Delaware medical journal
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Rivaroxaban is an oral anticoagulant approved for prevention of stroke, as well as for the treatment and prevention of venous thromboembolic disease. Hemopericardium is a serious complication of anticoagulant use, which has been reported with oral vitamin-K antagonists and newer oral anticoagulants. ⋯ I report a case of hemopericardium with associated tamponade in a patient who developed pericarditis while being treated with Rivaroxaban. The case highlights an important adverse effect of a newer anticoagulant, as well as the particular dangers of medication co-administration in the elderly.
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Delaware medical journal · Jan 2015
Road map to developing a fellowship program in a tertiary care hospital.
The American Academy of Pediatrics has identified the need for more subspecialists. Beginning a pediatric pulmonary fellowship program in a tertiary care hospital can be a challenging process. Persistence, perseverance, and working through barriers to education are important strides to take toward achieving this goal. We share our experience with this endeavor. The objective of this study was to describe our experience developing a pediatric pulmonary fellowship program, the challenges we faced, and the methods we used to meet and overcome those challenges. ⋯ Self-reflection by the program director, associate director, and coordinator involved in the development and implementation of a successful fellowship program. This includes the step by step process, effort, and time commitment needed for planning and implementing a fellowship program. Our goals are to share this information with the medical community. RESULTS/OUTCOMES/IMPROVEMENTS: Planning, preparing, and implementing a pediatric pulmonary fellowship program can be challenging in the current economic climate, especially considering budget constraints and increasingly demanding clinical mandates. Department chairs and administrators view work relative value units as a marker for remuneration; educational efforts are more often an unfunded mandate. Major difficulties included imposing new educational expectations on the clinical staff and expanding the budget to include fellows' costs. Developing a program information form (PIF) was a work-in-progress over a two-year period with the dedicated staff meeting regularly during this time.
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Medical marijuana is legal for use by minors in many states, but not Delaware. Anecdotes have accumulated suggesting efficacy in managing seizures in children and several other conditions in adults. ⋯ Challenges to effective pediatric medical marijuana use remain at the level of biochemistry, the individual patient, and society. Appropriate and effective use of medical marijuana in children will require significant legislative changes at the state and federal level, as well as high-quality research and standardization of marijuana strains.