Mountains on the moon: the role of imagination and style in science.
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Immobilization and or surgery, for repair of a mallet finger, does not always guarantee full extension of the distal interphalangeal joint. As therapists, we often will see a residual extension lag. This might be noted during the patient's first visit or sometimes after they start an exercise program. This author has expanded on the current digit extension neoprene tubes that focus on the proximal interphalangeal joints.
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The values held by health care administrators and inherent in the operation of the institution are of primary importance to the ministry of pastoral care. This narrative/story provides a case history in which the author recounts how these values change as administrators change. The results suggest that these values constitute one of the hidden variables that influenced the questionnaire results reported earlier in this work.
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Remarkable advances in instrument technology, automation and computer science have greatly simplified many aspects of previously tedious tasks in laboratory diagnostics, creating a greater volume of routine work, and significantly improving the quality of results of laboratory testing. Following the development and successful implementation of high-quality analytical standards, analytical errors are no longer the main factor influencing the reliability and clinical utilization of laboratory diagnostics. Therefore, additional sources of variation in the entire laboratory testing process should become the focus for further and necessary quality improvements. Errors occurring within the extra-analytical phases are still the prevailing source of concern. Accordingly, lack of standardized procedures for sample collection, including patient preparation, specimen acquisition, handling and storage, account for up to 93% of the errors currently encountered within the entire diagnostic process. The profound awareness that complete elimination of laboratory testing errors is unrealistic, especially those relating to extra-analytical phases that are harder to control, highlights the importance of good laboratory practice and compliance with the new accreditation standards, which encompass the adoption of suitable strategies for error prevention, tracking and reduction, including process redesign, the use of extra-analytical specifications and improved communication among caregivers.
In different study populations, several studies have shown that modest C-reactive protein elevation, in the range of apparently healthy individuals, is a strong predictor of future vascular events. Willcox and colleagues summarize the epidemiological and clinical observations that have led to the enthusiastic suggestion that determination of serum C-reactive protein levels could also be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease. Currently, high-sensitivity C-reactive protein assays as a screening test to ascertain individuals at risk of cerebrovascular disease does not provide an accurate determination of the risk of stroke likelihood, and adequate evidence that early detection improves health outcomes and that an early intervention is likely to have a beneficial impact. High-sensitivity C-reactive protein assays as a screening test, only provide inadequate evidence to be considered as an effective cerebrovascular screening test, especially in the elderly.
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Complete rupture of the anterolateral papillary muscle after successful coronary artery bypass procedure is an extremely rare event. We have been able to detect the initial phase of this uncommon complication just after weaning from cardiopulmonary bypass using intraoperative transesophageal echocardiographic examination.
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