Dabigatran etexilate is a new oral anticoagulant recently approved in Europe for the prevention of stroke or systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and at least one risk factor for stroke. With a fast onset of action and a predictable anticoagulant effect obviating the need for ...

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use ...

INTRODUCTION:This is a study of the process of diagnosis in family medicine (FM) in four practice populations from the Netherlands, Malta, Serbia and Japan. Diagnostic odds ratios (ORs) for common reasons for encounter (RfEs) and episode titles are used to study the process of diagnosis in international FM and to ...

OBJECTIVE: To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decision-making (SDM) from the health professional perspective. METHODS: Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. RESULTS: The ...

Abstract Use of herbal medicines among patients receiving Anti-retroviral Therapy (ART) remains by far an uncharacterised phenomenon in Africa and Uganda specifically. We evaluated the use of herbal medicines among patients on ART at the HIV clinic of Mbarara Regional Referral Hospital (MRRH), examined factors associated with their concomitant use ...

ObjectiveTo summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke.MethodsRecommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial ...

PURPOSE OF REVIEW: This article reviews current evidence on etiology, diagnosis and clinical management of patients with a challenging movement disorder referred to as focal hand dystonia (FHd). RECENT FINDINGS: Patients who present to a rhematologist with a history of repetitive overuse, weakness, pain and involuntary, end-range posturing of the ...

Hypothermia, either accidental or therapeutic, is when the body's core temperature is less than 35.0°C. This article examines the pathophysiology, clinical features and management of both intentional and unintentional hypothermia with a focus on the current literature regarding treatment protocols.

The objectives of this study were to assess burnout in a sample of general practitioners (GPs), to determine factors associated with depersonalisation and to investigate its impact on doctors' consultations with patients. Cross-sectional, postal survey of GPs using the Maslach Burnout Inventory (MBI). Patient survey and tape-recording of consultations for ...

How to identify and manage this life-threatening reaction to prolonged exposure. OVERVIEW: A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can be deadly, is common among trauma patients, and is often difficult to recognize. The author discusses predisposing conditions, the ...

Objective. To describe the experience of general pediatricians in weaning bronchiolitis patients, treated as outpatients, from oxygen. Methods. The authors surveyed members of the American Academy of Pediatrics' Council on Community Pediatrics regarding management of outpatient oxygen for bronchiolitis. Results. The survey had 214 (28.4%) responses from pediatricians, of whom ...

Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective ...

Airway management is primarily designed to avoid hypoxia, yet hypoxia remains the main ultimate cause of anaesthetic-related death and morbidity. Understanding some of the physiology of hypoxia is therefore essential as part of a 'holistic' approach to airway management. Furthermore, it is strategically important that national specialist societies dedicated to ...

Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the ...

Background. Resuscitation of patients occurs daily in emergency departments. Traditional practice entails family members remaining outside the resuscitation room. Objective. We explored the introduction of family witnessed resuscitation (FWR) as it has been shown to allow closure for the family when resuscitation is unsuccessful and helps them to better understand ...

Therapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a ...

Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anesthetic management of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the ...

The saga of malaria parasites precedes the history of humans. Malaria has always been part of the rising and decline of nations, of wars and of upheavals. People of ancient times attributed the malarial manifestations to supernatural influences. Myths about demons responsible for fevers and efforts to bring them under ...

Ecology is an inherently complex science coping with correlated variables, nonlinear interactions and multiple scales of pattern and process, making it difficult for experiments to result in clear, strong inference. Natural resource managers, policy makers, and stakeholders rely on science to provide timely and accurate management recommendations. However, the time ...

Five experiments (N = 390) tested the hypothesis that adopting an impression management goal leads the impression manager to view an interaction partner as having less of the trait he or she is attempting to express. This hypothesis was confirmed for the impression management goals of appearing introverted, extraverted, smart, ...

Long-term biological time-series in the oceans are relatively rare. Using the two longest of these we show how the information value of such ecological time-series increases through space and time in terms of their potential policy value. We also explore the co-evolution of these oceanic biological time-series with changing marine ...

In school, architects are taught "Form follows function," but all too often this concept is forgotten or not followed in planning medical practice environments. Things such as the architecture (look) of the building, the budget, the view from the office, etc., drive planning decisions when none of those can help ...

Structural fumigations of food processing plants to manage stored-product insects has been a major component of pest management programs, but limited information on field efficacy is available. Efficacy, based on pheromone trapping data, consists of initial reduction in captures after treatment and rebound in trap captures over time. Pattern of ...

BACKGROUND: Functional management of the ruptured Achilles tendon can be effective using orthoses like the removable walker boot (Foam Walker Boot, Air Cast UK Limited, Lincolnshire, United Kingdom). We conducted this study to look at the outcome of our protocol using this orthosis. MATERIALS AND METHODS: We retrospectively reviewed 107 ...

PURPOSE OF REVIEW: Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice. RECENT FINDINGS: The ...

Bloodletting in medicine is as old as mankind. Its survival in modern times and against all odds closely resembles an evolutionary pathway that involves step by step progress, with payoffs and experience gained at each step to refine and improve its use. In order to continue to function in a ...

In this era of reimbursement not keeping pace with overhead and healthcare reform an unknown, it is more important than ever to assess the use of the doctors' and mid-level providers' time in your practice. There could be a very large untapped revenue source in the misallocated time of these ...

Larger music practice rooms (>25 m(3)) present unique challenges compared to smaller, traditional practice rooms (6-12 m(3)) when employing active acoustics technology and integrated digital recording. An experiment was conducted comparing a ceiling array of 32 speakers in a large music practice room (5.3x5.7x2.7 m(3), 81 m(3)) with that of ...

Electronic medical records (EMRs) facilitate abnormal test result communication through "alert" notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. ...

St. Mary's Regional Medical Center in Lewiston, ME, was a recipient of the Putting Patients First grant program offered by AHRA and Toshiba. This article presents an overview of the grant activities and the salient findings. The dual focus of the best practice initiative was to promote the physician use ...

: Despite increased use of generic medicines, little is known about either the attitudes of patients towards them or the decision-making process surrounding them. Young adults use over-the-counter (OTC) analgesics relatively often. : To assess the preferences of patients for generic and branded OTC pain medicines, to identify clusters with ...

The presence of healthcare industry representatives poses a challenge for operating department managers. The healthcare industry is taken largely on trust, but in an era of clinical governance this is no longer acceptable. Managers need to establish criteria against which competencies can be measured to risk manage the presence of ...

Joining an IDS means that your practice will undergo changes in leadership, operations and resources. Here's how separate organizations can solve problems to combine strengths and succeed.

Aim The aim of the present study was to explore and describe what characterizes first- and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first- and second-line managers in different health care ...

Failure of passive transfer of immunity (FPT) in dairy replacement calves has been linked to increased neonatal morbidity and mortality and long-term decreases in productivity. The purpose of this study was to estimate the prevalence of FPT in US dairy heifer calves in 2007 and to use nationally representative data ...

BACKGROUND: A better safety climate has been linked to better compliance with safety behaviors. This study assessed whether "management support," the most commonly measured safety climate dimension, was associated with greater use of the hands-free technique (HFT), a work practice recommended for use during surgery to prevent exposure to blood ...

Realistic time management and organization plans can improve productivity and the quality of life. However, these skills can be difficult to develop and maintain. The key elements of time management are goals, organization, delegation, and relaxation. The author addresses each of these components and provides suggestions for successful time management.

Concierge medical practice is a relatively new and somewhat controversial development in primary-care practice. These practices promise patients more personalized care and dedicated service, in exchange for an annual membership fee paid by patients. The experiences of patients using these practices remain largely undocumented. To assess the experiences of patients ...

BACKGROUND: The changing trends in the management of vestibular schwannoma (VS) in our practice over the last two decades as well as the current status are presented here. MATERIALS AND METHODS: The observations are based on the experience of 559 consecutive cases of VS operated by the first author between ...

Calf mortality has remained at a high (risk approximately 7%) in Denmark, despite much knowledge disseminated to farmers. We conducted a qualitative interview to explore calf managers' perception of their own management and working situation, and how this related to calf mortality problems in their herds. Twenty-eight calf managers from ...

Delivery of the spectrum of anesthesia from sedation to general anesthesia for patients undergoing procedures outside of the operating room (OR) poses several problems not encountered in the OR. These include limited time to assess the patient and often no time to obtain consultations for medical conditions that may be ...

Reading the techniques of an unfamiliar operation from an operative textbook is frequently not sufficient to enable the performance of the actual operation. It is the small points - the tricks of the trade - that make the difference to the 'uninitiated'; it is the heuristics, the 'rule of thumb' ...

An experiment was conducted to determine the impact of an auditory model on blocked, random, and mixed practice schedules of three five-segment timing sequences (relative time constant). We were interested in whether or not the auditory model differentially affected the learning of relative and absolute timing under blocked and random ...

Pervosides A (1) and B (2), two new isoferulyl glucosides, have been isolated from the ethyl acetate soluble fraction of Perovskia atriplicifolia and their structures have been assigned on the basis of spectroscopic data. 3-Hydroxyestragole beta-D-glucopyranoside (3) has also been isolated and characterized for the first time from this species.

The New Zealand Pharmacovigilance Centre (NZPhvC) is the national centre responsible for monitoring adverse reactions to therapeutic products in New Zealand(NZ). The NZPhvC operates three pharmacovigilance programmes and this article explains how each of these programmes operate, focuses on their strengths and limitations, and looks to the future for medicines ...

The field of erectile dysfunction (ED) management over time has witnessed assorted interventions to enable men to perform sexual intercourse. In recent times, major progress in ED research has led to increasingly effective treatments based on a refined knowledge of the scientific basis for penile erection. Current concepts suggest that ...

We compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. Although the insertion time was similar, the time taken to intubate ...

A variety of experimental evidence indicates that the memory representation for multiplication facts (e.g., 6 x 9 = 54) incorporates bidirectional links with a forward association from factors to product and a reverse association from product to factors. Surprisingly, the authors did not find evidence in Experiment 1 of facilitative ...

Since 1995, air transport operators in New Zealand have been able to meet the flight and duty time (FDT) regulations by operating according to prescriptive FDT limits or by seeking approval to operate under a potentially more flexible company-specific FDT scheme. There has been no formal assessment of the impact ...

Tourniquets are widely employed in orthopaedic practice to maintain a bloodless operative field during extremity surgery. In areas of the world where reliable pressurized air systems for tourniquet inflation are not available, and as an alternative to the traditional Esmarch bandage, we report on the successful and safe use of ...