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In the evidence-based medicine stakes, obstetrics has risen from being the holder of the "wooden spoon" to being a world leader in the pursuit of best evidence and the use of formal systematic reviews. A prime example of evidence-based obstetric practice is the use of corticosteroids to reduce respiratory distress syndrome in preterm infants. ⋯ Researchers in Australia are now examining strategies to maximise dissemination of available best evidence into obstetric practice. Without reflective practice and effective dissemination of evidence, the present litigation phobia surrounding obstetric care could lead to evidence-based medicine being replaced by "nervousness-based medicine".
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Il Giornale di chirurgia · Oct 1997
Review[Role of total thyroidectomy in benign multinodular benign goiter].
The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.
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Peripartum care of parturients has contributed a great deal to the development of modern anaesthesia during the past 150 years. The introduction of general and regional anaesthesia provided new options of relieving pain during delivery and preventing suffering. ⋯ Using the MLAC model as a scientifically based pharmacodynamic measure of analgesia, empirically developed "recipes" can be compared and validated. The importance of this clinical model will be put into a pharmacological context including issues such as the up-down sequential allocation technique, dose-response curves and differential nerve blockade.
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J Interpers Violence · Apr 2017
Tensions and Ambivalent Feelings: Opinions of Emergency Department Employees About the Identification and Management of Intimate Partner Violence.
The objective of this study was to examine factors facilitating and constraining the identification and management of intimate partner violence (IPV) at an emergency department (ED). Semi-structured interviews were conducted with 18 ED employees of a university hospital in the Netherlands. All interviews were audiotaped, transcribed verbatim, and analyzed by using qualitative content analysis in Atlas.ti. ⋯ Although ED employees expressed openness and willingness to help, they also took the view that victims had a considerable responsibility of their own in disclosing and managing IPV, which led to ambivalent feelings. In conclusion, ED employees faced tensions in IPV identification and management caused by lack of awareness, knowledge and resources, conflicting priorities at the ED, and ambivalent feelings. Improvements can be made by supporting ED employees with guidelines in the form of a protocol and with training that also addresses the tensions ED employees face.
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Vector Borne Zoonotic Dis. · May 2013
Case ReportsRabid fox bites and human rabies in a village community in southern India: epidemiological and laboratory investigations, management and follow-up.
Human rabies transmitted from wild animals is rarely reported in endemic countries like India, where nearly 95% deaths occur due to bites from rabid dogs. In this paper, we report an incidence of rabid fox bites in a village in southern part of India involving 18 individuals, including 4 children. All people had category III exposures, including bites on the face and neck. ⋯ They were under regular follow-up and after nearly 2 years none have developed rabies. The partial Nucleoprotein (N) gene sequencing of the virus isolate from the patient who died of rabies had close homology with species I (prototype rabies) sequences available in GenBank and our own past isolates from dogs and humans, thus confirming that virus spillover from wildlife to domestic dogs continues to occur. This episode should prompt health authorities to focus more attention on training rural medical practitioners in state-of-the-art modern prophylactic measures.