The Treatment of Young Transgender People and the Law.

The law has slowly recognised the concept of a transgender person. After initially fixating on someone's physical birth gender, it has now accepted the concept of gender identity. It has been challenged by young people experiencing gender dysphoria seeking medical treatment.

Voluntary Assisted Dying, the Conscientious Objector Who Refuses to Facilitate it and Discrimination Law.

This article discusses the aspect of recent voluntary assisted dying (VAD) laws dealing with a health care provider who declines to provide VAD services. While the law permits the provider to do so, it is sometimes less clear what, if anything, they must do to facilitate VAD service provision by others. Legislation in three jurisdictions is silent on the matter.

The effect of a tiered provider staffing model on patient outcomes during the coronavirus disease 2019 pandemic: A single-center observational study.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, our hospital experienced a large influx of critically ill patients with acute respiratory failure. In order to increase intensive care unit (ICU) surge capacity, we adopted a "tiered model" for ICU provider staffing where multiple ICUs were staffed by noncritical care providers under the direction of an intensivist. We hypothesized that ICUs staffed with a tiered model would result in similar patient outcomes as ICU staffed with a traditional intensivist model.

Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.

Objective: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient."

Design: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified.

A Symptom-Triggered Benzodiazepine Protocol Utilizing SAS and CIWA-Ar Scoring for the Treatment of Alcohol Withdrawal Syndrome in the Critically Ill.

Background: There are limited data on the efficacy of symptom-triggered therapy for alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU).

Objective: To evaluate the safety and efficacy of a symptom-triggered benzodiazepine protocol utilizing Riker Sedation Agitation Scale (SAS) scoring for the treatment of AWS in the ICU.

Methods: We performed a before-and-after study in a medical ICU.

The Australian quarantine and biosecurity legislation: Constitutionality and critique.

Australia's quarantine and biosecurity laws have been in focus recently with the serious outbreak of the ebola virus and the not-so-serious incident involving an actor's dogs apparently gaining unauthorised access to Australia. These incidents have coincided with the move to replace Australia's existing quarantine legislation with a modern regulatory framework for managing biosecurity risks. This article critiques the existing and new Australian legislation, comparing them with approaches in other jurisdictions and discussing some relevant public policy issues.

A novel cause of community-acquired pneumonia in a young immunocompetent host.

Diffuse pulmonary infiltrates represent a common problem encountered by pulmonologists. The differential diagnosis is extensive and includes infectious, inflammatory, environmental and malignant conditions. Appropriate evaluation, aside from a thorough history and physical examination, includes serologic, radiographic and procedural elements.

Co-administration of furosemide with albumin for overcoming diuretic resistance in patients with hypoalbuminemia: a meta-analysis.

Purpose: To systematically review clinical studies of co-administration of albumin and loop diuretics in hypoalbuminemic patients as a strategy to overcome diuretic resistance.

Materials And Methods: Systematic search of electronic databases up to October 2012. We included randomized clinical trials of adults with hypoalbuminemia, comparing co-administration of loop diuretics and albumin versus loop diuretics alone.

Changing patterns in interventional bronchoscopy.

Background And Objective: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach.

Methods: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted.

Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature.

Background: Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy.

Methods: We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years.

A comparative human health risk assessment of p-dichlorobenzene-based toilet rimblock products versus fragrance/surfactant-based alternatives.

A comparison of the human health risk to consumers using one of two types of toilet rimblock products, either a p-dichlorobenzene-based rimblock or two newer fragrance/surfactant-based alternatives, was conducted. Rimblock products are designed for global use by consumers worldwide and function by releasing volatile compounds into indoor air with subsequent exposure presumed to be mainly by inhalation of indoor air. Using the THERdbASE exposure model and experimentally determined emission data, indoor air concentrations and daily intake values were determined for both types of rimblock products.

Argatroban therapy for heparin-induced thrombocytopenia in acutely ill patients.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated adverse reaction to heparin therapy. To evaluate clinical outcomes and effects of argatroban therapy in acutely ill HIT patients. Retrospective analysis.

Bilateral epidiymal cysts in an alpaca male used for breeding.

A 4-year-old alpaca stud was presented for examination of his reproductive tract. Ultrasonographic examination of the gonads revealed 2 cystic structures associated with the head of each epididymis. Biopsies of each testicle evidenced mild testicular degeneration.

Appendicectomy: who performs it, when and how?

A comparative review of changing patterns between 1997 and 2002 of who performs appendicectomy and a snapshot of the surgical approaches in use. It also indicates the stage at which competency in appendicectomy may be achieved by contemporary trainees in surgery and anaesthesia.

Lung volume reduction surgery: a meta-analysis of randomized clinical trials.

Background: Observational studies have suggested that lung volume reduction surgery (LVRS) is superior to optimal medical therapy for selected subsets of patients with advanced emphysema. Randomized clinical trials (RCTs) with the exception of the National Emphysema Treatment Trial (NETT), failed to enroll a sufficient number of patients to provide clinicians and patients with convincing outcome data on the usefulness of LVRS. It was postulated that a meta-analysis of these RCTs (3-12 months' follow up) may provide more compelling information on the value of LVRS in patients with emphysema.

Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care.

Objectives: To describe three levels of hospital-based critical care centers to optimally match services and personnel with community needs, and to recommend essential intensive care unit services and personnel for each critical care level.

Participants: A multidisciplinary writing panel of professionals with expertise in the clinical practice of critical care medicine working under the direction of the American College of Critical Care Medicine (ACCM).

Data Sources And Synthesis: Relevant medical literature was accessed through a systematic Medline search and synthesized by the ACCM writing panel, a multidisciplinary group of critical care experts.

Endotracheal tubes.

A variety of different endotracheal tubes are available for distinct purposes, though the majority of patients will be well served with the standard single-lumen endotracheal tube. Specialized endotracheal tubes have been developed to aid in specific situations and novel tubes continue to be evaluated as clinicians strive for improved outcomes in various clinical conditions. Ultimately, the choice of an endotracheal tube depends on the purpose it is intended to serve.

Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD.

Study Objectives: Several validated instruments are used to measure outcomes, such as exercise performance, dyspnea, and health-related quality of life after pulmonary rehabilitation (PR) in patients with COPD. However, no study has simultaneously compared the responsiveness of the most frequently used outcome measurements after PR. We designed this study to investigate the capacity of several of the most frequently used outcome measurements to detect changes after PR in a population of patients with severe COPD who qualified for lung volume reduction surgery.