Search

IntroductionPatient numbers in paediatric emergency departments (PED) are steadily increasing. Parental perception of waiting time and reasons for attending a PED with non-emergencies have been investigated in the UK, Australia, Korea, Canada and the USA. We sought to examine which factors influence parental satisfaction with waiting time in a tertiary Swiss PED and whether these differed from other countries.MethodsPaper surveys were administered to parents of children presenting to our interdisciplinary PED from February to May 2015. Primary outcome was parental satisfaction with waiting time, secondary outcomes were satisfaction with treatment, parental reasons for presentation with non-emergencies, parental perception of times to triage, first physician contact and disposition from ED, level of physician training, understanding of various anticrowding strategies and comparison of perceived and true waiting times to triage and physician contact.Results739 out of 750 surveys were returned (57 complete, 298 with 1 or 2 missing answers). Satisfaction with waiting time (on a 5-point-Likert-scale; 1 being the best possible answer) was higher in groups with shorter waiting time until triage (+0.41, p=0.001), first physician contact (+1.43, pConclusionTo counteract parental dissatisfaction associated with waiting time, we suggest the implementation of feasible measures including entertainment while waiting, early first medical review and timely discharge from the PED.

The Macedonian Society for Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) was established on September 1, 1992 in order to stimulate the development of nephrology and to unite experts from all professions interested in the research and treatment of kidney patients. Momir H. Polenakovic was elected President of MSNDTAO. The First congress of MSNTAO was held in Ohrid from October, 7 to 10, 1993 in hotel “Desaret” under the auspices of the first President of R. Macedonia, Kiro Gligorov. During the Congress, the Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was formed on October 9, 1993. The idea of cooperation with the Department of Nephrology from the Ege University, Izmir, R. Turkey was promoted. Some of the presented papers were published in the Proceedings “Nephrology ’93” as a supplement to the Macedonian medical review. The “Doctrine for performing nephrological activity in the Republic of Macedonia” was also promoted. The Second congress of MSNDTAO was held in Struga, R. Macedonia from September, 6 to 10, 1997 together with the Second BANTAO Congress. Selected papers were printed in the Macedonian Medical Review. The Third congress of MSNDTAO was held from May, 30 to June 2, 2001 in Skopje, at the Macedonian Academy of Sciences and Arts (MASA). Proceedings of papers was also published. In 2011 M. H. Polenakovic was elected Honorary President of MSNDTAO for life, and Goce Spasovski was elected the current President of MSNDTAO. The Fourth congress of MSNDTAO was held in Ohrid from June, 21 to 24, 2012 together with the Fourth Meeting of the South-Eastern European Pediatric Nephrology Working Group (SEEPNWG). The Fifth congress of MSNDTAO was held from June, 9 to 12, 2016 in Skopje, at MASA together with the 6th Southeastern European Pediatric Nephrology Working Group (SEPNWG) Meeting and IPNA (International Pediatric Nephrology Association) Teaching Course. The VIII Macedonian-Croatian Nephrology Days were also held during the Congress. The Sixth congress of MSNDTAO was held from September, 26 to 29, 2019 along with the 15th BANTAO Congress, in Skopje, at MASA. The Congress also marked the 80th anniversary of the birth of M. H. Polenakovic. Apart from the participants from R. Macedonia, the congress was attended by renowned nephrologists from Europe and the world. A novelty of the last congresses was the organization of 9 CME (Continuing Medical Education) courses with famous lecturers. CME courses supported by the ERA-EDTA and / or the ISN were as follows: 2005 - Ohrid (BANTAO), 2006 - Skopje (MSNDTAO), 2009 - Skopje (MSNDTAO), 2010 - Skopje (ERA-EDTA - ESAO), 2011 Skopje (ERA-EDTA - EUTox group), 2012 - Ohrid (MSNDTAO), 2014 -Skopje (MSNDTAO), 2016 - Skopje (MSNDTAO), 2018 - Skopje (MSNDTAO - ERA-EDTA & ISN), 2019 - Skopje (BANTAO - ISN & ERA-EDTA). In addition to the congresses, MSNDTAO has held meetings with nephrological associations from the neighboring countries as Croatia, Serbia, Albania and Kosovo. The congresses of MSNDTAO contributed to the introduction and education of doctors in the diagnosis and treatment of kidney patients. They were a strong stimulus for the development of nephrology in R. Macedonia and beyond.

Islam considers that marriage is not a relationship like an ordinary civil contract but a very strong contract or a solid agreement (mitsaaqaan ghaliizhaan). Marriage must pay attention to harmony, conditions, and restrictions so that it can be said to be legal according to the law. One limitation that needs to be considered is the prohibition of the marriage of susuan relations (one breastfeed). The prohibition of the marriage of susuan relations stipulated by Allah in the Qur'an verse must have scientific reasons. This article discusses the prohibition of the marriages of susuan relations in terms of Islamic law and medical aspects. Review of Islamic Law to find out how the limits so that someone can be said as a susuan relations. While a medical review is needed to uncover the scientific reasons why the prohibition of the marriage of susuan relations is prohibited by Allah. In this study, the author uses a normative juridical approach by analyzing secondary data, this research can also be said as a library research. This research approach is supported by using descriptive qualitative analysis methods . Keywords: Marriage Prohibition, Susuan Relations, Islamic Law, Medical

Introduction: Dysbaric osteonecrosis (DON) in people working under increased atmospheric pressure is well documented. It is generally less common in military and commercial divers than in caisson workers, except in some high-risk groups, such as in many indigenous diving industries where workers have little or no understanding of decompression principles. With the increasing popularity within the recreational diving community of deep air and mixed-gas decompression diving (‘technical diving’), it is likely that diving physicians may see an increase in the prevalence of DON in this group in the future. Methods: The case report is presented of a technical diving instructor, with a 30-year history of deep diving, who developed bilateral humeral head DON and required a right shoulder hemi-arthroplasty. A focused literature search was also undertaken to identify published cases of DON in recreational divers. Results: The frequency, duration and depth of exposure to pressure, inadequate decompression, the occurrence of DCS and increasing age have been common features associated with DON in both divers and caisson workers. Many of these features were present in this technical diver. Conclusions: Whilst DON is uncommon in recreational air scuba divers, all the above risk factors are present to a greater degree in technical diving. It is suggested that medical review for DON is merited from time to time in this potentially high-risk group of recreational divers.

Chronic right-sided salpingitis. Periophorium. Apoplexia and cystic degeneration of the right ovary. Gluttony. Recovery.

Clinical Handover has been identified as one of the most high-risk processes within medicine. Inadequate handover is a significant cause of avoidable adverse events across many hospitals. A likert-survey of the weekend handover system at a district general hospital demonstrated significant dissatisfaction amongst junior doctors. Intending to improve patient safety and reduce stress for on-call junior doctors, a weekend handover proforma was compiled according to the Royal College of Physicians and Surgeons guidelines. The proforma was trialed on six medical wards for six months with a before and after questionnaire being sent to doctors on the wards involved to determine the proforma’s merits on a scale of 1 (least effective) to 10 (most effective). Reports subsequent to implementation demonstrated a 67% increase ease of identifying outstanding weekend jobs. 57% of doctors reported better understanding of their patient’s diagnosis and management plan and 53% stated it was easier to identify the patients that required regular medical review over the weekend. Results also highlighted a 55% reported an increase in safety of weekend handovers (p, Highlights • Weekend handovers are a valuable tool to increase patient safety. • Weekend handovers can reduce stress levels in junior doctors. • Weekend handovers have been shown to reduce the financial and operational burden.

Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra-aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, "Do we have to replace the balloon pump when it fails?"

INTRODUCTION: Exposure to high G force is a known safety hazard in military aviation as well as civilian aerobatic flight. Tolerance to high G forces has been well studied in military pilots, but there is little research directed at civilian pilots who may have medications or medical conditions not permitted in military pilots.METHODS: In this case-control study, we identified 89 fatal high-G aerobatic accidents and 4000 fatal control accidents from 1995 through 2018 from the NTSB accident database and the FAA autopsy database. We retrieved medications and medical conditions from the FAA's pilot medical databases. Logistic regression models were used to explore the associations of drugs, medical conditions, height, and medical waivers with high-G accidents.RESULTS: Seven drugs (alprazolam, clonidine, ethanol, meclizine, phentermine, triamterene, and zolpidem) reached statistical significance in our models, but had such small case counts that we consider these findings to be uncertain, except for ethanol, which was found in seven cases. Of these, only triamterene was known to the FAA. Statistically significant medical predictors included only alcohol abuse (seven cases) and liver disease (only two cases).DISCUSSION: Our analysis found that the drug ethanol and the condition alcohol abuse are significantly associated with high-G accidents. Seven other factors were statistically significant, but should only be considered as hypothesis generating due to very low case counts. Our study does not suggest that restricting pilots with otherwise permissible medications or medical conditions from aerobatics is warranted.Mills WD, Greenhaw RM, Wang JMP. A medical review of fatal high-G U.S. aerobatic accidents. Aerosp Med Hum Perform. 2019; 90(11):959–965.

The IMPaCT (Integrated Mersey Palliative Care Team) model of care is designed to improve access for patients, their families, and professionals. The COVID-19 pandemic enabled implementation more quickly than envisaged. Waiting times for medical appointments in our integrated palliative medicine service were in excess of two weeks, restricting the clinic system’s ability to deal with acute problems. The team recognised that routine medical review of patients is often unnecessary, and with this in mind, all the referrals for outpatients are now assessed by a nurse specialist triage coordinator and those requiring routine follow-up are now fed into the nurse-led telephone assessment clinics for monitoring. There is a junior and a senior palliative medicine doctor assigned to the ambulatory medical clinic in the IMPaCT hub at Woodlands Hospice from Monday to Friday. There are a small number of pre-planned appointment slots for follow up, but the rest are used for urgent assessment of patients in person, by video consultation or by phone. Domiciliary visits can be undertaken if needed on the day. All admission requests and advice calls to the ward now come to the hub which means that the calls come into doctors with the necessary time to deal with issues as they arise, co-ordinating with other members of the team as needed. This also means the medical team on the inpatient unit have more time to see their patients. Co-location of the ambulatory medical clinics with the nurse triage coordinators has improved working relationships and means that all settings have an awareness of which patients are most complex. Admissions to the hospice are now appropriately more complex and the waiting time reduced to within 24 hours in the majority of cases in December 2020. Waiting times for medical assessments has reduced to within 24 hours of the request.

Aims In-hospital cardiac arrests are often preceded by a period of physiological deterioration that has often gone unnoticed. We proposed that the same might be true for out-of-hospital cardiac arrests (OHCAs) where ambulance crews leave patients at home who then subsequently go on to suffer a cardiac arrest. Methods and results We identified all OHCA over a 12-month period that had been seen and assessed by an ambulance crew within the 48 h preceding their cardiac arrest. We retrospectively calculated the patient’s NEWS2 score at the time of their initial assessment as a marker of their physiological status and need for hospital admission. Of 1960 OHCA patients, 184 (9.4%) had been assessed by ambulance crews within the preceding 48 h. Excluding those who had been taken to hospital (and then discharged), declined hospital conveyance or were on end-of-life care pathways, 79 (56% of total) were left at home through crew discretion. Thirty-four out of 79 (43%) patients not conveyed had either a NEWS score of 3 in a single parameter or a score of ≥5, which in hospital would mandate an urgent medical review. The most overlooked observation was respiratory rate. Conclusions In total, 1.7% of all OHCA had been assessed in the previous 48 h and inappropriately left at home by ambulance crews. This represents a missed opportunity to avert cardiac arrest. NEWS scoring has the potential to improve pre-hospital triage of these patients and avoid missing the deteriorating patient.

For the past several decades, medical malpractice claims in the state of Louisiana have been screened by a pretrial medical review panel (MRP). Composed of 3 physicians and 1 attorney, these panels are a method of filtering nonmeritorious lawsuits while expediting creditable claims. Currently, 14 jurisdictions in the United States require medical liability/malpractice cases be heard by an MRP or screening panel prior to trial. In this article, we review the MRP process in Louisiana and compare it to those in other states. Data are presented for the past 10 yr of malpractice claims in Louisiana with an emphasis on the neurosurgery specialty. Finally, the benefits and challenges of pretrial screening panels are discussed.

Objective To evaluate the implementation of an intervention for parents to escalate care if concerned about their child's clinical condition. Design Mixed-methods health-care improvement approach guided by the Theoretical Domains Framework. Methods Implementation of the 'Calling for Help' (C4H) intervention was informed by previously identified barriers and facilitators. Evaluation involved audit, review of clinical deterioration incidents, interviews and focus groups. Setting Australian specialist paediatric hospital. Participants Convenience sample of 75 parents from inpatient areas during the audit, interviews with ten parents who had expressed concern about their child's clinical condition; five focus groups with 35 ward nurses. Main outcome measures Parent awareness and utilization of C4H, parent and nurse views of factors influencing implementation. Results Parent awareness of C4H improved to 35% (25/75). Parent concern was documented prior to 21/174 (12%) clinical deterioration events. All interviewed parents and nurses who participated in focus groups were positive about C4H. Parents preferred to be informed about C4H by nurses, but nurses described this as time-consuming and selectively chose parents who they believed would benefit most. Parents and nurses described frustrations with and trepidation in escalating care. Nurses had used C4H to expedite urgent medical review. Conclusions There was an improvement in the level of parent awareness of C4H, which was viewed positively by parents and nurses alike. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required. Further strategies will be required for parents to feel confident enough to use C4H and to address interprofessional communication barriers.

Objectives To provide an introduction to the role of audiological evaluations with special reference to patients with skull base disease. Design Review article with case-based overview of the current state of the practice of diagnostic audiology through highlighting the multifaceted clinical toolbox and the value of mechanism-based audiological evaluations that contribute to otologic differential diagnosis. Setting Current state of the practice of diagnostic audiology. Main Outcome Measures Understanding of audiological evaluation results in clinical practice and value of contributions to interdisciplinary teams to identify and quantify dysfunction along the auditory pathway and its subsequent effects. Results Accurate auditory information is best captured with a test battery that consists of various assessment crosschecks and mechanism-driven assessments. Conclusion Audiologists utilize a comprehensive clinical toolbox to gather information for assessment, diagnosis, and management of numerous pathologies. This information, in conjunction with thorough medical review, provides mechanism-specific contributions to the otologic and lateral skull base differential diagnosis.

A substantial proportion of individuals with newly diagnosed epilepsy report prior seizures, suggesting a missed opportunity for early epilepsy care and management. Consideration of the causes and outcomes of diagnostic delay is needed to address this issue. We aimed to review the literature pertaining to delay to diagnosis of epilepsy, describing the components, characteristics, and risk factors for delay. We undertook a systematic search of the literature for full-length original research papers with a focus on diagnostic delay or seizures before diagnosis, published 1998-2020. Findings were collated, and a narrative review was undertaken. Seventeen papers met the inclusion criteria. Studies utilized two measures of diagnostic delay: seizures before diagnosis and/or a study-defined time between first seizure and presentation/diagnosis. The proportion of patients with diagnostic delay ranged from 16% to 77%; 75% of studies reported 38% or more to be affected. Delays of 1 year or more were reported in 13%-16% of patients. Seizures prior to diagnosis were predominantly nonconvulsive, and usually more than one seizure was reported. Prior seizures were often missed or mistaken for symptoms of other conditions. Key delays in the progression to specialist review and diagnosis were (1) "decision delay" (the patient's decision to seek/not seek medical review), (2) "referral delay" (delay by primary care/emergency physician referring to specialist), and (3) "attendance delay" (delay in attending specialist review). There were few data available relevant to risk factors and virtually none relevant to outcomes of diagnostic delay. This review found that diagnostic delay consists of several components, and progression to diagnosis can stall at several points. There is limited information relating to most aspects of delay apart from prevalence and seizure types. Risk factors and outcomes may differ according to delay characteristics and for each of the key delays, and recommendations for future research include examining each before consideration of interventions is made.

Background: Prescribing errors are quite common and according to one estimate out of 100 patients admitted into UK hospitals 15 will have some form of prescribing error in their records. It is a general understanding that most of the time these errors are made due to lack of awareness. Severity of these errors can range from minor to major mistakes that can lead to fatal results. Materials and Methods: A simplified anonymous approach of identifying these errors and then using a step wise approach to educate the prescribers’ especially junior doctors can be quite fruitful in reducing these errors. Unfortunately there are not many studies or projects available to back our proposal however these seems a logical way forward and is exactly what we have shown in our study. Results: We performed a prospective snapshot study involving 100 inpatients to get baseline measurements. The errors and mistakes were identified and fed back to the junior doctors in an anonymous manner. Clear & legible writing, frequency of use, responsible consultant name, allergy box filled, VTE assessment, oxygen prescribing and labeling of medication discontinuation were the most common negligence identified. At the same time junior doctors were reminded of local prescription standards and guidelines which usually don’t form part of induction. Conclusion: Multiple deficient areas were identified during this audit like legible writing, dosage frequency, VTE prophylaxis and oxygen prescription. It was highlighted to junior doctors how important are these components as they play a key role in patient getting better after medical review. Above mentioned steps did improve prescription errors to an extent, but aim should be to achieve 100% results. Repeated reminders are important in this case as that helps to improve practice and avoid clinical accidents.

This paper investigates the effects of introducing external medical review for disability insurance (DI) in a system relying on treating physician testimony for eligibility determination. Using a unique policy change and administrative data from Switzerland, I show that medical review reduces DI incidence by 23%. Incidence reductions are closely tied to difficult-to-diagnose conditions, suggesting inaccurate assessments by treating physicians. Due to a partial benefit system, reductions in full benefit awards are partly offset by increases in partial benefits. More intense screening also increases labor market participation. Existing benefit recipients are downgraded and lose part of their benefit income when scheduled medical reviews occur. Back-of-the-envelope calculations indicate that external medical review is highly cost-effective. Under additional assumptions, the results provide a lower bound of the effect on the false positive award error rate.

AimsTo establish the improvements in the quality of seclusion medical review after introducing a template to complete the review.BackgroundThe Mental Health Act – Code of Practice outlines the standards of patient care while in seclusion. It also emphasis that supportive engagement/observation schedules should be reviewed in person and continued at the point an episode of seclusion was initiated.Furthermore, NICE also set up standards to monitor side effect profile while prescribing psychotropic for such patients and regular management review. It also gives importance to staff training to ensure these standards.To improve the quality of the seclusion medical review, we completed an audit in July 2019 to ascertain whether medics are following Trust Policy.We identified good results (above 90%) in the following areas:Time of seclusion reviewRecord keepingManagement planGood documentation of risk, mental state examination and physical health.We also noticed that the following areas can be improved:Prescribed Medications. (60%)Medication side effects. (40%)Physical Observations (40%)We used the following audit standards for our audit after our last audit and a template was designed and after discussion with medics incorporated into the existing documentation template.Time of reviewReason and duration for seclusionPsychiatric diagnosisMental State Examination/BehaviourPhysical health (including physical observations)/EnvironmentMedication (prescribed, rapid tranquilisation, side effects, or adverse effects)Risk (to self-DSH or accidental) (risks to others)Plan :(frequency of physical obs./medical review, management, restrictions, exit plan for terminating seclusion, patient's capacity to understand it)MethodWe considered the following aspects:Retrospective data collection from 01.03.2020 to 30.08.2020.Sample selection: random selection of mixture of clinicians on different times and days of the week.Data analysis was carried out by using Microsoft Excel.ResultWe noticed a marked improvement in the quality of seclusion medical review (between 95% and 100%) after introducing a template for it. There were no major concerns identified during the re-audit.ConclusionTo continue to use the template for Seclusion Medical Review which has shown significant improvement in the quality of the reviews which will improve patient care.It also helped us to deliver person centred care and safe practice.To continue teaching and training of doctors.This QIP project motivated nurses to do an audit on nursing seclusion review and made necessary changes.

AimsWhilst patient psychiatric health is the primary focus in the acute psychiatric inpatient setting, there has been a recent focus on ensuring a greater integration with physical health to address the physical health outcome inequalities between patients with psychiatric conditions and those without. Despite the ward having a robust physical health clerking proforma, there were issues with its completion; at initial clerking patients often aren't able, or refuse, to consent to physical examination or investigations. This lead to the trust's electronic physical health form, designed to collate these results, not always being completed. Our aim was to increase the rates of completion.MethodChanges to ward handover sheets were made in an effort to increase rates of physical health form completion and improve 24 and 72 hour completion rates. Columns were added delineating which parts of the physical clerking were outstanding, ensuring the MDT were aware of which jobs needed actioning. Data for two months prior and post intervention were analysed.Result266 admissions were analysed for the two months prior and post the intervention. Form completion rose from July (88%) to October (100%), with 24 and 72 hour completion rate increasing from 47% & 55% respectively, to 84% & 96%, during the same time period. Greater completion rates of physical health forms led to increased knowledge of patients’ physical health issues. Having 96% of patients physical health issues within three days of admission (cf. 55%, July), led to a 'physical health huddle' being held during the MDT. This provided a platform to discuss relevant physical health treatment plans with the whole team. These findings were summarised under a new column on the handover sheet and updated biweekly during the MDT meeting. Placement on the handover sheet ensured daily visibility to all staff.ConclusionSimple structural changes can bring physical health to the fore in psychiatric care. Timely and more complete physical health data enabled biweekly reviews of physical health issues and allowed input across the MDT. Increased knowledge and awareness of physical health issues led to an increase in medical review requests. These are currently performed on an ad hoc basis, which can be quite disorganised and inefficient. The results above, of improved physical health outcomes based on a structured approach, have led to a recommendation of a biweekly physical health clinic, with specific staffing allocation, to ensure a more thorough and efficient way to address physical health.

Aim This Quality Improvement project aimed to increase the usefulness of ward rounds in a busy Special Care Baby Unit (SCBU; i.e. low dependency neonatal unit). Most babies’ primary reasons for remaining inpatient in SCBU are to gain weight and establish oral feeds. Despite this taking weeks for some, they were seen daily on ward round. Baseline data showed that 86% ward round plans for these low risk babies made no changes to management. My aim was to halve this number in four months. Method Babies that required daily medical review (table 1) were identified and excluded from the project, leaving only low risk infants. The medical team were instructed to actively seek out babies of concern by discussion with nurses before ward round. The first PDSA cycle introduced the project to colleagues. Subsequent cycles reduced the frequency of ward round to three times per week, trialling different days. Data was collected from clinical notes. Balancing measures were details of babies that became unwell in the data collection period. Results The frequency of ward round plans making no changes to management of low risk babies dropped from 86% to 17%, which surpassed the aim. Doctors felt they had more time to help colleagues on the postnatal ward, complete discharge paperwork further in advance (thus facilitating morning discharges) and for projects. Medical and nursing teams were satisfied that well babies were not examined and disturbed daily. Conclusion Medical and nursing teams are more satisfied with ward rounds occurring three times per week instead of daily for low risk babies in SCBU. More work is needed to look into ways to empower nursing staff to lead on care in low risk babies on their journey to discharge. This project would have had more impact if a reliable measure could be found for staff efficiency.

The application of teledermatology for evaluating acne patients has yielded comparable therapeutic outcomes with traditional face-to-face evaluation, but follow-up compliance between these modalities is not well-studied. Our objective is to compare the rate and duration of follow-up between acne patients initially evaluated by teledermatology versus in-person outpatient consultation. Electronic medical review of acne patients, 18-35 years-old seen via teledermatology and face-to-face evaluation at the University of Pittsburgh Medical Center between 2010-2018 was performed. Teledermatology patients were less likely to follow-up in the first 90 days (13.0% versus 31.0%, Plt;0.001) compared to patients seen face-to-face with overall follow-up rates of 22% among both modalities. The median time to follow-up was 45.5 days (IQR: 13/57) in the teledermatology group compared to 64 days (IQR: 56/77) in the face-to-face group (Plt;0.001). Teledermatology patients were more likely to be treated with oral antibiotics (43.0% versus 28.5%) or oral spironolactone (18.5% versus 12.5%) compared to patients seen face-to-face (Plt;0.001). Teledermatology poses a promising solution to extend dermatologic care with earlier access to follow-up. Our data demonstrates a need to improve teledermatology follow-up education to improve follow-up care.

Background There are cases where epidural analgesia is initially effective but subsequently fails and needs to be resited. We evaluated the rate of normal vaginal delivery and operative delivery among parturients who had resited epidurals compared to parturients with epidurals that were not resited. Methods A retrospective electronic medical review of parturients with a singleton gestation attempting normal vaginal delivery under epidural analgesia between the years 2012-2016 was conducted. Resited epidurals were defined as epidurals that were considered effective but subsequently removed and reinserted. For each resited epidural, two previous and two consecutive deliveries of parturients with normally functioning epidural catheter inserted by the same anesthesiologist were matched controls (non-resited epidurals). Results There were 35,984 attempted vaginal deliveries with 118 resited epidurals and 472 non-resited epidurals. When adjusted for nulliparity, oxytocin administration, sex and weight of the baby, and maternal BMI, labor epidural catheter replacement was not associated with need for instrumental or caesarean delivery, (OR 1.5, 95% CI 0.91-2.49, P = .11). Conclusions Need for labor epidural catheter replacement does not appear to be associated with need for operative delivery based on this single-centre cohort analysis.

Potencialno neprimerna zdravila (PIM), so tista zdravila, pri katerih tveganja ob uporabi presežejo želene koristi zdravljenja in se pogosto pojavljajo pri starejših odraslih. Med skupino zdravil, ki predstavljajo PIM, so psihofarmaki najbolj pogosto zastopana skupina, kar nakazuje na povečano potrebo za ukrepe in možnosti racionalizacije in optimizacije zdravljenja z zdravili na tem področju. Glede na dosegljive podatke raziskav, lahko uporaba PIM vodi v številne neželene učinke, nepotrebne hospitalizacije, vpliva na umrljivost in viša stroške zdravljenja. Vključevanje kliničnega farmacevta v zdravljenje z zdravili z uporabo storitve farmakoterapijskega pregleda, predstavlja enega izmed najpomembnejših načinov zmanjševanja PIM, kar je bilo dokazano v nekaterih raziskavah, a nam primanjkuje podatkov o vplivu kliničnega farmacevta na število PIM pri starejših bolnikih z duševnimi motnjami in polifarmakoterapijo. Glavni namen raziskave je določiti delež sprejetja farmacevtovih intervencij, raziskati razširjenost PIM ter ovrednotiti vpliv predlaganih intervencij kliničnega farmacevta na razširjenost PIM med starejšimi odraslimi z duševnimi motnjami. Izvedli smo retrospektivno, neintervencijsko, opazovalno kohortno raziskavo, v katero smo vključili bolnike ZD Ljutomer. Vključeni vzorec predstavljajo bolniki, starejši od 65 let, s polifarmakoterapijo in vsaj enim predpisanim zdravilom za zdravljenje duševnih motenj ter z vsaj eno diagnozo duševne motnje, ki so bili obravnavani pri kliničnem farmacevtu v obdobju raziskave. S pomočjo kliničnih izvidov in ostale medicinske dokumentacije smo si zabeležili podatke o terapiji in diagnozah bolnikov, ter intervencijah predlaganih s strani kliničnega farmacevta. S pomočjo Priscus liste in Beersovih kriterijev smo izračunali razširjenost in strukturo PIM med bolniki, ter izdelali napovedni model vpliva upoštevanja farmacevtovih intervencij na zmanjšanje števila PIM po farmakoterapijskem pregledu zdravil. Od 99 bolnikov, vključenih v raziskavo, jih je vsaj 1 PIM v terapiji prejemalo 69,7 % bolnikov glede na Priscus listo oz. 92,9 % bolnikov glede na Beersove kriterije. Najpogosteje razširjena skupina PIM je bila skupina benzodiazepinov in benzodiazepinom sorodna zdravila (t.i. »z«-zdravila). Zdravniki so skupno sprejeli 44,0 % vseh predlaganih intervencij. Intervencije kliničnega farmacevta so privedle do zmanjšanja števila PIM glede na Priscus listo za 21,1 % in glede na Beersove kriterije za 17,3 % (p < 0,05). Bolniki, pri katerih zdravniki predlogov kliničnega farmacevta niso upoštevali v celoti, so imeli v primerjavi z ostalimi bolniki, večje razmerje obetov za PIM glede na Beers kriterije (razmerje obetov = 3,8, interval zaupanja 1,4-10,1) in statistično neznačilno manjši obet za PIM glede na Priscus listo (razmerje obetov = 2,8, interval zaupanja 1,0-8,2). Rezultati raziskave dokazujejo pozitiven vpliv intervencij kliničnega farmacevta na kakovost zdravljenja z zdravili v smislu zmanjšanja števila zdravil, števila PIM glede na Beers in Priscus listo ter tako potrjujejo smotrnost navedenih intervencij v kliničnem okolju. Potentially inappropriate medications (PIMs) are medications where risks at use exceed the desired benefits of treatment, and their use is widespread among elderly patients. In the group of PIMs, the psychotropics are most often represented, what indicates the need of a rational pharmacotherapy with these medications. The results of several studies show that the use of PIM has many undesired effects, leads to unnecessary hospitalizations, higher mortality, and increases the costs of the medical treatment. An introduction of medical review provided by clinical pharmacist is one of the most important approach of PIM reduction, benefits have been shown in some studies although data about the influence of the clinical pharmacist on the number of PIMs in the elderly patients with mental disorders and polypharmacotherapy is missing. The main objective of the research is to determinate the interventions’ acceptance rate provided by clinical pharmacist, prevalence of PIM and the effect of clinical pharmacist’s interventions on the number of PIMs among elderly persons with mental disorders. A retrospective non-interventional observational cohort research, involving patients of the Community Health Centre was conducted. Only patients over 65 years with polypharmacotherapy and at least one psychotropic and one diagnosis of mental disorders who were screened by clinical pharmacist were included. Patients’ therapy and diagnosis and proposed clinical pharmacist’s interventions were collected from patients’ charts. Using the PRISCUS List and the Beers Criteria we have calculated the prevalence and structure of PIM among patients. Statistical models which evaluated the impact of clinical pharmacist’s interventions on the reduction of PIM number after the medical review were built. 99 patients were included in the research and at least one PIM was presented in 69.7 % (PRISCUS List) of patients and 92.9 % (Beers Criteria) of patients. Benzodiazepines and Z-drugs were the most common PIMs. Physicians accepted 44.0 % of all suggested interventions. The interventions led to 21.2 % decrease in the number of PIMs according to the PRISCUS List and 17.3 % decrease according to the Beers Criteria (p < 0.05). Patients where physicians did not fully accepted clinical pharmacist's interventions had higher odds ratios for PIM than those where interventions were fully accepted according to the Beers criteria (odds ratio for PIM = 3,8, confidence interval 1.4-10.1) and statistically insignificantly for PRISCUS list (odds ratio for PIM = 2,8, confidence interval 1.0-8.2). These results show positive effect of clinical pharmacist's interventions on the quality of the pharmacotherapy indicated by decrease in the number of medication and the number of PIMs according to the PRISCUS List and the Beers Criteria. These results confirm positive effects of clinical pharmacist’s interventions within this field in real clinical practice.

The long-term traveler can be defined as those traveling or residing overseas for more than 6 months and includes those going on extended holidays (gap year/backpackers/visiting friends and relatives) and those residing overseas (expatriates). Screening involves a medical review to identify possible exposure to risk of infections that may have implications for the health of the traveler. The type and extent of risk to the health of long-term travelers, and the screening of them on return, vary considerably according to the individual, their destinations, duration, and purpose of travel. The clinician must make a risk assessment, including a detailed history, in order to assess the likelihood of exposure to infectious and non-infectious travel-associated risks and assess the potential impact of that risk, for example, exposure to schistosomula, sexually transmitted and blood-borne infections, tuberculosis, and malaria, bearing in mind that infections may be asymptomatic or latent at screening.

OBJECTIVE: To examine the effects of Medicare's Medical Review (MR) program on short‐stay inpatient hospitalization. DATA SOURCES/STUDY SETTING: One Hundred percent of Medicare Part A and Part B claims and the Master Beneficiary Summary File (2007–2010). STUDY DESIGN: Retrospective observational study using a difference‐in‐differences approach. We examined six primary intake diagnoses, we believed likely to be targeted by MR. We stratified by hospital profit structure, bed size, system membership, and inpatient admission rate to test for differential effects. The comparison group was hospital visits occurring in those MACs that had yet to implement, as well as those that did not implement during the period of interest. DATA COLLECTION: None. PRINCIPAL FINDINGS: Medical Review significantly reduced the likelihood of inpatient admission for patients with an intake diagnosis of “Non‐Specific Chest Pain” by 1.29 percentage points (p

Background: Seizures in tuberous sclerosis complex (TSC) tend to be intractable over time and become a subsequent psychological burden for the patients. The purpose of the current study was to describe the onset, phenotype, and factors associated with seizure remission in patients with TSC. Methods: Patients diagnosed with TSC between 2009 and 2015 completed a questionnaire interview and underwent a systematic evaluation, including a medical review of their epilepsy history and neurobehavioral disorder assessment. Results: Of the 61 patients, 50 patients (82.0%) had a positive seizure history. The active (n = 34) and seizure remission (n = 16) groups showed significant differences in age, neurobehavioral disorder, history of refractory epilepsy, and onset age (p

AimsWe accessed whether medics are following Trust Policy while conducting seclusion medical review and identify the strengths in quality of seclusion medical review and identify the areas which need improvements to improve our quality and standards of patient's care and safety and to reduce risks.BackgroundThe Mental Health Act Code of Practice sets an expectation for mental health services for restrictive interventions (use of restraint, seclusion and rapid tranquilisation) by following good standards. Medical reviews provide an opportunity to evaluate and amend seclusion management plan. This clinical audit was undertaken by looking at quality of record keeping about seclusion review by junior doctors, staff grades and consultants at different times (day, night, and weekend).MethodData analysis was carried out by using Microsoft Excel. The audit had Humber Teaching NHSFT approval. We assessed electronic healthcare records. Data collection was carried out or retrospectively in 2019(n = 40) using following parameters: 1)A review of patient's physical and psychiatric health.2)An assessment medication prescribed and adverse effects of medication.3)A review of observations required.4)An assessment of the risk posed by the patient to others.5)An assessment of any risk to the patient from deliberate or accidental self-harm.6)An assessment of need for continuing seclusion, and whether it is possible for seclusion measures to be applied more flexibly, or in a less restrictive manner.7)Time of Seclusion Review: Within first hour after seclusion and then every 4 hours until internal MDT. After MDT twice a day.8)Record Keeping.ResultKey Successes (above 80%)Time of seclusion review (with in first hour or when required)Record keeping (accurate time and place for clinical notes).Plan for continuing need for seclusion.Good documentation of Risk to self and risk to others.Good documentation of mental state examination.Comments on physical health although it can be improved.Key Concerns(Less than 60%):Prescribed Medications.Medication side effects.Physical ObservationsConclusionMedics are missing some important parts in seclusion medical review. We developed a template for seclusion medical review according to trust guidelines which are based on Code of Practice and to incorporate in already existing seclusion review form. We also delivered teaching and training to doctors and also showed junior doctor's an example of documentation. We will re-audit in 1 years’ time to see improvement.

Zusammenfassung Einleitung Mit dem Krankenhausstrukturgesetz wurde der § 275a SGB V dem Sozialgesetzbuch eingefügt. Er präzisiert und erweitert die rechtlichen Voraussetzungen für Qualitätskontrollen in Krankenhäusern durch den Medizinischen Dienst der Krankenversicherung (MDK). Diese sollen dazu beitragen, eine qualitativ hochwertige, patienten- und bedarfsgerechte Versorgung der Bevölkerung sicher zu stellen. Anhand der mittlerweile 10-jährigen Praxis des MDK Hessen soll die Praktikabilität der Qualitätsprüfungen aufgezeigt werden. Methode Die bislang in den Krankenhäusern durchgeführten Qualitätsprüfungen betreffen die Überprüfung der Strukturqualität auf der Basis von Bestimmungen des G-BA zur Qualitätssicherung spezieller Versorgungskomplexe/Verfahren bzw. des DIMDI zu Komplexbehandlungen. Sämtliche Qualitätsprüfungen in den hessischen Kliniken werden von einem darauf spezialisierten Team des MDK durchgeführt. 2 fachärztliche Prüfer führen diese in Form von Begehungen vor Ort durch. Neben Verantwortlichen der Fachebene sind auch Mitglieder der Führungsebene aus dem Krankenhausmanagement bei den Qualitätsprüfungen vor Ort beteiligt. Ergebnisse In den Jahren 2006–2016 wurden 357 Qualitätsprüfungen gemäß den Bestimmungen des G-BA zu 10 verschiedenen Versorgungskomplexen/Verfahren durchgeführt. In rund 20% der Fälle wurden die vorgeschriebenen Anforderungen nicht erfüllt. Im selben Zeitraum wurden 1624 Qualitätsprüfungen gemäß den Vorgaben des DIMDI zu 33 verschiedenen Komplexkodes durchgeführt. In rund 40% der Fälle wurden die vorgeschriebenen Anforderungen nicht erfüllt. Schlussfolgerung Die bei den Prüfungen erhobenen Defizite belegen die Notwendigkeit von Qualitätskontrollen durch eine unabhängige und qualifizierte Instanz. Die Qualitätsprüfungen tragen zur Qualitätssicherung und damit zur Struktur-, Prozess- und Ergebnisqualität in den Krankenhäusern bei. Die in Hessen etablierte Prüfpraxis ist auf die zukünftig bundesweit durchzuführenden Qualitätskontrollen übertragbar.

Background: Bilva (Aegle marmelos Corr.) is an historical plant which is used for religious and medical purposes since time immemorial. It is often considered to be a sacred tree in India, where its leaves, fruits and owers are used for offerings to many deities. Apart from the above, Bilva has been used as a therapeutic in wide range of ailments in Ayurveda. The drug has also been in use as traditional medicinal practice by many tribal and village dwellers from centuries. Aims: To analyze the historical & ethnomedical uses of Bilva. Material & Methods: Various lexicons, religious scriptures and articles regarding ethno-botany were referred and essential data were compiled and analyzed. Results: The in-depth analyses of historical and ethno-medical usage of Bilva tree reveals that the drug was is in use right from the Vedic period till today albeit slight differences in its religious usage. Various references of the plant has been enlisted in lexicons of Ayurveda and the ethno medical usage has been found throughout India. Which has similar indications as observed in ethno medicinal claims in vast number of disorders, however the method of application shows minor differences. Conclusion: Bilva is one of the most important drug in modern times which has a rich history of its usage from Vedic period. The present insight on the ethnomedical usage of the drug on large group of disorders warrants the need of systematic clinical researches to ascertain its properties and mode of action.

The purpose of this study was to analyze the relationship between academic success and functional and dysfunctional families. A non-experimental, cross-sectional, descriptive correlational design was used. A convenience sample of 200 children between 6 and 13 years old, primary and junior high school students was conducted (32.3% were female and 67.7% were male). To assess the relationship, a study case of 21 reagents was designed to empty the obtained information from medical review records from a psychopedagogic clinic. Academic success was measured as from the revision of informal tests and standardized tests. Results showed that the population levels of academic success were average. However, a significant relationship between the age of the parents and the level of academic success was found, indicating that these variables are associated with this problem. Besides that, it was found that there is a tendency in children with cognitive, emotional and sensory problems reflected in low academic success. The findings provide information that could be considered for the development of programs of psychopedagogic intervention to treat children with learning disabilities and low academic success.

Married and childless. She never had a month, but every month her usual peeling of the cuticle of her entire body intensified, and her head hurt for 3-4 days. Sexual intercourse has always been indifferent.

The author cites the history of the illness of one patient with manifestations of cortical epilepsy: convulsions began on the face, then passed on to the arm and leg, for the most part the seizure was limited to one left side. Left n. facialis was paralyzed; in the left extremities - paresis with reduced rigidity and increased tendon reflexes, while in the arms paresis and rigidity were almost the same, and rigidity prevailed in the legs. After the seizure, the paralysis intensified sharply. Some seizures were preceded by a motor aura: clonic convulsions in the paralyzed limbs. Left side sensitivity was decreased; muscle feeling weakened, stronger in the arms, less in the legs. The patient died of tuberculous pneumonia. When opened, found in the right hemisphere softening, which occupied the lower third of the posterior central gyrus. Gyrus marginalis in the anterior part was destroyed. The softening into the depths did not extend equally. In the rear part, it went quite deep; the radiant end in the supramargi nalis area is softened, the system of long connecting paths, apparently, is not affected; small focus in the superior parietal gyrus In the middle of the focus, destruction is limited to the cortex. In the front part, the softening was located under the cortical layer and reached the inner capsule. Deep-lying gray masses, corpus callosum and cingulum have survived from destruction. Microscopic examination showed extensive degeneration in connective and adhesive pathways; the descending rebirth was barely expressed and was found only in Marchi.

Patient 31 years old, multiparous. She was ill after childbirth, she threw it out 2 times, and suffered from monthly disorders, pain and leucorrhoea. The patient is hysterical, and her aphony was of hysterical origin.

Each of the existing methods of caring for the umbilical cord has known advantages and disadvantages. So, the previous method of the author (powdering with a mixture of 10 hours of magisterii bismuthi and 1 hour of iodoform), having the property of causing dry mummification of the umbilical cord, the remainder, not accompanied by either irritation or separation, is the inconvenience that the remnant does not disappear before 7 days, and it slowly drags on to 10, due to which all the time mothers have to be released with the unreported umbilical cord residue from the fetus.

Patient 67 years old, does not wear blood since 50 years of age, suffers from 5 years of umbilical hernia and progressive enlargement of the abdomen. The hernia cannot be adjusted, the abdomen is greatly increased in volume. Above the hernia, the sound, when tapped, tympanic, with the sides - dull, passing at a distance of 4 fingers from the spine, in tympanic; below the hernia, the sound is dull. In the area of a dull sound, there is a ripple.