Facility-based approach for the management of acute ST segment elevation myocardial infarction with cardiogenic shock in a rural medical centre: the Durango model.

Introduction: Cardiogenic shock (CS) complicates 5%-15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS.

Methods And Analysis: The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre.

Very low risk of ST-elevation and non-ST-elevation myocardial infarction in patients with chest trauma.

Background: The goal of this study was to evaluate any association between blunt chest trauma and occurrence of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

Methods: Data from the National Inpatient Sample (NIS) database from 2010-2014, of patients over the age of 40, hospitalized for blunt chest trauma (ICD 959.11), with STEMI or NSTEMI, was used in this study.

Metaplastic Breast Cancer: Characteristics and Survival Outcomes.

Objectives Metaplastic breast cancer (MBC) is a rare neoplasm accounting for <1% of all breast cancer. We evaluated the clinical characteristics and survival outcomes of MBC. Methods Patients diagnosed with pathologically proven MBC were reviewed from the institutional breast cancer database from 2000 to 2017.

Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series.

Purpose: Though research exists regarding calcaneal fractures, the treatment approach for displaced intra-articular calcaneal fractures (DIACF) remains controversial. The most common approach, the extensile lateral approach (ELA), for the treatment of DIACFs has high rates of wound complications reported. In contrast, the sinus tarsi approach (STA) is becoming more popular due to its minimally invasive technique.

A Systematic Approach to the Surgical Correction of Combined Hallux Valgus and Metatarsus Adductus Deformities.

The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present.

Triplanar Correction for First Metatarsophalangeal Fusion.

Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well documented. Currently, there is limited discussion in the literature focusing on triplanar correction of the first MTP arthrodesis. Presented is a novel approach for triplane correction and fusion of the first MTP joint utilizing a biplanar locked plating system.

Analysis of Shortening and Elevation of the First Ray With Instrumented Triplane First Tarsometatarsal Arthrodesis.

Background: The Lapidus procedure using planar saw resection has often been criticized for complications related to excessive shortening and elevation of the first ray. The goal of this study was to assess the amount of shortening that occurs when using a cutting guide for controlled saw resection of the first tarsometatarsal (TMT) joint surfaces, along with assessment of deformity correction in all 3 anatomic planes.

Methods: A prospective multicenter study with IRB approval included 35 hallux valgus subjects evaluated at baseline and 6 months following instrumented triplane first TMT arthrodesis without lesser metatarsal osteotomies.

Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus.

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis.

Aging and erectile function.

The authors review and discuss numerous factors that influence erectile function and their interactions, based on the published literature. Of critical importance are vascular nitric oxide; nutrition; exercise; weight control and maintaining insulin sensitivity; early treatment of hypertension with attention to effects on erectile function; avoiding sources of oxidative stress such as obesity and smoking; reducing inflammation (e.g.

The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows.

Background: Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis.

Methods: The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia.

Frontotemporal dementia: latest evidence and clinical implications.

Background: Frontotemporal dementia (FTD) describes a cluster of neurocognitive syndromes that present with impairment of executive functioning, changes in behavior, and a decrease in language proficiency. FTD is the second most common form of dementia in those younger than 65 years and is expected to increase in prevalence as the population ages. This goal in our review is to describe advances in the understanding of neurobiological pathology, classification, assessment, and treatment of FTD syndromes.

Analgesics in the management of behavioral and psychological symptoms of dementia: a perspective review.

The objective of this review was to assess the efficacy and tolerability of analgesics in reducing behavioral and psychological symptoms of dementia (BPSD) among older adults from published randomized controlled trials (RCTs). A literature search was conducted of PubMed, MEDLINE, SCOPUS, PsycINFO, and Cochrane collaboration databases for RCTs in the English language that evaluated the use of analgesics in reducing the severity of BPSD among older adults. Additionally, references of full-text articles that were included in this review were searched for extra studies.

Obesity pandemic: causes, consequences, and solutions-but do we have the will?

Obesity has become pandemic owing to an obesogenic environment (inexpensive calorie dense food, technologies and structure of communities that reduce or replace physical activity, and inexpensive nonphysical entertainment) and excessive emphasis on low fat intake resulting in excessive intake of simple carbohydrates and sugar. Effects are greater for women owing to their smaller size and extra weight gain with each pregnancy, with 38% of American adult women being obese. Women are responsible for more than three-fourths of the more than 400 billion dollars of excess direct health care expenditures due to obesity.

Anatomical Study of the Axillary Nerve: Description of a Surgical Blind Zone.

Background: The aim of this study was to quantify the length of the axillary nerve that is able to be dissected through a standard anterior (deltopectoral) and posterior approach. The authors hypothesize that a segment of the axillary nerve cannot be reached using both approaches simultaneously.

Methods: Axillary nerves of five frozen cadavers were dissected using an anterior and posterior approach.

Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers.

Background: A majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. A national research initiative seeks effective new strategies for increasing successful smoking cessation outcomes among SED populations. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own.

Randomised trial of two nicotine patch protocols distributed through a state quitline.

Background: Most telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively.

Evaluation of "Steps to Surgical Success" (STEPS): a holistic perioperative medicine program to manage pain and anxiety related to surgery.

This empirical study found that a holistic perioperative program significantly reduced patient pain and anxiety about surgery. Modalities included guided imagery, eye pillow, aromatherapy, and a written personal healing plan. Nurses are in a prime position to deliver these interventions, given their frequent direct contact with patients.