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BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054625
Author(s):  
Ryan P Strum ◽  
Walter Tavares ◽  
Andrew Worster ◽  
Lauren E Griffith ◽  
Andrew P Costa

ObjectiveParamedic redirection from emergency department (ED) to subacute centres may be more beneficial for some patients, though little is known about which patients are potentially appropriate. We examined whether patient characteristics were associated with ED visits when the main intervention was suitable to be performed in a subacute centre.MethodsWe conducted a retrospective observational study using the National Ambulatory Care Reporting System from 2014 to 2018 in Ontario, Canada. We included all adult patients transported by paramedics and had a main physician intervention recorded. We used results of a RAND/UCLA modified Delphi study to categorise patients into either ED or a subacute care (urgent care and/or general practice centre) based on their main intervention. An independent logistic regression model was analysed for each subacute centre.ResultsA total of 2 394 072 ED visits were included; 59% of ED interventions were categorised as ‘urgent care’, 27% ‘ED only’, 9% either ‘urgent care’ or ‘general practice’ and 5% had an intervention not previously classified. ED visits suitable for ‘general practice’ had the highest percentage of patients discharged, while ‘ED only’ had the lowest. Lower medical acuity, younger age, time of triage in evening and overnight, and discharged from ED were independently associated with both subacute centres. ‘Urgent care’ visits/interventions were associated with an ED main diagnosis of the respiratory system (OR 3.49), while ‘general practice’ visits were associated with mental health disorders (OR 9.85) and injury/poison/consequences of external causes (OR 3.38).ConclusionsThe majority of ED visits had a main intervention that could have potentially been conducted in a subacute centre. We identified characteristics and diagnostic patterns associated with ED visits when the main intervention was categorised as a subacute centre intervention. This study contributes knowledge to inform which patients are potentially appropriate for paramedic redirection.


2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Hany Ebaid ◽  
Khaled Al-Rabbat ◽  
Ahmed Bakry ◽  
Muhammed Hammad ◽  
Al Shimaa Sabry

Author(s):  
Venkata RS. Subrahmanya Sarma ◽  
K. Gopalakrishna ◽  
K. Purnachandra rao ◽  
G. Somasekahr ◽  
Chowdary PSS ◽  
...  
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2021 ◽  
pp. 002076402110075
Author(s):  
Mellissa Withers ◽  
Tasfia Jahangir ◽  
Ksenia Kubasova ◽  
Mao-Sheng Ran

Introduction: Studies have demonstrated that mental health problems among university students may be increasing in both prevalence and severity. This study aimed to identify ways to reduce stigma and improve students’ utilization of mental health services. Methods: We performed a content analysis on video proposals to address stigma and mental health at universities, submitted by 15 teams from nine Asian-Pacific countries as part of a case competition. We examined five domains: (1) tone; (2) cultural context; (3) mental health issue of focus; (4) prevention versus secondary prevention; and (5) main intervention strategies. Results: Five main intervention strategies emerged: (1) educational campaigns; (2) peer interaction and support; (3) counseling; (4) screening; and (5) self-management. The results suggest that mental health literacy is low among students. Educational campaigns and events to increase awareness and reduce stigma were the most commonly incorporated strategy, through film screenings, mental health days, and social media. Building empathy through personal stories from celebrities and other students was also highly recommended. Second, counseling was incorporated in 80% of proposals, with a preference for peers and staff support, and web-based therapy over professional counselors, except in severe cases. Programs to increase social contact were the third most common strategy, suggesting students may feel isolated and disconnected. Creating common spaces for students to interact and pairing of students with and without mental health issues were widely suggested. The use of technology was recommended for self-management of mental health and for mandatory mental health screening, which was generally only recommended for incoming students. Conclusions: Our analysis provides insight into student-generated intervention approaches to prevent and address stigma associated with mental health issues among students. A greater university commitment is needed to provide a range of resources, including education and counseling, to leverage technology, and to foster stronger support networks among students.


Slavic Review ◽  
2021 ◽  
Vol 80 (2) ◽  
pp. 316-326
Author(s):  
Christy Monet

In this essay I address a gap in the study of contemporary Russia-US relations. I argue that the concepts of race and racialization are active in these relations and available for analysis, but they continue to receive very little attention as compared to concepts of democratization and securitization. My main intervention is the introduction of “race-conscious reading” as a methodological approach relevant not only to the narrow sphere of Russia-US relations, but to the field of Slavic studies more broadly. Presenting the concept of “race-conscious reading” first, I then sketch out a research agenda that extends W.E.B. Du Bois's race-conscious observation of Soviet Russia's “refusal to be white” into the contemporary era. My goal in sketching out this research agenda is to show how a race-conscious approach to reading post-Soviet Russia-US relations can bring fresh perspectives to long-standing questions—Is Russia part of the west?—and generate new questions of urgent relevance: Is there a difference between American and Russian conceptions of “whiteness,” and how and when do they clash?


2021 ◽  
Vol 15 ◽  
pp. 117955492110076
Author(s):  
Walid Alam ◽  
Youssef Bouferraa ◽  
Yolla Haibe ◽  
Ali Shamseddine

Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. Treatment options for ACC are limited, with resection the main intervention. Most cases present in late metastatic cases, and data regarding effective therapies is limited. We report a case of ACC in a 40-year-old woman with history of ACC postadrenalectomy, who presented with recurrent metastatic ACC in the left perinephric space. She was started on pembrolizumab which was added to her mitotane maintenance therapy. Complete radiological response was achieved after 4 cycles of pembrolizumab. As far as we know, this is the first case to achieve complete radiological response with mitotane and pembrolizumab in recurrent metastatic ACC, with negative prognostic markers and no prior radiotherapy. As our findings are in the setting of one clinical case, we suggest the need to perform a trial to assess the benefit of combining mitotane and pembrolizumab in treating metastatic ACC.


2020 ◽  
pp. 152-167
Author(s):  
Dov H. Levin

Chapter 5 provides an overview of the universe of American and Soviet/Russian interventions from 1946 to 2000 based upon the new dataset of such interventions utilized in this manuscript (PEIG). This chapter describes in detail the main methods used by the great powers for this purpose. It also answers some general questions of interest such as, for example, the regional and temporal patterns of electoral interventions throughout this period, the frequencies of the use of each of the main intervention methods, and the top targets of such U.S. and Russian interventions. It concludes with a discussion of additional evidence already visible from an early look at PEIG for the arguments made here and for other perspectives.


2020 ◽  
Vol 40 (2) ◽  
pp. 225-229
Author(s):  
Sarah Ghabrial

Abstract The main intervention of this special section is to identify and reposition race and colonial law as (conspicuously) absent referents in widely accepted genealogies of the state of exception—most notably, that of Giorgio Agamben—and to offer methodological pathways, based on historical and contemporary examples, of how colonial legal histories might be “written back” into this history. Collectively, these essays attempt to show how race thinking and exception each operate as the other's alibi: exception instantiating and substantiating race difference, and race difference justifying exception and ushering its expansion and normalization in steadily more realms of law and life. In so doing, this special section proposes at least three possible avenues of further inquiry, each of which builds on and into the other: First, by virtue of their geographic and temporal scope, these essays signal a way of approaching sovereignty and exception not as totalizing and synthetic, but rather as multivalent, recursive, and regenerative. Second, the designation of “partial personhood” or “disabled citizenship” is offered as a way of conceptually traversing trans-Mediterranean and trans-Atlantic historical experiences and legal traditions. Third, these essays signal the need for more sustained exploration at the nexus of law, labor, and violence.


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N A Abdelaziz ◽  
T M Abdalla ◽  
Y A Thabet ◽  
S M Fawzy

Abstract Aim of the Work This prospective analysis was planned for patients with chronic central serous retinopathy (CSR) more than three months who receive oral Eplerenone for treatment. It is aimed to reduce &resolve sub retinal fluid with improving anatomical and physiological visual functions. Patient &Methods sixteen eyes with untreated chronic Central Serous Chorioretinopathy patients who recruited from the ophthalmic clinic. Main intervention is medication by standard dose of Eplerenone, 50mg once daily. Investigated by Optical Coherence Topography at base line, one month after treatment and three months later. Over the course of the study, patients were monitored for side effects, visual and anatomical response to the medication. Results Significant difference in BCVA is found that was 0.675 ±0.2696 at base line to 0.48125±0.2287 after one month after treatment and to 0.04375±0.07274 three months after treatment, (p = 0.000). Sub retinal fluid measurements were improved significantly between each two visits as horizontal fluid volume is improved from 2137 ±987.93 at base line to1559.875 ±677.60 after one month after treatment and to 0 three months after treatment. Vertical fluid volume is improved from 203.125 ±118.73 at base line to122±49.876 after one month after treatment and to 0 three months after treatment. Central sub field thickness were improved significantly between each two visits as it is improved from 372.375 ±92.994 at base line to331.8125 ±90.283 after one month after treatment and to 250.25±25.970 three months after treatment. Contrast sensitivity improved significantly between each two visits as it is improved from 8.7625 ±4.029 at base line to 5.1968±3.227after one month after treatment and to 1.4968±0.4750 three months after treatment. Choroidal thickness was improved significantly between each two visits as it was improved from 267.9375 ±67.451 at base line to222±52.262 after one month after treatment and to 174.0625±23.713 three months after treatment. 100% of the patients complained from positive scotoma at base line, Improved to 44% of the patients complained from positive scotoma one month after treatment, improved to 0% three months after treatment. Conclusion Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic central serous Chorioretinopathy.


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