Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi.

Objectives: To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF).

Methods: This was a case-control study using data obtained from patients' records documented by the 'Fistula Care Center-Bwaila Hospital' in Malawi. Socio-demographic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined.

A Roadmap for Value-Based Payment Models Among Patients With Cirrhosis.

Healthcare reimbursement is shifting from fee-for-service to fee-for-value. Cirrhosis, which costs the U.S.

Electronic medical record: data collection and reporting for spinal cord injury.

Study Design: Presentation of implementation of International Spinal Cord Injury (SCI) Data Sets, International Standards for Neurological Classification of SCI (ISNCSCI), and other structured SCI tools in to the Electronic Medical Record (EMR) Epic.

Objectives: To describe the implementation of SCI tools in Epic at Rigshospitalet, University of Hospital, Capital Region of Denmark, and the ambitions for the future development of SCI related structured data and their reporting in the Epic EMR to be able to standardize data collection to facilitate research within institutions and collaboratively with other institutions locally and globally.

Setting: Denmark and United States of America.

Crisis in the Emergency Department: The Evaluation and Management of Acute Agitation in Children and Adolescents.

Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important.

Should Long-Term Consequences of NICU Care Be Discussed in Terms of Prognostic Uncertainty or Possible Harm?

We will examine several ethical considerations in the resuscitation of infants born at the margin of gestational viability in analyzing a case of preterm labor. More specifically, we will discuss the obligations of physicians in characterizing expected outcomes, both mortality and long-term morbidity, for extremely premature infants and how potential adverse outcomes should be framed-as complications of prematurity itself or as iatrogenic complications of care. We will also explore how the concept of a "trial of therapy" can support parents and neonatologists in decision making concerning withholding or withdrawing care for periviable infants.

Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.

Background: The awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle is a multicomponent complex intervention that improves outcomes for critically ill adults yet is inconsistently implemented. Effective interprofessional team function (how the team interacts) is key to ABCDE delivery but little is known about how to measure team interactions. The purpose of our study was to examine the reliability of an observational rating tool to assess team interactions about ABCDE in one ICU.

Spastic foot and ankle deformities: evaluation and treatment.

Spastic foot and ankle deformities can occur from various causes and have profound effects on individuals and society. Presentations can vary clinically and a thorough clinical evaluation, potentially with a dynamic electromyogram, is essential to selecting the most appropriate treatment. Nonoperative treatments, such as orthotics, casting, oral medications, and nerve blocks, can be effective but surgery is indicated if they are no longer effective.

Emergency radiology elective improves second-year medical students' perceived confidence and knowledge of appropriate imaging utilization.

Rationale And Objectives: Given recent advances in and wider availability of complex imaging, physicians are expected to understand imaging appropriateness. We introduced second-year medical students to the American College of Radiology Appropriateness Criteria (ACR-AC) in an interactive case-based elective to demonstrate their use in imaging for common emergency department clinical complaints.

Materials And Methods: Prospective pre- and post-test design assessed second-year medical students' performance on case-based knowledge applications and self-assessed confidence related to ACR-AC guidelines compared to second-year students participating in a different concurrent radiology elective.

The use of immunocytochemical study in the cytologic diagnosis of melanoma: evaluation of three antibodies.

There are limited studies on the utility of immunostaining in cytologic specimens suspected of melanoma. In this study, we examined the performance of the most commonly used antibodies including monoclonal antibodies against Melan-A (A103), S-100, and HMB-45 antigens. Immunostains were performed on formalin-fixed, paraffin-embedded cell blocks prepared from 100 cytologic specimens.

Olfactory groove meningioma: discussion of clinical presentation and surgical outcomes following excision via the subcranial approach.

Objectives/hypothesis: To describe surgical outcomes and radiographic features of olfactory groove meningiomas treated by excision through the subcranial approach. Special emphasis is placed on paranasal sinus and orbit involvement.

Study Design: Retrospective review of a series of patients.

Perioperative lumbar drain placement: an independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery.

Objective: To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications.

Design: Retrospective review of a series of patients (n = 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n = 45) underwent routine lumbar drain placement at the time of skull base surgery.

Medical marijuana in HIV-positive patients: what do we know?

On November 4, 2008, our state passed the Michigan Medical Marijuana Act (MMMA), which allows the medical use of marijuana for certain conditions and/or constellation of symptoms. This article will (1) review the current evidence that medical marijuana is useful for certain chronic conditions, particularly pain and wasting syndromes experienced by HIV-positive people; (2) discuss the adverse effects of marijuana; (3) summarize the new Michigan law and the challenges it poses for physicians, and (4) review the experience in California where medical marijuana has been legal since 1996.