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1.
Oral Maxillofac Surg ; 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33471220

RESUMEN

Hypercoagulable disorders can compromise success of free flap reconstruction. Factor V Leiden is one such disorder for which only one previously reported case of successful free tissue transfer in the head and neck has been described. We report a 70-year-old woman with factor V Leiden treated for stage IVA squamous cell carcinoma of the mandible with a composite resection and reconstruction with an osteocutaneous scapular free tissue transfer. The free tissue transfer occurred without complications, in the setting of intraoperative heparin, postoperative aspirin, and enoxaparin. The free tissue transfer continues to be viable at her most recent follow-up appointment. The hypercoagulable patient represents a diverse presentation of increased coagulation risk in the perioperative period. Considering a patient's history and understanding available treatment adjuncts can factor heavily in a patient with factor V Leiden successfully undergoing free tissue transfer for head and neck defects.

2.
Epilepsy Behav ; 116: 107712, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33460988

RESUMEN

OBJECTIVE: To examine the lateralizing value of unilateral peri-ictal and interictal headaches in patients with drug-resistant focal epilepsy (DRFE). METHODS: Four-hundred consecutive patients undergoing presurgical evaluation for DRFE were interviewed. Patients with headache were broadly divided into two groups: peri-ictal and interictal headache. The lateralizing value of unilateral headache was compared in each group between three diagnoses: temporal lobe epilepsy (TLE), extratemporal lobe epilepsy (ETLE), and temporal-plus epilepsy (TEMP+ epilepsy). RESULTS: Out of 400 patients, 169 (42.25%) had headaches. Peri-ictal headaches were experienced in 106 patients (26.5%) and interictal headaches were experienced in 63 (15.75%). In the peri-ictal group, unilateral headaches were present in 48 out of 60 patients (80%) with TLE; they were ipsilateral to the seizure focus in 45 out of 48 patients (93.75%). Unilateral headaches in patients with ETLE were present in 20 out of 31 patients (64.5%) and were ipsilateral to the seizure focus in 14 out of 20 patients (70%). In patients with TEMP + epilepsy, unilateral peri-ictal headaches were present in 9 out of 15 patients (60%); they were ipsilateral to the seizure focus in all 9 patients (100%). In the interictal headache group, unilateral headaches were ipsilateral the seizure focus in 9 out of 10 patients (90%) with TLE and 5 out of 6 patients (83.3%) with ETLE. None of the TEMP + epilepsy patients had a unilateral interictal headache. CONCLUSION: Headache is a frequently encountered symptom in patients with DRFE. When occurring in a unilateral fashion, it has a high lateralizing value in temporal and extratemporal lobe epilepsies. This has been demonstrated to be true for both peri-ictal and interictal headaches. In the vast majority of patients with DRFE, unilateral headache occurs ipsilateral to the seizure focus.

3.
Gerontol Geriatr Educ ; : 1-10, 2020 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-33140694

RESUMEN

To determine if student pharmacists' confidence in their knowledge and skills, and their attitudes toward older adults improved throughout pharmacy school with an integrated geriatrics didactic curriculum (years 1-3) and a final year of clinical training including a required advanced pharmacy practice experience (APPE) in geriatrics (year 4). A two-part voluntary anonymous survey was administered at three different time points to two large cohorts of student pharmacists. The first part of the survey assessed students' confidence in attaining geriatrics competencies. The second part of the survey used the UCLA Geriatrics Attitudes Scale to assess students' attitudes. Of the 286 students who were emailed the survey, 236 student pharmacists completed it at the first assessment. Student pharmacists showed an increase in confidence in achieving geriatrics competencies from their first year to their third year, and further increase after their clinical training. Most students also held a generally positive attitude toward older adults from P1 to P4 year. Integration of geriatrics throughout the didactic and experiential curriculum made an impact on student pharmacists' confidence in their competency toward caring for older adults, while maintaining a positive attitude toward older adults throughout pharmacy school.

4.
Am J Pharm Educ ; 83(7): 6988, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31619820

RESUMEN

Objective. To educate third-year pharmacy students about the role of pharmacists in the opioid crisis and measure their knowledge, confidence, and attitudes towards opioids and opioid overdose. Methods. All third-year students (n=130) enrolled in a Doctor of Pharmacy (PharmD) degree program participated in opioid overdose and naloxone education and training followed by a three-part laboratory session that included mock naloxone counseling, case-based discussion of the Prescription Drug Monitoring Program (PDMP), and equianalgesic opioid dose conversion scenarios. A pre- and post-assessment focused on the individual's clinical knowledge, confidence, and attitudes about opioid overdose management and naloxone use was administered before and after the laboratory session to evaluate the student's baseline understanding and experience compared to learning gains from the session. An evaluation of the laboratory session was also conducted. Results. Upon completion, 99% percent of students rated the opioid laboratory as excellent (59%) or good (40%). Students believed the laboratory was stimulating (93%), relevant to pharmacy practice (96%), and contributed to their professional development (97%), and that the information provided was at an appropriate level (98%). Knowledge-based assessments improved in the areas of PDMP timely reporting, differentiating between naloxone devices, and naloxone administration technique. Student attitudes toward managing opioid overdoses improved on a majority of items. The majority of students agreed they had enough information to help them manage an opioid overdose (88.5%) and denied the need for additional training (61.5%). Conclusion. An active-learning laboratory helped to improve pharmacy students' knowledge, confidence, and attitudes with regard to opioids and the use of naloxone to treat a patient who has overdosed.


Asunto(s)
Educación en Farmacia/métodos , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Estudiantes de Farmacia/psicología , Sobredosis de Droga/prevención & control , Evaluación Educacional , Conocimientos, Actitudes y Práctica en Salud , Humanos , Naloxona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Epidemia de Opioides , Trastornos Relacionados con Opioides/complicaciones , Trastornos Relacionados con Opioides/epidemiología , Rol Profesional
5.
Int J Health Sci (Qassim) ; 12(6): 3-7, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30534037

RESUMEN

Objective: Cellulitis is a commonly encountered medical illness and is most frequently caused by Group A ß-hemolytic Streptococcus species and Staphylococcus aureus. The purpose of this study was to compare clinical outcomes of patients with lower extremity cellulitis treated with broad-spectrum and narrow-spectrum antibiotics. Methods: This was a retrospective cohort study conducted in a community tertiary hospital between January 2016 and May 2016. Patients were included if they were diagnosed with uncomplicated non-purulent lower extremity cellulitis. Patients were divided into two groups: Individuals receiving narrow-spectrum antibiotics or receiving broad-spectrum antibiotics. Logistic regression analysis was used to estimate the odds ratio of repeat visit between the groups. Results: A total of 599 patients with uncomplicated cellulitis were identified; of which 120 were included in the study (93 in narrow-spectrum arm and 27 in broad-spectrum arm). Repeat visit due to cellulitis was similar in both Groups 1 (4%) and 3 (3%) (P = 0.89) in the broad-spectrum arm and narrow-spectrum arm, respectively. Conclusion: Broad-spectrum antibiotic use in uncomplicated cellulitis was common and unjustified given the results of our study. Implementation of clinical practice guidelines is recommended in limiting broad-spectrum antibiotics use in such population.

6.
Curr Pharm Teach Learn ; 10(2): 195-200, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29706275

RESUMEN

BACKGROUND AND PURPOSE: The purpose of this study was to determine what type of medical applications (apps) are being used by fourth-year students during advanced pharmacy practice experiences (APPEs). EDUCATIONAL ACTIVITY AND SETTING: Recent doctor of pharmacy school graduates were surveyed pertaining to their use of medical apps on APPEs, frequency of use for select apps, willingness to buy apps and at what cost, and their perceived importance on using medical apps in their pharmacy practice. The survey concluded by inquiring if medical apps should be taught in the pharmacy curriculum. FINDINGS: Ninety of 132 recent graduates responded to the survey and over 97% of the students used medical apps on their APPEs. Lexicomp®, UpToDate® and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk calculator were the most frequently used applications during APPEs. Of those surveyed, 83% believe that medical apps should be taught in pharmacy school. DISCUSSION AND SUMMARY: Medical apps are frequently used on APPEs. It may be prudent to teach students how to use and evaluate medical apps before going on experiences so that students and patients can get the most benefit from these tools.


Asunto(s)
Educación en Farmacia , Aplicaciones Móviles , Servicios Farmacéuticos , Farmacia/métodos , Aprendizaje Basado en Problemas , Estudiantes de Farmacia , Adolescente , Adulto , Curriculum , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
7.
Am J Pathol ; 187(9): 2080-2094, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28734730

RESUMEN

Resistance to antiangiogenic therapy in glioblastoma (GBM) patients may involve hypoxia-induced expression of C-X-C motif chemokine receptor 4 (CXCR4) on invading tumor cells, macrophage/microglial cells (MGCs), and glioma stem cells (GSCs). We determined whether antagonizing CXCR4 with POL5551 disrupts anti-vascular endothelial growth factor (VEGF) therapy-induced glioma growth and dissemination. Mice bearing orthotopic CT-2A or GL261 gliomas received POL5551 and/or anti-VEGF antibody B20-4.1.1. Brain tissue was analyzed for tumor volume, invasiveness, hypoxia, vascular density, proliferation, apoptosis, GSCs, and MGCs. Glioma cells were evaluated for CXCR4 expression and polymorphism and POL5551's effects on CXCR4 ligand binding, cell viability, and migration. No CXCR4 mutations were identified. POL5551 inhibited CXCR4 binding to its ligand, stromal cell-derived factor-1α, and reduced hypoxia- and stromal cell-derived factor-1α-mediated migration dose-dependently but minimally affected cell viability. In vivo, B20-4.1.1 increased hypoxic foci and invasiveness, as seen in GBM patients receiving anti-VEGF therapy. Combination of POL5551 and B20-4.1.1 reduced both glioma invasiveness by 16% to 39% and vascular density compared to B20-4.1.1 alone in both glioma models. Reduced populations of GSCs and MGCs were also seen in CT-2A tumors. POL5551 concentrations, evaluated by mass spectrometry, were higher in tumors than in neighboring brain tissues, likely accounting for the results. Inhibition of CXCR4-regulated tumoral, stem cell, and immune mechanisms by adjunctive CXCR4 antagonists may help overcome antiangiogenic therapy resistance, benefiting GBM patients.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos/uso terapéutico , Glioma/tratamiento farmacológico , Receptores CXCR4/antagonistas & inhibidores , Factor A de Crecimiento Endotelial Vascular/inmunología , Animales , Apoptosis/efectos de los fármacos , Calcio/metabolismo , Movimiento Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Glioma/metabolismo , Glioma/patología , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Ratones , Proteínas/farmacología , Transducción de Señal/efectos de los fármacos
8.
J Oral Maxillofac Surg ; 75(8): 1743-1751, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28063278

RESUMEN

PURPOSE: The advent of microvascular free tissue transfer has provided the reconstructive surgeon with an enormous array of treatment options for reconstruction of large head and neck defects. However, when indicated by defect size, the need for more than 1 flap not only increases surgical complexity but also patient morbidity. The combination of the anterolateral thigh (ALT) flap and the tensor fascia latae (TFL) flap can be used to reconstruct such complex head and neck defects, thereby minimizing any additional morbidity that would be imposed by an additional flap harvest site. The present study reports on the use of the combined ALT-TFL flap to reconstruct large and complex head and neck defects. MATERIALS AND METHODS: A retrospective chart review was conducted of all microvascular head and neck reconstructions performed by the Maxillofacial Tumor and Reconstructive Surgery Service at the University of Miami/Jackson Health System (Miami, FL) from 2013 through 2016. Inclusion criteria for the study were head and neck defects at least 20 m × 10 cm and reconstruction with soft tissue flaps using perforating vasculature to the TFL and ALT vascular territories. Other study data included disease history, location of defect, flap size, recipient vessels, harvest time, ischemia time, surgical complications, and overall flap survival. RESULTS: Seven patients met the inclusion criteria. Five patients were treated for the diagnosis of stage III osteoradionecrosis and 2 patients underwent reconstruction in conjunction with ablative surgery for head and neck carcinoma. All 7 patients underwent successful head and neck reconstructions using the ALT-TFL flap. There was no partial or total flap failure. One patient had a wound healing complication at the donor site that did not require surgical intervention. CONCLUSION: Reconstruction of a large head and neck soft tissue defect with a combined ALT-TFL flap is a reliable method with minimal donor site morbidity and no major postoperative complications. This combined flap should be considered when the defect size extends beyond the bounds allowed by the ALT flap alone.


Asunto(s)
Colgajos Tisulares Libres/irrigación sanguínea , Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Microvasos/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Mucoepidermoide/cirugía , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Femenino , Humanos , Masculino , Neoplasias Mandibulares/cirugía , Osteotomía Mandibular , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Neoplasias de la Parótida/cirugía , Radioterapia Ayuvante , Estudios Retrospectivos , Recolección de Tejidos y Órganos/métodos , Resultado del Tratamiento
9.
Saudi Med J ; 37(7): 791-5, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27381541

RESUMEN

OBJECTIVES: To explore medical students' attitudes towards communication skills learning in Western Saudi Arabia and to examine impact of socio-demographic variables on the attitudes towards learning these skills.   METHODS: In this cross-sectional study, sample of medical students were recruited from Taif University, Taif, Kingdom of Saudi Arabia during the second semester (January-May 2014). Participants were all year 2 (197 students) and year 5 (151 students). The study utilize the Communication Skills Attitude Scale (CSAS) to measure students' attitudes toward communication skills learning. The response rate was 93.9%.  RESULTS: The study showed that Taif medical students hold highly positive attitudes towards learning communication skills. Positive attitude score (PAS) was significantly higher in level 5 students, older age group.   CONCLUSION: Significant positive attitude toward learning communication skills clearly observed in target group. Students with more positive attitudes towards communication skills learning tended to be higher level and older age.


Asunto(s)
Actitud del Personal de Salud , Comunicación , Estudiantes de Medicina/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Arabia Saudita , Adulto Joven
10.
Am J Pharm Educ ; 80(9): 156, 2016 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-28090105

RESUMEN

Objective. To assess changes in pharmacy students' knowledge, skills, and self-efficacy after completing an advanced pharmacy practice experience (APPE) in geriatrics. Design. During the 2013-2014 academic year, 30 Virginia Commonwealth University (VCU) School of Pharmacy students were required to complete a 5-week Geriatrics APPE at Plaza Professional Pharmacy in Richmond, Virginia. All students completed a 25-point knowledge-based pre- and post-assessment to measure students' self-efficacy. The average time required to accurately fill one unit dose prescription card before and after completing the APPE was also evaluated. Assessment. Students' average score on the knowledge component improved significantly from 54% to 88% after completing the APPE. The average time required to fill one prescription decreased significantly from 4.0 minutes to 2.5 minutes. Students reported an increase in self-efficacy in the following areas: communication, immunizations, geriatrics-specific pharmacotherapy knowledge, and the ability to fill and check monthly unit dose prescription cards. Conclusion. Requiring fourth-year pharmacy students to complete a geriatrics APPE as a capstone experience to the integrated geriatrics content covered in the first through third years of the doctor of pharmacy (PharmD) curriculum provides an important opportunity to improve students' knowledge, skills, and self-efficacy in providing care to older adults.


Asunto(s)
Competencia Clínica , Geriatría/educación , Conocimientos, Actitudes y Práctica en Salud , Autoeficacia , Estudiantes de Farmacia , Adulto , Comunicación , Curriculum , Prescripciones de Medicamentos , Quimioterapia , Evaluación Educacional , Femenino , Humanos , Inmunización , Masculino , Aprendizaje Basado en Problemas , Adulto Joven
11.
Saudi Med J ; 33(10): 1053-8, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23047211

RESUMEN

This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.


Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Medicina General/educación
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