The Mount Sinai journal of medicine, New York
-
This article reviews the current legal arguments for and against affirmative action in medical education. It concludes that many of the traditional legal defenses for race-based admissions are imperiled or defunct. The author suggests that the best and probably most viable justification for affirmative action policies is the one that recognizes that racial diversity in the medical profession is important because it provides the physicians with whom minority patients can feel safe and comfortable. ⋯ Unfortunately, minorities' historical and current experience with the medical profession and health delivery system frequently breeds suspicion rather than faith. As a result, society and the medical profession have a compelling interest and duty to produce physicians who can inspire trust in patients. In the short-to-medium term, race-conscious admissions policies may be necessary to fulfill this duty.
-
Successful outcome from a traumatic cervical spinal cord injury (SCI) depends heavily upon the quality of the acute care rendered to the affected individual. In recent years, there have been significant advances in the acute management of SCI. We discuss current management strategies in the areas of prehospital care and transport, emergency room management, surgical considerations and pharmacotherapy.
-
Full oral rehabilitation with a high degree of success is now possible with osseointegrated implants. Osseointegration is a direct connection between living bone and the titanium implant at the level of the light microscope. Osseointegrated implants are currently used to replace single teeth, support fixed bridges and stabilize full dentures. ⋯ Bone grafts are sometimes placed on the floor of the nose or the floor of the maxillary sinus. Guided tissue regeneration is a technique used to generate bone within bony defects adjacent to implants. With long-term rates of success (5 years) of 99% for implants placed in the mandible and 95% for those placed in the maxilla, reconstruction of the jaws and cranial facial skeleton with osseointegrated implants has become the treatment of choice.
-
The predictable relationship between surgical injury responses and the ensuring postoperative pain has led to the development of the concept of preemptive analgesia, with its potential to improve the quality of the postoperative period. ⋯ Techniques directed toward reducing and/or eliminating postoperative pain are still being developed, and their clinical utility is yet to be fully evaluated.
-
An effective response to injury or inflammation requires leukocyte migration from the endovascular compartment into areas of inflammation. This process requires the appropriate expression of adhesion molecules, which mediate cell-cell and cell-extracellular matrix interactions. ⋯ The role of cell adhesion molecules in a variety of pathological conditions, including graft rejection, reperfusion injury, and acute lung injury are discussed. In addition, some recent studies that explore therapeutic uses of adhesion molecules are summarized.