Finding your first job in a community hospital

Community hospitals offer excellent opportunities for graduating orthopaedic trauma fellows. To successfully compete for these jobs, applicants today must be better prepared than their predecessors. Organizing your practice aspirations and researching job opportunities before the interview are necessary for an effective job search. Often, a collaborative effort with hospital administrators is required to establish a viable practice that fulfills the unique needs of the hospital and surrounding community while concurrently satisfying your practice goals. Issues to consider in defining your desired practice, guidelines on how to prepare for an interview with a community hospital, and suggestions on how to justify the expense of establishing your practice are presented.     

Finding a contract research organization for your research trial

Clinical research organizations (CROs) can provide consulting services and support to assist with the conduct of clinical trials from site initiation to study close-out. As the number of CROs continues to increase, it can be difficult to determine the optimal organization to help manage a large or even a small-scale project. We present uses for and attributes to consider when choosing a CRO, and provide examples of four CROs specializing in various therapeutic areas.     

Finding your first job in academics: interviewing strategies

Successfully obtaining your first academic orthopaedic surgery position is a daunting adventure, but one in which you can succeed with proper preparation. First, you must identify specifically what you want to be doing on a daily basis at work. Then, you find places where you can potentially do those things. The interview will provide more definitive information and will allow you to assess if you can happily work in that environment. Remember that you must have balance in your life, so consider if the area is suitable to your and to your family's needs. By identifying your personal goals and desires of this initial position and thoroughly preparing for the entire interview process, you will be able to locate the most desirable opportunity available.     

Efficacy of social worker role in corneal donation in two different periods

Introduction

The Brazilian National System of Transplantation and the Ministry of Health in Brazil establish procedures and effective actions for occupational health care so that there are increasing numbers of organ and tissue donations.

Objective

This study analyzes the performance of social workers at the Intrahospital Donation of Organs and Tissues for Transplantation, Clinical Hospital, State University of Campinas, Brazil (CIHDOTT).

Methods

We retrospectively analyzed the number of potential cornea donors, effective donations, family refusal, and the reasons for nonimplementation of the donations in 2009 (period studied with the presence of social workers) compared with 2006 (period studied without the presence of social workers).

Results

Data analysis revealed that in 2006 there were 141 potential cornea donors achieving 35 (25%) donations and 106 (75%) refusals. In 2009 there were 73 potential donors with 25 (34%) donations and 48 (66%) refusals. The causes of family refusal prevalent in both periods were similar: 65% from indecision and 25% from the family's wishes to maintain the patient's body intact.

Conclusion

The performance of social workers in this case was satisfactory, achieving an increase in donations and reducing the number of patients awaiting corneal transplantation while promoting their quality of life.     

Ethanol lock solution as an adjunct treatment for preventing recurrent catheter-related sepsis--first case report in dialysis setting.

Sir, Preliminary studies have reported the successful use of ethanollock or flush techniques in preventing or controlling catheter-relatedinfections in oncology patients [1] and in those on total parenteralnutrition [2–4]. Ethanol irrigation has also been usedfor valve disinfection of the Lifesite® haemodialysis accesssystem [5]. We     

Finding covert fluid: methods for detecting volume overload in children on dialysis

Background

Lung ultrasound is a novel technique for detecting generalized fluid overload in children and adults with end-stage renal disease (ESRD). Echocardiography and bioimpedance spectroscopy are established methods, albeit variably adopted in clinical practice. We compared the practicality and accuracy of lung ultrasound with current objective techniques for detecting fluid overload in children with ESRD.

Methods

A prospective observational study was performed to compare lung ultrasound B-lines, echocardiographic measurement of inferior vena cava parameters and bioimpedance spectroscopy in the assessment of fluid overload in children with ESRD on dialysis. The utility of each technique in predicting fluid overload, based on short-term weight gain, was assessed. Multiple linear regression models to predict fluid overload by weight were explored.

Results

A total of 22 fluid assessments were performed in 13 children (8 on peritoneal dialysis, 5 on haemodialysis) with a median age of 4.0 (range 0.8–14.0) years. A significant linear correlation was observed between the number of B-lines detected by lung ultrasound and fluid overload by weight (r?=?0.57, p?=?0.005). A non-significant positive linear correlation was observed between fluid overload by weight and bioimpedance spectroscopy (r?=?0.43, p?=?0.2), systolic blood pressure (r?=?0.19, p?=?0.4) and physical examination measurements (r?=?0.19, p?=?0.4), while a non-significant negative linear relationship was found between the inferior vena cava collapsibility index and fluid overload by weight (r?=??0.24, p?=?0.3). In multiple linear regression models, a combination of three fluid parameters, namely lung ultrasound B-lines, clinical examination and systolic blood pressure, best predicted fluid overload (R ² ?=?0.46, p?=?0.05).

Conclusions

Lung ultrasound may be superior to echocardiographic methods and bioimpedance spectroscopy in detecting volume overload in children with ESRD. Given the practicality and sensitivity of this new technique, it can be adopted alongside clinical examination and blood pressure in the routine assessment of fluid status in children with ESRD.

     

Adenosine as a non-opioid analgesic in the perioperative setting

Adenosine, a ubiquitous metabolic intermediate in the body, is involved in nearly every aspect of cell function, including neuromodulation and neurotransmission. Adenosine A(1) and A(2) receptors are widely distributed in the brain and spinal cord, and are a novel, non-opiate target for pain management. The potential of adenosine as a non-narcotic analgesic in anesthetized patients has been explored in clinical trials, including double-blind studies versus placebo and remifentanil infusion. These studies suggest that, compared to placebo or remifentanil, an intraoperative adenosine infusion stabilizes core hemodynamics and reduces the requirement for anesthesia during surgery. Further, adenosine improves postoperative recovery, as indicated by lower pain scores and less opioid consumption. The safety profile of adenosine has been well characterized based on use of currently approved adenosine products. The most common adverse events associated with its use include flushing, chest discomfort, dyspnea, headache, gastrointestinal discomfort, and lightheadedness. These effects are generally well tolerated and transient. Further studies are warranted to investigate the full potential of adenosine as a non-opioid analgesic in the perioperative setting.