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141. Patient Dignity (Formerly: Patient Modesty): Volume 92

, tacit agreement – no females were allowed. This would be strictly for men and men felt safe in these situations. I don’t think naked military induction exams really became standard until WW1. That’s not to say it didn’t occur during the Crimean War, the American Civil War or the Franco-Prussian War. We’d have to research that. But before “modern” warfare, governments were more interested in bodies in any condition to man the front lines. Doctor’s examining naked bodies didn’t really begin seriously (...) TO THE EXTENT THAT NONE OF YOU CAN TRULY APPRECIATE. PT At , said... Dr. Bernstein, I looked at Volume 12. There were more women participating back then and that was an excellent discussion about the pelvic exams in exchange for birth control. I hope that isn't still as mandatory as it was then. The discussion was as well a bit more focused on patients simply being modest and/or uncomfortable with opposite gender intimate care without going into staff misbehavior or unprofessional behavior as being

2018 Bioethics Discussion Blog

142. Patient Modesty: Volume 91

nurses always let their male patients lie nude longer than really needs too. It is at this time that I am going to give a bigger picture of the more common privacy violations that occur in hospitals. Definition of flashing: Female nurses open up their male patients gowns to expose the patient’s genitals when other female staff enter the male patients’s room. Location, neuro icu, micu, any intensive care unit whereby male patients are comatose by barb induced comas. This unnecessary exposure in the 70

2018 Bioethics Discussion Blog

143. Study of Probable Benefit of the Neuro-Spinal Scaffoldâ„¢ in Subjects With Complete Thoracic AIS A Spinal Cord Injury as Compared to Standard of Care

that these preexisting morbidities will increase risk, affect safety monitoring, or confound study results Spinal cord injury associated with significant traumatic brain injury or coma that, in the opinion of the Investigator, would preclude adequate assessment of spinal cord function, brain injury that could be associated on its own with sensory or motor deficits, or subjects with any other reason that results in an unreliable ISNCSCI exam Subjects with clinically significant pre-existing respiratory disease (...) for each study arm at visits (pre-surgery, 3-months, 6-months, 12-months, 24-months). Observed values and change from the baseline will be presented for each study arm.The ISNCSCI exam performed within 8 hours prior to surgery (pre-surgery ISNCSCI) will be used as the baseline. Change in motor scores [ Time Frame: 3-months, 6-months, 12-months, 24-months post-open spine surgery ] A numerical summary score of motor function in each extremity determined by the International Standards for Neurological

2018 Clinical Trials

145. Third Universal Definition of Myocardial Infarction

—as little as 20 min, or less in some animal models. 4 It takes several hours before myocardial necrosis can be identi?ed by macroscopic or microscopic post-mortem exam- ination. Complete necrosis of myocardial cells at risk requires at least 2–4 h, or longer, depending on the presence of collateral cir- culation to the ischaemic zone, persistent or intermittent coronary arterial occlusion, the sensitivity of the myocytes to ischaemia, pre- conditioning, and individual demand for oxygen and nutrients. 2

2012 European Society of Cardiology

146. Delirium

oximetry — to identify fever, hypoperfusion, hyperglycaemia, hypoglycaemia, or hypoxia. Carry out a general examination to identify such as: Respiratory conditions, for example chest infection, pulmonary embolus, heart failure, or chronic obstructive pulmonary disease. Cardiovascular conditions, for example myocardial infarction and heart failure. Abdominal conditions, for example acute abdomen, constipation, faecal loading (carry out a rectal exam if possible if impaction is suspected), urinary

2016 NICE Clinical Knowledge Summaries

147. Autologous Transplant Using Dose-Escalated Total Body Irradiation & Cyclophosphamide & Palifermin for NHL

Bilirubin > 20 mg/dL Unexplained seizures or coma Severe mucositis requiring intubation for airway protection Ileus requiring nasogastric decompression. Death Secondary Outcome Measures : Blood work will be used to evaluate recovery of white blood cells, red blood cells and platelets. [ Time Frame: 4 weeks ] To evaluate labwork during treatment and for 28 days post treatment Pulmonary Function Test will be used to evaluate side effects of total body irradiation [ Time Frame: 1 year ] Pulmonary Function (...) Test will be used to evaluate side effects of total body irradiation. CT scan or physical exam will be used to evaluate progression free survival. [ Time Frame: 1 year ] CT scan or physical exam will be used to evaluate progression free survival as deemed necessary. Mucositis measured by investigators. [ Time Frame: At the start of treatment and daily until mucositis resolves or 28 days post transplant whichever comes first. ] Mucositis physical examination done by investigators by accessing

2017 Clinical Trials

148. HIV and Stroke Outcomes in Uganda

the clinical and radiologic characteristics of stroke in Uganda, with particular attention to differences by HIV serostatus. We will describe the clinical presentation of stroke, including history and physical exam findings and presenting modified National Institutes of Health Stroke Scale (mNIHSS) score. We will also compare radiologic characteristics, including location of the stroke and its classification as either ischemic or hemorrhagic. We hypothesize that: i) HIV-infected patients are predominantly (...) in Uganda. We will fit regression models to identify predictors of poor outcomes as described in Aim 1, both in the total cohort, and restricted to the HIV-infected cohort. We hypothesize that age, presence of hypertension, dyslipidemia, smoking, and low Glasgow coma score are associated with PSO in Uganda and that HIV-specific predictors of poor outcome are low mid-upper arm circumference (MUAC), low CD4 cell count, high HIV viral load, and report of recent constitutional symptoms. Study Design Go

2017 Clinical Trials

149. Study of MEDI0382 in Combination With Dapagliflozin and Metformin in Overweight/Obese Subject With Type 2 Diabetes

and treatment emergent serious adverse events AEs related to changes in 12 lead ECG [ Time Frame: 57 days ] Measure by number of AEs related to clinically important changes in 12 lead ECG AE's related to clinically important changes in vital signs [ Time Frame: 57 days ] Measured by the number of AE's related to clinically important changes vital signs (including 24 hour HR and BP) AE's related to changes in physical exam [ Time Frame: 57 days ] Number of AE's related to changes in physical exam AE's (...) , a history of DKA, or hyperosmolar nonketotic coma or treatment with daily SC insulin within 90 days prior to screening Fasting hyperglycemia (> 250 mg/dL/ > 13.9 mmol/L) prior to randomization C-peptide level < lower limit of normal (LLN) History of acute or chronic pancreatitis or pancreatectomy Hypertriglyceridemia (> 400 mg/dL) at screening Significant inflammatory bowel disease, gastroparesis, or other severe disease or surgery affecting the upper gastrointestinal (GI) tract (including weight

2017 Clinical Trials

150. Cerebral Vascular Effects of Dexmedetomidine Versus Propofol Sedation in Intubated Mechanically Ventilated ICU Patients

for details. ClinicalTrials.gov Identifier: NCT03285165 Recruitment Status : Recruiting First Posted : September 15, 2017 Last Update Posted : September 15, 2017 See Sponsor: Assiut University Information provided by (Responsible Party): Hala Saad Abdel-Ghaffar, Assiut University Study Details Study Description Go to Brief Summary: Serial transcranial Doppler (TCD) exams in healthy volunteers and in animal models showed a strong linear relationship between middle cerebral artery (MCA) flow velocity (FV (...) Criteria: Adult trauma patients (18-50 years old, ASA I-II). With and without mild TBI. Mild traumatic brain injury will include; brain edema, brain contusion, fracture base, fissure fracture and depressed fracture. The severity of traumatic brain injury will be defined as mild based on basal Glasgow Coma Scale and basal Computerized tomography scanning. Requirements of endotracheal intubation, mechanical ventilation and light to moderate sedation because of associated abdominal or chest traumatic

2017 Clinical Trials

151. EMRs are robbing physicians of their writing skills

and the poet John Keats in the 1700s. In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan Doyle, and William Somerset Maugham. Examples from our time (or at least mine) are A.J. Cronin (Dr. Finlay) Robin Cook (Coma), Viktor Frankl (Man’s Search for Meaning), Michael Crichton (Jurassic Park), the Polish science fiction writer Stanislav Lem, M. Scott Peck (The Road Less Traveled), Oliver Sacks, Frank Slaughter, Sherwin Nuland, Walker Percy and more recently, Mainer Tess Gerritsen (...) is to prominently list the items that are required for payment and compliance purposes. Evaluation and management (E&M) reimbursement codes are built around how many aspects of a symptom or a physical exam are documented. Sometimes called “bullets,” each one is usually a separate sentence in the “printout” display of a medical record whereas to the documenting physician they may be a click box. Looking at the computer screen, they are sometimes quick to review, much like the paper forms, I used to create

2017 KevinMD blog

152. Patient Modesty: Volume 80

published, the topic has been roughly the same and unchanged, essentially, a patient's right for privacy when undressed either in the operating room, procedure room, office exam room or the patient's hospital room. The thread is about the ethical and perhaps legal right for the patient to be able to request and hopefully receive the medical attention by professionals of the patient's desired gender when undergoing a medical examination or procedure. That request to whatever part of the medical system (...) patients has never meant that I was unaware of the concept of modesty especially when applied to genital/rectal areas of the body and breasts in the female. And certainly that is why I always had a female chaperone present with female pelvic exams. But, in my mind, since I got no warnings from my patients, was that they looked at the examination value for their diagnosis and health as trumping any personal modesty issue and accepted that as such. Looking back I am not sure that for some of the requests

2017 Bioethics Discussion Blog

153. Compliance with evidence-based guidelines for computed tomography of children with head and abdominal trauma. (PubMed)

pediatric center with these guidelines as a tool for quality improvement.Records of children admitted to our pediatric trauma center one year before and two years after publication of head (Kuppermann '09) and abdominal trauma (Holmes '13) CT imaging guidelines were reviewed. Data collected included demographics, Glasgow coma score, (GCS), injury severity score (ISS), mechanism of injury, and indication for imaging based on criteria/guidelines from the prediction rule including history, symptoms (...) , and physical exam findings.There were 296 total patients identified. Demographic data, GCS, ISS, and mechanism of injury were similar between both groups before and after guideline publication. Prior to publication of head trauma imaging guidelines, 20.7% of head trauma patients had no indication for head CT prior compared with 19.5% after publication of imaging guideline (p=0.85). Prior to publication of abdominal trauma imaging guidelines, 28.9% of patients had no indication for abdominal CT compared

2017 Journal of Pediatric Surgery

154. A physician’s first code. See how it turned out.

with irreversible brain damage and lie in comas. Few ever leave the hospital. Death is greedy. Still, we have to try. I run down the corridor towards the patient’s bed. My sneakers make little squeaks against the linoleum floor, echoing off the walls of the mostly quiet hospital. My mind is a zoo. The flooring makes this place sound like a gymnasium. How many minutes in between epinephrine injections again? I should run more, I’m already out of breath. Think of causes, causes. The 5 H’s, the 4 T’s. What (...) stillness is serene, otherworldly. Impossible for a living being to achieve. The few remaining people in the room use hushed voices. The room feels sacred, somehow. I look at the man again. I think of Homer’s line from the Odyssey: “Upon his eyes gathered the mist of death.” I perform the death exam. I check his eyelids and see no corneal reflex. Feel no pulse. Hear no breath sounds. It’s done. I exit the room. A few feet from the door, a young black woman in cheery pink scrubs, is curled up in a ball

2017 KevinMD blog

155. Primary Care Corner with Geoffrey Modest MD: New Diabetes Guidelines From ADA

the risk for future episodes”. [Seems pretty reasonable to me, given that the first symptom of hypoglycemia in these patients can be coma, or death] Medical management of diabetes Need to address behavioral, dietary, lifestyle and drugs [I am surprised how often we as providers, perhaps a bit inured/numbed by the frequency we see diabetic patients, do not step back and talk to the patient about the really profound effects that diabetes has on their whole lives, both psychosocially (effects (...) control. Annual eye exam, and NOT substitute retinal photographs [retinal photographs are trashed in the summary, though in the full text article, they do think it has value though is not a substitute for a full eye exam when that is available. Also there are some data suggesting that meds, esp ACE-I/ARBs help here, not sure why they are not mentioned] Nerves: obtain best A1c, preferred drugs are pregabalin, duloxetine, tapentadol. But others used include tricyclics, gabapentin, venlafaxine

2016 Evidence-Based Medicine blog

156. Transcranial Electrical Stimulation for mTBI

and post-treatment assessments. Specific Aim 3 will study the relationship among IASIS treatment-related changes in rs-MEG slow-wave imaging, PCS, and neuropsychological measures in Veterans with mTBI. The investigators hypothesize that Reduced MEG slow-wave generation will correlate with reduced total PCS score, individual PCS scores (e.g., sleep disturbance, post-traumatic headache, photophobia, and memory problem symptoms), and improved neuropsychological exam scores between post-IASIS and baseline (...) exams. The success of the proposed research will for the first time confirm that facilitation of slow-wave generation in wakefulness leads to significant therapeutic benefits in mTBI, including an ultimate reduction of abnormal slow-waves accompanied by an improvement in PCS and cognitive functioning. Condition or disease Intervention/treatment Phase Mild Traumatic Brain Injury (mTBI) Post-traumatic Stress Disorder Device: IASIS Micro Current Neurofeedback Not Applicable Study Design Go to Layout

2017 Clinical Trials

157. The Impact of a Bundle of Preventive Measures for Post-intensive Care Syndrome on the Outcome of Critically Ill Patients

), with a length of ICU stay of at least 2 day, from January 01 to December 31 2018. Patients with severe cognitive deficits prior to admission, identified by clinical history obtained by the psychology or through the Mental State Mini Exam (MMSE), traumatic brain injury and stroke patients with Glasgow coma scale <14, will be excluded. On admission to the ICU, risk factors for PICS will be identified. During ICU stay, the patients will be submitted to nine interventions aiming at the prevention of PICS (...) , identified by clinical history obtained by the psychology or through the Mental State Mini Exam (MMSE), traumatic brain injury and stroke patients with Glasgow coma scale <14, will be excluded. Criteria Inclusion Criteria: . Adult non pregnant patients Length of ICU stay of at least 2 days. Exclusion Criteria: Severe cognitive deficits prior to admission. Traumatic brain injury with Glasgow coma scale < 14 Stroke with Glasgow coma scale < 14 Contacts and Locations Go to Information from the National

2017 Clinical Trials

158. Is Anesthetic Loss of Consciousness a Top Down or Bottom up Phenomenon. What Does the Neurologic Examination Say?.

Intervention/treatment Phase Anesthesia; Functional Diagnostic Test: FOUR coma scale and frontal espectrograpy evaluation Not Applicable Detailed Description: Clinical experimental randomized study, approved by the Ethic Committee, with informed consent, included ASA I- II adults, without neurological illness and normal physical exam. The patient randomized in two groups, rapid induction (GR) with propofol in target controlled infusion (TCI) effect site mode using the phamacokinetic (PK) model from Marsh (...) Posted : May 4, 2017 Last Update Posted : May 31, 2017 Sponsor: Universidad del Desarrollo Information provided by (Responsible Party): Pablo O. Sepulveda, Universidad del Desarrollo Study Details Study Description Go to Brief Summary: Using very slow or fast propofol intravenous injection, monitored using standard American Society of Anesthesiology (ASA) standard and SEDLine EEG (Med Tech), the patient was evaluate by a neurologist every 30 sec using the FOUR coma scale. Condition or disease

2017 Clinical Trials

159. Single Ascending Dose Study of MK-1092 in Healthy Participants and in Participants With Type 1 and Type 2 Diabetes Mellitus (MK-1092-001)

participants) of non-child bearing potential. A female non-child bearing potential is one who is postmenopausal without menses for at least 1 year or whose status is post hysterectomy, bilateral oophorectomy, or tubal ligation. Be judged to be in good health based on medical history, physical exam, vital sign measurements, ECG and laboratory safety tests Have adequate venous access to support execution of trial procedures For Parts 1 and 2 (Healthy adult participants) Healthy male and female participants (...) , comas or unconsciousness within 6 months prior to dosing. Has other major medical problems requiring medication (i.e., history of MI, hypercholesterolemia). Has a known history of celiac disease or significant food allergy, at the discretion of the investigator and Sponsor. Has a history of hypersensitivity to pharmacologic insulins or to any of the inactive ingredients in recombinant human insulin, or to any E.coli-derived drug product. For Part 4 (Adult participants with T2DM): Participant has

2017 Clinical Trials

160. Inhaled Nitric Oxide After Out-of-Hospital Cardiac Arrest

) [ Time Frame: 90 days after cardiac arrest (+/- 3 days) ] Barthel Index of Independence in Activities of Daily Living scored as a continuous 0-100 at designated time Time to awakening [ Time Frame: Within 4 days of cardiac arrest ] Time in hours until subject is noted to follow commands. Subjects exceeding 96 hours of coma and those that die without awakening will be designated as 100. Methemoglobin level [ Time Frame: Prior to study drug ] Methemoglobin content as proportion (%) of total hemoglobin (...) this is reason for exclusion) Alert and interactive patient with minimal evidence of neurologic injury Plan to extubate within 12 hours Post-cardiac arrest service (PCAS) physician opinion that patient will die with >95% likelihood. This may be based on: Multiple medical comorbidities Late discovery of don not resuscitate (DNR) or advanced directive Terminal diagnosis (other than OHCA; may have caused OHCA) Clinical judgement based on current exam and data Patient is known to be taking phosphodiesterase type

2017 Clinical Trials

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