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In addition, patients who were managed through femoral access require a longer hospital stay, as compared to those who received radial access. Manual compression would take a longer period of time to reach hemostasis, thus increasing strain on the healthcare system. Certain procedures such as the insertion of left ventricular assist devices and mitral/aortic valve replacement procedures require relatively larger femoral vascular access sites, making mechanical compression cumbersome, or a less effective method to achieve hemostasis. Femoral vascular closure devices can be divided into two broad categories. They can be either passive or active. Passive closure devices help with mechanical compression or by increasing thrombosis for effective hemostasis. However, passive devices do not hasten the actual time it takes to reach hemostasis. Active closure devices include suture devices, collagen plugs, and clips.Patient-centered, interprofessional (IP) teams are an effective method of delivering healthcare that has improved efficiency, patient satisfaction, and staff satisfaction. As a result, team-base care is on the rise in many healthcare settings. With this rise, there is now an increased need for interprofessional education in healthcare training. Some healthcare training programs require the use of IP education to meet accreditation standards. Implementation of IP educational experiences early in training improves team communication and teamwork. Poor communication is a leading cause of medical errors, and training healthcare professionals early to work collaboratively in a team environment must be a cornerstone of their training.Early introduction to the roles and responsibilities of other professions has the potential to improve the utilization of their specific expertise and, subsequently, to improve patient outcomes. Simulation is an active learning strategy that can be used for conducting IP education. Simulation-enhanced interprofessional education (Sim-IPE) is “when participants and facilitators from two or more professions are engaged in a simulated health care experience to achieve shared or linked objectives and outcomes.” Sim-IPE allows learners to interact in a shared experience to achieve shared learning outcomes or goals. Also, it can provide insight into the roles and responsibilities of the various disciplines within healthcare. The purpose of this review is to provide insight into the necessary components of Sim-IPE curricular development, identify and overcome potential barriers to successful implementation, and improve collaborative practice.Benign occipital seizures are classified as an occipital onset epilepsy syndrome, which occurs in children with normal developmental milestones, normal general and neurological examination, and without any structural abnormalities in the brain. These seizures are limited to childhood-onset only. Under the International league against epilepsy (ILAE) classification, this is classified under childhood epilepsy syndromes. These are rare conditions with a very low incidence; however, their exact incidence is unclear. These epilepsies are broadly classified into 2 categories based on their clinical presentation. Children with Panayiotopoulos syndrome (PS) have autonomic symptoms, while children with idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) have visual symptoms. A small number of patients with this syndrome cannot be placed in either of these 2 categories.Sleep is a swiftly reversible state of decreased metabolism, responsiveness and, motor activity, which is broadly categorized into rapid eye movement (REM) and non-rapid eye movement (NREM). The NREM sleep phase again subdivides into stage N1, stage N2, and stage N3. The K-Complex is a waveform identified on electroencephalography (EEG), which primarily occurs during Stage 2 (N2) of NREM sleep, along with sleep spindles, which make up the two distinct features seen in this stage. The K-complex (KC) is a sharp, well-delineated, high-voltage, biphasic wave that lasts for more than 0.5 seconds and has been termed as the largest event in a healthy human EEG. On EEG, it was described by Laurino et al. as having a short positive voltage peak, which is usually at 200 milliseconds, followed by a large negative complex at around 550 milliseconds and finally, a long-lasting positive peak at 900 milliseconds. However, the initial short positive peak may not always be present. The occurrence of K-complexes may be spontaneous (spontaneous K-complex [SKC]), as a response to an internal stimulus such as a respiratory interruption or in response to an external stimulus like a touch on the skin (evoked K-complex [EKC]). Though K-complexes are generated in widespread areas of the cortex, they are seen maximally over the frontal and superior frontal cortices.Fractures of the naso-orbital-ethmoid (NOE) complex involve the bones that form the NOE confluence, which includes the anterior cranial fossa, frontal bone, bones of the ethmoid and frontal sinuses, nasal bones, and orbits. They often occur alongside injuries to other parts of the face and body but can occur in isolation. Road traffic accidents and physical violence are the leading causes of these injuries, but this picture is changing with improved vehicle and road safety. Knowledge of regional anatomy is fundamental in understanding assessment and management. The approach to these injuries starts with the advanced trauma life support approach, as these patients can have injuries to critical structures such as the airway. Further assessment relies on thorough clinical assessment aided by radiological imaging. The operative intervention depends on the classification of the NOE complex fracture, which is based on the status of the medial canthal tendon. Meticulous primary surgical correction is key in restoring aesthetic features and preventing future complications of trauma. Operative approach and exposure is carefully considered to balance the need to correct the deformities but also to prevent further aesthetic disruption and complications.Factor XIII is the last factor in the coagulation cascade with unique chemical properties and physiological functions. The history of discovery of factor XIII can be traced back to 1923 when Barkan and Gasper first demonstrated that fibrin clots formed in the presence of calcium ions (Ca2+) were insoluble in weak bases. In 1948, Laki and Lorand first reported a non-dialyzable, thermolabile serum factor, which made fibrin clots insoluble in concentrated urea solution. They called this serum factor as 'protein fibrin stabilizing factor.' In 1961, Lowey et al. purified the factor from plasma and reported its enzymatic nature. However, the clinical importance of this factor was realized after Duckert et al. (1961) published the report of a pediatric patient with impaired wound healing, abnormal scar formation, and severe bleeding diathesis who was found to be deficient in this factor. Bafilomycin A1 manufacturer The International Committee on Blood Clotting Factors recognized this 'protein fibrin stabilizing factor' as a clotting factor in eficiency can be formulated to minimize the bleeding episodes.Acute mountain sickness (AMS) is a syndrome that arises in non-acclimatized individuals who ascend to high altitudes. It is a form of acute altitude illness that occurs due to a decrease in the atmospheric partial pressure of oxygen as the altitude increases, inducing hypoxia. This condition typically occurs at an altitude of >2500 meters; however, it can occur at lower elevations in high-risk individuals.St. John's Wort (Hypericum perforatum) is an herbal medication that consists of anthraquinones, which have displayed anti-inflammatory and anti-cancer effects. It has also been used as an antidepressant. It derives from a flowering plant found in Europe and Asia. It is common in the form of a tablet, capsule, tea, or liquid extract used to treat a handful of medical conditions which include but are not limited to the followingThe World Health Organization recognizes palliative care as a method of improving quality of life by preventing and treating pain and other physical, psychosocial, and spiritual issues. In 2006, the American Board of Medical Specialties approved the creation of a Hospice and Palliative Medicine (HPM) subspecialty. As technology has improved over the last 20 years, it has played a vital role in medical education, especially in simulation. Simulation-Based Medical Education (SBME) has been shown to improve clinical competence, patient safety, and is cost-effective if used appropriately. Many educational principles must be considered when developing an effective SBME curriculum, including curriculum integration, feedback, deliberate practice, and mastery learning. Simulation has also been used in palliative care education, especially early on in medical trainees’ careers. Ann Faulker was a medical educator in the UK who was one of the first to advocate for simulation in palliative care in 1994. Palliative care simulation is different than procedural based simulation, and this must be taken into consideration when developing a successful simulation technique. There should be more emphasis on communication tools, interpersonal skills, self-reflection, and end of life care.Calcium gluconate is the calcium salt of gluconic acid. Gluconic acid is an oxidation product of glucose. There is 93 mg of elemental calcium in a 10 ml ampoule of 10% calcium gluconate. In comparison, there is 272 mg of elemental calcium in a 10 mL of 10% solution of calcium chloride, another calcium salt. Calcium gluconate is typically preferred over calcium chloride due to lower the risk of tissue necrosis if the fluid is extravasated.The ankle joint is one of the most commonly injured joint and the most common type of fracture to be treated by orthopedic surgeons. The estimated incidence of ankle fractures is approximately 187 per 100,000 people per year. It appears that the incidence of these fractures is increasing in developed countries, presumably secondary to the increasing number of people involved in athletic activity, including physically active elderly patients. Most ankle fractures are malleolar fractures. Approximately 60% to 70% are unimalleolar fractures (predominately lateral malleolus), 15% to 20% bimalleolar, and only 7% to 12% are trimalleolar fractures. The overall incidence is fairly equivalent between sexes, though higher in young males and older females. Due to the fairly common presentation of ankle fractures, knowledge of the proper imaging evaluation of this complex anatomy is important. Though the initial evaluation is with radiography, an understanding of further evaluation with more advanced cross-sectional imaging is also important.Anatomically, the forefoot is considered the portion of the foot that extends from the tarsal-metatarsal joint to the tips of the toes, and pathology of the toes are typically subdivided into the pathology of the hallux, or great toe, and pathology of the lesser toes. The fifth toe is the most distal and lateral structure in the forefoot is comprised of the proximal, middle, and distal phalanges. The proximal phalanx articulates with the metatarsal at the metatarsophalangeal joint, and in turn, the proximal phalanx articulates with the middle phalanx at the proximal interphalangeal joint, and the middle phalanx articulates with the distal phalanx at the distal interphalangeal joint. Layer 1, or the most superficial layer, is comprised of the following structures. The abductor hallucis muscle serves to abduct the great toe, the flexor digitorum brevis muscle which inserts on the base of the middle phalanx of toes 2 to 5 and flexes the proximal interphalangeal joints and the abductor digiti minimi muscle which serves to abduct the fifth toe.
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