250 research outputs found
Theorizing conflict opponent noncompliance from ceasefire monitoring
No full textThird-party ceasefire monitoring is a common conflict response intervention generally correlated with
ceasefire durability. However, how ceasefire monitoring’s routine practices contribute to ceasefire
compliance and noncompliance is little understood. This dissertation aims to theorize and explain how
third-party ceasefire monitoring influences, or seeks to influence, the behaviours of conflict parties in
civil wars. Challenging the conventional view that ceasefire monitoring invariably promotes peace,
this study develops a practice-orientated, mechanism-based approach to explain the effects of
monitoring. Drawing on over 100 interviews, archival research, and document analysis from four
different contexts—Kosovo, South Sudan, Sri Lanka, and Ukraine—this study examines monitors’
practices of reporting, public speech, and remote sensing. The research takes a qualitative, abductive,
and inductive approach, integrating insights from bounded rationalism, practice theory, discourse
analysis, and surveillance studies.
Identifying a range of causal mechanisms, the study shows that ceasefire monitoring can both
constrain and provoke conflict actors. These mechanisms—such as how ceasefire monitoring provides
conflict parties with new signalling options, establishes expectations of conflict parties, and enables
conflict party resistance to surveillance—recur across conflict contexts.
By nuancing understandings of how monitoring operates in practice, this study contributes to peace
and conflict studies by showing how monitoring can produce both ceasefire compliance as well as
ceasefire noncompliance. Going beyond the generally positive, sometimes idealized, understanding of
monitoring interventions, the study shows that monitoring brings with it both risks and unintended
consequences
Use of a modified Delphi approach to develop research priorities for the Association of Coloproctology of Great Britain and Ireland.
No full textAIM:The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease.METHOD:Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority.RESULTS:Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions.CONCLUSION:It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest
Schistosomiasis: Still a Cause of Significant Morbidity and Mortality
No full textTropical diseases remain severe threats to global health with acute or chronic debility. Public health issues are regularly monitored and reported by the WHO. Conditions with high prevalence and virulence such as Schistosomiasis or Malaria still need active treatment. Advances over the decades in the treatment and management of Schistosomiasis have reduced morbidity and mortality in patients. However, poverty, adverse environments, lack of education and awareness, with parasites and vectors that can thrive if uncontrolled, remain issues for the successful global eradication of Schistosomiasis. From the disease’s discovery in 1850, the author relates historical details to its current status. Several countries previously affected, including Japan and Tunisia, have eliminated the disease while others seek the same goal. Africa remains the most severely affected continent with vulnerable women and children, although the infection persists in South America and the Far East of Asia as well. Realistic improvements for continuing health conditions are vogue and emphasized for those at risk or afflicted by the infection, illustrating success models of concerted efforts of extirpation. Constant proximity to infected water, with a parasite host, are hurdles in reducing exposure. Effective medication for acute treatment is available, and prophylaxis by vaccination is promising. Where endemic Schistosomiasis is prevalent, significant morbidity and mortality have far-reaching complications in multiple human organ systems, including irreversible pulmonary hypertension, renal, genitourinary, central nervous system conditions, and neoplasia. Two hundred and thirty million people are estimated to have contracted Schistosomiasis globally, with up to 700 million still at risk of infection, and 200,000 deaths occur annually. The disease may be more prevalent than thought after newer tests have shown increased sensitivity to pathological antigens. The author discusses infectivity risks, investigations, prognosis, treatment, and management, as well as morbidity and mortality.Other InformationPublished in: Research and Reports in Tropical MedicineLicense: https://creativecommons.org/licenses/by-nc/4.0/See article on publisher's website: https://dx.doi.org/10.2147/rrtm.s204345</p
Medical issues in flight and updating the emergency medical kit
No full textMohamud A Verjee,1 Robert Crone,2 Grigory Ostrovskiy3 1Primary Care Clerkship, Family Medicine in Clinical Medicine, 2Clinical and Faculty Affairs, Clinical Pediatrics and Anesthesiology, 3Emergency Medicine, Weill Cornell Medicine – Qatar, Qatar Foundation – Education City, Doha, Qatar Abstract: Airline travel is more affordable than ever and likely safer than ever too. Within half a day, a passenger can be on the other side of the world. However, medical care in-flight has been an issue for those with medical conditions and for those who fall sick during a journey. While airlines have the advice of multiple recognized organizations on needs and standards of care, in-flight emergencies occur at various levels. An emergency medical kit (EMK) together with trained cabin crew can be very effective at resolving the minor problems that arise and reducing the risk of escalation. On occasion, an overhead plea may be announced for additional medical expertise. Having the right content in a medical kit is more important in modern day travel, coupled with advances in equipment and passenger expectations. The authors address current issues of illness and other relevant conditions and suggest a content enhancement for an onboard EMK. Keywords: emergency medical kit, in-flight medical emergency, arterial oxygen partial pressure, pulse oximeter, automated external defibrillator, Federal Aviation Authority, International Civil Aviation Organizatio
Diabetic muscle infarction: often misdiagnosed and mismanaged
No full textMohamud A Verjee,1 Nael Amin Abdelsamad,2 Salman Qureshi,3,4 Rayaz A Malik1,5 1Department of Medicine, Weill Cornell Medicine – Qatar, Qatar Foundation, Education City, Doha, Qatar; 2Department of Paediatrics, University of Utah, Salt Lake City, UT 84112, USA; 3Department of Radiology, University of Manchester, Manchester M13 9PL, UK; 4Department of Radiology, Hamad Medical Corporation, Doha, Qatar; 5Institute of Cardiovascular Medicine, University of Manchester, Manchester, M13 9PL, UK Abstract: A patient with type 2 diabetes, retinopathy, neuropathy, and nephropathy presented with severe right distal thigh pain, which awoke him from sleep. He was diagnosed with musculoskeletal pain and discharged home. Two days later, the severity of pain increased in his right thigh and, subsequently, he developed pain in the proximal lateral aspect of his left thigh, for which he returned to hospital. He had elevated creatine kinase and myoglobin levels. An ultrasound of the right thigh identified a loss of definition of the normal muscular striations and subcutaneous edema. On MRI, the axial STIR image demonstrated extensive T2 hyperintensity in the right vastus medialis and left vastus lateralis, consistent with the diagnosis of diabetic muscle infarction (DMI). This presentation emphasizes the need for a thorough patient history and physical examination, and the importance of directed imaging for the prompt diagnosis of DMI. Keywords: muscle infarction, edema, microvascular, nephropathy, neuropathy, retinopathy, striation
Some international approaches to aminoglycoside monitoring in the extended dosing interval era
No full textAminoglycosides have rightly remained a cost-effective anti-microbial strategy for the treatment of Gram-positive infections for some 25 years. However, in recent years there has been a review of the traditional thrice-daily administration regimen in favor of an extended dosing interval strategy that takes into account the individual patient's renal function. The general recommendations that have been provided to date have been adopted in various ways internationally. These approaches were a matter of discussion for the Clinical Pharmacokinetics Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology at its congress (Vancouver, Canada; November 1997), and will again be a workshop issue at the Cairns (Australia) congress of the Association (September 1999). The present report provides examples of how these practices have been applied at a group of centers from Canada (2 centers), The Netherlands, Egypt, and Australia. These reports demonstrate a variety of approaches and highlight the need for further research for assessing clinical outcomes from different dosing strategies.Raymond G. Morris, Benedetta C. Sallustio, Alexander A. T. M. M. Vinks, Donald F. LeGatt, Zulfikarali H. Verjee, Ehab El Desok
Family medicine’s rapid establishment and early leadership role in Qatar’s health care system
No full textMohamud A Verjee,1 Mariam Ali Abdulmalik,2 Michael D Fetters31Department of Medical Education, Weill Cornell Medical College in Qatar, Qatar Foundation – Education City, Doha, Qatar; 2Primary Health Care Corporation, Doha, Qatar; 3Department of Family Medicine, University of Michigan, Michigan, USAAbstract: Family medicine is a focus of health care in Qatar, and it has emerged as a primary care pioneer in the Arabian Gulf Region. Strong governmental financial support has underpinned family medicine development in the country, and through proactive health care policy, free or highly affordable health care is available to all citizens and expatriates in primary health care centers and hospitals. An Ivy League and world-class medical school, Weill Cornell Medical College in New York established a second campus in Qatar in 2001, and enrolled its first students in 2002. The inaugural class graduated in 2008, including one graduate who matched to a family medicine residency in the United States. The College has already earned a reputation for an emphasis on cultural sensitivity in the curriculum. Qatar also has a well-established family medicine residency program overseen by the Primary Health Care Corporation. Its inaugural class of family medicine residents began training in 1995 and graduated in 1999. In contrast to a trend of fluctuating interest in family medicine training in many developed countries, the demand for residency slots in Qatar has been consistently high. Since November 2012, the Accreditation Council for Graduate Medical Education-International has approved all hospital-based residency positions. Formed in 2012, the Primary Health Care Corporation is dedicated to achieving accreditation for the family medicine residency in the near future. In 2011, Qatar’s 147 family physicians comprised about 18% of the total physician workforce. Through extended hours of operation at health centers, patients have ready access for acute care and follow-up consultations. Still, Qatar faces challenges including a projected population expansion from about 1.9 million in 2013 to 2.5 million people by 2020. Qatar’s National Primary Health Care Strategic Steering Group has recently submitted a new primary health care strategy to the government and identifies 12 challenges for the future of family medicine. Among these, ensuring access to clinical services that are patient and family centered, addressing the shortage of family physicians, expanding academic capacity, and increasing scholarly output are manifest.Keywords: family medicine, Qatar, undergraduate medical education, residency training, Arabian Gulf Regio
REFLECTING ON THE HUMANITIES, RELATED TO EXPERIENCES OF ILLNESS, WITH A CREATIVE EXPLORATION OF METAPHORIC SPACES
No full textEvery patient has a story to tell, and every experienced physician has a bank of stories to recall. A patient’s visit is not chance
but a search for a cure, amelioration of state, advice, guidance, a prescription, or for seeking reassurance, comfort, and in some
circumstances, permission to "be well". From the simplest tale to the most complex, narratives abound. Sometimes, the most intimate information shared with the physician confidante, go dark and deep, with a yearning to "tell all" after a period of suppression. Successful communication and rapport also depends on the carer's response, the degree of concentration, listening skills, body language, eye contact engagement, the patient relationship and empathy.
How do we as physicians cope with emotion on both sides when it comes to listening to a narrated story, keeping matters in
perspective, recognizing the effects of depression, grieving, anger, forgiveness, or the strength of the patient to be able to face their demons when cowardly acts of abuse have been committed.
The professionalism of doctors should always be at the highest level, but individuals vary in their responses. A price may be paid with arising stress, unsolved patient problems, an increase in new ones, and the general challenge of coping. Time may not be the only enemy with modern day medical practice.
Does narrative medicine have a place in reducing this dissonance, and will learning to share stories, as well as being a good
listener, limit adverse outcomes
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