Extensive intracranial calcification secondary to hypoxia,presenting with dyspraxic gait

The imaging appearances of a case of extensive intracranial calcification presenting with dyspraxic gait are described. Computed tomography showed bilateral calcification in the anterior, posterior and central watershed areas and in the basal ganglia. It is believed that the changes are secondary to previous hypoxaemia and hypotension, and that subsequent development of the symptoms is due to calcification in the dystrophic tissue.     

Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey

BACKGROUND

Increasingly, medical school policies limit pharmaceutical representatives’ access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.

OBJECTIVE

To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students’ practices and attitudes.

DESIGN, PARTICIPANTS

We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.

MAIN MEASURES

We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees’ attitudes and their schools’ National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.

KEY RESULTS

Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p?<?0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p?<?0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p?<?0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p?<?0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR?=?0.51, 95 % CI: 0.38–0.68, p?<?0.001), but the strength of institutional conflict of interest policies was not associated with this variable.

CONCLUSIONS

Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school’s policies concerning interactions with industry.     

Service Providers' Attitudes Toward LGBTQ Youth

This study examined mental health service providers' attitudes toward LGBTQ youth in an agency setting (n = 100) using the Homonegativity Scale, the Personal Comfort Assessment Tool, and the Gay Affirmative Practice Scale. The results of this study indicate that job category is associated with mental health agency employees' attitudes toward LGBTQ youth. Most notably, respondents from the Management/Supervisory category reported less homonegative attitudes toward LGBTQ youth than respondents from the Administrative/Clerical/Support job category. A post hoc regression analysis revealed that homonegative attitudes predict gay affirmative practice for this sample. Implications for policy and practice are explored.     

Patient‐centered,evidence‐based,and cost‐conscious cancer care across the continuum: Translating the Institute of Medicine report into clinical practice

In 2013, the Institute of Medicine (IOM) concluded that cancer care in the United States is in crisis. Patients and their families are not receiving the information that they need to make informed decisions about their cancer care. Many patients do not have access to palliative care and too few are referred to hospice at the appropriate point in their disease trajectory. Simultaneously, there is a growing demand for cancer care with increases in new cancer diagnoses and the number of patients surviving cancer. Furthermore, there is a workforce shortage to care for this growing and elderly population. The IOM's report, Delivering High‐Quality Cancer Care: Charting a New Course for a System in Crisis, outlined recommendations to improve the quality of cancer care. This article provides an overview of the IOM report and highlights the recommendations that are most relevant to practicing clinicians who care for patients with cancer across the continuum. The implementation of the recommendations in clinical practice will require better patient‐clinician communication, improved care coordination, targeted clinician training, effective dissemination of evidence‐based guidelines and strategies for eliminating waste, and continuous quality assessment and improvement efforts. CA Cancer J Clin 2014;64:408–421. © 2014 American Cancer Society.     

Peripheral Neurostimulation in the Management of Cervicogenic Headache: Four Case Reports

Introduction. Neuromodulation, mediated by invasive electric stimulation, has been shown to be effective when applied to patients with refractory and intractable neuropathic pain. Recent advances in neurostimulation have broadened the therapeutic uses of this therapy, with the placement of extraspinal electrodes for peripheral nerve stimulation. Methods. Four patients with long‐evolving, persistent, severe, uncontrolled, and localized pain in the occipital region, in whom other management options had been tried and failed, were treated with a peripheral, occipital, extraspinal electric stimulation (C1‐C2‐C3). We present, as case reports, the results of this intervention in these four patients. Results. In all cases, stimulation of the occipital region yielded good or very good global results. In all patients, continuous pain disappeared, the frequency and severity of the episodic pain decreased, function improved, and restful sleep improved. As a result of stimulation we were either able to reduce or discontinue medication usage in all of our patients.