Front Lines Of Medicine Research Articles

Current issues in medical epistemology and statistics: a view from the frontline of medicine

Current issues in medical epistemology and statistics: a view from the frontline of medicine

If You Can’t Stand the Heat, Get out of the Kitchen: Considerations for Medical Student Participation in Care During a Global Pandemic

Though SARS-CoV-2 is a novel virus, the concept of life-altering pandemics is not. This presentation discusses ethical issues with medical student participation in delivery of care during a global pandemic, and urges that medical students should continue to be an integral part of the healthcare team, allowing for development of the knowledge and skills necessary to progress through their medical education. Medical students have historically been on the front lines of medicine during previous pandemics, and COVID-19 is no different. Students are an integral part of the healthcare team and their removal would disrupt workflow and patient care. Additionally, withdrawing students from clinical experience in the name of their protection vastly hinders their education and professional development. There is already a physician shortage, and there is a reasonable risk that the number of physicians will be further reduced due to burnout, illness, or death from the COVID-19 pandemic. Ultimately, restricting student education could prevent the entry of new physicians in later years when the physician shortage may be even more severe. Critics argue that pulling from a pool of medical students during a pandemic results in patients receiving a lower quality of care compared to trained professionals. Additionally, many students argue that they should not be required to work in COVID-19 wards while paying tuition and not receiving the same hazard pay or other benefits offered to health professionals. They argue the risks outweigh their obligations. Students will not be able to continue to learn if they are not willing to expose themselves to risks inherent in medicine. Though they should not be required to treat COVID-19 positive patients, they must fulfill their role as members of the health care team for the public good. It is vital that medical students—who started their career in medicine out of a desire to help others—be willing to accept some personal risk in order to provide care to their community and prevent future physician shortages.

School Nurses on the Front Lines of Medicine: When You Don't Need to "STOP AT AN ER STAT!"-The Role of Urgent Care Centers in the Management of Students With Nonemergent Chief Complaints.

In the midst of our nation's growing primary care provider shortage and subsequent overutilization of the emergency room (ER), urgent care centers represent an accessible, convenient, and affordable alternative for the management of "urgencies" or nonemergent illnesses and injuries. Despite the presence of competent healthcare providers and a wide array of services at urgent care centers, patients continue to pursue care in the ER for urgencies. School nurses may utilize urgent care centers for the evaluation and management of students with nonemergent medical or traumatic chief complaints. This article discusses the field of urgent care medicine, describes the pediatric services provided at urgent care centers, and summarizes the capabilities of centers to deal with potential urgencies versus emergencies in children and adolescents based on their chief complaint.

The death of cancer: after fifty years on the front lines of medicine, a pioneering oncologist reveals why the war on cancer is winnable – and how we can get there

Em 1971, um decreto do presidente dos EUA , conhecido como o Decreto Nacional de Câncer, deu início à mundialmente conhecida “Guerra contra o câncer”. Desde então, bilhões de dólares do governo federal, coordenados pelo Instituto Nacional de Câncer dos EUA (NCI), foram investidos em pesquisa e assistência ao câncer. O oncologista norte-americano Vincent T. DeVita Jr.,editor do livro, com uma trajetória de mais de 50 anos como oncologista (e paciente) é explorada no livro The Death of Cancer lançado nos EUA em 2015 e sem tradução no Brasil.

School Nurses on the Front Lines of Medicine: The Approach to a Student With Severe Traumatic Bleeding.

With the continued threat of mass casualty incidents in schools and surrounding communities, it is essential for school nurses to be knowledgeable regarding the recognition of hemorrhagic shock due to massive bleeding and the acute management of these victims. In the past decade, increased interest and research in acute bleeding control have led to published evidence-based guidelines to reduce morbidity and mortality for victims of violent acts. It is essential that healthcare providers, including nurses who are the first responders in schools, are aware of methods to assess and control massive bleeding. This article summarizes the most up-to-date recommendations for the management of children with traumatic bleeding.

Deep neural network improves fracture detection by clinicians

Suspected fractures are among the most common reasons for patients to visit emergency departments (EDs), and X-ray imaging is the primary diagnostic tool used by clinicians to assess patients for fractures. Missing a fracture in a radiograph often has severe consequences for patients, resulting in delayed treatment and poor recovery of function. Nevertheless, radiographs in emergency settings are often read out of necessity by emergency medicine clinicians who lack subspecialized expertise in orthopedics, and misdiagnosed fractures account for upward of four of every five reported diagnostic errors in certain EDs. In this work, we developed a deep neural network to detect and localize fractures in radiographs. We trained it to accurately emulate the expertise of 18 senior subspecialized orthopedic surgeons by having them annotate 135,409 radiographs. We then ran a controlled experiment with emergency medicine clinicians to evaluate their ability to detect fractures in wrist radiographs with and without the assistance of the deep learning model. The average clinician's sensitivity was 80.8% (95% CI, 76.7-84.1%) unaided and 91.5% (95% CI, 89.3-92.9%) aided, and specificity was 87.5% (95 CI, 85.3-89.5%) unaided and 93.9% (95% CI, 92.9-94.9%) aided. The average clinician experienced a relative reduction in misinterpretation rate of 47.0% (95% CI, 37.4-53.9%). The significant improvements in diagnostic accuracy that we observed in this study show that deep learning methods are a mechanism by which senior medical specialists can deliver their expertise to generalists on the front lines of medicine, thereby providing substantial improvements to patient care.

School Nurses on the Front Lines of Medicine: The Approach to a Student After a Syncopal Event: Don’t “PASS OUT”

Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider's office, or directly to the closest emergency department via EMS). This article describes the initial assessment and management of two students presenting after syncopal events.

School Nurses on the Front Lines of Medicine: Take a BREATH: The Approach to a Student With Respiratory Distress.

Students presenting with varying degrees of respiratory symptoms and distress occur commonly in the school setting. It is important to develop a differential diagnosis for respiratory distress, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary health care provider's office, or directly to the closest emergency department via Emergency Medical Services). This article describes the initial assessment and management of a student presenting with respiratory distress.

School Nurses on the Front Lines of Medicine: Uppers and Downers: The Approach to the Student With Altered Mental Status.

Although a student presenting with altered mental status due to substance use may occur infrequently in the school setting, it is of utmost importance to develop a differential diagnosis and to initiate stabilization of the student. This article describes the initial assessment and management of a student presenting with altered mental status, focusing on the differential diagnosis of altered mental status, on the varying presentations associated with common intoxications and ingestions, and on the screening tools available for the detection of depression and substance use.

School Nurses on the Front Lines of Medicine: Connecting the Dots: SCRIPTS for Success in the Evaluation of Pediatric Rashes.

Although skin rashes may not necessarily prompt a visit to the school nurse's office, a rash associated with other systemic symptoms, such as fever, headache, difficulty swallowing or breathing, weakness, or abdominal pain, may cause a child to visit your office. This article describes the initial assessment and management of skin rashes in children and adolescents and delineates reasons that may prompt the school nurse to transfer a student with a rash to a local emergency department.

The death of cancer: after fifty years on the front lines of medicine, a pioneering oncologist reveals why the war on cancer is winnable-and how we can get there (devita, v. and devita-raeburn, e.; 2015) [Book Review

In this memoir of front-line action in the "war on cancer," the authors combine a survey of cancer biology with a recipe for more effective and personalized treatment of the myriad forms of cancer. Presented in chronological order in a smoothly written volume, the book tracks Dr. DeVita's early work as a clinical associate in the Division of Cancer Treatment (DCT) at the National Cancer Institute (NCI) through his pioneering treatment of Hodgkin's disease, and ultimately to his leadership of the NCI, and later of the Cancer Centers at Memorial Sloan Kettering in New York and at Yale in New Haven, Connecticut. Although at times a polemic against the Food and Drug Administration (FDA) for restricting patient access to new drugs, the book provides a vigorous defense for the "success" of hard-won advances in cancer treatment, such as improved cure rates and reduced mortality across the spectrum of all cancers, despite the huge allocation of effort and money (US$30 billion). In fact, it is the "boots on the ground" perspective of just how hard-won these advances have been that distinguishes this book from the other excellent book on this topic (The Emperor of All Maladies, by Siddhartha Mukherjee). Together, the two books provide a balanced perspective on the challenges that both patient and physician face when confronting cancer.

School Nurses on the Front Lines of Medicine: Emergencies 101 Ask the E.R. Pediatrician.

Pediatric emergencies, such as the exacerbation of medical conditions and injuries, may occur in the school setting. This article introduces the "School Nurses on the Front Lines of Medicine" series by discussing the incidence and the most common emergencies that occur in schools as well as published guidelines for school emergency preparedness.

Getting the swagger back into general practice.

Perhaps there never was a golden age of general practice but it seems to me there was an era when GPs sustained their local community by delivering babies, performing operations, and only deferring to secondary care in exceptional circumstances. In short, they were warriors on the front line of medicine. This perception, erroneous though it may be, presents an attractive career option; variety, excitement, and respect. It is markedly different from the perception, again erroneous, that many trainees in secondary care specialties have of GPs as referral-wallahs, sifting the sick to the appropriate secondary-care specialist. In the first case a life as a GP seems full of opportunity to buckle your swash, while the second seems drab and uninspiring. The role of GPs has been greatly eaten away over the …

Silver Pharmacology: Past, Present and Questions for the Future.

Silver pharmacology is at the cross-roads. It has a long history as a chemosterilent but is currently denigrated by some vested interests and other 'knowledge monopolies'. It deserves better--particularly in these critical times of ever mounting incidence of antibiotic resistance. This reappraisal outlines some approaches to a dispassionate debate as to why we should, or should not, be reconsidering silver as an addition to (not a substitute for) other antibiotics at the front line of medicine. This will require more understanding about (i) the chemistry of silver in a biological environment; (ii) the different physical and bio-reactive properties of ionised silver (Ag(I)) and nanoparticulate metallic silver (Ag(o)); (iii) the antibiotic potential of both Ag(I) and Ag(o); and (iv) establishing objective Quality Controls for potential silver therapies. Six appendices (A-F) provide some technical data and focus further upon the need to clearly define (a) procedures for manufacturing nanoparticulate metallic silver (NMS); and (b) the purity and properties of NMS preparations--especially stability, antibiotic efficacy and safety of products offered for clinical evaluation. A further appendix (G) deals with some political considerations currently impeding impartial clinical research on silver therapeutics.

Family Medicine and the Evolution of Academic Health Centers: A Dialogue With Leadership

Following are excerpts from the closing panel discussion of the session “Shaping the Future of Academic Health Centers: A Reconnaissance from the Front Lines of Medicine,” held during the 2005 annual meeting of the Association of American Medical Colleges (AAMC). ### J. Lloyd Michener, MD: I

A question of ethics

A recent CMAJ editorial about the outbreak of Clostridium difficile -associated diarrhea in certain Canadian hospitals[1][1] describes the “stifling of concerned voices on the front lines of medicine” as the “worst news” in a bad-news story. What causes silence in such situations? Health

At the Front Lines of Medicine: How the Healthcare System Alienates Doctors and Mistreats Patients... and What We Can Do about It

Chapter 1 Preface Part 2 Primary Care and Social Policy Chapter 3 Access, Costs, and the Failure of Past Policies Chapter 4 Local Problems and Global Policies Chapter 5 The Social Origins of Illness: Medical Care is not Enough Part 6 Clinical Challenges in Primary Care Chapter 7 The Social Context of Patient-Doctor Relationships in the Era of Managed Care Chapter 8 Trauma, Mental Health, and Physical Symptoms Part 9 Struggles for Health and Justice Chapter 10 Local Struggles for Access and Control Chapter 11 A National Health Program for the United States Chapter 12 Needed Changes in Society Chapter 13 Needed Changes in the Patient-Doctor Relationship Part 14 Appendix Part 15 Notes Part 16 Index

Somatoform and Factitious Disorders

Somatoform and Factitious Disorders

Patient Safety: Grantmakers Join The Effort To Reduce Medical Errors

Patient Safety: Grantmakers Join The Effort To Reduce Medical Errors

Quality in Health Care

The connection between generating new knowledge in medical research and putting that knowledge to use in medical practice is remarkably tenuous. In order to ensure and improve the quality of health care, the health care system apparently needs better ways to integrate the lessons of research into the routine activities of care. Recent investigations have focused on the degree to which physicians accept and apply new findings and on the methods by which health care organizations support the integration of new knowledge into routine care. Several research groups have illustrated how wide the gap is between technically possible quality and the quality actually achieved at the front line of medicine. In the Harvard Medical Practice Study,1-3for example, investigators reviewed 30 000 randomly selected records from acute care hospitals and found that adverse events (injuries caused by medical management that prolonged hospitalization or produced disability at the time of