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Stephenson L.M.,Public Health Unit | Biggs J.S.,Public Health Officer | Sheppeard V.,Director | Oakman T.L.,Public Health Unit
Communicable diseases intelligence quarterly report | Year: 2016

In 2013 an avian influenza outbreak occurred in a large poultry farm in Young (approximately 2 hours north-west of Canberra.) The responsible strain was H7N2, which is highly pathogenic and can affect humans. Daily surveillance was required for those individuals who were possibly exposed. This was conducted through the use of daily message through the short message service (SMS). A total of 55 people were identified as having had high risk exposure and requiring monitoring during the surveillance period from 16 to 25 October 2013. A SMS message was sent daily to each contact within 2 groups. (Group 1 were contacts who agreed to take Tamiflu prophylaxis, and Group 2 were contacts who were under surveillance but declined Tamiflu prophylaxis). The average daily response rate for SMS was 66% (median 75%) over a 9 day period. Of those who nominated to receive the daily SMS 98% confirmed they'd received the SMS and it reminded them to take their Tamiflu medication. The public health unit (PHU) team found the use of SMS to be less time consuming than conducting telephone follow-up interviews. The PHU team believed that the use of the technology decreased the likelihood of additional staff being required to assist in the outbreak. Utilising SMS was a new initiative for the PHU and staff found it overall easy to use. These findings confirm there can be significant benefits to using SMS during a large surveillance activity. The application of SMS during this outbreak was estimated at 2.5 times more cost effective that telephone follow-ups and would substantially reduce staffing costs further in the event of a very large outbreak.

PubMed | Director of Surgery and Peri Operative Programs at THP., Senior analyst within the Strategy Management and Project Management Office at THP., Senior analyst within the Strategy Management and Project Management Office at Trillium Health Partners THP in Mississauga, Director of Medical Device Reprocessing at THP. and 5 more.
Type: Journal Article | Journal: Healthcare quarterly (Toronto, Ont.) | Year: 2017

There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.

PubMed | Director, Former Chief Resident, Chief, Chief Resident and Fellow
Type: Review | Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons | Year: 2016

The purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10years.A systematic review for publications on the fibula free flap in mandibular reconstruction in the PubMed and Scopus databases was performed from January 1, 2005 until December 31, 2014. Publications were classified by topic, number of patients, and country of origin. The study period was split into 2 periods. The first 5-year period was compared with the second 5-year period.Eighty-five publications were identified. There was an increase in publications regarding restorative decision making (11 vs 9), surgical techniques (13 vs 6), outcomes (20 vs 10), and computer-aided design and computer-aided manufacturing (CAD-CAM; 8 vs 2) in the second 5-year period. The number of patients reported also increased in publications on surgical techniques (1,085 vs 59), outcomes (777 vs 254), bisphosphonate-related osteonecrosis of the jaw and osteoradionecrosis (165 vs 28), and CAD-CAM (65 vs 15) in the second 5-year period. The United States, India, China, and Europe produced most of the publications.In the past 10years, there was a surge in publications on the use of the fibula free flap for mandibular reconstruction. There was a 1.8-fold increase in the number of publications and a 3.4-fold increase in the number of patients undergoing this method of mandibular reconstruction in the second 5-year period. Publications from the United States, India, and China contributed to a large increase in the number of patients in the second 5-year period. More interest in CAD-CAM technology was seen in the second 5-year period that was not seen in the first 5-year period.

Kongsri S.,Mahasarakham University | Limwattananon S.,Khon Kaen University | Sirilak S.,Director | Prakongsai P.,International Health Policy Program | Tangcharoensathien V.,International Health Policy Program
Reproductive Health Matters | Year: 2011

This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban-rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended. © 2011 Reproductive Health Matters.

Carrington S.C.,Resident | Stone P.,Director | Kruse D.,Research Director
Journal of Foot and Ankle Surgery | Year: 2015

An accessory soleus muscle is a rare anatomic variant that frequently presents as an asymptomatic soft tissue swelling in the posteromedial ankle. Less frequently, the anomalous muscle can cause pain and swelling with activity. We present the case of a 17-year-old male with exertional compartment syndrome and associated tarsal tunnel syndrome secondary to a very large accessory soleus muscle. After surgical excision, the patient was able to return to full activity with complete resolution of symptoms. © 2015 American College of Foot and Ankle Surgeons.

Kuhn K.M.,Director
American journal of orthopedics (Belle Mead, N.J.) | Year: 2013

Acetabular fracture-dislocations are severe injuries that require urgent closed reduction of the hip and often require surgery to restore hip stability. Other authors have described acetabular fracture-dislocations associated with femoral neck fractures, but to our knowledge, this case report is the first to describe an acetabular fracture-dislocation in association with an ipsilateral pertrochanteric fracture and subtrochanteric extension. The polytraumatized patient initially was not stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mm Schanz screw was introduced percutaneously into the femoral head through the primary fracture site under fluoroscopic guidance. With inline traction on the leg, the Schanz screw was used to manipulate the femoral head back into the acetabular fossa. The Schanz screw was removed, the head remained reduced, and a skeletal traction pin was placed to maintain length and alignment of the pertrochanteric fracture until definitive stabilization was possible. We propose a staged treatment strategy consisting of early closed reduction of the hip, and after the patient has been stabilized, reduction and fixation of the fractures. This strategy may be useful in managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.

This presentation provides an overview of the Commonwealth of Pennsylvania's experiences and ongoing studies related to technologically enhanced, naturally occurring radioactive material (TENORM) in the oil and gas industry. It has been known for many years that Pennsylvania's geology is unique, with several areas having relatively high levels of natural uranium and thorium. In the 1950s, a few areas of the state were evaluated for commercial uranium production. In the late 1970s, scoping studies of radon in homes prompted the Pennsylvania Department of Environmental Protection (DEP) Bureau of Radiation Protection (BRP) to begin planning for a larger state-wide radon study. The BRP and Oil and Gas Bureau also performed a TENORM study of produced water in the early 1990s for a number of conventional oil and gas wells. More recently, BRP and the Bureau of Solid Waste developed radiation monitoring regulations for all Pennsylvania solid waste disposal facilities. These were implemented in 2001, prompting another evaluation of oil and gas operations and sludge generated from the treatment of conventionally produced water and brine but mainly focused on the disposal of TENORM solid waste in the state's Resource Conservation and Recovery Act Subtitle D landfills. However, since 2008, the increase in volumes of gas well wastewater and levels of Ra observed in the unconventional shale gas well flow-back fracking water has compelled DEP to fully re-examine these oil and gas operations. Specifically, with BRP in the lead, a new TENORM study of oil and gas operations and related wastewater treatment operations has been initiated (), supported by an American National Standards Institute standard on TENORM () and a U.S. Government Accountability Office report on shale resource development and risks (). This study began in early 2013 and will examine the potential public and worker radiation exposure and environmental impact as well as re-evaluate TENORM waste disposal. This presentation summarizes conventional and unconventional oil and gas well operations, geology and respective uranium/thorium content, radium content in oil and gas wastewater, treatment solids, radon in natural gas, the scope of other TENORM issues in the state, regulatory framework, national regulations and guidance. It also provides an overview of past and the status of ongoing TENORM studies in the Commonwealth (; Rowan and Kraemer 2012; ).

Few publications of prospective studies have described patient outcomes in community-acquired bacterial pneumonia (CABP)-associated bacteremia. Our objective, in performing this subgroup analysis, was to assess outcomes in subjects with CABP-associated bacteremia in 2 randomized, double-blind clinical studies comparing treatment with ceftaroline fosamil versus ceftriaxone. Our analysis summarizes baseline subject demographics, distribution of baseline pathogens isolated from blood cultures, clinical response rates at Day 4, and clinical cure rates at end of therapy and test of cure (8 to 15 days after end of therapy) in subjects with bacteremic CABP in the ceFtarOline Community-acquired pneUmonia trial vS ceftriaxone in hospitalized patients (FOCUS) studies. In the FOCUS studies, 23 of 614 patients in the ceftaroline fosamil-treated group and 22 of 614 patients in the ceftriaxone-treated group had CABP-associated bacteremia. Baseline demographics were similar between groups. Streptococcus pneumoniae was the most common baseline bloodstream isolate. For subjects with CABP-associated bacteremia, clinical response/cure rates were similar at Day 4 (60.9% vs 59.1%), end of therapy (69.6% vs 72.7%), and test of cure (69.6% vs 68.2%) for ceftaroline fosamil and ceftriaxone, respectively. In subjects with CABP-associated bacteremia, ceftaroline fosamil demonstrated similar clinical outcomes at Day 4, end of therapy, and test of cure compared with ceftriaxone.

PubMed | Director and VMMC & Safdarjung Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2017

Paretic upper limb in stroke patients has a significant impact on the quality of life. Modified Constraint Induced Movement Therapy (mCIMT) is one of the treatment options used for the improvement of the function of the paretic limb.To investigate the efficacy of four week duration mCIMT in the management of upper extremity weakness in hemiparetic patients due to stroke.Prospective single blind, parallel randomized controlled trial in which 30 patients received conventional rehabilitation programme (control group) and 30 patients participated in a mCIMT programme in addition to the conventional rehabilitation programme (study group). The mCIMT included three hours therapy sessions emphasizing the affected arm use in general functional tasks, three times a week for four weeks. Their normal arm was also constrained for five hours per day over five days per week. All the patients were assessed at baseline, one month and three months after completion of therapy using Fugl-Meyer Assessment (FMA) score for upper extremity and Motor Activity Log (MAL) scale comprising of Amount of Use (AOU) score and Quality of Use (QOU) score.All the 3 scores improved significantly in both the groups at each follow-up. Post-hoc analysis revealed that compared to conventional rehabilitation group, mCIMT group showed significantly better scores at 1 month {FMA1 (p-value <0.0001, es0.2870), AOU1 (p-value 0.0007, es0.1830), QOU1 (p-value 0.0015, es0.1640)} and 3 months {FMA3 (p-value <.0001, es0.4240), AOU3 (p-value 0.0003, es 0.2030), QOU3 (p-value 0.0008, es 0.1790)}.Four weeks duration for mCIMT is effective in improving the motor function in paretic upper limb of stroke patients.

PubMed | Director
Type: Journal Article | Journal: Annals of emergency medicine | Year: 2017

[National Highway Traffic Safety Administration: National Conference on Medical Indication for Air Bag Disconnection-July 16-18, 1997. Ann Emerg Med June 1998;31:782-783.].

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