bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastric Retention of Enteric-Coated Magnesium Chloride Tablets
Authors: Chapron Dennis J. , Korman Lisa B. , Barry William L.
Published: January 2017

OBJECTIVE:

To describe a patient with gastric retention of enteric-coated magnesium chloride tablets. Potential drug and disease etiologies accounting for failure to empty this dosage form are discussed.

DESIGN:

Single case report.

CASE SUMMARY:

A seriously ill patient with metastatic small-cell lung cancer accumulated 21 enteric-coated magnesium chloride tablets in his stomach during a four-day administration period. The patient had gastroscopic evidence of mild pylorospasm and suspected gastric motor dysfunction. The latter may have been the result of several factors including concurrent use of oxycodone, vagal dysfunction from chronic alcoholism and cisplatin-based chemotherapy, and possibly a paraneoplastic neuromuscular syndrome involving the gastrointestinal tract.

CONCLUSIONS:

Enteric-coated tablets are indigestible solids, often of considerable size. Strong antral contractions, associated with phase 3 of the interdigestive migrating myoelectric complex, are usually required to carry such dosage forms through a normal pyloric channel and into the duodenum. Seriously ill patients who may have gastric hypomotility or pyloric channel narrowing are probably not good candidates for therapy with large enteric-coated dosage forms.
Adverse Interaction between Clonidine and Verapamil
Authors: Jaffe Ronen , Livshits Tatyana , Bursztyn Michael
Published: January 2017

OBJECTIVE:

To report two cases of a possible adverse interaction between clonidine and verapamil resulting in atrioventricular (AV) block in both patients and severe hypotension in one patient.

CASE SUMMARIES:

A 54-year-old woman with hyperaldosteronism was treated with verapamil 480 mg/d and spironolactone 100 mg/d. After the addition of a minimal dose of clonidine (0.15 mg bid), she developed complete AV block and severe hypotension, which resolved upon cessation of all medications. A 65-year-old woman was treated with extended-release verapamil 240 mg/d. After the addition of clonidine 0.15 mg bid she developed complete AV block, which resolved after all therapy was stopped.

DISCUSSION:

An adverse interaction between clonidine and verapamil has not been reported previously. We describe two such cases and discuss the various mechanisms that might cause such an interaction. Clinicians should be acquainted with this possibly fatal interaction between two commonly used antihypertensive drugs.

CONCLUSIONS:

Caution is recommended in combining clonidine and verapamil therapy, even in patients who do not have sinus or AV node dysfunction. The two drugs may act synergistically on both the AV node and the peripheral circulation.
Therapeutic Controversies in the Treatment of Asthma
Authors: Kamada Alan K.
Published: January 2017

OBJECTIVE:

To introduce readers to the current controversial topics in the area of asthma therapy. Background is provided such that clinicians are aware of these issues and can make rational decisions.

DATA SOURCES:

Pertinent articles were individually identified and reviewed from each journal.

STUDY SELECTION:

Relevant studies, determined by topic and other specific criteria, e.g., testing methodology, were included.

DATA SYNTHESIS:

Further investigation is required in the areas discussed. Systemic effects, specifically growth suppression (in children), adrenal suppression, and osteoporosis, have been demonstrated with high-dose inhaled glucocorticoids; however, the clinical relevance of such intravenous glucocorticoid formulations via nebulizer have not been demonstrated. Likewise, data on the equivalence of the inhaled glucocorticoids, with regard to efficacy and potential systemic effects, and the differences between metered-dose inhalers and dry powder inhalers, with regard to aerosol characteristics and drug delivery, are unclear. Theophylline, when used with inhaled β-adrenergic agonists and systemic glucocorticoids for the treatment of acute asthma, as not been shown to provide clear benefit and may result in increased adverse effects. The use of regular (vs. “as needed” or prn) inhaled β-adrenergic agonists, although shown in two studies to be detrimental to the control of asthma and result in an increased risk of death or near death caused by asthma, has not been conclusively demonstrated to be harmful.

CONCLUSIONS:

Monitoring for adverse effects and the use of techniques to minimize systemic absorption (spacers and mouth rinsing) are recommended when high-dose inhaled glucocorticoid therapy is used. Intranasal and intravenous glucocorticoid products are not recommended for administration via nebulizer because of safety concerns. Until further data are available, inhaled glucocorticoids are thought to be equivalent on a μg-per-μg basis rather than an actuation-per-actuation basis. Theophylline is no longer recommended for treatment of acute exacerbations in nonhospitalized patients not already receiving the medication, and the link between deterioration of asthma control (and the risk for death) and regular inhaled beta-adrenergic agonists appears weak.
Multiple-Dose Pharmacokinetics of Pentoxifylline and its Metabolites during Renal Insufficiency
Authors: Paap Christopher M , Simpson Karon S , Horton Michael W , Schaefer Karen L , Lassman Howard B , Sack Marshall R
Published: January 2017

OBJECTIVE:

To characterize pentoxifylline (PTF) and metabolite disposition after multiple oral doses given two and three times a day to patients with renal dysfunction.

DESIGN:

An open-label, randomized, crossover, parallel group design.

SETTING:

Community-based clinical research center.

PATIENT POPULATION:

Subjects with renal function stratified based on 24-hour urinary creatinine clearance (Clcr): group I = Clcr >80 mL/min (n = 9); group II = Clcr 30-80 mL/min (n = 6); and group III = Clcr <30 mL/min (n = 10).

METHODS:

PTF 400 mg bid or tid was administered on days 1–7 and 400 mg bid or tid was given on days 14-20 with a 1-week washout. Timed blood samples were taken on days 1, 7, and 20. Blood samples were analyzed for PTF and its metabolites (M-I, M-IV, M-V) by gas-liquid chromatography.

MAIN OUTCOME MEASURES:

Maximum plasma concentration (Cmax), time to maximum concentration (tmax), average steady-state plasma concentration (Cssavg), and area under the plasma concentration-time curve at steady-state (AUCss) were determined by visual and model independent methods. ANOVA, paired t-test, and linear regression were used with significance level set at p < 0.05.

RESULTS:

The ratio of PTF AUCss (tid):AUCss (bid) and M-I AUCss (bid and tid) were not significantly different between the groups. Significant differences were found in M-IV and M-V Cmax, AUCss, Cssavg, and AUCss ratios (M-IV:PTF and M-V:PTF) between renal function groups (p < 0.05 for all). A change in dosage regimen from tid to bid resulted in significant changes in M-IV and M-V Cssavg for subjects with normal renal function and in those with moderate dysfunction, although not in subjects with severe renal dysfunction.

CONCLUSIONS:

Renal dysfunction did not cause significant accumulation of PTF or M-I after multiple bid and tid dosing; however, M-IV and M-V had significant accumulation in patients with renal impairment. Dosage reduction to 400 mg bid for patients with moderate renal impairment and 200-400 mg/d for severe renal impairment, as well as close clinical monitoring, seem prudent until the complex pharmacologic interactions of PTF and its metabolites can be further delineated.
Oleoresin Capsicum (CAP-STUN) Toxicity from Aerosol Exposure
Authors: Watson William A , Stremel Katrina R , Westdorp Ellen J
Published: January 2017

OBJECTIVE:

To describe the clinical toxicity caused by oleoresin capsicum (OC) spray during law-enforcement action.

DESIGN:

A medical record review.

SETTING:

Emergency department (ED), Truman Medical Center, Kansas City, MO.

PATIENTS:

Consecutive patients who presented to the ED after OC-spray exposure from law-enforcement action between June 1991 and June 1994.

MAIN OUTCOME MEASURES:

Patient presentation and symptoms at presentation, evaluation, and treatment during ED stay.

RESULTS:

Eighty-one ED patients, approximately 10% of all individuals sprayed by police officers, presented after exposure to OC. Ocular burning and redness were the most common presenting symptoms. None of the patients required hospitalization due to OC toxicity. Corneal abrasions and respiratory symptoms occurred in 7 and 6 patients, respectively.

CONCLUSIONS:

The need for ED evaluation and treatment was infrequent after exposure to OC. A transient burning sensation, erythema, and localized irritation were the most common findings. While no patients had adverse outcomes attributed to OC exposure, practitioners assessing exposure should consider the potential for pulmonary and ocular toxicity.
Neurologic Complications following Intranasal Administration of Heroin in an Adolescent
Authors: Zuckerman Gary B , Ruiz Donna C , Keller Irwin A , Brooks Jill
Published: January 2017

OBJECTIVE:

To describe an adolescent patient who developed a stroke following intranasal administration of heroin.

CASE SUMMARY:

A 17-year-old adolescent with no prior medical problems “snorted” an unknown quantity of heroin. The patient developed respiratory failure, shock, and seizures. When he regained consciousness, the patient had evidence of hypoxic-toxic encephalopathy on neuropsychologic examination. Magnetic resonance imaging revealed an infarct in the globus pallidus region of the brain.

DISCUSSION:

Serious neurologic complications following intranasal administration of heroin have been reported rarely in children. Correlations between findings on neuropsychologic examination and magnetic resonance imaging following drug overdoses have likewise been rarely described. We reviewed literature pertaining to the etiology, pharmacology, and pathophysiology of neurologic complications resulting from heroin intoxication.

CONCLUSIONS:

As the use of intranasal heroin is increasing in the pediatric population, healthcare professionals should be aware of the various potentially serious complications that may occur.
Inhaled Antibiotics in Cystic Fibrosis: A Review
Authors: Toso Cynthia , Williams Dennis M , Noone Peader G
Published: January 2017

OBJECTIVE:

To provide an overview of aerosol drug therapy, including physical considerations and aerosol drug delivery systems, and to review clinical experience with inhaled antibiotics in cystic fibrosis (CF) when used as adjunctive therapy to intravenous therapy for acute pulmonary exacerbations and chronic, suppressive therapy.

DATA SOURCES:

A MEDLINE search (1966-1995) of English-language literature describing the use of inhaled antibiotics for the management of CF.

STUDY SELECTION AND DATA EXTRACTION:

All articles were considered for possible inclusion in the review. Pertinent information as judged by the authors was selected for discussion.

DATA SYNTHESIS:

The use of inhaled antibiotics as adjunctive therapy to systemic therapy for acute exacerbations did not improve pulmonary function tests, increase hospital discharge rate, or permanently eradicate sputum Pseudomonas. Clinical trials of inhaled antibiotics as suppressive therapy yielded variable results. Individually, four trials documented a significant improvement in pulmonary function, three trials documented a slower decline in pulmonary function, and four trials reported a reduced frequency of hospitalizations. However, the trials were unable to collectively document a prolonged beneficial effect of inhaled antibiotics on pulmonary function, sputum bacterial density, and frequency of hospitalizations.

CONCLUSIONS:

Clinical trials conducted thus far suggest no role for inhaled antibiotics in the treatment of acute pulmonary exacerbations in patients with CF. Aerosolized antibiotics used as suppressive therapy may be useful in certain patients, but their use should be limited to select patients based on individual response to therapy. Additional long-term, well-controlled trials of inhaled antibiotics as suppressive therapy are needed before routine use can be recommended.
Methodologic Assessments of Quality of Life Measures in Clinical Trials
Authors: Kong Sheldon Xiaodong , Gandhi Sanjay K.
Published: January 2017

OBJECTIVE:

To provide a comprehensive overview and to evaluate the quality of published clinical trials assessing the effect of drug therapy on patients' quality of life.

DATA SOURCE:

Clinical trials that assessed the effect of drug therapy on patient quality of life published in English, peer-reviewed journals were identified through a MEDLINE search (1966–1995) and review of references from recent publications.

DATA EXTRACTION:

A data collection form was used to record information on trial demographics, quality-of-life assessment, study design, and statistical analyses. A quality score was computed for each article based on a checklist of items.

RESULTS:

Two hundred sixty-five articles were eligible for this study. Reliability data on the quality-of-life instruments were provided by 23.8% of the studies and validity data were provided by 21.5%. Quality of life was defined in about 14% of the trials, while 15% provided the rationale for selecting the specific instrument(s). The average overall quality score for the trials was 0.34, based on a scale of 0–1. The trials with quality-of-life scores as the primary end point had significantly higher quality scores than those designed primarily to measure clinical outcomes (p < 0.05).

CONCLUSIONS:

Although there was a gradual but significant improvement in the quality of published clinical trials over time, more attention should be paid to various aspects of quality-of-life assessment (e.g., defining construct, instrument selection).
Economic Evaluation of the Use of Nadroparin in the Treatment of Deep-Vein Thrombosis in Switzerland
Authors: Lloyd Adam C. , Aitken Judith A. , Hoffmeyer Ullrich K. , Kelso Emma J. , Wakerly Elizabeth C. , Barber Nicholas D.
Published: January 2017

OBJECTIVE:

To compare the cost implications, from the payer's perspective, of the use of nadroparin instead of unfractionated heparin in the initial treatment of deep-vein thrombosis.

DESIGN:

Cost-minimization study.

SETTING:

Switzerland.

MATERIAL:

Survey of clinical practice in six Swiss hospitals used to model three treatment regimens.

MAIN OUTCOME MEASURES:

Cost of treatment ($US) per patient.

RESULTS:

Treatment with nadroparin instead of unfractionated heparin would reduce costs by $153 per patient. Treatment with nadroparin instead of subcutaneous unfractionated heparin would reduce costs by $109 per patient.

CONCLUSIONS:

The cost of initial treatment of deep-vein thrombosis is considerably lower with nadroparin than with either of the alternative regimens. Nadroparin reduces costs through greater ease of administration and by reducing the amount of laboratory monitoring. Treatment with nadroparin might also allow patients to be discharged from the hospital more quickly than is possible with intravenous infusion of unfractionated heparin.
Stability of Amiodarone in an Oral Suspension Stored under Refrigeration and at Room Temperature
Authors: Nahata Milap C.
Published: January 2017

OBJECTIVE:

Amiodarone is currently available in a tablet dosage form, which cannot be used in young pediatric patients. The objective of our study was to determine the stability of amiodarone in an oral suspension stored at two temperatures.

METHODS:

Commercially available amiodarone tablets (200 mg each) were dissolved in purified water and a suspension prepared in methylcellulose 1 % and syrup to yield a concentration of 5 mg/mL. The dosage form was stored in 10 glass and 10 plastic prescription bottles. One-half of the bottles were stored at 4 °C and the others at 25 °C. Three samples were taken from each bottle at 0, 7, 14, 28, 42, 56. 70, and 91 days (n = 15). Amiodarone concentrations were measured by a validated and stability-indicating HPLC method; the pH was also determined in each sample. The drug was considered stable if its concentration exceeded 90% of the original concentration.

RESULTS:

The mean concentration of amiodarone was 90% or more at 4 °C for 91 days and at 25 °C for 42 days. The concentration was not affected by the type of storage container. Over 91 days, the pH did not change at 4 °C; it decreased slightly from 4.4 to 4.3 at 25 °C.

CONCLUSIONS:

Amiodarone was stable in an oral suspension for 3 months under refrigeration and for 6 weeks at room temperature.
Lovastatin-Induced Rhabdomyolysis Possibly Associated with Clarithromycin and Azithromycin
Authors: Grunden John W. , Fisher Kenneth A.
Published: January 2017

OBJFXTTVE:

To describe two cases of rhabdomyolysis in patients taking lovastatin that were precipitated by the use of the newer macrolide antibiotics clarithromycin and azithromycin.

CASE SUMMARIES:

In each case, the patients were treated over 5 years with lovastatin and developed rhabdomyolysis that coincided with the completion of a prescribed regimen of a newer macrolide antibiotic. Following intravenous hydration and administration of bicarbonate, the patients' condition resolved without permanent sequelae.

DISCUSSION:

Rhabdomyolysis is a clinical syndrome resulting from the destruction of skeletal muscle that may progress to renal failure. Several drugs have been associated with rhabdomyolysis, including lovastatin, a hydroxymethylglutaryl-coenzyme A reductase inhibitor. Erythromycin is a macrolide antibiotic that may increase the risk of lovastatin-induced rhabdomyolysis. To our knowledge, these cases are the first published reports of lovastatin-induced rhabdomyolysis associated with azithromycin and clarithromycin.

CONCLUSIONS:

The risk of drug-induced rhabdomyolysis due to the potential interaction between lovastatin and azithromycin or clarithromycin should be considered before the concomitant use of these agents.
Danaparoid in the Prevention of Thromboembolic Complications
Authors: Skoutakis Vasilios A.
Published: January 2017

OBJECTIVE:

To review the therapies used to prevent postoperative thromboembolic complications with a focus on the role of danaparoid, a new low-molecular-weight glycosaminoglycan.

DATA SOURCES:

A MEDLINE search was performed to identify pertinent English-language literature including studies, abstracts, and review articles. Key search terms included danaparoid, heparinoid, lomoparin, heparin, prophylaxis, thrombosis, embolism, thromboembolism, and thromboembolic and postoperative complications. The manufacturer of danaparoid was contacted for additional information related to this compound.

STUDY SELECTION AND DATA EXTRACTION:

All identified articles were reviewed for possible inclusion in this review. Comparisons primarily focused on data obtained from prospective, randomized, controlled, blind clinical trials. Another important consideration was the use of venography to determine the presence of deep venous thrombosis.

DATA SYNTHESIS:

Various therapies are available for the prevention of postoperative thromboembolic complications. Effective pharmacologic treatments currently available include adjusted-dose heparin, warfarin, aspirin, dextran, and low-molecular-weight heparins (LMWHs). Until recently, warfarin was considered the drug of choice for thromboprophylaxis in high-risk patients, including patients undergoing orthopedic surgical procedures. Because of their comparable efficacy and greater ease of use, LMWHs are gaining favor over warfarin in this patient population. In well-designed clinical trials involving patients undergoing elective total hip replacement or fractured hip surgery, danaparoid has demonstrated greater efficacy than other active treatments, including warfarin, dextran, aspirin, and heparin plus dihydroergotamine. While studies comparing danaparoid with LMWHs have not yet been published, danaparoid may be more useful in patients with heparin-associated thrombocytopenia.

CONCLUSIONS:

Danaparoid is an antithrombotic agent with characteristics that distinguish it from heparin and LMWHs. Based on the efficacy and safety data reviewed, danaparoid should be considered one of the drugs of choice for the prevention of thromboembolic complications in patients undergoing orthopedic hip procedures and the drug of choice for the management of any patient with heparin-induced thrombocytopenia who requires anticoagulant therapy.
The Environmental Politics of the International Waste Trade
Authors: Strohm Laura A.
Published: January 2017

To date, the international trade in toxic wastes has caused more significant political damage than actual environmental degradation. It has elicited a new dialogue about the concept of an “environmental factor” in comparative trade advantage. The realities of the waste trading system suggest that the current regime of Prior Informed Consent (PIC) is failing in all ways. Sovereign environmental risk assessment is compromised by information gaps and liability confusion. Our prescriptions for an international waste trading policy reflect the presence of three familiar underlying tensions in international negotiations, which yield lessons for international environmental policymaking.

“This firm's exports to Nigeria, Togo, Senegal, Lebanon, Syria, and Turkey had all been authorized by officials of those countries! The Italian government should seek reparations from foreign governments that refused to honor their commitments….” Comments of Renato Pent of Jelly Wax Company, an Italian waste exporter, upon being billed by the Italian government for the costs of politically required waste re-importations.1
Results of Microfracture in the Treatment of Articular Cartilage Defects of the Talus
Authors: Becher Christoph , Thermann Hajo
Published: January 2017

Background: The microfracture technique has been used successfully for the treatment of cartilage defects in the knee. The purpose of this study was to evaluate the microfracture technique in the treatment of osteochondral and degenerative chondral defects of the talus. Methods: In a prospective study, 30 ankles in 30 consecutive patients (17 men and 13 women; average age, 41 years; range 20 to 74 years) were treated with arthroscopic microfracture. Twenty patients had osteochondral defects and 10 had degenerative chondral defects. Patients were evaluated with clinical examination and MRI preoperatively and at 3, 6, 12, and 24 months postoperatively. Results: At a mean followup of 2 years (range 22 to 27 months), 29 patients were available for followup. The results for all ankles according to the Hannover Scoring System were 45% excellent, 38% good, and 17% satisfactory. Results in patients older than 50 years were not inferior to those in younger patients. Visual Analog Score revealed an average of 8 ± 2 for pain (preoperatively 3 ± 2; p ≤ 0.001), 8 ± 2 for function (preoperatively 3 ± 2; p ≤ 0.001) and 8 ± 2 for satisfaction (preoperatively 2 ± 2; p ≤ 0.001). MRI and arthroscopic assessment suggested the presence of cartilage in the microfractured area. Conclusions: At short-term followup, the microfracture technique appeared to repair severe cartilage damage with a good functional outcome. Age was not shown to be a limiting factor.
Functional Outcome of the Foot and Ankle After Free Fibular Graft
Authors: Daniels Timothy R. , Thomas Rhys , Bell Timothy H. , Neligan Peter C.
Published: January 2017

Background: The vascularized fibular bone graft (VFBG) is one of most common grafts used for free flap transfer. There have been no reports in the literature evaluating the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures. In addition, most of the patients in published studies have had contralateral or ipsilateral lower limb pathology. The purpose of this study was to evaluate the functional outcome of the foot and ankle after a VFBG using validated functional outcome measures in patients with no preexisting lower limb pathology. Methods: We conducted a retrospective analysis of our health center database and identified 28 patients who underwent free flap transfer for maxillofacial reconstruction. Patients were contacted by phone and mailed functional questionnaire packages. Functional outcome assessments were obtained through the use of the following validated functional outcome instruments: the Short Form-36 (SF-36), the Functional Foot Index (FFI), and the lower limb component of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). A matched student t-test was used to compare the experimental limb to the appropriate control group. Results: The response rate was 77%. The incidence of wound complications was 23% (five of 22). Two of the five were caused by wound dehiscence, and three were caused by infection. There was an 18% incidence of clawing of the great toe. The SF-36 scores were not significantly different between the VFBG cohort and the control group. There was a statistically significant difference in FFI scores for all three categories: pain (p = 0.01), disability (p = 0.03), and activity limitation (p = 0.01). Nine patients (41%) were dissatisfied with their foot and ankle function at 3.1 years. Conclusions: The VFBG is an ideal source for a free flap. The impact of the procedure on overall patient health is relatively minimal. However, there is a significant deleterious effect on foot and ankle function.
First Metatarsophalangeal Joint Motion After Hallux Valgus Correction: A Cadaver Study
Authors: Jones Carroll P. , Coughlin Michael J. , Grebing Brett R. , Kennedy Michael P. , Shurnas Paul S. , Viladot Ramón , Golanó Pau
Published: January 2017

Background: Surgical correction of hallux valgus deformities often results in decreased first metatarsophalangeal joint (MTPJ) range of motion. Loss of motion has been shown to affect patient satisfaction. The purpose of this study was to evaluate the immediate change in MTPJ range of motion that occurs after a distal soft-tissue reconstruction (DSTR) and proximal metatarsal osteotomy (PMO). Methods: DSTR and PMO were done on 16 below-knee cadaver specimens with clinically apparent hallux valgus deformities. Two examiners assessed preoperative and postoperative dorsiflexion (DF), plantarflexion (PF), and the total range of motion of the first MTPJ. The hallux valgus angle (HVA) and 1–2 intermetatarsal angle (1–2 IMA) were measured on simulated weightbearing radiographs before and after operative correction. Changes in motion were analyzed and correlated with the angular measurements. Results: The mean total range of motion preoperatively was 85.4 degrees (DF 70.5 degrees, PF 14.9 degrees) and significantly decreased (p < 0.005) 23.2 degrees to a postoperative value of 62.2 degrees (DF 47.9 degrees, PF 14.3 degrees). There was a significant (p < 0.005) decrease in DF (22.6 degrees) with the operative correction, but the loss of PF (0.6 degrees) was not significant (p = 0.7). There was no correlation between the magnitude of correction (HVA, 1–2 IMA) and the change in PF, DF, or total motion. Conclusions: Correction of a hallux valgus deformity with a DSTR and PMO is associated with an immediate loss of range of motion that primarily affects the DF arc of the first MTPJ. The selective loss of DF may be related to a nonisometric capsular repair or tight intrinsic musculature, although there was no correlation with the magnitude of angular correction. The immediate decrease in motion observed in this cadaver study underscores the importance of early postoperative joint mobilization to prevent long-term stiffness after bunion surgery.
AOFAS Member Experience with Computerization of the Office
Authors: Michelson James D. , Speer J. Adam
Published: January 2017

Background: The combination of the implementation of the Healthcare Information Portability and Accountability Act (HIPAA) and the widespread publicity surrounding the report by the Institute of Medicine on preventable medical errors has increased interest of AOFAS members in the use of office-based electronic medical record (EMR) systems. Despite the large number of vendors for office-based EMR systems, little has been written to guide orthopaedists in the selection and installation of EMR systems. Methods: A web-based AOFAS member survey was undertaken in the Spring of 2003, for the purpose of discovering EMR-related issues that are of most concern. Several questions were open-ended, so as to obtain the broadest set of answers. All responses were manually reviewed, collated, analyzed. Results: The 130 respondents were evenly distributed in age. Sixty-six percent were in private practice. Eighty-nine percent used a computerized billing system. Thirty-two percent used an EMR system. Use of an EMR system was more likely for those in academic practices ( p =.01029, chi square) but was not statistically influenced by age, size of the practice group, or the number of offices or hospitals used in the practice. The opinions expressed were exceptionally varied. The most common potential benefit of an EMR system cited was the ease of chart handling and accessibility. The most common perceived barriers to successful EMR implementation were cost (50%) and training of staff and physicians (30%). Conclusions: The survey highlighted the widely divergent opinions regarding the potential benefits (cost savings and improved quality of medical record) and barriers to implantations (e.g. issues dealing with mixed electronic and paper charts and managing the transition to an EMR system). The wide variety of opinions is partly a consequence of the lack of easily accessible information about office-based EMR systems and how to choose among the many vendors. A brief overview of the essential elements to be considered before acquiring an EMR system is included.
U.S. Civil Rights Policy and Access to Health Care by Minority Americans: Implications for a Changing Health Care System
Authors: Rosenbaum Sara , Markus Anne , Darnell Julie
Published: January 2017

The history of health care discrimination as well as ongoing, extensive evidence of racial disparities argue for continued vigilance in the area of health care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by health entities receiving federal financial assistance. Title VI health litigation is difficult because of complex issues of proof as well as confounding problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served. This has important implications for claims involving discrimination by managed care organizations. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evaluation are warranted.
Options for Assessing PPO Quality: Accreditation and Profiling as Accountability Strategies
Authors: Scanlon Dennis P. , Chernew Michael , Doty Hilary E. , Smith Dean G.
Published: January 2017

This article examines and discusses various alternatives for measuring the quality of care and services provided by preferred provider organizations (PPOs). The topic is approached from both a conceptual and a practical perspective, outlining key assumptions that underlie the desire to measure the quality of PPOs, while considering the current limitations and difficulties associated with existing PPO arrangements. Although the article does not provide normative judgments about which approach is best, it attempts to highlight the advantages and disadvantages of possible approaches in an unbiased manner. Significant attention is given to accreditation and profiling as possible methods for assessing the quality of care in PPOs.
Assessing PPO Performance on Prevention and Population Health
Authors: Schauffler Helen Halpin , McMenamin Sara
Published: January 2017

This article compares preferred provider organization (PPO) and health maintenance organization (HMO) performance on the utilization of and consumer satisfaction with preventive care. Surveys were conducted of California health plans, employers, and the insured population collected between 1996 and 1999. The authors found that PPOs were less likely than HMOs to cover some types of preventive care. PPO enrollees were less likely than HMO enrollees to receive blood pressure and mammography screenings or preventive counseling on gun safety, smoking, and sexually transmitted disease or HIV prevention. PPO enrollees were less satisfied with preventive care than HMOs enrollees. The authors concluded that there are significant differences between the rates at which preventive care is delivered in PPOs and HMOs, which can be understood in the context of PPO benefit plan design, and differences in their structural and financial characteristics. This suggests specific strategies through which it might be possible to improve preventive health care and promote population health among employees enrolled in PPOs.
Health Care Consumers: Choices and Constraints
Authors: McLaughlin Catherine G.
Published: January 2017

This article summarizes the research and data currently available on different dimensions of consumer choice. These dimensions include not only whether to participate in a health care plan and which plan to select if given a choice but also the decisions that lead to having a choice and the implications of making the choice. Data are presented on what choices consumers face, how many are given what kinds of choices, what constraints they face, what we know about how they make these choices, and what information they are given and what they use. The majority of Americans are offered some kind of health insurance plan either through their place of employment or as a dependent on someone else’s employer-sponsored health plan. About half of those offered health insurance are offered a choice, usually of only two or three plans. The majority elect to participate in one of those plans.
Functional Behavior Assessments and Behavior Intervention Plans: Legal Requirements and Professional Recommendations
Authors: Collins Lauren W. , Zirkel Perry A.
Published: January 2017

Functional behavior assessments (FBAs) and behavior intervention plans (BIPs) are critical components in the education of students with, or at risk for, emotional disturbance (ED). The purpose of this article is to compare the legal requirements with the professional requirements for FBAs and BIPs. The comparison is first according to the procedural dimension (e.g., the when and how questions) and then on the substantive dimension (the what question). The results reveal a dramatic difference between the legal requirements under the Individuals With Disabilities Education Act and the professional recommendations for best practice. Our recommendation for both scholars and practitioners is not to fuse or confuse these two levels: one representing the mandatory minimum and the other representing the professional desideratum. Rather, due differentiation provides a proper framework for proposed additions to federal and state laws, strategic opportunities for advocacy in the litigation process, and ample latitude for effective choices for prophylactic practice.
Would You like News with That? Compacting Brisbane's Courier-Mail
Authors: Lawrence Catherine A. , Burns Maureen
Published: January 2017

In 2006 Queensland's Courier-Mail was relaunched in a ‘compact’ format. This study compares one week of the broadsheet format of The Courier-Mail (the third week of September 2005) with the corresponding week from the new compact format a year later. The study demonstrates that the new format of the newspaper was not merely an aesthetic change: increased advertising and a more regular use of pullouts were accompanied by often-significant changes in editorial content. Refining Sparks' model of print media fields (2000: 14–15), the authors demonstrate how this change in positioning of the newspaper might be mapped against other print media and suggest that this model might also have wider application in understanding a media landscape experiencing legislative and technological change.
Saturday Morning Cartoons Go MMOG
Authors: Grimes Sara M.
Published: January 2017

This paper traces the migration of North American children's television into the realm of massively multiplayer online games (MMOGs), and the issues this raises in terms of the commercialisation of children's (digital) play. Through a content analysis of three television-themed MMOGs targeted to children, Nickelodeon's Nicktropolis, Cartoon Network's Big Fat Awesome House Party and Corus Entertainment's GalaXseeds, I examine how this new development within children's online culture operates in relation to existing industry practices of cross-media integration and promotion. Dominant trends identified in the content analysis are compared with emerging conventions within the MMOG genre, which is generally found to contain numerous opportunities for player creativity and collaboration. Within the cases examined, however, many of these opportunities have been omitted and ultimately replaced by promotional features. I conclude that all three case studies operate primarily as large-scale advergames, promoting transmedia intertextuality and third-party advertiser interests.
Beyond Broadcast Yourself™: The Future of Youtube
Authors: Jarrett Kylie
Published: January 2017

Since its launch in early 2005, video-sharing website YouTube has emerged as a culturally, politically and economically significant medium, and as one of the inheritors of the social role played by broadcast television. However, its continued growth and journey to profitability are not guaranteed. This paper queries the future of YouTube by exploring the tension inherent in the site's three key characteristics embodied within its slogan ‘Broadcast Yourself™’. The site is based within regimes of consumer production and identity practices, yet it is also located within a traditional fiscal economy as indicated by the trademark identifier. The contradictory pulls of these positions pose challenges for YouTube and its parent company Google. The difficulty of sustaining an emergent social economy alongside the requirements of advertising-driven economics raises questions about the future of YouTube, and indicates the complex terrain of what lies beyond broadcasting.
Coastlines, Cags and Communications
Authors: Johnston Jane , Gration Steve
Published: January 2017

This paper layers communication theory over a cultural context by examining how Community Action Groups (CAGs) have responded to development along Australian coastlines. It analyses how communication and media strategies and techniques have been adopted by the third sector to challenge commercial and government organisations which have proposed coastal development. As noted by Huntsman (2001): ‘It is this appropriation of the beach for the purposes of capitalism, and the contesting ideas about the beach that have captured the attention of critics.’ Indeed these critics, who in this paper are members of strategic alliances, or CAGs, exist all along the Australian coastline. The paper seeks to highlight how the connections that are felt with Australia's coasts provide a special impetus and motivation for CAGs which have emerged in response to development along Australia's coasts, from Western Australia to New South Wales and Queensland.
Beyond Literacy Panics: Digital Literacy and Educational Optimism
Authors: Gibson Mark
Published: January 2017

Public debate over education has been beset in recent years by highly charged ‘literacy wars’ between conservatives and progressives, casting a pall of gloom over the direction of education generally. This article argues that the theme of ‘digital literacy’ has a potential to shift these debates, opening new possibilities for educational optimism. It draws attention first to the discipline involved in the use of digital media, challenging easy assumptions that such discipline belongs only to print; second, to cognitive processes over content or values, significantly altering the way we think about the social significance of media; and third, to the production end of media use, neatly sidestepping tired debates over media consumption.
Turning Play into Pay: Digital Literacies and New Lessons for the Post-Web 2.0 Generation
Authors: Luckman Susan
Published: January 2017

Digital technologies are clearly enabling greater access to cultural production, broadening the spaces in which we market our sense of self, and thus facilitating small-scale creative entrepreneurialism. However, alongside the many opportunities undoubtedly offered by co-creator Web 2.0 technologies, true digital literacy requires an as yet unclear level of control over the whole process — both in the short and long term — in order to ensure that creative development is undertaken in a personally and collectively sustainable fashion. This article briefly outlines some of new digital literacies on which educators need to focus if we are to empower people for creation (production), not just consumption, in this emerging media landscape.
‘The Potential Diversity of Things We Call TV’: Indigenous Community Television, Self-Determination and Nitv
Authors: Rennie Ellie , Featherstone Daniel
Published: January 2017

The National Indigenous Television (NITV) service was launched in July 2007. NITV's public service broadcasting model has arrived after two decades of successful community-based enterprise. Indigenous groups, guided by policies of self-determination, developed a robust grassroots media system based on community ownership and regional collaboration. The arrival of NITV raised important questions for the sector. Can locally sourced content provide the levels of leadership and national unity achieved by public service media during the broadcast era? How can Indigenous media play a greater role in the Australian public sphere? Can locally controlled media offer national narratives? Where does industry development begin and end? As the Indigenous media sector faces up to these issues, two distinct approaches are emerging. One presents a unified picture of Indigenous Australia; the other enables diverse groups to tell their own stories. This paper examines the tensions and possibilities of the new Indigenous media landscape by looking back at the self-determination governance model of the past.
The Old New Television and the New: Digital Transitions at Home
Authors: Thomas Julian
Published: January 2017

Over the past decade, a major policy and regulatory problem for governments in Australia and elsewhere has been the implementation of strategies to switch from analogue to digital television broadcasting systems. Despite extensive debate, the transition to digital broadcasting remains fraught. What seems to be a technical matter conceals a range of intractable social, economic and cultural policy decisions. This article explores some of the challenges of digital television through the prism of an earlier, and often overlooked, transformation of television, namely the consumer-driven uptake of what can be called the ‘new television technologies’ of the 1970s and 1980s. These earlier forms of new television help to highlight several arguments: that television was not a stable object prior to digital broadcasting; that the connections between television and broadcasting have been contingent and provisional; and that a remarkable degree of innovation, disruption and adaptation has occurred at the fringes of the broadcasting system, leading to the creation of new audiovisual economies on the boundaries of the household and the market. The article then considers some examples of the ways in which this ‘household sector’ is developing as a new policy problem.
Balancing the Digital Democratic Deficit? E-Government
Authors: Freeman Julie , Hutchins Brett
Published: January 2017

This article responds to Thomas's (2004) call for investigation into how the internet and World Wide Web are changing government in Australia. It first discusses e-government principles and policies at the federal level, and then investigates initiatives and events in one of Australia's most populous municipalities, the City of Casey in Melbourne's southeast. The objective of this approach is to understand the broader context of e-government policy formulation in Australia, and connect this to the level of local government in order to understand the features and dynamics of existing e-government mechanisms. The evidence generated from this approach reveals an imbalance between service delivery and civic engagement in e-government strategies, with the emphasis on consumer-oriented service delivery far outweighing civic participation and political dialogue. The analysis that follows outlines actual and potential political problems flowing from this imbalance — or ‘digital democratic deficit’ — and offers suggestions on how equilibrium might be restored.
Informing Our Own Choices: A Proposal for User-Generated Classification
Authors: Brand Jeffrey , Finn Mark
Published: January 2017

New media are distrusted media, and computer games are the contemporary currency in new media. Computer game content, like other popular media content, is regulated in different jurisdictions by one of three general models: the open market in which consumption decides the availability of product, industry self-regulation in which industry bodies decide, and government regulation in which government or quasi-governmental bodies decide. Arguably, these models represent the twentieth century state of the art and fail to keep pace with changes in the aesthetics and technologies associated with interactive entertainment. In a networked economy, alternative models exist to serve content gatekeeping functions, and they serve to close the lags and limitations that plague existing models. These alternatives include innovations such as user-generated classification and dynamic meta-tagging. This paper examines current classification approaches and their limitations, and presents alternative approaches with a hypothetical game title.
When TV Formats Migrate: The Languages of Business and Culture
Authors: Moran Albert
Published: January 2017

Debate concerning media globalisation is paralleled by discussion of the emergence of a world language system. Will we all watch the same television programs and discuss them in English in the future? This article examines the dual linguistic structure which underlines the international circulation of TV program formats. It suggests that there is increasing homogeneity concerning business dealings to do with TV formats, even while there is increasing linguistic diversity so far as the cultural reception and understanding of formatted programs are concerned.
Australian Media Reception Histories
Authors: Arrow Michelle , Griffen-Foley Bridget , Hughes-Warrington Marnie
Published: January 2017

As the field of Australian media history expands, so too does the need for a broader and more innovative range of questions, issues and debates. This special issue of MIA responds to that need by considering the sources and research questions raised by media reception historians working on film, radio, television and the press. From print to new media, the papers assembled highlight the ingenuity of Australian historians working to recover the experiences of audiences in urban and regional settings.