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Epidemiology

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Multicystic Renal Dysplasia Treatment & Management: Medical Care, Surgical Care, Consultations

Multicystic dysplastic kidney (MCDK), a variant of renal dysplasia, is one of the most frequently identified congenital anomalies of the urinary tract. This article reviews the definition, embryology, epidemiology, etiology, pathology, clinical manifestations, associated malformations, natural history, differential diagnosis, complications, e...  
emedicine.medscape.com
over 4 years ago
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Rib Fracture: Background, Pathophysiology, Epidemiology

Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of thoracic injuries from nonpenetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures.  
emedicine.medscape.com
over 4 years ago
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Brunner & Suddarth's Textbook of Canadian Medical-surgical Nursing

This is the Second Edition of the popular Canadian adaptation of Brunner and Suddarth's Textbook of Medical-Surgical Nursing, by Day, Paul, and Williams. Woven throughout the content is new and updated material that reflects key practice differences in Canada, ranging from the healthcare system, to cultural considerations, epidemiology, pharmacology, Web resources, and more. Compatibility: BlackBerry(R) OS 4.1 or Higher / iPhone/iPod Touch 2.0 or Higher /Palm OS 3.5 or higher / Palm Pre Classic / Symbian S60, 3rd edition (Nokia) / Windows Mobile(TM) Pocket PC (all versions) / Windows Mobile Smartphone / Windows 98SE/2000/ME/XP/Vista/Tablet PC  
Google Books
over 4 years ago
Foo20151013 2023 1njk26?1444774138
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Doctor or a scientist?

"One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong" Sir William Osler Well, it's almost Christmas. I know it's Christmas because the animal skeleton situated in the reception of my University's Anatomy School has finally been re-united with his (or her?) Christmas hat, has baubles for eyes and tinsel on its ribcage. This doesn't help with my trying to identify it (oh the irony if it is indeed a reindeer). This term has probably been one of the toughest academic terms I've had, but then when you intercalate that is sort of what you choose to let yourself in for. I used to think that regular readings were a chore in the pre-clinical years. I had ample amounts of ethics, sociology and epidemiology readings to do but this is nothing compared to the world of scientific papers. The first paper I had to read this term related to Glycosaminoglycan (GAG) integrity in articular cartilage and its possible role in the pathogenesis of Osteoarthritis. Well, I know that now. When I first started reading it felt very much like a game of boggle and highly reminiscent of high school spanish lessons where I just sat and nodded my head. This wasn't the end. Every seminar has come with its own prescribed reading list. The typical dose is around 4-5 papers. This got me thinking. We don't really spend all that much time understanding how to read scientific papers nor do we really explore our roles as 'scientists' as well as future clinicians. Training programmes inevitably seem to create false divides between the 'clinicans' and the 'academics' and sometimes this has negative consequences - one simply criticises the other: Doctors don't know enough about science, academics are out of touch with the real world etc... Doctors as scientists... The origins of medicine itself lie with some of the greatest scientists of all time - Herophilus, Galen, Da Vinci, William Harvey (the list is endless). As well as being physicians, all of these people were also respected scientists who regularly made contributions to our understanding of the body's mechanics. Albeit, the concept of ethics was somewhat thrown to the wind (Herophilus, though dead for thousands of years, is regularly accused of performing vivisections on prisoners in his discovery of the duodenum). Original sketches by William Harvey which proved a continuous circuit of blood being supplied and leaving the upper limb. He used his observations to explain the circulatory system as we know it today What was unique about these people? The ability to challenge what they saw. They made observations, tested them against their own knowledge and asked more questions - they wanted to know more. As well as being doctors, we have the unique opportunity to make observations and question what we see. What's causing x to turn into y? What trends do we see in patients presenting with x? The most simple question can lead to the biggest shift in understanding. It only took Semmelweiss to ask why women were dying in a maternity ward to give rise to our concept of modern infection control. Bad Science... Anyone who has read the ranting tweets, ranting books and ranting YouTube TED videos of academic/GP Ben Goldacre will be familiar with this somewhat over used term. Pseudoscience (coined by the late great Karl Popper) is a much more sensible and meaningful term. Science is about gathering evidence which supports your hypothesis. Pseudoscience is a field which makes claims that cannot be tested by a study. In truth, there's lots and lots of relatively useless information in print. It's fine knowing about biomarker/receptor/cytokine/antibody/gene/transcription factor (insert meaningless acronym here) but how is it relevant and how does it fit into the bigger picture? Science has become reductionist. We're at the gene level and new reducing levels of study (pharmacogenetics) break this down even further and sometimes, this is at an expense of providing anything useful to your clinicial toolbox. Increasing job competition and post-graduate 'scoring' systems has also meant there's lots of rushed research in order to get publications and citations. This runs the danger of further undermining the doctors role as a true contributor to science. Most of it is wrong... I read an article recently that told me at least 50% of what I learn in medical school will be proven wrong in my lifetime. That might seem disheartening since I may have pointlessly consumed ample coffee to revise erroneous material. However, it's also exciting. What if you prove it wrong? What if you contributed to changing our understanding? As a doctor, there's no reason why you can't. If we're going to practice evidence-based medicine then we need to understand that evidence and doing this requires us to wear our scientist hat. It would be nice to see a whole generation of doctors not just willing to accept our understanding but to challenge that which is tentative. That's what science is all about. Here's hoping you don't find any meta-analyses in your stockings. Merry Christmas.  
Lucas Brammar
over 5 years ago
Foo20151013 2023 13vodzp?1444774194
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Is ADHD a difficult diagnosis?

In a recent article in the BMJ the author wonders about the reasons beyond the rising trend diagnosing Attention Deficit Hyperactivity Disorder (ADHD). The article attempts to infer reasons for this. One possible reason was that the diagnostic criteria especially DSM may seem for some to be more inclusive than ICD-10. The speculation may explain the rise of the diagnosis where DSM is used officially or have an influence. In a rather constructive way, an alternative to rushing to diagnosis is offered and discussed in some details. The tentative deduction that the Diagnostic Statistical Manual (DSM) may be one of the causes of rising diagnosis, due to raising the cut-off of age, and widening the inclusion criteria, as opposed to International Classification of Diseases, 10th revision (ICD-10), captured my attention. On reading the ICD-10 diagnostic criteria for research (DCR) and DSM-5 diagnostic criteria, I found them quite similar in most aspects, even the phraseology that starts with 'Often' in many diagnostic criteria, they seem to differ a bit in age. In a way both classification, are attempting to describe the disorder, however, it sounds as if someone is trying to explain a person's behaviour to you, however, this is not a substitute to direct clinical learning, and observing the behaviour, as if the missing sentence is 'when you see the person, it will be clearer'. El-Islam agrees with the notion that DSM-5 seems to be a bit more inclusive than ICD-10. A colleague of mine who is a child psychiatrist and she is doing her MSc. thesis in ADHD told me, that DSM-5 seems to be a substantial improvement as compared to its predecessor. The criteria - to her - though apparently are more inclusive, they are more descriptive with many examples, and she infers that this will payback in the reliability of the diagnosis. She hopes gene research can yield in biological tests for implicated genes and neurotransmitters in ADHD e.g. DRD4, DAT, gene 5,6,11 etc. One child psychiatrist, regretted the fact that misdiagnosis and under-diagnoses, deprive the patient from one of the most effective treatments in psychiatry. It is hoped the nearest forthcoming diagnostic classification (ICD-11), will address the issue of the diagnosis from a different perspective, or else converge with DSM-5 to provide coherence and a generalised newer standard of practice. The grading of ADHD into mild, moderate, and severe seem to blur the border between disorder and non-disorder, however, this quasi-dimensional approach seems realistic, it does not translate yet directly in differences in treatment approaches as with the case of mild, moderate, severe, and severe depression with psychotic symptoms, or intellectual disability. The author states that one counter argument could be that child psychiatrists are better at diagnosing the disorder. I wonder if this is a reflection of a rising trend of a disorder. If ADHD is compared to catatonia, it is generally agreed that catatonia is less diagnosed now, may be the epidemiology of ADHD is not artefact, and that we may need to look beyond the diagnosis to learn for example from environmental factors. Another issue is that there seems to be significant epidemiological differences in the rates of diagnosis across cultures. This may give rise to whether ADHD can be classified as a culture-bound syndrome, or whether it is influenced by culture like anorexia nervosa, or it may be just because of the raising awareness to such disorders. Historically, it is difficult to attempt to pinpoint what would be the closest predecessor to ADHD. For schizophrenia and mania, older terms may have included insanity, for depression it was probably melancholia, there are other terms that still reside in contemporary culture e.g. hypochondriasis, hysteria, paranoia etc. Though, it would be too simplistic to believe that what is meant by these terms was exactly what ancient cultures meant by them, but, they are not too far. ADHD seems to lack such historical underpinning. Crichton described a disorder he refers to as 'mental restlessness'. Still who is most often credited with the first description of ADHD, in his 1902 address to the Royal College of Physicians. Still describes a number of patients with problems in self-regulation or, as he then termed it, 'moral control' (De Zeeuw et al, 2011). The costs and the risks related to over-diagnosis, ring a warning bell, to enhance scrutiny in the diagnosis, due to subsequent stigma, costs, and lowered societal expectations. They all seem to stem from the consequences of the methodology of diagnosis. The article touches in an important part in the psychiatric diagnosis, and classifications, which is the subjective nature of disorders. The enormous effort done in DSM-5 & ICD-10 reflect the best available evidence, but in order to eliminate the subjective nature of illness, a biological test seems to be the only definitive answer, to ADHD in particular and psychiatry in general. Given that ADHD is an illness and that it is a homogeneous thing; developments in gene studies would seem to hold the key to understanding our current status of diagnosis. The suggested approach for using psychosocial interventions and then administering treatment after making sure that it is a must, seems quite reasonable. El-Islam, agrees that in ADHD caution prior to giving treatment is a recommended course of action. Another consultant child psychiatrist mentioned that one hour might not be enough to reach a comfortable diagnosis of ADHD. It may take up to 90 minutes, to become confident in a clinical diagnosis, in addition to commonly used rating scales. Though on the other hand, families and carers may hypothetically raise the issue of time urgency due to scholastic pressure. In a discussion with Dr Hend Badawy, a colleague child psychiatrist; she stated the following with regards to her own experience, and her opinion about the article. The following is written with her consent. 'ADHD is a clinically based diagnosis that has three core symptoms, inattention, hyperactivity and impulsivity in - at least - two settings. The risk of over-diagnosis in ADHD is one of the potentially problematic, however, the risk of over-diagnosis is not confined to ADHD, it can be present in other psychiatric diagnoses, as they rely on subjective experience of the patient and doctor's interviewing skills. In ADHD in particular the risk of under-diagnosis is even more problematic. An undiagnosed child who has ADHD may suffer various complications as moral stigma of 'lack of conduct' due to impuslivity and hyperactivity, poor scholastic achievement, potential alienation, ostracization and even exclusion by peer due to perceived 'difference', consequent feelings of low self esteem and potential revengeful attitude on the side of the child. An end result, would be development of substance use disorders, or involvement in dissocial behaviours. The answer to the problem of over-diagnosis/under-diagnosis can be helped by an initial step of raising public awareness of people about ADHD, including campaigns to families, carers, teachers and general practitioners. These campaigns would help people identify children with possible ADHD. The only risk is that child psychiatrists may be met with children who their parents believe they might have the disorder while they do not. In a way, raising awareness can serve as a sensitive laboratory investigation. The next step is that the child psychiatrist should scrutinise children carefully. The risk of over-diagnosis can be limited via routine using of checklists, to make sure that the practice is standardised and that every child was diagnosed properly according to the diagnostic criteria. The use of proper scales as Strengths and Difficulties Questionnaire (SDQ) in its two forms (for parents SDQ-P and for teachers SDQ-T) which enables the assessor to learn about the behaviour of the child in two different settings. Conner's scale can help give better understanding of the magnitude of the problem. Though some people may voice criticism as they are mainly filled out by parents and teachers, they are the best tools available at hands. Training on diagnosis, regular auditing and restricting doctors to a standard practice of ensuring that the child and carer have been interviewed thoroughly can help minimise the risk of over-diagnosis. The issue does not stop by diagnosis, follow-up can give a clue whether the child is improving on the management plan or not. The effects and side effects of treatments as methylphenidate should be monitored regularly, including regular measurement height and weight, paying attention to nausea, poor appetite, and even the rare side effects which are usually missed. More restrictions and supervision on the medication may have an indirect effect on enhancing the diagnostic assessment. To summarise, the public advocacy does not increase the risk of over-diagnosis, as asking about suicidal ideas does not increase its risk. The awareness may help people learn more and empower them and will lead to more acceptance of the diagnosed child in the community. Even the potential risk of having more case loads for doctors to assess for ADHD may help give more exposure of cases, and reaching more meaningful epidemiological finding. From my experience, it is quite unlikely to have marked over-representation of children who the families suspect ADHD without sufficient evidence. ADHD remains a clinical diagnosis, and it is unlikely that it will be replaced by a biological marker or an imaging test in the near future. After all, even if there will be objective diagnostic tests, without clinical diagnostic interviewing their value will be doubtful. It is ironic that the two most effective treatments in psychiatry methylphenidate and Electroconvulsive Therapy (ECT) are the two most controversial treatments. May be because both were used prior to having a full understanding of their mechanism of action, may be because, on the outset both seem unusual, electricity through the head, and a stimulant for hyperactive children. Authored by E. Sidhom, H. Badawy DISCLAIMER The original post is on The BMJ doc2doc website at http://doc2doc.bmj.com/blogs/clinicalblog/#plckblogpage=BlogPost&plckpostid=Blog%3A15d27772-5908-4452-9411-8eef67833d66Post%3Acb6e5828-8280-4989-9128-d41789ed76ee BMJ Article: (http://www.bmj.com/content/347/bmj.f6172). Bibliography Badawy, H., personal communication, 2013 El-Islam, M.F., personal communication, 2013 Thomas R, Mitchell GK, B.L., Attention-deficit/hyperactivity disorder: are we helping or harming?, British Medical Journal, 2013, Vol. 5(347) De Zeeuw P., Mandl R.C.W., Hulshoff-Pol H.E., et al., Decreased frontostriatal microstructural organization in ADHD. Human Brain Mapping. DOI: 10.1002/hbm.21335, 2011) Diagnostic Statistical Manual 5, American Psychiatric Association, 2013 Diagnostic Statistical Manual-IV, American Psychiatric Association, 1994 International Classification of Diseases, World Health Organization, 1992  
Dr Emad Sidhom
over 5 years ago
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Head and neck cancers in young adults are more likely to be a result of inherited factors

An article published online in the International Journal of Epidemiology pools data from 25 case-control studies and conducts separate analyses to show that head and neck cancers (HNC) in...  
medicalnewstoday.com
over 4 years ago
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Large scale sequence analysis yields insights into epidemiology of HIV-1 transmitted drug resistance

Only a limited number of surveillance drug-resistance mutations (SDRMs) are responsible for most instances of non-nucleoside reverse transcriptase inhibitor (NNRTI)- and nucleoside reverse...  
medicalnewstoday.com
over 4 years ago
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Epidemiology of human mycobacterium bovis disease, california, USA, 2003-2011

Tuberculosis (TB) can be caused by more than one type of bacteria, one of which is Mycobacterium bovis. TB caused by M.  
medicalnewstoday.com
over 4 years ago
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SGEM#113: EGDT – ProMISe(s) ProMISe(s)

Suneel is an Associate Clinical Professor Emergency Medicine at McMaster University and Associate Member of Clinical Epidemiology and Biostatistics. He is also the Chair CAEP standards committee and a sepsis researcher.  
thesgem.com
over 4 years ago
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SGEM#48: Thunderstruck (Subarachnoid Hemorrhage)

Guest Skeptic: Dr. Jeff Perry. Senior Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute. Associate Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa.  
thesgem.com
over 4 years ago
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A Guide to Dementia

Epidemiology & societal impact, genetic and other risk factors, differential diagnosis of dementia assessment methods, agitation, treatment & management and references.  
hopkinsmedicine.org
over 4 years ago
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SGEM#118: I Hope you Had a Negative D-dimer (ADJUST PE Study)

Guest Skeptics: Dr. Kerstin deWit. Kerstin did an Internal medicine and EM training in the UK. Since then she has worked in Thrombosis research and received a doctorate in the UK and a Masters in Epidemiology from the University of Ottawa. Kerstin currently works as a Thrombosis physician and Emergency Physician at McMaster University and member of Best Evidence in Emergency Medicine (BEEM).  
thesgem.com
over 4 years ago
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Basal Joint Arthritis Of The Thumb

Basal Joint Arthritis of the Thumb Christian Veillette, MD, MSc, BSc(Hon) Orthopaedic Resident PGY-4 Upper Extremity Rounds 2004 St. Michael’s Hospital  
slideshare.net
over 4 years ago
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MRSA In Practice

Aimed at junior hospital doctors and general practitioners, the In Practice Series has been devised by RSM Press to present cutting-edge and clear-cut opinion leader advice and summary acts related to every day clinical practice.MRSA is an all too familiar acronym in use in most UK hospitals. MRSA was discovered in the 1960s however has not been a public cause for concern until the current pandemic started in the 1990s. It shows no signs of abating and the UK now has about the highest prevalence in Europe. It has captured the attention of the public and politicians but how important is it in clinical practice? How did it evolve, will it go away or get worse - will it really develop into the untreatable superbug? Is it more virulent than Staphylococcus aureus, what are its common clinical presentation and the best treatments? What are the best ways to control it if indeed we should bother? How much does it cost the NHS? Do we have any new strategies up our sleeves? These are just some of the intriguing questions that a distinguished panel of authors from around the world have tried to answer in this monograph.Some of the topics covered include:Historical perspectives - Ian Phillips (London)Immunology and pathogenesis of MRSA - Von Belkum (Rotterdam) Antibiotic resistance in MRSA - Giles Edwards (Glasgow)Evolution of MRSA - Mark Enright (London University)Epidemiology of MRSA - Vuopia-Varkila (Finland) Control of MRSA - Barry Cookson (London) Georgia Duckworth (London) & Hans Kolmos (Denmark) Treatment of MRSA - Ian Gould (Aberdeen)Decolonisation of MRSA patient - A Seaton (Glasgow)Laboratory aspects- developments in detection and AST - Donald Morrison (Glasgow) Alternative treatments - Tom Riley (Perth, Australia)MRSA in the home and on the farm - Vos + Vos (Nijmegen/Rotterdam)Mopping up MRSA - Stephanie Dancer (Glasgow)Guidance to control MRSA from the Royal College of Physicians of Edinburgh - D Baird (Glasgow)With its easily accessible approach, broken down into easy-to read chapters, the tips and useful advice of this text makes this a key text for all hospital practitioners. MRSA In Practice is a book that no health care professional can afford to be without.  
books.google.co.uk
over 4 years ago
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Normal Labor and Delivery: Practice Essentials, Definition, Stages of Labor and Epidemiology

Labor is a physiologic process during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus. Stages of labor Obstetricians have divided labor into 3 stages that delineate milestones in a continuous process.  
emedicine.medscape.com
over 4 years ago
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Chapter 3: VACCINATION

This technology review presents the lattest understanding of Newcastle disease, its characteristics, epidemiology, symptoms and control. It will be of practical value to state and private veterinarians and to all those involved with rural poultry production who wish to control this disease.  
fao.org
over 4 years ago
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Polio epidemiology

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT...  
youtube.com
over 4 years ago
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Critical Care

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.  
ccforum.com
about 4 years ago
Www.bmj
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Strategies for dealing with loss of hearing in adulthood

I greatly enjoyed Ibrahim’s account of hearing loss and cochlear implantation.1 While I suspect that a formal study along the lines of “The epidemiology of cochlear implantation in epidemiologists” would ultimately founder under sample size considerations, I find it interesting to consider one aspect where our preimplantation experience diverged.  
feeds.bmj.com
about 4 years ago