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Emergency Medicine Treatment and Labor Act

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121. Medical imaging

in pharmaceutical clinical trials [ ] Medical imaging has become a major tool in clinical trials since it enables rapid diagnosis with visualization and quantitative assessment. A typical goes through multiple phases and can take up to eight years. or outcomes are used to determine whether the therapy is safe and effective. Once a patient reaches the endpoint, he or she is generally excluded from further experimental interaction. Trials that rely solely on are very costly as they have long durations and tend (...) to expand, including studies, , , and assessing the effects of disruption agents on cancer tumors. Nuclear medicine [ ] Main article: Nuclear medicine encompasses both diagnostic imaging and treatment of disease, and may also be referred to as molecular medicine or molecular imaging & therapeutics. Nuclear medicine uses certain properties of isotopes and the energetic particles emitted from radioactive material to diagnose or treat various pathology. Different from the typical concept of anatomic

2012 Wikipedia

122. Medical transcription

care to ensure that the impositions on MT autonomy are not so onerous as to outweigh its benefits. Medical transcription is still the primary mechanism for a physician to clearly communicate with other healthcare providers who access the patient record, to advise them on the state of the patient's health and past/current treatment, and to assure continuity of care. More recently, following Federal and State Disability Act changes, a written report (IME) became a requirement for documentation (...) notes that were added in the patient's file for interpretation by the primary physician responsible for the treatment. Ultimately, this mess of handwritten notes and typed reports were consolidated into a single patient file and physically stored along with thousands of other patient records in a wall of filing cabinets in the medical records department. Whenever the need arose to review the records of a specific patient, the patient's file would be retrieved from the filing cabinet and delivered

2012 Wikipedia

123. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version Late Effects of Treatment for Childhood Cancer (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf Warning: The NCBI web site requires JavaScript to function. Search database Search term Search NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. PDQ Cancer Information (...) for Childhood Cancer During the past five decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for more than 80% of children with access to contemporary therapies for pediatric malignancies.[ , ] The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as late effects , which manifest months to years after completion of cancer treatment

2016 PDQ - NCI's Comprehensive Cancer Database

124. Pheochromocytoma and Paraganglioma Treatment (PDQ®): Health Professional Version

of cyclophosphamide, vincristine, and dacarbazine (the Averbuch protocol).[ ] Results of this regimen in 18 patients after 22 years of follow-up demonstrated a complete response rate of 11%, a partial response rate of 44%, a biochemical response rate of 72%, and a median survival of 3.3 years.[ ][ ] Several other chemotherapy regimens have been used in small numbers of patients, but the overall results were disappointing.[ , ] Targeted therapy Novel targeted therapies are emerging as potential treatment (...) disease. Surgery Treatment for recurrent disease involves appropriate medical management (i.e., alpha-adrenergic blockade) followed by complete surgical resection, when possible. Palliative Therapy Palliation of symptoms, including those related to catecholamine excess and local mass effect, is the primary focus of treatment for disease that is not resectable. The following are options for patients with local-regional or metastatic disease who are not considered candidates for surgical resection

2015 PDQ - NCI's Comprehensive Cancer Database

125. EMTALA and Patients With Psychiatric Emergencies: A Review of Relevant Case Law. (Abstract)

EMTALA and Patients With Psychiatric Emergencies: A Review of Relevant Case Law. Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient (...) screening examination and did not detect an emergency medical condition that required stabilization.Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful.Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

2014 Annals of Emergency Medicine

126. The “go to the ER” mentality of American medicine

doctors or secretaries. People who need to be admitted are sent in “just to get checked before they go upstairs.” Or sometimes, so the physician on duty can do the negotiation with the hospitalist, rather than having the primary care physician do so. Why is the ED the default? In 1986 Reagan championed and Congress passed EMTALA, the Emergency Medical Treatment and Active Labor Act, which says you can’t turn anyone away for reasons of non-payment. Another well-intentioned bit of government meddling (...) with more and more complex and multi-varied duties in the emergency departments of the 21st century. I’m not a medical economist. I do have some thoughts on the well-intentioned but deeply flawed Affordable Care Act. However, I won’t go there right now. What I do want to address is the “go directly to the ER” mentality of modern American medicine. Call your physician. If it’s after hours, the recording for any physician or practice of any sort in America will have a message: “If this is an emergency

2016 KevinMD blog

127. Treatment and recommendations for homeless people with Chronic Non-Malignant Pain

with these patients to develop a plan of care. The practice adaptations recommended in this document are based on a comprehensive review of published reports and consensus opinion of clinicians with expertise in homeless health care, treatment of chronic pain, and addiction medicine. These recommendations are intended to be consistent with the standard clinical guidelines listed below. Their purpose is to facilitate adherence to these standards in the care of impoverished, displaced persons with multiple medical (...) indicated. FOLLOW-UP ? Determine frequency of follow-up based on stability of the patient and his/her living situation and risk of misuse. For patients with comorbid behavioral health issues who are receiving COT, more frequent visits with random urine drug tests may be necessary. In general, opioid prescriptions should be of shorter duration (1 month or less) to help reduce risk of diversion/ overdose/ loss of medications. ? At each visit, assess for behaviors outside the treatment plan, including

2011 National Health Care for the Homeless Council

128. Case studies at Denver Health: 'patient dumping' in the emergency department despite EMTALA, the law that banned it. Full Text available with Trip Pro

Case studies at Denver Health: 'patient dumping' in the emergency department despite EMTALA, the law that banned it. The Emergency Medical Treatment and Labor Act was enacted in 1986 to prevent hospitals from turning away patients with emergency medical conditions, often because they were uninsured--a practice commonly known as "patient dumping." Twenty-five years later, Denver Health--a large, urban, safety-net hospital--continues to experience instances in which people with emergency (...) conditions, many of whom are uninsured, end up in the safety-net setting after having been denied care or receiving incomplete care elsewhere. We present five case studies and discuss potential limitations in the oversight and enforcement of the 1986 law. We advocate for a more effective system for reporting and acting on potential violations, as well as clearer standards governing compliance with the law.

2012 Health affairs

129. Mad Libs for medicine. Do you think you can use these?

these with the nurses, and give the shift a little levity. Pain medication. You see, doctor, my pain specialist is in (foreign city). Before he left, he gave me a (duration of time) supply of (narcotic), and said if I had any problems I should go to the (health care facility). It turns out that my cousin’s (type of pet) got into my pills and (bodily function) all over half of them and ate the rest. If I could just get a (unit of weight or volume) of (drug that begins with D), I’ll be fine until my doctor comes back (...) . This time he says the pain is (erotic but not profane word), and feels as if he may (normal bodily function). His (government official) has the same thing and was (spa treatment) last week and then hospitalized. This patient insists that only IV (insect) serum will reverse the symptoms. Also a dose of (pain med that starts with D). Satisfaction scores. Dear (medical provider title): A review of your patient satisfaction scores reveals that you need to spend more time doing (type of massage) on your

2015 KevinMD blog

130. Diagnosis and Treatment Malaria in Pregnancy

promptly while obtaining IV artesunate). The UK guidelines explain expert consultation is required before the artesunate will be issued. 1 Severe malaria in pregnancy provides an urgent and pressing reason for artesunate to be issued (although this is not in the current guidelines). 1 IV clindamycin is a very slow-acting antimalarial and it is unlikely to add any additional value to IV artesunate, which is the fastest acting of all antimalarial drugs. In endemic countries, the treatment course when (...) of the infant to malaria. P. falciparum causes greater morbidity (maternal and fetal, principally low birth weight and anaemia) and mortality than non-falciparum infections 5,7–10 but there is mounting evidence that P. vivax is not as benign as had been previously thought. 12–14 Response to antimalarial treatment is multifactorial but is associated with the degree of prior immunity acquired from repeated exposures in childhood and the background level of drug resistance. The higher the transmission

2010 Royal College of Obstetricians and Gynaecologists

131. Late Effects of Treatment for Childhood Cancer

, the Children’s Oncology Group (COG), and the Institute of Medicine. A risk-based medical follow-up is recommended, which includes a systematic plan for lifelong screening, surveillance, and prevention that incorporates risk estimates based on the following:[ ] Previous cancer. Cancer therapy. Genetic predisposition. Lifestyle behaviors. Comorbid conditions. Sex. Part of long-term follow-up is also focused on appropriate screening of educational and vocational progress. Specific treatments for childhood (...) for medical late effects, the impact of health behaviors on cancer-related health risks is also emphasized. Health-promoting behaviors are stressed for survivors of childhood cancer. Targeted educational efforts appear to be worthwhile in the following areas:[ ] Abstinence from smoking, excess alcohol use, and illicit drug use to reduce the risk of organ toxicity and, potentially, subsequent neoplasms. Healthy dietary practices and active lifestyle to reduce treatment-related metabolic and cardiovascular

2012 PDQ - NCI's Comprehensive Cancer Database

132. Drug rehabilitation

or family-based recovery support systems. Whatever the methodology, patient motivation is an important factor in treatment success. For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems. Medication like and can be used to treat addiction to prescription opiates, and behavioral therapies can be used to treat addiction to prescription stimulants, benzodiazepines, and other drugs. Types of behavioral therapy include (...) their jobs, avoid crime and violence, and reduce their exposure to HIV and by stopping or reducing injection drug use and drug-related high risk . is a long-acting with few side effects. It is usually prescribed in medical conditions. Naltrexone blocks the euphoric effects of alcohol and opiates. Naltrexone cuts relapse risk during the first 3 months by about 36%. However, it is far less effective in helping patients maintain abstinence or retaining them in the drug-treatment system (retention rates

2012 Wikipedia

133. Drug abuse

-help organizations in which members support each other not to use alcohol. are significantly impaired in people suffering from due to the effects of alcohol on the brain, especially the area of the brain. It has been suggested that training adjunctive to inpatient treatment of alcohol dependence is probably efficacious, including managing the social environment. Medication [ ] A number of medications have been approved for the treatment of substance abuse. These include replacement therapies (...) such as and as well as antagonist medications like and in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including and . Methadone and are sometimes used to treat opiate addiction. These drugs are used as substitutes for other opioids and still cause withdrawal symptoms. Antipsychotic medications have not been found to be useful. Acamprostate is a glutamatergic NMDA antagonist, which helps

2012 Wikipedia

134. [Enzalutamide-a novel androgen receptor inhibitor that provides treatment options for patients with castration-resistant prostate cancer]. (Abstract)

[Enzalutamide-a novel androgen receptor inhibitor that provides treatment options for patients with castration-resistant prostate cancer]. The recent emergence of new hormonal or chemotherapeutic drugs has resulted in a paradigm shift in the treatment of castration-resistant prostate cancer(CRPC). Enzalutamide is a rationally designed, orally administered androgen receptor(AR)inhibitor. It inhibits multiple points in the androgen receptor signalling pathway, which is considered an important (...) free survival[rPFS], time to the first skeletal related event[SRE])as well as objective response outcomes(i.e. PSA, soft tissue, and quality of life[QOL]). On the basis of the AFFIRM results, Astellas and Medivation filed a new drug application with the United States Food and Drug Administration and the European Medicines Agency in 2012, and obtained their approval. Another phaseI/II enzalutamide trial was conducted in both chemotherapy-naïve patients and post-chemotherapy pa- tients

2014 Gan to kagaku ryoho. Cancer & chemotherapy

135. Corneal Abrasion (Treatment)

of ketorolac in the management of corneal abrasions. Acta Ophthalmol Scand . 2001 Apr. 79(2):177-9. . Salz JJ, Reader AL, Schwartz LJ, Van Le K. Treatment of corneal abrasions with soft contact lenses and topical diclofenac. J Refract Corneal Surg . 1994 Nov-Dec. 10(6):640-6. . Weaver CS, Terrell KM. Evidence-based emergency medicine. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?. Ann Emerg Med . 2003 Jan. 41(1 (...) acquired organisms to these drugs. In addition, fluoroquinolones have proven efficacy in the treatment of bacterial corneal ulcers. Prolonged and low-frequency dosing should be avoided to discourage the emergence of resistant organisms due to subinhibitory antibiotic concentrations on the ocular surface. Ofloxacin has effectiveness similar to that of tobramycin for external ocular infection, fortified cefazolin and tobramycin for bacterial keratitis, and fortified gentamicin and cefuroxime

2014 eMedicine.com

136. Cor Pulmonale (Treatment)

therapy, diuretics, vasodilators, digitalis, theophylline, and anticoagulation therapy are all different modalities used in the long-term management of chronic cor pulmonale. Patient education Patient education regarding the importance of adherence to medical therapy is vital because appropriate treatment of both hypoxia and underlying medical illness can improve mortality and morbidity. Complications Complications of cor pulmonale include syncope, hypoxia, pedal edema, passive hepatic congestion (...) that mimics the function of nitric oxide as well as acts synergistically with it to promote vasodilation. Unlike other advanced therapies, riociguat has been FDA approved for the treatment of group I pulmonary hypertension as well as group 4 pulmonary hypertension (chronic thromboembolic pulmonary hypertension). It was shown to improve exercise tolerance as well as reduce symptoms. [ ] Cardiac glycoside agents The use of cardiac glycosides, such as digitalis, in patients with cor pulmonale has been

2014 eMedicine.com

137. Eisenmenger Syndrome (Treatment)

. . Hascoet S, Baruteau A, Humbert M. 0425: Prognostic value of invasive hemodynamic parameters in Eisenmenger syndrome [abstract]. Arch Cardiovasc Dis Suppl . Jan 2016. 8(1):101-2. . [Guideline] Badesch DB, Abman SH, Simonneau G, Rubin LJ, McLaughlin VV. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest . 2007 Jun. 131 (6):1917-28. . Maron BA, Galie N. Diagnosis, treatment, and clinical management of pulmonary arterial hypertension (...) syndrome: results of the BREATHE-5 open-label extension study. Int J Cardiol . 2008 Jun 23. 127 (1):27-32. . Elshafay A, Truong DH, AboElnas MM, et al. The effect of endothelin receptor antagonists in patients with Eisenmenger syndrome: a systematic review. Am J Cardiovasc Drugs . 2017 Jun 28. . Ereminiene E, Kinderyte M, Miliauskas S. Impact of advanced medical therapy for the outcome of an adult patient with Eisenmenger syndrome. Respir Med Case Rep . 2017. 21:16-20. . Adriaenssens T, Delcroix M, Van

2014 eMedicine.com

138. Pulmonary Disease and Pregnancy (Treatment)

concentration. Because the glomerular filtration rate increases during gestation, drugs primarily eliminated by renal excretion are cleared more rapidly during pregnancy. Evaluation of medication use during pregnancy When considering use of a drug during pregnancy, ask the following questions: Is the drug necessary? What animal or human data are available to assess the effect of the drug on the fetus? What is the effect of the drug on the pregnancy, including labor and delivery? Does the dose or dosing (...) woman have symptomatic reflux. Initial therapy might consist of small meals and raising the head of the bed by 6 inches. Some patients might require antacids or H2-receptor–blocking medications. Medications during pregnancy While a natural reluctance exists to prescribe drug therapy in pregnancy, poorly controlled asthma is potentially more dangerous for the fetus than medication. The classic teratogenic period in humans occurs from 4-10 weeks after the last menstrual period. Medications are added

2014 eMedicine.com

139. Psychosocial and Environmental Pregnancy Risks (Treatment)

to be measurable in the fetal circulation compared to other chemicals. Recent studies indicate that more than 90% of pregnant women take medication during pregnancy, and many women take more than 4 different drugs during the course of pregnancy. The US Food and Drug Administration (FDA) requires animal testing before the approval of new medications. The FDA also uses a classification system to define fetal risks for all FDA-approved drugs. The pharmaceutical pregnancy risk classification by the FDA (...) of the defined regulations, prescribing through the internet, [ ] medication noncompliance. [ ] Etretinate is an extremely long-lasting oral retinoid used in the treatment of psoriasis. The medication is detectable in serum for more than 2 years after use. Neural tube defects, CNS malformations, skeletal abnormalities, and craniofacial defects have been observed. The duration with which the drug may continue to cause abnormalities is unknown. Etretinate should not be used in women of childbearing age

2014 eMedicine.com

140. Pyelonephritis, Acute (Treatment)

be treated initially in the emergency department (ED) with vigorous oral or IV fluids, antipyretic pain medication, and a dose of parenteral antibiotics. Studies have shown that outpatient therapy for selected patients is as safe as inpatient therapy for a comparable group of patients and is much less expensive. Use analgesics as needed. Early in the course of the illness, parenteral analgesics are often necessary to reduce morbidity from symptoms. Nonsteroidal anti-inflammatory drugs and narcotics (...) University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System Vecihi Batuman, MD, FASN is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Acknowledgements Amy J Behrman, MD Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine Amy J Behrman, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Christopher

2014 eMedicine.com

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