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26

Angioplasty with paclitaxel coated balloon reduces restenosis in peripheral artery disease

Percutaneous transluminal angioplasty using a paclitaxel coated balloon notably improves arterial patency at one year when compared with the same procedure using a standard uncoated balloon in patients with femoropopliteal artery disease, a study in the New England Journal of Medicine has shown.1  
feeds.bmj.com
about 5 years ago
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7

Surgical procedures for accelerating orthodontic treatment | Cochrane

Review question Orthodontic treatment (use of braces) is lengthy, typically taking over 18 months to complete, with brace adjustments required every six weeks or so. Usually brace treatment is carried out without the use of surgery. However, special surgical procedures have been proposed to speed up orthodontic treatment. This review, produced through the Cochrane Oral Health Group, examines the merits and risks of surgical methods for speeding up orthodontic treatment compared to standard orthodontic treatment in adolescents and adults.Background Reduction of orthodontic treatment duration is highly desirable. Surgery has been advocated to speed up tooth movement and may work by stimulating cells adjacent to the teeth or by reducing the resistance presented by the supporting bone and mechanically shifting teeth. These procedures are relatively new and may carry additional risks compared to standard treatment.Study characteristics The evidence on which this review is based is up to date as of 10 September 2014. We found four relevant studies to include in this review. These studies involved 57 participants ranging in age from 11 to 33 years. All of the studies investigated the effects of surgical procedures on either the time taken to align a displaced tooth or to close gaps between teeth. None of these studies reported being funded by the orthodontic industry.Key results Slightly faster tooth movement was found with the surgical procedures, although this result is based on a relatively small number of participants. In addition, there were some problems inherent in the design and quality of all the studies. Therefore, further research is needed to confirm whether additional surgery is warranted to speed up tooth movement. The studies did not provide any information about negative side effects from the treatment.Quality of the evidence The quality of the evidence concerning the rate of tooth movement was judged to be low for assessments one month and three months after the procedure.  
cochrane.org
about 5 years ago
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4

Interventions delivered by mobile phone to support client use of family planning/contraception | Cochrane

Contraception - methods or devices used to prevent pregnancy – has significant benefits for women's and children's health. Despite these benefits, an estimated 225 million women in developing countries were not using a modern contraceptive method in 2014 despite wanting to avoid pregnancy. Expansion of mobile phone use in recent years has led to increased interest in healthcare delivery via mobile phone and the potential to deliver support wherever the person is located, whenever it is needed, and to reach populations with restricted access to services. Mobile phone-based interventions have been demonstrated to be effective in other health areas, but not yet in the field of contraception.  
cochrane.org
about 5 years ago
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11

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns | Cochrane

Background: Newborn infants have the ability to experience pain. Newborns treated in neonatal intensive care units are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests.  
cochrane.org
about 5 years ago
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18

Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies

Objective To assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol’s iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for primary cervical cancer screening in sub-Saharan Africa.  
feeds.bmj.com
about 5 years ago
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1
10

A useful mnemonic for pre-anesthetic assessment

Assessing patients preoperatively is an important starting point to formulate effective anesthetic plan. Pre-anesthesia assessment includes a good history, a physical examination, and any indicated laboratory tests. The task of gathering necessary information and sharing that information among various providers is important. As outpatient anesthesia is becoming more popular with the majority of patients coming to the hospital shortly before undergoing a procedure, pre-anesthetic assessment has become more challenging. Moreover, there is a possibility of incomplete checkup due to anesthesiologist's busy schedule or when the case is presented at odd hours. This leads to missing of certain components of assessment, which becomes apparent only when the problem arises. The Australian Incident Monitoring Study database found that 11% of reports identified inadequate or incorrect preoperative assessment (478 of 6,271) or preoperative preparation (248 of 6,271).[1]  
ncbi.nlm.nih.gov
about 5 years ago
Sinaiem dark
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6

apneic-oxygenation

You are a first day intern (literally, for many of you), the cardiac room is overflowing with patients and you are asked to set up for endotracheal intubation on a patient with declining mental status.  You haven’t intubated since your anesthesia rotation and you’re worried you may experience some difficulty with the procedure.  What can you do to delay desaturation in the event that you need more time to intubate?  
sinaiem.org
about 5 years ago
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13

Critical Care

In severe respiratory and/or circulatory failure, extracorporeal membrane oxygenation (ECMO) may be a lifesaving procedure. Specialized departments provide ECMO, and these patients often have to be transferred for treatment. Conventional transportation is hazardous, and deaths have been described. Only a few centers have performed more than 100 ECMO transports. To date, our mobile ECMO teams have performed more than 700 transports with patients on ECMO since 1996. We describe 4 consecutive years (2010–2013) of 322 national and international ECMO transports and report adverse events.  
ccforum.com
about 5 years ago
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2
39

Oxford Handbook of Emergency Medicine

Fully revised and updated, the Oxford Handbook of Emergency Medicine is the definitive, best-selling guide for all of the common conditions that present to the emergency department. Whether you work in emergency medicine, or just want to be prepared, this book will be your essential guide. Following the latest clinical guidelines and evidence, written and reviewed by experts, this handbook will ensure you are up to date and have the confidence to deal with all emergency presentations, practices, and procedures. In line with the latest developments in the field, such as infection control, DNR orders, advanced directives and learning disability, the book also includes new sections specifically outlining patient advice and information, as well as new and revised vital information on paediatrics and psychiatry. For all junior doctors, specialist nurses, paramedics, clinical students, GPs and other allied health professionals, this rapid-reference handbook will become a vital companion for both study and practice.  
books.google.co.uk
almost 5 years ago
Www.bmj
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15

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
almost 5 years ago
Www.bmj
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9

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
almost 5 years ago
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7

Post tonsillectomy hemorrhage

Tonsillectomy is one of the most common procedures performed in children. Post op hemorrhage is either primary (within 24 hours) or secondary/delayed ≥24 hours. Primary hemorrhage is more rare and is seen in 0.2-2% of cases. Secondary hemorrhage is a bit more common, especially in the Emergency Department as kids have been home for several days. rates vary, but estimates settle around 3%. It most commonly occurs between 5-10 days post-op, with the median 6th POD. The cause is separation of the eschar – which may be precipitated by dehydration, vomiting or rarely infection. Most stop on their own, but rarely they can lead to calamitous bleeding and airway compromise – so it is obviously a good idea to take them seriously.  
pemcincinnati.com
almost 5 years ago
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2

Should doctors recommend homeopathy?

Peter Fisher criticises the methods of a recent review that found no evidence to support homeopathy. But inconclusive evidence, lack of rational explanation, and questions about safety make Edzard Ernst question Europe’s €1bn annual spend on such remedies  
feeds.bmj.com
almost 5 years ago
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6

Controversial online “scorecard” shows complication rates of 17 000 US surgeons

An analysis of the complication rates of nearly 17 000 US surgeons regarding eight elective procedures has been posted on the internet in a searchable database that allows patients to look up and compare individual physicians.  
feeds.bmj.com
almost 5 years ago
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6

Minor Head Trauma in Anticoagulated Patients: Admit for Observation or Discharge? - R.E.B.E.L. EM - Emergency Medicine Blog

Several European guidelines suggest that all anticoagulated patients with head trauma should be admitted for observation, even if the initial head CT is negative, based on limited data.  
rebelem.com
almost 5 years ago
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5

Heart-lung transplant man marks 30 years - BBC News

A London man celebrates 30 years since his heart-lung transplant - thought to be the longest anyone has survived after the procedure.  
bbc.co.uk
almost 5 years ago
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1
19

Everything You Think You Know About Addiction Is Wrong | Johann Hari | TED Talks

What really causes addiction — to everything from cocaine to smart-phones? And how can we overcome it? Johann Hari has seen our current methods fail firsthan...  
youtu.be
almost 5 years ago
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14

Should we really be packing abscesses?

When I was first taught how to drain an abscess I was taught to pack most with ¼ inch gauze. Initially it was iodoform gauze, later just plain old ribbon gauze. As with many things I felt like it worked and had no impetus to change. Recently, I began to reconsider based on a review of the literature and experience at the bedside. A recent survey of 350 Emergency Department providers revealed that 91% of respondents routinely packed abscesses – I wonder if many of them are asking the same question about how we perform this procedure, and why there seems to be so much heterogeneity.  
pemcincinnati.com
almost 5 years ago
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8

Hormonal birth control and fracture risk in observational studies | Cochrane

When bone mass declines with age, the risk of fractures increases. Birth control methods that have hormones may lead to changes in women’s bone density. Worry about fractures may limit the use of these effective methods. Observational studies can collect data on birth control use as well as fractures later in life. Through June 2015, we searched for such studies in several databases.   
cochrane.org
almost 5 years ago
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3

How has IVF developed since the first 'test-tube baby'? - BBC News

In 1978 Louise Brown was hailed as the world's first "test-tube baby", born through IVF. How does her story compare with modern procedures?  
bbc.co.uk
almost 5 years ago