Ethical Approach to the Abusive/Disruptive Physician.

Abusive, intimidating, and disruptive behavior is unprofessional and antithetical to the provision of medical care within a culture of safety. These behaviors affect all members of the health-care team, including trainees, and have shown to result in adverse patient outcomes. When events occur, rapid intervention utilizing structured processes as required by The Joint Commission and consistent with the AMA Code of Medical Ethics needs to be implemented to protect all involved.

Physician Unionization: Opportunities and Challenges for Anesthesiologists in the United States.

Physician unionization is gaining traction in the United States, with <10% of practicing physicians now members, up from historically weak support. Factors that drive interest in unions include a decreased number of independent practitioners, an increase in workloads, and the erosion of autonomy. Approximately 56% of anesthesiologists are considered employees and may be eligible for union membership.

Clinical utility of comprehensive circulating tumor DNA genotyping compared with standard of care tissue testing in patients with newly diagnosed metastatic colorectal cancer.

Background: Comprehensive biomarker testing is essential in selecting optimal treatment for patients with metastatic colorectal cancer (mCRC); however, incomplete genotyping is widespread, with most patients not receiving testing for all guideline-recommended biomarkers, in part due to reliance on burdensome sequential tissue-based single-biomarker tests with long waiting times or availability of only archival tissue samples. We aimed to demonstrate that liquid biopsy, associated with rapid turnaround time (TAT) and lower patient burden, effectively identifies guideline-recommended biomarkers in mCRC relative to standard of care (SOC) tissue testing.

Patients And Methods: Prospectively enrolled patients with previously untreated mCRC undergoing physician discretion SOC tissue genotyping submitted pretreatment blood samples for comprehensive circulating tumor DNA (ctDNA) analysis with Guardant360 and targeted RAS and BRAF analysis with OncoBEAM.

The efficacy of different vitamin D supplementation delivery methods on serum 25(OH)D: A randomised double-blind placebo trial.

Background: The use of vitamin D supplementation has increased due to greater recognition of widespread deficiency.

Aims: There has been little research on the effectiveness of different delivery methods and therefore the aim of was to test the efficacy of different delivery methods on serum 25(OH)D.

Methods: Using a randomised repeated measures double-blind placebo design (registered under ClinicalTrials.

Injury Patterns in Hip Hop Dancers.

Hip hop dance is becoming increasingly popular. It is performed in a variety of environments and can be fused with other dance styles. There is limited research on this dance demographic.

Effect of Vitamin D on Muscle Function and Injury in Elite Adolescent Dancers: A Randomized Double-Blind Study.

Purpose: A number of studies have noted low levels of vitamin D in dancers, and this has been associated with increased risk of injuries and decreased muscle-strength indices. The aim of the present study was to examine whether vitamin D supplementation over a 4-mo period can improve muscle function and injury incidence.

Methods: A total of 84 participants volunteered; exclusion criteria and dropout (19%) reduced the cohort to 67 participants (females = 29 and males = 38; 17-19 y).

Administration of Hypoxia-Activated Prodrug Evofosfamide after Conventional Adjuvant Therapy Enhances Therapeutic Outcome and Targets Cancer-Initiating Cells in Preclinical Models of Colorectal Cancer.

Cancer-initiating cells (C-IC) have been described in multiple cancer types, including colorectal cancer. C-ICs are defined by their capacity to self-renew, thereby driving tumor growth. C-ICs were initially thought to be static entities; however, recent studies have determined these cells to be dynamic and influenced by microenvironmental cues such as hypoxia.

Orthopaedic management of the Ehlers-Danlos syndromes.

The role of orthopedic surgery in Ehlers-Danlos syndrome is inherently controversial, opaque to most patients and many medical providers, and difficult to discern from available medical literature. Non-operative treatment is preferable, but for carefully selected patients, specific joint stabilization and nerve decompression procedures can provide symptomatic relief when conservative measures fail. © 2017 Wiley Periodicals, Inc.

Quadriceps traumatic myositis ossificans in a football player: management with intravenous pamidronate.

Myositis ossificans (MO) can be a significant complication of traumatic muscle contusion. Bisphosphates have been used in management of heterotopic ossification after spinal cord injury, but there is a lack of evidence with respect to MO in the sporting population. We present a case of a 14-year-old male football player with posttraumatic quadriceps MO, treated with 2 doses of intravenous pamidronate.

The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study.

Objectives: Athletes who train indoors during the winter months exhibit low serum 25-hydroxyvitamin D [25(OH)D] concentrations due to a lack of sunlight exposure. This has been linked to impaired exercise performance. The purpose of this study was to assess the effects of oral vitamin D₃ supplementation on selected physical fitness and injury parameters in elite ballet dancers.

Vitamin D status in professional ballet dancers: winter vs. summer.

Objective: Serum 25-hydroxyvitamin D is produced by the exposure of the skin to sunlight. Therefore athletes who train indoors, such as dancers, are vulnerable to vitamin D deficiency. The purpose of the study was to evaluate the serum 25-hydroxyvitamin D status in UK professional dancers during periods of reduced and increased sunlight exposure (i.

Changes in bone turnover markers during the close season in elite football (soccer) players.

Objectives: Bone turnover marker changes in response to physical activity are well documented. There is, however, little information on the extent and severity of skeletal de-conditioning in athletes in response to rest periods. This study analyses changes in markers of bone resorption and bone formation during the close season within the squad of an English Football Association Championship club.

Predictive value of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination for neurologic outcome after coronary artery bypass graft surgery.

Objective: We intended to define the role of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination in identifying adverse neurologic outcomes in a large international sample of patients undergoing cardiac surgery.

Methods: We evaluated 4707 patients undergoing cardiac surgery with cardiopulmonary bypass at 72 centers in 17 countries between November 1996 and June 2000. Prespecified overt neurologic outcomes were categorized as type I (clinically diagnosed stroke, transient ischemic attack, encephalopathy, or coma) or type II (deterioration of intellectual function).

Effects of modified ultrafiltration on coagulation as measured by the thromboelastograph.

Hemodilution during cardiopulmonary bypass (CPB) continues to be a cause of morbidity associated with coagulation dysfunction, bleeding, and allogeneic blood transfusion. Clot formation and strength have been shown to impact bleeding and transfusions. Strategies to reduce hemodilution may be negated based on the course of the cardiac procedure itself.

Eccentric exercises; why do they work, what are the problems and how can we improve them?

Eccentric exercises (EE) have proved successful in the management of chronic tendinopathy, particularly of the Achilles and patellar tendons, where they have been shown to be effective in controlled trials. However, numerous questions regarding EE remain. The standard protocols are time-consuming and require very motivated patients.

The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans.

Objective: Degenerative disorders of tendons present an enormous clinical challenge. They are extremely common, prone to recur and existing medical and surgical treatments are generally unsatisfactory. Recently eccentric, but not concentric, exercises have been shown to be highly effective in managing tendinopathy of the Achilles (and other) tendons.

Last night I had the strangest dream: Varieties of rational thought processes in dream reports.

From the neurophysiological perspective, thinking in dreaming and the quality of dream thought have been considered hallucinatory, bizarre, illogical, improbable, or even impossible. This empirical phenomenological research concentrates on testing whether dream thought can be defined as rational in the sense of an intervening mental process between sensory perception and the creation of meaning, leading to a conclusion or to taking action. From 10 individual dream journals of male participants aged 22-59 years and female participants aged 25-49 years, we delimited four dreams per journal and randomly selected five thought units from each dream for scoring.