This article was checked by iThenticate. Similartiy Index 20% Bu makalede araştırma ve yayın etiğine uyulmuştur.
Rationale:Perineural cysts, commonly referred to as Tarlov cysts, are cerebrospinal fluid-filled dilations between the perineurium and endoneurium typically arising at the junction of posterior and dorsal root ganglia in the neural foramina. This anatomical location is in close proximity to usual needle trajectory during performing transforaminal epidural injection, and therefore presents a potential risk of dural puncture and associated complications.Patient concerns:Severe lower extremity pain interfering with activities of daily living.Diagnoses:Lumbar radiculopathy secondary to left-sided L4-5 disc herniation in the presence of multilevel Tarlov cysts in the neural foramina.Interventions:Posterior interlaminar epidural steroid injection technique was preferred, as opposed to transforaminal approach, to avoid potential risk of dural puncture and associated complications in the presence of multilevel Tarlov cysts in the neural foramina.Outcomes:The patient responded favorably to epidural steroid injection via interlaminar approach with complete resolution of pain, symptoms, and signs. There were no complications. The patient was able to tolerate physical therapy, wean pain medications, and achieve normal activities of daily living without any significant limitations.Lessons:In patients presenting with an MRI report of “Tarlov cysts”, meticulous evaluation of diagnostic images should be an essential first step before considering invasive spinal procedures. Should there be any presence of Tarlov cyst in close proximity to planned needle trajectory, we recommend appropriate modification of spinal intervention to avoid potential complications.
Background:Physician counseling on the risks of tobacco smoking and the benefits of cessation has been shown to be an effective method of increasing the rate of smoking cessation. Using the “Help Your Patients Quit Smoking: A Coaching Guide” also referred to as the “7A's of Smoking Cessation” guideline from the New York City Department of Health and Mental Hygiene is thought to be effective to convey the importance of smoking cessation.Aim:To study the efficacy of the “7A's of Smoking Cessation” guideline counseling conducted by osteopathic medical students.Materials and Methods:Osteopathic medical students were trained to counsel smokers for 3–10 min based on New York City Department of Health's “7A's of Smoking Cessation” guidelines by a licensed physician. Students then counseled health fair participants who were cigarette smokers for 3–10 min. Postcounseling, participants were administered an 4 question survey to evaluate the effect counseling had on their desire to quit smoking. Survey data were collected and analyzed. Institutional Review Board approval was obtained for this study.Results:A total of 13 anonymous health fair participants who were also smokers were administered both counseling sessions and surveys. 11/13 (84.6%) participants stated that the session motivated them to quit smoking. 9/13 (69.2%) participants responded that they were now motivated to discuss smoking cessation with their doctor after being counseled. Of these participants 12/13 (92.3%) had previously attempted to quit smoking without success.Conclusion:Participants reported an increased willingness to stop smoking after being counseled by osteopathic medical students. Participants also reported an increased motivation to discuss smoking cessation with their physician. These findings indicate that smoking cessation counseling administered by osteopathic medical students effectively in encouraging smokers to consider reduction or cessation of tobacco use.
ÖzetAmaç: Ömür boyu mezuniyet sonrası eğitimi de içeren sürekli tıp eğitimi (STE) çok önemlidir ve bu konuda tüm dünyada bir çok çalışma yapılmış-tır. Türkiye'de ilk STE çalıştayı 1991 yılında Türk Tabipler Birliği tarafından yapılmıştır. 1994 yılında STE kredilendirme kurulu oluşturulmuştur. Çalışma-mızda Türkiye'deki göğüs hastalıkları uzmanlarının STE ile ilgili yaklaşımla-rını ve durumlarını belirlemeyi amaçladık. Gereç ve Yöntem: Kesitsel tipteki bu anket çalışma Türkiye'deki devlet ve göğüs hastalıkları hastanelerinde çalışan göğüs hastalıkları uzmanlarında uygulanmıştır. 36 ilde eğitim hastanelerinde çalışmayan 130 göğüs hastalıkları uzmanları çalışmaya çağrıl-dı. Bulgular: Cevap oranı 54.6%. Katılımcıların 28.2%'si düzenli olarak mezuniyet sonrası eğitim aktivitelerine katılmışlardır. Uzmanlıkları ile ilgili yayın ve web sayfasını düzenli olarak takip edenlerin oranı sırası ile 58.8% ve 63.5% idi. Katılımcıların58.8%'i kendilerini mesleklerinde gerilemiş hissettiklerini, 72.9%'u mesleksel açıdan gelişmek için eğitim araştırma hastanelerine rotasyona gidebileceklerini belirtmişlerdir. Tartışma: Ülkemizde STE kavramının henüz tam olarak olgunlaşmamış olması sağlık hizmetlerindeki kaliteyi, dolaylı olarak da doktorların özgüvenini tehdit etmektedir. Yapılanların yanında yapılması gerekenler de mevcuttur. Anahtar KelimelerEğitim; Tıp; Sürekli Abstract Aim: Continuing medical education (CME) including the life long post-graduate training considered very important and serious work done in this direction worldwide. In Turkey, CME workshop was done by the Turkish Medical Association in 1991 firstly and CME credit board has been created in 1994.We aimed to determine approachments and status of the pulmonologists on CME, in Turkey. Material and Method: The cross-sectional, questionnairebased study was carried out among pulmonologists working in state or chest disease hospitals in Turkey. 130 pulmonologists in 36 provinces those did not work in training hospitals invited to participate to study. Results:Response rate was 54.6%. 28.2% of the participants had been participating to post-graduate education activities regularly. The participants that followup a publication and a web site about their specialty on a regular basis were 58.8% and 63.5%; respectively. 58.8% of the physicians sometimes feel themselves regressed in their profession and 72.9% of them request for rotation to training and research hospitals to develop themselves in professional respect. Discussion: In conclusion, not yet fully evolved concept of CME in our country threatens the quality of healthcare, and indirectly, safety of the physician. There are needs to be done as well as those made of.
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