Prevalence of hallux valgus in the general population : a systematic review and meta-analysis

BACKGROUND: Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender. METHODS: Electronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model. RESULTS: A total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis. CONCLUSIONS: Notwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research.

What do emergency physicians think of law?

What do emergency physicians think of law? Do they know the law? What role does it have in the practice of emergency medicine? Emergency physicians in New South Wales, Victoria and Queensland are being asked about these issues in a study by the Queensland University of Technology, Brisbane, Australia, titled ‘Withholding and withdrawing life-sustaining treatment from adults who lack capacity: The role of law in medical practice’. The study aims to examine the role that law plays in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity.

Should law have a role in end-of-life care?

What do physicians think of law? Do they know the law? What role does it have in the provision of end-of-life care? Physicians in New South Wales, Victoria and Queensland are being asked about these issues in a study by the Queensland University of Technology entitled ‘Withholding and withdrawing life-sustaining treatment from adults who lack capacity: The role of law in medical practice’. This research aims to examine the role that law plays in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity.

Menopause as a long-term risk to health : implications of general practitioner accounts of prevention for women’s choice and decision-making

Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) the hormonal menopause – symptoms, risk, prevention; (ii) the informed menopausal woman; and (iii) decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f.Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having ‘choices’ and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved from a discursive shift in medicine and that there exists within this new configuration, claiming the empowerment of women as an integral part of health care for menopause, the possibility for change in medical practice which will broaden, strengthen, and maintain this position.

Honesty about adverse event : more honoured in the breach than in the observance?

Part of the chapter: "Sale of Sperm, Health Records, Minimally Conscious States, and Duties of Candour" Although ethical obligations and good medical practice guidelines clearly contemplate open disclosure, there is a dearth of authority as to the nature and extent of a legal duty on Australian doctors to disclose adverse events to patients.

The effectiveness of health education using the teach-back method on adherence and self-management in chronic disease: A systematic review protocol

Review question/objective What is the effect of using the teach-back method for health education to improve adherence to treatment regimen and self-management in chronic disease? Inclusion criteria Types of participants This review will consider all studies that include adult patients (aged 18 years and over) in any healthcare setting, either as inpatients (eg acute care, medical and surgical wards) or those who attend primary health care, family medical practice, general medical practice, clinics, outpatient departments, rehabilitation or community settings. Participants need to have been diagnosed as having one or more chronic diseases including heart failure, diabetes, cardiovascular disease, cancer, respiratory disease, asthma, chronic obstructive pulmonary disease, chronic kidney disease, arthritis, epilepsy or a mental health condition. Studies that include seriously ill patients, and/or those who have impairments in verbal communication and cognitive function will be excluded. Types of intervention This review will consider studies that investigate the use of the teach-back method alone or in combination with other supporting education, either in routine or research intervention education programs; regardless of how long the programs were and whether or not a follow-up was conducted. The intervention could be delivered by any healthcare professional. The comparator will be any health education for chronic disease that does not include the teach-back method. Types of outcomes Primary outcomes of interest are disease-specific knowledge, adherence, and self-management knowledge, behavior and skills measured using patient report, nursing observation or validated measurement scales. Secondary outcomes include knowledge retention, self-efficacy, hospital readmission, hospitalization, and quality of life, also measured using patient report, nursing observation, hospital records or validated measurement scales.

Failure to administer a drug and causation

Case note on King v Western Sydney Local Health Network In King v Western Sydney Local Health Network [2013] NSWCA 162 the appellant sought damages for the severe physical and intellectual disability she suffered as a result of foetal varicella syndrome (FVS) caused by her mother contracting varicella (chickenpox) in the second trimester of her pregnancy. The mother had been exposed to the virus and sought advice from a doctor at Blacktown Hospital as she had not had the virus herself and therefore did not possess immunity. In such circumstances at the time, the standard medical practice was to offer the mother varicellazoster immunoglobulin (VZIG) to boost her defence to the virus. The appellant’s mother however was not offered this treatment and contracted chickenpox resulting the appellant’s condition...

Dispensing doctor : an underutilise resource?

Introduction Multidisciplinary models of organising and providing care have been proposed to decrease the health services gap between urban and rural populations but health workforce shortages exist across most professions and are further exacerbated by maldistribution. Flexibility and expansion of the range of tasks that a health professional can undertake were proposed. Dispensing doctors (DDs) are such an example. As part of DDs’ routine medical practice, DDs are able to both prescribe and dispense medicines to their patients. The granting of a dispensing licence to a doctor is intended to improve rural community access to medicines where there is no pharmacy within a reasonable distance. Method An iterative, qualitative descriptive methodology was used to identify factors which influenced DDs’ practice. Qualitative data were collected by in-depth face-to-face and telephone interviews with DDs. A combination of processes: qualitative content analysis and constant comparison were used to analyse the interview transcripts thematically. Member checking and separate coding were utilised to ensure rigour. Result Thirty-one interviews were conducted. The respondents universally acknowledged that the main reason for dispensing were for the convenience and benefits of their patients and to ensure continuity of care. DDs’ communities were generally more isolated and smaller when compared to their non-dispensing counterparts. DD-respondents viewed their dispensary as a service to the community. Peer pressure on prescribing was a key factors in self-regulating prescribing and dispensing. Conclusion DDs fulfill an important area of unmet needs by providing continuity of pharmaceutical care but the practice is hindered by significant barriers

Double effect and palliative care excuses

• The doctrine of double effect is an exception to the general rule that taking active steps that end life is unlawful. • The essence of the doctrine at common law is intention. • Hastening a patient’s death through palliative care will be lawful provided the primary intention is to relieve pain, and not cause death, even if that death is foreseen. • Some States have enacted legislative excuses that deal with the provision of palliative care. • These statutory excuses tend to be stricter than the common law as they impose other requirements in addition to having an appropriate intent, such as adherence to some level of recognised medical practice.

Humanness and Dehumanization

What does it mean to be human? Why do people dehumanize others (and sometimes themselves)? These questions have only recently begun to be investigated in earnest within psychology. This volume presents the latest thinking about these and related questions from research leaders in the field of humanness and dehumanization in social psychology and related disciplines. Contributions provide new insights into the history of dehumanization, its different types, and new theories are proposed for when and why dehumanization occurs. While people’s views about what humanness is, and who has it, have long been known as important in understanding ethnic conflict, contributors demonstrate its relevance in other domains, including medical practice, policing, gender relations, and our relationship with the natural environment. Cultural differences and similarities in beliefs about humanness are explored, along with strategies to overcome dehumanization. In highlighting emerging ideas and theoretical perspectives, describing current theoretical issues and controversies and ways to resolve them, and in extending research to new areas, this volume will influence research on humanness and dehumanization for many years.

Hans Krakauer and Elizabeth Krakauer nee Gottschalk; Boston, New York. Portraits Couples

Photograph taken in front of the house in Boston, in upstate New York outside of Buffalo, where in 1939 they set up their private medical practice. After WWII, they built a new house next door.

Hans Krakauer and Elizabeth Krakauer nee Gottschalk; Boston, New York. Portraits Couples

Photograph taken in front of the house in Boston, in upstate New York outside of Buffalo, where in 1939 they set up their private medical practice. After WWII, they built a new house next door.

Hans Krakauer and Elizabeth Krakauer nee Gottschalk; Boston, New York. Portraits Couples

Photograph taken in front of the house in Boston, in upstate New York outside of Buffalo, where in 1939 they set up their private medical practice. After WWII, they built a new house next door.

Hans Krakauer and Elizabeth Krakauer nee Gottschalk; Boston, New York. Portraits Couples

Photograph taken in front of the house in Boston, in upstate New York outside of Buffalo, where in 1939 they set up their private medical practice. After WWII, they built a new house next door.

My Family Biography.

Memoir in four volumes, richly illustrated with photographs, drawings, correspondence, genealogical tables, and newspaper clippings.