author Silvia Spoto, Emanuele Valeriani, Damiano Caputo, Eleonora Cella, Marta Fogolari, MDe, Elena Pesce, Maria Tea Mulè, Mariacristina Cartillone, Sebastiano Costantino, MDa, Giordano Dicuonzo, Roberto Coppola, Massimo Ciccozzi and Silvia Angeletti,
Journal Medicine (2018) Volume 97 Issue 3
Publisher Wolters Kluwer Health, Inc.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779742/pdf/medi-97-e9496.pdf
| 3 | | R455.00 | |
| | Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro | Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Overview
Noroviruses (NoVs) and Sapoviruses (SaVs) are enteric caliciviruses that have been detected in multiple mammalian species, including humans. Currently, efficient cell culture systems have been established only for murine NoVs and porcine SaV Cowden strain. Establishment of an efficient in vitro cell culture system for other NoVs and SaVs remains challenging; however, human NoV (HuNoV) replication in 3D cultured Caco-2 cells and a clone of Caco-2 cells, C2BBe1, human enteroids and in human B cells has been reported.
In this study, we tested various cells and culture conditions to grow HuNoVs and a human SaV (HuSaV) to test the possibility of the propagation in different cells and culture conditions. We also attempted to grow a bovine NoV (BoNoV) in ex vivo organ cultures. Our results demonstrated that HuNoVs, BoNoV and HuSaV largely failed to grow in vitro under our test conditions. Our purpose is to share our findings with other researchers with the goal to develop efficient, reproducible simplified and cost-effective culture systems for human and animal NoVs and SaVs in the future.
Acknowledgement
Author Tomoichiro Oka, Garrett T. Stoltzfus, Chelsea Zhu, Kwonil Jung, Qiuhong Wang and Linda J. Saif.
Journal PLoS ONE
Publisher Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810978/pdf/pone.0178157.pdf
| 3 | | R445.00 | |
| | Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study: | Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Overview
Prescription opioid use is highly associated with risk of opioid-related death, with 1 of every 550 chronic opioid users dying within approximately 2.5 years of their first opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications.
However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental opioid related death in patients receiving opioids. The objective of this study was to investigate whether co-prescription of opioids and gabapentin is associated with an increased risk of accidental opioid-related mortality. We conducted a population-based nested case-control study among opioid users who were residents of Ontario, Canada.
In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and opioids.
Acknowledgement
Author Tara Gomes, David N. Juurlink, Tony Antoniou, Muhammad M. Mamdani, J. Michael Paterson and Wim van den Brink.
Journal PLoS Medicine Volume 14 Issue 10
Publisher Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626029/pdf/pmed.1002396.pdf
| 3 | | R470.00 | |
| | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review
Overview
Cardiovascular evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published since 2016. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. Despite the empirical debate regarding the cognitive benefit of de-worming for STH, the current ethical, clinical and health policy environments remain strongly skewed in favor of de-worming for child growth, prevention of anaemia and potentially avoidance of preventable cognitive deficits
Acknowledgement
Author
Noel Pabalan, Eloisa Singian, Lani Tabangay, Hamdi Jarjanazi, Michael J. Boivin, Amara E. Ezeamama
Journal PLoS Neglected Tropical Diseases
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766095/pdf/pntd.0005523.pdf
Publisher Cross Mark
| 3 | | R465.00 | |
| | Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase. | Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Overview
Mitochondrial DNA (mtDNA), the discrete genome which encodes subunits of the mitochondrial respiratory chain, is present at highly variable copy numbers across cell types. Though severe mtDNA depletion dramatically reduces mitochondrial function, the impact of tissue-specific mtDNA reduction remains debated. Previously, our lab identified reduced mtDNA quantity in the putamen of Parkinson's Disease (PD) patients who had developed L-DOPA Induced Dyskinesia (LID), compared to PD patients who had not developed LID and healthy subjects.
Here, we present the consequences of mtDNA depletion by ethidium bromide (EtBr) treatment on the bioenergetic function of primary cultured neurons, astrocytes and neuron-enriched cocultures from rat striatum. EtBr also increases glycolytic activity in astrocytes, whereas in neurons it reduces the expression of mitochondrial creatine kinase mRNA and levels of phosphor-creatine. Further, we show that mitochondrial creatine kinase mRNA is similarly downregulated in dyskinetic PD patients, compared to both non-dyskinetic PD patients and healthy subjects.
Our data support a hypothesis that reduced striatal mtDNA contributes to energetic dysregulation in the dyskinetic striatum by destabilizing the energy buffering system of the phospho-creatine/creatine shuttle.
Acknowledgement
Author Emily Booth Warren, Aidan Edward Aicher, Joshua Patrick Fessel and Christine Konradi
Journal PLoS ONE
Publisher Cross Mark
| 3 | | R455.00 | |
| | Pediatric multiple sclerosis: current perspectives on health behaviours | Pediatric multiple sclerosis: current perspectives on health behaviours
Pediatric multiple sclerosis: current perspectives on health behaviours
Pediatric multiple sclerosis: current perspectives on health behaviours
Overview
Pediatric-onset multiple sclerosis (POMS) accounts for -5% of all multiple sclerosis cases, and has a prevalence of -10,000 children in the USA. POMS is associated with a higher relapse rate, and results in irreversible disability on average 10 years earlier than adult-onset multiple sclerosis. Other manifestations of POMS include mental and physical fatigue, cognitive impairment, and depression. Health behaviours of physical activity, diet, and sleep may have potential benefits in POMS, and present a scoping review of the existing literature.
Physical activity participation was associated with reduced relapse rate, disease burden, and sleep/rest fatigue symptoms. Nutritional factors, particularly vitamin D intake, may be associated with relapse rate. Obesity has been associated with increased risk of developing POMS. POMS is associated with better sleep hygiene, and this may benefit fatigue and quality of life.
Participation in health behaviours, particularly physical activity, diet, and sleep, may have benefits for POMS. Nevertheless, there are currently no interventions targeting promotion of these behaviours and examining the benefits of managing the primary and secondary manifestations of POMS.
Acknowledgement
Author Elizabeth Morghen Sikes, Robert W Motl , Jayne M Ness
Journal Pediatric Health, Medicine and Therapeutics 2018:9 17–25
Publisher Dovepress
| 3 | | R450.00 | |
| | Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer | Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer
Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer
Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer
Overview
Radiation therapy (RT) is a standard treatment for head and neck cancer; however, it is associated with inflammation, accelerated atherosclerosis, and cerebrovascular events. Human papillomavirus (HPV) is found in nearly half of head and neck cancers and is associated with inflammation and atherosclerosis.
The outcome of interest was the composite of ischemic stroke and transient schemic attack, and the association between HPV and CVEs was assessed using Cox proportional hazard models, competing risk analysis, and inverse probability weighting. In a multivariable model, HPV-positive status was associated with a >4 times increased risk of CVEs. In this study, HPV-positive status is associated with an increased risk of stroke or transient ischemic attack following RT for head and neck cancer. Acknowledgement
Author Daniel Addison, MD; Sara B. Seidelmann, MD, PhD; Sumbal A. Janjua, MD; Hamed Emami, MD; Pedro V. Staziaki, MD; Travis R. Hallett, BA; Balint Szilveszter, MD; Michael T. Lu, MD; Richard P. Cambria, MD; Udo Hoffmann, MD, MPH; Annie W. Chan, MD; Lori J. Wirth, MD; Tomas G. Neilan, MD, MPH
Journal Journal of the American Heart Association Volume 6 Issue 9
Publisher
2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
| 3 | | R470.00 | |
| | Non-invasive Brain Stimulation in Children with Unilateral Cerebral Palsy: a protocol and risk mitigation guide | Non-invasive Brain Stimulation in Children with Unilateral Cerebral Palsy: a protocol and risk mitigation guide
Non-invasive Brain Stimulation in Children with Unilateral Cerebral Palsy: a protocol and risk mitigation guide
Non-invasive Brain Stimulation in Children with Unilateral Cerebral Palsy: a protocol and risk mitigation guide Overview
Non-invasive brain stimulation has been increasingly investigated, mainly in adults, with the aims of influencing motor recovery after stroke. However, a consensus on safety and optimal study design has not been established in pediatrics. The low incidence of reported major adverse events in adults with and without clinical conditions has expedited the exploration of NIBS in children with paralleled purposes to influence motor skill development after neurological injury. Considering developmental variability in children, with or without a neurologic diagnosis, adult dosing and protocols may not be appropriate.
Combining our experiences has allowed us to improve our own protocols, with the immediate goal of child safety and the overarching goal to establish a consensus that helps to define best NIBS practice and practice guidelines
The purpose of this paper is to present recommendations and tools for the prevention and mitigation of adverse events (AEs) during NIBS in children with unilateral cerebral palsy (UCP). Consistent reporting of safety, feasibility, and tolerability will refine NIBS practice guidelines contributing to future clinical translations of NIBS.
Acknowledgement
Author Bernadette T. Gillick, Andrew M. Gordon, Tim Feyma , Linda E. Krach, Jason Carmel, Tonya L. Rich, Yannick Bleyenheuft and Kathleen Friel
Journal Frontiers in Pediatrics Volume 6 Article 56
Publisher Cross Mark https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864860/pdf/fped-06-00056.pdf
| 3 | | R455.00 | |
| | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study) | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Overview
Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant death in high-income countries. Central respiratory system dysfunction seems to contribute to these deaths.
Excitation that drives contraction of skeletal respiratory muscles is controlled by the sodium channel NaV1.4, which is encoded by the gene SCN4A. Variants in NaV1.4 that directly alter skeletal muscle excitability can cause myotonia, periodic paralysis, congenital myopathy, and myasthenic syndrome.
Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths.
Acknowledgement
Author Dogan Roope Männikkö, Leonie Wong, David J Tester, Michael G Thor, Richa Sud, Dimitri M Kullmann, Mary G Sweeney, Costin Leu, Sanjay M Sisodiya, David R FitzPatrick, Margaret J Evans, Iona J M Jeffrey, Jacob Tfelt-Hansen, Marta C Cohen, Peter J Fleming, Amie Jaye, Michael A Simpson, Michael J Ackerman, Michael G Hanna, Elijah R Behr, Emma Matthews
Journal
Vol 391 April 14, 2018
Publisher
Cross Mark https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899997/pdf/main.pdf
| 3 | | R470.00 | |
| | Cerebral Venous Sinus Thrombosis in a patient with Ulcerative Colitis Flare | Cerebral Venous Sinus Thrombosis in a patient with Ulcerative Colitis Flare
Cerebral Venous Sinus Thrombosis in a patient with Ulcerative Colitis Flare
Cerebral Venous Sinus Thrombosis in a patient with Ulcerative Colitis Flare
Overview
Inflammatory bowel disease is characterized by a chronic inflammatory state and is therefore associated with abnormalities in coagulation and a hyper-coagulable state. Cerebral venous sinus thrombosis is a rare complication of inflammatory bowel disease yet contributes significant morbidity and mortality to those affected. Early diagnosis is critical, as a delay in diagnosis portends a worse prognosis.
The study starts by discussing the case of a seventeen-year-old female who presented with ulcerative colitis flare and developed new-onset seizures, found to be caused by a large venous sinus thrombosis. Evidence-based medicine supports IBD to be an independent risk factor for venous sinus thrombosis, as numerous studies have demonstrated a correlation.
The mechanism for this is multi-factorial and incompletely understood. Most healthcare professionals are not aware of this correlation and may not know how to quickly and confidently identify venous sinus thrombosis on various imaging modalities. This paper seeks to highlight the relationship, as a delay in diagnosis of CVT portends a worse prognosis in these young, at-risk patients.
Acknowledgement Author L. M. Conners , R. Ahad, P. H. Janda, and Z. Mudasir
Journal Case Reports in Neurological Medicine
Publisher Hindawi | 3 | | R480.00 | |
| | Transition Needs of Adolescents With Sickle Cell Disease. | Transition Needs of Adolescents With Sickle Cell Disease.
Transition Needs of Adolescents With Sickle Cell Disease.
Transition Needs of Adolescents With Sickle Cell Disease.
Overview
This article describes how adolescents with sickle cell disease (SCD) perceive their ability to perform everyday tasks required for transition to adult health care and independent living. SCD negatively affects transition from pediatric to adult health care and independent living (Anie & Telfair, 2005).
The Adolescent Autonomy Checklist (AAC) was adapted to include skills associated with managing SCD (AAC-SCD) and was administered to adolescents during clinic visits. Participants indicated "can do already" or "needs practice" for 100 activities in 12 categories. Of 122 patients, the percentage of adolescents who needed practice was greatest in living arrangements (38.7%), money management (35.8%), vocational skills (29.6%), and health care skills (25.5%).
We found a significant effect of age and of cerebrovascular injury on the percentage of those who reported "needs practice" in multiple categories. We found no effect of gender and limited effect of haemoglobin phenotype on any skill category. Findings support the need for educational intervention to improve transition skills in adolescents with SCD.
Acknowledgement:
Author: Abel RA, Cho E, Chadwick-Mansker KR, D'Souza N, Housten AJ, King AA
Journal:
The American Journal of Occupational Therapy Volume 69 Issue 2
Publisher: AOTA Press
| 3 | | R455.00 | |
| | Dose and Timing in Neurorehabilitation: Prescribing Motor Therapy After Stroke | Dose and Timing in Neurorehabilitation: Prescribing Motor Therapy After Stroke
Dose and Timing in Neurorehabilitation: Prescribing Motor Therapy After Stroke
Dose and Timing in Neuro-rehabilitation: Prescribing Motor Therapy After Stroke.
Overview
Prescribing the most appropriate dose of motor therapy for individual patients is a challenge because minimal data are available and a large number of factors are unknown. This review explores the concept of dose and reviews the most recent findings in the field of neuro-rehabilitation, with a focus on relearning motor skills after stroke.
Appropriate dosing involves the prescription of a specific amount of an active ingredient, at a specific frequency and duration. Dosing parameters, particularly amount, are not well defined or quantified in most studies. Compiling data across studies indicates a positive, moderate dose-response relationship, indicating that more movement practice results in better outcomes. This relationship is confounded by time after stroke.
These findings suggest that substantially more movement practice may be necessary to achieve better outcomes for people living with the disabling consequences of stroke. Preclinical investigations are needed to elucidate many of the unknowns and allow for a more biologically driven rehabilitation prescription process. Likewise, clinical investigations are needed to determine the dose-response relationships and examine the potential dose-timing interaction in humans.
Acknowledgement:
Author: Lang CE, Lohse KR, Birkenmeier RL
Journal: Current Opinion in Neurology.
Publisher: HHS Public Access
| 3 | | R430.00 | |
| | Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population | Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population
Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population
Diagnostic Approaches for Invasive Aspergillosis—Specific Considerations in the Pediatric Population
Overview
The Invasive aspergillosis (IA) is a major cause of morbidity and mortality in children with hematological malignancies and those undergoing hematopoietic stem cell transplantation. Similar to immune-compromised adults, clinical signs, and symptoms of IA are unspecific in the pediatric patient population. As early diagnosis and prompt treatment of IA is associated with better outcome, imaging and non-invasive antigen-based such as galactomannan or ß-D-glucan and molecular biomarkers in peripheral blood may facilitate institution and choice of antifungal compounds and guide duration of therapy.
The early and reliable diagnosis of IA is difficult in immune-compromised patients, in particular in the pediatric population. In patients in whom imaging studies suggest IA or another mold infection, invasive diagnostics such as broncho-alveolar lavage and/or bioptic procedures should be considered. Here we review the current data of diagnostic approaches for IA in the pediatric setting and highlight the major differences of performance and clinical utility of the tests between children and adults.
Acknowledgement
Author Thomas Lehrnbecher , Angela Hassler , Andreas H. Groll and Konrad Bochennek
Journal Frontiers in Microbiology
Publisher Cross Mark
| 3 | | R480.00 | |
| | Is the Serum Oxytocin Level Altered by Treatment in Rheumatoid Arthritis Patients Complicated with Depression | Is the Serum Oxytocin Level Altered by Treatment in Rheumatoid Arthritis Patients Complicated with Depression
Is the Serum Oxytocin Level Altered by Treatment in Rheumatoid Arthritis Patients Complicated with Depression
Is the Serum Oxytocin Level Altered By Treatment In Rheumatoid Arthritis Patients Complicated With Depression?
Overview
The objective of this study was to investigate the factors associated with depression, including serum oxytocin levels, disease activity, activities of daily living, and quality of life, and their effects on rheumatoid arthritis.
This study included 42 RA patients who received treatment with a biological agent. We measured the following variables before and after 6 months of treatment: baseline characteristics, including age, sex, disease duration, smoking, and body mass index; prednisolone and methotrexate dose; serum level of matrix metalloproteinase -3; erythrocyte sedimentation rate; and C-reactive protein level.
The HAM-D score significantly correlated with the SDAI, and the mental component summary score of SF-36. However, the serum OXT levels did not correlate with the HAM-D score. Regression analysis using the HAM-D score as the objective variable identified female sex, smoking, BMI, and all the three component scores of SF-36, but not serum OXT levels, as significant factors. The variables of female sex, smoking, BMI, and QOL correlated with depression complicated with RA. However, serum OXT levels did not correlate directly.
Acknowledgement Author Yusuke Miwa , Hidekazu Furuya, Ryo Yanai, Tsuyoshi Kasama, and Kenji Sanada
Journal European Journal of Rheumatology ( EJR) 2018; 5: 22-6
Publisher Medical Research and Education Association
| 3 | | R430.00 | |
| | Head and Neck Reconstruction with Pedicled Flaps in the Free Flap Area | Head and Neck Reconstruction with Pedicled Flaps in the Free Flap Area
Head and Neck Reconstruction with Pedicled Flaps in the Free Flap Area
Head and Neck Reconstruction with Pedicled Flaps in the Free Flap Era.
Overview
Nowadays, the transposition of micro-vascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to micro-vascular free flap reconstruction in terms of complications, functionality and prognosis.
A total of 93 patients, the majority with oral cancer, were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction.
Multivariate regression analysis of complicated flap healing showed that only co-morbidities remained an explaining factor. Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. Pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis.
Acknowledgement
Author:
R. MAHIEU, G. COLLETTI, P. BONOMO, G. PARRINELLO, A. IAVARONE, G. DOLIVET, L. LIVI, A. DEGANELLO
Journal:
Acta Otorhinolaryngol Ital 2016;36:459-468
Publisher:
Azienda Ospedaliero-Universitaria Careggi
| 3 | | R450.00 | |
| | The effect of group exercise frequency on health-related quality of life in institutionalised elderly. | The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
Overview
The study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. One hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. A quasi-experimental design was used to compare the effect of a 12 week group exercise programme on two groups of participants using pre-test and post-test procedures.
Mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week. The exercise intervention at a frequency 3X/ week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of 2X/week. Additional benefits in vitality were achieved by exercising 3X/week. This may assist the elderly in preserving their independence.
Further targeted longitudinal intervention based studies are required to investigate the impact of intensity, frequency, duration and type of physical activity that is required to obtain mental and physical health benefits.
Acknowledgement
Author Nivash Rugbeer, Serela Ramklass, Andrew Mckune, Johan van Heerden
Journal
Pan African Medical Journal
Publisher
Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/pdf/PAMJ-26-35.pdf
| 3 | | R400.00 | |
| | Effectiveness of Electro-stimulation as a Treatment for Bell’s Palsy: An Update Review. | Effectiveness of Electro-stimulation as a Treatment for Bell’s Palsy: An Update Review.
Effectiveness of Electro-stimulation as a Treatment for Bell’s Palsy: An Update Review.
Overview
Idiopathic peripheral facial paralysis or Bell’s palsy is the most frequent cause of facial paralysis. The treatment of this condition includes pharmacological and physiotherapeutic approaches, but it is important to start treatment within 72 hours of the appearance of symptoms. Studies have showed low or no positive results for the treatment of Bell’s palsy with electro-stimulation. This review was done to search for evidence that supports electro-stimulation as a treatment option.
An update (2000-2014) review of randomized and controlled clinical trials was done. Five studies met the inclusion criteria and they were examined and compared in this review. According to the searched literature there is insufficient evidence to support electrotherapy effectiveness when applied as a monotherapy, nor when combined with other procedures to treat Bell’s palsy.
Electro-stimulation is still used as treatment and since there are few controlled studies that show a minimal usefulness of ES for treating Bell’s palsy, more controlled studies with scientific strictness on this topic are needed.
Acknowledgement
AUTHORS:
Ramos-Jimenez Arnulfo
Jose Manuel Garcia-Rivera
Rosa Patricia Hernandez-Torres
Erik Holguin
Rafael Villalobos-Molina JOURNAL: Journal of Novel Physiotherapies PUBLISHERS: OMICS International URL: https://www.omicsonline.org/open-access/effectiveness-of-electrostimulation-as-a-treatment-for-bells-palsy-an-updatereview-2165-7025-1000260.pdf | 3 | | R380.00 | |
| | Medical Tourism. | Medical Tourism.
Overview
BACKGROUND: Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment.
OBJECTIVE:
This article provides an outline of the current research around medical tourism, especially its impact on Australians.
DISCUSSION:
Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad
Acknowledgement
Author:
Leggat P
Journal:
Australian family physician.
Publisher:
Focus Environmental
| 3 | | R360.00 | |
| | Suicide in Pretoria: A retrospective review, 2007 - 2010. | Suicide in Pretoria: A retrospective review, 2007 - 2010.
Suicide in Pretoria: A retrospective review, 2007 - 2010.
Overview
Background: The World Health Organization has declared suicide a global ealth crisis, predicting that ~1.53 million people will commit suicide annually by 2020.
Obejective:
A study from South Africa reviewed 1 018 suicide cases in Pretoria over 4 years (1997 - 2000). Our study was undertaken to establish whether there have been substantial changes in the profile of suicide victims who died in Pretoria a decade later.
Methods:
Case records at the Pretoria Medico-Legal Laboratory were reviewed retrospectively from 2007 to 2010.
Results:
A total of 957 suicide cases were identified. Hanging was the most common method of suicide, followed by self-inflicted firearm injury. The true incidence of suicidal intake of prescription drugs/medication was difficult to determine, because of a backlog at the state toxicology laboratories. White males and females appeared to be over-represented among suicide victims, but there has been an increase in suicide among blacks. There seems to have been a substantial decrease in the use of firearms to commit suicide - possibly reflecting a positive outcome of gun control legislation that has been introduced in the interim.
Conclusion: Suicide continues to constitute almost 10% of all fatalities admitted to the Pretoria Medico-Legal Laboratory, confirming suicide as a major cause of mortality in our society. Further research is needed to clarify the profile of suicidal deaths, with a view to informing resource allocation and to improve preventive strategies
Acknowledgement
Author:
Engelbrecht C, Blumenthal R, Morris NK, Saayman G
Journal:
South African medical journal.
Publisher:
SAMJ Research
http://www.samj.org.za/index.php/samj/article/view/12015/8182
| 3 | | R410.00 | |
| | Ability in daily activities after early supported discharge models of stroke rehabilitation. | Ability in daily activities after early supported discharge models of stroke rehabilitation.
Ability in daily activities after early supported discharge models of stroke rehabilitation.
Overview
One of the major causes of disability in the Western world is stroke. There is also an assumption that the burden of stroke will rise in the long run because the population of elderly people is increasing fast. More so, there are currently better survivals after stroke. Thus, there is need for more knowledge about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL).
The objective of this study was therefore to compare three models of outpatient rehabilitation, namely; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. The method used for this research was a group comparison study that was designed within a randomized control trial.
Results from this research indicated that there were no significant group differences in pre–post changed ADL ability measured by the AMPS. It was also concluded that more research needs to be done to find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills.
ACKNOWLEDGEMENT
AUTHORS: Tina Taule, Liv Inger Strand, Jörg Assmus & Jan Sture Kouen
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHERS: Taylor & Francis Group
URL: http://dx.doi.org/10.3109/11038128.2015.1042403 Overview
One of the major causes of disability in the Western world is stroke. There is also an assumption that the burden of stroke will rise in the long run because the population of elderly people is increasing fast. More so, there are currently better survivals after stroke. Thus, there is need for more knowledge about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL).
The objective of this study was therefore to compare three models of outpatient rehabilitation, namely; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. The method used for this research was a group comparison study that was designed within a randomized control trial.
Results from this research indicated that there were no significant group differences in pre–post changed ADL ability measured by the AMPS. It was also concluded that more research needs to be done to find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills.
ACKNOWLEDGEMENT
AUTHORS: Tina Taule, Liv Inger Strand, Jörg Assmus & Jan Sture Kouen
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHERS: Taylor & Francis Group
URL: http://dx.doi.org/10.3109/11038128.2015.1042403
| 3 | | R420.00 | |
| | Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients, | Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients,
Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients,
Overview
Alcohol consumption has been clearly revealed by emergency department (ED) based studies to be risk factor to sustaining an injury. However, it remains unclear how acute alcohol consumption affects injury patterns to various body regions.
This study was therefore carried out to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). The data for this study was a cross sectional retrospective review of prehospital patient care reports (PCRs) that evaluated injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. More so, PCRs were reviewed independently by two abstractors to determine if the patient was documented to have acutely consumed alcohol proximate to his/her injury.
Results from the findings nevertheless revealed that alcohol users were more likely to present with injury secondary to assault, fall/trip, as well as an unknown mechanism of injury.
ACKNOWLEDGEMENT
AUTHORS: David J. Barton BS, Frank W. Tift MD, Lauren E. Cournoyer BS, Julie T. Vieth MBChB & Korin B. Hudson MD
JOURNAL: Prehospital Emergency Care
PUBLISHERS: Taylor & Francis online
URL: http://dx.doi.org/10.3109/10903127.2015.1076101 | 3 | | R350.00 | |
| | Body Psychotherapeutic Treatment for Anxiety Disorders. | Body Psychotherapeutic Treatment for Anxiety Disorders.
Body Psychotherapeutic Treatment for Anxiety Disorders.
Edited By: David Wilson
An introduction to the field of body psychotherapy, which aims to address anxiety by intervening at the bodily level rather than the traditional reliance on verbal talking cures. Modern attachment theory has accumulated a rich source of data based on decades of audio-visual recordings, documenting the genesis of our earliest non-verbal patterns of interpersonal relating. It is hoped that this introduction will pave the way for clinicians frustrated with the limits of the talking cure to undertake further exploration in both theory and techniques suggested by body psychotherapeutic traditions as an adjunct to their existing clinical repertoire. | 3 | | R400.00 | |
| | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease. | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Richard Casaburi, Ph.D., M.D., and Richard ZuWallack, M.D.
This online course discusses the successes and failures of a respiratory rehabilitation programme designed for an overweight, sedentary 61-year-old woman who has been diagnosed with chronic obstructive pulmonary disease.
| 3 | | R400.00 | |
| | Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder. | Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder.
Comparative assessment of onabotulinumtoxinA and mirabegron for overactive bladder.
OVERVIEW
There are indications that OAB and urinary incontinence (UI) are associated with recurrent urinary tract infection and skin breakdown, infection, and/or ulceration. More so, UI is also largely associated to social stigma and may subsequently result to loss of independence thereby reducing the patient's health related quality of life. Thus, the objective of this study was to evaluate the relative efficacy of mirabegron and onabotulinumtoxinA in patients with idiopathic OAB.
The design of this study was a network meta-analysis while data was obtained by searching through 9 electronic databases, review documents, guidelines and websites. The methods used in carrying out this study were randomized trials that aimed at comparing any licensed dose of onabotulinumtoxinA or mirabegron with each other.
Results from the trials indicated that patients in the onabotulinumtoxinA trials had more urinary incontinence and urgency episodes at baseline than patients in the mirabegron trials and these differences were adjusted for using NMR. The results further indicated that both onabotulinumtoxinA and mirabegron were more efficacious than placebo at reducing the frequency of urinary incontinence, urgency, urination and nocturia.
ACKNOWLEDGEMENT
AUTHORS: Nick Freemantle, David A Ginsberg, Rachael McCool, Kelly Fleetwood, Mick Arber, Kristin Khalaf, Clara Loveman, Quanhong Ni, Julie Glanville
JOURNAL: BMJ Open Journal
PUBLISHER: group.bmj.com
URL: http://bmjopen.bmj.com | 3 | | R355.00 | |
| | Comparison of Conventional Radiography and Digital Computerized Radiography in Patients in the Emergency Department | Comparison of Conventional Radiography and Digital Computerized Radiography in Patients in the Emergency Department
Comparison of Conventional Radiography and Digital Computerized Radiography in Patients in the Emergency Department
OVERVIEW
Digital radiography (Digital CR) has many advantages some of which include the manipulation of digital data at various stages between image acquisition as well as its final interpretation. Digital CR further has more multiple advantages to conventional radiography. With that said, the purpose of this study is to compare the differences between conventional radiography and digital computerized radiography (CR) in patients at the emergency department.
The study however focused on consecutive patients who needed chest radiology at the emergency department. In the course of the study, a quality score of the radiogram was assessed with visual analogue score (VAS-100 mm), measured in terms of millimeters. It is worth noting that the examination time, interpretation time, the total time, as well as cost of radiograms were equally calculated.
The results from the findings nevertheless revealed that there were significant differences between conventional radiography and digital CR groups in terms of location unit (Care Unit, Trauma, Resuscitation), hour of presentation, diagnosis group, examination time, interpretation time, and examination quality.
ACKNOWLEDGEMENT
AUTHORS: Enver ozcete, Bahar Boydak, Murat Ersel, Selahattin Kiyan, Ilhan Uz, Ozgur cevrim
JOURNAL: Emergency Medicine Association of Turkey
PUBLISHER: Kare Publishing
URL: http://www.kareyayincilik.com | 3 | | R475.00 | |
| | Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis. | Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis.
Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis.
OVERVIEW
Many studies have recognized that that individual foods or nutrients are not eaten in isolation, and there are potential synergistic effects of multiple components within the diet. Similarly, there are also indications that the Consumption of healthy dietary patterns has been associated with reduced risk of cardiovascular disease and metabolic syndrome.
Since dietary intervention greatly targets disease prevention, many studies have increasingly used biomarkers of underlying inflammation and metabolic syndrome progression to examine the diet-health relationship. Nonetheless, the extent to which biomarkers contribute to the body of evidence on healthy dietary patterns is unknown. This study thus, aimed at determining the effect of healthy dietary patterns on biomarkers associated with adiposity, insulin resistance, and inflammation in adults. Seventeen studies were obtained from Scopus, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials and used for this research.
The criteria used for inclusion were randomized controlled trials; effects of dietary patterns assessed on C-reactive protein (CRP), total adiponectin, high-molecular-weight adiponectin, tumour necrosis factor–a, adiponectin: leptin, resistin, or retinol binding protein. This research however found evidence for favourable effects of healthy dietary patterns on CRP, with limited evidence for other biomarkers.
ACKNOWLEDGEMENT
AUTHORS: E.P. Neale, M.J. Batterham, L.C. Tapsell
JOURNAL: Science Direct
PUBLISHER: Elsevier Inc
URL: https://www.elsevier.com
| 3 | | R89.00 | |
| | Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma. | Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.
Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.
OVERVIEW
Liver Cancer is the sixth most common type of cancer in the world. It is equally the second most common cause of cancer death in the world. However, prognostic assessment in patients with hepatocellular carcinoma (HCC) remains controversial. Thus, this study sort to develop and validate a new prognostic system for patients with HCC using the Italian Liver Cancer (ITA.LI.CA) database.
During this study, ITA.LI.CA stages were first of all defined using only tumor characteristics. A parametric multivariable survival model was then used to calculate the relative prognostic value of ITA.LI. However, The ITA.LI.CA integrated prognostic score showed optimal discrimination and calibration abilities in Italian patients. Findings from this study further revealed that observed as well as predicted median survival in the training and internal validation sets largely coincided.
The study equally concluded that the ITA.LI.CA prognostic system shows a strong ability to predict individual survival in European and Asian population.
ACKNOWLEDGEMENT
AUTHORS: Fabio Farinati1, Alessandro Vitale1, Gaya Spolverato, Timothy M. Pawlik, TehlaHuo Yun-Hsuan Lee, Anna Chiara Frigo, Anna Giacomin, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Rodolfo Sacco, Filomena Morisco, Elisabetta Biasini, Francesco Giuseppe Foschi, Antonio Gasbarrini, Gianluca Svegliati Baroni, Roberto Virdone, Alberto Masotto, Franco Trevisani, Umberto Cillo1, ITA.LI.CA study group
JOURNAL: PLOS Medicine
PUBLISHER: Public Library of Sciences (PLOS)
URL: https://www.plos.org | 3 | | R330.00 | |
| | Diagnosis and Management of Asthma in Children. | Diagnosis and Management of Asthma in Children.
Diagnosis and Management of Asthma in Children.
OVERVIEW
Asthma is a very common illness faced by children the world over. With that said, rather than escalating treatment in severe and problematic cases of childhood cancer, a more systematic approach is needed to find a solution to this problem. Elements of the systematic approach included a review of the diagnosis, adherence, the ability to take drugs correctly as well as the environment of the children in question.
The objective of this article was therefore to review other articles concerning the treatment and management of childhood asthma that should prompt a focused and urgent review of what trigger factors led to asthma attacks and whether the attacks were appropriately managed. Some of the articles that were reviewed during this research were obtained from PubMed and Cochrane database.
However, only articles related to the diagnosis and practical management of asthma were selected for this research. Also, small trials and case series were excluded if the findings had been subsumed into a meta-analysis or Cochrane review.
ACKNOWLEDGEMENT
AUTHORS: Andrew Bush, (paediatrics) and Louise Fleming (senior clinical lecturer)
JOURNAL: BMJ Journals
PUBLISHER: BMJ Open
URL: https://www.group.bmj.com
| 3 | | R400.00 | |
| | Ebola Virus Disease: Clinical Review. | Ebola Virus Disease: Clinical Review.
Ebola Virus Disease: Clinical Review.
Overview
Ebola transmission may occur as a result of close contact with body fluids of infected patients. The incubation period for Ebola after infection is said to be 5-9 days, with a range of 1-21 days in 95% or more of patients,2 3 with the patients not considered infectious until they develop symptoms.
This article is therefore a clinical review whose objective is to investigate what makes the differential diagnosis of Ebola broad. This article therefore examines the causes of the Ebola virus as we as the pathophysiology of this infection. This article equally went further to examine the infection prevention and control measures are used to curb the spread of Ebola from one country to another.
The hypothesis here was that there is high likelihood of infected people travelling, thus, all countries are expected to have tested and practiced protocols ready for screening and managing Ebola patients. Of course the article also outlined some of the clinical features as well as the symptoms of the virus.
ACKNOWLEDGEMENT
AUTHORS:
Nicholas J Beeching, Manuel Fenech, Catherine F Houlihan
JOURNAL:
BMJ Open
| 3 | | R400.00 | |
| | How Rheumatoid Arthritis Affects a Woman’s Sexual Well-Being. | How Rheumatoid Arthritis Affects a Woman’s Sexual Well-Being.
How Rheumatoid Arthritis Affects a Woman’s Sexual Well-Being.
Catriona Boffard, Sexologist (ECPS).
Rheumatoid arthritis (RA) is a chronic auto-immune disease, which primarily affects the joints in the body. This leads to inflammation of the joints and affects the body systemically. It can lead to progressive joint destruction and disability, due to persistent inflammation and is the most common form of polyarthritis. | 3 | | R400.00 | |
| | Important Common Eye Conditions: Cataracts. | Important Common Eye Conditions: Cataracts.
Important Common Eye Conditions: Cataracts.
Overview
There is a great need to be aware of common eye conditions and subsequently recognize them. Cataract is a popular eye condition that needs to be treated correctly to avoid complications. This paper therefore explores the various forms and symptoms of cataracts. It equally goes to explore the best possible ways to carry out cataract diagnosis. Of course, the paper also investigated the various treatments of cataract as well as the consequences in terms of associated illnesses.
It is also worth mentioning that this article equally highlights the important and need for eyes to be checked regularly against cataract. This article was written as a result of a respectable size survey in the USA which revealed that about 47% of the adults that were questioned worried more about losing their sight than losing their memory.
One of the major conclusions of this article is nonetheless the fact that there exist a great level of ignorance in very community that is not aware of the warning signs of eye diseases and conditions that could cause damage as well as blindness if not detected and treated in time.
ACKNOWLEDGEMENT
AUTHORS: Dr Cyril John Harrisberg
JOURNAL:
PUBLISHER:
URL:
| 3 | | R375.00 | |
| | Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month. | Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month.
Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month.
OVERVIEW
Shingles, or herpes zoster (HZ), is caused by reactivation, of varicella-zoster virus (VZV) from a latent infection in the dorsal root ganglion.
The purpose of this study was thus to examine the burden of comorbidity, polypharmacy and herpes zoster (HZ), an infectious disease, and its main complication post-herpetic neuralgia (PHN) in young (50–70 years of age: 70-) and old (=70 years of age: 70+) patients. This study took place in primary care in France from November 20, 2006 to September 12, 2008. For this study, 644 general practitioners (GPs) collected data from 1358 patients aged 50 years or more with acute eruptive HZ. Validated questionnaires were used to investigate HZ and PHN burden, pain, quality of life (QoL).
The results of this study indicated that older patients more frequently presented with comorbidities, frequently took analgesics and had poorer response on all questionnaires, indicating greater burden, at inclusion as compared with younger patients.
ACKNOWLEDGEMENT
AUTHORS: Gisèle Pickering et al.
JOURNAL: BMJ Open
PUBLISHER: BMJ Group
URL: http://www.bmjopen.bmj.com
| 3 | | R330.00 | |
| | Lumbar Spine: Taping for Pain Relief of Spinal Conditions. | Lumbar Spine: Taping for Pain Relief of Spinal Conditions.
Lumbar Spine: Taping for Pain Relief of Spinal Conditions.
OVERVIEW
Low back pain can be difficult to treat. Management of chronic low back pain and leg pain requires a multifactorial approach. This course will not only help you to identify the underlying causative factors of LBP, but will also provide you with techniques that will enable you to assist patients to increase their active control of the passively unstable and associated areas in a way that will minimise symptom re-occurrences. Add an important modality to your tool box.
Spinal pain, particularly nerve root pain, can be extremely disabling for a patient. Treatment usually alleviates symptoms but the treatment effect can be short lived with the symptoms often returning with a vengeance. Chronic symptoms may even be exacerbated with treatment, as long-term adaptive changes in the soft tissues can be difficult to alter. Equally, unravelling the cause of the pain can be a challenge for the clinician, the symptoms can be quite remote from the site of pain.
Additionally, there may be confounding problems of hyper/ hypomobility in the surrounding soft tissues making response to treatment less predictable. If clinicians can minimize treatment exacerbations and prolong treatment effectiveness then they can expedite a patient’s recovery from low back pain. | 3 | | R400.00 | |
| | Mindful Meditation: A Review of Core Research and Theories, and Implications for Clinical Psychotherapeutic Applications. | Mindful Meditation: A Review of Core Research and Theories, and Implications for Clinical Psychotherapeutic Applications.
Mindful Meditation: A Review of Core Research and Theories, and Implications for Clinical Psychotherapeutic Applications.
Edited By: David Wilson.
The present module investigates one of the most elegantly simple methods of intervention i.e. mindful or breath meditation. Mindful meditation (MM) is rooted in ancient Eastern techniques, but has become a very popular, almost faddish method, applied and practised free of any specific religious belief systems. It has been used to assist in the treatment of a vast array of concerns; from physical illnesses, to pain and stress modulation, through to depression, anxiety, panic disorders, addictions and even attention deficits.
This module includes an article discussing basic principles of mindful meditation in treating anxiety and depression. A podcast from the University of California, Los Angeles (UCLA) Mindfulness Awareness Research Centre (MARC) is attached in order to provide a sample of the most basic guided breath meditation. This is NOT compulsory, but the interested researcher is encouraged to explore the innumerable sites which offer free access to different audio-visual meditation experiences. | 3 | | R400.00 | |
| | Musculoskeletal Ultrasound: Focused Impact on MRI. | Musculoskeletal Ultrasound: Focused Impact on MRI.
Musculoskeletal Ultrasound: Focused Impact on MRI.
OVERVIEW
The objective of this article is to compare and contrast image interpretation, accuracy, observer variability, economic impact and education with regard to musculoskeletal ultrasound and MRI because these factors will influence the growth of musculoskeletal ultrasound and the impact on MRI.
The use of musculoskeletal ultrasound continues to grow and there are a numerous factors that impact MRI. The development of less expensive portable ultrasound machines has opened the market to non-radiologists and application for musculoskeletal ultrasound has broadened. Selective substitution of musculoskeletal ultrasound for MRI can result in significant cost saving to the health care system. Although this change could decrease the use of MRI, issues related to accuracy, variability, education, and competence must be addressed.
ACKNOWLEDGEMENTS:
AUTHOR: Jon A. Jacobson1
JOURNAL: American Journal of Roentgenology
PUBLISHER:ARRS
URL: https:/www.arrs.org
| 3 | | R400.00 | |
| | Orthopaedic Medicine General Principles Part 1. | Orthopaedic Medicine General Principles Part 1.
Orthopaedic Medicine General Principles Part 1.
Orthopaedic medicine is concerned with the diagnosis and treatment of soft-tissue lesions. These disorders effect a substantial proportion of all patients in general and family medicine; cases are additionally found in departments of orthopaedic surgery, rheumatology, neurology, and casualty and, in particular, physiotherapy and sports clinics. Soccer or later nearly everyone suffers some such complaint.
In broad terms, these disorders embrace conditions commonly called arthritis, rheumatism, fibrositis, neck ache, backache, lumbago, sprained back muscles, sacroiliac strain, sciatica, trapped nerve, pulled muscles, frozen shoulder, tennis elbow, strained wrist, repetitive strain injuries (RSI), sprained knee and ankle, aches, sprains, inflammation and sports injuries generally.
However, this broad nomenclature encompasses what is in reality a multitude of distinct and readily distinguishable conditions. Once accurately diagnosed they permit the formation of rapid and effective treatment, without which the pain and disability may persist unnecessarily for weeks, months or years.
Soft-tissue lesions are thus a common cause of unavoidable pain. | 3 | | R400.00 | |
| | Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint. | Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint.
Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint.
OVERVIEW
At last! ….. An easy to understand insight into the applied biomechanics of the patella. Along with discussions of various exercise and treatment modalities make this online course immediately applicable in your clinical practice
Some authors believe that the patella is not very important in extensor mechanism mechanics (1) and therefore readily recommended patellectomy. Others, on the contrary, attribute to the patella a more prominent role2,3 recommending its preservation whenever possible. The patella acts as a guide for the quadriceps tendon in centralizing the divergent input from the four muscles of the quadriceps, transmitting these forces to the patellar tendon.
Finally, the patella plays a role in the aesthetic appearance of the knee. This can be appreciated in the patellectomized knee in which the flattened ends of the condyles are easily visible with the knee flexed. Of all these functions, the most important role of the patella is in extension of the knee. Patellectomy results in weakened extension of the knee or even incomplete knee extension. | 3 | | R400.00 | |
| | Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain. | Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain.
Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain.
OVERVIEW
This article offers you clinical tips for selection of taping techniques for knee pain based on the author’s clinical experience using the McConnell method. Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapists and orthopedic surgeons (Fulkerson & Hungerford 1990). Despite its prevalence, the etiology, pathogenesis, and recommended treatment remain unclear (Insall et al 1976).
The success rate of treatment regimens for this condition has been very poor and in the long-term, the condition frequently recurs (McConnell 1996). In the past, the only available options were surgery or curtailing physical activity.
Jenny McConnell, an internationally renowned physiotherapist, has developed an easy, painless, safe and inexpensive alternative (McConnell 1986). The treatment involves a unique method of taping the painful knee to realign the patella within the femoral trochlea. Once the patient is pain free, specific quadriceps and pelvic motor control training is under-taken. This is accompanied by stretching of tight muscles and correction of the lower limb and foot position. Read further to see the success of various selections of taping
| 3 | | R400.00 | |
| | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
OVERVIEW
Hospital admission for chronic obstructive pulmonary disease (COPD) is a significant burden on healthcare resources. The readmission rates are equally high. As a matter of fact, COPD is the second most common reason for emergency hospital admission in the UK.
The objective of this study was to investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The design of this study was a retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. The setting of this study was primary care in Lothian Scotland. Participants of this study were from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. The patients were however followed up until 2010, death or they left a participating practice.
Based on the results of this study, it was concluded that several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission.
ACKNOWLEDGEMENT
AUTHOR: L C Hunter, R J Lee, Butcher, C J Weir, C M Fischbacher, D McAllister, S H Wild, N Hewitt, R M Hardie
JOURNAL: Respiratory Medicine
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com
| 3 | | R355.00 | |
| | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care. | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
OVERVIEW
Most often, majority of patients presenting to primary care with a suspected lower respiratory tract infection (LRTI) are prescribed antibiotics. That doesn’t however change the fact that most respiratory tract infections are viral and only marginal benefit is achieved from the prescription of antibiotics that in some cases does not outweigh the risk of harm.
The aim of this research was thus to determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. This study was however done following a qualitative methodology based on grounded theory. This study was however undertaken in two stages. The first consisted of semi structured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. The second stage on the other hand was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios.
The study concluded that Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services.
ACKNOWLEDGEMENT
AUTHOR: Jeremy R Huddy, Melody Z Ni, James Barlow, Azeem Majeed, George B Hanna
JOURNAL: Journal of Clinical Pathology
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com/ | 3 | | R355.00 | |
| | Pornography Addiction in the Context of the Concepts of Supranormal Stimuli and Neuroplasticity. | Pornography Addiction in the Context of the Concepts of Supranormal Stimuli and Neuroplasticity.
Pornography Addiction in the Context of the Concepts of Supranormal Stimuli and Neuroplasticity.
Edited By: David Wilson.
Addiction has been a divisive term when applied to various compulsive sexual behaviours (CSBs), including obsessive use of pornography. Despite a growing acceptance of the existence of natural or process addictions based on an increased understanding of the function of the mesolimbic dopaminergic reward systems, there has been a reticence to label CSBs as potentially addictive. While pathological gambling (PG) and obesity have received greater attention in functional and behavioural studies, evidence increasingly supports the description of CSBs as an addiction. | 3 | | R380.00 | |
| | Practice Issues. | Practice Issues.
OVERVIEW
It is important to note that the responses to the various questions are the views independently expressed and are not necessarily opinions shared by cpdexpress.co.za. As matters involving Ethics and the law are subject to interpretation, the responses cannot, in any way, be regarded as binding or necessarily endorsed by the regulatory authorities.
There are ethical dilemmas regarding patients, colleagues and associates that one doesn’t even consider until they become issues in their practice. There are many questions to be asked regarding ethics, touting, canvassing, advertising, competition and many other issues that need to be addressed and this article addresses most of them. | 3 | | R450.00 | |
| | Private Practice: The Do's And Don'ts. | Private Practice: The Do's And Don'ts.
Private Practice: The Do's And Don'ts.
OVERVIEW
You have studied extensively to become a healthcare professional in your field of study. You have learned and become adept at identifying a vast range of conditions. You can diagnose and effectively treat those conditions within the scope of the discipline.
Now you are faced with a plethora of dilemmas. What is fair value for your services? What appliances are appropriate and reasonable? What commercial and legal structures are appropriate for you? What influence may these commercial and legal structures have on your clinical recommendations? Who may have access to your record cards? What responsibility can you delegate to your staff? Who carries final responsibility for payment of your claims – member or medical aid? What constitutes anti-competitive behavior?
This is a very informative article that will help you to run your practice within the various guidelines. | 3 | | R400.00 | |
| | Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male. | Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male.
Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male.
OVERVIEW
Cannabis, which is produced from leaves of plants called Cannabis sativa is mostly used by youths in most parts of the world, Europe inclusive. However, there are believes that cannabis is a relatively benign substance, just like alcohol and tobacco as compared to the adverse effects that heroin, ecstasy, and cocaine are associated with.
Although it is pleasure inducing, C. sativa has also some side effects in various organ systems, particularly the cardiovascular system. Sometimes, it may even threaten life. This paper is basically a case report of a 26-year-oldmale patient presenting to emergency department with acute coronary syndrome and acute renal failure. It is worth mentioning that this patient had used various forms of cannabis for a long time and had a number cardiovascular risk factors. In this article, the mechanism of action of cannabis was also discussed and analysed.
The study was concluded that coronary heart disease, acute coronary syndrome, and acute renal failure as a complication of cannabis use are likely to increase in the future.
ACKNOWLEDGEMENT
AUTHORS: Turgut Karabag, Burcu Ozturk, Seda Guven, Nurettin Coskun, Erkan Ilhan, Nihan Turhan Caglar
JOURNAL: International Journal of the Cardiovascular Academy
PUBLISHER: Elsevier Inc
URL: https://www.elsevier.com
| 3 | | R350.00 | |
| | Rewarding yet demanding: client perspectives on enabling occupations during early stages of recovery from Schizophrenia. | Rewarding yet demanding: client perspectives on enabling occupations during early stages of recovery from Schizophrenia.
Rewarding yet demanding: client perspectives on enabling occupations during early stages of recovery from Schizophrenia.
OVERVIEW
Schizophrenia is known to be a severe mental illness that is characterized by psychotic symptoms, negative symptoms such as apathy and anhedonia, as well as impaired cognitive functioning. Schizophrenia can also result to significant risk of impaired functioning in areas such as self-care, independent living skills, social relationships, work, and going to school.
The aim of this study was therefore to seek a better understanding of how people with schizophrenia experience an occupational therapy intervention designed to enable them to carry out meaningful occupations in the early phases of recovery. The methodology of this research was a qualitative design that comprised of an eight-week client-centred occupational therapy intervention with semi-structured interviews of five of the six clients out of 10 who completed the intervention. It is imperative to acknowledge that Braun and Clark’s thematic analysis was applied to the transcripts.
Results from this study indicated that participants valued engaging in real-life occupations while anchoring new strategies.
ACKNOWLEDGEMENT
AUTHORS: S.T.B. Bjørkedal, A.M.B. Torsting and T. Møller
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHER: Taylor and Francis
URL: http://www.tandfonline.com | 3 | | R360.00 | |
| | Running Mechanics and Gate Analysis: Common Overuse Injuries in Running. | Running Mechanics and Gate Analysis: Common Overuse Injuries in Running.
Running Mechanics and Gate Analysis: Common Overuse Injuries in Running.
OVERVIEW
Running is a hugely popular activity – but many runners overdo it, suffer injuries as a result and then turn to us as physiotherapists to sort them out – as quickly as possible. This course will help you learn about the common risk factors for running overuse and how to prevent them. Also described in this course are the most common running-related injuries which include patellofemoral pain and iliotibial band syndromes and their biomechanics and prevention.
Although runners occasionally sustain acute injuries such as ankle sprains and muscle strains, the majority of running injuries can be classified as cumulative micro trauma (overuse) injuries. Running is one the most popular activities, and overuse injuries of the lower extremity occur regularly. There is no agreed-on or standardized definition of an overuse running injury, but several authors have defined it as a musculoskeletal ailment attributed to running that causes a restriction of running speed, distance, duration, or frequency for at least 1 week.
The runners in these studies vary considerably in their running experience and training habits – read further to discover about running mechanics.
| 3 | | R400.00 | |
| | Sexual Addiction: A Psychological Controversy in the Content of Current Neurobiology and Social Technological Factors. | Sexual Addiction: A Psychological Controversy in the Content of Current Neurobiology and Social Technological Factors.
Sexual Addiction: A Psychological Controversy in the Content of Current Neurobiology and Social Technological Factors.
OVERVIEW
Sexual motivation is a fundamental behaviour in human. For a long time, this behaviour has been somehow ignored from psychological and neuroscientific research. In this article – reflecting the collaboration of a clinical psychologist and a neuroscientist – we show that in the current period, sexual affiliation is one of the most promising affiliation context to articulate a debate, a dialog and convergence points between psychoanalysis and neuroscience. Recent data on healthy sexual behaviour and its compulsive variant are discussed under the prism of neuroscience and psychoanalysis.
An introduction to the integration of modern psychoanalytic findings regarding the existence of the notion of sexual addiction with details of typical core personality traits and defenses and attempts to correlate psychic phenomena with numerous neurobiological explorations. The editor stresses the questions arising from our unique social context in which digital pornographic exposure has become pervasive. | 3 | | R400.00 | |
| | Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries. | Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries.
Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries.
OVERVIEW
For many years the prescription of NSAIDs for all kinds of sport injuries (soft tissue injuries, tendon injuries and bone fractures) has been a staple of sports medicine. NSAIDs have well established analgesic effects, but also have proven side effects. Despite the risks, the medical community has considered the safety/efficiency ratio satisfactory enough to accept the administration of NSAIDs. But does this conventional wisdom still hold true?
This course looks at recent research around NSAIDs – some of which has produced surprising results. This information is important to every medical professional who frequently prescribes or recommends NSAIDs to deal with sports injuries. | 3 | | R400.00 | |
| | Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach. | Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach.
Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach.
OVERVIEW
Bree is a 27-year–old single female working in a law firm presenting with anterior left hip (groin) pain. She has a very busy lifestyle outside work, mainly occupied with training for and playing her primary sport of field hockey. She currently plays as a goalie in club, national and international field hockey which involves up to six training sessions per week, along with playing games and attending gym training sessions.
Bree’s main symptom was localised left anterior hip pain which did not extend further afield. She described this pain (pain A) as sharp and which, on a numerical rating scale, reached 7/10 at its worst. She also reported a second pain (pain B) which was a residual dull ache associated with a ‘weak’ feeling that lingered after undertaking aggravating activities. The symptoms are outlined on the body chart (Figure 1). Pain A was aggravated by general use of the hip and leg, including activities such as running and stair climbing, but also by end range hip movements, such as squatting and lunging.
Pain B was aggravated by prolonged sitting. Bree commented that she felt better in the mornings and did not complain of any symptoms of pins and needles, clicking or catching in the hip. There were no issues with her hip related to work.
Take this online course and learn about Bree’s treatment and the outcomes thereof.
| 3 | | R400.00 | |
| | Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation. | Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation.
Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation.
Dr Eyal Lederman DO, PhD.
Recovery of range of movement (ROM) can be effected by pain, swelling, protective motor response and movement – related anxiety.
The recovery process following loss of range of motion, injury or surgery is associated with three processes:
- Repair,
- Adaptation,
- Modulation of symptoms.
The success of rehabilitation depends on skilfully addressing these intrinsic mechanism.
| 3 | | R400.00 | |
| | Synergies, tensions and challenges in HIV Prevention, treatment and cure research. | Synergies, tensions and challenges in HIV Prevention, treatment and cure research.
Synergies, tensions and challenges in HIV Prevention, treatment and cure research.
OVERVIEW
The ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. Because HIV cure research is relatively new to the region, significant ethical and social challenges are anticipated.
In-depth interviews were conducted on a purposive sample of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured.
Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging.
It was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure.
ACKNOWLEDGEMENT
AUTHORS: Keymanthri Moodley, Theresa Rossouw, Ciara Staunton and Christopher J. Colvin
JOURNAL: BMC Medical Ethics
PUBLISHER: Biomed Central
https://www.biomedcentral.com/
| 3 | | R89.00 | |
| | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE. | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
OVERVIEW
Venous thromboembolism (VTE) is a chronic condition with estimated incidence at 1 per 1000 person years. In fact, it is the third most common cardiovascular disease after heart attack.
This condition often presents as deep vein thrombosis (DVT), with some patients suffering an embolism in the lungs known as a pulmonary embolism. Therefore, the objective of this study was to review studies developing or validating a prognostic model for individual venous thromboembolism (VTE) recurrence risk following cessation of therapy for a first unprovoked VTE0. This review basically aims at determining whether reliable prognostic models exist and, if not, what further research is needed within the field.
For this study, bibliographic databases including MEDLINE, EMBASE and the Cochrane Library were searched using index terms relating to the clinical field and prognosis.by the end of the study, 3 unique prognostic models were identified including the HERDOO2 score, Vienna prediction model and DASH score.
ACKNOWLEDGEMENT
AUTHORS: Joie Ensor, Richard D Riley, David Moore, Kym E Snell, Susan Bayliss, David Fitzmaurice
JOURNAL: BMJ Open
PUBLISHER: BMJ Gourp
URL: http://bmjopen.bmj.com | 3 | | R325.00 | |
| | The Development of the Concept of Psychic Skin and Envelopes in Psychoanalytic Theories of Infancy. | The Development of the Concept of Psychic Skin and Envelopes in Psychoanalytic Theories of Infancy.
The Development of the Concept of Psychic Skin and Envelopes in Psychoanalytic Theories of Infancy.
OVERVIEW
This paper aims to review the topic of psychic envelopes and to sketch the main outlines of this concept in infancy. We first explore the origins of the concept in Freud's “protective shield” and then its development in adult psychoanalysis before going on to see how this fits in infancy with post-Bionian psychoanalysis and development. Four central notions guide this review:
Freud's “protective shield” describes a barrier to protect the psychic apparatus against potentially overflowing trauma. Anzieu's “Skin-Ego” is defined by the different senses of the body. Bick's “psychic skin” establishes the concept in relation to infancy. Stern's “narrative envelope” derives from the intersection between psychoanalysis and neuroscience.
Although it has received relatively little attention elsewhere, the concept of psychic envelopes is being used in psychoanalysis in France. The aim of the present article is to undertake a broad investigative review of this concept, and to specify its main characteristics, particularly as applied in understanding infant development. To facilitate this, we will focus on four notions in which the concept is rooted: the protective shield (Freud), the SkinEgo (Anzieu), the psychic skin (Bick) and the narrative envelope (Stern) | 3 | | R400.00 | |
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