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E/M Medical Decision Making


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9141. A review of the evidence for the use of telemedicine within stroke systems of care Full Text available with Trip Pro

tPA for treatment of stroke within 3 hours of stroke onset and recommendations for the use of tPA, only a small percentage of stroke patients receive this therapy. One of the barriers to intravenous tPA treatment is the lack of availability of neurological expertise on an emergent basis. Emergency physicians are often not comfortable making the decision to institute tPA treatment without this guidance. Patients who might benefit from tPA may not receive treatment because of the treating (...) and the National Electric Manufacturers Association published standards for digital imaging and communications in medicine, now the standard for transmissible medical images. In 1994, the American College of Radiology published standards for teleradiology applications. Equipment used for teleradiology systems must be approved by the US Food and Drug Administration (FDA). The Joint Commission and other accrediting bodies play an important role in the performance appraisal and credentialing of teleradiology

2009 American Academy of Neurology

9142. Evaluation and Management of Adult Hypoglycemic Disorders Full Text available with Trip Pro

search filter search input Article Navigation Close mobile search navigation Article navigation 1 March 2009 Article Contents Article Navigation Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline Philip E. Cryer 1Washington University School of Medicine (P.E.C.), St. Louis, Missouri 63110 Search for other works by this author on: Lloyd Axelrod 2Massachusetts General Hospital and Harvard Medical School (L.A.), Boston, Massachusetts 02114 Search (...) for other works by this author on: Ashley B. Grossman 3Barts and the London School of Medicine, Queen Mary University of London (A.B.G.), London E1 2AD, United Kingdom Search for other works by this author on: Simon R. Heller 4University of Sheffield (S.R.H.), Sheffield S10 2TN, United Kingdom Search for other works by this author on: Victor M. Montori 6Mayo Clinic (V.M.M., F.J.S.), Rochester, Minnesota 55905 Search for other works by this author on: Elizabeth R. Seaquist 5University of Minnesota (E.R.S

2009 The Endocrine Society

9143. Definition and evaluation of transient ischemic attack Full Text available with Trip Pro

of patients with TIA will have myocardial infarction or sudden cardiac death as will have a cerebral infarction. A prior AHA scientific statement provides detailed guidance on the coronary risk evaluation in patients with TIA. Risk Stratification Several studies have identified risk factors for stroke after TIA, which may be useful in making initial management decisions. Three very similar formal prediction rules have been developed and cross-validated in northern California and Oxfordshire (...) individuals. TIA incidence rates have been projected from different study cohorts in the United States and abroad, ranging from 0.37 to 1.1 per 1000 per year. An overall TIA incidence rate of 1.1 per 1000 US population has been estimated on the basis of a review of the National Hospital Ambulatory Medical Care Survey among 2 623 000 TIA cases diagnosed in US emergency departments between 1992 and 2000. From the Greater Cincinnati/Northern Kentucky population between 1993 and 1994, the overall race-, age

2009 American Academy of Neurology

9144. Early metabolic acidosis and coma in massive acetaminophen overdose

yanide, carbon monoxide A cetaminophen T heophylline M ethanol, metformin U remia D iabetic ketoacidosis (or alcoholic ketoacidosis) P ropylene glycol I ron, INH L actic acidosis E thyelene glycol Related post: Posted in , by Leon Gussow « » Comments are closed. Search for: The Best of TPR Archives » TPR Is Currently Reading: by Cliff Sloan and David McKean Drug Culture Medical Blogs Medical Journals Medical Tools Toxicology Organizations Toxicology Podcasts Copyright ©2019 The Poison Review Designed by (...) Early metabolic acidosis and coma in massive acetaminophen overdose Early metabolic acidosis and coma in massive acetaminophen overdose » The Poison Review Early metabolic acidosis and coma in massive acetaminophen overdose August 7, 2015, 1:33 pm Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print] This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient

2015 The Poison Review blog

9145. In defense of single-payer: How it would reduce administrative waste

of health care.” To be fair, Dr. Accad makes a good point ridiculing the extraordinarily complex and “byzantine scheme of codification” used by Medicare (and followed by private insurers) for billing purposes. “[A] CPT code 99204-21 (new patient visit, E/M coding level 4, prolonged service) associated with ICD-9 code 786.50 (chest pain, unspecified),” he notes, “hardly conveys any real knowledge and cannot possibly be a basis on which relevant decisions can be made or value established.” No, it can’t (...) (not surprisingly). In fact, Dr. Accad doesn’t really deal with any of the literature about the administrative efficiency of different types of health care systems. Instead, he employs a “Hayekian perspective” to make the argument that central economic planning is inherently inferior to an atomized free market where individual economic actors buy and sell, rationally relying on their intimate knowledge of local market circumstances. “Only in a decentralized system,” he argues, “of decision making, where price

2015 KevinMD blog

9146. ACR-SNMMI-SPR Practice Guideline for the Performance of Pulmonary Scintigraphy in Adults and Children

, or advances in knowledge or technology subsequent to publication of the guidelines. However, a practitioner who employs an approach substantially different from these guidelines is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always (...) and Technical Standards on the ACR web page ( by the Guidelines and Standards Committee of the ACR Commission on Nuclear Medicine in collaboration with the SPR and the SNM. Collaborative Committee ACR Mark F. Fisher, MD, Chair Paul D. Shreve, MD 4 / Pulmonary Scintigraphy PRACTICE GUIDELINE SNM Warren R. Janowitz, MD, JD Henry D. Royal, MD SPR Michael J. Gelfand, MD Marguerite T. Parisi, MD Stephanie E. Spottswood, MD Guidelines and Standards Committee – Nuclear Medicine Jay

2009 Society of Nuclear Medicine and Molecular Imaging

9147. Supporting Clients on Methadone Maintenance Treatment

evidence-based nursing practice. It is to be reviewed and applied as a resource tool that addresses the specific needs of an organization or practice setting. The guideline is not offered as a “cookbook” solution, but rather as a tool to enhance ef- fective decision-making in the provision of individualized client care. In addition, the guideline provides an overview of the appropriate structures and supports necessary for the provision of best possible care. This document is meant to be used (...) research (Health Canada, 2008). Best practice guidelines are an accepted method of provid- ing current evidence for nurses to use to guide their practice. These guidelines synthesize the current evidence, and recommend best practices based on the evidence. They offer nurses a reliable source of information on which to make decisions concerning practice. This guideline will focus on recommendations for any youth, adult or older adult either already on MMT or those who are potential candidates for MMT

2009 Registered Nurses' Association of Ontario

9148. Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour

of the client. This guideline should not be applied in a “cookbook” fashion, but used as a tool to assist in decision-making for individualized client care and in ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals and administrators who are leading and facilitating practice changes will find this document valuable for the development of policies, procedures, protocols, educational programs, assessment and documentation (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Appendix O – Educational Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Appendix P – Framework for Ethical Decision-making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Appendix Q – Description of the Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Appendix R – Additional Readings Suggested

2009 Registered Nurses' Association of Ontario

9149. Clinical Holding Guidelines

treatment plan including: • there will be known triggers for behaviour change in some patients which will help practitioners to make decisions which specifically relate to each patient at the time the treatment is carried out; • the timing of appointments, medication and other aspects of daily routine may be crucial in delivering effective treatment outcomes for some patients; • the use of augmentative techniques (such as relaxation techniques, music therapy, embedded commands etc) may be beneficial (...) as a result of the risks that arise from their behaviour (e.g., children, young people and adults with learning disabilities), there are many other patient groups that present clinical staff with compromises or difficulties during assessment and treatment. Consequently, these guidelines have been developed to help clinicians make appropriate decisions relating to the assessment and treatment outcomes for those patients who may require some form of physical support or intervention as part

2010 British Society for Disability and Oral Health

9150. Guideline update for MASCC & ESMO in the prevention of chemotherapy and radiotherapy-induced nausea and vomiting

process was based on a literature review through 1 June 2009 using MEDLINE (National Library of Medicine, Bethesda, MD, USA) and other databases, with evaluation of the evidence by an expert panel composed of 23 oncology professionals in clinical medicine, medical oncology, radiation oncology, surgical oncology, oncology nursing, statistics, pharmacy, pharmacology, medical policy and decision making. With the participating experts coming from 10 different countries, on ?ve continents, we believe (...) . A. Clark- Snow 8 , B. T. Espersen 9 , P. Feyer 10 , S. M. Grunberg 11 , P. J. Hesketh 12 , K. Jordan 13 , M. G. Kris 14 , E. Maranzano 15 , A. Molassiotis 16 , G. Morrow 17 , I. Olver 18 , B. L. Rapoport 19 , C. Rittenberg 20 , M. Saito 21 , M. Tonato 22 & D. Warr 23 On behalf of the ESMO/MASCC Guidelines Working Group* 1 Department of Medical Oncology, S. Maria University Hospital, Terni, Italy; 2 Odense University Hospital, Odense, Denmark; 3 Institut Multidisciplinaire d’Oncologie, Genolier

2010 European Society for Medical Oncology

9151. Prostate cancer

. Immediate hormone therapyaloneisnot recommended.Watchfulwaitingwithdelayedhormonetherapy intheevent ofsymptomatic progression isanoption formen whoarenotsuitablefor,orunwillingtohave,radicaltreatment. Therearenocompletedrandomizedcontrolledtrialscomparing theseoptionswithinthecontextoflow-riskdisease.Prospective, non-randomizedstudieshavedescribedthemorbidityassociated with eachtreatment option, andmay be usedas aguide to decision making. Ten-yearprostate cancer speci?csurvival approaches100 (...) 2008; 26: 242–245. 41. Petrylak DP, Tangen C, Hussain M et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 2004; 351: 1513–1520. 42. Price P, Hoskin PJ, Easton D et al. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 1986; 6: 247–255. 43. Chow E, Harris K, Fan G et al. Palliative radiotherapy trials for bone metastases

2010 European Society for Medical Oncology

9152. Early-stage and locally advanced (non-metastatic) non small cell lung cancer

Early-stage and locally advanced (non-metastatic) non small cell lung cancer Annals of Oncology 21 (Supplement 5): v103–v115, 2010 doi:10.1093/annonc/mdq207 clinical practice guidelines Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up L. Crino ` 1 , W. Weder 2 , J. van Meerbeeck 3 & E. Felip 4 On behalf of the ESMO Guidelines Working Group* 1 Dept of Medical Oncology, University Hospital (...) preoperative chemotherapy followed by surgery and primary surgery in resectable stage I (except T1N0), II and IIIA non-small cell lung cancer. Lung Cancer 2003; 41 (Suppl 2): S62. 46. Pisters KMW, Vallieres E, Crowley JJ et al. Surgery with or without preoperative paclitaxel and carboplatin in early-stage non-small-cell lung cancer: Southwest Oncology Group Trial S9900, an intergroup, randomized, phase III trial. J Clin Oncol 2010; 28: 1843–1849. 47. Gilligan D, Nicolson M, Smith I et al. on behalf

2010 European Society for Medical Oncology

9153. Familial colorectal cancer risk

, germline genetic testing would be indicated. If loss of MLH1/PMS2 expression is observed, methylation of the MLH1 promoter or testing of the somatic BRAF V600E mutation should be performed ?rst to rule out hypermethylation of the MLH1 promoter (10%–15% of sporadic cases are related to this somatic event) [C]. Prediction models that estimate the likelihood of ?nding a MMR gene mutation constitute another clinical tool to identify individuals at risk of Lynch syndrome and help in clinical decision making (...) ; E-mail: Approved by the ESMO Guidelines Working Group: August 2008, last update December 2009. This publication supercedes the previously published version—Ann Oncol 2009; 20 (Suppl 4): iv51–iv53. Con?ict of interest: The authors have reported no con?icts of interest. ª The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions

2010 European Society for Medical Oncology

9154. Anal cancer

Anal cancer Annals of Oncology 21 (Supplement 5): v87–v92, 2010 doi:10.1093/annonc/mdq171 clinical practice guidelines Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up R. Glynne-Jones 1 , J. M. A. Northover 2 & A. Cervantes 3 On behalf of the ESMO Guidelines Working Group* 1 Mount Vernon Centre for Cancer Treatment, Northwood; 2 St Mark’s Hospital, Harrow, UK; 3 Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain (...) Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997; 15: 2040–2049. 9. Greene FL, Page DL, Fleming ID et al. (eds): Staging Manual AJCC, 6th edn. New York: Springer 2002; 125–130. 10. Touboul E, Schlienger M, Buffat L et al. Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients. Cancer 1994; 73: 1569–1579. 11. Ajani JA, Winter KA, Gunderson LL et al. US intergroup anal carcinoma

2010 European Society for Medical Oncology

9155. Primary colon cancer

in a polyp requires a thorough review with the pathologist for histological features that are associated with an adverse outcome. Making the decision to undergo surgical resection for a neoplastic polyp that contains invasive carcinoma involves the uncertainties of predicting and balancing adverse disease outcome against operative risk. Unfavourable histological ?ndings include lymphatic or venous invasion, grade 3 differentiation, level 4 invasion (invades the submucosa of the bowel wall below the polyp (...) Engl J Med 2004; 350: 991–1004. 9. Stewart BW, Kleihus P (eds): World Cancer Report. Lyon: IARC Press 2003. 10. Aarnio M, Sankila R, Pukkala E et al. Cancer risk in mutation carriers of DNA- mismatch-repair genes. Int J Cancer 1999; 81: 214–218. 11. Cochrane Database Syst Rev. 2007 Jan 24; (1): CD001216 Screening for colorectal cancer using the faecal occult blood test, Haemoccult. 12. Accp. Advisory Committee on Cancer Prevention. Recommendations on cancer screening in the European union. Eur J

2010 European Society for Medical Oncology

9156. PET in Radiotherapy Planning

,10Ave.Hippocrate,1200Brussels,Belgium. E-mail address: (V. Gregoire). Radiotherapy and Oncology 96 (2010) 275–276 Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.comNuclear Medicine physicians and other related specialists on the proper use of PET in radiotherapy planning. References [1] ICRU. International Commission on Radiation Units and Measurements. Prescribing, recording and reporting Intensity-Modulated Photon-Beam (...) for radiation therapy planning in gastro-intestinal tumors. Radiother Oncol 2010;96:339–46. [25] Pichio M, Giovannini E, Crivellaro C, et al. Clinical evidence on PET–CT for radiation therapy planning in prostate cancer. Radiother Oncol 2010;96:347–50. [26] Haie-Meder Ch, Mazeron R, Magné N. Clinical evidence on PET–CT for radiation therapy planning in cervix and endometrial cancers. Radiother Oncol 2010;96:351–5. 276 Editorial/Radiotherapy and Oncology 96 (2010) 275–276Editorial Clinical use of PET-CT data

2010 European Association of Nuclear Medicine

9157. EANM procedure guidelines for therapy of benign thyroid disease

, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands e-mail: D. Handkiewicz Junak Department of Nuclear Medicine and Endocrine Oncology, M Sklodowska Curie Memorial Cancer Center and Institute of Oncology, 44100 Gliwice, Poland M. Lassmann Department of Nuclear Medicine, University of Würzburg, 97080 Würzburg, Germany M. Dietlein Department of Nuclear Medicine, University of Cologne, 50937 Cologne, Germany M. Luster Department of Nuclear Medicine, University of Ulm, 89081 Ulm, Germany Eur (...) in patients with medical contraindications to thyroid surgery, patients with slight or moderate compressive symptoms, patients with a large goitre, and patients who whish to avoid surgery. The interdisciplinary approach to patients followed by well-balanced decision making and informed consent allow individualized selection between the alterna- tive treatment options. Special consideration should be given to the patient’s profession as 131 I is without risk of paralysis of the recurrent laryngeal nerve. D

2010 European Association of Nuclear Medicine

9158. An overview of current management of auditory processing disorder (APD)

Appendix A. Authors and stakeholder involvement 44 Appendix B. Functional difficulties often associated with APD 45 Appendix C. Test-driven auditory training (Bamiou et al, 2006) 46 Appendix D. Summary of Bellis/Ferre APD subtypes (Bellis, 2003) 47 Appendix E. Classroom audit 48 Appendix F. Making your classroom a better place to listen and learn 49 Appendix G. Suggestions for teachers 50 Appendix H. Activities to minimise the effects of APD (at home and school) 51 Appendix I. Strategies to minimise (...) the effects of APD (primary schools) 52 Appendix J. Strategies to minimise the effects of APD (high school and beyond) .. 54 Appendix K. Components of phonological and phonemic awareness 55 Appendix L. Practical tips and guidelines for improving phonological awareness ... 56 Appendix M. Shared reading 57 Appendix N. Developing good listening skills 58 Appendix O. University and beyond! A few practical suggestions 60 Practice Guidance British Society of Audiology Management of APD 2011 © BSA 2011 5 2

2010 British Society of Audiology

9159. What is the ‘balance of benefits and harms’?

. Simplistically, and aside from the communicative aspects of the job, medicine is about decisions. Doctors and other healthcare professionals make decisions with and for their patients in what both consider to be the patient’s best interests. In order to come to the correct decision, they need to be able to balance the benefits and harms of each intervention relevant to the patient in front of them. What are ‘benefits and harms’? Most would agree that the patient’s ‘best interests’ are in their condition (...) -centred care and good evidence-based medicine. Links Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, Ward K, Ebrahim S. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD004816. DOI: 10.1002/14651858.CD004816.pub5. Tags: I'm a final year pharmacology student and hopeful future dentist, passionate about evidence-based medicine and how it can be better taught and incorporated into students' practice. Also keen on debunking dodgy health claims in the media! Leave

2015 Students 4 Best Evidence

9160. If only surgery wasn’t such a pain in the…. knee!!

. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study. Journal of Pain and Palliative Care Pharmacotherapy 2010;24:119-128. [18] Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD, Dieppe P, Blom AW. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain 2015;156:47. [19] Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, Ben (...) -Nun A, Sprecher E, Best L, Granot M. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk. Pain 2008;138:22-28. Share the love Filed Under: , , Comments Anton Harms says Thank you Kristian for your presentation; very interesting. When I began working in the Osteoarthritis Hip and Knee Service (OAHKS), an Orthopaedic screening clinic assessing OA knees six years ago, I had little idea of the fascinating clinical experience that was to unfold. In addition

2015 Body in Mind blog

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