Missouri medicine
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The completion of the human genome project in 2003 ushered in the era of genomics, the systematic study of our DNA sequence. Proteomics, the study of the full complement of proteins present in a cell, is a natural extension of genomics. ⋯ All students and physicians in training will need to acquire enough knowledge of the underlying science, including medical genetics, epidemiology, bioinformatics and statistics, so they will intuitively understand the technology and recognize the strengths and limitations of genomic/proteomic tests. Because genomic or proteomic testing may yield extensive information about a person's genetic makeup and disease risks, consideration will need to be given throughout the medical curriculum to the ethical issues raised by the application of this new technology to the diagnosis and treatment of patients.
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The extraordinary discoveries of 20th century medicine and technology have created a scientific renaissance. This explosion of new knowledge and the tantalizing potential it holds for altering the course of human health and disease will change the practice of medicine and require the education of a new generation of translational/clinical scientists and physician-scientists as well as an accelerated evolution of the teaching paradigms for the training of physicians.
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This study is to determine the assessment accuracy for the diagnosis of stroke by EMS dispatchers and paramedics compared to emergency physicians (EPs). Of the 191 patients who met inclusion criteria, dispatchers assessed 133 as having a stroke; EPs agreed in 67 (50%) cases. ⋯ Dispatcher and paramedic sensitivity for diagnosing stroke was 61% and 64%, respectively; specificity was 20% and 63% respectively. Sensitivity for the detection of acute stroke was nearly identical between EMS dispatchers and on-scene paramedics; overall agreement with emergency physician diagnosis was moderate.
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The treatment of sepsis and septic shock is an important clinical problem. While effective antibiotic intervention and strong supportive care have improved survival, mortality remains at unacceptable levels. ⋯ The available evidence would support the conclusion that microbial mediators can function synergistically in the induction of host inflammation, providing a potential explanation that anti-endotoxin and anti-inflammatory agents have not been particularly successful in clinical trials to treat septic shock. The identification of specific recognition molecules on the surface of inflammatory mediator cells responsible for initiation of signal transduction, as well as the elucidation of the specific molecular pathways leading to gene expression, provide new opportunities for the development of effective intervention strategies for treatment of septic shock.