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BackgroundAmbulance-based telemedicine is an innovative strategy through which transport time can be used to rapidly and accurately triage stroke patients (i.e., mobile telestroke). The acute phase of stroke is a time-sensitive emergency, and delays in care during this phase worsen outcomes. In this literature review, we analyzed studies that investigated the feasibility and reliability of ambulance based telestroke.MethodsWe followed PRISMA guidelines to perform a keyword-based search of PubMed, Web of Science, CINHAL, and Academic Search Complete databases. We reviewed references of search-identified articles to screen for additional articles. Articles for inclusion were selected according to author consensus in consideration of the studies' investigation of feasibility, reliability, or validity of ambulance-based telestroke.ResultsWe identified 67 articles for secondary screening from which 19 articles were selected for full text review. The selected studies reported diverse methods of development, implementation, and assessment of ambulance-based telestroke systems. Although the methods and results varied among these studies, most concluded that the implementation of ambulance based telestroke is feasible.ConclusionThis topical review suggests that ambulance based telestroke is a feasible method for enhanced prehospital stroke care in a variety of settings. Further prospective research is needed to assess the real-world challenges and to identify additional strategies that bolster rapid and accurate prehospital assessment of acute stroke patients.

New Zealand Herald cartoonist Malcolm Evans was dismissed from the newspaper after he refused to follow his editor's instruction to cease cartooning on the Israeli-Palestinian conflict. Members of the Jewish community were upset by a number of his cartoons, drawn during the first half of 2003. Evans is not alone among cartoonists to attract the anger of Jewish community lobbies and the hesitation of their editors when presenting cartoons dealing with the activities of the Israeli government. Cartoonists Tony Auth (Philadelphia Inquirer) and Michael Leunig (The Age) have also presented controversial cartoon commenting on the Israeli Government and, with Evans, defend their work on the grounds that while cartoons may offend an audience the content is not necessarily wrong. Cartoonists fiercely defend their licence to mock politicians, governments and states. This article examines this defence and the space within which cartoonists examine political subjects. We analyse the parameters within which mass circulation newspaper editors operate, principally in the Australian context. We defend a wide licence for cartoonists and argue that this licence represents an important measure of free speech in an era when the threat of terrorism looms large on national political agendas.

A letter to the editor is presented in response to an article on open heart surgery in the April 1986 issue.

Purpose: Young adult Latino testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion regulation Therapy (GET) to improve distress symptoms, goal navigation skills, and emotion regulation. This open pilot trial extended GET to Latino young adult survivors of testicular cancer and assessed feasibility and tolerability as well as changes in anxiety and depressive symptoms. Secondary outcomes included goal navigation, emotion regulation, and components of hope-related goal processes (i.e., agency and pathway mapping). To assess the extent to which GET is culturally congruent or in need of adaptation, the influence of simpatía and acculturative stress were also examined., Methods: Thirty-five eligible young adult (age 18-39) survivors treated with chemotherapy were enrolled and assessed at baseline. Study acceptability, tolerability, and therapeutic alliance were examined. Preliminary efficacy was evaluated for changes in anxiety and depressive symptoms as well as psychological processes (goal navigation, agency, goal pathway skill, and emotion regulation) from baseline to immediate post- and 3-month post-intervention., Results: Among the 35 men assessed at baseline, 54% initiated intervention sessions. Among these, 94.7% completed all study procedures. Helpfulness ratings of intervention components and therapeutic alliance scores were strong. Repeated measures ANOVA revealed significant reductions in anxiety and depressive symptoms from pre- to post-intervention with sustained change at the 3-month follow-up. Favorable patterns of change were also observed in GET-related psychological processes. Simpatía was associated with less depressive symptoms at post-intervention, but not change in anxiety. Acculturative stress was associated with increased anxiety and depressive symptoms over time., Conclusion: GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adult Latino men. Results should be considered preliminary but suggest meaningful changes in emotional and psychological outcomes., (© 2024. The Author(s).)

Purpose: This study investigated the correlates of well-being with psychosocial and clinical factors in young adult childhood cancer survivors (YACCS) above and beyond depressive symptoms., Methods: Participants were from the Project Forward Cohort, a population-based study of young adult survivors of childhood cancers. Participants (n = 1166, M age = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County). A majority received a diagnosis of leukemia (36.1%) or lymphoma (21.7%). Participants completed self-reported questionnaires at one timepoint. Multiple regression analyses were performed with well-being as the outcome variable and psychosocial and clinical variables (social support, sense of adulthood, posttraumatic growth, treatment intensity, and self-rated health) as the independent variables. Covariates included demographics (age, gender, relationship status, race/ethnicity) and depressive symptoms., Results: In the multivariable model, posttraumatic growth, social support, sense of adulthood, and self-rated health were significantly associated with well-being (all ps < .05), when controlling for depressive symptoms. Treatment intensity and years since diagnosis were not significantly associated with well-being, when controlling for depressive symptoms., Conclusions: There are unique correlates of well-being above and beyond depressive symptoms among YACCS. This finding illuminates individual differences that may be associated with well-being and provides targets for intervention., Implications for Cancer Survivors: Psychosocial interventions and survivorship care for YACCS should consider the broad aspects of well-being, independent of depressive symptoms., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The objective of the study was to compare outcomes of women with placenta accreta who underwent cesarean hysterectomy with and without prophylactic intravascular balloon catheters., Study Design: Case-control study of women at risk for placenta accreta identified using hospital databases and billing records from January 1995 to January 2006. Subjects with preoperative intravascular balloon catheter (BC) placement plus hysterectomy were compared with those that had hysterectomy alone., Results: Sixty-nine subjects had cesarean hysterectomy performed for placenta accreta; 19 subjects had balloon catheters plus hysterectomy and 50 subjects had hysterectomy alone. No significant differences were noted in estimated blood loss (P = .79), transfused blood products (P = .60), operative time (P = .85), and postoperative hospital days (P = .85). There were no significant differences in secondary outcomes between groups. Three of the 19 BC subjects (15.8%) had complications from catheter placement; 2 required stent placement and/or arterial bypass., Conclusion: Prophylactic intravascular balloon catheters did not benefit women with placenta accreta undergoing cesarean hysterectomy.

Advances in medicine have improved the delivery of health care, making it more technologically superior than ever and, at the same time, more complex. Nowhere is this more evident than in the surgical arena. Plastic surgeons are able to perform procedures safely in office-based facilities that were once reserved only for hospital operating rooms or ambulatory surgery centers. Performing procedures in the office is a convenience to both the surgeon and the patient. Some groups have challenged that performing plastic surgery procedures in an office-based facility compromises patient safety. Our study was done to determine whether outcomes are adversely affected by performing plastic surgery procedures in an accredited outpatient surgical center. A retrospective review was performed on 5316 consecutive cases completed between 1995 and 2000 at Dallas Day Surgical Center, Dallas, Texas, an outpatient surgical facility. Most cases were cosmetic procedures. All cases were analyzed for any potential morbidity or mortality. Complications requiring a return to the operating room were determined, as were infection rates. Events leading to inpatient hospitalization were also included. During this 6-year period, 35 complications (0.7 percent) and no deaths were reported. Most complications were secondary to hematoma formation (77 percent). The postoperative infection rate for patients requiring a return to the operating room was 0.11 percent. Seven patients required inpatient hospitalization following their procedure secondary to arrhythmias, angina, and pulmonary emboli. Patient safety must take precedence over cost and convenience. Any monetary savings or time gained is quickly lost if safety is compromised and complications are incurred. The safety profile of the outpatient facility must meet and even exceed that of the traditional hospital-based or ambulatory care facility. After reviewing our experience over the last 6 years that indicated few complications and no deaths, we continue to support the judicious use of accredited outpatient surgical facilities by board-certified plastic surgeons in the management of plastic surgery patients.

The objective of this study was to assess the quality of the medical contribution to patient records in a children's department. It was carried out in a tertiary level teaching hospital. A structured audit of 100 randomly selected case records, with independent observers using a grading system for 3 of the measures, was performed. The outcome provides a comparison with the hospital's guidelines for case histories and notes. The results of this study show inadequate documentation of basic information. Communication was hindered by poor hand writing and the use of abbreviations. Overall comprehension of the course of the patients' illnesses was regarded as only fair to average. Recording of diagnosis and initial plans of management were present in over 70% of records. While discharge information was well recorded, the recommendation for the duration of drug therapy was inadequate. Mediocre handwriting and poor documentation are still prevalent in medical records. Strict supervision of this important area of medical practice is mandatory.