A High-Value Care Curriculum Using Individual and Group Structured Reflection.

Objective: One-third of all healthcare dollars are wasted, primarily in the form of clinician-ordered unnecessary diagnostic tests and treatments. Medical education has likely played a central role in the creation and perpetuation of this problem. We aimed to create a curriculum for medical students to promote their contribution to high-value care conversations in the clinical environment.

Potentially inappropriate medicines for older adults with intellectual disability: Clinical implications from a medication audit.

Objective: To investigate medications that have the potential to be inappropriately prescribed for people with intellectual disability (ID) and to explore possible issues surrounding the potential harm that can result from the use of groups of medicines for people with ID who are ageing and living longer.

Methods: An audit of medical case records of 350 patients under the care of an organisation in New Zealand was undertaken to examine existing medication profiles.

Results: Of the 350 patients, 95% were prescribed at least five or more medicines, with 7% of patients have 10 or more medicines.

Elevated Hair Mercury Levels Are Associated With Neurodevelopmental Deficits in Children Living Near Artisanal and Small-Scale Gold Mining in Peru.

Children living near artisanal and small-scale gold mining (ASGM) are at risk of exposure to mercury, a neurotoxicant. It is not certain whether such exposures are harming development, as they occur in underresourced contexts entwined with other stressors, such as malnutrition and enteric infection. This study sought to investigate the association between hair-mercury levels and visual-motor, cognitive, and physical development among children living near ASGM in the Peruvian Amazon.

Case Report: Mucosal Leishmaniasis Presenting with Nasal Septum Perforation after Almost Thirty Years.

Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation.

Therapeutic options for bleeding oesophageal varices: cyanoacrylate and balloon-occluded retrograde obliteration (BRTO).

A 56-year-old male with cirrhosis presented with acute bleeding from cardiofundal gastroesophageal varices (GOV) and was treated with endoscopic cyanoacrylate glue. Glue therapy achieved stabilisation of the patient in the emergent setting. Three months later, the patient suffered rebleeding.

Premature Bioprosthetic Aortic Valve Degeneration Associated with Allergy to Galactose-Alpha-1,3-Galactose.

We present the cases of two patients with bioprosthetic aortic valves who developed an allergy to alpha-gal. Each had premature degeneration of their bioprosthesis and demonstrated rapidly increasing transvalvular gradients after development of their allergy. Each underwent successful replacement with a mechanical aortic valve within 1-2 years of symptom onset.

The hitchhiker's guide to global health blogging.

Social media use in modern medicine is fraught with ethical dilemmas and risks of unprofessional behavior. This essay surveys the existing literature on the possibilities and pitfalls of social media use by health-care professionals and concludes that non-engagement with social media is not an option. A mindful approach, not vague guidelines or long checklists, will foster a generation of physicians comfortable using online platforms for education and reflection.