Articles: outcome.
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The dislocated radial head in missed Monteggia fracture loses its concave articular surface and displays hypertrophic changes and flattened humeral capitellum configuration, thereby limiting the range of motion. We evaluated the results of open reduction in missed Monteggia fractures by various techniques. ⋯ Hirayama's osteotomy is inherently more stable than the simple transverse osteotomy and it should be combined with annular ligament reconstruction. Palmaris longus graft for ligament reconstruction provides more stability as compare to Bell Towse's procedure.
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The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes. ⋯ Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion.
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Background. Outcomes following burn injury have improved considerably in recent years due to early excision and skin grafting. Despite a reduction in late burn complications, up to 70% of patients experience long-term pain at both the injured area and the skin-grafted scar. Current therapies do not ameliorate these symptoms for a majority of these patients. This report presents initial results of a new technique using a bilayer dermal substitute (Integra™, [Integra LifeSciences, Plainsboro, NJ]) for revision of painful scars. ⋯ Scar excision, interval placement of a bilayer dermal matrix, and subsequent skin grafting is a new technique that can improve, and in some cases ameliorate, burn scar related pain. .
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The use of automated external defibrillators (AEDs) following a cardiac arrest in the out-of-hospital setting has demonstrated increased survival rates, likely because up to 71% of out-of-hospital cardiac arrests are associated with rhythm disturbances that are able to be treated with defibrillation. It is less clear whether the use of AEDs in the hospital setting would be effective because fewer patients (approximately 25%) have initial cardiac rhythms that respond to defibrillation and because survival may be compromised if the use of AEDs contributes to interruptions in the delivery of chest compressions. ⋯ Of the 11,695 patients with cardiac arrests, the majority (82.2%; n=9616) were in a nonshockable rhythm, such as asystole or pulseless electrical activity (PEA). Only 17.8% (n=2079) of patients in the study were in a shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used on 4515 patients (38.6%). An overall survival to discharge rate of 18.1% (n=2117) was reported. The use of an AED was associated with lower survival rates (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78-0.92; P<0.001). AED use in those patients with asystole or PEA (unshockable rhythms) was associated with lower survival (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65-0.83; P<0.001). Where shockable rhythms, such as ventricular tachycardia or ventricular fibrillation, were present, AED use did not increase survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88-1.13; P=0.99). These trends were consistent for AED use in both monitored and nonmonitored hospital units (p>.10). For cardiac arrest due to asystole or PEA the use (or not) of an AED did not influence the rates of ROSC. For cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia the rates of ROSC and survival at 24 h did not differ by AED use. AED use did not shorten the time to defibrillation and for those patients with ROSC, and was not associated with shorter CPR times or fewer administered defibrillations. Overall the authors concluded that the use of AEDs in hospitalised patients following cardiac arrest was not associated with improved survival.
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To determine the long-term prognostic value of stress imaging and clinical risk scoring for cardiovascular mortality in chest pain patients after ruling out acute coronary syndrome (ACS). ⋯ TIMI and GRACE score but not DSE and MPS are accurate predictors of long-term cardiovascular mortality, even in chest pain patients with a normal or non-diagnostic electrocardiogram undergoing a rule-out protocol.