A Practical Guide to Etiquette in the Orthopaedic OR for the Rotating Medical Student

The Operating Room, the operating theatre, the lair of the Orthopaedic surgeon, it goes by many names. It is a place most try to avoid, but this daunting windowless room is a classroom and training ground for many. And for the medical student interested in an orthopaedic surgery career, making an impression in the operating room is vital to matching into their desired orthopaedic residency.1 Unfortunately, making an impression in the operating room is difficult, or more precisely, making a good impression in the operating room is difficult. Furthermore, every operating room dynamic can be different, and the personalities of the surgeon, fellow, resident, and surgical team can vary widely. Stone et al, found that 72% of medical students felt unsure about the expectations in the surgical OR.2Thus, with the approach of orthopaedic rotations, students should undertake some training or at least consider how to act in such an environment

United States Citizens Detained as Enemy Combatants : The Right to Counsel as a Matter of Ethics

The Supreme Court will decide as a matter of law whether an American citizen detained as an enemy combatant has the right to counsel. The author argues that as a matter of ethics, the answer is clear - there is a right to counsel. In this Article, the author analyzes the cases regarding Jose Padilla and Yaser Esam Hamdi discusses ABA Model Rule 4.2, and its application, and proposes an amendment to Rule 4.2\u27s Comment

Cracking a Back is not Rehabilitation: A Comparative Analysis of Chiropractic vs. Physical Therapy

There is an increasingly common belief among the general public that chiropractic care is more successful in treating injuries than physical therapy. Research shows that chiropractic care cannot be compared to physical therapy due to their different skill sets, knowledge of treatment, and applications; therefore, one modality cannot be determined better than the other. While the two domains are incomparable, individuals continue to feel pressured to select between chiropractic care and physical Therapy. Analyzing the influence of the false claims and misinformation that surrounds rehabilitation services, the belief that physical therapy treatment is able to be replaced by chiropractic treatment breeds opportunities for malpractice. In addition to the high percentage of mistreatment within chiropractic care, this paper questions the overall efficacy of the chiropractic treatment modality. To successfully dismantle the belief that these treatments are interchangeable, the accessibility of physical therapy must be improved. Within the PT, there appears to be a demographic divide among those who pursue the treatment, with gender identity, socioeconomic status, and occupation existing as potential barriers. This review calls to attention the need for increased accessibility within physical therapy, legislation restricting the domain of chiropractic care, and more education surrounding medical professionals

Successful Rechallenge with Vemurafenib and Corticosteroids in a Patient with Vemurafenib Induced Liver Dysfunction, Previously Treated with Ipilimumab

Introduction: There are multiple new systemic therapies for patients with metastatic melanoma, including vemurafenib and ipilimumab. Because of this, more patients will be exposed to multiple medicines during their treatment course. Here we present the case of a successful rechallenge with vemurafenib and concurrent corticosteroids in a patient with vemurafenib responsive metastatic melanoma and vemurafenib induced liver dysfunction thought to be related to previous treatment of ipilimumab.Presentation of case: A 60-year-old woman with a history of stage 3 melanoma presented with metastases to her liver and lymph nodes, normal liver function tests (LFTs) and was started on ipilimumab. After her symptoms increased and her disease progressed, ipilimumab treatment was stopped and vemurafenib was initiated. She experienced good regression in her disease burden but subsequently experienced a grade 4 elevation in her LFTs, which resolved with a corticosteroid taper. Her disease responded well to a vemurafenib rechallenge at a reduced dose; however, she experienced another increase in her LFTs.  By administering vemurafenib with corticosteroids concurrently, she achieved good tumor shrinkage without liver dysfunction.Conclusion: The reader should have an increased appreciation for the emerging adverse event profile of patients treated with multiple systemic metastatic melanoma therapies during their course and potential management strategies

Local Matching of Surfaces Using Critical Points

The local matching problem on surfaces is: Given a pair of oriented surfaces in 3-space, find subsurfaces that are identical or complementary in shape. A heuristic method is presented for local matching that is intended for use on complex curved surfaces (rather than such surfaces as as cubes and cylinders). The method proceeds as follows: (1) Find a small set of points-called critical points -on the two surfaces with the property that if p is a critical point and p matches q, then q is also a critical point. The critical points are taken to be local extrema of either Gaussian or mean curvature. (2) Construct a rotation invariant representation around each critical point by intersecting the surface with spheres of standard radius centered around the critical point. For each of the resulting curves of intersection, compute a distance map function equal to the distance from a point on the curve to the center of gravity of the curve as a. function of arc length (normalized so that the domain of the function is the interval [0,1]). Cll the set of contours for a given critical point a distance profile. (3) Match distance profiles by computing a correlation between corresponding distance contours. (4) Use maximal compatible subsets of the set of matching profiles to induce a transformation that maps corresponding critical points together, then use a cellular spatial partitioning technique to find all points on each surface that are within a tolerance of the other surface

Music Interventions and Dementia: A Systematic Review

Purpose or Research Questions: The purpose of this project is to provide a systematic review on available research on how therapy techniques involving the use of music affect the cognitive or communication outcomes or symptoms of dementia in elderly patients with dementia. Background: There is limited research on non-pharmacological methods for treating patients with dementia. Alternative treatments to medicine can be financially beneficial and also have the potential to reduce negative side effects of drugs. One potential avenue for behavioral treatment is interventions that incorporate music. Methods/Proposed Methods: For this systematic review, the researchers searched CINAHL Plus with Full Text, PubMed, and Health Source: Nursing/Academic Edition for any applicable research up to the end of January 2017 with the following search terms: (dementia OR Alzheimer’s OR memory loss OR cognitive impairment) AND (therapy OR treatment OR intervention OR strategies OR techniques) AND (music*) AND (cogniti* OR communicat* OR language). The inclusion/exclusion criteria were: exclude studies in which the studied population has coexisting neurological impairments (not dementia), only include studies published in English, and only include studies reporting original data. The cognitive and communication outcomes are defined as those involving memory, executive functioning, and language. The original search resulted in 265 articles. After the two researchers completed a title/abstract review independently, 74 articles remained. The inter-rater reliability was found to be 80% and any disparities were discussed and resolved. Then, the researchers independently completed full text reviews. The reliability was 92.5% and any disparities were discussed and resolved. Results/Anticipated Results: A total of 11 articles were reviewed for evidence appraisal after the full text review. Four articles were qualitative studies, five were randomized controlled trials, one was a clinical controlled trial, and one was a cohort-prospective/retrospective study. The researchers determined all to be good quality studies except for two, which were determined to be of lesser quality. The researchers’ inter-rater reliability for the quality appraisal was 85.7%, and all disagreements were discussed and resolved. Effects of therapy and interventions involving music on language and cognition aspects of dementia will be reported. Discussion Music therapies could be a cost effective, clinically significant way to aid behavioral or emotional outcomes. However, there is varying research on the effects of music on cognitive outcomes for dementia patients. Clinical implications and future directions for research will be discussed

Rate of Intraoperative Proximal Femoral Fractures with Automated Broaching

Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique

Omega 6 fatty acids for the primary prevention of cardiovascular disease

Background Omega 6 plays a vital role in many physiological functions but there is controversy concerning its effect on cardiovascular disease (CVD) risk. There is conflicting evidence whether increasing or decreasing omega 6 intake results in beneficial effects. Objectives The two primary objectives of this Cochrane review were to determine the effectiveness of: 1. Increasing omega 6 (Linoleic acid (LA), Gamma-linolenic acid (GLA), Dihomo-gamma-linolenic acid (DGLA), Arachidonic acid (AA), or any combination) intake in place of saturated or monounsaturated fats or carbohydrates for the primary prevention of CVD. 2. Decreasing omega 6 (LA, GLA, DGLA, AA, or any combination) intake in place of carbohydrates or protein (or both) for the primary prevention of CVD. Search methods We searched the following electronic databases up to 23 September 2014: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (Issue 8 of 12, 2014); MEDLINE (Ovid) (1946 to September week 2, 2014); EMBASE Classic and EMBASE (Ovid) (1947 to September 2014); Web of Science Core Collection (Thomson Reuters) (1990 to September 2014); Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database, and Health Economics Evaluations Database on the Cochrane Library (Issue 3 of 4, 2014). We searched trial registers and reference lists of reviews for further studies. We applied no language restrictions. Selection criteria Randomised controlled trials (RCTs) of interventions stating an intention to increase or decrease omega 6 fatty acids, lasting at least six months, and including healthy adults or adults at high risk of CVD. The comparison group was given no advice, no supplementation, a placebo, a control diet, or continued with their usual diet. The outcomes of interest were CVD clinical events (all-cause mortality, cardiovascular mortality, non-fatal end points) and CVD risk factors (changes in blood pressure, changes in blood lipids, occurrence of type 2 diabetes). We excluded trials involving exercise or multifactorial interventions to avoid confounding. Data collection and analysis Two review authors independently selected trials for inclusion, extracted the data, and assessed the risk of bias in the included trials. Main results We included four RCTs (five papers) that randomised 660 participants. No ongoing trials were identified. All included trials had at least one domain with an unclear risk of bias. There were no RCTs of omega 6 intake reporting CVD clinical events. Three trials investigated the effect of increased omega 6 intake on lipid levels (total cholesterol, low density lipoprotein (LDL-cholesterol), and high density lipoprotein (HDL-cholesterol)), two trials reported triglycerides, and two trials reported blood pressure (diastolic and systolic blood pressure). Two trials, one with two relevant intervention arms, investigated the effect of decreased omega 6 intake on blood pressure parameters and lipid levels (total cholesterol, LDL-cholesterol, and HDL-cholesterol) and one trial reported triglycerides. Our analyses found no statistically significant effects of either increased or decreased omega 6 intake on CVD risk factors. Two studies were supported by funding from the UK Food Standards Agency and Medical Research Council. One study was supported by Lipid Nutrition, a commercial company in the Netherlands and the Dutch Ministry of Economic Affairs. The final study was supported by grants from the Finnish Food Research Foundation, Finnish Heart Research Foundation, Aarne and Aili Turnen Foundation, and the Research Council for Health, Academy of Finland. Authors’ conclusions We found no studies examining the effects of either increased or decreased omega 6 on our primary outcome CVD clinical endpoints and insufficient evidence to show an effect of increased or decreased omega 6 intake on CVD risk factors such as blood lipids and blood pressure. Very few trials were identified with a relatively small number of participants randomised. There is a need for larger well conducted RCTs assessing cardiovascular events as well as cardiovascular risk factors