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21. Paediatric trauma protocols

radiation burden. ? An example of a suitable contrast and timings calculator is included (see the Camp Bastion contrast wheel, Appendix 2). ? A hand injection of contrast is appropriate in very small children and babies. ? There are no mechanisms of injury which mandate abdominal CT as an isolated factor. Decisions to perform abdominal CT should be made on the basis of the clinical history and examination. 29 ? Where there is an isolated head injury, a reduced Glasgow Coma Scale (GCS) score should (...) –16 1% 6% 4% 11% 55% 23% Sites: all UK hospitals; Date range: 01/04/2012–31/03/2013. Admission type: Direct; Age limit: 15 Other hospitals ISS 159 www.rcr.ac.uk Figure 2. Percentage of all directly admitted patients with CT within four hours of emergency department arrival that had a full body scan in this timeframe 2 The hospital data submitted to TARN shows that in the majority of paediatric cases injuries were mainly of the extremities, and to a lesser extent the head and cervical spine

2014 Royal College of Radiologists

22. Diagnosis and Management of Acute Pulmonary Embolism

and biomarkers . . . . . . . . . . . . . . . .3049 4.3.1 Markers of right ventricular dysfunction . . . . . . . . .3049 4.3.2 Markers of myocardial injury . . . . . . . . . . . . . . . .3049 4.3.3 Other (non-cardiac) laboratory biomarkers . . . . . .3050 4.4 Combined modalities and scores . . . . . . . . . . . . . . . .3051 4.5 Prognostic assessment strategy . . . . . . . . . . . . . . . . .3051 5. Treatment in the acute phase . . . . . . . . . . . . . . . . . . . . . .3052 5.1 Haemodynamic and respiratory (...) the segmental level. 131 –133 The PIOPED II trial observed a sensitivity of 83% and a speci?city of 96% for (mainly four-detector) MDCT. 134 PIOPED II also highlighted the in?uence of clinical probability on the predictive value of MDCT. In patients with a low or intermediate clinical prob- ability of PE as assessed by the Wells rule, a negative CT had a high negative predictive value for PE (96% and 89%, respectively), whereas this was only 60% in those with a high pre-test probability. Conversely

2014 European Society of Cardiology

23. Patient Dignity (Formerly: Patient Modesty): Volume 94

of the patient on the belt (entry into the doctor's office, for example) through to the 10 minute history taking and onward to the exam room with its structural and other attending issues of privacy and then perhaps a procedure with the attending assistants and so forth. The "conveyor belt", as in the NEJM article is there starting up actually even before the patient arrived at the major hospital to "prepare" for the "endpoint". The "belt" is for efficiency and meeting some goals set by the profession (...) to financial aspects of medical care but the other misbehaviors toward their patients. What do you think? ..Maurice. At , Anonymous said... Not much preservation of patient dignity at this facility: https://www.theguardian.com/us-news/2019/jan/08/phoenix-woman-coma-gives-birth-hacienda-healthcare-ceo-resigns REL At , said... This Comment was attempted to be posted today on Volume 86 of course closed to further comments but I thought it was worthy of publishing it here on Volume 94. ..Maurice. At Wednesday

2019 Bioethics Discussion Blog

24. Clinical guidance for responding to suffering in adults with cancer

on the instru- ments/tools available to assess suffering, its synonyms, and/or its symptoms; and 42 articles evaluating the effec- tiveness of interventions to alleviate the suffering of people diagnosed with cancer. The systematic review provided the evidence base for this guidance and was further supplemented by the clinical expertise of Cancer Australia's Cancer suffering and spirituality issues multidisciplinary working group. This guidance provides further information and vignettes relating to four key (...) follow-up care. 8, 13, 43 Understanding the possible emotional and spiritual responses that patients may have at different stages of cancer can help healthcare professionals anticipate when individual patients are likely to need more support. 9 For exam- ple, studies have shown that acknowledging a terminal prognosis earlier rather than later ultimately contributes to relief of suffering. 4 The recognition of death can offer a shift in perspective from small concerns to a deep appre- ciation of life

2014 Cancer Australia

25. Delirium

) asking about: The onset, nature, and course of the behaviour change — acute behaviour change (developing over hours or days) which fluctuates is suggestive of delirium. Baseline functional and cognitive state. If possible carry out a cognitive screening test (for example the General Practitioner Assessment of Cognition [GPCOG] test) and if available, compare the current score with a previous score to help differentiate acute and chronic cognitive changes — for more information on cognitive screening (...) 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

2017 NICE Clinical Knowledge Summaries

27. Management of Orthopaedic Trauma

minimizes infection. J Orthop Trauma. 2015;29:1-6. Damage Control Orthopaedic Surgery Townsend RN, Lheureau T, Protech J, Riemer B, Simon D. Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9). J Trauma. 1998 Jun;44(6):977-982; discussion 982-983. Damage Control Orthopaedics. Roberts CS, Pape HC, Jones AL, et al. J Bone Joint Surg Am. 2005 Feb;87(2):434-449. Nicola R. Early Total Care versus Damage Control: Current Concepts in the Orthopaedic Care of Polytrauma (...) deficit or lactate, might be more accurate to inform decision- making. A retrospective review of 10traditionally resuscitated patients with an injury severity score (ISS) of > 18 and a femur fracture stabilized within 24 hours of admission found that patients with a lactate of >2.5 had a higher pulmonary and infectious complication rate when compared with those with a normal lactate. Additionally, patients with severe traumatic brain injury proceeding to definitive fixation are less likely to have

2015 American College of Surgeons

28. Cervical Spine Collar Clearance in the Obtunded Adult Blunt Trauma Patient

Eligibility Our PICO question and protocol were registered with the PROSPERO international prospective register of systematic reviews [7][8] on August 23, 2013 (Registration Number: CRD42013005461) and last revised on June 18, 2014. Inclusion criteria consisted of adult blunt trauma patients 16 years or older, who underwent C-spine CT with axial thickness of less than 3 mm and who were obtunded with any author-specified definition of this term (Glasgow Coma Scale [GCS] score < 15, unconscious, intubated (...) reassessment, cervical collar complication (e.g., pressure ulcer), and time to cervical collar clearance. The term obtunded required an operationalized definition using the terms Glasgow Coma Scale , altered , intoxicated , intubated , unconscious , and/or u nreliable exam . Unstable injuries were identified primarily using the system delineated by White and Punjabi and the three-column model of Denis. [9–11] C-spine instability required either a fracture or fractures involving contiguous columns or levels

2015 Eastern Association for the Surgery of Trauma

29. Clinical practice guideline for care in pregnancy and puerperium

Technologies Assessment Agency (AETSA), Seville. Rocío García-Aguilar. Diploma in Nursing, Andalusian Health Technologies Assessment Agency (AETSA), Seville Laura Martínez-García. Specialist in Preventive Medicine and Public Health, Iberoamerican Cochrane Centre, Santa Creu i Sant Pau Hospital, Barcelona. Maria de las Nieves Respaldiza-Salas. Specialist in Immunology, Andalusian Health Technologies Assessment Agency (AETSA), Seville. David Rigau-Comas. Specialist in Clinical Pharmacology, Iberoamerican (...) , Appendix 5) should be used to confirm the diagnosis of postpartum depression in women who have answered ‘yes’ to the previous questions. v A score of over 12 points in the EPDS should be taken as a reference point for the diagnosis of postpardum depression Weak We suggest the use of the EPDS scale in the first six weeks after childbirth to ensure that the risk of depression in women is correctly discriminated. Support groups during the puerperium v Puerperium support groups should be created in primary

2014 GuiaSalud

30. Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

dysarthria, neglect, gaze preference, and a visual field defect. 4 Pupillary abnormalities are a reflection of significant brainstem shift, typically not expected on initial presenta- tion, and develop within the first 3 to 5 days. An early Horner syndrome may point to an acute carotid artery occlusion or dissection. 4 The initial National Institutes of Health Stroke Scale score is often >20 with dominant hemispheric infarction and >15 with nondominant hemispheric infarction, although this clinical (...) predictor has not undergone rigorous prospective validation. 31–33 The initial score is a reflection of stroke sever - ity and infarct volume, not a marker of tissue swelling, and although sensitive, it is not highly specific. The most specific sign of significant cerebral swelling after stroke is a decline in the level of consciousness attrib- utable to brain edema shifting the thalamus and brainstem, where major components of the ascending arousal system are situated. 34 Although right hemisphere

2014 Congress of Neurological Surgeons

31. Treatment and recommendations for homeless people with Opioid Use Disorders

for comorbidities that are strongly associated with opioid use disorders, including polysubstance use and sexually transmitted/ bloodborne infections. ? Evaluate findings from the clinical history, physical exam, and diagnostic testing to determine diagnosis and severity of opioid use disorder; identify any contraindications to medication-assisted treatment or acute conditions requiring a higher level of care. PLAN OF CARE ? Work collaboratively with patients to develop realistic, attainable, short-term goals (...) and transgender persons are among those at highest risk for sexual and physical assault (Kushel 2003). Elicit information about a history of trauma/ abuse: Has anyone ever hurt you? Are you safe now? Have you had to have sex in exchange for drugs? Inquire about head injuries, falls, assaults, accidents, participation in military combat or contact sports, and if the patient has ever been knocked unconscious or been in a coma. Did you ever hit your head or pass out? Do you have bad dreams? If so, inquire about

2014 National Health Care for the Homeless Council

32. General practice management of type 2 diabetes 2014-15

at www.racgp. org.au/your-practice/business/tools/support. Four of these indicators are relevant to diabetes care: Indicator number Description 1 Practice infrastructure to support safety and quality of patient care 5 Assessment of absolute cardiovascular risk 12 Screening for retinopathy in patients with diabetes 13 Screening for nephropathy in high-risk patients (including diabetes) Use of clinical indicators to assess care is advised but entirely voluntary.10 General practice management of type 2 (...) Assessment Tool (AUSDRISK, www.ausdrisk. com.au) (Appendix C) was developed in 2007 and agreed on as a national type 2 diabetes risk assessment tool by the Federal and all state and territory governments. AUSDRISK calculates the risk of developing diabetes over a 5-year period. Patients with scores of 12 or more are considered at high risk.General practice management of type 2 diabetes 11 According to AUSDRISK research: • For scores of 12–15, approximately one person in every 14 will develop diabetes

2014 Clinical Practice Guidelines Portal

33. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

blood count CNS Central nervous system FFP Fresh frozen plasma CPAP Continuous positive airway pressure FHR Foetal heart rate RFDS Western Operations Version 6.0 Clinical Manual Issue Date: January 2013 Part 1 - Clinical Guidelines Abbreviations & Measures ii FM Foetal movements NGT nasogastric tube GCS Glasgow coma score NIBP Non-invasive blood pressure GIT Gastrointestinal tract NIV Non invasive ventilation GPS Global positioning system NM Neuromuscular GTN Glyceryl trinitrate NSAIDS Non-steroidal (...) and clinical acumen to determine risk of deterioration, many of these parameters also form the basis of the more complex scoring systems. The measures available to us are more closely aligned to MET call or EWS scores and indeed less well resourced locations would have retrieval of the patient as part of their escalation process. With this in mind the following limits are reminders of what may require an escalation in care. Table 1. Physiological Predictors of Deterioration 60 50 40 30 30 30 180 180 160

2014 Clinical Practice Guidelines Portal

34. Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? (PubMed)

, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected.One-hundred thirty-three patients (78.2%) received a head CT scan, 7 (5.3%) of which demonstrated fractures (...) Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? Recent studies have provided guidelines on the use of head computed tomography (CT) scans in pediatric trauma patients. The purpose of this study was to identify the prevalence of these guidelines among concussed pediatric patients.A retrospective review was conducted of patients four years or younger with a concussion from blunt trauma. Demographics

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2018 Kansas Journal of Medicine

35. Treating Severe Brain-injured Patients With Apomorphine

to receive a 4-weeks regimen of daily subcutaneous infusions of apomorphine hydrochloride. Patients will be monitored for four weeks before the initiation of the therapy, closely during treatment and they will undergo a 4-weeks inpatient follow-up after washout, as well as a two-year long-term remote follow-up. Shortly before and after the treatment regimen, the subjects will receive a multimodal assessment battery including neuroimaging exams. Primary outcome will be determined as behavioral response (...) ), Communication (0-2 points), Arousal (0-3 points). The subscores are summed to calculate a total score ranging from 0 to 23 points. Higher scores indicate better functions. More importantly, it provides the patient's diagnosis (coma, UWS, MCS-, MCS+, EMCS) based on the presence of specific items in different subscales (regardless of total score). Analyses will look for changes of diagnosis, changes of total score and changes of each subscore before, during and after apomorphine treatment. Secondary Outcome

2018 Clinical Trials

36. Randomized Controlled Trial for Vestibular Treatment in Concussion

memory. These modules are used to form four composite cores: verbal and visual memories (%), visual motor processing speed (#), and reaction time (sec). The ImPACT takes 20-30 minutes to administer. The interest in ImPACT scores is in both each timepoint to assess cognitive performance against the normal for age and change between time points as an assessment of recovery. Pittsburgh Sleep Quality Index (PSQI) [ Time Frame: enrollment, 2-week, 4-week study visits ] The PSQI will be used to assess (...) : University of Pittsburgh Collaborator: United States Department of Defense Information provided by (Responsible Party): Anthony P. Kontos, Ph.D., University of Pittsburgh Study Details Study Description Go to Brief Summary: A prospective, single-blind, four-group multi-center randomized controlled trial (RCT) of targeted rehabilitation exercises for vestibular symptoms and impairments (T-REV) in civilians with mild traumatic brain injury (mTBI) will be conducted at the University of Pittsburgh Medical

2018 Clinical Trials

37. Cervico-vestibular Rehabilitation for Mild Traumatic Brain Injury

] The severity and impact of symptoms will be measured by a self-reported scale, the PCSS. This scale is a list of 22 symptoms for which participant rate each symptom for severity on a 0 (none) to 6 (severe) numerical scale. The maximum possible score is 132 (22 x 6 = 132). This valid and reliable scale has a minimal detectable change (90% confidence interval) of 12.3 PCSS points. Normative values have been established. The symptoms list can be divided in four main sub-groups (physical, cognitive, emotional (...) Criteria: Patients with more than 30 minutes of loss of consciousness for the current episode; Patients with more than 24 hours of post-traumatic amnesia; Glasgow Coma Scale score lower than 14 at the time of injury; Patients with radiographic evidence of subdural hemorrhage, epidural hemorrhage, intraparenchymal hemorrhage, and cerebral or cerebellar contusion; Post-injury hospitalization for more than 48 hours; Fracture (head, neck and spine); Having a neurological condition, other than the actual

2018 Clinical Trials

38. Patient Modesty: Volume 90

" in ways totally different than the "patient satisfaction" scoring by Ganey. Very interesting and fits with what has been written on this Patient Modesty thread. ..Maurice. At , Anonymous said... Hello, Please read the article (url below) about the lack of informed consent - another blow to patient dignity/ self-determination. http://blogs.einstein.yu.edu/minnesota-case-demonstrates-continuing-erosion-of-informed-consent/?utm_source=The+Doctor%27s+Tablet&utm_campaign=0a4cc73c66-RSS+Subscribers (...) by a dietitian. Because a lot of patients are diabetic, so it’s important. Billy bob is brought by ambulance to the hospital and admitted and he is found to have a high blood sugar of over 600. Technically, he should be in a coma. Billy bob dosen’t like the hospital food cause it tastes bland so Billy Bob orders a pizza from the local Pizza Hut and has it delivered to his room, his favorite, anchovies, pepporini, double cheese and mushrooms. But Billy Bob is non-compliant with the physicians orders regarding

2018 Bioethics Discussion Blog

39. 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

40. 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

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