Biomechanical comparison of four isometric prosthetic ligament repair techniques for tarsal medial collateral ligament injury.

Objective: To compare the stability, ultimate strength, and isometry of 4 prosthetic ligament repairs for canine tarsal medial collateral ligament injury.

Methods: 24 cadaveric canine distal hind limbs with induced medial tarsal instability were randomly divided into 4 groups. Simulated medial shearing injury of the collateral and medial malleolus were repaired using 1 of 4 isometric suture techniques: bone tunnels with nylon suture (TN), ultrahigh-molecular-weight polyethylene (UHMWPE) suture (TU), tibial bone anchor with nylon suture (AN), or talar bone anchor with UHMWPE suture (AU).

When Corona Came to Canada: The 2003 SARS Outbreak and Its Aftermath.

Severe Acute Respiratory Syndrome (SARS) was the first pandemic of the 21st century, and Canada was the only Western nation to experience an outbreak. The effects of the outbreak on Canadian society provide a window to understanding responses to future pandemics. Over the short run, SARS had a major effect on the Canadian economy: adverse effects were experienced by health-care workers, who were at greatest risk of contracting the disease; by workers in the hospitality industry, who lost income as tourism and travel ground to a halt; and by the Chinese-Canadian community, who experienced discrimination because of the Chinese origins of SARS.

Corrigendum: Outcomes Associated With Osteochondral Allograft Transplantation in Dogs.

[This corrects the article DOI: 10.3389/fvets.2021.

Outcomes Associated With Osteochondral Allograft Transplantation in Dogs.

The purpose of this study was to retrospectively characterize outcomes and complications associated with osteochondral allograft transplantation for treating chondral and osteochondral lesions in a group of client-owned dogs with naturally-occurring disease. Records were reviewed for information on signalment, treated joint, underlying pathology (e.g.

Merchants of Health: Shaping the Experience of Illness Among Older People.

Despite nearly universal health-care coverage for older Americans, the quality of care for the sickest and frailest remains sub-optimal. Understanding why requires analysis of the medical ecosystem. This paper considers the role of four of the principal actors in this system: physicians, hospitals, drug companies, and Medicare.

Clinical outcomes associated with the initial use of the Canine Unicompartmental Elbow (CUE) Arthroplasty System(®).

We evaluated mid- to long-term outcomes with respect to function and complications in dogs undergoing canine unicompartmental elbow (CUE) arthroplasty for treatment of medial compartment disease of the elbow. This prospective multicenter case series is the first group of clinical cases to receive CUE arthroplasty. Cases (each elbow that underwent CUE performed by a participating surgeon) were enrolled into an electronic database and prospectively followed to determine and record all associated complications, as well as functional outcomes.

Re-engineering shared decision-making.

Shared decision-making is widely accepted as the gold standard of clinical care. Numerous obstacles to achieving shared decision-making have been identified, including patient factors, physician factors and systemic factors. Until now, the paradigm is seldom successfully implemented in clinical practice, raising questions about the practicality of the process recommended for its use.

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients.

Background: Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided.

Objectives: We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers.

Targeted chemotherapy, the medical ecosystem, and the future of American health care.

In light of the difficulties experienced by the pharmaceutical industry in developing important new drugs, the rapid design and introduction of the targeted chemotherapeutic agent, crizotinib, is a significant achievement. Understanding the roles of the patient, the physician, the regulator (FDA), health insurance companies, and the manufacturer (Pfizer) in the development of this drug can shed light on the prospects for future drugs and on the workings of the complicated health-care ecosystem. Patients were eager for an effective drug against lung cancer with minimal toxicity but were reluctant to enroll in clinical trials.

The new tools: What 21st century education can teach us.

This article explores the shifting education paradigm that leverages videos and massive online open courses (MOOCs) and the implication of these developments for the patient-doctor encounter. This essay argues that medicine can learn from the rapid evolution of online video learning techniques to empower both patients and clinicians. Video technology is a powerful tool for the patient and physician and has the potential to significantly improve the delivery of care in an increasingly complex health care system.

The medical ecoculture at work: the case of the metal-on-metal hip.

The United States has the most expensive, technologically intensive system of medical care in the world, but not the most effective. Reforming health care will require understanding the interactions among the many individuals and institutions that collectively constitute the health-care ecoculture, an ecosystem with a major human component. Because technology is a key driver of health-care costs and a critical component of the patient's experience of American medicine, it is fruitful to consider an example of a particular technology: why it was embraced, who benefited from its use, and the response of the ecoculture when a critical flaw in the technology emerged.

Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.

Purpose: Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer.

Patients And Methods: We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers.

A randomized controlled trial of a goals-of-care video for elderly patients admitted to skilled nursing facilities.

Objective: To determine the impact of a video on preferences for the primary goal of care.

Design, Subjects, And Intervention: Consecutive subjects 65 years of age or older (n=101) admitted to two skilled nursing facilities (SNFs) were randomized to a verbal narrative (control) or a video (intervention) describing goals-of-care options. Options included: life-prolonging (i.

Doing the right thing: a geriatrician's perspective on medical care for the person with advanced dementia.

Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. Physicians are the locus of decision making for persons with dementia. It is the responsibility of the physician to assure that the surrogate understands the nature and trajectory of the disease and then to elicit the desired goal of care.

No place like the hospital.

The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company.

'In technology we trust'.

But for many patients, our intervention-oriented medical culture doesn't produce humane care.

The critical role of religion: caring for the dying patient from an Orthodox Jewish perspective.

Background And Objective: Culturally competent medical care for the dying patient by families and health care professionals is a challenging task especially when religious values, practices, and beliefs influence treatment decisions for patients at the end of life. This article describes end-of-life guidelines for hospital health care professionals caring for Orthodox Jewish patients and their families. Religious perspectives on advance directives, comfort care and pain control, nutrition and hydration, do not resuscitate/do not intubate (DNR/DNI), and extubation are often unfamiliar to the American medical community.

Caring for the frail, demented and dying. An interview with Muriel Gillick. Interviewed by Les Olson.

Prolonging life at the expense of its quality can rob elderly people of peaceful, meaningful years, Muriel Gillick tells Les Olson.

The challenge of applying advance directives in hospital practice.

Critically ill elderly patients facing crucial decisions about their future medical treatment routinely come under the care of hospital physicians who may have no previous relationship with them or their families. The majority of patients for whom this sort of decision must be made are unable to participate in decision making because of dementia, delirium, or both. They are desperately ill, often with a new medical problem with which they have had little time to come to terms.