bluuebunny/crossref_metadata_2025 huggingface dataset:
Terazosin versus Alfuzosin in Treatment of Acute Urinary Retention in Patients with Benign Prostatic Hypertroph
Authors: Tang HN , Lui CT , Tsui KL , Fung HT
Published: December 2017

Objective

To compare the efficacy and adverse reactions of terazosin and alfuzosin in treatment of acute urinary retention in patients with benign prostatic hypertrophy.

Design

Case control study.

Setting

Emergency department of a regional hospital in Hong Kong.

Methods

Our study included all adult male with age at least 18 years old presented with acute urinary retention, having residual urine volume greater than or equal to 300 ml after urinary catheterisation and with a presumed diagnosis of benign prostatic hypertrophy. Patients treated with terazosin from December 2013 to February 2014 were retrospectively included while patients treated with alfuzosin from April to September 2014 were prospectively included. We compared the two groups on: trial without catheter (TWOC) rate, potential adverse effects including drug‐associated postural hypotension, haemodynamic changes and prolongation of corrected QT interval in electrocardiogram. Cost effectiveness analysis was performed.

Results

A total of 116 patients were included with 59 and 57 patients in the terazosin and alfuzosin group respectively. Logistic regression showed that residual urine volume (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996‐0.999, p=0.008) and presence of precipitating factors (OR=2.264, 95% CI=1.045‐5.793, p=0.045) were independent predictors of successful TWOC. There was no significant difference in the TWOC rate for patients treated with alfuzosin and terazosin. There was significantly more symptomatic postural hypotension in the terazosin group compared with the alfuzosin group. The number need to treat with alfuzosin for terazosin to avoid one adverse drug effect was 12.3 patients (95% CI=4.7‐21.6) and 9.9 patients (95% CI=5.3‐84.6) to reduce one postural hypotension and symptomatic postural hypotension respectively.

Conclusions

Alfuzosin is comparable to terazosin in TWOC rate. However, alfuzosin is associated with a lower rate of symptomatic postural hypotension and less haemodynamic impact than terazosin. (Hong Kong j.emerg.med. 2015;22:210‐218)
Assessment of Geographic Variations regarding the Transportation of Stroke Patients in Korea
Authors: Sohn YD , Ahn JY , Park SM , Lee YH , Ahn HC
Published: December 2017

Introduction

Stroke recently became the second cause of death in Korea. Nevertheless, many studies have reported that the delay of emergency medical service (EMS) transportation in specific areas is a major obstacle to reduce the mortality and morbidity of stroke. The objective of this study was to assess geographic variation regarding this factor at the national level in Korea throughout a funnel plot.

Setting

Emergency departments.

Methods

Data were obtained from the “2010 Emergency Medicine Annual Report” published by the National Emergency Medical Centre of Korea. This report describes the general characteristics of eligible Emergency Departments (EDs) across Korea. Therefore, we were able to calculate retrospectively the percentage of stroke patients who reached an ED within 3 hours after the development of symptoms against the volume of total visiting patients according to area. Subsequently, we generated a correlation matrix between ratio of stroke patients who visited EDs within the therapeutic period and ratio of usage of EMS ambulances.

Results

We found that four areas out of 16 administrative divisions in Korea were located beyond the lower control limit and one area was between the lower warning and lower control limits, according to a funnel plot showing the percentage of patients within the therapeutic period of stroke against the total volume of patients according to area. The ratio of stroke patients who visited EDs within the therapeutic period was significantly correlated with the ratio of use of EMS ambulances to a moderately positive degree (r=0.51; p<0.05).

Conclusions

Encouraging the public in Korea to use an EMS ambulance in case of stroke may shorten the pre‐hospital delay.
Practical Experiences and Lessons of Medical Response to Major Disasters in China
Authors: Shen WF , Jiang LB , Zhang M , Ma YF , Jiang GY , He XJ
Published: December 2017

Introduction

The construction of a medical emergency response system for disasters, which plays an important role in medical emergency response to multiple catastrophic events, has been sped up in China since the 2008 Wenchuan earthquake. However, the implementation process has also exposed some problems, particularly the disaster relief system.

Methods

In this review, we summarised and analysed emergency medical rescue efforts after major disasters in China in recent years, including 2008 Wenchuan earthquake, 2010 Yushu earthquake, ‘7.23’ Yongwen major railway line accident and 2013 Lushan earthquake.

Results

Critically wounded persons after Wenchuan and Lushan earthquake were managed according to the “four centralised strategies of care”, namely casualties, experts, resources and patients, which were designed to make the best use of limited resources. The collection of disaster response resources was not the sooner the better. The vulnerability and anti-disaster capacity of quake-hit zone and the degree of matching between critical elements of a response system and its supporting systems should be considered. The training of rescue teams in rural and high-altitude areas should be strengthened. Non-government organisations, the government and the public should join together to deal with the disaster.

Conclusions

In this paper, we evaluate the disaster relief systems in China through a retrospective analysis of medical practice of catastrophic events in recent years. This review suggests that there are a lot of experiences and lessons on how to prepare and respond to disasters in China, especially those in plateau mountain region and those considering emergency responses to catastrophic events. (Hong Kong j.emerg.med. 2015;22:270-280)
The Comparison between two Methods of Basic Life Support Instruction: Video Self-Instruction versus Traditional Method
Authors: Assadi T , Mofidi M , Rezai M , Hafezimoghadam P , Maghsoudi M , Mosaddegh R , Aghdam H
Published: December 2017

Introduction

Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method.

Methods

Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline.

Results

The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001).

Conclusions

Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. (Hong Kong j.emerg.med. 2015;22:291-296)
Predictors of Recurrent Seizure before Admission in Children Presented with Seizure to Emergency Department
Authors: Cheung ACK
Published: December 2017

Objective

To identify predictors for short term recurrence in young children presented with seizure to the accident & emergency department (A&E) in Hong Kong.

Methods

It was a retrospective cohort analysis based on A&E data from one district hospital. The study period was from 1st January 2008 to 31st December 2012. All children aged below 6 years presented with seizure attended A&E who required admissions to paediatric ward were included. Baseline characteristic factors were recorded. Primary outcome was presence of recurrent seizure before admission to paediatric ward. Binominal logistic regression was applied to identify the predictive factors.

Results

Total 650 cases were included for analysis. Recurrent seizure before admission occurred in 101 cases (15.5%). Final diagnoses consisted of febrile seizure (77.8%), afebrile seizure (6.6%), epilepsy (13.8%), status epilepticus (1.2%) and others (0.5%). Statistically significant predictive factors include pre-hospital seizure duration 5-15 minutes (odds ratio [OR]=2.960; p<0.001), pre-hospital seizure duration more than 15 minutes (OR=16.164; p<0.001), history of prematurity (OR=3.941; p=0.006), history of epilepsy (OR=2.531; p=0.010) and fever in A&E (≥38°C) (OR=2.072; p=0.030).

Conclusions

In children aged below 6 years presented with seizure to A&E, prior seizure duration of 5-15 minutes, prior seizure duration of more than 15 minutes, history of prematurity, history of epilepsy and fever in A&E are independent predictors for recurrent seizure before admission. (Hong Kong j.emerg.med. 2015;22:297-302)
A Case of Acute Calcific Tendinitis of the Hand: An Uncommon Condition that is Easily Overlooked and Misdiagnosed
Authors: Yip KC , Chan WL , Luk MS , Chan CW
Published: December 2017

Acute calcific tendinitis of the hand is uncommon, yet it has a high rate of misdiagnosis as it resembles other conditions such as fractures, inflammatory and infectious causes that give rise to pain and swelling in the hand. We present a case of acute calcific tendinitis in a middle age woman affecting the extensor pollicis longus to raise awareness of this uncommon, but easily treatable cause of pain and swelling. This case was first diagnosed as septic arthritis of the interphalangeal joint of the thumb. Correct diagnosis was made after careful review of history, physical examination findings, laboratory results and radiographs. (Hong Kong j. emerg.med. 2015;22:316-319)
The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis
Authors: Zhu BF , Chen HL , Shen JH , Xing JL , Chen JR
Published: December 2017

Objective

To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest.

Design

Systematic review.

Methods

Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time.

Results

A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p<0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p<0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p<0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes.

Conclusions

Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)
The Effect of the Emergency Physicians' Clinical Decision of Targeted Ultrasonography Application in Non-Traumatic Shock Patients
Authors: Dine SE , Soyuncu S , Dinc B , Oskay A , Bektas F
Published: December 2017

Introduction

Clinical evaluation of non-traumatic shock patients with high risk of mortality and morbidity is problematic for emergency physicians. In this study, changes in the investigations, diagnosis and treatment decision of the physicians using the Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) protocol were examined.

Methods

In this clinical prospective study, the patients were ultrasonographically examined within the scope of the ACES protocol at 6 quadrants including cardiac, pleural, peritoneal, inferior vena cava and aorta. Pre- and post-US investigations, diagnoses and treatments were compared.

Results

A total of 141 patients were included in this study. Of these, 92 (65.2%) of the patients were males and 49 (34.8%) were females. The average age of the patients was 62.9±16.8 years (18-97). After the ultrasonographic evaluation, request for new investigations was needed in 25 (17%), and modification of the treatment was needed in 57 (40.4%) of the patients. It was seen that with a targeted ultrasonography (US), the number of the considered pre-diagnoses decreased in 51 (36.2%) of the patients, and the physicians made a new pre-diagnosis in 6 (4.3%) of the patients. When the pre-diagnoses made by the physicians after the US and the final diagnoses clinically made at the end of the follow-up process were compared, there were no changes in the diagnoses in 124 (87.9%) patients.

Conclusion

Ultrasonographic examination is considered useful for rapid evaluation, early diagnosis and treatment planning in non-traumatic shock patients in emergency department. (Hong Kong j.emerg.med. 2015;22:364-370)
Twelve‐Year Experience with Necrotising Fasciitis in an Intensive Care Unit of a Local Regional Hospital
Authors: Yip HW , Wong OF , Lee HM , Lam SK
Published: December 2017

Background

Necrotising fasciitis (NF) is a life threatening condition and is a medical and surgical emergency. The mainstay of management includes early recognition, prompt surgical intervention, appropriate antibiotics and intensive care for organ support. However, the mortality is still very high despite the advance in the intensive care.

Objective

To examine the 12‐year outcomes, causative organisms, time to diagnosis, surgery and institution of adequate antibiotic coverage of patients with NF admitted to the intensive care unit (ICU) in a local regional hospital; and to identify the independent predictors of ICU mortality.

Method

We performed a retrospective analysis of the clinical records of all patients with NF admitted to the ICU between 1st July 2002 and 30th June 2014. Logistic regression analysis was conducted to identify the independent predictors of ICU mortality.

Results

One hundred and thirty seven patients were recruited. Causative organisms included: Group A Streptococcus (16.2%), other streptococcus (31.1%), Methicilin‐resistant Staphylococcus aureus (8.8%), Vibrio species (14%) and other Gram negatives (44%). The mean length of ICU stay was 9.9 days (range: 1‐74 days) and the ICU mortality rate was 42.3%. The APACHE II score (odds ratio [OR] 1.132; 95% confidence interval [CI] 1.060‐1.209), Diabetes Mellitus (OR 5.017; 95% CI 1.919‐13.119), Glasgow coma scale ≤8 (OR 4.525; 95% CI 1.319‐15.530), low white cell count (OR 0.931; 95% CI 0.876‐0.990) and urea level (OR 1.049; 95% CI 1.001‐1.100) were statistically significant independent predictors of ICU mortality.

Conclusions

The mortality of patients with NF in ICU remains very high. The causative microorganisms in our locality are similar to those observed elsewhere. NF patients treated in ICU with underlying diabetes mellitus or presenting with Glasgow Coma Scale less than 8 are significantly more likely to die.
Lactate as an Early Predictor for Early Massive Transfusion in Trauma Patients: A Retrospective Study
Authors: Kyoung KH , Kim YH , Jung YJ , Hong SK
Published: December 2017

Objective

Transfusion is a key treatment for patients with hemorrhage. Early massive transfusion (EMT) is defined as transfusion of 10 or more units of red blood cells (RBC) within the first 6 hours. We attempted to determine whether metabolic markers can be used as predictors for EMT.

Method

We retrospectively reviewed outcomes in 71 patients who visited the emergency department within 12 hours after trauma and received at least 1 unit of RBC within 24 hours between January 2008 and June 2010.

Results

Of the 71 patients, 54 were male and 17 were female; their mean age was 50.3±17.7 years. Of these, 15 required EMT and 56 did not; these patients received 17.7±13.1 and 2.8±2.3 units of RBCs, respectively. There were significant differences between EMT and non‐EMT groups in injury severity score (ISS; p=0.001), systolic blood pressure (SBP; p=0.010), base deficit (p=0.003), and lactate concentration (p=0.001). Logistic regression analysis showed that SBP <90 mmHg (odds ratio [OR] 11.71, 95% CI 1.83‐74.77, p=0.009), ISS ≥25 (OR 23.39, 95% CI 1.87‐293.23, p=0.015), and lactate ≥3.5 mmol/L (OR 6.99, 95% CI 1.10‐44.33, p=0.039) were significant predictors of EMT. The area under the curve for ≥3.5 mmol/L lactate was 0.79 (p=0.001), with a sensitivity of 76.7% and a specificity of 67.8%. The 30‐day mortality rate was significantly higher in patients with lactate ≥3.5 mmol/L than in those with lactate <3.5 mmol/L (p=0.002).

Conclusion

Lactate concentration is an important predictor of the need for EMT and should be considered in the initial phase of trauma resuscitation to prepare for massive transfusion.
Hong Kong Poison Information Centre: Annual Report 2015
Authors: Chan YC , Tse ML , Lau FL
Published: December 2017

Objective

To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015.

Methods

In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis.

Results

A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed.

Conclusions

This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.
An Unusual Cause of Ear Pain. A Life Threatening Disease Revealed by a Common Symptom
Authors: Sierecki M , Marchetti M , Verdier M , Ghazali A
Published: December 2017

A 40-year-old woman presented to the emergency department (ED) for bilateral otalgia as her sole complaint. The physician's otoscopic examination was normal and the rest of the examination was unremarkable except for previously unknown high blood pressure. The patient had no chest pain or dyspnea. She was discharged from the ED with antihypertensive therapy, pain-relief medications, and an appointment with a cardiologist. Twelve days later, transthoracic echocardiography revealed pericardial effusion and dilated ascending aorta. Computed tomography scan finally diagnosed an aortic dissection (AD) type A (Stanford classification) which necessitated emergency surgery.
Emergency Critical Care Service in Emergency Medicine Ward: The Experience in North Lantau Hospital
Authors: Wong OF , Ko S , Cheung WH , Wong WY , Ma HM , Lit ACH
Published: December 2017

With the increased demand of critical care, emergency physicians often provide a significant proportion of critical care for the critically ill patients apart from their primary roles in resuscitation and initial stabilisation. The dual training pathway of emergency medicine and intensive care medicine enables the Accident and Emergency Departments (AEDs) to be staffed with emergency intensivist to provide care of critically ill patients in the AEDs beyond the initial resuscitation. North Lantau Hospital is a community hospital located in central Tung Chung of Lantau Island. Transporting critically ill patients to the nearest tertiary hospital requires a significant amount of time which poses high risk to them. An “Emergency Critical Care Management” pilot program was created under these circumstances. In this pilot program, up to 2 beds in the Emergency Medicine Ward (EMW) are used for managing critically ill patients. The experience and preliminary outcomes of implementing critical care service in the EMW are shared in this article.
Beware Neck Pain in a Haemodialysis Patient: Spontaneous Spinal Epidural Haematoma
Authors: Sun JM , Chen YH , Chang CJ , Hsieh CT
Published: December 2017

Spontaneous spinal epidural haematoma is a rare and devastating disorder. To the best of our knowledge, only 4 haemodialysis patients with the diagnosis of spontaneous spinal epidural haematoma have been reported in the literature. Here, we reported a 70-year-old male haemodialysis patient who presented with a sudden onset of severe sharp neck pain. Spontaneous spinal epidural haematoma with cord compression from C2 to C6 was diagnosed by magnetic resonance imaging. After emergency surgery, the patient recovered completely from the profound neurological deficits. The relevant literatures were also reviewed.
Bamboo snake (Trimeresurus Albolabris) Bite in Hong Kong and its Prognostic Factors for Local Complications with Surgical Intervention, Coagulopathy and Thrombocytopenia
Authors: Suen PY
Published: December 2017

Introduction

Bamboo snake bite accounts for the majority of venomous snake bites in Hong Kong. The objectives of this study were to evaluate the clinical features and outcomes of Bamboo snake bite in Hong Kong and to identify its prognostic factors for local complications requiring surgical intervention, coagulopathy and thrombocytopenia.

Methods

It was a retrospective cohort study conducted in a regional hospital of Hong Kong from 1st January 2001 to 31st December 2015.

Results

Sixty-three subjects were in the final analyses. The mean age was 60 years old. The incidences of swelling, local bruises, blistering, regional lymphadenopathy and local necrosis were 90.5%, 33.3%, 6.3%, 1.6% and 3.2% respectively. The incidences of local complications with surgical intervention, coagulopathy and thrombocytopenia were 6.3%, 13% and 13% respectively. Univariate analysis showed only local necrosis (p=0.003) was significantly associated with local complications with surgical intervention; and only cardiovascular disturbance due to snakebite envenomation (p=0.002) was significantly associated with coagulopathy; and no significantly associated factor was found for thrombocytopenia. There were no case with systemic bleeding and death after Bamboo snake bite. There was no case with allergic reaction after the use of antivenom.

Conclusions

Local necrosis is significantly associated with surgical intervention. Cardiovascular disturbance is significantly associated with coagulopathy. Allergic reaction after the use of antivenom is rare in Hong Kong.
Teaching Prevention: An Interdisciplinary Approach to Improving Population Health through Law and Policy
Authors: Tyler Elizabeth Tobin
Published: December 2017

This interdisciplinary course, which included students from medicine, public health, law, and public policy, explored the concept of “prevention” and the role of law and public policy preventing disease and injury and improving population health. In addition to interdisciplinary course content, students worked in interdisciplinary teams on public health law and policy projects at community organizations and agencies.
Reflections on Mentoring
Authors: Crossley Mary , Silverman Ross D.
Published: December 2017

Reflecting on their service as mentors in the fellowship program, the authors describe their experiences and offer thoughts on lessons learned about mentoring, individuals' roles in institutional changes, their own professional growth, and implications for and evaluation of legal and interprofessional education.
The Importance of Including the Deans
Authors: Hoffmann Diane E.
Published: December 2017

This article describes the benefits of including institutional leadership (the deans) in a faculty fellowship program where faculty were tasked with implementing a curricular innovation at their home institution. These benefits included: (1) serving as an ally, advocate, and defender for the faculty fellow; (2) seeing the bigger picture and how the fellowship can be leveraged to benefit the institution in other ways; and (3) assisting to ensure the fellowship project will be ongoing at their institution.
Informed Consent Should Be a Required Element for Newborn Screening, Even for Disorders with High Benefit-Risk Ratios
Authors: Fost Norman
Published: December 2017

Over-enthusiastic newborn screening has often caused substantial harm and has been imposed on the public without adequate information on benefits and risks and without parental consent. This problem will become worse when genomic screening is implemented. For the past 40 years, there has been broad agreement about the criteria for ethically responsible screening, but the criteria have been systematically ignored by policy makers and practitioners. Claims of high benefit and low risk are common, but they require precise definition and documentation, which has often not occurred, undermining claims that involuntary testing is justified. Even when the benefits and risks are well established, it does not automatically follow that involuntary testing is justified, a position supported by the widespread tolerance for parental refusal of immunizations and newborn screening.
Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical
Authors: Brady Michael T.
Published: December 2017

Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The CDC and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits.
Circumcision Is Unethical and Unlawful
Authors: Svoboda J. Steven , Adler Peter W. , Van Howe Robert S.
Published: December 2017

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.

Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.

Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.

In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision.
Kings to Cowards: One-Punch Assaults
Authors: Schreiber Jason , Williams Angela , Ranson David
Published: December 2017

Methodology: Literature Review and medico-legal commentary. Results: Fatal one-punch assaults have been reported extensively in the media. This article provides a commentary on recent policy developments and legislative amendments in Australia regarding so called ‘one-punch’ assaults. Comparisons are made with the situation in other jurisdictions including the UK, US, and Europe. The clinical forensic medical aspect of fist strikes to the head and face is examined in the context of the recent media attention and public interest these cases have attracted. The increased recognition of the risk of harm and death inherent in these types of assaultive behavior is reflected in the policy and legislative changes that have taken place in some jurisdictions. Conclusion: One punch strikes may result in a range of injuries that can include permanent neurological impairment and death. Recent media and community concern regarding these cases and the need for stronger deterrence has resulted in a change in public policy and consequent legislative amendments.
Taxing Sugar-Sweetened Beverages to Lower Childhood Obesity
Authors: Wetter Sarah A. , Hodge James G.
Published: December 2017

Consumption of sugar-sweetened beverages (SSBs) contributes to multiple health problems including obesity, diabetes, and tooth decay, especially among children. Excise taxation has been proven efficacious in changing purchasing behaviors related to tobacco use with resulting improvements in public health outcomes. Similar taxes applied to SSBs are starting to take hold internationally and domestically. SSB taxes have been proposed in over 30 U.S. jurisdictions since 2009, but only Berkeley (CA) has passed and implemented one to date. Given empirical evidence of their effectiveness, governments should consider implementation of SSB excise taxes based on uniform definitions of SSBs and other factors.
Making Health Care Truly Affordable after Health Care Reform
Authors: Jost Timothy Stoltzfus , Pollack Harold A.
Published: December 2017

The Affordable Care Act (ACA) is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity. Consistent with these finding, one recent analysis of credit report data finds that Medicaid expansion was associated with between a $600 and $1000 decline in collection balances among individuals who gained coverage. Notwithstanding these gains, premiums and cost-sharing are still too high for many Americans. And cost-sharing has continued to edge higher for the majority of Americans who have coverage through employer-based plans. Measures to address these challenges must build on the ACA to provide greater protection to millions of Americans and to address continued dissatisfaction with our health care financing system among middle-income Americans.
Health Reform in a New Presidency: The Challenge of Finding Common Ground
Authors: Wilensky Gail R.
Published: December 2017

Finding “common ground” to fix some of the policy problems with the ACA was never expected to be easy. How challenging depends on the election outcome. With split government or even same party control of the Congress and White House but without a supermajority in the Senate, fixing identifiable problems requires remedies that might garner bipartisan cooperation. Some potential strategies that might meet this requirement are described.
Food Labeling and Consumer Associations with Health, Safety, and Environment
Authors: Sax Joanna K. , Doran Neal
Published: December 2017

The food supply is complicated and consumers are increasingly calling for labeling on food to be more informative. In particular, consumers are asking for the labeling of food derived from genetically modified organisms (GMO) based on health, safety, and environmental concerns. At issue is whether the labels that are sought would accurately provide the information desired. The present study examined consumer (n = 181) perceptions of health, safety and the environment for foods labeled organic, natural, fat free or low fat, GMO, or non-GMO. Findings indicated that respondents consistently believed that foods labeled GMO are less healthy, safe and environmentally-friendly compared to all other labels (ps < .05). These results suggest that labels mean something to consumers, but that a disconnect may exist between the meaning associated with the label and the scientific consensus for GMO food. These findings may provide insight for the development of labels that provide information that consumers seek.
Incidence and Predictors of Mortality Among Newborns With Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria
Authors: Ekwochi Uchenna , Asinobi Nwabueze I , Osuorah Chidiebere DI , Ndu Ikenna K , Ifediora Christian , Amadi Ogechukwu F , Iheji Chukwunonso C , Orjioke Casmir JG , Okenwa Wilfred O , Okeke Bernadette Ifeyinwa
Published: December 2017

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I ( P = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) ( P = .030). Fatality outcome was more correlated with SARNAT ( R = .280; P = .000) than APGAR ( R = −.247; P = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery ( P = .010), place of delivery ( P = .032), and mode of delivery ( P = .042). Finally, it was noted that newborns that were female ( P = .007), or born outside the hospital ( P = .010), or with oxygen saturations <60% ( P = .001), or with heart rate <120 ( P = .000), and those with respiratory rate <30 ( P = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation.
Newspaper Coverage of Alzheimer's Disease: Comparing Online Newspapers in Hebrew and Arabic across Time
Authors: Werner Perla , Schiffman Ile Kermel , David Dana , Abojabel Hanan
Published: December 2017

The aim of the present study was to examine the objective characteristics and the portrayal of Alzheimer's disease and of persons with Alzheimer's disease in Hebrew and Arabic online newspapers across time. The sample included 180 articles published in seven national online newspapers between 2010–2011 and 2014–2015 and dealing specifically with the topic. The majority of the articles in both periods and languages were published in the Health section of the newspapers, had a neutral tone, and experts or researchers as the main sources of information. Stigmatizing elements were infrequent. While small differences were found across time, significant differences were found between Hebrew and Arabic online newspapers, with Arabic newspapers concentrating more on objective, health-related and expert-based information. As the use of online newspapers increases, policy makers should consider the use of this media as a viable way for improving knowledge and awareness about AD and dementia.
Experiences of Integrated Care for Dementia from Family and Carer Perspectives: A Framework Analysis of Massive Open Online Course Discussion Board Posts
Authors: Robertshaw David , Cross Ainslea
Published: December 2017

Background

Integrated Care for dementia is an increasingly popular approach to supporting people with dementia, bringing services together to form a single cohesive provision for service users. This approach is still in its infancy but has the potential to improve the management of dementia, social care and to enhance the patient experience.

Aims

To understand views and experiences of integrated health and social care for dementia from the perspective of carers, families, healthcare professionals and researchers.

Methods

Crowdsourcing views and experiences from ‘Bridging the Dementia Divide’, a massive open online course at the University of Derby, provide a rich source of qualitative data from carers, families and healthcare professionals. We analysed 847 massive open online course discussion board posts using a Framework Analysis approach.

Results

Participants described how Integrated Care for dementia should be person-centred and holistic, involving a multidisciplinary team of health and social care practitioners, as well as the patient, the family and the wider community. The establishment of Integrated Care for dementia was viewed positively.
Dementia looming!
Authors: Oliemeulen Lisette
Published: December 2017

Background

I, the 45-year-old scientist, the PhD, the sublime researcher, now subject to dementia? I felt confused, very ashamed and told no one, until they found out. I suffer from brain atrophy, associated with multiple sclerosis I am suffering from for years. My cognitive impairment is the result of my shrinking brain!

Objectives

With my personal view ‘Dementia Looming!’, I hope to contribute to and support healthcare professionals and scientists in understanding the meaning of dementia. Although not scientific, my paper gives a unique behind-the-scenes view into what it means to experience dementia symptoms.
The lived experiences of dementia in married couple relationships
Authors: Clark Suzannah , Prescott Tim , Murphy Gemma
Published: December 2017

Background and purpose

There are a growing number of couples who become affected by dementia as one partner develops the condition while the other becomes a carer. However, our knowledge about the experiences of couples affected by dementia is limited. Very little knowledge about the impact of dementia on couples has been gained in previous research. The aim of this study was to explore the dyadic perspective of dementia within a couple relationship. Methodology: Six couples were interviewed about their experience of living with dementia. Interview transcripts were subjected to interpretive phenomenological analysis to identify themes across participants’ accounts. Results and conclusion: The analysis revealed three themes: (i) maintaining a bond, (ii) change and adjustment, and (iii) the challenge of coping. The results highlight the importance of studying the dyadic perspective and including people with dementia in research. Couples experienced an enduring commitment to one another as they adjusted to life with dementia.
Introducing the Care Certificate Evaluation: Innovative practice
Authors: Argyle Elaine , Thomson Louise , Arthur Antony , Maben Jill , Schneider Justine , Wharrad Heather
Published: December 2017

Although investment in staff development is a prerequisite for high-quality and innovative care, the training needs of front line care staff involved in direct care have often been neglected, particularly within dementia care provision. The Care Certificate, which was fully launched in England in April 2015, has aimed to redress this neglect by providing a consistent and transferable approach to the training of the front line health and social care workforce. This article describes the early stages of an 18-month evaluation of the Care Certificate and its implementation funded by the Department of Health Policy Research Programme.
Using public engagement and consultation to inform the development of ageing- and dementia-friendly pharmacies – Innovative practice
Authors: Gilmartin-Thomas Julia F-M , Orlu Mine , Alsaeed Dalal , Donovan Ben
Published: December 2017

This study explored public perceptions about the importance of, and how to create, ageing- and dementia-friendly pharmacists and pharmacies. In September 2016, four focus groups (45 minutes each) were conducted with 16 participants who represented organisations, groups or forums working with and/or for older people and people with dementia in Greater London. Discussions were recorded via handwritten notes and thematically analysed. Participants confirmed the importance of pharmacists and pharmacies being ageing- and dementia-friendly and described variability in whether this is currently the case. Suggested strategies for improvement included targeting communication, pharmacist leadership and shop layout.
A Visual Arts Education pedagogical approach for enhancing quality of life for persons with dementia (innovative practice)
Authors: Tietyen Ann C , Richards Allan G
Published: December 2017

A new and innovative pedagogical approach that administers hands-on visual arts activities to persons with dementia based on the field of Visual Arts Education is reported in this paper. The aims of this approach are to enhance cognition and improve quality of life. These aims were explored in a small qualitative study with eight individuals with moderate dementia, and the results are published as a thesis. In this paper, we summarize and report the results of this small qualitative study and expand upon the rationale for the Visual Arts Education pedagogical approach that has shown promise for enhancing cognitive processes and improving quality of life for persons with dementia.
Art museum-based intervention to promote emotional well-being and improve quality of life in people with dementia: The ARTEMIS project
Authors: Schall Arthur , Tesky Valentina A , Adams Ann-Katrin , Pantel Johannes
Published: December 2017

ARTEMIS (ART Encounters: Museum Intervention Study) is an art-based intervention designed especially for people with dementia and their care partners that involves a combination of museum visits and artistic activity. This paper reports the results of a randomized wait-list controlled study on the influence of the ARTEMIS intervention on the emotional state, well-being, and quality of life of dementia patients. People with mild-to-moderate dementia (n = 44) and their care partners (n = 44) visited the Frankfurt Städel Museum once a week on six pre-arranged occasions. The intervention consisted of six different guided art tours (60 minutes), followed by art-making in the studio (60 minutes). Independent museum visits served as a control condition. A mixed-methods design was used to assess several outcomes including cognitive status, emotional well-being, self-rated aspects of quality of life, and subjective evaluations by informal caregivers. In a pre-post-assessment, we found significant improvements in participants’ self-rated quality of life (t = −3.15, p < .05). In a situational assessment of emotional well-being immediately before and after each of the museum sessions, we were able to demonstrate statistically significant positive changes with medium effect sizes (dcorr = .74–.77). Furthermore, the total Neuropsychiatric Inventory score as well as the affective (depressed mood and anxiety) and apathy subscales were significantly lower after the ARTEMIS intervention (tNPI total = 2.43; tNPI affective = 2.24; tNPI apathy = 2.52; p < .05). The results show that art museum-based art interventions are able to improve the subjective well-being, mood, and quality of life in people with dementia. This promising psychosocial approach deserves further attention in future studies and consideration in community-based dementia care programs.
Living with incontinence: The experience of people with dementia
Authors: Cole Laura , Drennan Vari M
Published: December 2017

Dementia is a distressing condition in which individuals progressively require the support of others. Many people experience problems with incontinence and continence management. The presence of incontinence is influential in decisions for people with dementia to move into a care home. This study, in the interpretative tradition, investigates for the first time the person with dementia’s perspective on these problems and their strategies for managing them. We conducted semi-structured conversational interviews with seven people with mild-to-moderate dementia and analysed the transcripts thematically. Our participants described both a variety of problems with incontinence and continence management, and their embarrassment and humiliation. Strategies included managing their presentation of self to others to keep such problems hidden, although it was evident that for some their cognitive problems led to strategies that were potentially problematic for others. In addition, some described the ways in which they acted to protect others, such as spouses, from the stigmatising effect of the incontinence.
Can a systems approach reduce adverse outcomes in patients with dementia in acute settings? (innovative practice)
Authors: Duah-Owusu White Mary , Vassallo Michael , Kelly Fiona , Nyman Samuel
Published: December 2017

People with dementia experience adverse outcomes such as pressure sores during their stay in acute hospitals. The application of a systems approach in an acute setting places an emphasis on the patient’s journey in addition to the organisational factors that are present within a hospital context. This article draws upon principles obtained from a theoretical model, which was extracted from the work of Edwards (1972), Hawkins (1987) and Zecevic et al. (2007), in order to illustrate how the application of a novel systems approach (human interaction, environment, equipment and policy) could be used in acute hospital settings to reduce adverse health outcomes by using an imaginary patient with dementia.