Harefuah
-
Pain in the neonatal period is frequently experienced by 6-10% of newly born infants, preterm and term, who require neonatal intensive care. Repetitive painful procedures without adequate analgesia provided by the medical staff may bear long-term or even life-long adverse consequences. The use of pharmacological and non-pharmacological modalities in the management of pain may change this undesirable situation. ⋯ In addition to pain management in the neonatal intensive care units, neonatal circumcision is the most frequent surgical procedure performed in males, and is frequently conducted without appropriate analgesia. The simple available methods of analgesia for neonatal circumcision are discussed and should be employed in order to avoid painful circumcision. Many pediatric medical associations in the developed world consider failure to provide proper routine analgesia for neonatal circumcision to be an unethical and sub-optimal medical practice.
-
Cardiovascular complications are important causes of morbidity with major non cardiac procedures. Preoperative risk stratification relies on the identification of the cardiac problem, its stability, its severity and previous treatment. The approach to risk stratifying preoperative patients should be performed by accepted guidelines used for patients with suspected coronary artery disease (CAD) or known CAD and not as an "obligatory test" prior to operation. ⋯ The use of invasive diagnostic and therapeutic methods, such as cardiac catheterization, PCI, CABG, has to be restricted only to patients who are at very high risk. The partial reduction of the cardiac event rate in the short term and monitoring for 24 hours after operation is most important, as well as the administration of beta blockers, starting prior to surgery. Furthermore, long term follow-up for cardiac events in these patients in essential, as the clinical predictors and cardiac tests performed for preoperative risk stratification are also used for long term prognosis.
-
Various methods exist for rewarming hypothermia casualties. Most of these methods necessitate sophisticated medical equipment or vigorous hemodynamic and electrolytic monitoring. Therefore, only a few methods remain suitable for pre-hospital scenarios. ⋯ In moderate or severe hypothermia casualties, hypothermia (rectal temperature below 32 degrees C) however, is characterized by suppressed or deficient endogenous heat producing mechanisms. Passive rewarming is not enough in these cases, necessitating the addition of active, central or peripheral rewarming methods. Studies regarding the use of various active rewarming methods in severe hypothermia casualties revealed low rewarming efficacy for the low heat capacity methods, such as warm air inhalation, and a high rewarming efficacy for the high heat capacity methods, such as forced air methods.
-
Paget's disease of the breast is a rare malignancy of the nipple-areola complex, comprising 0.5-4% of all breast cancers which is often associated with an underlying in-situ or invasive carcinoma in the breast parenchyma. It is manifested by progressive eczematoid changes of the areola with persistent soreness or itching. Due to the seemingly benign appearance, diagnosis is often delayed by more than six months. ⋯ In the absence of a mass the prognosis is invariably better as it usually reflects a noninvasive tumor (DCIS). The standard treatment has been mastectomy. However in an era when breast conserving surgery is implemented even for advanced infiltrating breast tumors, there might be a role for such a treatment for selected patients with Paget's disease.
-
The gap between infinite healthcare needs and finite health resources imposes on practicing physicians a dual commitment to patients' needs and to the fair allocation of health care resources. The ethical principles of a fair allocation of resources are egalitarianism, utilitarianism and a transition from individual to group-based ethics. ⋯ Proposed approaches to these barriers to the fair allocation of resources include respect of patient autonomy with full disclosure of the limitations in the services provided by the health plan; adherence to clinical practice guidelines; and an open access for patients to second medical opinion. I believe that the fairness of resource allocation may be further improved by the prohibition of private practice by physicians employed in public health care institutions, and by enhancement of physicians' self-awareness of subconscious discrimination against some patients.