No abstract available.

No abstract available.
Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Treatment Outcome* ; Biomarkers, Tumor*

Pattern diagnosis is an integral aspect of Chinese medicine (CM). CM differentiates biomedical diseases into patterns, based upon the patient's symptoms and signs. Pattern identification (PI) is used to diagnose, direct the treatment principle and determine the treatment protocol. Most CM research has used fixed formula treatments for Western-defined diseases with outcomes measured using objective biomedical markers. This article presents an innovative method used in a randomised controlled pilot study using acupuncture for participants with hepatitis C virus. Each participant's CM patterns were identified and quantified at baseline which directed the treatment protocol for the treatment group. Data identified that while each participant expressed different patterns at baseline all participants displayed multiple patterns. Six patterns showed some expression by all 16 participants; Liver (Gan) yin vacuity expressing a group aggregate mean percentage of 47.2, binding depression of Liver qi 46.9, and Liver Kidney (Shen) yin vacuity 45.1. Further sub category gender grouping revealed that pattern ranking changed with gender; Liver yin vacuity (male 53.4%, female 51.93%), binding depression of Liver qi (male 50.0%, female 42.86%) and Liver Kidney yin vacuity (male 42.9%, female 47.96%). The quantification of CM patterns described in this article permitted statistical evaluation of presenting CM patterns. Although this methodology is in its infancy it may have potential use in the integration of PI with rigorous evidence based clinical research. Biomedical markers often do not relate to symptom/signs and therefore this innovative measure may offer an additional CM evaluation methodology and further CM PI understanding.
Acupuncture Therapy ; Adult ; Biomedical Research ; Evidence-Based Medicine ; Female ; Hepacivirus ; physiology ; Hepatitis C ; therapy ; virology ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Pilot Projects ; Practice Patterns, Physicians' ; Randomized Controlled Trials as Topic

The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.

Background: Despite workplaces having policies on fire evacuation, many employees still fail to evacuate when there is a fire alarm. The Reasoned Action Approach is designed to reveal the beliefs underlying people's behavioral decisions and thus suggests causal determinants to be addressed with interventions designed to facilitate behavior. This study is a uses a Reasoned Action Approach salient belief elicitation to identify university employees' perceived advantages/disadvantages, approvers/disapprovers, and facilitators/barriers toward them leaving the office building immediately the next time they hear a fire alarm at work. Methods: Employees at a large public United States Midwestern university completed an online cross-sectional survey. A descriptive analysis of the demographic and background variables was completed, and a six-step inductive content analysis of the open-ended responses was conducted to identify beliefs about leaving during a fire alarm. Results: Regarding consequence, participants perceived that immediately leaving during a fire alarm at work had more disadvantages than advantages, such as low risk perception. Regarding referents, supervisors and coworkers were significant approvers with intention to leave immediately. None of the perceived advantages were significant with intention. Participants listed access and risk perception as significant circumstances with the intention to evacuate immediately. Conclusion Norms and risk perceptions are key determinants that may influence employees to evacuate immediately during a fire alarm at work. Normative-based and attitude-based interventions may prove effective in increasing the fire safety practices of employees.

Methods: This is a retrospective case series of patients who underwent TKA after IMN fixation of tibial fractures.Patient and case data, including need for hardware removal, staged vs non-staged procedures, operative time, and need for revision implants, were recorded. Postoperative data, including complications and revision, were recorded.Oxford Knee Score (OKS) was performed at follow-up. Results: Nine patients were identified consisting of eight women and one man. Follow-up ranged from 0.8–13 years. Non-staged removal of the intramedullary hardware occurred in three cases that had increased operative lengths recorded. There were no complications related to wound healing or infection. No patients required revision.Two of the three patients who underwent non-staged TKA developed arthrofibrosis requiring manipulation. OKS scores in patients who underwent non-staged surgery were consistently low. Conclusions Conversion TKA after tibial IMN fixation can result in satisfying outcomes in many patients. However, intramedullary hardware presents challenges to TKA similar to more extensively studied conversion TKA scenarios.Removing hardware in either a staged or non-staged fashion results in increased resource utilization and imparts perioperative challenges with only theoretical benefits of one approach compared to the other. Increased stiffness may be associated with a non-staged approach to hardware removal and TKA. Several technical factors may permit component positioning without removal of hardware. Despite limitations, this is the first series to discuss this challenging clinical scenario and provides surgeons with technical guidance and data on operative outcomes.

BACKGROUND: Numerous medical conditions require timely medication administration in the emergency department (ED). Automated dispensing systems (ADSs) store premixed common doses at the point-of-care to minimize time to administration, but the use of such automation to improved time to medication administration has not been studied. Since vancomycin is a commonly used empiric antimicrobial, we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED. The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness.METHODS: The institional review board approved the retrospective quality improvement study took place in a single, urban academic tertiary care ED with an annual census of 80000. Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30, 2008 and the same time period in 2009. The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness.RESULTS: Sixty-three patients had weight and dosing information available (29 before and 34 after intervention) and were included in the study. Before intervention, no patient received vancomycin in less than 60 minutes, while after intervention 14.7％ of the patients received it in less than 60 minutes (difference in proportions 14.7％, 95％ CI 0.39％-30.0％, P=0.04). A similar proportion of the patients received correct dosing before and after intervention (44.8％ vs. 41.2％, difference in proportions 3.7％, 95％ CI -20.0％-26.7％, P=0.770).CONCLUSION: The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.