RESUMO
The objective of this study was to ascertain knowledge of the normal anatomy and appreciation of components of an 'adequate' or 'acceptable' reduction by the medical staff responsible for management of distal radius fractures in the emergency departments (A&E) in UK. A nationwide structured questionnaire survey based on literature review was performed on 138 doctors. Of the 100 (72%) respondents, only 40% could cite the correct values for volar tilt, radial inclination and ulnar variance, there being a significant difference between orthopaedic, n = 16 (64%) and A&E staff, n = 24 (32%); p = 0.031; chi(2) = 12.17. Only 18% respondents were aware of the acceptable ranges of adequate reduction; with orthopaedic staff, n = 12 (48%) being more aware than A&E staff, n = 6 (8%); p = 0.002; chi(2) = 6.38. Only 19% formally measure the key parameters before decision making (52% orthopaedic vs. 8% A&E staff; p = 0.018; chi(2) = 7.31). Only 14% of respondents from hospitals equipped with picture archive navigation system stated that they used the angle measurement function.A lack of knowledge of the normal anatomical values and implementation of generally accepted measurement criteria predictive of fractures unlikely to benefit from repeat manipulations is evident. It is important to emphasise the influence of factors reported to affect stability such as age, functional demands of the patient and extent of initial fracture displacement in decision making. The introduction of a set of guidelines and further education of the medical staff could reduce the number of inappropriately treated distal radial fractures in the A&E setting with significant economic implications.
Assuntos
Competência Clínica/normas , Serviço Hospitalar de Emergência/normas , Fraturas do Rádio/terapia , Rádio (Anatomia)/anatomia & histologia , Tomada de Decisões , Serviço Hospitalar de Emergência/economia , Custos de Cuidados de Saúde , Humanos , Osteoporose/complicações , Guias de Prática Clínica como Assunto , Fraturas do Rádio/economia , Fraturas do Rádio/etiologia , Inquéritos e Questionários , Reino UnidoRESUMO
The synthesis of isoxazole-based derivatives utilizing Baylis-Hillman chemistry and results of their preliminary bioevaluation as hypolipidemic agents in triton model are described.
Assuntos
Hipolipemiantes/síntese química , Hipolipemiantes/farmacologia , Isoxazóis/síntese química , Isoxazóis/farmacologia , Acetais/química , Acrilamidas/química , Amidas/química , Animais , Técnicas de Química Combinatória , Commiphora , Avaliação Pré-Clínica de Medicamentos , Fibrinolíticos/farmacologia , Lipídeos/sangue , Camundongos , Extratos Vegetais/uso terapêutico , Gomas Vegetais , Ratos , Estereoisomerismo , Relação Estrutura-AtividadeRESUMO
In a patient with previously documented myocardial infarction, we assessed myocardial perfusion by using power contrast imaging and a newer intravenous echo contrast agent. The images were captured and stored digitally, and various image processing algorithms were used to assess myocardial perfusion. An apical perfusion defect was clearly visualized, and it correlated with radionuclide findings.
Assuntos
Meios de Contraste/administração & dosagem , Circulação Coronária , Ecocardiografia , Humanos , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Injeções Intravenosas , Masculino , Pessoa de Meia-IdadeRESUMO
Using the methodology of activity-based costing as a conceptual framework, the authors present the potential cost reduction of a new office routine and a medical procedure. The costs of a new instrument for colorectal cancer screening and a new surveying and follow-up of at-risk patients show that time and relevant costs in the G.I Clinic and G.I Endoscopy Lab were significantly reduced.