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42. Controversies in Migraine Management

that coverage policies requiring attempts with other treatments before using BOTOX are reasonable and reflect current practice. The CTAF Panel urged that research be performed to allow identification of patients who are better candidates for first-line treatment with BOTOX. Lastly, CTAF examined care options for migraine patients in emergency departments (EDs). These patients receive parenteral opioids over 50% of the time, even though the CTAF Panel confirmed that strong evidence shows that opioids offer (...) known triggers. These include stress, hormones in women, hunger (missed or delayed meals), too little or too much sleep, lack of regular exercise, certain foods and food additives, and odors (perfumes, cigarette smoke). Clinical understanding of the basis for migraine headaches is still at an early stage. Initially thought to be caused by dilation and constriction of blood vessels in the head, experts now believe that electrical activity in the surface layer of the brain (characterized by waves

2014 California Technology Assessment Forum

43. Treatment and Recommendations for Homeless Patients with Chlamydial or Gonococcal Infections

clue cells. ? KOH: no yeast, negative whiff test. Assessment: Unremarkable clinical examination with exception for pelvic exam. The cervix is mildly friable, but there is no chandelier sign or tenderness with deep palpation. Greenish, mucopurulent discharge draining from the os with characteristic “musty” odor noted. Pap smear obtained and swabs for gonorrhea and chlamydia were collected. Diagnosis: Suspected gonorrhea and/or chlamydia. Wet mount shows clinical signs indicative of trich vaginalis (...) is suspected. ? Prior STIs Ask about history of STIs in both male and female patients. ? Reproductive health Obtain gynecological history including best possible menstrual history for females. ? Readiness to change Assess patient's developmental level and readiness to change. ? Partner history Always ask whether partner needs to be treated. Physical Examination ? Preventive care For female patient, do breast exam with pelvic exam to address preventive as well as acute care needs. For male patient, include

2013 National Health Care for the Homeless Council

44. Allergic Rhinitis

by the patient. Allergic Rhinitis Patient population: Adults and pediatrics Objectives: Assist in the diagnosis and cost-effective treatment of allergic rhinitis. Key Aspects & Recommendations: Diagnosis. Allergic rhinitis is an antigen-mediated inflammation of the nasal mucosa that may extend into the paranasal sinuses. Diagnosis is usually made by history and examination (“itchy, runny sneezy, stuffy”). A symptom diary and a trial of medication may be helpful to confirm a diagnosis. Allergy testing (...) be present in addition to allergic rhinitis; symptoms may wax and wane over time; chronic hyposmia. Viral URI Self-limited course with symptoms (clear rhinorrhea, cough, ache, low grade fever) usually resolving within 3-7 days Structural abnormalities Include nasal septal deviation, nasal polyps, enlarged turbinates, adenoidal hypertrophy. Obstruction may be unilateral or bilateral and may or may not be seen on routine nasal examination. Gustatory rhinitis Clear rhinorrhea caused by hot (i.e. soup

2013 University of Michigan Health System

45. Clinical Consensus Statement: Appropriate Use of Computed Tomography for Paranasal Sinus Disease

to increased cancer risk, and overuse concerns. Radiation exposure is much greater with imaging modalities such as multiphase studies; abdomen, pelvis, and chest CT imaging; interventional radiology procedures; and nuclear medicine studies compared with standard sinus and skull base CT imaging (conventional and cone beam CT [CBCT]). Overall, the average per capita exposure to ionizing radiation from imaging examinations increased by nearly 600% from 1980 to 2006 in the United States. Reports have indicated (...) diagnosed uncomplicated acute sinusitis (statement 3); however, it is indicated for recurrent acute and chronic sinusitis (statement 4) and patients with cerebrospinal fluid (CSF) rhinorrhea (suspected or confirmed, spontaneous or iatrogenic). The panel reached consensus that CT imaging in the asymptomatic patient, in conjunction with physical and endoscopic examination, is appropriate in certain circumstances such as tumor surveillance and to monitor areas not well visualized clinically (statement 6

2012 American Academy of Otolaryngology - Head and Neck Surgery

46. Induction of chronic migraine phenotypes in a rat model after environmental irritant exposure. Full Text available with Trip Pro

. Here, we examine whether chronic environmental irritant exposure induces migraine behavioral phenotypes. Male rats were exposed to acrolein, a transient receptor potential channel ankyrin-1 (TRPA1) agonist, or room air by inhalation for 4 days before meningeal blood flow measurements, periorbital cutaneous sensory testing, or other behavioral testing. Touch-induced c-Fos expression in trigeminal nucleus caudalis was compared in animals exposed to room air or acrolein. Spontaneous behavior (...) and olfactory discrimination was examined in open-field testing. Acrolein inhalation exposure produced long-lasting potentiation of blood flow responses to a subsequent TRPA1 agonist and sensitized cutaneous responses to mechanical stimulation. C-Fos expression in response to touch was increased in trigeminal nucleus caudalis in animals exposed to acrolein compared with room air. Spontaneous activity in an open-field and scent preference behavior was different in acrolein-exposed compared with room air

2017 Pain

47. RCT of a Polyherbal Dietary Supplement for Prediabetes

, but still promising, thereby preserving study power; this will be determined by examination of available unblinded endpoint data by an independent statistician after 30 subjects are enrolled. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 40 participants Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: This study is a 12-week, randomized, double-blinded, placebo-controlled clinical (...) utilized in this clinical trial will be formulated to be as similar as possible to the active in appearance, odor, and other key characteristics, and packaging for both intervention and placebo will be the same. The de-identified study product will be packaged and labeled according to the study code and participant identification numbers; the Study Coordinator will oversee a locked master list of these, in addition to batch numbers. Primary Purpose: Treatment Official Title: A Randomized, Placebo

2017 Clinical Trials

48. Efficacy of Inhalation of Essential Oil on the Reduction of Inhalants Craving

to examine the effects of inhalation of essential oil (EO) and perfume (PF) on the reduction of cue-induced craving for inhalants in a cohort of thirty-four Thai males with inhalants dependence. The craving response was measured by the modified version of Penn Alcohol Craving Score for Inhalants (PACS-inhalants) Condition or disease Intervention/treatment Phase Inhalants Craving Combination Product: Essential oil Combination Product: Perfume Behavioral: Cue-induced inhalants craving Phase 3 Study Design (...) is extracted by a cold compressed method from the lavandula angustifolia (lavender) grown in Australia. Combination Product: Essential oil To inhale the essential oil in an air-conditioned room, the container was flipped over to soak the roll-on cap that was then rolled-on circularly at the right mid-palm of the subject at 2 centimeter in diameter for 5 cycles. Behavioral: Cue-induced inhalants craving Exposing individuals with a set of 12 pictures for one-minute (e.g., 5 second display per picture) every

2017 Clinical Trials

49. Patient Dignity (Formerly: Patient Modesty): Volume 93

gynecological procedures on women. Before that time, only midwives examined women intimately. I have this very picture on an article I wrote about . Misty At , Anonymous said... Misty On your site regarding your illustration “ what to expect during a pelvic exam”, it would be beneficial to readers that female patients can additionally request drapes to cover their inner and outer thighs for more privacy. Many more proactive facilitiesare doing just this to enhance the patient experience. Again, thank you (...) have had those procedures w/o sedation, I was allowed to keep my pants and underwear on for an upper endoscopy and a T.E.E., both procedures for which having nothing on but a gown is standard protocol, and when I had a little dust up with Dermatology over not wanting a female scribe and LPN in the room for my exam, Patient Relations went to bat for me and effected a policy change in large part because of the manner in which I presented my complaint. I overheard the Patient Relations person

2019 Bioethics Discussion Blog

50. Patient Dignity (Formerly: Patient Modesty): Volume 93

gynecological procedures on women. Before that time, only midwives examined women intimately. I have this very picture on an article I wrote about . Misty At , Anonymous said... Misty On your site regarding your illustration “ what to expect during a pelvic exam”, it would be beneficial to readers that female patients can additionally request drapes to cover their inner and outer thighs for more privacy. Many more proactive facilitiesare doing just this to enhance the patient experience. Again, thank you (...) have had those procedures w/o sedation, I was allowed to keep my pants and underwear on for an upper endoscopy and a T.E.E., both procedures for which having nothing on but a gown is standard protocol, and when I had a little dust up with Dermatology over not wanting a female scribe and LPN in the room for my exam, Patient Relations went to bat for me and effected a policy change in large part because of the manner in which I presented my complaint. I overheard the Patient Relations person

2019 Bioethics Discussion Blog

51. Volatile Inhalant

Bagging Substance poured into a bag and inhaled Most dangerous method of Inhalant Abuse due to combination with anoxia and hypercarbia V. Symptoms Mood swings or VI. Findings: Signs and Symptoms See ral observation Staining of clothes Chemical inhalant odor to breath Room with multiple inhalant cans (e.g. air fresheners) Mouth and nose changes Perioral lesions, discoloration, erythema or "de-fatting" (with chronic use) Dominant hand changes Staining of s or skin De-fatting of dominant hand (...) Inhalant , Inhalation Drug Use , Inhalant Abuse , Volatile Inhalant Abuse , Sudden Sniffing Death Syndrome , Huffing From Related Chapters II. Epidemiology Common abuse in 10-14 years old (easy access to household inhalants) III. Forms Organic Nitrates (" ") Also found in aerosol bottles (see below) Gasoline, Propane, or other Hydrocarbons Butane (lighter fluid, hair spray, deodorants) Propane (Gas grill fuel, room freshener, spray paint) Fluorocarbons ( or spray, Freon gas) Chlorinated hydrocarbons

2018 FP Notebook

52. Aromatherapy and Essential Oils (PDQ®): Health Professional Version

and healthy humans have been published in the context of odor and neurobiology (and in the absence of the specific term aromatherapy). In addition to uses,[ ] aromatherapy has also been proposed for use in care [ , ] and to treat a variety of and illnesses such as , , and .[ - ] Aromatherapy has also been studied via for airway reactivity.[ ] Studies on aromatherapy have examined a variety of other conditions: sedation and ;[ , ] startle reflex and reaction time;[ , ] states such as mood, , and general (...) to result from the binding of chemical components in the essential oil to in the , impacting the brain’s emotional center, the . Topical application of aromatic oils may exert , , and effects. Studies in show and effects of specific essential oils as well as positive effects on behavior and the immune system. studies in humans support the influence of odors on the limbic system and its emotional pathways. Human clinical trials have investigated aromatherapy primarily in the treatment of and in patients

2016 PDQ - NCI's Comprehensive Cancer Database

53. AAWC Pressure Ulcer Guidelines

, treatment, procedure or falls (Manesse et al., 1994): time spent immobile, room temperature, pressure reducing surfaces used and repositioning considerations if appropriate to patient for all settings a. Acute care , including Emergency Department (Schoonhoven et al, 2006; Langemo et al 2006; Linares et al., 1987 Lyder et al 2001) Association for the Advancement of Wound Care Guideline of Pressure Ulcer Guidelines Legend: Bold: Evidence Level A. Italics = Level B, Normal = Level C; Underlined if cost (...) analysis was performed. Each recommendation has Content Validity > 0.75 based on 31 multidisciplinary independent survey respondents. © Association for the Advancement of Wound Care 2010 October 1, 2010 Page 3 of 14 b. Long term care (Bergstrom & Braden 1992; Bergstrom, Braden, Kemp et al., 1998) c. Operating room and post-anesthesia care unit (Schoonhoven et al, 2006; Aronovich 2007) d. Procedural lab; e.g. for oncology, radiological or catheter-related procedures such as dialysis (Reed et al., 2003

2011 Association for the Advancement of Wound Care

54. Patient Modesty: Volume 90

surgeon operating on him might not be comfortable with an MA or CNA assisting them with a shower. He might be comfortable being examined by a female physician but uncomfortable with her bringing a female chaperone into the room. Conversely the healthcare world does not differentiate between levels in this regard and expects patients to be equally comfortable with the trained-on-the-job MA as with the surgeon. At , said... Biker, Speaking of context, may I ask about your handle; "Biker in Vermont (...) agrees to step aside immediately, BUT . Again, NO accountability in the system. I guess all those who made complaints (going back to 2000) were labeled as OUTLIERS... -- Banterings At , said... From the Allegations against Tyndal article: “In fact, USC nurses, chaperones and other staff members were regularly present in the examination rooms, observed the inappropriate sexual molestation, and took no steps to stop it as it occurred,” the complaint says. To me this is the larger problem in healthcare

2018 Bioethics Discussion Blog

55. Patient Modesty: Volume 90

surgeon operating on him might not be comfortable with an MA or CNA assisting them with a shower. He might be comfortable being examined by a female physician but uncomfortable with her bringing a female chaperone into the room. Conversely the healthcare world does not differentiate between levels in this regard and expects patients to be equally comfortable with the trained-on-the-job MA as with the surgeon. At , said... Biker, Speaking of context, may I ask about your handle; "Biker in Vermont (...) agrees to step aside immediately, BUT . Again, NO accountability in the system. I guess all those who made complaints (going back to 2000) were labeled as OUTLIERS... -- Banterings At , said... From the Allegations against Tyndal article: “In fact, USC nurses, chaperones and other staff members were regularly present in the examination rooms, observed the inappropriate sexual molestation, and took no steps to stop it as it occurred,” the complaint says. To me this is the larger problem in healthcare

2018 Bioethics Discussion Blog

56. Life as a doctor is selfless and selfish at the same time

Coumadin clinic, where his INR was checked biweekly and blood thinner dose adjusted appropriately. According to the primary team, the lab called his cell phone and instructed him to come to the hospital immediately for an INR level of 17. On questioning him, they found that he had been taking twice the prescribed dose of Coumadin. I went to the patient’s room to do a full history and physical exam. Roy was a 78-year-old gentleman with scraggly hair and pockmarked skin. He was probably five-foot-seven (...) odor. I was apathetic, overtaken by a weariness I vowed as a medical student never to have. Morning rounds passed without incident. All our CABG patients were more or less stable. I collected each patient’s overnight events, vital signs, laboratory values, daily chest X-ray, EKG, fluid balance and wound status. With my attending’s blessings, I titrated their blood pressure drips to protect their blood vessels, kept them sedated and paralyzed if they were mechanically ventilated, fed them

2018 KevinMD blog

57. Nausea and Vomiting (PDQ®): Health Professional Version

, cyclophosphamide, and other drugs (e.g., doxorubicin and ifosfamide) given at high doses or on 2 or more consecutive days. Anticipatory N&V (ANV): ANV is nausea and/or vomiting that occurs before a new cycle of chemotherapy is begun, in response to conditioned stimuli such as the smells, sights, and sounds of the treatment room. ANV is a classically conditioned response that typically occurs after three or four chemotherapy treatments after which the patient experienced acute or delayed N&V. Breakthrough N&V (...) nurse, chemotherapy room). These previously neutral stimuli then become conditioned stimuli and elicit ANV in future chemotherapy cycles. ANV is not an indication of psychopathology but is rather a learned response that, in other life situations (e.g., food poisoning), results in adaptive avoidance. A variety of correlational studies provide empirical support for classical conditioning. For example, the prevalence of ANV before treatment with any chemotherapy is very rare, and few patients ever

2015 PDQ - NCI's Comprehensive Cancer Database

58. Nutrition in Cancer Care (PDQ®): Health Professional Version

.[ , ] Standardized definitions and cutoff points that designate malnutrition or cachexia are being developed; however, the true prevalence of malnutrition in the oncology population is unknown. A growing body of literature examines the prevalence of malnutrition in obese cancer patients. In a study of clinical data obtained from 1,469 patients with metastatic primary cancers, 41.9% were identified as overweight or obese.[ ] Upon assessment, 50% were at risk of being malnourished, and 12% were already (...) by the patient. There are four sections comprising 17 data points evaluating weight/weight history, food intake, symptoms, and activities/function. The remainder of the PG-SGA is completed by a health care practitioner, accounting for information about disease and metabolic demand and the completion of a physical exam. The abPG-SGA and PG-SGAsf use only the section completed by the patient. Responses are then scored and, on the basis of the score, patients are stratified into four nutrition triage categories

2015 PDQ - NCI's Comprehensive Cancer Database

59. The patient who was a former bowling champion

. Over the previous months, his worried family members had made several attempts to see him, but he always pushed them away with excuses why they should not visit. One day over his protests, his daughter went to his house. “His voice sounded so different!” she said. When she pushed her way into the house, she had been alarmed at how he looked. She had taken him to the community hospital and, after a stop in the emergency room there, he was sent by ambulance to our medical center. An examination (...) and CT scan confirmed that he had a very large, inoperable throat cancer. Because he was in danger of completely obstructing his airway, we immediately took him to the operating room for a tracheotomy and a feeding tube. He spent the next few days getting accustomed to the new tubes. Now, he was getting close to heading back to his daughter’s house where he would stay while undergoing cancer treatment. I stopped by his room and found him resting comfortably. As I entered, I greeted his daughter

2017 KevinMD blog

60. Obese patients are among our most vulnerable

— an intravenous catheter to infuse fluids or medications — takes more time. A physical exam is more difficult and invariably less precise: heartbeats and breath sounds are muffled by the layers of fat; palpating abdominal organs is practically impossible. When the nurse went into the patient’s room to draw labs, she couldn’t get an intravenous line in. She called a fellow nurse, who tried a few times. She, too, failed. Thus, the doctor was called to put in a femoral line. When arms and hands fail, we go (...) the reason the patient is the way she is, perhaps we should instead recognize these patients for what they are — among the most vulnerable of all. Sure, we felt frustrated by the extra work our patient’s body habitus put us through. But it was not her choice to be in that room with layers of fat lifted by a stranger, causing that smell to emanate from her skin. She didn’t put that on us — we put that on her . If having witnesses to your body’s odors isn’t uncomfortable, then what is? In the ED, we only

2017 KevinMD blog

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