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11

Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations ≥150 μmol/L (male) or ≥130μmol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.  
jasn.asnjournals.org
about 4 years ago
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4
35

Middle Ear Surgery

This comprehensive, richly illustrated textbook provides a systematic approach to frequent otological operations. Procedures in surgery of the ear canal, acute and chronic middle ear diseases, otosclerosis, cochlear implantation and vertigo are visualized step-by-step to acquaint the beginner with proven surgical repertoires. The book is written by two famous experts, and even the experienced surgeon will find valuable hints and suggestions to facilitate routine middle ear operations.  
books.google.co.uk
about 4 years ago
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4
212

Errors in Emergency Medicine: Rapid Sequence Intubation

*Rapid Sequence Intubation* Rapid sequence intubation (RSI) is a medical procedure involving a prompt induction of general anesthesia and subsequent intubati...  
youtube.com
almost 4 years ago
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4
177

Cardiac Catheterization

Cardiac catheterization procedure can diagnose a variety of heart conditions and determine the health of your coronary arteries, heart valves, and heart muscle.  
youtube.com
over 3 years ago
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3
65

Teaching public health in medical schools: a case study in three universities in Paraná - Brazil

Historically, different concepts of Public Health have influenced the specific teaching of this field of knowledge as well as medical education. The objective of this paper is to study the teaching of Public Health in medical schools, focusing on its structure and implications in curriculum design in three universities in Paraná - Brazil: State University of Londrina (UEL), Federal University of Paraná (UFPR) and the Positivo University (UnicenP). The research questions focused on the content of Public Health selected in their respective curricula, the teaching-learning relationships, program emphasis and the partnerships established with public health services. Qualitative research data collection from the perspective of key informants was carried out based on the analysis of pedagogical projects and on how they were effectively experienced. Eleven managers and 18 teachers were interviewed and 4 focus groups with students were developed in the three universities. Outcomes showed the presence of between 5% to 20% of Public Health themes in the course syllabi, depending on the teaching strategies used. However, they always appeared associated with academic issues strongly linked to health services, which were strengthened by the local development of the Comprehensive Health Care System in the two cities, Curitiba and Londrina in which studies were carried out. Public Health is present and very relevant in the curriculum required for doctors’ qualification regardless of the characteristics of the university studied, the bureaucratic and academic course structures and the different methods for hiring teachers. Besides not being a main articulator axis in two of the medical courses studied, Public Health provides the necessary balance for the technical dimension of medical knowledge, represented by the awareness of the challenges and commitment to the reality. On the contrary, because of the complexity of medical education, the strong presence of Public Health in the other medical course studied not necessarily guarantees the ideal qualification of the medical professional.  
João Campos
almost 10 years ago
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3
89

Review of orthopaedic services: Prepared for the Auditor General for Scotland. March 2010

Review of orthopaedic services: Prepared for the Auditor General for Scotland. March 2010. Website http://www.audit-scotland.gov.uk/media/article.php?id=128 "In recent years, the National Health Service (NHS) in Scotland has significantly reduced the length of time people are waiting to receive orthopaedic procedures such as hip replacements and knee operations. Over 95% of patients are now treated within 26 weeks of referral, compared to only 66% in 2003. But there is scope to make savings by working more efficiently. An Audit Scotland report, Review of orthopaedic services, says there is high demand for these services. Orthopaedic care is particularly important for older people, who have the highest rates of fractures and joint replacement."  
Chris Oliver
over 9 years ago
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3
36

Eating Disorders in Type 1 Diabetics

This presentation descibes to the listener the eating disorders that can occur in type 1 diabetes mellitus. I have focused on 'Diabulimia', a disorder where diabetics omit their insulin in order to lose weight leading to drastic complications. The presentation looks at evidence based medicine and potential methods of treatment for these highly specialised patients.  
Deborah Green
over 8 years ago
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3
53

Two Videos Showing Fluoroscopy and Animation of the TAVI Procedure

Fluoroscopy with Videography Showing Deployment of the Valve: The valve is deployed during rapid right ventricular pacing. The crimped valve and support frame are expanded with underlying balloon inflation. Also seen are the transesophageal echocardiography probe and the temporary right ventricular pacing lead. Animation of the Complete Transfemoral Transcatheter Aortic-Valve Implantation (TAVI) Procedure: The procedure for transfemoral TAVI involves insertion of the sheath through the femoral artery, retrograde balloon aortic valvuloplasty, advancement of the TAVI system across the aortic valve, and subsequent deployment of the valve and support frame.  
Nicole Chalmers
over 5 years ago
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3
74

Male Catheterisation - Full Process

Male Catheterisation performed following official University Hospitals of Leicester (UHL) guidelines. Stage 1: Consent - 0:36 Stage 2: Equipment - 1:54 Stage 3: Procedure - 3:02 Stage 4: After Care - 12:23 For more videos and resources visit our website: www.leicesterclinicalskills.weebly.com  
Leicester Clinical Skills
over 5 years ago
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3
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Female Catheterisation - Procedure Only

Female catheterisation performed following the official University Hospitals of Leicester (UHL) guidelines. This video only covers the procedure part of this skill. View our video of the Full Process video for more information. Find more videos and resources at our website: www.leicesterclinicalskills.weebly.com  
Leicester Clinical Skills
over 5 years ago
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3
24

Female Catheterisation - Full Process

Female Catheterisation performed following the official University Hospitals of Leicester (UHL) guidelines. Stage 1: Consent - 0:38 Stage 2: Equipment - 1:53 Stage 3: Procedure - 2:58 Stage 4: After Care - 11:19 Find more videos and resources at: www.leicesterclinicalskills.weebly.com  
Leicester Clinical Skills
over 5 years ago
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33

Emergency Contraception

Emergency contraception These below methods do not cause abortion. Instead, they prevent ovulation, fertilisation, and/or implantation. Those who believe life begins at fertilisation may argue that abortion can occur with these methods, and may have objections. However, the method does not cause any alteration to an embryo after implantation.    
almostadoctor.com - free medical student revision notes
over 5 years ago
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3
155

Sepsis and SIRS

Definitions. Before discussing SIRS along with the various sepsis syndromes, it is important to understand some basic definitions. Infection: This is the inflammatory response initiated by the presence of a micro-organisms in normally sterile tissue. Bacteraemia: The presence of live bacteria in the blood stream. This can occur in a healthy individual and present with no symptoms. Common causes include surgery, dental procedures and even tooth brushing.  
almostadoctor.com - free medical student revision notes
over 5 years ago
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47

OSCE-Aid : the online revision community for medical students and junior doctors

In your OSCE, you may be asked to explain a procedure and gain consent for it. You may even be provided with a consent form for the patient to sign after your discussion. It is vital to remember that FY1 doctors should not be gaining consent for procedures, and that a doctor should be able to perform a procedure before they can consent a patient for it. Below are some common procedures that are discussed in OSCE stations, along with a structure about how to explain it to a patient: Liver biopsy Endoscopy Endoscopic retrograde cholangiopancreatography Colonoscopy Bronchoscopy  
osce-aid.co.uk
over 5 years ago
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3
82

Applied Radiological Anatomy

This thoroughly illustrated text will provide radiologists with a unique overview of normal anatomy as illustrated by the full range of modern radiological procedures. The theme throughout is not only to illustrate the appearance of normal anatomical features as visualized by radiology, but also to provide a comprehensive text that describes, explains, and evaluates the most current imaging practice for all the body systems and organs. Where necessary, line drawings supplement the images, illustrating essential anatomical features. The wealth of high-quality images fully supported by an authoritative text will give all radiologists an insight into normal anatomy--a vital prerequisite for interpreting abnormal radiological images. The volume is designed to be accessible to medical students, but will also prove to be a valuable resource for radiologists.  
Google Books
over 4 years ago
Foo20151013 2023 eztttu?1444774181
3
128

Dealing with Personal Illness in Med School

Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to. Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight. I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week. The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day. In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything. I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable. I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January. During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive! I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term. My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time. The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.  
Nicole Mooney
over 5 years ago
Foo20151013 2023 e7fpn8?1444774293
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339

The Importance Of Clinical Skills

In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees. Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this. In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment. In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room. What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it? Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important. Those wanting to read more similar stories can download a free e book from Smashwords. The title is: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH." You can access the e book here.  
DR William LeMaire
over 5 years ago
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3
83

Anaesthesia UK : Analgesia for labour

 There are many different techniques, both regional and non-regional, to provide labour analgesia.  Non-regional techniques are the most frequently employed methods for labour analgesia.  Meperidine (pethidine) is the most frequently used opioid for labour analgesia. Its limited efficacy and side-effects are well documented.  Inhalation of nitrous oxide relieves labour pain to a significant degree and is especially beneficial in hospitals where other analgesic options are not available.  Epidural analgesia, when compared with other methods, provides superior analgesia for labour.  There is no association between epidural analgesia and an increased risk of Caesarean delivery or post-partum backache. There is an association with prolongation of labour and increased operative vaginal delivery.  
anaesthesiauk.com
over 4 years ago
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2
437

Innovative Programme Elements Add Value to a FAIMER Regional Institute Faculty Development Fellowship Model in Southern Africa

The Foundation for the Advancement of Medical Education and Research (FAIMER) is a US-based non-profit organisation committed to improving health professions education to improve global health. FAIMER traditionally offers a two year fellowship programme; 2 residential and 3 distance learning sessions and an education innovation project in the fellow’s home institution. The focus is on education methods, leadership/management, scholarship and the development of an international community of health professions educators. During the past 5 years, FAIMER has expanded the programme and established regional institutes in India[3], Brazil[1] and Southern Africa (SAFRI)[1]. We implemented the programme in Africa in 2008, introducing 5 innovations to the generic programme. SAFRI was created as an independent voluntary association to reflect the multinational intent of the programme. Aim of project To understand the impact of the innovations in the structure and implementation of the programme on its quality and the experience of the participants in it. Conclusions Faculty development programmes can significantly enhance their impact: Be sensitive to the local political climate Demonstrate wide ownership Focus on developing a community of practice Work within the professional time constraints of Fellows and faculty Maximise learning opportunities by linking to other scholarly activities  
Juanita Bezuidenhout
almost 10 years ago
12
2
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Diagnosis and Staging of Lung Cancer: A Pulmonologist's Perspective (Video)

This slide presentation by Dr. Gerard Silvestri, pulmonologist at Medical Univ. of South Carolina, covers the key methods of evaluating a new lung cancer, including initial diagnosis and staging studies.  
Howard (Jack) West, MD
about 9 years ago