Background:  All newly qualified doctors will look after patients in the last stages of life. Context:  This article is a review of the literature regarding medical students learning from hospice patients, focusing on practical concerns of relevance to those involved in organising or conducting medical student teaching. Innovation:  Medical students ...

Objective. To define the extent of an outbreak of Achromobacter xylosoxidans bacteremia, determine the source of the outbreak, and implement control measures. Design. An outbreak investigation, including environmental and infection control assessment, and evaluation of hypotheses using the binomial distribution and case control studies. Setting. A 50-bed medical surgical unit in a hospital ...

Dynamic MRIs showing changes over time in 2 patients with progressive cerebellar tonsillar ectopia who have a disorder of brain overgrowth. See article by Mirzaa et al. in this issue.

BACKGROUND: While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs. METHODS: We developed the ACUTE Center at Denver Health Medical Center to medically ...

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This ...

Oral anticoagulation used to be synonymous with warfarin until the recent approval of oral direct thrombin inhibitors and factor Xa inhibitors in United States and other countries across the world. Thrombosis prevention and treatment continue to be the main objective and goal for surgical and medical patients. Regulatory agencies continue ...

BACKGROUND Clinical teratology studies often rely on patient reports of medication use in pregnancy with or without other sources of information. Electronic medical records (EMRs), administrative databases, pharmacy dispensing records, drug registries, and patients' self-reports are all widely used sources of information to assess potential teratogenic effect of medications. The ...

BACKGROUND: Alzheimer's disease and related disorders (ADRD) are prevalent in older adults, increase the costs of chronic heart failure (CHF) management, and may be associated with undertreatment of cardiovascular disease. OBJECTIVE: The purpose of our study was to determine the relationship between comorbid ADRD and CHF medication use and adherence ...

Background: Autopsy is an important educational and quality-control tool in the intensive care unit (ICU), but rates of traditional medical autopsies have declined worldwide. "Virtual" autopsy involving only advanced radiographic techniques might provide an alternative approach to postmortem examinations. Objective: To assess the value of postmortem multidetector computed tomography as ...

Disorders of the scalp often result in severe cosmetic interference with quality of life, creating the need for optimal medical surveillance. We tested the latest generation of ultrasound machines in patients with scalp pathology and prepared a cross-sectional library encompassing a wide assortment of conditions. Normative data on the sonographic ...

To determine current and projected supply, demand and shortfall of medical oncologists (MOs) and the Australian chemotherapy utilisation rate. A 2009 cross-sectional observational study of Australian adult medical oncology practice work patterns. Electronic or paper self-administered questionnaire. The 2009 and projected (2014) supply, demand and shortfall of full-time equivalent (FTE) MOs, and ...

studies have shown that these medication can themselves lead to adverse patient outcomes. Interventions that facilitate a total dose reduction in analgesic and sedative medications e.g. the use of nurse controlled protocol guided sedation, the combination of spontaneous awakening and breathing trials, and the use of short acting medications, are ...

The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS) trial, a randomized clinical trial comparing aggressive medical management to stenting with aggressive medical management for symptomatic intracranial stenosis, was prematurely halted when a high rate of periprocedural events was found in the stent arm. The ...

BACKGROUND: Uncertainty exists regarding the management of antithrombotic medications in ischemic stroke and transient ischemic attack (TIA) patients around the time of colonoscopy. We sought to evaluate whether there was a difference in adverse events among patients who continued medications and those who had temporary discontinuation. METHODS: Using a hospital ...

BACKGROUND: Infection is a major complication associated with the use of central venous catheters. Guidelines for medical management of catheter-related bacteraemia have been published, but no study has assessed the appropriateness of physician practices. AIM: To assess medical practices in cases of central venous catheter-related bacteraemia (CRB) in a university ...

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System ...

This issue provides a clinical overview of plantar fasciitis focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this ...

Purpose: The purpose of this study was to compare prescriber monitoring for safety and efficacy of medication classes used to treat benign prostatic hyperplasia (BPH). Methods: This was a retrospective chart review of patients diagnosed with BPH who were prescribed medications within a family medicine clinic between January 2008 and ...

Abstract Background. Preventable harm from medical care has been extensively documented in the inpatient setting. Emergency medical services (EMS) providers care for patients in dynamic and challenging environments; prehospital emergency care is a field that represents an area of high risk for errors and harm, but has received relatively little ...

Hepatobiliary scintigraphy with sincalide stimulation is a commonly performed examination to evaluate gall bladder function. The importance of fasting and the possible interference by opioids are well-known considerations in the preparation of patients for this study. We present another medication, dicyclomine, that may interfere with the validity of the results. ...

At present, the College of American Pathologists checklist requires documentation of communication of critical values in anatomic pathology to caregivers. Recently, our institution has begun using the electronic medical record to document the lack of imminent danger or emergency associated with the case rather than calling the caregiver. I sought ...

Anemia is a worldwide health problem that manifests in different types. This illness has some causes, which affect body health generally. Studies have shown that some anemia types make humans more sensitive to infections.A 23-year-old woman was referred to our clinic with complaints about tooth mobility. Generalized severe alveolar bone ...

Poor adherence to psychotropic medication is a significant issue for patients with bipolar disorder. The effectiveness of medication treatment is limited by high rates of medication non-adherence among this population. Motivational Interviewing is an evidence-based intervention that has been efficacious in promoting behavioral health regimens and treatment recommendations, including medication ...

The aim of this study was to adapt the Zarit Burden Interview (ZBI) to family caregivers of inpatients in medical and surgical clinics to assess the validity and reliability of the Turkish version. The study design was descriptive and methodological. A total of 223 family caregivers providing care to patients ...

A substantial threat to the overall health of the American public is nonadherence to medications used to treat diabetes, as well as physicians' failure to initiate patients' use of those medications. To address this problem, we evaluated an integrated, pharmacy-based program to improve patients' adherence and physicians' initiation rates. The ...

Disclaimer: ACMG standards and guidelines are designed primarily as an educational resource for medical geneticists and other health care providers to help them provide quality medical genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical outcome. These standards and guidelines should not be considered ...

Objective: Playing-related musculoskeletal disorders (PRMD) are common among musicians. Acupuncture is well established in Germany as a treatment for orthopedic conditions, but it is not commonly used in the treatment of PRMD yet. The authors examined the musicians' health literature and provide a brief overview about the background of acupuncture. ...

Objectives: To describe the types and causes of medication discrepancies in the electronic medical record identified by pharmacist medication reconciliation during outpatient medical visits and to identify patient characteristics associated with the presence of discrepancies.Design: Observational case series study.Setting: Indigent primary care clinic in Pittsburgh, PA, from April 2009 to ...

Objective To assess the feasibility of a medically supervised, publicly funded interdisciplinary program for obesity management in a Canadian setting. Design Retrospective chart audit using electronic medical records. Setting Wharton Medical Clinic in Hamilton and Burlington, Ont. Participants A total of 2739 consenting patients attending the interdisciplinary obesity-management program at ...

Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for "patient-centered" care has led to relabeling of this problem from "noncompliance" to "nonadherence" and later to a rhetoric of "concordance" and "shared decision making" in which physicians ...

Background  Medication errors frequently occur when patients are transferred between health care settings. The main objective of this study was to investigate the frequency, type and severity of prescribing and transcribing errors for drugs dispensed in multidose plastic packs when patients are discharged from the hospital. The secondary objective was ...

Abstract Conclusions: This study suggests that adjuvant anti-anxiety medication may be helpful for patients with benign paroxysmal positional vertigo (BPPV) even after a successful canalith repositioning procedure (CRP). Objective: Although the CRP is an effective treatment for BPPV, many patients suffer from persistent dizziness despite successful CRPs. The aim of ...

The purpose of this study was to generate national estimates of the prevalence of medically unnecessary emergency medical services (EMS) transports to emergency departments (EDs) over time and to identify characteristics that may be associated with medically unnecessary transports. A previously published algorithm was applied to operationalize medical necessity based ...

This study analyzed registered nurse workarounds in an academic medical center using bar code medication administration technology. Nurse focus groups and a survey were used to determine the frequency and potential causes of workarounds. More than half of the nurses surveyed indicated that they administered medications without scanning the patient ...

Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology ...

A 26-year-old male patient with sudden-onset paraplegia was presented. Clinical and imaging evaluation revealed isolated spinal cord lesions at thoracal levels and anterior spinal arterial involvement. Diagnosis of Behcet's disease was established with associating clinical findings with medical history. Vigorous medication and rehabilitation program were performed. Through the 1-year rehabilitation ...

A review of all medication incidents reported to the National Reporting and Learning System (NRLS) in England in Wales between 1(st) January 2005 and 31(st) December 2010 was undertaken. The 526,186 medication incident reports represented 9.68% of all patient safety incidents. Medication Incidents from acute general hospitals (394,951) represented 75% ...

BACKGROUND: Medication errors are considered to be a significant cause of morbidity and mortality. For each patient, emergency departments (EDs) are expected to compile a list of medications, reconcile them, and pass them along to the next provider. The electronic medical record provides a method to automatically capture and propagate ...

ABSTRACT: There is a manifest lack of psychometrically sound instruments designed for specific and multidimensional assessment of satisfaction with methadone as a medication within the context of methadone maintenance treatment. Therefore, it may be worthwhile to assess the pertinence and utility of using a generic and multidimensional medication satisfaction instrument ...

OBJECTIVES: To describe disaster preparedness among chronically ill patients and to examine how differences in health, functional, and disability conditions are associated with disaster preparedness, focusing on rheumatoid arthritis (RA) patients with various functional and disability levels. METHODS: In 2007, 1,477 members of a nationwide RA patient group in Japan ...

OBJECTIVES: The objective of the study was to evaluate the impact of adding a clinical pharmacist within a pediatric emergency department (ED) on medication omissions and delays, as well as medication errors on patients with prolonged ED stays of 8 hours or greater. METHODS: This is a retrospective review of ...

Background:When scheduling clinic appointments, scheduling patients expected to have different visit durations for different minutes of time reduces patient waiting time and staff idle time. Maintaining an active medication list is an important (and, in the United States, required) component to the meaningful use of electronic medical records. We hypothesized ...

Background  Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population. Aim  To characterise CAM utilisation and assess its impact on medical adherence in the IBD population. Methods  Inflammatory bowel disease ...

Background: Common practice in patients overusing medication is to place major emphasis on detoxification.Overview: This is based on decades of disappointing experience trying to treat patients with prophylactics despite medication overuse. Several trials have shown that, when patients are taken off medication overuse, approximately 50% of them get so much ...

ABSTRACT: BACKGROUND: Venous thromboembolism prophylaxis has been shown to safely and cost-effectively reduce the incidence of thromboembolic events in medical inpatients. However, there is a gap between evidence and medical practice. The aim of this study was evaluate the appropriateness of prescribing venous thromboembolism prophylaxis in accordance with local recommendations ...

Fibromyalgia is a common and disabling disease, and treatment can be challenging. More recently, pregabalin has been approved to treat pain associated with fibromyalgia. However, it can have serious neuropsychiatric sequelae. Several case reports have documented delirium secondary to pregabalin, usually in older patients with multiple medical comorbidities and concurrent ...

Emergency department (ED) staff comments frequently about how patients are poorly prepared to answer important medical questions. To determine if the impression that patients were or were not prepared, a total of 309 patients were all asked a series of important medical questions and were graded as positive (or prepared) ...

OBJECTIVES:: The aim of this study was to evaluate the effectiveness of prophylactic treatment with laxatives and antiemetics on the incidence of gastrointestinal adverse reactions such as constipation, nausea and vomiting in cancer patients who received oral opioid analgesics for the first time. METHODS:: A multi-institutional retrospective study was carried ...

ObjectiveTo assess the relationship among Type D personality, self-efficacy, and medication adherence in patients with coronary heart disease.MethodsThe study design was prospective and observational. Type D personality, self-efficacy for illness management behaviors, and medication adherence were measured 3 weeks after hospitalization for acute coronary syndrome in 165 patients (mean [standard ...

This issue provides a clinical overview of hip fracture focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this ...