Vertebroplasty: A Systematic Approach

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 367-380
Author(s):  
Mubin I. Syed
Keyword(s):  
Clinical Practice ◽  
Patient Selection ◽  
Systematic Approach ◽  
Spinal Pain ◽  
The United States ◽  
The Past ◽  
Post Procedure ◽  
Methodical Approach ◽  
Hands On ◽  
Difficult Procedure

Background: Though vertebroplasty is a well-known and extremely effective procedure in experienced hands, it is a much more difficult procedure to learn than standard spinal pain injection procedures. We therefore present a simplified, methodical approach to vertebroplasty that can be adopted by trained interventionalists. Many practitioners who attend hands-on cadaver workshops lack confidence to apply this technique in live patients. Objectives: To present a methodical, reproducible, and proven technique. To provide strategies on pre-procedure and post-procedure care in order to optimize outcomes in vertebroplasty patients. Study Design: A step-by-step tutorial is presented outlining the steps in the vertebroplasty procedure. A discussion of anatomic considerations, pre-procedure patient selection issues, and post-procedure management is also presented. Methods: Sections are presented on anatomy, patient selection, a 10-step technique on performance of vertebroplasty, a discussion of how this technique is advantageous, and post-procedure management. Results: This technique has been proven in clinical practice for over 1,500 vertebroplasties and has been well-received the past 4 years by hundreds of trainees taught at numerous hands-on courses (Stryker Interventional Pain, Arthrocare, and Society of Interventional Radiology). Conclusion: A basic tutorial is presented for the beginner who is interested in vertebroplasty. This safe and reproducible technique has been proven in clinical practice. The anatomic considerations, patient selection issues, technique, and post-procedure management has been taught and well received by hundreds of physicians at numerous hands on courses within the United States and Canada. Key words: vertebroplasty, fluoroscopic anatomy, PMMA

The Water Turbine Competition: A Hands-On Approach to Teaching Conservation Principles

2004 ◽  
Author(s):  
Bret Van Poppel ◽  
Michael D. McKay ◽  
A. O¨zer Arnas ◽  
Daisie Boettner
Keyword(s):  
Ground Level ◽  
The United States ◽  
United States Military Academy ◽  
United States Military ◽  
Military Academy ◽  
The Past ◽  
Hands On ◽  
Water Turbine ◽  
Approach To Teaching ◽  
Conservation Principles

For the past five semesters, the Water Turbine Competition has added significant excitement and motivation to the historically dreaded Fluid Mechanics course offered in the Department of Civil and Mechanical Engineering at the United States Military Academy. The Water Turbine Competition is an adaptation of the national Hydropower Contest. Teams of two or three students build a water turbine that will lift a weight using only the potential energy stored in a tank of water that is suspended above ground level. The water turbine project has proven to be an exciting and beneficial educational tool.

scholarly journals Colon Cancer Clinical Practice Guidelines in Oncology

2003 ◽  
Vol 1 (1) ◽  
pp. 40 ◽  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
The United States ◽  
Treatment Modalities ◽  
Comprehensive Management ◽  
The Past ◽  
Management Algorithm ◽  
Recent Version

Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States, and in 2002, an estimated 107,300 new cases of colon cancer will have occurred. Despite these statistics, mortality from colon cancer has decreased over the past 30 years, possibly because of earlier diagnosis through screening and better treatment modalities. The NCCN clinical practice guidelines for managing colon cancer discuss these advances and provide a comprehensive management algorithm. For the most recent version of the guidelines, please visit NCCN.org

The Outcome of Liver Transplantation in Patients With Hepatocellular Carcinoma in the United States Between 1988 and 2001: 5-Year Survival Has Improved Significantly With Time

2003 ◽  
Vol 21 (23) ◽  
pp. 4329-4335 ◽  
Author(s):  
Hwan Y. Yoo ◽  
Cary H. Patt ◽  
Jean-Francois Geschwind ◽  
Paul J. Thuluvath
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Patient Selection ◽  
Patient Survival ◽  
The United States ◽  
Control Group ◽  
Cox Regression Analysis ◽  
The Past ◽  
Kaplan Meier ◽  
Improvement In Survival

Purpose: We hypothesized that the outcome of liver transplantation in patients with hepatocellular carcinoma (HCC) has improved over the past decade because of the application of published criteria for patient selection. In this study, we compared the outcome of liver transplantation in patients with and without HCC at different time periods using the United Network for Organ Sharing data. Patients and Methods: We excluded children, patients with multiple organ transplantation or retransplantation, and those with incomplete survival data. The study period was arbitrarily divided into three time intervals: 1987 to 1991, 1992 to 1996, and 1997 to 2001. Results: During the study period, 985 patients with HCC (HCC group), and 33,339 without HCC underwent liver transplantation (control group). Kaplan-Meier patient and graft survivals were significantly lower for the HCC group compared with the control group. Cox regression analysis (after adjusting for other confounding variables) confirmed a lower patient survival in the HCC group (1-year survival, 77.0% v 86.7%; hazard ratio [HR], 1.7; 95% CI, 1.5 to 2.0; P < .0001) compared with the control group (5-year survival, 48.2% v 74.7%; HR, 2.2; 95% CI, 1.9 to 2.4; P < .0001); HCC was an independent predictor of survival. Kaplan-Meier analysis showed a significant improvement in 5-year patient survival with time in patients with HCC (1987 to 1991, 25.3%; 1992 to 1996, 46.6%; 1997 to 2001, 61.1%; P < .0001). During the same period, there was only minimal improvement in survival among the control group. Conclusion: Five-year survival of patients transplanted for HCC is excellent, with a steady improvement in survival over the past decade. It is possible that the published criteria for patient selection may have contributed to the better outcome.

Epidemiology of Pediatric Tympanostomy Tube Placement in the United States

2020 ◽  
Vol 163 (3) ◽  
pp. 600-602
Author(s):  
Neil Bhattacharyya ◽  
Sophie G. Shay
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Practice Guidelines ◽  
National Health Interview Survey ◽  
The United States ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
The Past ◽  
Interview Survey ◽  
Ear Infections

The prevalence of pediatric tympanostomy tube placement (TTP) in the United States has not been reassessed in the past decade. To assess the prevalence of TTP and frequent ear infections (FEI), the National Health Interview Survey for the calendar year 2014 was used. Among 73.1 million children, 6.26 million (8.6%) had TTP. The incidence of FEI was 3.49 million (4.8%). Males (9.6%) were more likely than females (7.5%) to undergo TTP ( P = .004). Among children under 2 years of age, 9.1% reported FEI, compared to 3.9% of children aged 3 to 17 years. Among children under 2 years of age, 25% with FEI received TTP vs 1.5% without FEI ( P < .001). Among children aged 3 to 17 years, 31.1% with FEI received TTP vs 8.6% without FEI ( P < .001). TTP may be increasing nationally, although further assessment of adherence to clinical practice guidelines is needed to investigate this potential trend.

scholarly journals Iodine

2011 ◽  
Vol 16 (3) ◽  
pp. 190-194 ◽  
Author(s):  
Chris D. Meletis
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Human Body ◽  
The United States ◽  
Cellular Level ◽  
Future Research ◽  
The Past

Iodine levels in the United States have dropped precipitously over the past few decades, whereas antagonists such as bromine, perchlorate, and fluoride have become more ubiquitous. These changes have placed a nutritional burden on the human body and increased the potential for pathophysiological change at the cellular level. This review examines the clinical and peer-reviewed literature and provides perspective related to health-compromising trends that warrant close scrutiny in clinical practice and future research mandates.

scholarly journals A systematic approach to the disclosure of genomic findings in clinical practice and research: a proposed framework with colored matrix and decision-making pathways

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kenji Matsui ◽  
Keiichiro Yamamoto ◽  
Shimon Tashiro ◽  
Tomohide Ibuki
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Approach ◽  
Genomic Medicine ◽  
Research Subjects ◽  
The Past ◽  
Key Concepts ◽  
Medical Importance ◽  
Comprehensive Framework ◽  
Disclosure Practice

Abstract Background Whether and how to disclose genomic findings obtained in the course of genomic clinical practice and medical research has been a controversial global bioethical issue over the past two decades. Although several recommendations and judgment tools for the disclosure of genomic findings have been proposed, none are sufficiently systematic or inclusive or even consistent with each other. In order to approach the disclosure/non-disclosure practice in an ethical manner, optimal and easy-to-use tools for supporting the judgment of physicians/researchers in genomic medicine are necessary. Methods The bioethics literature on this topic was analyzed to parse and deconstruct the somewhat overlapping and therefore ill-defined key concepts of genomic findings, such as incidental, primary, secondary, and other findings. Based on the deconstruction and conceptual analyses of these findings, we then defined key parameters from which to identify the strength of duty to disclose (SDD) for a genomic finding. These analyses were then applied to develop a framework with the SDD matrix and systematic decision-making pathways for the disclosure of genomic findings. Results The following six major parameters (axes), along with sub-axes, were identified: Axis 1 (settings and institutions where findings emerge); Axis 2 (presence or absence of intention and anticipatability in discovery); Axis 3 (maximal actionability at the time of discovery); Axis 4 (net medical importance); Axis 5 (expertise of treating physician/researcher); and Axis 6 (preferences of individual patients/research subjects for disclosure). For Axes 1 to 4, a colored SDD matrix for genomic findings was developed in which levels of obligation for disclosing a finding can be categorized. For Axes 5 and 6, systematic decision-making pathways were developed via the SDD matrix. Conclusion We analyzed the SDD of genomic findings and developed subsequent systematic decision-making pathways of whether and how to disclose genomic findings to patients/research subjects and their relatives in an ethical manner. Our comprehensive framework may help physicians and researchers in genomic medicine make consistent ethical judgments regarding the disclosure of genomic findings.

International Research and Variation in Views of Ethnicity

2012 ◽  
Vol 2 (2) ◽  
pp. 66-72
Author(s):  
Ella Inglebret ◽  
Amy Skinder-Meredith ◽  
Shana Bailey ◽  
Carla Jones ◽  
Ashley France
Keyword(s):  
United States ◽  
Classification System ◽  
International Research ◽  
The United States ◽  
Research Articles ◽  
Journal Articles ◽  
Research Participants ◽  
The Past ◽  
International Scale ◽  
Publication Patterns

The authors in this article first identify the extent to which research articles published in three American Speech-Language-Hearing Association (ASHA) journals included participants, age birth to 18 years, from international backgrounds (i.e., residence outside of the United States), and go on to describe associated publication patterns over the past 12 years. These patterns then provide a context for examining variation in the conceptualization of ethnicity on an international scale. Further, the authors examine terminology and categories used by 11 countries where research participants resided. Each country uses a unique classification system. Thus, it can be expected that descriptions of the ethnic characteristics of international participants involved in research published in ASHA journal articles will widely vary.

Overview of Current Approaches to Aural Rehabilitation for Adults With Cochlear Implants

2020 ◽  
Vol 5 (5) ◽  
pp. 1175-1187
Author(s):  
Rachel Glade ◽  
Erin Taylor ◽  
Deborah S. Culbertson ◽  
Christin Ray
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Cochlear Implants ◽  
Practice Patterns ◽  
The United States ◽  
Care Providers ◽  
Aural Rehabilitation ◽  
Starting Point ◽  
Clinical Models ◽  
Hearing Health

Purpose This clinical focus article provides an overview of clinical models currently being used for the provision of comprehensive aural rehabilitation (AR) for adults with cochlear implants (CIs) in the Unites States. Method Clinical AR models utilized by hearing health care providers from nine clinics across the United States were discussed with regard to interprofessional AR practice patterns in the adult CI population. The clinical models were presented in the context of existing knowledge and gaps in the literature. Future directions were proposed for optimizing the provision of AR for the adult CI patient population. Findings/Conclusions There is a general agreement that AR is an integral part of hearing health care for adults with CIs. While the provision of AR is feasible in different clinical practice settings, service delivery models are variable across hearing health care professionals and settings. AR may include interprofessional collaboration among surgeons, audiologists, and speech-language pathologists with varying roles based on the characteristics of a particular setting. Despite various existing barriers, the clinical practice patterns identified here provide a starting point toward a more standard approach to comprehensive AR for adults with CIs.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽  
2020 ◽  
pp. 1-5
Author(s):  
Shannon Lange ◽  
Courtney Bagge ◽  
Charlotte Probst ◽  
Jürgen Rehm
Keyword(s):  
United States ◽  
Suicidal Ideation ◽  
Random Effects ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
The United States ◽  
Individual Level ◽  
The Past ◽  
Meta Analyses ◽  
Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

EDITORIAL: Migration and competitiveness: Japan and the United States

2013 ◽  
Vol 10 (2) ◽  
pp. 115-124
Author(s):  
Philip L. Martin
Keyword(s):  
United States ◽  
The United States ◽  
Variable Cost ◽  
Fixed Cost ◽  
Special Issue ◽  
Science And Engineering ◽  
The Past ◽  
Past Half Century ◽  
Key Sectors ◽  
Past Half

Japan and the United States, the world’s largest economies for most of the past half century, have very different immigration policies. Japan is the G7 economy most closed to immigrants, while the United States is the large economy most open to immigrants. Both Japan and the United States are debating how immigrants are and can con-tribute to the competitiveness of their economies in the 21st centuries. The papers in this special issue review the employment of and impacts of immigrants in some of the key sectors of the Japanese and US economies, including agriculture, health care, science and engineering, and construction and manufacturing. For example, in Japanese agriculture migrant trainees are a fixed cost to farmers during the three years they are in Japan, while US farmers who hire mostly unauthorized migrants hire and lay off workers as needed, making labour a variable cost.

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