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Perception Exam

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161. Burnout- The Hot Topic in Medicine

, the development of negative, cynical attitudes and feelings towards one’s clients (in the case of physicians, the patient is the client). This dehumanized perception is further described as one that could lead some to view their clients as somehow deserving of their troubles. The third scale is decreased personal accomplishment, in which people have a sense of futility and do not believe their actions make an impact. Maslach, a social psychologist, observed this syndrome of emotional exhaustion and cynicism (...) associated with lower In-Training Exam scores. 3 At the attending physician level, a 2012 JAMA original investigation entitled “Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population” not only compared physicians across medical specialties but also compared them to the general workforce population. It was found that of the 7,288 physicians surveyed, 45.8% reported at least 1 symptom of burnout. Of note, there were substantial differences by specialty

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2017 Clinical Correlations

163. CRACKCast E104 – Delirium and Dementia

Perception NOT better explained by another neurocognitive disorder Important to note these things on history (collateral hx is crucial): Inattention Short term memory impairment Sleep-wake cycle changes Inquiry about disturbed perceptions – hallucinations or delusions On physical exam: Autonomic system dysfunction: Elevated or decreased: Pulse, RR, temp, BP. Wernicke’s Encephalopathy Ataxia, 6th Cranial Nerve Palsy, and Confusion Remember that magnesium is a cofactor in thiamine utilization!! Replace (...) disturbances. Here is the big three step approach for us in the ER: Take a full collateral hx and do a physical exam to determine if this is delirium or dementia Rapidly treat any underlying cause of delirium “Establish a supportive environment and employ pharmaceutical adjuncts as needed” [1] List the four key diagnostic criteria for delirium. BOX 94.1 – Diagnostic Criteria for Delirium FOUR KEY CHARACTERISTICS Acute onset with fluctuating course Disturbs attention and awareness (inattention) Disturbed

2017 CandiEM

165. Tympanostomy Tubes in Children with Otitis Media

address the effectiveness of TT, we considered intermediate outcomes, including the prevalence of middle ear effusion, measures of hearing and vestibular function, such as improved hearing thresholds (audibility), tests of auditory perception and discrimination (clarity), and balance and coordination (vestibular function). For KQ 2, measures of recurrent AOM, including otorrhea were extracted. Quality of life and patient-centered outcomes were considered, including global and otitis- specific child (...) to 12 NR Antibiotic prophylaxis (25) vs. Oral steroid (25) vs. Placebo (25) vs. TT +/- adenoidectomy (25) Composite cure (appearance, audiometry, tympanography) Gates 1987 3683478 U.S. 88 suspected SOM with MEE persisting >= 2 months 4 to 8 4/1980- 6/1984 TT (129) vs. Myringotomy (107) vs. vs. TT & Adenoidectomy (125) vs. Myringotomy & Adenoidectomy (130) Time with abnormal hearing & time with HL >= 20 dB Percent time with effusion & time to 1st recurrence, proportion of exams with effusion Mandel

2017 Effective Health Care Program (AHRQ)

166. Tinnitus

; H. Jeffrey Kim, MD k ; Michael D. Luttrull, MD l ; Diego Nunez Jr, MD, MPH m ; Lubdha M. Shah, MD n ; Aseem Sharma, MD o ; Vilaas S. Shetty, MD p ; Sophia C. Symko, MD q ; Rebecca S. Cornelius, MD. r Summary of Literature Review Introduction/Background Tinnitus is the perception of sound when no external sound is present. It is common, occurring in approximately 10% of the U.S. adult population [1]. Tinnitus is not a disease; rather, it is a symptom that can result from a number of underlying (...) . In this variant, a preceding clinical exam is important because otoscopy may identify a cause such as cerumen impaction, a middle ear infection, or mass [3]. Any imaging decisions should be guided on those examination findings, rather than the symptom of tinnitus. If there is concomitant asymmetric hearing loss, neurologic deficit, or head trauma, imaging should be guided by the ACR Appropriateness Criteria ® for “Hearing Loss and/or Vertigo” [4], “Cerebrovascular Disease” [6], or “Head Trauma” [5

2017 American College of Radiology

167. Gynecological Conditions: Periodic Screening With the Pelvic Examination

from June 28, 2016, to July 25, 2016. One concern expressed in the comments was the perception that the USPSTF was recommending against performing screening pelvic examinations and therefore against screening for cervical cancer. The USPSTF has clarified that it is recommending neither for nor against screening with pelvic examination for gynecologic conditions other than cervical cancer, gonorrhea, or chlamydia. The evidence on performing pelvic examinations to screen for conditions other than (...) With Pelvic Examination: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 147. AHRQ Publication No. 15-05220-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2017. Guirguis-Blake JM, Henderson JT, Perdue LA. Periodic screening pelvic examination: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2017;317(9):954-966. Tiemstra JD, Pela E. Urinary symptoms after a routine pelvic exam. J Am Board Fam Med. 2011;24(3

2017 U.S. Preventive Services Task Force

168. Early pregnancy loss

, Brisbane Qld 4001, email, phone (07) 3234 1479. Refer to online version, destroy printed copies after use Page 2 of 39 Queensland Clinical Guideline: Early pregnancy loss Flow Chart: Assessment of suspected early pregnancy loss Haemodynamically stable? Assessment • History • Confirm pregnancy • Physical Exam • Serial ß-hCG • USS (TVS preferred) • FBC and blood group • MSU as indicated • STI screen as indicated Ectopic pregnancy Refer to flowchart: Ectopic pregnancy Confirm (...) support after hearing bad news such as quiet time and opportunity to contact close family/friends Refer to online version, destroy printed copies after use Page 28 of 39 Queensland Clinical Guideline: Early pregnancy loss 9.3 Supportive care Table 25. Supportive care Aspect Consideration General principles • Emotional care is central to women’s perception about the quality of care received • Treat women with early pregnancy complications with dignity and respect, being aware that women will react

2017 Queensland Health

170. Postplacental insertion of intrauterine devices

the potential for financial savings with post- placental IUD insertion, predicting a cost savings of $282,540over2yearsforevery1000womenwhodesired a postpartum IUD [83]. For programs that offer postplacental IUD insertion, comprehensive counseling regarding risks and benefits is essential.It isespecially importantto avoid contraceptive coercion or perception of coercion in this setting. LARC methods may be particularly susceptible to potential coercion due to dependence on a health care provider to insert (...) and remove the device [84]. Given the history of forced sterilization in the United States and patient perceptions about directive counseling and coercion by health care providers [85], providers must ensure that women receive nonjudgmental patient-centered counsel- ing and maintain autonomy in their contraceptive decision-making. The health care team must make sure that women have the information and time necessary to make informed decisions without coercion based on their personal preferences

2017 Society of Family Planning

171. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

In prior studies, investigators have reported the positive impact of TPE on knowledge, behavioral, psychosocial, and health outcomes 6–11 ; however, there is a gap in understanding how TPE mechanisms impact specific self-management outcomes (eg, cardiac condition or disease clinical indicators and health behaviors). Furthermore, it is unclear what strategies are useful to address TPE barriers (eg, health literacy, cognition). 10,12 These gaps in evidence related to TPE underscore the need to exam- ine (...) re: symptom monitoring and self-care Tailored messages via telehealth after discharge 6 wk Increased energy expenditure (physical activity: P<0.05) Improved physical (P<0.05) and role- physical functioning (P<0.005) in both groups over time Broadbent et al 44 (2009) MI RCT N=103 I=52 C=51 Hospital UC vs 1:1 explanation of MI, exploration of causal perceptions, and personal action recovery plan In person by health psychologist before discharge Four 30-min sessions Better understanding

2017 American Heart Association

172. Point-of-care devices for detecting diabetic polyneuropathy

). There have been many studies looking into the screening process of diabetic neuropathy. The majority of the tests have poor sensitivity and specificity for identifying early stages of DPN. The review by Cornblath (8) has highlighted that there is some degree of inconsistency between the different modalities of quantitative testing methods. Quantitative testing for thermal and vibratory perception are not as precise as nerve conduction studies (NCS), which is why this form of quantitative measurement (...) ) 96 (92-98) 96 (91-98) 92 (87-95) Severe 91 (82-96) 95 (92-97) 84 (72-91) 98 (95-99) One study of 57 diabetic patients (17) assessed the accuracy of the Neuropad compared to established measures of somatic and autonomic neuropathy i.e. to the NDS, neuropathic symptoms score, cold detection, heat as pain perception threshold visual analogue score and deep breathing heart rate variability and intra-epidermal fibre density. The sensitivity of an abnormal Neuropad response in identifying a clinical

2016 NIHR DEC Oxford

173. Management of Type 2 Diabetes Mellitus

and physical activity [IID]. • Check weight, calculate BMI [IID]. • Feet should be inspected at each visit if neuropathy present. Otherwise visual foot exam and neuropathy evaluation annually [IA]. • Smoking cessation counseling provided for patients with tobacco dependence [IB]. • Review and reinforce key self- management goals (See Table 3) [IA]. • Dilated retinal examination by eye care specialist: if good blood sugar and blood pressure control and previous eye exam was normal, every 2 years (...) months. If 2 of 3 spot urine albumin/creatinine ratios > 30 mg/gm 1. Check creatinine, electrolytes and estimated glomerular filtration rate (eGFR) [ID g ]. 2. Begin ACE inhibitor or ARB [IA d ] (if electrolytes allow use of ACE inhibitor). Recheck creatinine and electrolytes within 1–2 weeks of initiating therapy. Neuropathy Perform foot exam: (1) visually inspect, (2) check pulses (each visit if patient has a history of neuropathy; otherwise annually), and (3) monofilament (annually), see Table 13

2017 University of Michigan Health System

174. Management of Osteoarthritis of the Hip

health perception) SF-36(General Health) Reoperation implant revision() implant revision(survival with revision for any reason as endpoint) Harris Hip Score(improvement) SF-12(physical improvement) implant revision(cumulative survival rate) Mortality mortality() 59 DETAILED DATA TABLES Reference Title Quality Outcome Details Duration N Treatment (Details) Comparison Confounding Adjustment Statistic Result Significance Aranda, Villalobos P., 2013 Low Quality WOMAC (pain change from baseline) 3 years

2017 American Academy of Orthopaedic Surgeons

176. Diagnosis and Treatment of Low Back Pain

, treatment goals, and challenges is essential and should be guided by evidence-based information tailored to the patient’s needs. An empathetic and non- judgmental approach to communication with a patient is highly recommended in order to build trust and facilitate frank discussions relating to the social, economic, emotional, and cultural factors that influence patients’ perceptions, behaviors, and decision making. The information that patients are given about treatment and care should be culturally

2017 VA/DoD Clinical Practice Guidelines

177. Management of Opioid Therapy (OT) for Chronic Pain

to poorly localized symptoms such as diffuse pain, burning, numbness, or a feeling of skin sensitivity. A comprehensive pain assessment includes a biopsychosocial interview and focused physical exam. Elements of the biopsychosocial pain interview include a pain-related history, assessment of pertinent medical and psychiatric comorbidities including personal and family history of SUD, functional status and functional goals, coping strategies, and a variety of psychosocial factors such as the patient’s

2017 VA/DoD Clinical Practice Guidelines

179. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

. The USPSTF reports insufficient evidence to support screening for alcohol problems and insufficient evidence for primary care behavioural interventions to prevent or reduce the abuse of prescription or non-prescription drugs by children and adolescents. Nevertheless, a consensus recommendation to screen is included in the Greig Health Record based on the significant prevalence of problem drinking in Canadian youth and the possible effectiveness of education programs in changing youth perceptions of drug

2016 Canadian Paediatric Society

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