A recent U.S. survey demonstrated wide variation in the management of syphilis. 25/31 (73.5%) Consultants and Specialist Registrars in Infectious Diseases and Genitourinary Medicine, in Ireland were surveyed. 23 (92%) treat more than 50 HIV patients a year, 18 (72%) had been consulted on a patient with syphilis in the ...

BACKGROUND: The present study describes the development of evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer using a wiki platform to enable wide international stakeholder consultation and maintain currency. METHODS: A dietitian steering committee and a multidisciplinary steering committee were established for consultation. ...

Setting up a medical practice is daunting. Physicians who make the decision to strike out on their own have to come up with the money to fund their businesses, find an office space, vet and hire capable staff, purchase the necessary technology and equipment, and devote time and resources to ...

The veterinary profession recently acknowledged its responsibility to provide behaviour support, following criticism for focussing on the physiological aspects of welfare and overlooking the psychological. To further understand the practising of behavioural medicine, a 'fly-on-the-wall' approach was used to investigate welfare discussions during dog booster vaccinations. Seventeen consultations involving six ...

Practitioners in transfusion medicine, long involved in consultations emphasizing clinical issues such as alloantibody reporting and transfusion reaction evaluation, have more recently been engaged as experts and consultants in hemostasis and coagulation. Given the growing complexity in laboratory coagulation testing and its interpretation, the shortage of specialists in this arena, ...

Purpose:To describe the role that an emergency medicine (EM) clinical pharmacist has on the management of patients presenting to the emergency department (ED) with sepsis, severe sepsis, or septic shock.Methods:The clinical consultations documented by the EM pharmacists at an academic, teaching hospital over a 2-year period were retrospectively reviewed.Results:During the ...

Malaria is among the most significant travel-related infections encountered by travellers to endemic countries in terms of morbidity and mortality. The aim of this study is to assess the knowledge and practices about malaria prophylaxis of travel medicine consultants in Greece. A standardized questionnaire was sent to travel medicine consultants ...

BACKGROUND: Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution. AIMS: To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellencebased chronic obstructive pulmonary ...

Background: Some specialties in the UK use structured templates in electronic (e) Portfolios to encourage reflective practice. This study looked at completion of an 11-field template by UK Paediatric specialty trainees. Methods: A reflective ePortfolio log from all Paediatric specialty trainees in one large UK deanery was assessed by two ...

In May 2011, the European Medicines Agency (EMA) released for public consultation a draft guideline on the pharmaceutical development of medicines for paediatric use. Prescrire made 20 constructive proposals. Background information can be found at english.prescrire.org.

Jung's work is fundamentally an experience, not an idea. From this perspective, I attempt to bridge conference, consulting room and living psyche by considering the influence of the 'Red Book' on clinical practice through the subtle and imaginal. Jung's journey as a man broadens out to have relevance for women. ...

BACKGROUND: Issues in the management of the occipito posterior (OP) position have been the subject of clinical controversy over decades. Manual rotation has the potential to reduce operative delivery for fetal malposition. AIM: To determine the current obstetric practice with regard to manual rotation in the management of the second ...

PURPOSE OF REVIEW: To guide the optimal fluid management during cesarean delivery. The article focuses on fluid management to prevent hypotension during cesarean delivery performed under spinal anesthesia and excludes obstetric hemorrhage. RECENT FINDINGS: The literature underlines that crystalloid preloading is ineffective or poorly effective to prevent spinal hypotension during ...

Bleeding symptoms commonly seen by multiple physician specialties may belie undiagnosed congenital or acquired bleeding disorders. Acquired hemophilia is a potentially life-threatening cause of unexplained acute bleeding manifested by an abnormal activated partial thromboplastin time (aPTT) that does not correct with 1:1 mixing with normal plasma. Practicing physicians (hematology/oncology, emergency ...

During the past decade, our understanding of biomechanics and its importance in rehabilitation has advanced significantly. The kinetic chain, a concept borrowed from engineering, has helped us better understand the underlying physiology of human movement. This understanding, in turn, has facilitated the development of new and more rational rehabilitation strategies. ...

Background. Case management provided by health care assistants (HCAs) is effective in improving primary care for depressive patients. Little is known on the implementation-related aspects of case management performed in small family practices. Objective. To explore family doctors' perspectives on clinical and organizational aspects of implementation of case management and ...

INTRODUCTION: Majority of studies on evaluation of emergency management courses have focused on outcomes such as knowledge and skills demonstrated in non-clinical or traditional testing manner. Such surrogate outcomes may not necessarily reflect vital changes in practice. The aim of this study was to determine if and to what extent, ...

AIM: To investigate ownership and perceived utility of written asthma action plans (WAAPs) in general practice. METHODS: Questionnaires were completed by 225 adults and 75 children with GP-diagnosed asthma from 31 practices. Regression models for WAAP ownership allowed for confounders and clustering by practice. Five audio-recorded focus groups were conducted ...

Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify ...

A deferral of stance during the openings of general practice consultations is discussed in this paper as a possible systematic and important device for accomplishing gate keeping. The paper draws upon video recordings of naturally occurring consultations in Denmark. It is found that doctors defer their explicit stances when patients ...

To estimate the self-medication prevalence in low-income adults and identify associated factors. Data from a population survey performed in São Paulo municipality, Southeastern Brazil in 2005, were used. The sample strategy included two domains, favelas and non-favelas, with clustered sampling performed in two stages with a total of 3,226 eligible ...

Some of the most celebrated triumphs of chemical biology are molecularly targeted therapeutics to combat human disease. However, a grand challenge looms as informative diagnostic strategies must be developed to realize the full impact of these promising pharmaceutical agents.

The ability to alter cell identity with small molecules represents a powerful approach to restore biological function lost because of cellular deficiency. Developing this capability through advances in chemical biology could have an enormous impact on human health.

To analyze the component law of Chinese patent medicines for anti-influenza and develop new prescriptions for anti-influenza by unsupervised data mining methods. Chinese patent medicine recipes for anti-influenza were collected and recorded in the database, and then the correlation coefficient between herbs, core combinations of herbs and new prescriptions were ...

A workshop at the 2008 ASPHO Annual Meeting functioned as the first step in a systematic needs assessment of the particular challenges to satisfaction and success in the middle and senior phases of career development for pediatric hematologist/oncologists (PHOs). The 61 ASPHO members who attended were randomly distributed to small ...

Chronic myeloid leukemia (CML) management varies across Asia due to disparities in affluence and healthcare provision. We surveyed CML management practice at 33 hospitals in 14 countries/regions to identify treatment challenges and opportunities for harmonization. Patients were generally treated according to international guidelines; however, tyrosine kinase inhibitors (TKIs) and molecular ...

The purpose of Clinical Problem Solving manuscripts is to present management challenges in an attempt to give practicing neurosurgeons insight into how field leaders address these dilemmas. This illustration is accompanied by a brief review of the literature on the topic. We describe the case of a patient who presented ...

This paper applies the concepts of 'adaptive leadership', as developed by Ron Heifetz, MD, to the practice of medicine. Literature review and theory development. Patients are complex adaptive systems facing both adaptive and technical health challenges. Technical health challenges are amenable to the simple or complicated expert-mediated technical interventions that ...

Massive hemoptysis is a life-threatening condition requiring multidisciplinary management not often available in resource-deprived countries with a limited range of therapeutic options. Prognosis is poor when salvage surgery is offered during active bleeding.

Regenerative medicine is a new multi-disciplinary field aiming at the repair or replacement of disease body parts. The field is progressing at an unprecedented pace and although the opportunities are immense, many hurdles lie ahead. This brief review analyses the opportunities and challenges faced by regenerative medicine.

Widespread global use of rifampin for 2 decades preceded the emergence of clinically significant multidrug-resistant tuberculosis (MDR-TB) in the early 1990s. The prevalence of MDR-TB has gradually increased such that it accounts for approximately 5% of the global case burden of disease (approximately half a million cases in 2007). Eclipsing ...

Capitalizing on spousal support may enhance the effectiveness of interventions for chronic disease management. However, couples-based interventions present logistical challenges. We describe our experience and lessons learned while recruiting couples into the Couples Partnering for Lipid-Enhancing Strategies (CouPLES) trial. This trial seeks to reduce serum low-density lipoprotein cholesterol levels using ...

A survey about time management in the workplace was distributed to obtain a sense of the level of job satisfaction among preclinical safety professionals in the current economic climate, and to encourage reflection upon how we manage time in our work environment. Roughly equal numbers of respondents (approximately 32%) identified ...

Trainees may encounter a range of difficulties during their training period. Supporting a trainee in difficulty can be extremely challenging, yet immensely rewarding.

The phenomenon of plagiarism has evolved as a major problem in many fields with the increasing accessibility of material on the internet. It poses dilemmas for those involved in secondary and tertiary education, as well as for book publishers and those who edit journals. This editorial reviews important recent decisions ...

Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment ...

Neurologic complications of bacterial endocarditis have been observed for centuries but its management has remained challenging at all times. The cerebrovascular complications of this disorder are the most feared and difficult to address. The management of mycotic aneurysms, recent ischemic/hemorrhagic strokes with and without brain abscesses, and mechanical valve patients ...

One response to the challenges of modern day clinical practice has been to employ "mid-level providers" (MLPs), such as physician assistants and nurse practitioners. MLPs may complement physicians by supporting patient self-management and performing routine, protocol-guided management. In turn, MLPs may improve health outcomes and simultaneously lower costs. Within gastroenterology, ...

Personalized medicine is health care that tailors interventions to individual variation in risk and treatment response. Although medicine has long strived to achieve this goal, advances in genomics promise to facilitate this process. Relevant to present-day practice is the use of genomic information to classify individuals according to disease susceptibility ...

BACKGROUND: Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be ...

AIM: While China has become a significant contributor and prolific publisher in regenerative medicine, its role in the field is not well understood. We analyze how capacity in regenerative medicine was built in China to identify some of its main strengths and challenges. MATERIALS & METHODS: This case study of ...

BACKGROUND: A delay is evident between the development of new policies on TB diagnostics and their implementation at country level. The Stop TB Partnership would benefit from information from national TB program (NTP) managers on progress towards implementation of new recommendations as well as the opportunities and challenges encountered in ...

Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established ...

Biomechanical factors profoundly influence the processes of tissue growth, development, maintenance, degeneration, and repair. Regenerative strategies to restore damaged or diseased tissues in vivo and create living tissue replacements in vitro have recently begun to harness advances in understanding of how cells and tissues sense and adapt to their mechanical ...

This collection of case studies is designed to illustrate challenging and controversial aspects of perioperative medicine. The authors guide readers through four case narratives punctuated by practical multiple-choice questions followed by the authors' commentary on the evidence supporting various answer choices and related considerations. The objective is to examine issues ...

The approach to managing a point-of-care testing (POCT) program has evolved over recent years. Although many of the essential features of early POCT management programs remain intact, contemporary challenges including expansion of the test menu, changing regulatory requirements, and the development of more sophisticated data management connectivity require ongoing adaptation ...

Michael Servetus was the first doctor ever to challenge and scientifically argue against the theories of Galen, which predominated for 14 centuries in medical schools worldwide. Even though he was relatively correct in scientific terms, Servetus was punished because of his boldness in challenging Galen's theories and was condemned to ...

Cerebral palsy is a long recognized ''symptom-complex'' that is the most common cause of childhood physical impairment. A neurodevelopmental disability sub-type, it has an essential core of objective neuro-motor impairment and its present conceptualization includes explicit recognition of activity limitations and varying associated co-morbidities. This review explores this disorder's incidence, ...

Unwanted immunogenicity is a significant issue affecting most biotherapeutic products, including subsequent entry biological (SEB) medicines. Such immunogenicity can be associated with adverse reactions and can cause impaired clinical responses to the biotherapeutic. This feature article provides an overview of the challenges facing the biotechnology industry with regard to the ...

The open abdomen technique is one of the greatest advances in recent times and has enormous application in the daily management of the critically ill or injured patient. It results in tremendous benefits to the initial resuscitation of these patients but also brings on many challenges beyond those that might ...