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clinical experience

Emilie M Flament, Keith R Berend, Jason M Hurst, Michael J Morris, Joanne B Adams, Adolph V Lombardi
BACKGROUND: In past decades, polyethylene wear was a major cause of failure in total knee arthroplasty (TKA). Polyethylene for use in arthroplasty has been vastly improved in recent years, with improved materials as well as manufacturing and sterilization processes. Testing has shown that infusion of vitamin E prevents oxidative degradation of polyethylene without remelting, allowing the material to maintain mechanical properties and wear resistance over time. The purpose of this study is to review the early result of patients undergoing primary TKA with vitamin E antioxidant-infused polyethylene inserts...
October 26, 2016: Surgical Technology International
Sarah B Bateni, Frederick J Meyers, Richard J Bold, Robert J Canter
BACKGROUND: The impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011-2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types...
2016: PloS One
Darshana Kadekar, Sonal Rangole, Vaijayanti Kale, Lalita Limaye
BACKGROUND: The limited cell dose in umbilical cord blood (UCB) necessitates ex vivo expansion of UCB. Further, the effective cryopreservation of these expanded cells is important in widening their use in the clinics. During cryopreservation, cells experience oxidative stress due to the generation of reactive oxygen species (ROS). Conditioned medium from mesenchymal stem cells (MSCs-CM) has been shown to alleviate the oxidative stress during wound healing, Alzheimer's disease and ischemic disease...
2016: PloS One
Michelle T Nguyen, Laurence B McCullough, Frank A Chervenak
In obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital's availability of resources and the obstetrician's training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery...
October 25, 2016: Journal of Perinatal Medicine
Masoumeh Ghafarzadeh, Mehrdad Namdari, Ali Eatemadi
Congenital heart disease (CHD) is the most prevalent congenital anomaly in newborn babies. Cardiac malformations have been induced in different animal model experiments, by perturbing some molecules that take part in the developmental pathways associated with myocyte differentiation, specification, or cardiac morphogenesis. The exact epigenetic, environmental, or genetic, basis for these molecules perturbations is yet to be understood. But, scientist have bridged this gap by introducing autologous stem cell into the defective hearts to treat CHD...
October 22, 2016: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Ruby Charak, Brianna M Byllesby, Michelle E Roley, Meredith A Claycomb, Tory A Durham, Jana Ross, Cherie Armour, Jon D Elhai
The aims of the present study were first to identify discrete patterns of childhood victimization experiences including crime, child maltreatment, peer/sibling victimization, sexual violence, and witnessing violence among adult trauma victims using latent class analysis; second, to examine the association between class-membership and suicidal behavior, and third to investigate the differential role of dispositional anger on the association between class-membership and suicidal behavior. We hypothesized that those classes with accumulating exposure to different types of childhood victimization (e...
October 22, 2016: Child Abuse & Neglect
Frederick Romberg, Bennett A Shaywitz, Sally E Shaywitz
We examine the dilemmas faced by a medical student with dyslexia who wonders whether he should "out" himself to faculty to receive the accommodations entitled by federal law. We first discuss scientific evidence on dyslexia's prevalence, unexpected nature, and neurobiology. We then examine the experiences of medical students who have revealed their dyslexia to illustrate the point that, far too often, attending physicians who know little about dyslexia can misperceive the motives or behavior of students with dyslexia...
October 1, 2016: AMA Journal of Ethics
Yenupini Joyce Adams, Manfred Stommel, Adejoke Ayoola, Mildred Horodynski, Address Malata, Barbara Smith
PURPOSE: The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. DESIGN: Cross-sectional matched-pairs survey design. METHODS: Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi...
October 25, 2016: Journal of Nursing Scholarship
Carolyn Talbott, Lynn Watson, Joseph Tariman, Matthew Sorenson
AIMS AND OBJECTIVES: The purpose of this study was to assess the acceptability and usability of a standardized communication tool for nurses. BACKGROUND AND SIGNIFICANCE: Communication is key in healthcare. On a daily, if not hourly, basis, nursing staff is inundated with new information regarding tools and resources, practice changes and the work environment. However, there is currently no standardized messaging or delivery method to effectively communicate new information...
October 25, 2016: Journal of Clinical Nursing
Ryan A Devenyi, Francis A Ortega, Willemijn Groenendaal, Trine Krogh-Madsen, David J Christini, Eric A Sobie
Imbalances of ionic currents can destabilize the cardiac action potential and potentially trigger lethal cardiac arrhythmias. Here we combined mathematical modeling with information-rich dynamic-clamp experiments to elucidate regulation of action potential morphology in guinea pig ventricular myocytes. Parameter sensitivity analysis was used to predict how changes in ionic currents alter action potential duration, and these were tested experimentally using dynamic clamp, a technique that allows for multiple perturbations to be tested in each cell...
October 24, 2016: Journal of Physiology
Ho Yong Choi, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim
STUDY DESIGN: Retrospective case series. OBJECTIVE: To evaluate and compare the surgical, radiographic, and clinical outcomes of pedicle subtraction osteotomy (PSO) according to surgeon's experience. SUMMARY OF BACKGROUND DATA: Although PSO has been widely used to correct spinal deformities, it still remains technically demanding procedure with high complications. METHODS: Comparative analysis of 40 consecutive patients treated with lumbar PSOs was performed...
October 24, 2016: Spine
Jeremy S Juern, David Milia, Panna Codner, Marshall Beckman, Lewis Somberg, Travis Webb, John A Weigelt
INTRODUCTION: Blunt pelvic fractures can be associated with major pelvic bleeding. The significance of contrast extravasation (CE) on computed tomography (CT) is debated. We sought to update our experience with CE on CT scan for the years 2009-2014 to determine the accuracy of CE in predicting the need for angioembolization. METHODS: This is a retrospective review of the trauma registry and our electronic medical record from a Level I trauma center. Patients seen from July 1, 2009 to September 7, 2014 with blunt pelvic fractures and contrast enhanced CT were included...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Grace S Rozycki
Senior surgeon leaders have unique knowledge and wisdom that should be shared with the next generation of surgeons. In order to assess the type of wisdom and the best methods of transferring it, 62 senior surgeons with more than 30 years of clinical and leadership experience were interviewed to obtain the answers to eight questions. Replies were transcribed verbatim and qualitative research software was used to determine the most frequent replies. The reasserting of core values by today's surgical leaders is the first step in the transfer of knowledge and wisdom to the next generation of surgeons...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Regina Cunningham, Mary K Walton
Increasingly, healthcare organizations are adopting patient and family advisory councils as a key strategy to create a culture grounded in patient- and family-centered principles and improve the patient experience. In the 1st of a 3-part series, the chief nurse executive and the director of patient- and family-centered care at a Magnet®-designated academic medical center discuss how a stronger patient voice can lead to better care and improved clinical outcomes. The authors examine ways in which the Magnet culture helped drive change and offer tips to establish a successful patient and family advisory council...
November 2016: Journal of Nursing Administration
Meghan M McConnell, Sandra Monteiro, Molly M Pottruff, Alan Neville, Geoff R Norman, Kevin W Eva, Kulamakan Kulasegaram
PURPOSE: Training to become a physician is an emotionally laden experience. Research in cognitive psychology indicates that emotions can influence learning and performance, but the materials used in such research (e.g., word lists) rarely reflect the complexity of material presented in medical school. The present study examined whether emotions influence learning of basic science principles. METHOD: Fifty-five undergraduate psychology students were randomly assigned to write about positive, negative, or neutral life events for nine minutes...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Nagy A Mekhail, Emad Estemalik, Gerges Azer, Kristina Davis, Stuart J Tepper
BACKGROUND: A recent multicenter study presented 52-week safety and efficacy results from an open-label extension of a randomized, sham-controlled trial for patients with chronic migraine (CM) undergoing peripheral nerve stimulation of the occipital nerves. We present the data from a single center of 20 patients enrolled at the Cleveland Clinic's Pain Management Department. METHODS: In this single center, 20 patients were implanted with a neurostimulation system, randomized to an active or control group for 12 weeks, and received open-label treatment for an additional 40 weeks...
October 25, 2016: Pain Practice: the Official Journal of World Institute of Pain
M Moschini, F Soria, A Briganti, S F Shariat
BACKGROUND: Surgical treatment of the primary tumor in patients with metastatic prostate cancer (mPCa) is gaining traction. We discuss the biological rational and the existing literature on this approach. METHODS: We reviewed the literature regarding surgical management of advanced and mPCa disease. RESULTS: Surgical removal of the primary tumor despite metastases is becoming a standard in an increasing number of malignancies. Basic science data support the use of surgical removal of the prostate in metastatic PCa...
October 25, 2016: Prostate Cancer and Prostatic Diseases
K Shukla, S Shahane, W D'Souza
BACKGROUND: Considering a huge working population in health sector faced with stressful work life, limited autonomy in work and declining work contentment calls for an overemphasis on evaluating and monitoring their satisfaction associated with work-related quality of life (WRQoL). This study evaluates WRQoL of hospital employees and validates the bilingual (English and Marathi) version of WRQoL scale. METHODS: The study was conducted during March-April'2014 on employees of a corporate hospital of Pune, India after ethical approval and informed consent from employees...
October 24, 2016: Journal of Postgraduate Medicine
M Priegnitz, S Barczyk, L Nenoff, C Golnik, I Keitz, T Werner, S Mein, J Smeets, F Vander Stappen, G Janssens, L Hotoiu, F Fiedler, D Prieels, W Enghardt, G Pausch, C Richter
Prompt γ-ray imaging with a knife-edge shaped slit camera provides the possibility of verifying proton beam range in tumor therapy. Dedicated experiments regarding the characterization of the camera system have been performed previously. Now, we aim at implementing the prototype into clinical application of monitoring patient treatments. Focused on this goal of translation into clinical operation, we systematically addressed remaining challenges and questions. We developed a robust energy calibration routine and corresponding quality assurance protocols...
November 21, 2016: Physics in Medicine and Biology
Patrizia Bonadonna, Massimiliano Bonifacio, Roberta Zanotti
Mastocytosis is a clonal disease characterized by proliferation and accumulation of mast cells (MC) in different tissues, preferentially skin and bone marrow, leading to a wide variety of clinical manifestations, mainly caused by the inappropriate release of MC mediators. As a consequence, patients with mastocytosis may experience symptoms due to massive MC activation and release of mediators. Anaphylaxis is the most frequent manifestation of this phenomenon.Drugs are possible triggers of anaphylaxis in patients with mastocytosis, even though the association between mastocytosis and drug anaphylaxis does not appear to be as strong as anaphylaxis after hymenoptera sting; nevertheless, MC disorders might be ruled out in cases of severe systemic reactions to drugs...
September 28, 2016: Current Pharmaceutical Design
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