scholarly journals Delayed anaphylaxis due to gadolinium- A rare clinical scenario

2021 ◽  
Vol 16 (9) ◽  
pp. 2522-2525
Author(s):  
Sudeep Acharya ◽  
Shamsuddin Anwar ◽  
Samragnyi Madala ◽  
Sakura Thapa ◽  
Rabih Maroun
Keyword(s):  
Clinical Scenario ◽  
Delayed Anaphylaxis

Responding to Clinicians' Challenges in Working With Geriatric Patients

2011 ◽  
Vol 16 (1) ◽  
pp. 22-29
Author(s):  
Lisa Y. Milliken ◽  
Dawn Ralph ◽  
Sally Jones-McNamara
Keyword(s):  
Health Care ◽  
Geriatric Patients ◽  
Clinical Scenario ◽  
Medical Diagnoses ◽  
Communication Deficits ◽  
Resident Care ◽  
Physical Limitations

Clinicians work with older residents who have not only multiple physical limitations, but cognitive loss, communication deficits, dysphagia, and multiple medical diagnoses. They must work within procedural, regulatory, and reimbursement systems that challenge them to provide optimal resident care. In this article, the authors will discuss some specific challenges brought forth by clinicians in response to a clinical scenario and will provide information and feedback from several health-care consultants.

Clinical scenario of patients with multiple sclerosis (MS): A north Indian perspective

2017 ◽  
Vol 381 ◽  
pp. 240
Author(s):  
P. Banerjee ◽  
D. Khurana ◽  
B. Saikia ◽  
P. Singh ◽  
K. Jangra
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Scenario ◽  
Indian Perspective

scholarly journals Eye Protection in ENT Practice During the COVID-19 Pandemic

OTO Open ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 2473974X2110104
Author(s):  
Jia Hui Ng ◽  
Dan Daniel ◽  
Anton Sadovoy ◽  
Constance Ee Hoon Teo
Keyword(s):  
Health Care ◽  
Protective Equipment ◽  
Evidence Based ◽  
Clinical Scenario ◽  
Degree Of Contamination ◽  
Eye Protection ◽  
Fluorescent Microscope ◽  
Set Up ◽  
Evidence Based Guidelines ◽  
Care Worker

Objectives There is a lack of evidence-based guidelines with regard to eye protection for aerosol-generating procedures in otolaryngology practice. In addition, some recommended personal protective equipment (PPE) is not compatible with commonly used ENT equipment. This study aims to investigate the degree of eye protection that commonly used PPE gives. Study Design Simulation model. Setting Simulation laboratory. Methods A custom-built setup was utilized to simulate the clinical scenario of a patient cough in proximity of a health care worker. A system that sprays a xanthan-fluorescein mixture was set up and calibrated to simulate a human cough. A mannequin with cellulose paper placed on its forehead, eyes, and mouth was fitted with various PPE combinations and exposed to the simulated cough. The degree of contamination on the cellulose papers was quantified with a fluorescent microscope able to detect aerosols ≥10 µm. Results When no eye protection was worn, 278 droplets/aerosols reached the eye area. The use of the surgical mask with an attached upward-facing shield alone resulted in only 2 droplets/aerosols reaching the eye area. In this experiment, safety glasses and goggles performed equally, as the addition of either brought the number of droplets/aerosols reaching the eye down to 0. Conclusion When used with an upward-facing face shield, there was no difference in the eye protection rendered by safety goggles or glasses in this study. Safety glasses may be considered a viable alternative to safety goggles in aerosol-generating procedures.

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

scholarly journals Pathologic validation of an yttrium-90 trans-arterial radioembolization dosimetry: a case report

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Jacqueline B Baikovitz ◽  
Lindsay Thornton ◽  
Monica T Garcia-Buitrago ◽  
Alan S Livingstone ◽  
Matthew T Studenski ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Liver Resection ◽  
Pathologic Response ◽  
Clinical Scenario ◽  
Complete Pathologic Response ◽  
Pathological Findings ◽  
Rigorous Approach ◽  
Yttrium 90

Abstract Yttrium-90 (Y-90) trans-arterial radioembolization (TARE) is used in the management of unresectable hepatocellular carcinoma (HCC). During the last 5 years, dosimetry software has been developed to allow for a more rigorous approach of dose prescription in Y-90 TARE. We present here a case study of a 77-year-old woman diagnosed with HCC, who underwent a Y-90 TARE as a bridge procedure to liver resection. This clinical scenario represents a unique opportunity to illustrate the predictive value of dosimetric findings correlating dosimetry with pathological findings. In this case, Y-90 TARE dosimetry was predictive of treatment response in which the tumor received a mean dose of 156 Gy and demonstrated a complete pathologic response.

scholarly journals Keto-Sleuths – An Unusual Cause of Loss of Ketosis?

2021 ◽  
Vol 8 ◽  
pp. 2329048X2110297
Author(s):  
Christine M. Foley ◽  
Christopher Ryan ◽  
Stacey Tarrant ◽  
Ann M. Bergin
Keyword(s):  
Effective Treatment ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Clinical Scenario ◽  
Diet Restriction ◽  
Ketogenic Diets ◽  
Control And Prevention

Ketogenic diets provide a non-pharmaceutical alternative for treatment of refractory epilepsy. When successful in reducing or eliminating seizures, medication numbers or doses may be reduced. Unexpected loss of ketosis is a common problem in management of patients on ketogenic diets and, especially when the diet is an effective treatment, loss of ketosis may be associated with an exacerbation in seizures. Identification of the cause of loss of ketosis is critical to allow rapid resumption of seizure control, and prevention of unnecessarily increased diet restriction or increased medication doses. Here an unusual environmental cause of loss of ketosis is described (contamination with starch-containing drywall dust), illustrating the extent of investigation sometimes necessary to understand the clinical scenario.

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