“Conventional” isthmus ablation without fluoroscopy

Recently, a new technology for nonfluoroscopic 4-D catheter tracking has been introduced (MediGuide). This system allows precise catheter visualization on prerecorded conventional fluoroscopy loops. We report about the first experience in atrial flutter ablation using a MediGuide-supported ablation catheter. For successful ablation besides the 6 s for loop acquisition, no further fluoroscopy was used.     

Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion

Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of life-threatening uterine rupture.     

Treatment of Tularemia in Pregnant Woman,France

A pregnant woman who had oropharyngeal tularemia underwent treatment with azithromycin and lymph node resection and recovered without obstetrical complication or infection in the child. Azithromycin represents a first-line treatment option for tularemia during pregnancy in regions where the infecting strains of Francisella tularensis have no natural resistance to macrolides.     

The interplay between autonomy and dignity: summarizing patients voices

Patients have to be respected with dignity as the masters of their own lives. The problem, however, is that autonomy may become so dominant and the fundamental value of caring in professional nursing that the patient’s dignity is affected. The aim of this article is to point out some of the issues with the interplay between autonomy, also called self-management and dignity. Given voice to the patient perspective the background is provided by cases from research conducted through qualitative interviews with patients and expanded by summarizing empirical research concerning the interplay between autonomy and dignity. The search strategy and the research question gave five empirical research papers and three theoretical studies and concept analyses. A concise overview of the relevant research contains information about all the major elements of the studies. The background research and an interpretative summary address new issues to be taken into account in dignity conserving care.     

UNDERUTILIZATION OF MENTAL HEALTH SERVICES BY ASIANAMERICANS RESIDING IN THE UNITED STATES

Asian-Americans are the fastest-growing minority in the United States, and they are a culturally diverse group. Knowledge about this growing minority population is important for the purposes of planning appropriate mental health care. Asian-Americans living in the United States rarely use mental health services. The reasons for this, along with suggestions for developing more culturally sensitive mental health services, are presented. A model for cultural competence can provide a framework for psychiatric nurses and other mental health professionals (MHPs) to become more aware of Asian-American values and beliefs and provide more culturally sensitive care. Awareness tools are included to guide MHPs in determining whether culturally competent care is available locally to meet the needs of this underserved population.     

The curriculum indexing database for stanford university school of medicine

The Curriculum Indexing Database (CID) was created to index the content of preclin‐ical courses on a session‐by‐session basis using a controlled vocabulary. A commercially available database software package, Filemaker Pro, allows the system to be set up, maintained, and utilized by individuals with little computer expertise and at reasonable expense. The development of the database vocabulary, consisting of 382 keywords in 20 possible categories, is discussed. A large free‐text field enables more specific content identification. Keywords from one or more fields can be designated for a search. A variety of report formats are available and custom reports can be created. CID provides an accurate curriculum inventory that has been useful in reducing redundancy and avoiding omissions, reviewing sequencing of material, planning vertical integration of special topics, and providing background information for the development or restructuring of courses. We are currently adding the required clinical curriculum to CID.     

Long-term Mortality Among Adults With Asthma: A 25-Year Follow-up of 1,075 Outpatients With Asthma

BackgroundData from long-term follow-up studies of patients with well-characterized asthma are limited. We studied all-cause and cause-specific mortality and risk factors in a large cohort of adults with asthma.MethodsA total of 1,075 adult patients with asthma were recruited consecutively from an outpatient clinic from 1974 to 1990 and followed up until the end of 2011. Subjects were classified as having allergic or nonallergic asthma on the basis of a detailed history, spirometric tests, tests for IgE-mediated allergy (skin prick tests and radioallergosorbent test), and bronchial challenge tests. Information on vital status and cause of death were obtained from the Danish Death Register and the Danish National Board of Health. All-cause mortality was also studied in an age- and sex-matched group of subjects without asthma.ResultsAll-cause mortality was increased significantly among patients with asthma compared with control subjects (261 cases vs 124 control subjects; relative risk (RR), 2.1; 95% CI, 1.4-3.0; P < .001). The excess mortality was primarily due to death from obstructive lung disease (95 deaths). Subsequent death from asthma was significantly associated with age (P < .001), level of FEV₁ % predicted (P < .001), bronchodilator reversibility (P < .01), peripheral eosinophil count (P < .0001), and previous acute hospital contacts for asthma (P = .002) at enrollment. No significant association was found between smoking habits or self-reported symptom severity, and subsequent death from asthma. After adjusting for age and level of FEV₁ % predicted, nonallergic asthma was associated with a higher risk of death from asthma (RR, 1.9; 95% CI, 1.1-3.2; P = .001).ConclusionThis 25-year prospective study of a large cohort of adults with well-characterized asthma showed an excess mortality compared with matched control subjects, to a large extent explained by death from obstructive lung disease.     

Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder

Background

Bodybuilding is a demanding sport, which requires high-volume, high-resistance weight training and augmented nutritional intake, toward an increase of overall body muscle mass accompanied by an overall decrease of body fat percentage and mass. Among bodybuilders, the use of various legal and illegal supplements is common. These supplements may be naturally occurring or man-made.