It is the 'moral compass', however subtle, that underpins leadership. Leadership, meaning showing the way, demands as much conviction as gentile diplomacy in the discourse with supporters and detractors. In particular, leadership defends the goal by safeguarding its principles from its detractors. The authors writing in the Forum on Complexity ...

Clinicians involved with nutrition therapy traditionally concentrated on macronutrients and have generally neglected the importance of micronutrients, both vitamins and trace elements. Micronutrients, which work in unison, are important for fundamental biological processes and enzymatic reactions, and deficiencies may lead to disastrous consequences. This review concentrates on vitamin B(1), or ...

Background Spirometry is an important tool when diagnosing chronic respiratory conditions in general practice. However, the equipment may harbour pathogenic micro-organisms and cross-transmission of aerolised pathogens could occur if hygiene measures are insufficient. Methods We assessed microbiological contamination in 16 spirometers from a convenience sample of South Australian general practices. ...

Topiramate is associated with various psychiatric and neurocognitive side effects. We report a case of a 21-year-old woman who was prescribed topiramate for the treatment of migraine headaches by her neurologist. She developed episodes of dissociation while receiving topiramate. These episodes increased when the dose of medicine was increased. The ...

Aim.  The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. Background.  The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have ...

A voluntary risk-based control program on paratuberculosis in dairy cattle was initiated in Denmark in 2006. Cows were categorized as high-risk (antibody-positive at least once within the last 3 tests) or low-risk animals based on the results of 3 to 4 annual milk ELISA detecting Mycobacterium avium ssp. paratuberculosis (MAP)-specific ...

The first 24 h in the management of aneurysmal subarachnoid hemorrhage (SAH) represent a critical time period for medical intervention. We review the current literature and discuss our current clinical practices related to management of acute SAH. A brief objective review of the current evidence along with a subjective overview of ...

Significant literature on the management of acute severe acute pancreatitis has emerged in recent years. The new information ranges from data on newer single or multiparameter severity assessment tools and classification systems to therapeutic modalities. However, a few basic issues-the ideal severity assessment modality, volume of intravenous fluids required in ...

Information on the practice of family medicine in Arab countries is scant. In this study we aim to describe the current state of the specialty in the region. This includes scope of practice, practice setting, training programs, and the numbers and profiles of their graduates. A survey of leaders in ...

A report on the Future of Genomic Medicine IV meeting held in La Jolla, California, USA, 3-4 March 2011.

The concept of a medical emergency, i.e., a time when immediate action is required to stabilize and restore the vital functions, is absent in the tradition of ancient medicine, which seeks to cure the sick. The theoretical and conceptual development of a prompt medical assistance definitely owes much to the ...

Thrombotic thrombocytopenic purpura (TTP) is a rare but frequently fatal complication of SLE. It occurs in the context of both active and inactive lupus and carries a worse overall prognosis than idiopathic acquired TTP. Recent advances in the knowledge and treatment of TTP do not seem to have brought similar ...

Management of vascular trauma has evolved tremendously since the turn of the 20(th) century. The lessons from each major military conflict over the past 100 years have refined our understanding of how to care for soldiers and civilians with vascular injuries. The recent wars in Iraq and Afghanistan have likewise ...

Exhaled breath condensate (EBC) collection and analysis offers a unique non-invasive method to sample the airway lining fluid. It enables classification and quantification of airway inflammation associated with various pulmonary diseases such as asthma. Over the last decade, innumerable efforts have been made to identify biomarkers in EBC for diagnosis ...

This study introduces a short measure for burnout (the Bergen Burnout Inventory, BBI) and examines its validity and reliability among managers in Finland and Estonia by means of confirmatory factor analysis. Burnout comprises three dimensions: (1) exhaustion at work (emotional component), (2) cynicism toward the meaning of work (cognitive component), ...

Climate may be described as refined weather The meteorologist notes the day-to-day variations of the weather components, extracts the principal frequencies which then describe the seasons, and once the average values have been derived over long periods of time, there emerges the concept of climate. Advances in preventive and curative ...

The quincentenary of Ambroise Paré's birth celebrates a man who rose from a humble origin to become the leading surgeon of the Renaissance. Now remembered as a celebrated war surgeon, especially for his gentle treatment of gunshot wounds, it is generally forgotten that Paré also treated children and wrote about ...

The latest flurry of research seems to show that malpractice reforms haven't done much to stop defensive medicine. The solution depends on whom you ask. "The focus ought to be on preventing medical errors--and not on taking away people's rights and capping their damages once they've been injured," says Todd ...

The management of wounds is a specialty in its infancy. Success requires more than the use of dressings. All wounds require a diagnosis, a point well illustrated by the management of these cases which depended solely on stopping nicorandil.

Containing effluent from an enterocutaneous fistula (ECF) requires expertise, critical thinking skills, and creativity. Using a combination of products readily available to WOC nurses practicing in the United States, I have designed a suction pouch that reliably contains fistula output. A standard ostomy pouch can be converted into a suction ...

Delayed wound healing is one of the major therapeutic and economic issues in medicine today. Cutaneous wound healing is an extremely well-regulated and complex process basically divided into 3 phases: inflammation, proliferation, and tissue remodeling. Unfortunately, we still do not understand this process precisely enough to give direction effectively to ...

While there is a consensus that clinical practice should be evidence based, this can be difficult to achieve due to confusion about the value of the various approaches to wound management. To address this, the European Wound Management Association (EWMA) set up a Patient Outcome Group whose remit was to ...

BACKGROUND: Postoperative wound infections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence, there are few data regarding appropriate management and prevention strategies. MATERIALS AND METHODS: In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial ...

This article explains the process of developing a 10-week course entitled Advanced Wound Management, in preparation for the implementation of Outcome and Assessment Information Set-C (OASIS-C). The impetus for choosing wound management was the result of a Needs Assessment completed by the nursing staff. The wound management learning needs identified ...

BACKGROUND:: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without operation. The practice of deciding which patients may not need surgery after penetrating ...

BACKGROUND: While use of biocomposite temporary dressings in burn wounds is common practice, the complex anatomic structures of the hand make this treatment option challenging. For this reason, the Biobrane ((R)) Glove (Smith&Nephew) has been developed. However, limited information regarding burn treatment with Biobrane ((R)) Gloves can be found in ...

Management of these non-healing wounds typically involves practices that diverge from those used in other settings. The final article of this four-part series explores the holistic approach required in dealing with the complex symptoms.

Wound healing remains a challenging clinical problem and correct, efficient wound management is essential. Much effort has been focused on wound care with an emphasis on new therapeutic approaches and the development of technologies for acute and chronic wound management. Wound healing involves multiple cell populations, the extracellular matrix and ...

Contemporary wound management practices are not always applicable to the non-healing status of malignant wounds. Instead, care must be multidisciplinary, holistic and truly individual to the needs of each patient and their family.

Diverticular hemorrhage is the most common cause of lower gastrointestinal bleeding in Westernized cultures. Fortunately, the majority of diverticular bleeds will spontaneously resolve; however, 20% of patients will require therapeutic interventions to obtain hemostasis. The diagnostic and therapeutic options for the management of diverticular hemorrhage are discussed.

BACKGROUND: Acute cancrum oris (NOMA) is a major health concern in most parts of northern Nigeria, affecting children aged 2-9 years. The management of the acute phase/condition poses a great clinical challenge. We present our protocol for the management of acute NOMA in a referral health facility in northern Nigeria. ...

While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information in the next decade. It is ...

Biofilm is a relatively new concept in the fields of infectious disease, wound infection, and healing. Although scientific research and "noise" regarding wound biofilm is increasing, little is known about the presentation, diagnosis, potential implications, and management strategies regarding wound biofilms. A series of four clinical cases is utilized to ...

A review of the literature on traditional medical practices and beliefs in Papua New Guinea (PNG) was conducted in order to provide context and background information for the Department of Health's National Policy on Traditional Medicine for Papua New Guinea. The literature review examined accounts that refer to all 19 ...

One of the ultimate goals of wound healing research is to find effective healing techniques that utilize the regeneration of similar tissues. This involves the modification of various wound dressing biomaterials for proper wound management. The biopolymer chitosan (beta-1,4-D-glucosamine) has natural biocompatibility and biodegradability that render it suitable for wound ...

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries ...

BACKGROUND: Hypertrophic scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and regeneration-regulating mechanism control is lost. These abnormal fibrous growths present a major therapeutic dilemma and challenge to the plastic surgeon because they are disfiguring and frequently recur. OBJECTIVE: To provide updated clinical ...

A three-year-old intact, male Siberian Husky was presented for complete loss of its left metatarsal pad. The wound was managed as an open wound and left to be closed by second intention healing. Conservative management consisted of regular lavage and bandage changes along with oral antibiotic administration and exercise restriction. ...

BACKGROUND: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units. METHOD: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI. Participants: Respondents included physical therapists (PTs; n=24) and occupational therapists (OTs; n=15). MAIN ...

Over the last decade, the application of and indications for negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) have grown tremendously. This is particularly true in orthopaedic trauma in the management of injuries to the leg, ankle, and foot. ...

To assess the knowledge of final year medical students in Nigeria, about good prescribing and the application of this knowledge to their prescribing skills. Thirty four final year medical students of the Lagos State University College of Medicine (LASUCOM), Ikeja, were interviewed with a structured questionnaire that assessed their knowledge ...

Occasionally, the bovine practitioner is presented situations requiring application of techniques regarding wound repair and healing. Less commonly encountered in bovine practice than equine practice for example, principles and management of traumatic wound healing should be regarded as similar. Frequently, bovine practitioners need to apply knowledge of healing principles when ...

Various strategies have been considered in attempts to improve the outcomes of dialysis patients. Such strategies include increasing dialysis dose, using alternative depuration methods, changing dialysis schedules and focusing on preventing or treating specific co-morbidities and complications. In this Viewpoint, Andreas Pierratos discusses the first three strategies, and concludes that ...

Effective management of wound exduate is a considerable challenge for clinicians. Treatment of the patients underlying condition, accurate assessment of the wound and exudate, as well as selection of an appropriate dressing are all important factors for success. A variety of dressings are available to the clinician for the management ...

The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibiotic-resistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with ...

Bowhead whales (Balaena mysticetus) experienced a severe demographic population bottleneck caused by commercial whaling that ceased in 1914. Aboriginal subsistence whale harvests have continued and are managed by the International Whaling Commission. In an effort to provide management advice for bowhead whales, 25 microsatellite loci were isolated from genomic DNA ...

The recent conflicts in Afghanistan and Iraq have demonstrated that body armor has led to increase survival of combatants but the extremity injuries have been alarming. The increased numbers of extremity injuries have led to the acceptance and use of negative pressure therapy (NPT) in managing large wounds. This article ...

Maggot-therapy is the application of disinfected fly larvae to chronic wounds to debride the wound bed of necrotic tissue, reduce bacterial contamination and enhance the formation of healthy granulation tissue. Interest in the use of maggot-therapy in human medicine is growing as a result of the prevalence of antibiotic resistant ...

A growing body of research and empirical evidence have supported the re-discovery of medicinal grade honey as a wound management agent. Pre-clinical study results suggest that honey has therapeutic benefit; clinical study results have shown that honey effectively addresses exudate, inflammation, devitalized tissue, and infection. Honey-containing dressings and gels have ...

OBJECTIVE: To review the current evidence on the mechanism of actions and clinical applications of maggot debridement therapy. DATA SOURCES: Literature search of PubMed and Medline was performed up to January 2007. STUDY SELECTION: Original and major review articles related to maggot debridement therapy were reviewed. Key words used in ...