The Mount Sinai journal of medicine, New York
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Reduction in retained surgical items is an important part of any operating room patient-safety effort. Any item used in an operation can result in a retained surgical item, but sponges are the most frequent and the abdomen is the most common location. ⋯ This review will examine counting, teamwork, radiography, and new technology as methods used to prevent retained surgical items. Even though none of these techniques individually is likely to completely prevent retained surgical items, when used together the numbers can be reduced.
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This report reviews and critically evaluates the development of 3 movements in healthcare that have had a profound impact on changes occurring at all levels of medical education: patient safety, healthcare simulation, and competency-based education (exemplified by the Accreditation Council for Graduate Medical Education). The authors performed a critical and selective review of the literature from 1999 to 2011 to identify uses of simulation to address patient-safety issues aligned according to the Accreditation Council for Graduate Medical Education 6 core competencies: (1) patient care; (2) medical knowledge; (3) interpersonal and communication skills; (4) professionalism; (5) practice-based learning; and (6) systems-based practice. ⋯ Simulation-based learning can lead to positive patient outcomes and reduction of medical errors particularly when used for individual skills. However, particular attention needs to be placed on the organizational context in which it is implemented if improvements in practice-based learning and systems-based practice are to be realized.
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Anaphylaxis is a life-threatening allergic condition. The 3 most common triggers for anaphylaxis are food, medications, and insects. All of these triggers are the sources of considerable morbidity and mortality, but of the 3, only insect allergy is treatable through means other than trigger avoidance. ⋯ The proper and primary means of treating acute anaphylaxis is immediate epinephrine-and studies suggest that it is underutilized in the acute setting. However, it is venom immunotherapy, a disease-modifying therapy, that provides the affected individual with the most effective protection against future sting reactions. Long-term management of insect allergy and anaphylaxis includes appropriate referral to an allergist familiar with insect allergy and, if indicated, venom immunotherapy.
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Atopic dermatitis, commonly known as eczema, is a common chronic, relapsing skin disease characterized by pruritus, disrupted epidermal barrier function, and immunoglobulin E-mediated sensitization to food and environmental allergens. Atopic dermatitis is a complex disease that arises from interactions between genes and the environment. Loci on several chromosomes have been identified, including a family of epithelium-related genes called the epidermal differentiation complex on chromosome 1q21. ⋯ Conventional therapy includes avoidance of irritants and potential allergens, as well as continued hydration of the skin with thick emollients. Topical corticosteroids and topical immunomodulators are often used primarily. Other therapies including phototherapy, antimicrobials, antihistamines, and systemic immunosuppressives are also options in certain situations.
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Palliative care is a medical specialty that aims to improve the quality of life for patients with chronic and advanced serious illness and their families. It is appropriate throughout all stages of the trajectory of illness, which distinguishes it from hospice care. Hospice care is limited to patients with terminal prognoses. ⋯ Palliative care has been associated with improved outcomes for patients and families and has experienced a rapid expansion in available services. Despite this, palliative care consultation continues to be underutilized. As the number of patients living with complex and serious illness burden continues to increase, palliative care specialists will play an important role in providing timely access to critical supportive services and the provision of high-quality care.