Nurse practitioners and the organization of primary care
Naomi Chambers in Nurse Practitioners in Primary Care, 2021
The kind of doctor who would be attracted to a management specialist role is one who is getting somewhat tired of routine surgery work and may have already found that they enjoy the organization and management part of their current work as a partner. One such doctor can be found in the Johns Practice focus groups. In contrast to colleagues, he claims to understand the place, purpose and value of having meetings. There are also the doctors who enjoy computing, and many practices now harbour such enthusiasts. Others volunteer to serve in medical representative organizations. The consequences on morale of a lack of a career trajectory for GPs have been pointed out (McBride and Metcalfe, 1995). An explicitly recognized move into management may be a solution to this and to early ‘burnout’, which Kirwan and Armstrong have uncovered (Kirwan and Armstrong, 1995).
Toxic Megacolon in Crohn’s Colitis
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
Over the course of the next two days she became more unwell, had further abdominal distension, and had worsening per rectal bleeding necessitating blood transfusions. She was transferred to the intensive care unit (ICU) and commenced on inotropic support. At this time, a plan was made for a magnetic resonance imaging (MRI) scan of the abdomen and pelvis, as well as a flexible sigmoidoscopy. At sigmoidoscopy, the patient was noted to have significant colitis involving the rectum and distal colon extending up to the mid transverse colon (Figure 20.1). Biopsies were taken and the patient was sent for the MRI scan. The MRI scan demonstrated features of florid colitis from the mid transverse colon to the anus, with proximal colonic dilatation proximally to the cecum (Figure 20.2). The cecum to the proximal/mid transverse colon did not appear grossly inflamed, but the cecal diameter was approximately 10 cm with a transverse colon diameter of 6 cm. There was no free perforation. At this point, a surgical consultation was sought for assessment of the need for surgery.
Chronic Pain Is a Family Problem
Michael S. Margoles, Richard Weiner in Chronic PAIN, 2019
As far as health problems are concerned, you and your family have been very fortunate. The only problems you have had were never more than a day or two of stiffness in your back after doing too much housework, yard work, or playing too hard at tennis, baseball, or the like. Then, one day at work, you injure your back. After 1 month off work, bed rest, and physical therapy, you are no better. An magnetic resonance imaging study and myelogram are done and show that a lower lumbar disc is “out.” Surgery is performed. The operation seems to work. However, when you return to work 6 weeks after your back surgery, the back pain, with associated leg pain and weakness, becomes unbearable. You have to stop working after only 3 days. A series of medications is used to try to get you going again. Corsets, physical therapy, traction, and even a transcutaneous electrical nerve stimulator unit are tried. Numerous blocks and spinal injections are given with only limited success. Before you know it, a year has slipped by.
Macrophage infiltration promotes regrowth in MYCN-amplified neuroblastoma after chemotherapy
Published in OncoImmunology, 2023
Anders Valind, Bronte Manouk Verhoeven, Jens Enoksson, Jenny Karlsson, Gustav Christensson, Adriana Mañas, Kristina Aaltonen, Caroline Jansson, Daniel Bexell, Ninib Baryawno, David Gisselsson, Catharina Hagerling
Once high-risk neuroblastoma patients complete the rapid-COJEC therapy regimen, they undergo surgery to achieve complete removal of any remaining primary tumor. The time from completed treatment to surgery is typically a couple of weeks to allow recuperation. We hypothesized that, during the interval between chemotherapy and surgery, surviving tumor cells could proliferate in cooperation with macrophages. To explore whether inhibition of macrophage recruitment could prevent tumor regrowth we used an in vivo neuroblastoma PDX–COJEC model and anti-CSF1R, inhibiting the recruitment of macrophages.36 Dissociated organoids from the PDX#3 model were subcutaneously (s.c.) injected into the flank of nude mice (Figure 5a).39 COJEC treatment was administered for three weeks. After chemotherapy, the tumors were allowed to regrow for three weeks without or with intraperitoneal (i.p.) treatment with anti-CSF1R, inhibiting the recruitment of macrophages.40,41 All PDX tumors treated with COJEC shrank during the treatment period and started to regrow once the treatment ended. Importantly, the anti-CSF1R treatment, which impaired macrophage infiltration (Figure 5d,e and Supplementary Fig 5a-c), prevented the regrowth of the tumors (Figure 5b,c). In line with the abovementioned data, the POST tumors in this experiment had increased expression of CCL2 than the untreated tumors (Figure 5f).
Perceptions and preparedness of senior medical students about antimicrobial stewardship programs: are we providing adequate training to future prescribers?
Published in Expert Review of Anti-infective Therapy, 2023
Wenjing Ji, Ali Hassan Gillani, Dan Ye, Hang Zhao, Jiaxi Du, David J McIver, Yun Tian
This study is first of its kind to assess attitudes and perceptions of senior medical students about AMR and their preparedness toward AMS activities across multiple medical schools of Northwest China. Most students intended to pursue residency training in internal medicine and surgical specialties. More than 2/3 (69.8%) of our respondents were of the view that medical schools should impart more education on the antimicrobial resistance, and 70% agreed that they would like to acquire more knowledge on the appropriate use of antimicrobials. A previous study found similar results, which highlighted that there was an urgent need to accommodate antimicrobial education into the curriculum of medical students, including pharmacy [17]. In similar studies conducted in USA and United Kingdom (UK), almost every student requested more education focused on antimicrobial prescribing [18]. Accordingly, in the past years, medical schools in the UK have revised their syllabi to enhance the student decision-making for proper antimicrobial selection and prescribing practices [19].
The pros and cons of follicular unit extraction (FUE) versus elliptical donor harvesting (FUT)
Published in Journal of Cosmetic and Laser Therapy, 2022
Rohail Memon, Marc Avram
In summary, both techniques have advantages and disadvantages which should be discussed during a consult with a patient, as each technique will have patient-specific advantages (2). There is no superior donor harvesting technique, and that the “best” procedure will depend on patient-specific needs and lifestyle. Thus, it becomes important for a physician to talk with a patient prior to the decision of which surgery they want to go ahead with as well as other factors that may be affected by a certain modality of surgery. For example, women and older men who might wear their hair longer and who would not mind a linear scar due to it being concealed by the longer hair should be counseled toward FUT procedures for the potentially lower transection rates and lack of trimming the donor area down for extraction. For those patients who wear their hair shorter or may be worried due to the “invasive” nature of an FUT procedure, a FUE procedure may be the preferred route after discussion between physician and patient.
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