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The risk and outcome of deep vein thrombosis (DVT) in patients who sustained spinal cord injury (SCI) remain a challenge. We aimed to assess the incidence, risk, burden, and prophylaxis of DVT after SCI. Thirty-nine studies were identified from among 250 relevant articles based on firstly, broad criterion of DVT among SCI cases. secondly, "risk factors" impacting DVT, thirdly, published reports from apex bodies of global importance such as World Health Organization, Centre for disease control, Atlanta USA, and others were given due weightage for their authenticity. SCI is characterized by loss of motor, sensory, and autonomic function with partial or total damage of the anatomical structure leading to increased risk of thrombogenesis. SCIs present a higher risk of venous DVT constituting 9.7% of deaths in the 1st year of follow-up. Currently, prophylaxis with mechanical methods, vena cava filters and antithrombotic chemoprophylaxis in SCI are interventions for the management of DVT. DVT in SCI patients is not uncommon and needs a high index of suspicion and implementation of institutional prophylaxis protocol. [ABSTRACT FROM AUTHOR]

Objective: To identify and characterize the top-cited articles on idiopathic intracranial hypertension.Methods: We used "Web of Science database" to identify the top-cited articles published between the years of 1975-2017. The articles were evaluated using citation count and other factors that have an effect on the citation count.Results: The search yielded a total of 2,141 articles and the most frequently cited articles received between 58-476 citations. Most articles were published between the years 1990-1999. The most popular study design involved natural history studies. USA ranked first in productivity with 72 articles and the leading institution was University of Iowa. The journal "Neurology" published the greatest number of articles. In assessing the specialties, neurology contributed to 32% of top 100 articles. There was no correlation between the citation count and number of references, years since publication, number of authors, authors' H-index, and number of institutions that had collaborated. There were positive correlations between the citation count and journal impact factor, Scimago journal rank and journal source-normalized impact per paper values. While descriptive keywords were more frequent between 1980s and 1990s, keywords describing surgical management options such as "nerve sheath decompression" and "cerebrospinal-fluid diversion" were top-listed keywords after the year 2000.Conclusions: Our study can help researchers identify the most significant and impactful articles on idiopathic intracranial hypertension, as well as to provide insight into the most noteworthy scientific trends and to visualize future research needs of the topic. [ABSTRACT FROM AUTHOR]

Presents several abstracts of academic papers on health education in the United States. Includes `Human Doctoring: Bringing Authenticity to Our Care,' by Cathy Risdon and Lori Edey; `The Liberal Arts Physician,' by Gerard N. Burrow; `Community-Based Training in Family Medicine--a Different Paradigm,' by Bob Mash and Marietjie de Villiers.

Background: To estimate the pooled odds of oral contraceptive pills consumption (OCPs) use as well as pregnancy history and multiple sclerosis (MS) risk. Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, Google scholar, and gray literature including references of the references as well as conference papers. The search strategy in PubMed was ((Oral contraceptive pills) OR OCP) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating) AND (gravidity) OR (pregnancy). Results: Four studies were included. The pooled odds of developing MS in women with pregnancy history compared with nulligravid women was 0.64 (95%CI = 0.53 - 0.78) (I² = 0, P = 0.5), which means that pregnancy reduces the risk of MS by 36%. The pooled odds of OCP consumption and risk of MS were 1.09 (95% CI = 0.67 - 1.76). By comparing the pooled odds of OCP consumption and risk of MS according to the country of the origin, we found that the pooled odds in Iranian studies was 1.03 (95% CI = 0.31 - 3.45) and the pooled OR in studies that were conducted in the United States was 1.13 (95% CI = 0.65 - 1.98), which showed that the country of the origin was not the cause of heterogeneity. Conclusions: The results of this systematic review show that pregnancy history is a protective factor for MS development, whereas OCP use has no significant effect. [ABSTRACT FROM AUTHOR]

Although there has been a lot of research focused on the effect of war on child refugees, along with those impacted directly, there are no recent studies comparing these two groups side‑by‑side. In this paper, we review psychiatric comorbidities associated with children (defined as 17‑year‑olds and younger) exposed to war, with an additional emphasis on approaches to treatment. In addition, we aim to understand these children’s thoughts and insights into their situation(s). We will do so by presenting narratives given by close relatives of (1) two children currently in Ukraine in the midst of the war, (2) another young Ukrainian child war refugee who was able to recently leave the country, and (3) an adult and his experiences of being a war refugee and then resettling in the United States as a child. We never know when or where a war will begin. It is important that we have mental health professionals that can help children through the current and unexpected adversities that arise with war and displacement. These children need assistance with their uncertainties about the future and the risk of disruption of peace or comfort. Moreover, mental health disparities are substantial amongst children exposed to the traumas associated with war, and treatment is limited. We share this research to encourage mental health professionals to seek understanding of the impact the current war is having on Ukrainian youth. It is our hope that, with presenting these narrative accounts, mental health providers will gain a deeper understanding of what these children are encountering and will become prepared to support them and their mental health. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines provide a framework against which quality of care is measured. Recommendations contained within guidelines are used for decision-making not only within the clinical domain but also other related issues within the health systems. As such the use of research evidence for formulating recommendations contained in a guideline is a global standard to ensure guideline quality. The paper briefly reviews how the need for and use of evidence in guideline development shaped up historically and then provides an overview of the four typologies of guideline development mechanisms at the country level. [ABSTRACT FROM AUTHOR]

Clinical trials that allow significant heterogeneity of population or interventions often result in uncertain outcomes. In this paper, we review the outcomes of five recent trials of endovascular interventions in acute ischemic stroke in the context of the neutral results of previous large clinical trials on the subject. [ABSTRACT FROM AUTHOR]

Huge cost pressures and the need to drive faster approvals has driven a technology transformation in the clinical trial (CT) industry. The CT industry is thus leveraging mobile data, cloud computing, social media, robotic automation, and electronic source to drive efficiencies in a big way. Outsourcing of clinical operations support services to technology companies with a clinical edge is gaining tremendous importance. This paper provides an overview of current technology trends, applicable Food and Drug Administration (FDA) guidelines, basic challenges that the pharma industry is facing in trying to implement such changes and its shift towards outsourcing these services to enable it to focus on site operations. [ABSTRACT FROM AUTHOR]

The article presents a scientometric analysis for identifying major specialties of pharmacological research and the countries contributing the highest number of articles in pharmacology. According to the analysis, 1,471 research papers were published from 57 nations. The first nation with 30 percent score of total publications was the U.S. followed by Japan with 13 percent and Great Britain with 8.3 percent. About 37 nations published research papers on cellular and molecular pharmacology.

In addition to the expensive and lengthy process of developing a new medicine, the attrition rate in clinical research was on the rise, resulting in stagnation in the development of new compounds. As a consequence to this, the US Food and Drug Administration released a critical path initiative document in 2004, highlighting the need for developing innovative trial designs. One of the innovations suggested the use of adaptive designs for clinical trials. Thus, post critical path initiative, there is a growing interest in using adaptive designs for the development of pharmaceutical products. Adaptive designs are expected to have great potential to reduce the number of patients and duration of trial and to have relatively less exposure to new drug. Adaptive designs are not new in the sense that the task of interim analysis (IA)/review of the accumulated data used in adaptive designs existed in the past too. However, such reviews/ analyses of accumulated data were not necessarily planned at the stage of planning clinical trial and the methods used were not necessarily compliant with clinical trial process. The Bayesian approach commonly used in adaptive designs was developed by Thomas Bayes in the 18th century, about hundred years prior to the development of modern statistical methods by the father of modern statistics, Sir Ronald A. Fisher, but the complexity involved in Bayesian approach prevented its use in real life practice. The advances in the field of computer and information technology over the last three to four decades has changed the scenario and the Bayesian techniques are being used in adaptive designs in addition to other sequential methods used in IA. This paper attempts to describe the various adaptive designs in clinical trial and views of stakeholders about feasibility of using them, without going into mathematical complexities. [ABSTRACT FROM AUTHOR]

Electronic health records (EHRs) have emerged as a major topic in health care and are central to the federal government's strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health) Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve "meaningful use" of "certified" EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS)-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices. [ABSTRACT FROM AUTHOR]

During the last decade, despite increased investment in drug research and development related activity, stagnation in new drug discovery has been documented. Despite a 70% increase in investment in research and development-related activities, a 40% fall in launch of new chemical entities was seen during 1994-2004. A steep rise in the attrition rate of drug development has complicated the matter. Rising cost and increased attrition rates proved major barriers to investment in higher risk drugs or in therapies for uncommon diseases or diseases that predominantly afflict the poor. This prompted Food and Drug Administration (FDA) to highlight this problem in a 2004 white paper classified as "Critical Path Initiative" (CPI) and to initiate steps to target stagnation and rise in attrition rates. Many new drug development projects have started worldwide taking cue from CPI; adopting microdosing, adaptive designs and taking advantage of newly developed biomarkers under the CPI. This review discusses the various strategies adopted under CPI to decrease attrition rate and stagnation of new drug development, and the challenges and controversies associated with CPI. [ABSTRACT FROM AUTHOR]

Currently, there are more than 445,000 veterans receiving compensation for hearing loss associated with military service, and 395,000 receiving compensation for service-related tinnitus. In addition to compensation payments, service-related hearing disorders cost the US Department of Veterans Affairs in terms of provision of hearing aids, hearing aid-related services, and clinical services at its 220 facilities nationwide. It is imperative that hearing conservation among military personnel and veterans be addressed. In this paper, we describe the rationale for and the development of a multimedia Hearing Loss Prevention Program aimed at preventing the progression of hearing loss among veterans associated with social, recreational, and nonmilitary occupational noise exposure. The program was developed based on the principles outlined in the Health Belief Model of Rosenstock (1966) and the Health Promotion Model of Pender et al. (2002). [ABSTRACT FROM AUTHOR]

As the US health-care system continues on a path toward greater patient and provider dissatisfaction and decreasing access to primary health services, there is a growing need for leadership among tomorrow's health professionals. Students of today must acquire the skills to lead the United States toward solutions that will offer universal access and eliminate disparities. As examined in the US, there are two main modes for students to learn these meaningful skills; curriculum- and institution-based leadership development and organiz ation-based leadership development. In this paper we review these two methods from an American perspective and discuss ways that educational institutions can support student leadership development. In addition, we address ways in which non-governmental organiz ations can provide opportunities to foster student leadership. Lastly, we offer recommendations for US policy change at institutional, local, state, and national levels to help achieve the goals stated above. [ABSTRACT FROM AUTHOR]

Because much of health professions education in the US is publicly financed, the actions of politicians have profound effects on the organization of health professions education. The success of health professions education programs, therefore, depends in part on the ability of educators to advocate for change in the legislature. Successful legislative advocacy requires a general understanding of the legislative process and the needs of politicians combined with effective communications strategy. The tools of individual legislative advocacy include position papers, letter writing, politician meetings and visits, and using the media. Professional associations advocate on behalf of their members through coalitions, key contact programs, grassroots campaigns, and lobbyists. Successful legislative advocacy depends on credibility and the development of long-term relationships with members of the legislature. The process of legislative advocacy is straightforward and should be viewed as an integral part of health professions education. [ABSTRACT FROM AUTHOR]

There is growing interest and investment in health-related collaboration in the United States. In an environment characterized by increasingly complex health problems, substantial resource constraints, and a fragmented health system, public and private organiz ations as well as communities are recognizing that most objectives related to health and health care cannot be achieved by any single person or organiz ation working alone. Partnerships that bring together diverse people and organiz ations have the potential for developing new and creative ways of dealing with today's turbulent environment. Despite its potential advantages, collaboration also presents daunting challenges. Further, documenting the effectiveness of partnerships in improving health and well-being has been difficult. Given the significant difficulties of collaboration and the lack of evidence of its effectiveness, questioning whether the investment in health partnerships is justified seems reasonable. In this paper we address this question by illustrating the connective power of collaboration. We describe how collaboration, by connecting individual-level services, broadening community involvement in population-based health strategies, and linking individual-level services and population-based strategies, can improve the health of communities. We then discuss activities that could assist partnerships in reaching their collaborative potential and conclude by presenting the most compelling reasons for pursuing collaboration. [ABSTRACT FROM AUTHOR]

Internationally, 20th century medical education concentrated on equipping new graduates with technical skills and pushing the frontiers of technological sciences to extend and enhance life in ways unimaginable in previous decades. In the 21st century, health services are expected to be characterized not by the ''fix-up-when-things-go-wrong'' type of care that 20th century physicians have become so good at, but by preventive care that can obviate much of the need for these fix-up services. Enabling doctors to deal with the different health care needs of future patients will require a values shift in medical education. The United States leads the world in per capita health care expenditure yet trails in many important measures of health status. It epitomizes many elements of both the good and the bad in current medical education that may be less obvious in other countries that are less wealthy, less technologically oriented, and less committed to individual freedoms. In this paper we use the US as a case study to argue the need for a fundamental shift in values away from the 20th century emphasis on disease, specialization and treatment, and towards health, generalization and prevention. We draw on data from the National Ambulatory Medical Care Survey to compare roles of primary care physicians and other office-based medical specialties in delivering preventive health care. We also estimate the cost of providing preventive care in terms of physician time. Finally, we contemplate how medical education values must change in the US and other countries if 21st century physicians are to be prepared to meet the health care needs of their communities. [ABSTRACT FROM AUTHOR]

Purpose: The Keeping Families Healthy (KFH) program at the University of Florida College of Medicine is a new community-based course designed to improve physician-patient relationships. This paper describes the experience of the first-year medical students' home visits, which were developed to foster health promotion and disease prevention. Approach: This two-semester course offers first-year medical students the opportunity to integrate prevention, service, and humanism into the established educational curriculum. During the course the learners have opportunities to interact with families who have volunteered to serve in partnership with the College of Medicine faculty as community lay teachers. The program provides a valuable service to the participating families by helping them identify useful community resources, and by formulating healthy care plans for prevention of illness and stabilization of chronic illness. Conclusions: Community-based learning and home visits expose students to personal travails (e.g. lack of financial resources) in a way that cannot be addressed in traditional settings. This exposure may involve students in community-building strategies that can assist not only individual patients, but also communities. Additionally, home visits provide an opportunity for pre-clinical students to have an active rather than passive role in their education. [ABSTRACT FROM AUTHOR]

Introduction: The problem of counterfeiting of drugs is assuming alarming proportions and is getting difficult to combat due to its trans-national character. It is undermining the faith of people on health care system. Therefore, there is a need to adopt zero tolerance approach to combat the problem. The Way Forward: There are many solutions available which are being adopted in piece meal manner by individual manufacturers. However, for wholesalers and resellers it is getting difficult to maintain multiple solutions. Therefore, there is a need to adopt a unified solution preferably with the help of the government. Conclusions: This paper discusses the available solutions, their shortcomings and proposes a comprehensive solution where at each level in the supply chain the authenticity is verified preferable linking it with Unique identification. [ABSTRACT FROM AUTHOR]

The article explores the potential use of dexmedetomidine in pediatric cardiac anesthesia. Dexmedetomidine is not yet approved by the U.S. Food and Drug Administration for use in pediatric patients, although several papers describe its use in pediatric patients in operating room, in catheterization laboratory, in magnetic resonance imaging (MRI) suits and in intensive care units (ICU). It cites several studies which indicate cardiovascular and neuroprotective properties of this drug.