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Managing Patient Flow: Is High Hospital Occupancy A Root Cause Of Ambulance Diversion?, Paris B. Lovett

Paris B Lovett

Inefficient patient flow through an

emergency department (ED) causes

long wait times, reduced patient satisfaction,

and increased walkouts (that is,

leaving without being seen, or LWBS).

Ste Sidebar 1 on page 5 for a look at

related Joint Commission requirements.

Poor patient flow may also lead to ambulance diversion- a request by an attending physician for ambulances to transport patients to other hospitals (while continuing to accept walk-in patients). EDs may go on ambulance diversion when they reach a critical state in which the volume of patients exceeds its capacity to see and treat them.

Stuart E. Greene, M.B.A., Paris …

Elsa-Brasil: Historico [In Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Vigilância Em Doença Cerebrovascular [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Mcnamara 2011 Mpmicro - Multi-Probe Microscopy (10/31/2011), George Mcnamara

George McNamara

Multi-Probe Microscopy is an ~1500 page Word document summarizing what I know and/or found interesting in light microscopy, fluorescence microscopy and digital image analysis, from 1995-2005. Very little has been updated since 2005.

Proliferation Of Acid-Secretory Cells In The Kidney During Adaptive Remodelling Of The Collecting Duct, Desa Welsh-Bacic, Marta Nowik, Brigitte Kaissling, Carsten A. Wagner

Desa Welsh

The renal collecting duct adapts to changes in acid-base metabolism by remodelling and altering the relative number of acid or alkali secreting cells, a phenomenon termed plasticity. Acid secretory A intercalated cells (A-IC) express apical H+-ATPases and basolateral bicarbonate exchanger AE1 whereas bicarbonate secretory B intercalated cells (B-IC) express basolateral (and apical) H+-ATPases and the apical bicarbonate exchanger pendrin. Intercalated cells were thought to be terminally differentiated and unable to proliferate. However, a recent report in mouse kidney suggested that intercalated cells may proliferate and that this process is in part dependent on GDF-15. Here we extend these observations to …

Orbital Disorders, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Introduction: The effects caused by orbital diseases are governed by: 1. Pathophysiology of the disease process 2. Anatomic pattern of involvement (location of the lesion). This is more evident from the fact that small tumors of orbital apex causes early symptoms due to involvement of 2,3,4,5 and 6th cranial nerves. These patients will also manifest with progressive vision loss during early course of the lesion. Laterally placed orbital Meningiomas cause features of superior orbital syndrome which could manifest before or along with loss of visual acuity.

A Reappraisal Of Stroke Mortality Trends In Brazil (1979 To 2009), Paulo A. Lotufo

Paulo A Lotufo

Background: Brazil has the highest cerebrovascular death rate in the Western Hemisphere. We investigated temporal trends according to gender and stroke subtypes. Methods: We analysed mortality rates between 1979 and 2009 for different stroke subtypes. Data were stratified by sex and age (35–74 y). The annual percent change (APC) and significant changes in the trends were identified with joinpoint Poisson regression. The average annual percent change (AAPC) for 2005-09 was presented because that period had the best quality of information. Results: After excluding deaths due to stroke sequels, for men, the APCs (95% confidence intervals) were: 1979-84: 0.7 (-0.8 to …

The Effect Of Midazolam On End-Tidal Concentration Of Isoflurane Necessary To Prevent Movements In Dogs, Reza Seddighi Dvm, Ms, Phd, Dip Acva

Reza Seddighi

Objective To determine the possible additive effect of midazolam, a GABAA agonist, on the end-tidal concentration of isoflurane that prevents movement (MACNM) in response to noxious stimulation. Study design Randomized crossover experimental study. Animals Six, healthy, adult intact male, mixed-breed dogs. Methods After baseline isoflurane MACNM (MACNM-B) determination, midazolam was administered as a low (LDS), medium (MDS) or high (HDS) dose series of midazolam. Each series consisted of two dose levels, low and high. The LDS was a loading dose (Ld) of 0.2 mg kg-1 and CRI (2.5 μg kg-1 minute-1) (LDL), followed by an Ld (0.4 mg kg-1) and …

A Preliminary Study Comparing The Use Of Allogenic Chondrogenic Pre-Differentiated And Undifferentiated Mesenchymal Stem Cells For The Repair Of Full Thickness Articular Cartilage Defects In Rabbits, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Chondrogenic differentiated mesenchymal stem cells (CMSCs) have been shown to produce superior chondrogenic expression markers in vitro. However, the use of these cells in vivo has not been fully explored. In this study, in vivo assessment of cartilage repair potential between allogenic-derived chondrogenic pre-differentiated mesenchymal stem cells and undifferentiated MSCs (MSCs) were compared. Bilateral full thickness cartilage defects were created on the medial femoral condyles of 12 rabbits (n = 12). Rabbits were divided into two groups. In one group, the defects in the right knees were repaired using alginate encapsulated MSCs while in the second group, CMSCs were used. …

Breast Cancer In A Multi-Ethnic Asian Setting: Results From The Singapore-Malaysia Hospital-Based Breast Cancer Registry, Awang Bulgiba

Awang Bulgiba Awang Mahmud

Two hospital-based breast cancer databases (University Malaya Medical Center, Malaysia [n = 1513] and National University Hospital, Singapore [n = 2545]) were merged into a regional registry of breast cancer patients diagnosed between 1990 and 2007. A review of the data found 51% of patients diagnosed before the age of 50 years. and 72% percent of the women were Chinese followed by Malays (16%), Indians (8%), and other races (4%). Median tumor size at presentation was 26 mm and about 25% of patients presented with TNM stage III or IV disease. Most tumors were of ductal histology (87%). Fifty-seven percent …

Meniere’S Disease Second Edition Incorporating Recent Advances, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

In late 19th century Prosper Meniere described a condition characterized by ear block, tinnitus, and vertigo. He even correctly identified the site of lesion to be labyrinth. It wont be a understatement to say that precious little has been added to the knowledge and understanding of the disorder since then. Prosper Meniere infact lived far ahead of his time. He was born in 1799 in France. In 1848 he began to translate the text book on hearing loss authored by Kramer. The book was written in German. This kindled his interest in otology.

Platelet-Rich Plasma (Prp) Enhances Bone Healing In Non-United Critical-Sized Defects: A Preliminary Study Involving Rabbit Models, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Introduction: The use of bone grafts in treating non- or delayed unions as the result of large bone loss is well established. However, despite good outcomes, the time to achieve complete union is still considerably long. To overcome this problem, the use of platelet-rich plasma (PRP) has been advocated albeit with varying success. To determine the true effectiveness of PRP in treating non-/delayed unions, a study was conducted using (n = 12) rabbit models. Methods and materials: Critical-sized defects measuring 2 cm created in the midshaft of the right rabbit tibias were stabilised using 2.7-mm small fragment plates. A spacer …

Predictors Of 3-Month Abstinence In Smokers Attending Stop-Smoking Clinics In Malaysia, Awang Bulgiba

Awang Bulgiba Awang Mahmud

Introduction: Much is known about the predictors of success in quitting smoking. In particular, nicotine dependence, but not strength of motivation to stop, appears to predict abstinence. However, to date, studies have come almost exclusively from Western countries. More data are needed on the cross-cultural generalizability of these findings. Methods: One hundred and ninety-eight smokers attending 5 stop-smoking clinics in Malaysia completed a questionnaire prior to their target quit date and were followed up 3 months after this date. Predictors included sociodemographic variables, smoking patterns, past history of quitting, characteristics of current quit attempt, and smoking motives as well as …

Environmental Toxins: Biological, Chemical And Radiological Terrorism, Richard N. Bradley

Richard N Bradley

Children have greater risk of harm than adults after exposure to chemical, biological or radiological weapons, as may be seen following some acts of terrorism. This chapter reviews potential chemical agents, separating them into four categories: nerve agents, blister agents, cyanides, and choking agents. It reviews both recognition and treatment. The chapter also reviews symptoms, modes of transmission and treatment for the following biological agents: smallpox, plague, tularemia, anthrax, botulism, and viral hemorrhagic fevers.

Prevalence Of Thyroid Disorders Among Older People: Results From The São Paulo Ageing & Health Study, Paulo A. Lotufo

Paulo A Lotufo

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1) [women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; …

Clinical Subjectivation: Anthropologies Of Contemporary Biomedical Training., Seth M. Holmes Phd, Md, Angela C. Jenks Phd, Scott Stonington Phd, Md

Seth M. Holmes PhD, MD

No abstract provided.

En-Case-Ing The Patient: Disciplining Uncertainty In Medical Student Patient Presentations., Seth M. Holmes Phd, Md, Maya Ponte Phd, Md

Seth M. Holmes PhD, MD

The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant obser- vation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as …

Anthropology And Its Contact Zones., Seth M. Holmes Phd, Md

Seth M. Holmes PhD, MD

No abstract provided.

Structural Vulnerability And Hierarchies Of Ethnicity And Citizenship On The Farm., Seth M. Holmes Phd, Md

Seth M. Holmes PhD, MD

Every year, the United States employs nearly two million seasonal farm laborers, approximately half of whom are migrants (Rothenberg 1998). This article utilizes one year of participant observation on a berry farm in Washington State to analyze hierarchies of ethnicity and citizenship, structural vulnerability, and health disparities in agriculture in the United States. The farm labor structure is organized along a segregated continuum from US citizen Anglo-American to US citizen Latino, undocumented mestizo Mexican to undocumented indigenous Mexican. The ethnography shows how this structure symbolically reinforces conflations of race with perceptions of civilized and modern subjects. These hierarchies produce what …

A Preliminary Study Of The Effects Of Glucosamine Sulphate And Chondroitin Sulphate On Surgically Treated And Untreated Focal Cartilage Damage, Tunku Kamarul Zaman

Tunku Kamarul Zaman

The effects of Glucosamine Sulphate (GS) and Chondroitin Sulphate (CS) on the healing of damaged and repaired articular cartilage were investigated. This study was conducted using 18 New Zealand white rabbits as experimental models. Focal cartilage defects, surgically created in the medial femoral condyle, were either treated by means of autologous chondrocyte implantation (ACI) or left untreated as controls. Rabbits were then divided into groups which received either GS+/-CS or no pharmacotherapy. Three rabbits from each group were sacrificed at 12 and 24 weeks post-surgery. Knees dissected from rabbits were then evaluated using gross quantification of repair tissue, glycosaminoglycan (GAG) …