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  • ISSN: 2379-0547
    Volume 3, Issue 4
    Case Report
    Shahla Namak*, Keli Beck, Heather Mertz, and Richard Lord
    The axillary digital traction maneuver to relieve shoulder dystocia is a maneuver that was mentioned in medical literature as early as the 17th century by a midwife. It has appeared in a few recent publications as an option to address complicated shoulder dystocia and was added to the list of approved maneuvers in the Advanced Life Support in Obstetrics course (ALSO) in 2013. Unfortunately, the axillary digital traction maneuver has not yet become a standard part of traditional management. Resolving the shoulder dystocia by digital traction to the posterior or anterior axilla, or both, can successfully relieve shoulder impaction. Digital axillary traction can result in shortened head to body delivery time with minimal maternal and newborn morbidity, when chosen as an early attempt to relieve the shoulders during delivery. Three cases featuring shoulder dystocia are described in this article. In these cases, these of McRoberts Maneuver accompanied by suprapubic pressure with Rubin I Maneuver were unsuccessful prior to the use of axillar digital traction which resulted in delivery. Consideration of implementing axillary traction maneuver in modern clinical practice as a viable management option for shoulder dystocia ought to be considered.
    Review Article
    José Luis Turabian* and Benjamin Perez Franco
    Turning point is a key concept in the developmental life course approach, but is currently understudied in Family Medicine, and merits further research. A turning point often involves a particular event, experience, or awareness of it, that results in changes in the direction of a pathway or persistent trajectory over the long-term. Turning points are transitions of healthcare, or changes demographic, epidemiological, psychological, social, or economic, or the key political events, crises, or decisions or regulations in the health system. Turning points are risky times which can make that the patient (and his entire family) is more vulnerable or stronger. In this article, we aim: 1) To provide a general vision of the relevant literature in the concept of “turning points”; 2) To discuss the methodological and practical considerations to use the indicators of “turning points” in the routine assistance in the consultation of the Family Medicine; and 3) To suggest areas for future research. The practical approach could be a way to see not only “problems” in patients, but also their transitions. The family doctor allows changes, where patients move from one stage to another, while help keeping all possibilities to achieve positive results. From this perspective, addressing the apparent problems and obstacles of life does not necessarily mean risks or chaos, but opportunities to gain depth in vision, and identify strengths unknown. Once the family doctor adopts this position can better help his patient to rearrange and recreate their world.
    Research Article
    Gordon Bush and Julie Adkison*
    Family physicians are becoming increasingly responsible for diagnosing and managing the mental health concerns of their patients. A psychopharmacy seminar was created to integrate pharmacotherapy teaching with behavioral medicine skills to advance the residents' management of the complexities of these patients. Our study was designed as a pilot study to gather feedback from learners on the usefulness of the concepts taught in the psychopharmacy seminar on routine patient care. The teaching seminar has been in existence for more than 5 years and has received positive verbal feedback from learners. In order to evaluate the seminar in a formal manner, a survey was distributed to the 42 family medicine residents about their perceptions regarding the utility of the seminar content in terms of patient management. An overall response rate of 21 out of 42 residents (50%) was achieved. Pharmacologic teaching points about the use of antidepressants, including the initial selection of therapy, determining when to switch therapy, and strategies for augmenting ineffective therapy, were all rated as “often useful.” Behavioral medicine teaching points on developing a treatment plan, troubleshooting an ineffective plan, and learning to discuss mental health issues with patients were also rated as “often useful.” Similar results were obtained through solicited written comments. The positive responses to the seminar indicate the utility of integrating these two disciplines in training residents. Seminars focusing on behavioral medicine and pharmacology could play a vital role in training family physicians to effectively manage complex mental health disorders.
    Leonard A. Jason*, Laura Nicholson, and Madison Sunnquist
    For decades, researchers and patients have been debating the terms and criteria for chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME). This has led to considerable difficulties in clearly communicating to the public the nature of these illnesses, and has produced considerable methodological challenges for researchers who study these illnesses. If different laboratories do not employ comparable criteria to select patients, this will have negative consequences for understanding epidemiology, etiology, diagnostic and treatment approaches. In part due to this ongoing controversy, the Institute of Medicine in 2015 recommended new criteria and a new name. The present study surveyed a relatively large sample of patients both in and outside the US to determine attitudes toward the primary names and criteria that have been used to characterize these patients. Assessing patient opinions is an activity that might help provide gatekeepers (i.e., federal officials, scientific and patient organizations) with valuable input for ultimately clarifying this debate regarding names and criteria.
    Mini Review
    Maria A. Karalexi, Marios K. Georgakis, and Eleni Th. Petridou*
    Indisputable are the benefits of assisted reproductive technology (ART), including in vitro fertilization (IVF) for subfertility treatment. These technologies have been increasingly adopted, albeit concerns regarding potential short- and long-term consequences on children's health. We aimed to review previous relevant publications on a topic of major public health concern. IVF pregnancies seem to be associated with increased perinatal morbidity, including prematurity, multiple births, low birth weight and congenital malformations, as well as, neonatal mortality. Regarding long-term outcomes, IVF has been significantly associated with increased risk for cerebral palsy, mainly attributed to prematurity, whereas the neurodevelopment outcome does not seem to be affected. IVF is also related to exposure to high stress levels; yet, the so far findings about cardiometabolic consequences remain controversial. More robust seem to be the results for certain rare malignancies, including retinoblastoma/ hepatoblastoma, and specific childhood acute leukemia subtypes. It is not clear whether the effect of IVF on the epigenetic profile can be attributed to the underlying subfertility or the procedure itself. In conclusion, IVF increases the incidence of premature and high-risk newborn, whereas pre-implantation diagnostic techniques can be used to reduce the likelihood of transmission of genetic diseases. Future epidemiologic and basic research is anticipated to more meticulously assess the long-term consequences as the cohort of IVF children is growing and to assist informed choices for sub fertile couples.
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