Craniosynostosis has a varied clinical spectrum, ranging from isolated single suture involvement to multi-sutural fusions. Greater understanding of the pathogenesis of craniosynostosis has led to the development of practical treatment protocols. Three stages of growth have determined the approach to managing craniosynostosis : the early period, up to 12 months; the intermediate period, from 1 to 10 years; and the late period, beginning at 10 years. This review discusses current surgical management and future perspectives in craniosynostosis.
Clinical Protocols ; Craniosynostoses* ; Neurosurgery ; Sutures

No abstract available.
Clinical Protocols* ; Temporomandibular Joint Disorders*

PURPOSE: To present our treatment protocol and surgical outcome for patients with congenital brachymetatarsia in which treatment was decided according to the number of affected rays. MATERIALS AND METHODS: Sixty-nine metatarsals in 44 patients with single or multiple congenital brachymetatarsia were included in the study. When a single ray was affected in a foot, we performed a one-stage lengthening using an intercalary autogenous iliac bone graft. We overcame excessively short rays by the double level lengthening at the metatarsal and proximal phalanx as one stage. When multiple rays were affected in one foot, we performed a one-stage combined shortening and lengthening procedure without an iliac bone graft. RESULTS: All patients were satisfied with the cosmetic and functional results. The average length gain by one-stage lengthening in 56 metatarsals of 38 patients was 14 (6-21) mm. Six patients with a combined shortening and lengthening procedure regained a nearly normal parabola of the involved foot. Neurovascular complication was not identified. CONCLUSION: Satisfactory results were achieved for the treatment of patients with congenital brachymetatarsia, by individualizing the surgical options according to the number of affected rays and general foot appearance.
Clinical Protocols ; Foot ; Humans ; Metatarsal Bones ; Transplants

Medical internal radiation dosimetry (MIRD) is an important part of nuclear medicine research field using therapeutic radioisotope. There have been many researches using MIRD for the development of new therapeutic approaches including radiopharmaceutical, clinical protocol, and imaging techniques. Recently, radionuclide therapy has been re-focused as new solution of intractable diseases, through to the advances of previous achievements. In this article, the basic concepts of radiation and internal radiation dosimetry are summarized to help understanding MIRD and its application to clinical application.
Achievement ; Clinical Protocols ; Nuclear Medicine ; Radiometry

The dispatch life support(DLS) copes with the emergent situations with the pre-arrival instructions. The instructions are made based on the logical branch which simulates and reflects the knowledge and decision processes of the emergency medical dispatcher. The present practice of the emergency fire-fighting offices in our country is such that the identification of the emergency caller and other administrative affairs are principal, and there is not any systematic standard medical instruction by use of communications system. The emergency medical system(EMS) is defined as the integrated system which can provide the emergency patients with the proper supports with a timely manner and it is essential to construct the emergency medical communication system which connects the patient with all the people involved in the situation. This study focuses on development of the basic DLS model in the emergency communication model. The model comprises of the systematic and standard instructions which can be used for the recovery of the emergency patient. 32 AMPDS, one items of the Heart! Respiratory Arrest are selected, and the communication treatment protocols are prepared for development of DSL model for this items. The DSL will help the communications between the patients and emergency medical dispatchers, and will make the medical dispatcher control the situation by providing a patient with medical instructions before his arrival.
Clinical Protocols ; Emergencies* ; Heart ; Humans ; Logic

Despite the increasing number of osteochondral lesions of the talus, there are a lack of definite evidence-based treatment protocols. Several types of treatments are available, each having their advantages and disadvantages. First-line therapy consists of well-conducted conservative treatment. Surgical treatment is the second choice. Treatments are chosen based on the size of the lesion, location, chronicity, and the condition of the neighboring cartilage. This article reviews the current updates in the treatment of osteochondral lesions of the talus to help clinicians use the available treatment strategies more efficiently.
Cartilage ; Chondrocytes ; Clinical Protocols ; Joints ; Talus

Benign paroxysmal positioning vertigo (BPPV) is the most common disease that causes dizziness which is usually resolved spontaneously or by office-based physical therapy. However, clinicians sometimes encounter atypical or intractable BPPV cases which show poor effect with physical therapy including canalith reposition therapy and liberative maneuvers and frequent recurrence. There is no common definition, diagnosis and treatment protocols for intractable BPPV. Various types of intractable BPPV and reported treatment methods are discussed in this review.
Clinical Protocols ; Diagnosis ; Dizziness ; Recurrence ; Vertigo

Sudden sensorineural hearing loss is an emergent disease in otologic field. Because the etiology and pathological mechanism were not proven yet, treatment protocol was not established. Therefore, medications, duration, and dosage were different from each institute. In this review, authors collected and analyzed articles on sudden sensorineural hearing loss published during recent 11 years. From those, we described the recommendations on the criteria and method of diagnosis, tools for treatment and their results, and guideline for reporting results and follow up.
Audiometry ; Clinical Protocols ; Hearing Loss, Sensorineural ; Prognosis

BACKGROUNDEffective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials (RCTs) support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown.

METHODS/DESIGNIn partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco's Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to: (1) assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and (2) evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a two-month pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders.

DISCUSSIONEffectiveness research in "real-world" practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide clinical acupuncture services and maintain a rigorous research design, practice-based trials of acupuncture require careful planning and attention to setting-specific, contextual factors.

TRIAL REGISTRATIONThis trial has been registered in ClinicalTrials.gov. The identifier is NCT01988194, registered on November 5, 2013.

BACKGROUNDSpring water therapies have been used since at least 1550 BC. Despite the growing body of evidence supporting these therapies for a range of conditions, including musculoskeletal, dermatological, respiratory and cardiovascular conditions, they do not currently form part of mainstream healthcare in many countries. The protocol established in this paper aims to support systematic reviews that examine the health outcomes associated with human exposure to regional spring waters, using the Australia and New Zealand context as a case study.

METHODS/DESIGNThe protocol searches for studies in eight health/medical databases, searches three local health/medical journals, and includes forwards and backwards searching. Standard systematic review methods are used including: specifying pre-determined inclusion criteria and data management plans, appraising the studies for bias, and allocation to a hierarchy of evidence.

DISCUSSIONThe protocol supports a review and comprehensive synthesis of the current evidence regarding the health effects of natural spring water, and can be adapted for reviews in other regions. From this evidence, recommendations regarding practice and future research can be made on the therapeutic role of spring water.