Drug treatment of obesity: don't throw the baby out with the bath water.
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Sharp-end, frontline human error occurs close to the delivery of patient care. The purpose of this article is to examine the mechanism of human error and cognition, and to explore the antecedents, attributes, and consequences of frontline human error. Fallible decision-making and actions leading to patient injury are explicated in a case study. The discussion includes strategies for preventing patient injury by refining system flaws.
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Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.
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Since major histocompatibility (MHC) antigen matching was introduced in the early 1970s as the key factor determining kidney transplant allocation, several studies, mainly arising from organ-sharing organizations in the United States and Europe, have debated this complex issue. The first fundamental concern is the interaction of human leukocyte antigen matching with other transplant outcome risk factors, for example, prolongation of ischemia and matching for age. Much concordant data advocate restraining MHC antigen-based allocation in terms of space and time limits. The second fundamental concern is the balancing of the advantages of better antigen matching in terms of improved graft survival and the improved transplantation rate in immunologically high-risk patients with the major drawback of inequitable access for ethnic minorities and patients with rare MHC haplotypes. These issues have led to considering renewed kidney allocation rules, discarding human leukocyte antigen matching from algorithms, or modifying the specificity allocation level by using cross-reactive group matching or class II MHC antigen matching. The evolving concepts in the field of histocompatibility support the need for periodically updated, flexible, and hybrid allocation systems, as designed in France by the Etablissement français des Greffes.