PURPOSE/OBJECTIVES:: Homelessness is a social condition increasing in frequency and severity across Canada. Interventions to end and prevent homelessness include effective case management in addition to an affordable housing provision. Little standardization exists for service providers to guide their decision making in developing and maintaining effective case management programs. The ...

When a patient's wishes conflict with "best practice"

As drug discovery and translational scientists think about using stratification with biomarkers to improve the chances of getting medicines to patients, several areas of expertise need to be considered. These include analytical validation, clinical validation, regulatory affairs and intellectual property. Getting the right input from the right expert at the ...

Many treatment options are available for the management of the free end saddle. This paper reviews past and current treatment methods for management of this situation. CLINICAL RELEVANCE: To understand the problem posed by the free end saddle and the techniques available to clinicians for its management in general dental ...

Herbal formulations being widely accepted therapeutic agents as antidiabetics, antiarthritics, hepatoprotectives, cough remedies, memory enhancers, and adaptogens. The commonest myth regarding herbal medicines is that these medicines are completely safe, and can therefore be safely consumed by the patient on his/her own, without a physician's prescription. This belief has led ...

Objective-To examine veterinarian solicitation of client concerns in companion animal practice. Design-Cross-sectional descriptive study. Sample-20 veterinarians in companion animal practice in Eastern Ontario and 334 clients and their pets. Procedures-Beginning segments of 334 appointments were coded for a veterinarian solicitation (open- or closed-ended question) used to elicit client concerns. Appointments ...

Heart failure (HF) is a common condition associated with high rates of morbidity and mortality. Implantable cardiac defibrillators (ICDs) are an important management strategy in HF management and decrease mortality for both primary and secondary prevention. An emerging body of literature identifies the challenges of managing ICDs at the end ...

A cloud of ash drifting from the erupting Eyjafjallajökull volcano in Iceland in April and May 2010 covered Europe and created an unprecedented situation. It resulted in an almost complete lockdown of European airspace in the period from 15th to 21st April, 2010: more than 100,000 flights were cancelled, 10 ...

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients ...

Abstract The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and ...

Local anaesthetic (LA) has long been an indispensable aid to dermatological practice. With the development and expansion of dermatological surgery as a subspecialty within dermatology, and the increasing complexity of procedures being undertaken by clinicians, it would seem reasonable to assume that the volume of LA being used in dermatology ...

As dialytic practice has evolved, hemodialysis (HD) adequacy has come to be defined in terms of small molecule clearance. A growing body of evidence suggests that fluid dynamics, specifically ultrafiltration rate (UFR), bear clinical and physiological significance and should perhaps play a more central role in titrating HD therapy. Three ...

ETHNOPHARMACOLOGICAL RELEVANCE: Arsenicals have been known as poisons and paradoxically as therapeutic agents. In the early 1970s, Chinese physicians from Harbin revived the medicinal use of arsenicals as anticancer agents. Notable success was observed in the treatment of acute promyelocytic leukemia (APL) with arsenic trioxide (ATO). The FDA approved ATO ...

New advances in nanotechnology has been responsible for the development of a new science called nanomedicine. In the recent years many discoveries as nanotubes and nanoparticles, especially for pharmaceuticals use, has increasing the application of nanotechnology for medical purposes. In this direction the development of nanoradiopharmaceuticals are also promising as ...

Combination antiretroviral therapy (cART) was one of the greatest achievements in medicine in the twentieth century. It has rapidly evolved during the last 10 years from suboptimal monotherapy to an effective triple therapy that can change the natural history of HIV-1 infection from a deadly disease to a chronic, manageable ...

In Part I of this article, in the January/February 2011 issue, we discussed how the delivery of healthcare of the future will be dramatically different from the past for physicians in private practice. As the debate continues to swirl around the Patient Protection and Affordable Care Act, physicians in private ...

The introduction of new agents in the treatment of multiple myeloma, such as thalidomide, bortezomib, or lenalidomide, has represented an important step forward in the management of this disease, with improvement in both treatment response and patient survival. On the other hand, when new drugs are used it is very ...

With increased awareness of complementary/alternative medicine (CAM) and concern of potential adverse effects or limited effectiveness of conventional medications, patients and parents are looking to CAM approaches as either an alternative or as adjunct therapy, especially for chronic diseases such as asthma or cystic fibrosis. It is important that practitioners ...

PURPOSE OF REVIEW: The management of immunologically mediated occupational asthma may be difficult in clinical practice since complete avoidance of exposure to the sensitizing agent is associated with a substantial adverse socio-economic impact. The purpose of this review was to critically analyze the available information on the effectiveness of reducing ...

An environmental assessment of six scenarios for handling of garden waste in the Municipality of Aarhus (Denmark) was performed from a life cycle perspective by means of the LCA-model EASEWASTE. In the first (baseline) scenario, the current garden waste management system based on windrow composting was assessed, while in the ...

PURPOSE OF REVIEW: To review the emerging literature on traumatic brain injury (TBI) caused by explosive blast. RECENT FINDINGS: Efforts are underway to understand how explosive blast injures brain, what is the clinical presentation and how best to manage it. A major way blast injures brain is from detonation pressure ...

With recent developments in nanotechnology, nanomaterials have been successfully employed in various industrial applications such as medicine and cosmetics. Nanomaterials demonstrate useful properties such as electronic reactivity and tissue permeability that are absent in micromaterials. Thus, it is anticipated that nanomaterials will be developed as innovative materials in medicine and ...

Bhasmas are unique Ayurvedic metallic preparations used for medicinal purposes since ancient times. With increasing knowledge of risk of nanomaterials, it becomes imperative to assess the safety of nanoparticulate Ayurvedic medicines using toxicity models. In this study, zinc bhasma was characterized using modern physicochemical techniques. In vitro toxicity test revealed ...

Ayurveda is one of the oldest systems of medicine, practiced in Indian sub continent. We are working to calibrate classical parameters of good manufacturing practices of Ayurvedic bhasma on parameters and language of contemporary science. Bhasma in accordance of classical expectation are Swarna bhasma, Makshika bhasma, Abhrak bhasma, Tamra bhasma ...

The recognition of epileptic seizures in newborns is challenging as neonates exhibit a variety of paroxysmal motor phenomena, some epileptic but others not. The distinction, frequently requiring video-EEG monitoring, is crucial for management. Causes are often multi-factorial, specific to country/region, and change over time. Hypoxia-ischemia and infection are still common ...

AIMS: Primary brain tumours in adults are rare, with high-grade gliomas (HGG) being the most common and most aggressive type. The clinical management of rare tumours such as HGG can be heterogeneous across different cancer centres. The aim of this survey was to determine current UK practice in the primary ...

Chemotherapy can induce various clinical emergencies. Prompt recognition and management of these adverse events are important for avoiding further morbidity and mortality. Some events such as hypersensitivity and extravasation are quite common, whereas emergencies such as neutropenic typhlitis, pancreatitis, and acute haemolysis are very rare. Little information exists on the ...

CONTEXT: The therapeutic scenario for metastatic renal cell carcinoma (mRCC) has been evolving rapidly, with sunitinib, sorafenib, bevacizumab, everolimus, pazopanib, and temsirolimus being successfully tested and approved in a short period of time. Oncologists must be familiar with the management of toxicity that these biologic agents cause, as such toxicity ...

The new paradigm of therapy in rheumatoid arthritis is to aim toward early and complete remission, using a larger use of conventional DMARDs and biologic agents. The present recommendations were established through a consensus to help practitioners in their daily use of those agents, to reflect the current "best practice" ...

Background. The rapid scale-up of antiretroviral therapy in resource-limited settings has greatly increased demand for antiretroviral medicines and raised the importance of good forward planning, especially in the context of the new 2010 WHO treatment guidelines. Methods. Forecasting of the number of people receiving antiretroviral therapy from 2010 to 2012 ...

Cinchona is one of the most important medicinal plants as it contains quinine, a potent medicine for malaria. In this review, I reveal the history of cinchona introduction and cultivation in Japan. Cinchona was first introduced to Japan in 1876 from Java based on the proposal submitted by Takeaki Enomoto ...

BACKGROUND: In the last 3 decades, and from a therapeutic point of view, the classical concept of ischemic penumbra based on hemodynamic and electrophysiological parameters has loosened up the rigidity of therapeutic windows in acute stroke management. Thirty years later, the ischemic penumbra is an evolved concept that presents more ...

Local anesthetics are widely used in the practice of medicine, particularly within the field of interventional radiology. When used properly, these agents are safe and effective in preventing procedural pain and treating postprocedural pain. The clinician should be aware of proper dosing regimens, techniques, and applications and the methods of ...

XBACKGROUND: Acute pulmonary oedema is a life threatening emergency that requires immediate intervention with a management plan and an evidence based treatment protocol. OBJECTIVE: This article describes the features, causes, prevalence and prognosis of heart failure and the management of acute pulmonary oedema. DISCUSSION: Presentations of acute pulmonary oedema and ...

Rodenticides have historically been common agents in attempted suicides. As most rodenticides in the United States (U.S.) are superwarfarins, these ingestions are generally managed conservatively with close monitoring for coagulopathy, and if necessary, correction of any resulting coagulopathy. However, alternate forms of rodenticides are imported illegally into the U.S. and ...

Local anaesthetic administration is a common clinical practice not only in the operating theatres, but also in other clinical settings. Relevant monitoring and resuscitation facilities in certain clinical settings outside the operation rooms may not be optimal. Despite the low incidence of severe complications associated with administration of local anaesthetics, ...

Understanding biochemical concepts can assist in the diagnosis and treatment of certain presentations in the emergency department. Knowledge of the biochemistry responsible for certain presentations in the emergency department as well as behind various therapies also provides physicians better insight into the use of specific treatments. This review will focus ...

As traditional Chinese medicine (TCM) has become more popular there have been increasing concerns about safety and potential toxicity of the Chinese materia medica (CMM) comprising plants, animal parts and minerals. The potential toxicity of many CMM is well recognised in TCM and to reduce risks use of some herbs ...

Acute exacerbations in chronic onstructive pulmonary disease (COPD) are common and systemic steroids play an important role in the management of these cases along with the bronchodilators. Nebulized budesonide is being used in the acute attacks of bronchial asthma either in children or in adults. But the role of nebulized ...

Personalized medicine has the potential of revolutionizing patient care. This treatment modality prescribes therapies specific to individual patients based on pharmacogenetic and pharmacogenomic information. The mapping of the human genome has been an important milestone in understanding the interindividual differences in response to therapy. These differences are attributed to genotypic ...

Herbal medicines are widely used in the world and are generally considered effective and safe, although many studies have demonstrated their potential toxic effects, particularly for the liver. We present a case of a woman, who developed a mixed cholestatic/hepatocellular liver injury due to herbal products. Firstly, she was admitted ...

Perioperative fluid management in paediatrics has been the subject of many controversies in recent years, but fluid management in the neonatal period has not been considered in most reviews and guidelines. The literature regarding neonatal fluid management mainly appears in the paediatric textbooks and few recent data are available, except ...

We describe three giant cell aortitis patients who were operatively managed at our institution over the last seven years and review the recent relevant literature to highlight the specific features of the disease and the salient points of management in relation to the cardiac surgeon. 

Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treatment modalities are plagued by the ...

OBJECTIVE: To compare maternal and neonatal outcomes in deliveries managed by a policy of expectant management and active management of women with preterm prelabor rupture of membranes (pPROM), at 34-36 completed weeks of gestation. DESIGN: Retrospective multicenter cohort study. SETTING: Three tertiary care teaching hospitals in France. POPULATION: Women with ...

Given the vast and growing volume of medical literature, it is essential to develop reliable strategies for identifying articles of importance and relevance. Here, we summarize 5 notable articles for general internal medicine published in 2008 and 2009. Clinical vignettes are presented to illustrate situations in which each study might ...

Background: Neonatal hypoglycaemia is a common problem linked to both brain damage and death. There is controversy regarding both the definition of and best treatment for neonatal hypoglycaemia. Aim: To determine current management of neonatal hypoglycaemia within the Australian and New Zealand Neonatal Network (ANZNN). Methods: Four questionnaires were sent ...

The updated Dutch guidelines on Neonatal Resuscitation assimilate the latest evidence in neonatal resuscitation. Important changes with regard to the 2004 guidelines and controversial issues concerning neonatal resuscitation are reviewed, and recommendations for daily practice are provided and argued in the context of the ILCOR 2005 consensus.

The importance of vascular access in neonatal clinical practice is increasing, because of the survival of a larger number of premature babies, who require administration of long-term intravenous fluids and medications than in the past. In these newborn central venous lines are preferred to peripheral lines, particularly Peripherally Inserted Central ...

Rosai-Dorfman disease (RDD) is a rare entity of non-Langerhans cell histiocytoses (non-LCH) which usually presents with bilateral painless cervical lymphadenopathy. We describe a neonate with RDD who presented with anemia, thrombocytopenia and hepatomegaly. He recovered spontaneously with conservative management. This represents an atypical presentation of RDD. Conservative management with close ...