Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department

Objective

The HEART score serves risk stratification of chest pain patients at the emergency department (ED). Quicker and more solid decisions may be taken in these patients with application of this score. An analysis of medical consumption of 122 acute chest pain patients admitted before the introduction of this score may be indicative of possible savings.

Methods

Numbers of cardiology investigations and clinical admission days were counted. Charged cost of medicine was divided into three categories: ED, in-hospital, and outpatient clinic.

Results

The total cost of care was € 469,631, with an average of € 3849 per patient. Seventy-five percent of this cost was due to hospitalisation under the initial working diagnosis of acute coronary syndrome (ACS). This diagnosis was confirmed in only 29/122 (24 %) of the patients. The low-risk group (41 patients with HEART scores 0–3) included one patient with a previously scheduled CABG. In the remaining 40 patients, hospitalisation occurred in 12/40 (30 %) patients and 30/40 (75 %) patients visited the outpatient clinic. The total cost of medical care after presentation of these 40 patients was € 37,641; there were no cases where a new diagnosis of coronary artery disease was made. When medical care in this subgroup is declared redundant, major savings on national medical care budgets could be made.

Conclusion

If the HEART score were to be routinely applied, diagnostic pathways could be shortened and costs reduced, in particular in low-risk patients.     

Biofilm formation by Candida albicans on various prosthetic materials and its fluconazole sensitivity: a kinetic study

Candida albicans has the ability to colonize various materials used in prostheses. In this report, we have studied the kinetics of biofilm formation on prosthetic materials and their susceptibility to fluconazole at various stages of development. Results indicated that C. albicans efficiently adheres to and colonizes polystyrene, polyvinylchloride, silicon, and polycarbonate surfaces. Candida albicans biofilm formation was observed to be both strain- and substrate dependent. Adhesion of cells to solid substrates was found sufficient to induce fluconazole resistance. Drug susceptibility at different stages of biofilm growth showed that Candida biofilms on these substrates are highly resistant to fluconazole. The study focuses on the limitations of fluconazole to combat biofilm-related infections and emphasizes the need for better therapeutic strategies against prosthesis-associated C. albicans infections.     

Ecological behaviour of herbaceous forest species along a pH gradient: a comparison between oceanic and semicontinental regions in northern France

Aim On the basis of 2402 phytoecological relevés, with complete species lists, and real pH measurements resulting from chemical analyses of the top layer of forest soils, this paper compares quantitatively the ecological response of 46 herbaceous forest species along a pH gradient in two regions of northern France. Location The two regions investigated are oceanic north‐western France (NW) and semicontinental north‐eastern France (NE). Methods For each of the 46 species with more than 50 occurrences in both NW and NE regions, an ecological response curve was computed with simple logistic regression models, and two synthetic numerical values were derived: ecological optimum (OPT) and ecological amplitude (AMP). A comparison of the ecological behaviour of species present in both regions was performed in terms of shift in optimum and/or amplitude. Results All 46 species did reveal a reaction to pH. Our main observation was the relative stability of the behaviour of most species with reference to pH conditions, which is consistent with results from some previous studies. Slight differences regarding the two synthetic parameters (OPT and AMP) were however observed between the NW and NE regions, probably due to a form of competitive release in neutral environments in the NW. Main conclusions Among the main possibilities that could explain a geographical shift in the ecological behaviour of herbaceous species, competitive effects are, we suggest, the most plausible explanation. In the light of former studies, it seems that further analyses of geographical shifts in the ecological behaviour of forest plant species over large areas are needed, such as for example over the European continent. Nomenclature Tutin et al. (2001 ).     

Sweet corn phosphorylase: purification and properties

Sweet corn 1,4-α-glucan phosphorylase was purified 190-fold to a near homogeneous state. The enzyme had a molecular weight of about 315,000 on Sephadex G-200 chromatography. The pyridoxal 5′-phosphate content was found to 1 mole per 140,000 g protein, suggesting that the enzyme is dimeric. On sucrose density gradient ultracentrifugation the sweet corn phosphorylase was dissociated to an active monomeric species with a molecular weight of 150,000 and a sedimentation coefficient of 8 S. The priming specificity of the sweet corn phosphorylase was investigated; maltose was not a primer and maltotriose was the smallest apparent primer. The Michaelis constants for the maltosaccharide series from maltopentaose to maltooctaose were determined. The effect of d-enzyme on the apparent priming specificity of the enzyme was investigated. Adenosine diphosphoglucose and 2,3-diphosphoglycerate were found to inhibit the enzyme activity.     

Effects of photoperiod and ageing on the carbon isotope composition of Bryophyllum daigremontianum Berger

Abstract. Changes in crassulacean acid metabolism (CAM) in the leaves of Bryophyllum daigremontianum were studied comparatively under closely controlled (phytotron) and semi-natural (greenhouse) conditions utilizing measurements of natural carbon isotope composition (δ¹³C) of the total leaf matter. Abrupt transfer of plants from long days to short days resulted in an overall increase of CAM in mature leaves (no. 3 from the apex and older) and thus in a higher CAM level for the whole plant. Study during the course of a year in semi-natural conditions showed that a progressive increase in length of day and day night temperature differences (February ← June) activated CAM but only a passage to short days (June ← October) produced the maximum CAM. Under the experimental conditions employed, the maximum shift from the C₃-type to the C₄-type of metabolism was observed in plants subjected to semi-natural progressive variations in the environment, i.e. the δ¹³C values indicated that for plants in the greenhouse the total carbon flow entering the cells was mediated by phosphoenolpyruvate carboxylase activity.     

‘Fitness’ and ‘altruism’: Traps for the unwary,bystander and biologist alike

At one level, this paper is a lament and a warning. I lament biologists borrowing well-known terms and then drastically and awkwardly changing their meanings, and I warn about the mischief this does. Biology's public image is at stake, as is its general usefulness. At another level, I attempt to clarify the misnamed concepts, beyond what has been achieved in recent philosophical writings. This helps to account for the mischief, and to see how it might be avoidable. But the most important thing about the paper is that, at a third level, it is an argument against physicalism and materialism, especially those variants which deny the autonomy of organisms and the existence of intrinsic goods. Interpreting biology from the point of view of those denials leads to unsatisfactory and even bizarre results.David Hull made wonderful criticisms of an early draft, for which many thanks.     

Chronomodulated chemotherapy: clinical value and possibilities for dissemination in the United States

Modern medicine has been relatively slow to apply chronotherapeutic principles to standard oncologic practice. Despite the impressive body of evidence supporting the use of chronochemotherapy, with only a rare exception most oncology clinics in the United States lack the expertise and capability to implement it. At the same time, American medicine has increasingly come to recognize the importance of toxicity mitigation, cytoprotection, and quality of life for patients undergoing cancer treatment. However, toxicity mitigation strategies such as chronomodulated infusional chemotherapy and novel cytoprotective agents are not widely embraced by U.S. physicians. This article explores some reasons why this situation exists, including the influence of non-medical biases that may affect management decisions on the application of chemotherapy. The author conducted a survey of U.S. companies representing the three private insurance payers available (HMO, PPO, Indemnity) as well as representatives of Medicare and Medicaid. Responses to the survey confirmed that U.S. insurers do not at present officially reimburse for chronotherapy; however, changes will come about through educational efforts aimed at increasing awareness among insurers as to the clinical benefits and cost-effectiveness of this mode of treatment. At this juncture, the outlook for cancer chronotherapy as a first-line approach to the treatment of metastatic cancer in the United States remains uncertain. Under the current method of insurance reimbursement, the advancement of chronotherapy in the United States is threatened despite evidence that such treatment is both therapeutically sound and cost-effective.     

Medical professionalism videos on YouTube: Content exploration and appraisal of user engagement

BackgroundSocial media has become the fastest growing platform for sharing and retrieving information and knowledge, and YouTube is one of the most popular and growing sources of health and educational information video-sharing website. But, videos on this open platform are not peer-assessed, therefore, the accessible data should be adequately assessed. Till date, no exploration and analysis for assessing the credibility and usefulness of Medical professionalism videos available on YouTube are conducted.ObjectiveTo analyze the video sources, contents and quality of YouTube videos about the topic of medical professionalism.MethodsA systematic search was accomplished on YouTube videos during the period between March 1, 2020 and March 27, 2020. The phrases as significant words used throughout YouTube web search were ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, ‘Attributes of professionalism’. The basic information collected for each video included author’s/publisher’s name, total number of watchers, likes, dislikes and positive and undesirable remarks. The videos were categorized into educationally useful and useless established on the content, correctness of the knowledge and the advices. Different variables were measured and correlated for the data analysis.YouTube website was searched the using keywords ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, and ‘Attributes of professionalism’.ResultsAfter 2 rounds of screening by the subject experts and critical analysis of all the 137 YouTube videos, only 41 (29.92%) were identified as pertinent to the subject matter, i.e., educational type. After on expert viewing these 41 videos established upon our pre-set inclusion/exclusion criteria, only 17 (41.46%) videos were found to be academically valuable in nature.ConclusionMedical professionalism multimedia videos uploaded by the healthcare specialists or organizations on YouTube provided reliable information for medical students, healthcare workers and other professional. We conclude that YouTube is a leading and free online source of videos meant for students or other healthcare workers yet the viewers need to be aware of the source prior to using it for training learning.     

新形势下军队院校与非军队院校医学生的就业观调查

目的:了解新医疗形势下军队院校医学生与非军队院校医学生就业观的区别。方法:采用自行设计的调查问卷对113名军队院校(第四军医大学)和432名非军队院校2014年应届毕业生(包括西安交通大学医学院、西安医学院及延安大学医学院)进行问卷调查,并对结果进行分析。结果:军队院校和非军队院校医学生基本情况及填报医学专业动机的初衷大致相同(P0.05);但影响其就业的主要因素不同(P0.01),军队院校就业压力小,非军队院校认为当前紧张的医患关系是影响其就业的主要因素;同时由于受军队特殊环境的影响,他们毕业后工作选择及去向也不相同(P0.01);但对就业都保持乐观态度(P0.05)。结论:无论是军队院校医学生还是非军队院校医学生,就业观均受到当前医疗环境及就业压力等多方面因素的影响。而军队的特殊环境使得军队院校医学生就业观区别于非军队院校医学生,但总体来说医学生对医疗环境保持乐观态度,愿意投身到医疗工作中去。面对目前的就业压力,学校和相关教学医院应该通过多种途径加强对医学生的就业价值观的教育,应开设法律、道德等相关课程,帮助学生树立正确的就业观。