A case of bilateral anomalous origin for dorsalis pedis arteries (anomalous dorsalis pedis arteries)

Summary A case of bilateral anomalous arterial supply of the lower limb is presented. In this case, both anterior tibial arteries were hypoplastic. These arteries came to the anterior (extensor) compartment by passing superiorly through the interosseous membrane. They ran between the tibialis anterior and the extensor hallucis longus muscles and terminated after giving numerous muscular and fascial branches. The dorsalis pedis arteries originated from the peroneal arteries. The peroneal arteries reached the anterior compartment by piercing the interosseous membrane at its lower part and ran as the dorsalis pedis arteries. Awareness of the anatomical variations in anatomy of the distal popliteal artery is important for angiographers, vascular surgeons and reconstructive surgeons who operate upon these regions.

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Un cas d'origine anormale bilatérale des artères dorsales du pied

Résumé Un cas de vascularisation artérielle anormale bilatérale du membre inférieur est présenté. Dans ce cas les deux aa. tibiales antérieures étaient hypoplasiques. Elles gagnaient la loge antérieure de la jambe en traversant la partie haute de la membrane interosseuse. Elles passaient entre les mm. tibial antérieur et long extenseur de l'hallux et se terminait en donnant de nombreuses branches musculaires et fasciales. Les aa. dorsales du pied naissaient des aa. fibulaires. Les aa. fibulaires gagnaient la loge antérieure de la jambe en traversant la partie basse de la membrane interosseuse et avaient ensuite le trajet normal des aa. dorsales du pied. La connaissance des variations anatomiques de la partie distale de l'a. poplitée est importante pour les radiologues pratiquant l'angiographie, les chirurgiens vasculaires et les chirurgiens reconstructifs opérant dans ces régions.

     

Developing skills for thoracic aortic surgery with hypothermic circulatory arrest

Objectives

To examine the performance curves of 8 early-career aortic surgeons with the use of hypothermic circulatory arrest (HCA) and to analyze the impact of the learning curve on perioperative outcomes.

Comparison of Serum Total IgA Levels in Severe and Mild COVID-19 Patients and Control Group

Journal of Clinical Immunology - The present study aimed to compare serum total IgA levels between severe and mild COVID-19 patients’ groups and the control group. In this cross-sectional...     

Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions

PURPOSE: To identify the frequency and type of iatrogenic medical events requiring admission to an intensive care unit. To assess the consequences of iatrogenic medical events for patients and institutions. To assess the prevalence of disclosure of iatrogenic medical events to patients, surrogates, and institutions. METHODS: The project on Care Improvement for the Critically Ill enrolled 5727 patients to 8 intensive care units at 4 Boston teaching hospitals. To determine the nature, consequences, and disclosure of iatrogenic medical events, we did a retrospective chart review on all patients whose admission to an intensive care unit was precipitated by an iatrogenic event. RESULTS: Sixty-six patients (1.2 %) were identified by an intensive care unit's clinical team as having an iatrogenic medical event as the primary reason for admission to the unit. The majority (29, or 45%) of iatrogenic medical events were secondary to technical error, but a high percentage (21, or 33%) was due to iatrogenic drug events. Twenty-two (34%) cases were assessed by the investigators to have been preventable. In 60 (94%) cases there was no documentation in the patient's chart of communication to the patient regarding the reason for admission to the intensive care unit. In 11 (17%) cases there was documentation of a discussion with the surrogate about the reason for admission to the unit. In only 3 (5%) cases was there documentation that the patient or surrogate was informed that an iatrogenic medical event was the reason for admission to the intensive care unit. Incident reports or malpractice claims were filed in only 4 (6 %) cases. CONCLUSION: The frequency of iatrogenic medical events resulting in admission to intensive care units is lower than previous studies have reported. Iatrogenic drug events continue to be an important source of error. A considerable percentage of iatrogenic events may be preventable. Health care professionals rarely document disclosure of iatrogenic events to patients and surrogates.     

Medical Students’ Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools

BACKGROUND

It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations.

OBJECTIVE

To characterize medical students’ views and knowledge of the ACA and to assess correlates of these views.

DESIGN

Cross-sectional email survey.

PARTICIPANTS

All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52 % [2,761/5,340]).

MAIN MEASURES

Level of agreement with four questions regarding views of the ACA and responses to nine knowledge-based questions.

KEY RESULTS

The majority of respondents indicated an understanding of (75.3 %) and support for (62.8 %) the ACA and a professional obligation to assist with its implementation (56.1 %). The mean knowledge score from nine knowledge-based questions was 6.9 ± 1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR = 0.6 [0.4–0.7], OR = 0.4 [0.3–0.6], respectively), less likely to indicate a professional obligation to implement the ACA (OR = 0.7 [0.6–0.9], OR = 0.7 [0.5–0.96], respectively), and more likely to have negative expectations (OR = 1.9 [1.5–2.6], OR = 2.3 [1.6–3.5], respectively). Moderates, liberals, and those with an above-average knowledge score were more likely to indicate support for the ACA (OR = 5.7 [4.1–7.9], OR = 35.1 [25.4–48.5], OR = 1.7 [1.4–2.1], respectively) and a professional obligation toward its implementation (OR = 1.9 [1.4–2.5], OR = 4.7 [3.6–6.0], OR = 1.2 [1.02–1.5], respectively).

CONCLUSIONS

The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.KEY WORDS: Medical students, Health care reform, Affordable Care Act, Survey     

Subtrochanteric Fractures: Comparison of Proximal Femur Locking Plate and Intramedullary Locking Nail Fixation Outcome

Fixation of subtrochanteric fracture, even for experienced surgeons, is a challenge. This fracture is most difficult to treat, and the incidence of complications in this type of fracture is higher. This study compared surgical results of two methods, proximal femur locking compression plate and intramedullary locking nail. This is an analytic study, performed on all patients with subtrochanteric fracture who were referred to the hospital during 3 years. They were treated with proximal femur locking plate or intramedullary locking nail. The postoperative complications were evaluated and recorded. Finally, the data were analyzed by SPSS software. Complications were studied in both groups. Neither treatment has statistically significant difference in complications, onset of complications incidence, and time of full-weight bearing. Although the Harris Hip Score among patients improved in both methods of treatment, there is no significant difference between the two groups. The results of subtrochanteric fracture fixation by intramedullary or locking plate were similar and had the same outcome.     

Health Care Resource Utilization and Costs Associated with Transitioning to 3-month Paliperidone Palmitate Among US Veterans

Purpose

The aim of this article was to describe and compare treatment patterns, health care resource utilization (HRU), and health care costs before and after transition in veterans with schizophrenia who were transitioned from paliperidone palmitate given once monthly (PP1M) to paliperidone palmitate given every 3 months (PP3M) according to prescribing-information guidelines.

Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial

Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning(biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals(HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or activeassisted modes(where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan? robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off(SAT) before(T1) and immediately after(T2) training on days 1 and 2(T3 and T4). The change in SAT after 2 days of training(T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode(T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied "as-needed." This study was approved by the local ethical committee(Comité d'éthique médicale, CHU UCL Namur, MontGodinne, Yvoir, Belgium; Internal number: 54/2010, Eudra CT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov(Identifier: NCT03974750) on June 5, 2019.