Electronic Health Records: Cure-all or Chronic Condition?

Computer-based information systems feature in almost every aspect of our lives, and yet most of us receive handwritten prescriptions when we visit our doctors and rely on paper-based medical records in our healthcare. Although electronic health record (EHR) systems have long been promoted as a cost-effective and efficient alternative to this situation, clear-cut evidence of their success has not been forthcoming. An examination of some of the underlying problems that prevent EHR systems from delivering the benefits that their proponents tout identifies four broad objectives - reducing cost, reducing errors, improving coordination and improving adherence to standards - and shows that they are not always met. The three possible causes for this failure to deliver involve problems with the codification of knowledge, group and tacit knowledge, and coordination and communication. There is, however, reason to be optimistic that EHR systems can fulfil a healthy part, if not all, of their potential

ROLE OF ANATOMICAL OBSTRUCTION IN THE PATHOGENESIS OF CHRONIC SINUSITIS

Sinusitis is a commonly diagnosed condition in the general population.This article is a study to asses the role of anatomical obstruction in the pathogenesis of chronic sinusitis,based on symptomatology and radiological findings of the patients.The frequency of major anatomical variants like deviated nasal septum,concha bullosa and paradoxical middle turbinate leading to chronic sinusitis have been analyzed.Most of the time the obstruction at osteomeatal complex leading to chronic sinusitis is caused by more than one anatomical factor. 

Adapting clinical guidelines to take account of multimorbidity

Most people with a chronic condition have multimorbidity, but clinical guidelines almost entirely focus on single conditions. It will never be possible to have good evidence for every possible combination of conditions, but guidelines could be made more useful for people with multimorbidity if they were delivered in a format that brought together relevant recommendations for different chronic conditions and identified synergies, cautions, and outright contradictions. We highlight the problem that multimorbidity poses to clinicians and patients using guidelines for single conditions and propose ways of making them more useful for people with multimorbidity

A new outlook towards kidney injuries

Acute and chronic progression of injury to the kidney leads to the failure of the renal system and has become an increasingly important cause of morbidity and mortality. Present diagnosis detects the condition only after irreversible loss of 70 percent of kidney function. Current research is focused only on the clinical manifestations after the kidney injuries and not towards the exact cause of the condition. Here we propose a new outlook- that there is an involvement of a pathogen in the pathogenesis of kidney injuries. Basis for our proposal is given by the similarity of the pathogenesis events occurring between a classical example of hepatitis and kidney injuries. Furthermore, literature regarding the role of early kidney injury biomarkers in innate immunity indicates the involvement of the pathogen. Research in this theme possesses a strong possibility in the development of therapeutic, preventive and management strategies for the acute and chronic kidney injuries

CALM Evaluation Narrative Report to MFH

Childhood asthma is the leading cause of emergency room visits, inpatient hospitalizations and school absenteeism among children under age 15 due to a chronic condition. This report outlines the collaboration between a child's school, medical care provider and other community organizations. This collaboration has lead to better overall asthma care for the child, as well as a reduction in symptoms

Exercise intolerance and fatigue in chronic heart failure: is there a role for group III/IV afferent feedback?

Exercise intolerance and early fatiguability are hallmark symptoms of chronic heart failure. While the malfunction of the heart is certainly the leading cause of chronic heart failure, the patho-physiological mechanisms of exercise intolerance in these patients are more complex, multifactorial and only partially understood. Some evidence points towards a potential role of an exaggerated afferent feedback from group III/IV muscle afferents in the genesis of these symptoms. Overactivity of feedback from these muscle afferents may cause exercise intolerance with a double action: by inducing cardiovascular dysregulation, by reducing motor output and by facilitating the development of central and peripheral fatigue during exercise. Importantly, physical inactivity appears to affect the progression of the syndrome negatively, while physical training can partially counteract this condition. In the present review, the role played by group III/IV afferent feedback in cardiovascular regulation during exercise and exercise-induced muscle fatigue of healthy people and their potential role in inducing exercise intolerance in chronic heart failure patients will be summarised

The chaperone protein clusterin may serve as a cerebrospinal fluid biomarker for chronic spinal cord disorders in the dog

Chronic spinal cord dysfunction occurs in dogs as a consequence of diverse aetiologies, including long-standing spinal cord compression and insidious neurodegenerative conditions. One such neurodegenerative condition is canine degenerative myelopathy (DM), which clinically is a challenge to differentiate from other chronic spinal cord conditions. Although the clinical diagnosis of DM can be strengthened by the identification of the Sod1 mutations that are observed in affected dogs, genetic analysis alone is insufficient to provide a definitive diagnosis. There is a requirement to identify biomarkers that can differentiate conditions with a similar clinical presentation, thus facilitating patient diagnostic and management strategies. A comparison of the cerebrospinal fluid (CSF) protein gel electrophoresis profile between idiopathic epilepsy (IE) and DM identified a protein band that was more prominent in DM. This band was subsequently found to contain a multifunctional protein clusterin (apolipoprotein J) that is protective against endoplasmic reticulum (ER) stress-mediated apoptosis, oxidative stress, and also serves as an extracellular chaperone influencing protein aggregation. Western blot analysis of CSF clusterin confirmed elevated levels in DM compared to IE (p < 0.05). Analysis of spinal cord tissue from DM and control material found that clusterin expression was evident in neurons and that the clusterin mRNA levels from tissue extracts were elevated in DM compared to the control. The plasma clusterin levels was comparable between these groups. However, a comparison of clusterin CSF levels in a number of neurological conditions found that clusterin was elevated in both DM and chronic intervertebral disc disease (cIVDD) but not in meningoencephalitis and IE. These findings indicate that clusterin may potentially serve as a marker for chronic spinal cord disease in the dog; however, additional markers are required to differentiate DM from a concurrent condition such as cIVDD

Diagnosis and treatment of canine hypoadrenocorticism

Canine hypoadrenocorticism (Addison’s disease), the ‘great pretender’ of internal medicine, is a disease that should be frequently considered as a differential diagnosis of several clinical presentations, albeit it is less commonly the actual cause of the clinical signs. Hypoadrenocorticism cannot be diagnosed on clinical signs alone and further investigations are always required. There have been some interesting new ideas about diagnostic options for this condition and new treatment options are available for both acute and chronic therapy of the condition in dogs. It is therefore pertinent to review the causes, diagnosis and treatment of hypoadrenocorticism in dogs

A grounded theory analysis of the occupational impact of caring for a partner who has multiple sclerosis

Chronic progressive conditions such as multiple sclerosis impact engagement in and orchestration of daily occupations by people with the condition, and their family members. This qualitative study addressed the way in which multiple sclerosis can affect family life, particularly exploring how it affects the occupations of the partner of a person with the condition. The study involved in-depth interviewing and grounded theory analysis to explore the occupational nature of being a partner of someone who has multiple sclerosis. Findings reveal how partners’ occupations are affected over time, with occupational opportunities inspired by multiple sclerosis and occupational constraints provoked by the disorder, including nostalgia for an multiple sclerosis free existence, the transition to being a carer and an occupationally uncertain future

Growing up with a Chronic Condition

__Abstract__ Becoming an adult often proves extra challenging for those who grow up with chronic conditions, because adaptive tasks related to living with a chronic condition can clash with normal developmental milestones. Finding a good balance and integrating these tasks in daily life is also referred to as self-management. This thesis deals with three major themes. First, the concept of self-management and self-management support in current health care for young people with chronic conditions is explored. Then, the development of self-management skills, and what factors may influence this process in young people with chronic conditions are addressed. Finally, the effectiveness of self-management