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Asian Cardiovasc Thorac Ann · Jun 2013
Comparative StudyMonitoring pulmonary artery pressure in children undergoing the Fontan procedure.
To compare external and internal jugular venous pressures to monitor pulmonary artery pressure during the Fontan procedure. ⋯ The external jugular venous pressure correlates well with both internal jugular venous pressure and femoral venous pressure as a marker of pulmonary artery pressure in children undergoing the Fontan procedure. The use of external jugular venous pressure may also preclude the risk of thrombosis.
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Acta Neurochir. Suppl. · Jan 2008
Assessment of mitochondrial impairment and cerebral blood flow in severe brain injured patients.
We believe that in traumatic brain injury (TBI), the reduction of N-acetyl aspartate (NAA) occurs in the presence of adequate cerebral blood flow (CBF) which would lend support to the concept of mitochondrial impairment. The objective of this study was to test this hypothesis in severely injured patients (GCS 8 or less) by obtaining simultaneous measures of CBF and NAA. ⋯ Considering the direct link between energy metabolism and NAA synthesis in the mitochondria, this study showed that in the absence of an ischemic insult, reductions in NAA concentration reflects mitochondrial dysfunction.
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Comparative Study
The effect of pre-service training on post-graduation skill and knowledge retention among mid-level healthcare providers in Mozambique.
Mozambique suffers from critical shortages of healthcare workers including non-physician clinicians, Tecnicos de Medicina Geral (TMGs), who are often senior clinicians in rural health centres. The Mozambique Ministry of Health and the International Training and Education Center for Health, University of Washington, Seattle, revised the national curriculum to improve TMG clinical knowledge and skills. To evaluate the effort, data was collected at graduation and 10 months later from pre-revision (initial) and revised curriculum TMGs to determine the following: (1) Did cohorts trained in the revised curriculum score higher on measurements of clinical knowledge, physical exam procedures, and solving clinical case scenarios than those trained in the initial curriculum; (2) Did TMGs in both curricula retain their knowledge over time (from baseline to follow-up); and (3) Did skills and knowledge retention differ over time by curricula? Post-graduation and over time results are presented. ⋯ Although curriculum revision had limited effect, marginal improvements in the revised group show promise that these TMGs may have increased ability to synthesize clinical information. Weaknesses in curriculum and practicum implementation likely compromised the effect of curriculum revision. An improvement strategy that includes strengthened TMG training, greater attention to pre-service clinical practice, and post-graduation mentoring may be more advantageous than curriculum revision, alone, to improve care provided by TMGs.
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Whatever strategy is adopted for the development of viral vectors for delivery of veterinary vaccines there are several key points to consider: (1) Will the vectored vaccine give a delivery advantage compared to what's already available? (2) Will the vectored vaccine give a manufacturing advantage compared to what's already available? (3) Will the vectored vaccine provide improved safety compared to what's already available? (5) Will the vectored vaccine increase the duration of immunity compared to what's already available? (6) Will the vectored vaccine be more convenient to store compared to what's already available? (7) Is the vectored vaccine compatible with other vaccines? If there is no other alternative available then the answer to these questions is easy. However, if there are alternative vaccines available then the answers to these questions become very important because the answers will determine whether a vectored vaccine is merely a good laboratory idea or a successful vaccine.
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Ned Tijdschr Geneeskd · Apr 1999
Practice Guideline Guideline[Physician-assisted suicide for a patient with a psychiatric disorder: guidelines for psychiatrists. Dutch Association of Psychiatry].
In September 1998, the Dutch Association of Psychiatry published guidelines for the psychiatrist concerning cases of psychiatric patients requesting assistance with suicide. Assistance with suicide is restricted to a psychiatrist in his role as a treating physician of a patient with a psychiatric disorder. Requests for assisted suicide should primarily be considered as requests for help with life. ⋯ In addition an independent psychiatrist should be consulted as well as former treating physicians, general practitioner, family members and other people involved. If a somatic specialist or a general practitioner is asked to assist in suicide consultation of two psychiatrists is required. The guidelines offer psychiatrists a framework for taking great care when their patients request assisted suicide and will certainly play a part in the legal control of assisted suicide.