RESUMEN
After beginning with a search of more than 809 titles and ending up with 5 randomized controlled trials and 2 prospective comparative trials, the authors of a recent systematic review discovered that a statistically significant but nonclinical difference existed between anterior cruciate ligament reconstructions performed using a hamstring graft with either cross-pin or interference screw femoral fixation.
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Ligamento Cruzado Anterior/cirugía , Tornillos Óseos , Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Humanos , Estudios Prospectivos , TendonesRESUMEN
Worldwide, there is no more consistently stressful job than that of the police officer. In the United States, police officers are more likely to die by suicide than by any type of criminal or criminal activity. This article discusses the Badge of Life Psychological Survival for Police Officers Program (BOL), founded in 2008, with the goal of developing an effective police officer suicide primary and secondary prevention program. Such a program is not a regular entity within the majority of accredited law enforcement agencies. Along with standard suicide prevention protocols typically used in other programs, an Emotional Self-Care Program (ESC) was designed to focus on the officer's ability and responsibility to care for his own emotional well-being. The model relies on teaching the factor of resilience as a significant component of stress-resistance (Everly, Welzant, & Jacobson, 2008). Selected for their credibility and trust level, peer support officers conduct the actual annual training workshops, set the example, and encourage involvement at all levels. A "cradle-to-the-grave" program (i.e., rookies to retirees), ESC calls upon departments to begin teaching their personnel about the effects of job-related stress and trauma while they are still in the academy, emphasizing the importance of voluntary, confidential "annual mental health checks." Representatives of BOL now lecture regularly across the United States and Canada. All consultations, lectures, educational and training workshops, services, and referrals are free, as are original training materials developed and approved by the BOL Board of Directors.
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Policia , Estrés Psicológico , Prevención del Suicidio , Canadá , Humanos , Grupo Paritario , Prevención Primaria , Desarrollo de Programa , Prevención Secundaria , Apoyo Social , Estados UnidosAsunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 22 , Edema/diagnóstico , Edema/genética , Dedos/patología , Deformidades Congénitas del Pie/genética , Deformidades Congénitas de la Mano/genética , Derrame Pleural/genética , Cromosomas en Anillo , Adolescente , Niño , Preescolar , Consanguinidad , Femenino , Genes Recesivos , Humanos , LactanteRESUMEN
BACKGROUND: : Viral respiratory illness triggers asthma exacerbations, but the influence of respiratory illness on the acute severity and recovery of childhood asthma is unknown. Our objective was to evaluate the impact of a concurrent acute respiratory illness (based on a clinical definition and PCR detection of a panel of respiratory viruses, Mycoplasma pneumoniae and Chlamydia pneumoniae) on the severity and resolution of symptoms in children with a nonhospitalized exacerbation of asthma. METHODS: : Subjects were children aged 2 to 15 years presenting to an emergency department for an acute asthma exacerbation and not hospitalized. Acute respiratory illness (ARI) was clinically defined. Nasopharyngeal aspirates (NPA) were examined for respiratory viruses, Chlamydia and Mycoplasma using PCR. The primary outcome was quality of life (QOL) on presentation, day 7 and day 14. Secondary outcomes were acute asthma severity score, asthma diary, and cough diary scores on days 5, 7, 10, and 14. RESULTS: : On multivariate regression, presence of ARI was statistically but not clinically significantly associated with QOL score on presentation (B = -0.36, P = 0.025). By day 7 and 14, there was no difference between groups. Asthma diary score was significantly higher in children with ARI (B = 0.41, P = 0.039) on day 5 but not on presentation or subsequent days. Respiratory viruses were detected in 54% of the 78 NPAs obtained. There was no difference in the any of the asthma outcomes of children grouped by positive or negative NPA. CONCLUSIONS: : The presence of a viral respiratory illness has a modest influence on asthma severity, and does not influence recovery from a nonhospitalized asthma exacerbation.
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Asma , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/epidemiología , Virosis/complicaciones , Virosis/epidemiología , Adolescente , Análisis de Varianza , Asma/complicaciones , Asma/epidemiología , Asma/microbiología , Asma/virología , Distribución de Chi-Cuadrado , Niño , Preescolar , Infecciones por Chlamydophila , Chlamydophila pneumoniae/genética , Femenino , Humanos , Masculino , Mycoplasma pneumoniae , Nasofaringe/microbiología , Nasofaringe/virología , Neumonía por Mycoplasma/genética , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Estadísticas no Paramétricas , Virosis/virología , Virus/genéticaRESUMEN
A mobile interactive online health system was used to conduct virtual ward rounds at a regional hospital which had no specialist paediatrician. The system was wireless, which allowed telepaediatric services to be delivered direct to the bedside. Between December 2004 and May 2005, 43 virtual ward rounds were coordinated between specialists based in Brisbane and local staff at the Gladstone Hospital. Eighty-six consultations were provided for 64 patients. The most common conditions included asthma (27%), chest infections (12%), gastroenteritis (10%) and urinary tract infections (10%). In the majority of cases, there were partial (67%) or complete changes (11%) in the clinical management of patients. Specialist services were offered by a team of 13 clinicians at the Royal Children's Hospital: 10 general paediatricians, two physiotherapists and one registered nurse. Feedback from all consultants involved in the service and local staff in Gladstone was extremely positive. In 43 videoconference calls there were three technical problems, probably due to an intermittent mains power supply at the regional hospital. There appears to be potential for other rural and regional hospitals to adopt this model of service delivery.
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Servicios de Salud del Niño/estadística & datos numéricos , Atención a la Salud/estadística & datos numéricos , Internet , Servicios de Salud Rural/estadística & datos numéricos , Especialización , Telemedicina/métodos , Actitud del Personal de Salud , Niño , Preescolar , Estudios de Factibilidad , Humanos , Satisfacción del Paciente , Queensland , Robótica , Telemedicina/instrumentación , Telemedicina/estadística & datos numéricosRESUMEN
Academic health centers (AHCs) have struggled in recent years to redefine their special position in healthcare delivery. This article presents a description of structural and process features at AHCs to serve as a framework for redesigning healthcare delivery at AHCs. We review and synthesize the literature regarding health system performance. In addition, we address attributes of healthcare delivery that represent both challenges and opportunities for AHCs, including costs of care; comprehensiveness and capacity of care; coverage; continuity, communication, and coordination of care; consistency of practice; and consolidation. Recommendations on priorities for AHCs are given, and specific features of desirable academic delivery systems for the future are described.
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Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/economía , Costos de la Atención en Salud , Estados UnidosRESUMEN
Percutaneous provisional cuff fixation can facilitate arthroscopic rotator cuff repair with devices that eliminate the need to tie surgical knots.