Medicine and Health Sciences Commons^™

Emergency Medical Services Transport Delays For Suspected Stroke And Myocardial Infarction Patients, Ashley Pedigo Golden, Agricola Odoi

Agricola Odoi

Background: Prehospital delays in receiving emergency care for suspected stroke and myocardial infarction (MI) patients have significant impacts on health outcomes. Use of Emergency Medical Services (EMS) has been shown to reduce these delays. However, disparities in EMS transport delays are thought to exist. Therefore the objective of this study was to investigate and identify disparities in EMS transport times for suspected stroke and MI patients. Methods: Over 3,900 records of suspected stroke and MI patients, reported during 2006–2009, were obtained from two EMS agencies (EMS 1 & EMS 2) in Tennessee. Summary statistics of transport time intervals were computed. …

Evaluation Of Protein-Energy Wasting And Inflammation On Patients Undergoing Continuous Ambulatory Peritoneal Dialysis And Its Correlations, Venkatramanan Krishnamoorthy, Sham Sunder, Himansu Sekhar Mahapatra, Himanshu Verma, Neera Sharma, Rajesh Jayaraman, Satyanand Sathi, Shikha Khanna, Ashik Mohamed

Ashik Mohamed

No abstract provided.

Milna Bubur Bayi Organik, Mpasi Terbaik Untuk Si Kecil, Rosdiana Diana Basri

Rosdiana Diana Basri

Bunda memerlukan informasi tentang makanan pendamping ASI yang tepat untuk Si Kecil? Anda sedang membaca informasi yang benar, dan kami sarankan untuk memilih Milna Bubur Bayi Organik, MPASI Terbaik Untuk Si Kecil, Mengapa? Baca lebih lanjut yuk ...!

Is It A Rheumatological Disease?, Richard A. Pascucci

Richard A. Pascucci

No abstract provided.

Health Benefits Of Endurance Training Alone Or Combined With Diet For Obese Patients Over 60: A Review, Walid Bouaziz

Walid Bouaziz

The prevalence of obesity is rapidly increasing in older patients and it is ubiquitous in many developed countries. Obesity is related to various negative health outcomes, making it a major public health target for intervention. The aim of this study was to explore and summarise the literature that addresses endurance training alone or combined with nutrition interventions to combat obesity in obese patients over age 60. We searched online electronic databases up to September 2014 for original observational and intervention studies published between 1995 and 2014 on the relationship between endurance training alone or combined with a diet in obese …

Rheumatologic Considerations In The Geriatric Patient, Richard A. Pascucci

Richard A. Pascucci

No abstract provided.

Multimodal Secondary Prevention Behavioral Interventions For Tia And Stroke: A Systematic Review And Meta-Analysis., Maggie Lawrence

Dr. Maggie Lawrence

Background Guidelines recommend implementation of multimodal interventions to help prevent recurrent TIA/stroke. We undertook a systematic review to assess the effectiveness of behavioral secondary prevention interventions.

Strategy Searches were conducted in 14 databases, including MEDLINE (1980-January 2014). We included randomized controlled trials (RCTs) testing multimodal interventions against usual care/modified usual care. All review processes were conducted in accordance with Cochrane guidelines.

Results Twenty-three papers reporting 20 RCTs (6,373 participants) of a range of multimodal behavioral interventions were included. Methodological quality was generally low. Meta-analyses were possible for physiological, lifestyle, psychosocial and mortality/recurrence outcomes. Note: all reported confidence intervals are 95%. …

Bystander Performance Using Automated External Defibrillators During Simulated Cardiac Arrest, Richard N. Bradley, Lynda M. Schoenstein, Wesley H. Hamilton, Mark R. Boyle

Richard N Bradley

Objective: Automated external defibrillators (AEDs) are becoming widely available to the public. This study examined the hypothesis that less than 75% of the general population can defibrillate using an AED in less than three minutes.

Methods: This was a survey of the behavior of individuals over age 12 in a major airport on Jan. 2–3, 2003. After obtaining consent, an investigator told the subject that he/she was walking down the concourse and saw a person collapse. The subject demonstrated his/her response, using only a telephone and an AED simulating ventricular fibrillation. Data were analyzed using a one-sample test of proportions. …

Harris Health System Ems Protocols And Standing Delegation Orders, Richard N. Bradley

Richard N Bradley

As the EMS Medical Director for Harris Health System-EMS, I have approved these Protocols and Standing Delegation Orders to provide a treatment plan for the various types of injuries and illnesses that may commonly occur. These Protocols and Standing Delegation Orders are not intended to replace on-line Medical Control by a qualified physician, but rather to provide standing orders for specific interventions prior to the point that establishing control with a qualified physician becomes mandatory.

Authorized personnel are those basic and/or advanced life support trained HARRIS HEALTH SYSTEM-EMS personnel who have been approved in writing by the Medical Director in …

American Red Cross Sac Advisory On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

American Red Cross Scientific Review On Obstructed Airway-Adults, Richard N. Bradley, Stamatios Lerakis

Richard N Bradley

INTRODUCTION: There were 4,700 deaths due to choking in the United States in 2012. This study was a structured literature review with the objective of determining whether in adults, either conscious or unconscious, with acute foreign body airway obstructions, if any specific resuscitation technique, compared to other techniques, leads to different outcomes.

METHODS: We developed an a priori search definition, and searched PubMed, Google, and OneSearch@IU. We sought additional articles by reviewing the reference lists of articles that we included. We included articles if they addressed original research of treatment of foreign body airway obstruction in adults. We excluded articles …

Personalizing Attribution Of Adverse Events In Phase I Oncology Studies, Alexia Iasonos, John O'Quigley

Alexia Iasonos

Background: In Phase I trials, attribution of adverse events (AE) is a complicated process. The current endpoint of dose limiting toxicity (DLT) assumes attribution is known. Such a simplified endpoint ignores individual-specific or drug-specific information. We propose an approach that allows for personalized scores that account for the uncertainty in AE attribution. Methods: The proposed design takes into account possible errors when attributing AE and allows investigators to explicitly express their degree of uncertainty in whether any AE is drug-related or disease-related. A score of 100% means that the AE is certainly drug-related, whereas a score of 0% means that …

Treatment Of Ebola Virus Disease., Paul E. Kilgore, Jd Grabenstein, Am Salim, M Rybak

Paul E. Kilgore

In March 2014, the largest Ebola outbreak in history exploded across West Africa. As of November 14, 2014, the World Health Organization has reported a total of 21,296 Ebola virus disease (EVD) cases, including 13,427 laboratory-confirmed EVD cases reported from the three most affected countries (Guinea, Liberia, and Sierra Leone). As the outbreak of EVD has spread, clinical disease severity and national EVD case-fatality rates have remained high (21.2-60.8%). Prior to 2013, several EVD outbreaks were controlled by using routine public health interventions; however, the widespread nature of the current EVD outbreak as well as cultural practices in the affected …

Role Of Imaging In Rhinology, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

This E book discusses the role of imaging in rhinology. Since this book has been authored by an otolaryngologist it goes without saying that a surgeon's perspective will be evident throughout the book. It contains about 250 CT scan images with succinct description.

Community Health Worker Interventions For Latinos With Type 2 Diabetes: A Systematic Review Of Randomized Controlled Trials, Tariana V. Little, Monica L. Wang, Eida M. Castro, Julio Jiménez, Milagros C. Rosal

Tariana V. Little

This systematic review aimed to synthesize glucose (HbA1c) outcomes of community health worker (CHW)-delivered interventions for Latinos with type 2 diabetes that were tested in randomized controlled trials and to summarize characteristics of the targeted populations and interventions, including the background, training, and supervision of the CHWs. Searches of PubMed and Google Scholar databases and references from selected articles identified 12 studies that met the inclusion criteria. Of these, seven reported statistically significant improvements in HbA1c. Study participants were largely low-income, female, and Spanish-speaking and had uncontrolled diabetes. The CHWs led the interventions alone, in pairs, or as part of …

Cavernous Hemangioma Uvula An Interesting Case Report And Review Of Literature, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Elongated uvula is mostly asymptomatic. In rare instances it may be come symptomatic. This article discusses a patient who presented with intractable cough due to cavernous hemangioma involving uvula. Uvula in this patient was found to be in contact with the posterior portion of the tongue. This case is being presented for its rarity.

Odontogenic Keratocyst Mandible An Interesting Case Report And Literature Review, Balasubramanian Thiagarajan, Geetha Ramamoorthy

Balasubramanian Thiagarajan

The term odontogenic keratocyst was first described by Philipsen in 1956. This cyst actually arises from the cell rests of dental lamina. It can occur anywhere in the jaw but is commonly seen in the posterior part of the mandible. Since the clinical features and radiological appearance are not characteristic this condition is commonly misdiagnosed. This is more so when the lesion is related to the nonvital tooth. Odontogenic keratocyst has been rechristened as keratocystic odontogenic tumor by WHO working group in 2005. This was necessitated to differentiate this lesion from its orthokeratinizing variant which is currently considered as odontogenic …

Subperiosteal Hematoma Of Orbit An Interesting Case Report And Review Of Literature, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Subperiosteal Hematoma orbit is an uncommon disorder which may occur following injury to orbit. Of course there are other causes that cause this condition as well. This condition has been reported in young adults. This case report discusses a patient who developed subperiosteal hematoma following trivial injury to orbit. Since this condition had occurred following trivial injury to orbit diagnosis was not made pre operatively. It was discovered only on the table. A high index of suspicion and an accurate history is necessary to identify this condition. This case is being reported not only for its rarity but also to …

Endoscopic Orbital Decompression, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Orbital decompression surgery has been indicated in patients with compressive optic neuropathy, severe corneal exposure, cosmetic deformity due to proptosis. Traditional orbital decompression approaches were fraught with complications. With the advent of nasal endoscopes decompression is being carried out transnasally under endoscopic guidance. The entire medial wall of orbit can be taken down transnasally using nasal endoscope, and the inferior wall of orbit can be removed using the same approach. Currently endoscopic orbital decompression is being preformed commonly with very minimal complications. The aim of this paper is to review the current literature on the subject.

Orbital Complications Of Sinusitis A Review, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Introduction: Despite availability of excellent antibiotics, orbital complications’ following sinusitis is rather common. With the emergence of fungal sinusitis orbital involvement by the disease is getting frequent. Prevalence of life style disorders like diabetes mellitus has added to the woes. This article attempts to review the entire gamut of orbital complications following sinus infections. Aim: This study aims at analyzing orbital complications following sinusitis at Government Stanley Medical College Hospital during the period 2009 – 2013. Study design: Retrospective study Methodology: Cases with rhinosinusitis treated in our Institution during the period 2009-2013 were taken up for analysis. 112 patients were …

Patterns Of Orbital Disorders, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

This article discusses various patterns of presentations of orbital lesions. Since this article has been authored by an otolaryngologist, the entire concept has been viewed from otolaryngologist's angle. With the advent of nasal endoscope trans nasal access to orbit is becoming the order of the day. Major advantage being that external skin incision is avoided.

Laying The Tears Highway- A Drive Through Endo-Dcr, Balasubramanian Thiagarajan, Srikamakshi Kothandaraman

Balasubramanian Thiagarajan

This article is an attempt to review the technique of Dacryocystorhinostomy in the treatment of epiphora and bring to light the various modifications that have been developed in recent times to refine the procedure and optimize the outcome of surgery.

Ultrasound-Guided Interscalene-Supraclavicular Block For An Intramedullary Nailing Of A Pathologic Humeral Fracture: Practical Application Of Ultrasound-Guided Regional Anesthesia, Christian Falyar

Christian R Falyar

Fractures of the proximal upper extremity present a challenge to the anesthesia provider when administering a regional anesthetic because the dermatomal distribution of the upper extremity requires more local anesthetic coverage than any single brachial plexus nerve block can provide. A 60-year-old woman underwent intramedullary nailing of a pathologic humeral fracture using a combination of regional and general anesthesia. This case study shows how ultrasound guidance permitted the performance of both an interscalene and supraclavicular nerve block for a single procedure without the increased volume of local anesthetic that would normally be required, while still providing complete coverage of the …

Dose Expansion Cohorts In Phase I Trials, Alexia Iasonos, John O'Quigley

Alexia Iasonos

A rapidly increasing number of Phase I dose-finding studies, and in particular those based on the standard 3+3 design, frequently prolong the study and include dose expansion cohorts (DEC) with the goal to better characterize the toxicity profiles of experimental agents and to study disease specific cohorts. These trials consist of two phases: the usual dose escalation phase that aims to establish the maximum tolerated dose (MTD) and the dose expansion phase that accrues additional patients, often with different eligibility criteria, and where additional information is being collected. Current protocols typically do not specify whether the MTD will be updated …

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar Mbbs, Fcps, Syed Ather Enam Md, Phd, Frcs, Facs

Muhammad Babar Khan

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.

Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …

Catastrophic Incident Search And Rescue Lessons From The 2013 Colorado Floods, Thomas Miner, Richard N. Bradley

Richard N Bradley

The response to the Colorado floods is a textbook example of how to respond to catastrophic disasters Responders from hundreds of different organizations came together to form a single coordinated, unified command structure that resulted in the rapid and effective evacuation and rescue of hundreds of people in just three days. Local responders performed hundreds of highly dangerous rescues during the height of the storm. They established incident command at the county level using type 3 incident command teams. When they realized they were facing an unprecedented storm with catastrophic damage they asked for help and state and federal responders …

My Cv (2014), Hossein Gholizadeh

Hossein Gholizadeh

No abstract provided.

Presbyacusis A Review, Balasubramanian Thiagarajan

Balasubramanian Thiagarajan

Life expectancy of Humans is on the rise. World’s human population is aging rapidly. According to a report of US census Bureau nearly 24% of current world population is above the age of 50. This is a phenomenal number. Hearing loss due to degenerative process is rather common in old age. Presbyacusis is defined as a progressive bilateral symmetrical age related sensorineural hearing loss. The hearing loss is confined to higher frequencies. This causes a greater burden on them considering the fact that they already have failing eyesight. This article attempts to review the current scenario pertaining to Presbyacusis with …

Obstetric Emergencies, Si Lay Khaing

Khaing Si Lay

Life Saving, The obstetric patient is unique in medicine as two or more lives are involved with the challenge of needing to balance the sometimes conflicting interests of the mother and her fetus within a pregnant physiology.

Mutational Falsetto: A Panoramic Consideration, Balasubramanian Thiagarajan, Srikamakshi Kothandaraman

Balasubramanian Thiagarajan

This article is intended to present everything that is known about puberphonia in a comprehensive yet concise manner. The evolution of the approach and attitude to its treatment from ancient concepts to recent trends is highlighted.