Articles: cations.
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The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, exter-nal landmark-guided technique. The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. ⋯ In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cas-es), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure. We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.
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Sleep medicine reviews · Feb 2001
Medico-legal aspects of sleep disorders: sleepiness and civil liability.
Excessive sleepiness is associated with motor vehicle accidents and is responsible for enormous social and financial loss. The specific legal obligations for an individual with a sleep disorder, their employer and those health care practitioners associated with that individual are reviewed. Although there are related implications within the criminal law and in particular criminal negligence, the arguments developed in this paper will be largely confined to the context of the civil liability. ⋯ Factors which influence this liability include: the extent to which the implications of the condition is known and understood generally; the extent to which the condition is suspected or identified in an individual employee; the extent of a proper screening and treatment program and the way in which risk management programs have been implemented. Although the issue of sleepiness and civil liability is examined from an Australian legal context, the principles have direct relevance to other legal systems. The authors highlight the degree of uncertainty provided by the common law and statutory provisions, and that decisions rest on the balance of public interests, which mean that many of the current dilemmas facing practitioners may only be solved in the courts.
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Practice guidelines are not only an ancient tradition, but they are a fact of life. The first guidelines were developed in the 1840s, shortly after the use of anesthesia was first demonstrated. ⋯ In spite of the great potential of clinical practice guidelines, and the involvement of numerous medical societies and physician groups, there is still a great debate within the profession not only about the pros and cons of the development and usage of the guidelines, but also conflicting and controversial opinions on both sides of the issue, i.e., providers and patients vs payors. This article discusses the development, usage, advantages, disadvantages and the implications of practice guidelines to interventional pain medicine specialists.
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Objective. To investigate whether a simple static stiffness model adequately relates the angles and net joint torques (NJT) developed in the ankles (sagittal plane) and in the hips (frontal plane) following perturbations delivered in multiple directions to partially constrained subjects standing quietly. Materials and Methods. ⋯ Conclusions. The relationship between the ankle angles and NJT and hip angles and NJT following perturbed stance can be described as static stiffness. The implications for arm-free paraplegic standing are discussed and a new control scheme is proposed.
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Vertebroplasty is the percutaneous placement of polymethylmethacrylate (PMMA) into vertebral compression fractures for relief of pain. Polymethylmethacrylate is the cement used by orthopedic surgeons for rapid stable fixation of prosthetics in living bone. While the exact mechanism of pain relief is unknown, it is believed that the delivery of the PMMA into the fracture stabilizes the vertebral body, obtaining an analgesic effect. ⋯ Vertebroplasty provides a safe procedure that allows for long-term pain relief, decreased use of medication, and increased activities of daily living. This article is a review of the history, indications, contraindications, and key outcome studies. The technique is described along with complications, preprocedural care, and postprocedural care.