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Complex case management

Vicente Mosquera, Carlota Fernández, Amer Zanabili, Jose A Del Castro, Mónica G Pandavenes, Manuel Alonso
BACKGROUND: Iliac vein injury associated with pelvic fracture due to blunt trauma is an uncommon and difficult diagnosis but a life-threatening condition which often requires an emergent management. Although open repair has been traditionally used as the treatment of choice in unstable patients, it is controversial, given the difficulty injured vessel exposure in patients with significant retroperitoneal hematoma as well as tamponade effect loss associated to laparotomy. We present a challenging case of iliac vein laceration successfully treated by placement of a self-expanding covered stent...
August 13, 2018: Annals of Vascular Surgery
Henn Ojaveer, Bella S Galil, James T Carlton, Heidi Alleway, Philippe Goulletquer, Maiju Lehtiniemi, Agnese Marchini, Whitman Miller, Anna Occhipinti-Ambrogi, Melita Peharda, Gregory M Ruiz, Susan L Williams, Anastasija Zaiko
The human-mediated introduction of marine non-indigenous species is a centuries- if not millennia-old phenomenon, but was only recently acknowledged as a potent driver of change in the sea. We provide a synopsis of key historical milestones for marine bioinvasions, including timelines of (a) discovery and understanding of the invasion process, focusing on transfer mechanisms and outcomes, (b) methodologies used for detection and monitoring, (c) approaches to ecological impacts research, and (d) management and policy responses...
2018: PloS One
Catharina Bjørkquist, Maria Forss, Finn Samuelsen
INTRODUCTION: As a growing number of seniors with complex needs are living at home, the implementation of telecare has become a priority. This article aims to identify factors influencing inter- and intra-organisational collaboration in Norwegian primary care. The focus is on collaboration in service provision for senior users with telecare solutions, in this case personal alarms. METHODS: Data were collected from two individual interviews with each of seven middle managers from four different units...
August 16, 2018: Scandinavian Journal of Caring Sciences
Jian Zhang
Laparoscopic surgical instruments are expensive and have complex structures, the management is always huge challenge for managers. This paper introduces the basic concepts of UDI, Dot Pin Marking engraving in DPM technology and the practical solution to the case of laparoscopic instrument management. This paper summaries the application of UDI in the application of laparoscopic instruments and the prospect of future use.
July 30, 2018: Zhongguo Yi Liao Qi Xie za Zhi, Chinese Journal of Medical Instrumentation
M Simopoulou, K Sfakianoudis, P Tsioulou, A Rapani, G Anifandis, A Pantou, S Bolaris, P Bakas, E Deligeoroglou, K Pantos, M Koutsilieris
Surrogacy is an assisted reproduction-based approach in which the intended parents assign the gestation and birth to another woman called the surrogate mother. The drivers of surrogacy refer largely to infertility, medical conditions, same-sex couples' parenting, and cases of diversity regarding sexual identity and orientation. Surrogacy consists of a valid option for a variety of conditions or circumstances ranging from medical to social reasons. However, surrogacy may be associated with risks during the preimplantation, prenatal, and neonatal period...
2018: BioMed Research International
Julie E Sinclair, Mike Austin, Mark Froats, Shannon Leduc, Justin Maloney, Richard Dionne, Andy Reed, Christian Vaillancourt
BACKGROUND: In Ontario, Canada, there currently are no prehospital treat-and-release protocols and the safety of this practice remains unclear. We sought to describe the characteristics, management, and outcomes of patients with hypoglycemia treated by paramedics, and to determine the predictors of repeat access to prehospital or emergency department (ED) care within 72 hours of initial paramedic assessment. METHODS: We performed a health record review of paramedic call reports and ED records over a 12-month period...
August 15, 2018: Prehospital Emergency Care
Christine L Cain, Stephen D Cole, Charles W Bradley Ii, Michael S Canfield, Elizabeth A Mauldin
BACKGROUND: The Burkholderia cepacia complex (Bcc) is an emerging cause of opportunistic infections. Deep pyoderma associated with Bcc infection has been reported previously in dogs receiving ciclosporin. OBJECTIVE: To report the clinical and histopathological features of four additional cases of Bcc dermatitis in dogs, one of which progressed to septicaemia. ANIMALS: Four dogs with a skin culture yielding growth of Bcc and skin biopsies for histopathological investigation...
August 14, 2018: Veterinary Dermatology
Nathalie Moise, Louise Falzon, Megan Obi, Siqin Ye, Sapana Patel, Christopher Gonzalez, Kelsey Bryant, Ian M Kronish
INTRODUCTION: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies...
August 14, 2018: Journal of General Internal Medicine
Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Chih-Jung Chen, Ya-Ling Lin, Shu-Hsin Pai, Dar-Ren Chen, Shou-Jen Kuo
BACKGROUND: Experience with application of a robotic surgery platform in the management of breast cancer is limited. The preliminary results of the robotic nipple-sparing mastectomy (R-NSM) and immediate breast reconstruction (IBR) with Gel implant procedure are reported. METHODS: The medical records of patients from a single institution who underwent an R-NSM and IBR with Gel implant procedure for breast cancer during the period March 2017 to February 2018 were assessed...
August 14, 2018: Annals of Surgical Oncology
Cassandra Formeck, Agnieszka Swiatecka-Urban
Atypical hemolytic uremic syndrome (aHUS) is a rare and complex disease resulting from abnormal alternative complement activation with a wide range of clinical presentations. Extra-renal manifestations of aHUS can involve many organ systems, including the peripheral and central nervous, gastrointestinal, cardiovascular, integumentary, pulmonary, as well as the eye. While some of these extra-renal manifestations occur in the acute phase of aHUS, some can also occur as long-term sequelae of unopposed complement activation...
August 14, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Joanna Goldthorpe, Caroline Sanders, Lesley Gough, Jean Rogers, Colette Bridgman, Martin Tickle, Iain Pretty
BACKGROUND: A primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service...
August 14, 2018: BMC Health Services Research
Domenico D'Amico, Emanuela Sansone, Licia Grazzi, Ambra M Giovannetti, Matilde Leonardi, Silvia Schiavolin, Alberto Raggi
OBJECTIVES: Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, i.e. the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim is to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS: In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH...
August 14, 2018: Acta Neurologica Scandinavica
Ahmed I El-Sakka
Numerous studies have highlighted the intimate association between erectile dysfunction (ED) and diabetes mellitus (DM). However, the true pathogenesis of ED among diabetic men has not yet been fully discovered. The treatment of ED in diabetic patients remains an interesting area of research. The last two decades have witnessed phenomenal advances in the management of ED with the efficacy of pharmacotherapy for ED in diabetic patients encouraging, especially with introduction of innovative conservative tools for treatment...
August 14, 2018: Expert Opinion on Pharmacotherapy
Eric Macnaughton, Geoffrey Nelson, S Kathleen Worton, Sam Tsemberis, Vicky Stergiopoulos, Tim Aubry, Julian Hasford, Jino Distasio, Paula Goering
The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi-component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced...
August 14, 2018: American Journal of Community Psychology
P K Musale, S Kothare
BACKGROUND: Deep carious lesions in immature permanent molars with pulp necrosis pose a serious challenge to contemporary paedodontic practice. A further complex clinical scenario is an immature permanent molar with varying root formation in both roots. This case report demonstrates the successful management of an immature permanent mandibular first molar. CASE REPORT: An 8-year-old boy was referred for endodontic management of 36 by a general practitioner. After clinical and radiographic evaluation, a diagnosis of recurrent chronic periapical abscess with abrupt root closure in the mesial root and cessation of root closure in the distal root was made...
August 13, 2018: European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry
Ugochi C Okoroafor, Lisa K Cannada
Background: The American Academy of Orthopedic Surgeons (AAOS) has provided Clinical Practice Guidelines (CPG) and Appropriate Use Criteria (AUC) regarding management of distal radius fractures. The purpose of this study was to evaluate current practices in management of distal radius fractures among orthopedic trauma surgeons and to examine adherence to the AAOS criteria. Methods: An online survey was posted and distributed via the Orthopaedic Trauma Association (OTA) website...
2018: Iowa Orthopaedic Journal
Francesco Simonit, Fabio Bassan, Carlo Scorretti, Lorenzo Desinan
Complex suicides are rare and consist in the use of more than one method to induce death, representing a challenging investigation for forensic pathologists. According to the several combinations reported in literature, they have been classified into "typical" (where two common suicide methods are associated) and "atypical" (where more than two methods, or infrequent combinations of suicide methods are involved). In the case discussed here, an elderly man suffering of depression was found dead inside the tool shed of his house with a knife embedded in the abdomen and two plastic bags fastened around the neck using a twine...
August 2, 2018: Forensic Science International
Frederico T Silva, Sóstenes L S Lins, Alfredo M Simas
The concept of random coordination ratios, RCRs, is advanced for lanthanide complexes. RCRs describe the relative probabilities of occurrence of subsets of stereoisomers of same-symmetry point groups in the limiting situation when energetic effects are equivalent. We then introduce a method to uniquely identify the stereoisomer of the coordination polyhedron of a given crystallographic structure and introduce a notation that fully characterizes its stereochemistry in an unambiguous manner, from which absolute configuration naturally follows...
August 13, 2018: Inorganic Chemistry
Maria Paola Ciliberti, Rosa D'Agostino, Laura Gabrieli, Anna Nikolaou, Angela Sardaro
Hemangiopericytoma (HPC) is an extremely rare hypervascular tumor of mesenchymal lineage. It tends to recur and to develop distant metastases even many years after primary surgical resection. The management of recurrent and metastatic disease is not always so well defined. A complete surgical resection does not eliminate the high risk of local recurrences that occur in the central nervous system, often in the same surgical bed. However, treatment with adjuvant radiotherapy even in cases of complete resection remains controversial...
July 4, 2018: Oncology Reviews
Rakhi Bansal, Naveen Paliwal, Rakesh Karnawat, Akanksha Kothari
Parasitic twin is a rare form of conjoined twins with an incidence ranging from 1 in 50,000 to 1,00,000 live births. In thoracopagus type, both hearts are joined together and often are associated with underlying congenital cardiac malformations. The separation surgery is a challenging task for both the surgeon as well as anesthetist due to the complexity of the procedure and long duration of surgery, carrying mortality close to 100% in case of significant cardiac fusion. Here, we are sharing anesthetic management of successful separation of a rare type of parasitic male conjoined twins who had connected hearts and common liver...
July 2018: Saudi Journal of Anaesthesia
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