Legal medicine implications of a multidisciplinary approach to managing Traumatic Encephalopathy Syndrome in Australia.

The medical profession has a fundamental obligation to accurately diagnose and effectively treat a range of diseases and conditions. In the case of Traumatic Encephalopathy Syndrome (TES), where there are no universally accepted clinical diagnostic criteria, a clear clinical diagnosis can pose significant challenges for healthcare providers and for subsequent appropriate management. "Nihilism" or an uncertain working diagnosis is not acceptable in the medical field and deserves further consideration. This paper explores the legal obligations that are placed upon healthcare professionals, both individually and as a part of a multidisciplinary team. This article analyses the responsibilities and expectations of medical professionals in diagnosing and treating complex medical conditions, such as TES. The authors address legal issues that must be considered for an effective operation of integrated medicine to enhance the overall quality of care and improving patient outcomes for those affected with underlying Chronic Traumatic Encephalopathy (CTE).

Community-Based Epidemiology of Hospitalized Acute Kidney Injury.

BACKGROUND: Acute kidney injury (AKI) may lead to short- and long-term consequences in children, but its epidemiology has not been well described at a population level and outside of ICU settings. METHODS: In a large, diverse pediatric population receiving care within an integrated health care delivery system between 2008 and 2016, we calculated age- and sex-adjusted incidences of hospitalized AKI using consensus serum creatinine (SCr)-based diagnostic criteria. We also investigated the proportion of AKI detected in non-ICU settings and the rates of follow-up outpatient SCr testing after AKI hospitalization. RESULTS: Among 1 500 546 children, the mean age was 9.8 years, 49.0% were female, and 33.1% were minorities. Age- and sex-adjusted incidence of hospitalized AKI among the entire pediatric population did not change significantly across the study period, averaging 0.70 (95% confidence interval: 0.68-0.73) cases per 1000 person-years. Among the subset of hospitalized children, the adjusted incidence of AKI increased from 6.0% of hospitalizations in 2008 to 8.8% in 2016. Approximately 66.7% of AKI episodes were not associated with an ICU stay, and 54.3% of confirmed, unresolved Stage 2 or 3 AKI episodes did not have outpatient follow-up SCr testing within 30 days postdischarge. CONCLUSIONS: Community-based pediatric AKI incidence was ∼1 per 1000 per year, with two-thirds of cases not associated with an ICU stay and more than one-half not receiving early outpatient follow-up kidney function testing. Further efforts are needed to increase the systematic recognition of AKI in all inpatient settings with appropriate, targeted postdischarge kidney function monitoring and associated management.

Discitis in an adult following acupuncture treatment: a case report.

Recent papers, including a review conducted by van Tulder et al., have suggested that there is paucity of information as to the efficacy of acupuncture treatment. However, there has been a significant increase in the use of acupuncture therapy for treatment of various ailments, including lower back pain. Chiropractors, along with other health care professionals, are using acupuncture as an adjunct to their main therapeutic intervention as demonstrated by a recent survey by the Canadian Chiropractic Protective Association (CCPA). However, like many other interventions, including NSAIDs and spinal manipulations, signs of side effects should be monitored when acupuncture treatments are considered. Recent papers have noted such complications as pneumothorax and hepatitis following acupuncture treatments. A case is presented in which a patient, who received previous acupuncture treatments, presented to a chiropractic clinic complaining of low back and leg pain. Early recognition of potential complications after acupuncture treatment may minimize significant impairments and disability.