Pathways of Care and Treatment Options for Patients with Neurogenic TOS

Procreation is confounded when clinical professionals misdiagnose, misrepresent, or switch reproductive cells or entities. These errors lead patients to initiate, continue, or terminate pregnancies in ways that thwart their efforts to have a child of one kind or another: How serious is that reproductive injury? Do its benefits outweigh its harms? What are the chances of it manifesting within certain windows of time and at varying levels of severity? How likely is it that misconduct is what caused procreation to be confounded? Is some other factor responsible in addition or instead? To what extent was genetic randomness or diagnostic uncertainty to blame? The seriousness of that harm depends on its foreseeable impact on people’s lives—injury severity is an objective inquiry that begins by asking what kind of child the plaintiffs wanted and why. The variable expression of medical conditions or other targeted traits ratchets up the guesswork to forecast how a defendant’s negligence that thwarted their prenatal selection can be expected to affect the plaintiff. But all this uncertainty needn’t keep courts from assessing how serious confounded procreation is in particular cases: Just because any such determination is bound to admit of some arbitrariness doesn’t mean injury severity can’t be worked out in a principled and systematic way. For health conditions, relevant factors include foreseeable implications for offspring lifespan, impairment, medical care, and treatment options. Courts should reduce dollar awards by however much confounded procreation can be expected to simultaneously benefit plaintiffs, depending on its associated reasons and repercussions.

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Access to Pain Management Programs: A Multifactorial Analysis of the Pathways of Care for Chronic Pain Patients in the University Clinic Erlangen

Das Gesundheitswesen ◽

10.1055/a-0832-2173 ◽

2019 ◽

Vol 82 (08/09) ◽

pp. e94-e107

Author(s):

Lisa Dorscht ◽

Christoph Schön ◽

Christa Geiss ◽

Elmar Gräßel ◽

Carolin Donath

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Research Question ◽

Treatment Options ◽

Management Program ◽

Interdisciplinary Treatment ◽

Chronic Pain Management ◽

Pain Management Program ◽

The University ◽

Pathways Of Care

Abstract Background Different treatment options are offered for patients suffering from chronic pain, which differ in intensity and costs: 1) monodisciplinary treatment, mostly in outpatient care and 2) interdisciplinary treatment with the option of participating in pain management programs as outpatients or inpatients. The present work investigates how patients at the University Clinic Erlangen receiving monodisciplinary treatment differ from those receiving interdisciplinary treatment (research question I) as well as how patients participating in a pain management program differ from those who do not (research question II). The aim is to generate insights into whether the differences between the patient groups under various treatment modalities reflect the officially defined criteria for the indication of chronic pain management programs. Methods Routine data of 1,833 patients treated from January 2008 to March 2013 at the University Clinic Erlangen were analyzed. After univariate preanalyses and checks for multicollinearity, the remaining variables were used for the final multivariate model (multiple binary logistic regression) for research question I and II. Results Research question I: Patients getting interdisciplinary treatment were more often employed, had higher affective experience of pain, more often regarded their pain as treatable, had more often participated in at least one pain-associated rehabilitation treatment in the past, were younger and rarely had application for retirement in consideration. Research question II: Patients who participated in a pain management program were more often female, more often employed, described their pain as mainly located at the upper part of the body, had more concomitant symptoms, were more often diagnosed with musculoskeletal pain and rarely had a retirement request pending. Conclusions It could be shown that patients in the analyzed pathways of care mainly differed in demographic variables, and regarding pain management programs, also in the type of pain. Differences between patients in different treatment paths reflecting the officially defined indication criteria for chronic pain management programs were detectable only to a minor extent. Clearer and operational practical guidance should help support the clinical decision to assign patients to different treatment options and close the gap between theory and practice.

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Prevalence of enamel defects in premature children, care and treatment options

Journal of Dental Health Oral Disorders and Therapy ◽

10.15406/jdhodt.2019.10.00498 ◽

2019 ◽

Vol 10 (5) ◽

pp. 280-282

Author(s):

Sara Alshammery ◽

Mais Alomran ◽

Noura Alturki

Keyword(s):

Treatment Options ◽

Enamel Defects ◽

Premature Children ◽

Care And Treatment

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Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis

BMC Family Practice ◽

10.1186/s12875-020-01307-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Ana Toledo-Chávarri ◽

Vanesa Ramos-García ◽

Alezandra Torres-Castaño ◽

María M Trujillo-Martín ◽

Wenceslao Peñate Castro ◽

...

Keyword(s):

Primary Care ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Treatment Options ◽

Stepped Care ◽

Generalized Anxiety ◽

Qualitative Evidence ◽

Level Of Confidence ◽

Care And Treatment ◽

Outpatient Settings

Abstract Background Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. Methods Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. Results The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. Conclusions Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.

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Thoracic Outlet Syndrome

Neurosurgery ◽

10.1227/01.neu.0000137333.04342.4d ◽

2004 ◽

Vol 55 (4) ◽

pp. 897-903 ◽

Cited By ~ 135

Author(s):

Jason H. Huang ◽

Eric L. Zager

Keyword(s):

Thoracic Outlet Syndrome ◽

Treatment Options ◽

Surgical Anatomy ◽

Diagnostic Tools ◽

Surgical Approaches ◽

Neurovascular Compression ◽

Transaxillary Approach ◽

Detailed Medical History ◽

First Rib Resection ◽

Neurogenic Tos

Abstract OBJECTIVE: Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. We provide a review of this difficult-to-treat disorder, including a brief overview, clinical presentations, surgical anatomy, treatment options, and outcomes. METHODS: TOS represents a spectrum of disorders encompassing three related syndromes: compression of the brachial plexus (neurogenic TOS), compression of the subclavian artery or vein (vascular TOS), and the nonspecific or disputed type of TOS. Neurovascular compression may be observed most commonly in the interscalene triangle, but it also has been described in the costoclavicular space and in the subcoracoid space. Patients present with symptoms and signs of arterial insufficiency, venous obstruction, painless wasting of intrinsic hand muscles, paresthesia, and pain. A careful and detailed medical history and physical examination are the most important diagnostic tools for proper identification of TOS. Electromyography, nerve conduction studies, and imaging of the cervical spine and the chest also can provide helpful information regarding diagnosis. Clinical management usually starts with conservative treatment including exercise programs and physical therapy; when these therapies fail, patients are considered for surgery. Two of the most commonly used surgical approaches are the supraclavicular exposure and the transaxillary approach with first rib resection. On occasion, these approaches may be combined or, alternatively, posterior subscapular exposure may be used in selected patients. CONCLUSION: TOS is perhaps the most difficult entrapment neuropathy encountered by neurosurgeons. Surgical intervention is indicated for vascular and true neurogenic TOS and for some patients with the common or nonspecific type of TOS in whom nonoperative therapies fail. With careful patient selection, operative intervention usually yields satisfactory results.

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Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.637560 ◽

2021 ◽

Vol 12 ◽

Author(s):

Joanna Fox

Keyword(s):

Mental Health ◽

Health Care ◽

Decision Making ◽

Mental Health Care ◽

Shared Decision Making ◽

Service User ◽

Treatment Options ◽

Service Users ◽

Shared Decision ◽

Care And Treatment

Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.

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