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181. Patient Modesty: Volume 89

; basically what the average physician in the area would have done. If the physician documented a reason for denial (including it is my right to), attempted to educate the patient (gave him ACS pamphlet on recommended screening), periodically revisited the topic (and noted refusal again), and did not ignore the patient's request for alternative testing (FOBT vs colonoscopy), then the physician did everything possible and has a defensible position. That does NOT mean the physician will be dismissed from (...) the patient's former occupation and possible asbestos exposure. ..Maurice. At , Anonymous said... Maurice Pleural effusion can also be attributable to CHF, renal disease or a fall. I shudder to think people coming to a diagnosis with occupation first in mind. That the diagnosis could be arrived at after some investigation clinically or after a series of diagnostic tests. I might mention that prior to Hipaa laws in 1995 much of patient information from medical offices was placed in dumpsters. With names

2018 Bioethics Discussion Blog

182. Direct payments in residential care: ideas for implementation and some concerns about their value Full Text available with Trip Pro

since the financial crash of 2008, at a time of increasing demand (Lewis and West, 2014). Back in 2012, the Government initiated a pilot programme to test direct payments in residential care and participating local councils were ‘pilot sites’. When the Government extended its commitment in 2016, to introduce direct payments in residential care across England, the pilot sites became ‘trailblazers’, although national implementation has since been postponed. Methods The paper by Ettelt and colleagues (...) workers and care home residents, which as Lewis and West (2014) argue is critical to improving the quality of residential care. The barriers to implementing direct payments in residential care make it difficult to envisage how the scheme can be rolled by the new target date of 2020. Strengths and limitations The research had a clear aim – exploring barriers to implementing direct payments in residential care. A qualitative approach was appropriate because the aim was to understand and explore barriers

2018 The Social Care Elf

183. Patient Dignity (Formerly: Patient Modesty): Volume 92

women are concerned. Today, when a man with modesty concerns goes for a male specific intimate exam, test, or procedure, he is faced with the real possibility of being intimately exposed and handled by a gauntlet of women he neither knows, nor wants to be exposed in front of. To a modest man, this kind of exposure being forced upon him can have devastating results. Effects that some gentlemen never recover from. Men don't go around making fun of women for wanting a female nurse or aid

2018 Bioethics Discussion Blog

184. The Big R’s… Reform or Revolution?

Jack Chew and Connect Health took action, got the ball rolling, and are facilitating this initiative doesn’t mean they are leaders of the revolution. Also just because The Big Rs is mostly a social media initiative this doesn’t mean its only for physios who use social media. The Big Rs is for anyone who is interested in progressing and improving MSK physio in the UK. It just happens that most physios who are interested in staying up to date and in touch with progress and advances (...) . I know this first hand working as an Extended Scope Practitioner myself 2 days a week. I have been trained and given responsibility to order and review scans, blood tests, to do injections and scans myself and even consent and list patients for surgery, but technically as an ‘extended scope physio’ I am not allowed or supposed to give patients any rehab or exercise advise when I see them. This is just nuts and it is harming the physio profession and decimating physio departments across

2018 The Sports Physio blog

185. Nurses aren’t commodities

spinal immobilization to inspect the rest of his body, he was no longer responding to painful stimuli. What came next was literally nauseating. I felt such infuriation and overwhelming grief when we log rolled this beautiful baby and it became evident that he had been subjected to such extensive sexual abuse that I was secretly thankful he was now unresponsive. Just as Josh was out of spinal immobilization, I scooped him into my arms to cradle him in his mother’s absence. Once the charge nurse heard (...) about the test results, he suddenly became concerned about Josh and moved him from the pediatric ED to a trauma bay. I wanted to stay with Josh in the trauma bay; after all, he was my patient, and I was his nurse. Instead, a different nurse would take over. With no choice in the matter, I felt forced into abandoning and dismissing Josh. The move into a trauma bay was futile, and a trauma activation wouldn’t have saved him. Nothing further could be done for him, except to offer him some human touch

2018 KevinMD blog

186. Why is antivaccine activist Robert F. Kennedy, Jr. meeting with government health and science officials months after meeting with President Trump? Full Text available with Trip Pro

with President Trump? By on August 21, 2017. Poor Robert F. Kennedy, Jr. He went from admired environmental activist to reviled antivaccine campaigner so quickly. It began when he outed himself in 2005 with his infamous about thimerosal in Salon.com and Rolling Stone . Basically, RFK Jr. is a member of what we used to call the mercury militia, a branch of the antivaccine movement that believes, more than anything else, that it is the mercury-containing preservative thimerosal that used to be in several (...) for pushing back against Kennedy's misinformation, though. For instance, Kennedy claims: We need to do double-blind placebo testing. Because particularly when it comes to injecting aluminum or mercury into babies, the consequences may be latent. In other words, they may not manifest or diagnosed to age 3 or 4. So the current protocols, which require testing for vaccines of sometimes as little as 48 hours, are not going to disclose the kind of dangers that the public and the regulators ought to know about

2017 Respectful Insolence

187. Will 2018 be the year that the FDA finally regulates homeopathic remedies as drugs?

a large uptick in products labeled as homeopathic that are being marketed for a wide array of diseases and conditions, from the common cold to cancer. In many cases, people may be placing their trust and money in therapies that may bring little to no benefit in combating serious ailments, or worse – that may cause significant and even irreparable harm because the products are poorly manufactured, or contain active ingredients that aren’t adequately tested or disclosed to patients,” said FDA (...) to be worse in homeopathic sector. Gina Fredenburgh I didn’t realize that homeopathy had its own pharmacopeia but none of this magic water would pass true compendial testing. There’s some comedy gold in this aspect. jrkrideau In this case I suspect pharmacopeia = grimoire. mdfinfer I suspect that Scott Gottleib feels that the sale and use of nonsense, such as homeopathy, in some way threatens the real pharmaceutical industry. We have seen that sort of reasoning spelled out recently in the FDA’s attempt

2017 Respectful Insolence

188. 2017 year-ender: What I’ve learned from reading health news every morning

stories, and email them to the HealthNewsReview.org team. By the end of this year, I may hit 1,000 articles. As a health care reporter, I have found it’s a worthy practice. It helps me keep up with the news of the day and demonstrates how any one item—a prominent study or new screening guidelines—can be framed in different ways. I’ll admit to having favorite sites and less-than-favorite ones. And yet any of the news stories I log and share with the team has the potential to be a 5-star story or a 2 (...) . It’s clickbait. Headlines . Beware the hyped-up headline. Nothing makes me skeptical faster than a headline telling me how to . And it’s hard not do a second roll of eyes when I scan ahead to see the article describing findings from an . I also watch for any of publisher Gary Schwitzer’s you shouldn’t use. Headlines, head-spinning version . Talk about different framings to a story! In April we about seemingly opposite headlines on stories covering the same study. One news outlet’s story

2017 HealthNewsReview

189. The old Respectful Insolence is dead. Long live the new Respectful Insolence!

also want to roll the title bar clc, like the rest of the universe. This is my first time seeing on a phone. zackoz test…and Congrats to Orac on his third regeneration Denice Walter In other anti-vax news… @ kimrossi1111: claims that you can’t discuss vaccine injury ( on CNN) or gun control because “‘Merica loves its shots” ** Funny, all I seem to be hearing somehow involves control. other twits tweeting @ del bigtree and @ TMRProf ( Zoey O’Toole) ** PGP might ‘enjoy’ this twitter account and her (...) a final comment. Denice Walter What’s that poem? “We rise, we rise” No, no it’s not vampire. At any rate, I will continue to scour the crankosphere for new woo daily. As a side note, perhaps Orac’s move has inspired Jake to show up at AoA. This can be the start of something big. Heh. I feel that using RI.com, RI.org and RI.net will serve as an intelligence test, leaving many of Orac’s critics out. ( see the recent hilarious guessing game about Sceptical Raptor at AoA for a sample) If Orac and Alain

2017 Respectful Insolence

190. Why You Should Ignore “The Plant Paradox” by Steven Gundry

information under the assumption that it is good science. Is it possible that Dr. Gundry is just out to make a quick buck? He admits that his patients give up to a dozen vials of blood for testing every couple of months at his clinic. Overtesting is common practice in supplement-driven clinics. This extensive testing, (which are another topic), is almost always used to demonstrate some type of nutritional pathology, which of course can only be corrected by taking the suggested supplements. And of course (...) sense not to try it wirh his patients. I even bet his customers sat at home eatting popcorn and drinking gin and call one another after every show and roll with laughter at how gullible the people are that attend the show. Personally, I feel sorry for them! Dr. Oz should be have feathers glued on his bottom and made to do the rooster dance and sing cockledoodleado until his sense of decency and compassion for other human beings returns. says: i totally agree with you: they “should be have feathers

2018 The Skeptical Cardiologist

191. Patient Modesty: Volume 89

; basically what the average physician in the area would have done. If the physician documented a reason for denial (including it is my right to), attempted to educate the patient (gave him ACS pamphlet on recommended screening), periodically revisited the topic (and noted refusal again), and did not ignore the patient's request for alternative testing (FOBT vs colonoscopy), then the physician did everything possible and has a defensible position. That does NOT mean the physician will be dismissed from (...) the patient's former occupation and possible asbestos exposure. ..Maurice. At , Anonymous said... Maurice Pleural effusion can also be attributable to CHF, renal disease or a fall. I shudder to think people coming to a diagnosis with occupation first in mind. That the diagnosis could be arrived at after some investigation clinically or after a series of diagnostic tests. I might mention that prior to Hipaa laws in 1995 much of patient information from medical offices was placed in dumpsters. With names

2018 Bioethics Discussion Blog

192. More manual therapy bickering…

, and this needs to be promoted more. There is an argument that many of the manual therapy postgraduate courses do a good job in developing more skilled physiotherapists with better examination and diagnosis skills. Well, this may be true. I have seen many of the postgraduate courses and MSc programs run by manual therapy institutions in the UK such as the and and they do cover some enhanced clinical reasoning and assessment skills such as blood test and radiology interpretation. However, I also know (...) training? Even before I became a physio for years I had my non-trained mother step on my back cause it felt good to get a little “crack” or “pop” out of my spine and it was free, now my non-trained wife has to do it haha. I remember reading an article about how the McGill group discussed how rolling around willy nilly on a foam roller could destabilize the spine and that spinal manipulations should only ever be done by well trained clinicians. Even as a PT student, at the time, I laughed at how

2018 The Sports Physio blog

193. Planning guide for the health sector response to HIV

, Mayada Y oussef Fox. The compilation of the guide was directed and coordinated by Mazuwa Banda. Secretarial support was provided by Elizabeth Mottier-d’Souza acknowledgements2 ABC Activity-Based Costing Model ART Antiretroviral Therapy ARVs Antiretroviral drugs ASAP AIDS Strategy and Action Plans CCM Country Coordinating Mechanisms HTC HIV Testing and Counselling IDU Injecting drug use IHP+ The International Health Partnership and Related Initiatives M&E Monitoring and Evaluation MDG Millennium (...) Development Goals MoH Ministries of Health MTEF Medium-Term Expenditure Framework MTR Mid-term Reviews NHPS National Health Policies, Strategies and Plans PEPFAR President’s Emergency Fund for AIDS Relief PITC Provider-Initiated Testing and Counselling PMTCT Prevention of mother to child transmission RNM Resource Needs Model SWAps Sector-Wide Approaches TA Technical Assistance abbreviations 3 about the Planning guide This guide sets out basic principles, processes and steps relating to strategic

2011 World Health Organisation HIV Guidelines

194. What is the effect of family presence on the efficacy of pediatric trauma resuscitation?

of various resuscitation components including log-roll, first radiograph, IV access, central line, chest tube and intubation. Elapsed time for completion of log-roll. No significant difference between yes-family-presence and no-family-presence groups. This was an observational study with no active randomizable intervention. As such, it was vulnerable to confounders between the two groups. No significant demographic differences were noted between the two groups with respect to gender, race, trauma score (...) was yes-family-presence. The control was no-family-presence. The primary outcome measure was time from arrival in trauma room to departure for CT scan. The secondary outcome measure included time to completion of all laboratory tests, emergency procedures, portable radiographs and the secondary survey. Time from arrival in the trauma room to departure for CT scan between the yes-family-presence and no-family-presence groups. There was no significant difference. This study was not fully randomized

2011 BestBETS

195. Virtual reality as a treatment for persecutory delusions

, participants completed some baseline questionnaires to measure symptoms of psychosis (Positive and Negative Syndrome Scale – positive scale; Psychotic Symptoms Rating Scale), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), and the use of safety behaviours (Safety Behaviours Questionnaire – Persecutory Beliefs). Participants rated the conviction of their persecutory delusion from 0% (do not believe at all) to 100% (absolutely certain). They completed a 5 minute behavioural test (...) that involved entering a social environment that they wanted to be less fearful in (e.g. walking to the local shop). Then participants went to the virtual reality lab and were randomised using an online randomisation generator to either undergo virtual reality cognitive therapy (‘Threat belief testing group’) or virtual reality alone (‘Exposure group’). Both groups experienced the virtual reality environments, but the difference between the groups is that the threat belief testing group were encouraged

2016 The Mental Elf

196. Proactive nurse care for recurrent or chronic depression

. This RCT tested whether structured, nurse-led proactive care of patients with chronic depression in primary care improved outcomes. Methods The trial was designed to compare usual primary care (appointments with a GP) with proactive care appointments with a nurse , scheduled every three months over a two year period for people with chronic and/or recurrent depression. The term ‘proactive care’ was used to describe the treatment arm nurse appointments as these took place even if the service user felt (...) during the two year study, whilst the Work and Social Adjustment Scale (WSAS, incorrectly named the Work and Social Activity Scale in the text), a questionnaire of DSM-IV criteria and the EuroQol measure of quality of life were taken at the beginning and end of the trial. The nurses received three days of additional training, which on the one hand seems pragmatically reasonable if such a model is to be rolled out more widely, but on the other seems somewhat brief if teaching on motivation

2016 The Mental Elf

197. Patient Modesty: Volume 81

and so what got said is limited but hopefully the message can be reinforced with some comments. You have to be logged in to comment, and as yet I have not found where I can register so as to comment. If someone figures that out, I'd appreciate hearing it. I would add that the search feature they have does not seem very robust either. Even if articles can't say everything that you would like to say or can't say it forcefully enough, the more articles that get out there the more awareness (...) is enough give us a choice. They’ve been brow beaten for so long by the system, they’re brainwashed on the idea they will be completely exposed and humiliated and that’s the way it is. The other group of guys are the ones that haven’t had to use the system yet. They naively believe the healthcare system is going to protect their privacy and respect their dignity. Then they go in for an exam or test & come out of the encounter shell shocked when they see what we were saying is how it is. The other road

2017 Bioethics Discussion Blog

198. The 3-Shot Hepatitis B Vaccine – Do I Need to Restart the Series if I Am Off the Recommended Schedule?

with the first shot of the 3 shot series. I’m HbsAg positive (Reading says >250 IU/ml). And my HBV-DNA test says 91 IU/ml (1.96 Log value). My wife is HbsAg Negative and she got 2 out 3 HepB vaccine(Engerix) shots (0, 1 month). 1. How safe is to have sex(Unprotected) after 2 doses? If it is not safe now, when exactly she would be completely protected? 2. What treatment is recommended (Oral Medicine or Interferon)? We consulted couple of doctors and we got different opinions. 3. Any other precautions I/my (...) + miu, could i possibly aquire hepa b? Hello: Your hepatitis B surface antibody level is above 10 mIU/mL, so you should be protected against infection. For more information, please read: Good luck. hello im positive for hepa b, can i get vaccine for hepa b? Hello: If you are already infected with hepatitis B and test positive for the hepatitis B surface antigen (HBsAg), then the vaccine will not help you. The vaccine contains only HBsAg, which is the viral protein that covers the surface

2017 hepbblog

199. Ch, ch, ch, changes…

manipulators, dry needlers, K-tapers, machiners that go buzz who also promote and bombard us with claims that getting quick and significant changes in our patients’ symptoms helps them buy into our active treatments and improves our outcomes and success rates. I disagree Despite these claims, I don’t think we need to change things that much or that quickly for many of our patients to have successful outcomes. Now as a young, eager, and rather annoying junior physio I was taught to always test-retest (...) . But that’s no excuse to roll over and take the easy option. If we as healthcare professionals are not prepared to take the harder path, then why should we expect our patients to do the same. We need to lead by example. We need to stop looking for the easy yet unpredictable, unreliable quick fix, and focus our efforts on the harder more stable, more reliable, more challenging long term changes. As the late great David Bowie said… Ch,ch, ch, changes… turn and face the strange,Time may change me, but you

2017 The Sports Physio blog

200. Ch, ch, ch, changes…

manipulators, dry needlers, K-tapers, machiners that go buzz who also promote and bombard us with claims that getting quick and significant changes in our patients’ symptoms helps them buy into our active treatments and improves our outcomes and success rates. I disagree Despite these claims, I don’t think we need to change things that much or that quickly for many of our patients to have successful outcomes. Now as a young, eager, and rather annoying junior physio I was taught to always test-retest (...) . But that’s no excuse to roll over and take the easy option. If we as healthcare professionals are not prepared to take the harder path, then why should we expect our patients to do the same. We need to lead by example. We need to stop looking for the easy yet unpredictable, unreliable quick fix, and focus our efforts on the harder more stable, more reliable, more challenging long term changes. As the late great David Bowie said… Ch,ch, ch, changes… turn and face the strange,Time may change me, but you

2017 The Sports Physio blog

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