Search

Emergency Medical Services play a fundamental societal role since they provide pre-hospital care to patients in critical and time-constrained conditions. In this context, the hospital selection decision is vital to respond in a timely, effective and efficient way. By means of simulation experiments, the present study compares the effects of different assignment logics against a set of performance dimensions. To this end, we develop a Discrete Event Simulation model that covers the entire Emergency Medical Service process, from the ambulance transportation to final departure of the patient from the Emergency Department. Results demonstrate that the use of effectiveness-related criteria (e.g. expected waiting time, resource saturation) significantly enhances the overall performance and, at the same time, guarantees higher quality of care. Thus, the study contributes in enhancing hospital selection decisions by supporting decision-makers through a comprehensive decisional model, distancing from prior researches that predominantly considered efficiency-driven criteria (i.e. proximity). [ABSTRACT FROM AUTHOR]

Background and importance: Intramedullary spinal cord metastases (ISCMs) are rare and no cases of ISCM from an adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) have been reported. Clinical presentation: We report a 54-year old man complaining backpain and worsening myelopathy. He had an ACC of the EAC resected years prior. A spinal MRI demonstrated a contrast-enhancing intramedullary lesion within the conus medullaris. The histopathological diagnosis of the patient was consistent with the patient's primary cancer. At 3 months follow-up, the neurological condition of the patient was unchanged. Conclusions: This is the first reported case of ISCM from a primary ACC of the EAC. [ABSTRACT FROM AUTHOR]

In a recent checklist, some 531 moss species were reported (Natcheva and Ganeva [110]), but in a subsequent account of the mosses of SE Europe some 576 species have been recorded from this country (Blockeel, Bednarek-Ochyra, et al. [25]; Blockeel, Chlebicki, et al. [26]; Sabovljevi'c et al. [143]). Bedn.-Ochyra & Ochyra, I B. pachydictyon i (Cardot) Bedn.-Ochyra & Ochyra and I B. heterostichoides i (Cardot) Bedn.-Ochyra & Ochyra (Bednarek-Ochyra et al. [13]; Bednarek-Ochyra and Ochyra [8], [9], [10], [11], [12]; Blockeel, Bastos, et al. [22]; Ellis, Bednarek-Ochyra, et al. [57]; Ellis et al. [55]; Ellis, Aleffi, et al. [52]; Ochyra and van Rooy [118]; Bednarek-Ochyra [7]; Ochyra et al. [123]). As a result of this taxonomic conclusion, the phytogeographical status of I D. longifolius i changed from that of a pan-south-cool-temperate species to an amphiatlantic south-cool-temperate one, the latter distribution pattern being typical of many bryophyte species (e.g. Ochyra and Vána [119]; Ochyra and Lewis Smith [116]; Ochyra and Zander [120]; Blockeel, Bednarek-Ochyra, et al. [23]; Ochyra and Bednarek-Ochyra [115]). Bedn.-Ochyra & Ochyra, I B. striatipila i (Cardot) Bedn.-Ochyra & Ochyra, I B i . This species is primarily distributed in southern South America from where it deeply penetrates into the tropics in the northern Andes and SE Brazil (Hedenäs [75]), and to the northern maritime Antarctic (Ochyra, Bednarek-Ochyra et al. [122]; Li et al. [97]). [Extracted from the article]

Adventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to discussions about the appropriateness of AESs for young people. For some, participation in AESs reflects social deviance. Research from this perspective has focused on testing this notion. However, in recent years research has questioned the perceived link to risk arguing that many acceptable activities might be 'riskier'. Research from this perspective focuses on the positive side of AESs. Evidence points to a growing interest in AESs by young people and that AES activities might be useful to enhance the uptake of and adherence to physical activity, and support mental wellbeing in young people. This perspective suggests (1) AESs are important for the overall development of young people, (2) policy makers across sectors should recognize AESs when considering future interventions. [ABSTRACT FROM AUTHOR]

Background and aim: Response to ursodeoxycholic acid (UDCA) is crucial for the prediction of primary biliary cholangitis (PBC) prognosis, and different response criteria were validated and proposed by reference centers for PBC. To date, rates of non-response to UDCA from real-world series are lacking. Methods: Hepatology/Gastroenterology centers belonging to 'Club Epatologi Ospedalieri' (CLEO) and 'Associazione Italiana Gastroenterologi Ospedalieri' (AIGO) were invited to participate in the study, and asked to extract all patients followed for PBC, without any selection or exclusion, and fill in the database provided. Results: Thirty-four centers were enrolled throughout Italy, for a total of 713 patients. None of these centers, except one, had a hepatology outpatient clinic devoted to the care of patients with autoimmune liver diseases. After excluding 79 cases of PBC/autoimmune hepatitis overlaps, 634 patients were analyzed: mean age, 64.4 ± 12.0 years; 91.2% females; F/M 10.3/1. For patients with at least 1 year of UDCA treatment (583), rates of non-response to UDCA were evaluated according to the Paris-I/-II, Toronto and GLOBE criteria, and compared with those in the original cohorts: 27% vs 39% in Paris-I cohort; 39.6% vs 52% in Paris-II; 20.1% vs 43.5% in Toronto; 15.7% vs 30% in GLOBE (age-specific cutoffs). Mean alkaline phosphatase levels on UDCA treatment, and the age-adjusted prevalence of F3/F4 fibrosis, appeared lower in this PBC population than in reference cohorts. Conclusions: A mean ∼15% better response to UDCA is observed in a real-world PBC population, probably due to migration of some of most severe/advanced cases to PBC referral centers. [ABSTRACT FROM AUTHOR]

Skateboarding has become an international action sport attractive to young people. For this reason, skateboarding has been promoted by some researchers as important for encouraging young people to become more physically active. However, skateboarding is also considered to be inherently dangerous by the medical and broader community and as a result skateboarding is banned in many places. This paper reviews scientific literature on the features, outcomes and risk factors related to skateboarding injuries. Findings suggest that while skateboarding injuries can be severe, skateboarding is not as dangerous as it might appear if appropriate risk management steps are taken. Skateboarding should be encouraged as a worthy physical activity and local communities should consider providing specialised, supervised spaces for young people to practice this sport. [ABSTRACT FROM AUTHOR]

Pseudotumor cerebri occurs quite rarely in the pediatric population and its clinical features differ from adults in many ways. Intracranial hypertension with papilledema should obviously be treated promptly to avoid permanent visual damage, but various more or less invasive options have been proposed over the years, from bariatric surgery for obesity to optic nerve sheath fenestration. We report a prospective study on a group of 15 children, aged 3–16 years, with clinical and instrumental diagnosis of pseudotumor cerebri. All the patients were treated simply by external lumbar cerebrospinal fluid drainage with a mean volume of 10 ml/h for 3–5 days, with hypocaloric diet and with appropriate dosages of acetazolamide. All had immediate relief of headache, a considerable reduction in papilledema and marked improvement of both visual loss and cranial nerve palsies within 2 months. None of the patients relapsed during the follow-up period, ranging from 12–48 months. [ABSTRACT FROM AUTHOR]

There are at least 100 entities that present a significative conjunction between skin signs and skeletal or other bony changes that can be detected by radiological means (skin and bones and others). The aim of this article is to underline that sometimes a radiological examination could guide to a correct diagnosis in dermatology. In addition, bloody diagnostic procedures could be avoided in ambiguous skeletal lesions if the radiologist remembers that skin and bone diseases exist. We review the literature and suggest a practical classification, including skin markers of occult radiological changes, skin diseases often associated with skeletal or other bony changes that require a radiological evaluation for a diagnosis, radiological changes mimicking cutaneous diseases, skeletal side effects of dermatological therapies (topical and systemic) and skin lesions occurring as a consequence of bone injury. [ABSTRACT FROM AUTHOR]

METHOD: The activity and amount of SOD1 in erythrocyte lysates and the plasma amino acid content were evaluated in four familial ALS patients bearing the L84F SOD1 mutation (fALS), in an asymptomatic family member with the mutation (L84F[sub 5]), in sporadic ALS patients (sALS) and controls. Three of the fALS patients and the L84F[sub 5] subject were tested once a year for three consecutive years. RESULTS: At the first evaluation SOD1 activity was similar in controls, sALS and fALS; the amount of SOD1 protein was lower (P < 0.01) in fALS. In the subsequent 2 years, 34% and 52% decrease of SOD1 activity was recorded in fALS patients. The plasma amino acid pattern did not differ between controls and sALS, whereas fALS patients displayed high levels of plasma aspartate and glutamate. Aspartate was in the normal range but glutamate was still elevated in the subsequent evaluations. The L84F[sub 5] subject had remarkably low levels of aspartate, glutamate and branched-chain amino acids. CONCLUSIONS: The method of measuring mutant SOD1 amount is indirect but the results are indicative of a reduction of mutant SOD1 taking place during fast-worsening phases of the disease. Since the disease onset of fALS patients is 42.8 ± 11.3 years and the L84F[sub 5] family member is asymptomatic at the age of 66, low levels of excitotoxic and branched-chain amino acids in plasma may constitute a protective factor against disease development. [ABSTRACT FROM AUTHOR]

Highlights `Operation Kauai,' a disaster relief simulation to illustrate the potential of disaster simulation for medical students or faculty in order to develop and assess the integration of professional competencies in medical practice. Simulation as basis for the promotion or assessment of teamwork skills and individual performance.

This research looked at students' satisfaction with, and changes in approach to, learning during their first year in problem‐based curricula for agriculture, architecture, medicine and paramedicine. While students at each school showed little change in approach apart from achievement orientation in the six‐month period after entry to the course, there were different patterns of approach at each school. Satisfaction with their respective schools was uniformly high — notably in terms of their emotional climate, supportiveness, student and teacher interaction, and meaningful learning experiences. Correlations between students' approach to learning and degree of satisfaction with their course strongly support earlier claims and research findings on the merits of problem‐based curricula, although they still need more careful definition to be useful to curriculum planners. [ABSTRACT FROM PUBLISHER]

While the purpose, theory and method of evaluation of educational programmes are well‐documented, there is little published evidence on the actual evaluation of higher professional educational programmes and their outcomes. This paper outlines the background and development of programme evaluation in a new institution of higher professional education. It outlines current programme monitoring activities and their effects, and identifies the urgent and feasible tasks to be undertaken in the methodologically difficult and politically sensitive area of outcome evaluation. [ABSTRACT FROM PUBLISHER]

A pilot study recently reported in this journal by Wakeford raised several important issues concerning the measurement and interpretation of students’ perpeption of the learning environment in five British medical schools. Some of those issues are developed in this paper as a result of similar, more comprehensive, research involving students in five Australian medical schools. One issue is the almost inevitable problem of methodology associated with large scale surveys of this kind. Another is the prospect for educational reform within an educational institution based heavily on students’ perceptions alone. [ABSTRACT FROM PUBLISHER]

Educational programmes within the profession need a new approach if graduates are to be adequately prepared for their roles in the twenty‐first century. This approach should emphasize two broad capabilities for professional practice ‐‐ one related to immediate performance after graduation, and the other recognizing the need for further education. Graduates can develop these capabilities if a set of essential competencies is defined, and if their assessment is treated as an integral part of the educational programme. This paper describes new instruments and procedures together with guidelines for ensuring their reliability and validity. [ABSTRACT FROM PUBLISHER]

This paper examines the problems of fostering appropriate attitudes towards continuing education in undergraduates. It outlines the obligation for educators in the professions to promote actively progressive independence of student learning. It describes how this has been attempted as part of the undergraduate medical curriculum at the University of Newcastle, Australia. Strategies and problems of implementation in the students’ learning, assessment and evaluation programmes are presented. The paper concludes with a partial answer to the focal question, ‘Can progressive independence of learning be planned as an undergraduate objective, or is it simply an option for some students?’ [ABSTRACT FROM PUBLISHER]

The new Faculty of Medicine at the University of Newcastle, NSW, has introduced an innovative undergraduate education programme. It has been just as determined to set up a comprehensive and systematic programme for evaluation of the effectiveness, efficiency and acceptability of its educational endeavours. This paper outlines these developments and the constraints during the first year of its operation — not only as a record of events, but also a possible guide for similar developments elsewhere. [ABSTRACT FROM PUBLISHER]

Assessment of student progress and achievement may support or weaken the educational goals of an institution. This paper describes the assessment methods developed so far to support the undergraduate education programme in the Faculty of Medicine at Newcastle, New South Wales. Formative assessment designed for frequent, informal diagnostic feedback to the student is an integral part of the various learning experiences. It requires further development to be a useful guide to the required depth of study. It aims to assist students to integrate and apply their studies. Summative assessment is required for certification and as a formal indicator of cumulative learning. A great deal of effort has been devoted to relate it to higher level intellectual competence, to keep it open to student criticism, to take account of individual rates of learning and to use it diagnostically. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to the "Adult idiopathic occlusion of Monro foramina: Intraoperative endoscopic reinterpretation of radiological data and review of the literature," by C. Schonauer and colleagues in the August 2015 issue.