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E/M Medical Decision Making

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8861. Workplace interventions for people with common mental health problems

. This systematic review is designed to provide evidence-based answers on key questions related to mental ill health in the workplace. It is intended to assist managers, occupational health professionals and other interested parties in making management decisions and offering advice in the confidence that they are based on the most robust evidence available. Where evidence does not exist or is not robust recommendations are made for further research in areas that appear promising or of interest. Research (...) . This approach appears promising, although its effectiveness has currently only been demonstrated only in the short term (one month) • A stronger effect is associated with employees in high-control jobs. 45 INTRODUCTION This review is designed to provide evidence-based answers on key questions related to mental ill health in the workplace. It is intended to assist managers, occupational health professionals and other interested parties in making management decisions and offering advice in the confidence

2005 British Occupational Health Research Foundation

8862. Trauma - thoracic trauma

, Dixon S, Yates D. A randomised controlled trial of pre-hospital intravenous ?uid replacement therapy in serious trauma: The NHS Health Technology Assessment Programme 4(31), 2000. 2 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). 3 Bickell WH, Wall MJJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed ?uid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J (...) thinking is that ?uids should only be given when major organ perfusion is impaired. If there is visible external blood loss greater than 500mls, ?uid replacement should be commenced with a 250ml bolus of crystalloid (maximum of 2 litres). Central pulse ABSENT, radial pulse ABSENT – is an absolute indication for urgent ?uid. If the patient has a carotid pulse but no radial pulse then other clinical factors should also be considered before decision on ?uid administration. Central pulse PRESENT, radial

2007 Joint Royal Colleges Ambulance Liaison Committee

8863. Obstetrics/Gynaecology - birth imminent-normal delivery/delivery complications

UNIT. It is useful to obtain the following information: a. mother’s name b. mother’s date of birth c. age d. hospital registration number e. name of consultant f. history of this pregnancy g. estimated date of delivery (EDD) h. previous obstetric history. Ask to see the mother’s own hospital notes which most women keep with them. Is the mother unwell or injured? This stage of the assessment is concerned with medical and traumatic conditions that may not be directly associated with pregnancy (...) or leg) warrant IMMEDIATE transfer to the NEAREST OBSTETRIC UNIT. REFERENCES 1 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). METHODOLOGY Refer to methodology section. Birth Imminent (normal delivery and delivery complications) Obstetrics and Gynaecological Emergencies October 2006 Page 7 of 9 Obstetrics & Gynaecological EmergenciesAppendix 1 – Maternal Assessment Birth Imminent (normal delivery and delivery

2007 Joint Royal Colleges Ambulance Liaison Committee

8864. Recommendations for standards of monitoring during anaesthesia and recovery : fourth edition

Recommendations for standards of monitoring during anaesthesia and recovery : fourth edition Published by The Association of Anaesthetists of Great Britain and Ireland, 21 Portland Place, London W1B 1PY Telephone 020 76311650 Fax 020 7631 4352 www.aagbi.org March 2007 RECOMMENDATIONS FOR STANDARDS OF MONITORING DURING ANAESTHESIA AND RECOVERY 4th EditionMEMbERSHIp OF THE wORkING pARTY Dr R J S Birks Chairman/Vice President Dr L W Gemmell Council Member Dr E P O’Sullivan Council Member Prof D J (...) Rowbotham Council Member Prof J R Sneyd Council Member Ex-Officio Dr D K Whitaker President Prof M Harmer Immediate Past President Dr I H Wilson Honorary Treasurer Dr A W Harrop-Griffiths Honorary Secretary Prof W A Chambers Immediate Past Honorary Secretary Dr I G Johnston Honorary Membership Secretary Dr D G Bogod Editor-in-Chief, Anaesthesia This document will be reviewed regularly and may be revised or updated before the formal publication of a new edition. For the latest version, please refer

2007 Association of Anaesthetists of GB and Ireland

8865. Evaluation of the Uptake of Advice, Directives and Guidelines to the NHS Concerning Patient Safety by the SABS System

: From incident report to safety alert (Diagram from DH) Patient Safety Incidents Medical Device Fault NHS Staff and other Healthcare Professionals Patients Equipment Manufacturers Report Incidents To Relevant Organisation NPSA (National Patient Safety Agency) MHRA Devices (Medicines and Healthcare products Regulatory Agency) DH Estates and Facilities Department of Health Incidents investigated/lesson learnt Decision to issue safety alert Section 1 6 Diagram 1.2: Issuing a safety alert – gathering (...) Evaluation of the Uptake of Advice, Directives and Guidelines to the NHS Concerning Patient Safety by the SABS System Y O R K Health Economics C O N S O R T I U M University of York, Market Square, Vanbrugh Way, Heslington, York YO10 5NH Tel: 01904 433620 Fax: 01904 433628 Email: yhec@york.ac.uk http://www.york.co.uk York Health Economics Consortium is a Limited Company Registered in England and Wales No. 4144762 Registered office as above. PATIENT SAFETY RESEARCH PORTFOLIO A Multi-Method Study

2007 York Health Economics Consortium

8866. Leukocytosis as a predictor for progression to haemolytic uraemic syndrome in Escherichia coli O157:H7 infection

, independent and reliable early risk factor for predicting progression to HUS in children with E coli O157:H7 infection. (Grade B) The absence of an elevated WBC count during early stages of the illness makes HUS an unlikely event following E coli O157:H7 infection in children. (Grade B) Formulation of a well validated clinical decision rule (CDR) incorporating leukocytosis with other risk factors is likely to help with early identification of children at risk of developing HUS following E coli O157:H7 (...) Leukocytosis as a predictor for progression to haemolytic uraemic syndrome in Escherichia coli O157:H7 infection BestBets: Leukocytosis as a predictor for progression to haemolytic uraemic syndrome in Escherichia coli O157:H7 infection Leukocytosis as a predictor for progression to haemolytic uraemic syndrome in Escherichia coli O157:H7 infection Report By: M A Anjay - Specialist Registrar in Paediatrics Search checked by P Anoop, A Britland - Specialist Registrars Institution: James Paget

2007 BestBETS

8867. Intermediate care - Hospital at Home in COPD

of evidence IV] Recommendation N (R1) A hospital should use an assessment proforma, protocol or ICP if setting up an integrated care service in order to deliver uniform care and facilitate audit. [Grade D] The decision to treat at home In making this decision, several questions need to be asked: N During the period of the exacerbation, patients are likely to need increased social or nursing input to enable them to manage their essential activities of daily living. Can this be provided by relatives, social (...) of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(Suppl I):1–232. 3 Skwarska E, Cohen G, Skwarski KM, et al. Randomized controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary disease. Thorax 2000;55:907–12. 4 Davies L, Wilkinson M, Bonner S, et al. ‘‘Hospital at home’’ versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial. BMJ

2007 British Thoracic Society

8868. Thoracic trauma

, Dixon S, Yates D. A randomised controlled trial of pre-hospital intravenous ?uid replacement therapy in serious trauma: The NHS Health Technology Assessment Programme 4(31), 2000. 2 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). 3 Bickell WH, Wall MJJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed ?uid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J (...) thinking is that ?uids should only be given when major organ perfusion is impaired. If there is visible external blood loss greater than 500mls, ?uid replacement should be commenced with a 250ml bolus of crystalloid (maximum of 2 litres). Central pulse ABSENT, radial pulse ABSENT – is an absolute indication for urgent ?uid. If the patient has a carotid pulse but no radial pulse then other clinical factors should also be considered before decision on ?uid administration. Central pulse PRESENT, radial

2006 Joint Royal Colleges Ambulance Liaison Committee

8869. Birth imminent (normal delivery and delivery complications)

. It is useful to obtain the following information: a. mother’s name b. mother’s date of birth c. age d. hospital registration number e. name of consultant f. history of this pregnancy g. estimated date of delivery (EDD) h. previous obstetric history. Ask to see the mother’s own hospital notes which most women keep with them. Is the mother unwell or injured? This stage of the assessment is concerned with medical and traumatic conditions that may not be directly associated with pregnancy or labour, and may (...) or leg) warrant IMMEDIATE transfer to the NEAREST OBSTETRIC UNIT. REFERENCES 1 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). METHODOLOGY Refer to methodology section. Birth Imminent (normal delivery and delivery complications) Obstetrics and Gynaecological Emergencies October 2006 Page 7 of 9 Obstetrics & Gynaecological EmergenciesAppendix 1 – Maternal Assessment Birth Imminent (normal delivery and delivery

2006 Joint Royal Colleges Ambulance Liaison Committee

8870. Neck and back trauma

, Nicholl J, Webber L, Cox H, Dixon S, Yates D. A randomised controlled trial of pre-hospital intravenous ?uid replacement therapy in serious trauma: The NHS Health Technology Assessment Programme 4(31), 2000. 44 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). 45 Browne GJ, Lam LT, Barker RA. The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency (...) Trauma Emergencies October 2006 Page 7 of 8 Trauma EmergenciesAPPENDIX 1 – Immobilisation Algorithm Neck and Back Trauma Page 8 of 8 October 2006 Trauma Emergencies Trauma Emergencies In an adult patient with potential spinal injury can you con?rm the following: Patient is conscious, alert and able to fully co-operate with examination? I M M O B I L I S E Patient is not under the in?uence of alcohol or drugs – illicit or prescribed (including analgesia)? Patient has no complaint of spinal pain? (note

2006 Joint Royal Colleges Ambulance Liaison Committee

8871. Evidence Based Research: Selecting Doorbells for People with Hearing Impairment

not be sensitive to signals from a flashing light, and must be able to operate the system (Royal National Institute for Deaf People & British Deaf Association, 1999). Because the health status of people changes over time, the appropriateness of interventions may change over time; reassessment should be ongoing. Consumer preferences. The person for whom the device is intended should be the primary person involved in decision-making throughout the entire process (Ross & Mulvany, 2003). The acceptability (...) communication: family, community members, and even emergency personnel initiate contact at the front door. With only a conventional doorbell, people who are deaf may miss important safety and social contact. Because severe and profound deafness cannot be medically or surgically treated, assistive devices are necessary to enable people with severe or profound deafness to respond to a doorbell. Visual signalling assistive devices produce a visual signal instead of or in addition to an auditory signal and can

2006 Home Modification Information Clearinghouse

8872. Coatings: Evidence Based Research: Selecting Coatings for Tiled Floors

resistance should be evaluated. Policy Development An international standard for the measurement of slip resistance would permit reliable comparison between slip resistant measurements from different floor surfaces and different countries. A labelling standard for products that are marketed as effective in increasing slip resistance would allow consumers to make more informed decisions. References: Ali, W. Y., & Khashaba, M. I. (1998). Slip resistant epoxy coatings filled by graphite, silicon oxide (...) . CCH's Australian OH&S, 12(1), 10-13. Gronqvist, R., Hirvonen, M., & Skytta, E. (1992). Countermeasures against floor slipperiness in the food industry. In S. Kumar (Ed.), Advances in Industrial Ergonomics IV (pp. 989-996). Espoo: Taylor & Francis. Hauptmann, J., & Wiedemann, G. (2003). Laser micro-structuring of polished floor tiles. Key Engineering Materials, 250, 262-267. Hill, K., Vrantsidis, F., Haralambous, B., Frean, M., Smith, R., Murray, K., et al. (2004). An analysis of research

2005 Home Modification Information Clearinghouse

8873. Evidence Based Research: Selecting Diameters for Grabrails

components. Hand size is a critical component in the grabrail design decisions relating to diameter because it influences the quality of the grasp and grip strength. Due to the variation in hand sizes across the population, it is not possible to specify one grabrail diameter for all applications. Consequently, it is not possible to make a definitive statement regarding the suitability of 25mm diameter grabrails installed for older people in their homes. However, as people’s size appears to diminish (...) : Public spas (Standard No. 0 7262 8353 3). Sydney: Standards Australia. Standards Australia. (1994). Guidelines for safe housing design (Standard No. 0 7262 9107 2). Homebush: Standards Australia. Steinfeld, E., Levine, D. R., & Shea, S. M. (1998). Home modifications and the Fair Housing law. Technology and Disability, 8, 15-35. Steinfeld, E., Shea, S., & Levine, D. (1996). Technical Report: Home Modifications and the Fair Housing Law. Retrieved 1 July, 2004, from www.ap.buffalo.edu/idea/publications

2006 Home Modification Information Clearinghouse

8874. Evidence Based Research: Use of Reeded (Ribbed) Timber for Decks, Ramps and Paths

’ specifications (Gatton Sawmilling Co., 1998a, 1998b; James Pierce & Associates, 2000). The product manufacturer produces these documents to assist the consumer make more informed product decisions. The documents also serve to reduce liability of the manufacturer by listing the conditions for safest application of their product. The specifications relevant to reeded-decking installation follow: Attributes Deckwood sawn top Deckwood reeded (rippled) top Typical uses Bridge decking Loading docks Maintenance (...) ). Slip resistance standards: Sorting it all out. Safety and Health(March). Authored by C. Bridge & K. Jegaraj for the Home Modification Information Clearinghouse Reeded Timber: Evidence based research: May 2003 F ISBN: 1 86487 568 2 www.homemods.info 7 Redfern, M. S., & McVay, E. J. (1993). Slip potentials on ramps. Paper presented at the Human Factors and ergonomics society 37th Annual meeting, Seattle, Washington. Safe-T-Plus Australia. (2001). Anti-Slip Coating Solutions. Retrieved August, 2002

2003 Home Modification Information Clearinghouse

8875. Does magnesium offer any additional benefit in patients having anti-arrhythmic treatment for atrial fibrillation following cardiac surgery?

magnesium will be of any benefit. Rather than prescribing blind treatment you decide to review the literature before making your decision. Search Strategy Medline 1966 to Oct 2004, Embase 1980 to Oct 2004 and CINAHL 1982 to Oct 2004 using the OVID interface. [exp atrial fibrillation/ OR atrial fibrillation.mp OR AF.mp OR exp atrial flutter OR atrial flutter.mp OR exp supraventricular tachycardia/ OR SVT.mp] AND [exp magnesium/ OR magnesium.mp]. In addition, the 2001 American Heart Association (AHA (...) conversion rate when 2 g or more was given (Compared with 0 or 1 g) 74% vs. 61% P=0.043 Brodsky et al, 1994, USA 18 medical outpatients presenting with AF 100 and Double blind PRCT (level 2b) Mean Vent. Rate of End point reached in 10 (100%) of Mg and Digoxin group. End point reached in 4/8 (50%) patients in digoxin alone group. P Small sample size Hays et al, 1994, USA 15 Patients with AF (Vent rate>99) Mg group (n=7) 2 g Mg over 1 min followed by 4 g Mg over 4 h and 0.5 mg digoxin after 30 min. Control

2005 BestBETS

8876. Fatigue and anaesthetists

Version Page 6 of 28 June 2005 5.2. The aviation industry and pilot organisations have recognised that fatigue and sleep deprivation are important factors in lowering mental fitness leading to irrational behaviour and deterioration in performance and decision-making. This is greatest in tasks requiring self-generated arousal such as systems monitoring and may be unrecognised. 13 5.3. The catastrophic consequences of fatigue-related incidents in aviation have led to the establishment of fatigue (...) factor. Nevertheless: • NASA attributed fatigue resulting from work-rest patterns in managers as having contributed to flawed decision-making in the space shuttle ‘Challenger’ incident. 15 • The National Safety Transportation Board found that fatigue in a 60-year- old captain who had completed more than 14 hours of duty that included two additional, unscheduled flights in the night with a probationer First Officer contributed to a Air New England plane crashing in 1979 16 • Similar factors

2004 Association of Anaesthetists of GB and Ireland

8877. Consent for anaesthesia 2 revised edition 2006

a voice to adults without capacity to consent, and has imposed a series of duties upon clinicians to promote capacity. It has also formalised the Advance Decision (formerly Advance Directive) and extended Powers of Attorney to include medical decision-making. This alone was enough to justify the Association producing new advice, but perhaps of more impact to the ‘ordinary’ patient-doctor interaction is the increased emphasis placed by the courts on patient’s autonomy, crystallised in the House (...) not be considered to lack the competence to decide about their medical treatment, merely because they are gravely ill, are receiving sedative drugs or lack the ability to communicate orally. These patients should be allowed to indicate their consent, and wherever possible, written documentation of consent discussions should be recorded [25]. The MCA makes an explicit demand that every effort should be made to try to assist a temporarily incapacitated individual in making an informed decision. In order

2006 Association of Anaesthetists of GB and Ireland

8878. Critical Incident Reporting

. situation awareness and decision-making). In high-risk industries such as aviation, and increasingly in medical domains such as anaesthesia, data from accidents and near misses have been used to develop non- technical skills (interpersonal and cognitive skills not directly related to technical expertise, but crucial for maintaining safety, e.g. teamwork, leadership, situation awareness and decision-making 27,35 ). Such skills would appear particularly important for the ICU, with studies examining (...) Patient with ARDS and multi- organ failure Language and communication Patient does not speak English Patient factors Personality and social factors Patient agitated Task design and clarity of structure Ability to connect oral syringe to IV cannula Availability and use of protocols Spontaneous breathing trial protocol not used Availability and accuracy of test results Chest X-ray not available Task factors Decision-making aids Alarms not set appropriately Knowledge, skills and competence Lack of skill

2006 Intensive Care Society

8879. Asthma education and patient monitoring

Asthma education and patient monitoring Asthma education and patient monitoring | CMAJ Main menu User menu Search Search for this keyword Search for this keyword Article Asthma education and patient monitoring Patient education Because asthma is a chronic but variable disease, patients and their families must be prepared to make lifestyle changes and adhere to drug therapy for long periods, even at times when symptoms are not evident. They must also be capable of making rapid decisions about (...) of certain changes that suggest loss of asthma control: nocturnal symptoms; increase in β 2 -agonist use; diminished response or decreased duration of response to β 2 -agonists. Adherence to action plans appears to be good in only a third of patients; many are reluctant to increase the dosage of inhaled glucocorticosteroids or make self-management decisions when asthma symptoms worsen. The roles of education (even a single session), PEF monitoring and action plans advocating patient-initiated changes

1999 CPG Infobase

8880. Acupuncture

of a problem in studies not involving pain. 8 What Is the Place of Acupuncture in the Treatment of Various Conditions for Which Sufficient Data Are Available, in Comparison or in Combination With Other Interventions (Including No Intervention)? Assessing the usefulness of a medical intervention in prac­ tice differs from assessing formal efficacy. In conventional practice, clinicians make decisions based on the character­ istics of the patient, clinical experience, potential for harm, and information from (...) report of the consensus panel and is not a policy statement of the NIH or the Federal Government. Reference Information For making bibliographic reference to this consensus state­ ment, it is recommended that the following format be used, with or without source abbreviations, but without authorship attribution: Acupuncture. NIH Consens Statement 1997 Nov 3-5; 15(5): 1-34. Continuing Medical Education This Continuing Medical Education activity was planned and produced in accordance

1997 NIH Consensus Statements

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