Archive for the ‘Medicine’ Category

The impact of the BP oil spill on tourism

May 23, 2013

Understanding the effects of a tourism crisis: The impact of the BP oil spill on regional lodging demand

From Journal of Travel Research

Tourism as one of the most economically important industries is also one of the most vulnerable to crises and disasters. When crises or disasters take place, tourism industries, the tourists they serve, and the local community are affected such events divert tourism flows away from not only a particular destination but also neighboring regions or countries. As argued in this article, there have been a growing number of crises and disasters affecting the tourism industries, giving rise to a need to better understand the impact of such events.

This study has attempted to assess the impact of the 2010 Gulf oil spill across the U.S. coastal regions with the greatest predicted risk of oil spill contact. Two valid and reliable sources of secondary data were assessed to allow year-on-year comparisons of commercial lodging performance in the region. The results underscore the difficulties in determining damages at the macro level that in this case has resulted to date in US$13.5 billion of out of court settlements paid by BP to settle business owner claims. The data clearly show the complexity of the impact, with both winners and losers from the disaster identified in the data presented in this article. It provides a better understanding of the impact of the Gulf oil spill on the accommodation industry as a whole, as well as comparisons between the hotel and the vacation rental industries, and between regions in the affected area.

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Achilles tendon injuries more likely in male “Weekend Warriors” than others

May 22, 2013

Achilles Tendon Injuries in a United States Population

From Foot & Ankle International

Male athletes are the group most likely to tear their Achilles tendon, according to this study. The activity most likely to cause the injury was basketball, and NBA players such as Kobe Bryant have been in the news lately for this exact injury. The authors of this article reviewed 406 records from patients at one clinic diagnosed with Achilles tendon injuries from August 2000 and December 2010.  The average age was 46 years old, 83% of the patients were males, and sports were responsible for 68% of the ruptures. “Delayed diagnosis and treatment have been shown to result in poorer outcomes,” says Steven Raikin, MD, of the Rothman Institute in Philadelphia, PA, and American Orthopaedic Foot & Ankle Society (AOFAS) member.  “Older individuals, and those with a higher BMI, should be evaluated carefully if they have lower leg pain or swelling in the Achilles tendon region.” The study supported previous findings that an Achilles tendon rupture on one leg increases the likelihood of a rupture on the other leg.

For further information on how to take care of your feet and ankles, or to find a local orthopaedic foot and ankle surgeon, visit the American Orthopaedic Foot & Ankle Societypatient website at www.footcaremd.org

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Support needed for children losing parent at early age

May 16, 2013

The long-term impact of early parental death: lessons from a narrative study

From Journal of the Royal Society of Medicine 

This study exploring the impact of early parental death has revealed the long-term damage and suffering that can be experienced by individuals in adult life if appropriate levels of support are not provided at the time of bereavement. The paper describes the low self-esteem, loneliness, isolation and inability to express feelings of some individuals who lost a parent in childhood, with the effects felt for as long as 71 years after the bereavement. The researchers found common themes that affect the experience of parental loss, including disruptions and continuity, the role of social networks and affiliations, and communication. Professor Mari Lloyd Williams speaking on behalf of the research team said: “Moving home and separation from family and friends makes adjustment to parental death significantly more difficult and increases stress in bereaved children. Long periods of disruption or living arrangements that do not meet the needs of the bereaved child means they are more likely to experience emotional difficulties and feelings of insecurity and loneliness in adult life.” The researchers suggest a model to identify and support individuals who may be more vulnerable to less favourable outcomes in adult life and point to the best practice guidelines set by The Childhood Bereavement Network which provide a framework for support of parents of bereaved children.

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Junior doctors lack understanding of NHS reforms

May 14, 2013

Junior doctors and healthcare reforms: Are they ready? A questionnaire study

From JRSM Short Reports

Junior doctors are uninformed about current NHS reforms, despite being interested and concerned, according to this paper. The researchers found that basic understanding of health politics and NHS reforms was poor, even on issues affecting future training. A total of 17.7% could not name the health secretary, 66.7% did not know the budget of the NHS and 71.6% did not know who would be responsible for health-care commissioning after the reforms. 90.2% felt they would value formal education on the current changes. One author comments: “Most worryingly, almost three quarters of foundation doctors surveyed were unaware of significant changes that could affect their own training, namely that deaneries will no longer be responsible for coordinating education.” He concludes concludes: “Given foundation year doctors will be implementing current health policy, and arguably forming the policy of the future, it is essential to engage this population. It may be that improving health politics education – whether through formal teaching sessions for junior doctors or integration into medical student training – will be the only way in which this may occur.”

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How effective is the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital?

May 10, 2013

The Liverpool Care Pathway for cancer patients dying in hospital medical wards: A before–after cluster phase II trial of outcomes reported by family members

From Palliative Medicine

Death in hospital remains very common for cancer patients in developed countries. Although hospital surveys show that death was highly expected, patients dying in hospital have a high probability of unrelieved and poorly treated physical suffering, and emotional, spiritual and social distress. Quality improvement programmes in the United States and United Kingdom suggest that aspects of the ‘excellent practice’ of palliative care can be transferred to other settings. The Liverpool Care Pathway (LCP) for the dying patient is one pathway that seeks to achieve this. It offers a structured programme aimed at providing improvements in the quality of care for all relevant dimensions at the end of life. 

This study aims to assess the effectiveness of the LCP on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. It implements an uncontrolled before–after intervention cluster trial performed within four hospital wards participating in the pilot. A total of 2 months after the patient’s death, bereaved family members were interviewed. The results provide the first robust data collected from family members, in any reasonably sized sample, of a potential clinically significant improvement in some aspects of quality of care – in particular respect, kindness and dignity, family emotional support, self-efficacy of the family and coordination of care.

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Reviewing the advantages and limitations of intermittent fasting for weight loss and prevention of diabetes and cardiovascular disease

May 8, 2013

Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease?

From British Journal of Diabetes & Vascular Disease

There has been a significant increase in obesity and type 2 diabetes in recent decades. Intermittent fasting, in which individuals fast on consecutive or alternate days, has been reported to facilitate weight loss and improve cardiovascular risk. This review evaluates the various approaches to intermittent fasting and examines the advantages and limitations for use of this approach in the treatment of obesity and type 2 diabetes.

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Identifying hospital organizational strategies to reduce readmissions

May 2, 2013

From American Journal of Medical Quality

With looming financial penalties for institutions with high readmission rates, hospital administrators are under pressure to implement strategies to reduce readmissions. The objectives of this study were to understand the process of developing readmission reduction strategies. The authors designed a qualitative study consisting of semistructured interviews with hospital administrators with the goal of better understanding the range of approaches being used to reduce readmission rates. They found that perceived risk factors for readmission were not just about patient characteristics such as disease-level factors, but extended to population-level, institution-level, and system-level factors. This research illustrates the complexity of developing readmission reduction strategies and the numerous challenges faced by hospital administrators. In summary, this research demonstrates that reducing readmissions has become a top priority at these hospitals and that administrators have allocated significant resources to readmission reduction strategies even during a time of increasingly scarce resources.

 

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Using mobile phone apps in weight-loss programs

April 25, 2013

Design and pilot results of a mobile phone weight-loss application for women starting a meal replacement programme

From Journal of Telemedicine and Telecare

Mobile phones using text messaging and monitoring have been shown to be useful additions to health programs. The objective of this study was to develop and evaluate a weight-loss intervention delivered by a smartphone app that supported individuals embarking on a diet and that was evidenced-based. Researchers developed and tested a mobile phone application (app) to support individuals embarking on a partial meal replacement program (MRP).

Overweight or obese women were randomly allocated to one of two study groups an intervention group and a control group. The intervention group received an MRP Support app. The control group received a static app based on the information available with the MRP. A total of 58 adult women) participated in the 8-week trial. Objective data suggested that users of the Support app were more engaged than those using the control app.  Women in the intervention group reported a greater increase in positive affect (i.e. mood) than those in the control group. At Week 8, those in the control group reported a greater decrease in the effort they were willing to put into staying on the diet than those who received the Support app  Preliminary data suggests that the MRP Support app has the potential to increase positive mood and maintain motivation during a weight loss programme. This study indicates that the support app could be a useful adjunct to existing MRPs for psychological outcomes.

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Medication errors during the home-to-hospital transition of epileptic children are unacceptably common

April 23, 2013

Anticonvulsant medication errors in children with epilepsy during the home-to-hospital transition

From Journal of Child Neurology

Since the Institute of Medicine’s report ‘‘To Err Is Human,’’  efforts to reduce medical errors have been intensified, especially for high-risk populations. A  group at increased risk for hospitalization and who can be particularly vulnerable to medication reconciliation errors, children with epilepsy can have multiple medical conditions and are frequently hospitalized, often for reasons unrelated to seizures. In such children, careful anticonvulsant management is the primary strategy for minimizing breakthrough seizures and attendant morbidity and mortality. Thus, optimizing anticonvulsant management is of high importance,

This study sought to estimate the frequency of anticonvulsant medication errors during transition into the hospital in children with epilepsy hospitalized for reasons other than seizures, and to examine factors associated with the occurrence of such errors. Of the children examined in the study almost a quarter experienced an anticonvulsant medication error. Findings indicate Anticonvulsant medication errors during the home-to-hospital transition were unacceptably common in children with epilepsy admitted for reasons other than seizures.

 

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Does obesity begin in the first year of life?

April 10, 2013

Pilot study – Does obesity begin in the first year of life?

From Clinical Pediatrics

Recent research shows that obesity might begin much earlier in life than previously believed creating a lifelong weight struggle and numerous comorbidities that reduce life span. Once it appears, obesity tends to remain throughout a life course and systematic reviews reveal that rapid growth in infancy can be associated with a greater risk of later-life obesity.  This study conducted and graphed a longitudinal analysis of body mass index means based on the age postbirth. Data was gathered from 7 well-child visits during the first year of life for infants who remained healthy and uninjured from birth to 5 years age. Study aims were to (a) describe growth patterns in the first year of life and (b) determine if the first-year BMI values were associated with 5-year BMI values. The paper concludes that growth patterns in the first year of life can signify a pattern that indicates early development of obesity. The earlier in life we can identify obesity, then the earlier we can guide individualized interventions in the first year  after birth while precursors of later health are still forming.

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