How Should Wet Market Practices Be Regulated to Curb Zoonotic Disease Transmission?

Consumption and trade of wild animals presents major zoonotic disease transmission risks. Policies that aim to limit these practices must balance environmental health against the fact that trade and consumption of wild animals are important sources of livelihood and food security for many people. This commentary on a case suggests how public health threats posed by the wild animal trade, wet markets, and bushmeat practices might guide policies and actions of relevant stakeholders. A One Health approach is offered to navigate competing interests and balance ethical concerns.

Spontaneous secondary pneumothorax due to cannabis-induced bullous lung disease: a case report.

Marijuana use has grown rapidly in the last decade with a prevalence greater than that of cocaine and opioids. With its increasing recreational and medical use, potential adverse outcomes from heavy use may be associated with bullous lung disease and spontaneous pneumothorax. This case report has been reported in line with the SCARE Criteria. Case presentation: The authors describe a case of an adult male with a past medical history of spontaneous pneumothorax and long-standing marijuana use presenting with dyspnoea who was found to have a secondary spontaneous pneumothorax requiring invasive treatment. Clinical discussion: The aetiology of lung injury due to heavy marijuana smoke may be from direct tissue injury from inhaled irritants and the method of which marijuana smoke is inhaled compared with tobacco smoke. Conclusion: Chronic marijuana use should be considered when evaluating structural lung disease and pneumothorax in the setting of minimal tobacco use.

What Should Health Professions Students Know About Industrial Agriculture and Disease?

Concentrated animal feeding operations (CAFOs) perpetuate deforestation, biodiversity loss, pollution, and climate change; increase risk of zoonotic disease transmission and antimicrobial resistance; and exacerbate environmental and health injustice. Risks CAFOs pose to human health demand the attention of clinicians and those who teach them, since they have duties to respond with care to patients and communities where health is undermined by CAFOs' presence.

Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis.

Background: In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers. Methods: A PRISMA systematic review was utilized from PubMed from the years 1952-2022. A broad keyword search of "Cardiology Anesthesiology Echocardiogram" and "Echocardiography Anesthesiology" to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists. Results: Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study. Conclusion: Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.

Recognition and repair of an incidental umbilical hernia repair during abdominoplasty.

Introduction: Umbilical hernias are found in 2% of the American adult population with increasing prevalence in overweight and multiparous women. A mesh repair is considered to be a suitable option for those desiring non-cosmetic surgical repair. Despite the mesh plug's reported value in reduction of the recurrence of umbilical hernia from 11% to 1%, there is an increased risk in de-vascularizing the umbilicus with its use. Presentation of Case: We present a case which avoids fascial incisions near the umbilicus, thus preserving the blood supply employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication. Discussion of Case: Hernia repair can be associated with a host of issues, minor and major, including regional tissue ischemia and the distortion of natural anatomy, likely due to ischemia of the epigastric vessels. Abdominoplasty is a suitable option for patients with redundancy of the abdominal skin and laxity abdominal wall musculature. Abdominoplasty has excellent exposure and correction of abdominal wall hernias. This "anatomic repair" employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication can be used in place of a mesh overlay for the purposes of umbilical hernia repair especially when the hernia may be asymptomatic. Conclusion: Abdominoplasty uniquely allows for an open hernia repair when anticipated or discovered at the time of surgery and is considered a true anatomical repair of an umbilical hernia which does not necessitates the use of foreign materials.

Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck.

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.

BACKGROUND AND OBJECTIVES: During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. DESIGN: Qualitative study using focus groups and in-depth semi-structured interviews of residents, nurses, and physicians involved in episodes of acute-illness care in nursing home residents. SETTING: Four nursing homes participating in a longitudinal study of the course and outcomes of lower respiratory infection. PARTICIPANTS: Focus groups included nurses and physicians with experience in nursing home care. Interviews were conducted with those involved in six episodes of acute illness. Interviewees included four nursing home residents (two others were not cognitively intact), seven nurses, and six physicians or their staff. DATA ANALYSIS: Identifying themes from focus group contributions and content analyses of interviews. RESULTS: We identified a four-stage model describing illness identification and management. Content analysis of interview transcripts revealed 22 factors that influenced timeliness of effective care with communication problems commanding the central focus. Barriers included: (1) failure of the communication medium; (2) evening or weekend illness onset with concomitant difficulty in contacting an on-call physician; (3) clinical decision-makers who interact through intermediaries; (4) the communication of inappropriate or inaccurate information; (5) inadequate information transfer at shift changes; and (6) prior relationship between staff nurse and physician. CONCLUSION: Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.

Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.

BACKGROUND AND OBJECTIVES: During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. DESIGN: Qualitative study using focus groups and in-depth semi-structured interviews of residents, nurses, and physicians involved in episodes of acute-illness care in nursing home residents. SETTING: Four nursing homes participating in a longitudinal study of the course and outcomes of lower respiratory infection. PARTICIPANTS: Focus groups included nurses and physicians with experience in nursing home care. Interviews were conducted with those involved in six episodes of acute illness. Interviewees included four nursing home residents (two others were not cognitively intact), seven nurses, and six physicians or their staff. DATA ANALYSIS: Identifying themes from focus group contributions and content analyses of interviews. RESULTS: We identified a four-stage model describing illness identification and management. Content analysis of interview transcripts revealed 22 factors that influenced timeliness of effective care with communication problems commanding the central focus. Barriers included: (1) failure of the communication medium; (2) evening or weekend illness onset with concomitant difficulty in contacting an on-call physician; (3) clinical decision-makers who interact through intermediaries; (4) the communication of inappropriate or inaccurate information; (5) inadequate information transfer at shift changes; and (6) prior relationship between staff nurse and physician. CONCLUSION: Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.