Permanent Medical Grounding in Royal Canadian Air Force Pilots (20082017)

BACKGROUND: The aim of this retrospective registry study was to review the medical causes of RCAF pilot permanent grounding during the period 20082017 and to compare our findings to the previous study of 19781987 to determine if disease patterns had changed.METHODS: Material was obtained from the RCAF 1 Canadian Air Division Surgeons' medical registry of military pilots. Anonymized data for permanently grounded pilots were classified by medical diagnosis, age, and training status.RESULTS: During the period 20082017, there were a total of 162 pilots permanently grounded, of which 110 were trained and 52 untrained.DISCUSSION: In comparison to the 1991 study, there has been a decrease in permanent groundings due cardiovascular disease, but an increase due to mental health conditions, musculoskeletal issues, and motion sickness.Haworth D, Gray G, Zoltenko R, Bashirzadeh AJ. Permanent medical grounding in Royal Canadian Air Force pilots (20082017). Aerosp Med Hum Perform. 2021; 92(11): 913-918.

Survival of Patients with Multi-Level Malignant Bowel Obstruction on Total Parenteral Nutrition at Home

Home parenteral nutrition (HPN) may improve the survival in selected patients with malignant bowel obstruction. This retrospective, medical registry-based study aimed to identify clinical and laboratory markers predicting short survival, which would allow a more accurate selection of patients that would benefit from HPN in inoperative bowel obstruction. In a retrospective analysis of 114 patients receiving HPN, the median survival was 89 days after discharge home, and the three and six-month survival probability was 48% and 26%, respectively. Parenteral nutrition was provided during 98% of overall survival time and ended on a median of one day before the patient’s death. Discontinuing chemotherapy, anemia, severe hypoalbuminemia, and water retention appeared correlated with survival shorter than three months. In these cases, routine initiation of HPN should be discouraged, as it may not bring any benefits to the patient. The decision on the initiation of HPN should be made along with continuing or initiating chemotherapy.

International Radiographers in British Universities: A Case Study

Many British universities offer radiographic reporting programs, but these programs are designed to allow British citizens only to join those programs. Usually, these programs are a part-time and those programs use the “spoon-feeding education” approach which is not the same approach that used with international students. Usually, internationals allowed to join self−learning programs that make unqualified radiographers who will not be able to pass any examination from any medical registry organization worldwide. Usually, these post−graduate programs use distance learning, self-learning, no exams, no GPA, no score, and continues assessment approach. All the programs that international students can join, are non-Health and Care Professions Council (HCPC) accredited programs. If these programs had an accreditation, the graduates will be able to work in the United Kingdom to fill the shortage of Reporting Radiographers. Due to the discriminatory regulations by British university against international applicants, they could not join any good accredited program. Keywords: Discrimination; International Students; Radiographic Reporting; Admission, Education

WAR THORACIC WOUNDS AMONG CIVILIANS CASUALTIES IN ADEN DURING THE 2015

Thoracic injury during warfare was associated with a high incidence of morbidity and mortality. In wartime, civilians have became a direct target and accounted for one-half to two-thirds of the casualties. We aimed to highlight the incidence and pattern of thoracic injury and its outcomes management among civilians during the war in Aden. This retrospective study was based on the data were prospectively recorded in Medical Registry. There were 84 civilian casualties identified during the study period. Of those, 97.6% of casualties were males and 2.4% were females. The overall mean age was 30.8 ± 9.8 years (range: 10 – 65 years). Of those, 73.8% of casualties were produced by rifle bullets, while 26.2% of casualties were due to fragmentation weapons. Hemopneumothorax was the most common injury patterns. Abdomen injury was the most common associated injuries. Of those, 91.7% of casualties were treated with chest tube insertion alone. Thoracotomy was performed for 7.1% of casualties. The overall complications were 54.8%. Wound infection was the most frequent complications. The overall mortality rate was 3.6%. The overall mean hospital stay was 8.3 ± 5.9 days. We concluded that chest drain is best option for treatment the majority penetrating chest wounds.

Development of an application for accessing and analyzing RDPLF data

The collection of information in the database of a medical registry finds its first interest in the possibility for a doctor and a care team to analyze their results and to compare themselves with other teams for the purpose of sharing experience and knowledge. Since 1986, the French Language Peritoneal Dialysis Registry (RDPLF) has collected data from 45,000 patients with renal failure treated at home in French-speaking countries. A partnership has been created between the RDPLF and Datastorm (https://www.datastorm.fr), the expertise and consultancy subsidiary of the ENSAE-ENSAI Group (National Schools of Economics and Statistics) in order to develop an application that allows to carry out simple statistical queries on the RDPLF database, by means of a user-friendly WEB interface. Thus, any doctor or member of the healthcare team can evaluate, without any special statistical skills, results by region and by French-speaking country. Special access also allows any center to compare its own results with those of a reference region. The generated graphics can be used for presentations during team meetings or for work. The application is based on the R software (https://www.r-project.org) and its SHINY visualization interface (https://shiny.rstudio.com). We report on development modalities and its functionalities (based on preselected criteria: incidence rate, prevalence, survival, infection rate, distribution of treatments, nursing aspects). This article describes how both nurses and doctors can easily realize studies with the application. Its bilingual interface also opens it up to English-speaking communities and thus facilitates international communication.

Chronic heart failure and adherence to medication: methods for assessing adherence to therapy and unresolved issues

The review of the literature examines the General problems of treatment of chronic heart failure, among which special attention is paid to the problem of adherence. This problem remains one of the most urgent and difficult to solve in medicine, because it directly affects the effectiveness of treatment and the outcome of the disease. The article considers the commitment of both doctors to comply with clinical recommendations and patients to prescribed therapy. Some of the reasons that explain the lack of adherence to treatment (such as gender, age, institution where the patient is observed, and others) are described. It is also described that comorbidity is an aggravating factor in the treatment of chronic heart failure. It is described that comorbidity is an aggravating factor in the treatment of chronic heart failure. The presence of concomitant diseases increases the number of medications taken, which exacerbates the problem of adherence to medication therapy. It is noted that medical registry is the ideal model for studying adherence in clinical practice. The main Russian registers included of patients with chronic heart failure are considered. It is noted that in none of them a full assessment of patients’ adherence to therapy was carried out. In the largest foreign chronic heart failure registers, the assessment of commitment is also given insufficient attention. Separate clinical trials are described, including randomized trials, specifically studying various aspects of the problem of adherence and its impact on the course of the disease. Special attention is paid to the methods of assessing adherence in these studies. It is noted that there is no “gold standard” for its evaluation, and existing methods (such as Chips, determining the concentration of the drug in the blood, counting prescription forms and others) are unacceptable for real clinical practice. This indicates the need and prospects for further work on assessing adherence to therapy in patients with chronic heart failure.