scholarly journals 84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements

1996 ◽  
Vol 11 (S2) ◽  
pp. S48-S48
Author(s):  
Edward A. Michelson ◽  
Kenneth S. Pearlman
Keyword(s):  
Abdominal Pain ◽  
Blood Glucose ◽  
Test Performance ◽  
Urban Population ◽  
Altered Mental Status ◽  
Level Of Consciousness ◽  
History Of ◽  
One Year ◽  
Not At Risk

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.

Effectiveness of a Modified Version of Airflow Therapy

1982 ◽  
Vol 47 (2) ◽  
pp. 160-164
Author(s):  
Glenn L. Falkowski ◽  
Arthur M. Guilford ◽  
Jack Sandler
Keyword(s):  
Success Rate ◽  
Scientific Literature ◽  
Future Research ◽  
Relative Importance ◽  
Differential Effectiveness ◽  
History Of ◽  
One Year ◽  
Main Components

Utilizing airflow therapy, Schwartz (1976) has claimed an 89% success rate with stutterers following treatment and an 83% success rate at one year follow-up. Such claims have yet to be documented in the scientific literature. The purposes of this study were: (a) to investigate the effectiveness of a modified version of airflow therapy; (b) to examine the relative importance of its two main components—passive airflow and elongation of the first vowel spoken. The speech of two adult male stutterers with a lengthy history of stuttering, was assessed with spontaneous speaking and reading tasks. Results indicated marked improvement in both subjects' speech on the reading task was maintained at follow-up 10 weeks later. For spontaneous speech, results were generally weaker and less durable. Effects of the two treatment components were cumulative and did not allow determination of any differential effectiveness between components. Implications of these findings were considered and directions for future research discussed.

scholarly journals Ludność powiatu bialskiego w latach międzywojennych – wybrane aspekty analizy demograficznej

2020 ◽  
Vol 17 (4) ◽  
pp. 32-51
Author(s):  
Anna Madej ◽  
Keyword(s):  
Population Growth ◽  
Urban Population ◽  
Data Sets ◽  
Demographic Structure ◽  
Age And Gender ◽  
Peripheral Position ◽  
History Of ◽  
And Gender ◽  
Demographic Potential

The Biała Podlaska poviat was almost at the geographical centre of the interwarperiod Second Polish Republic (1918–1939). However, its peripheral position in relation to other Districts of central voivodships resulted in a number of events and processes that were taking place at that time having a slightly different outmode in its territory. The article attempts to present selected aspects of the demographic structure to confront the extent to which the field of interest diverges from the neighbouring areas. Besides a determination of the population of the district, its structure was analysed in terms of age, gender, level of urbanization and structure of employment. Particularly valuable information was obtained through confrontation of data from the 1921 and 1931 censuses in terms of changes taking place among employment in fundamental branches of the economy. The period was also important for the urban population, which is one of the determinants of the level of modernity of society. Presentation of population growth the county and its characteristics in terms of age and gender provided information on the demographic potential of the analysed area. The analysis provided a number of interesting data sets, somewhat corroborating the varied character of the Biała Podlaska district. The information can be used for further research on the history of the district.

scholarly journals A Case of Supplement-Induced Hepatotoxicity

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Fong-Kuei Frank Cheng ◽  
Peter Dunaway
Keyword(s):  
Abdominal Pain ◽  
Liver Disease ◽  
Liver Injury ◽  
Dietary Supplements ◽  
Medication Use ◽  
Over The Counter ◽  
Caucasian Male ◽  
History Of ◽  
One Year ◽  
Specific Agent

A 45-year-old Caucasian male presented with a two-week history of jaundice and right-upper quadrant (RUQ) abdominal pain. Transaminases and biliary enzymes were markedly elevated with hyperferritinemia and mildly elevated INR. Imaging tests showed no significant abnormality. He denied prescription or over-the-counter (OTC) medication use, but he had been taking at least 9 dietary supplements for 12 months. Other causes of liver disease were excluded. His supplements were discontinued, and his liver-associated enzymes significantly markedly improved over the next 6 weeks and remained normal after one year suggesting supplement-induced hepatotoxicity. Due to the number of supplements, no specific agent could be identified as the primary cause of his liver injury. This case illustrates the importance of inquiring and educating patients of the potential harmful risks of over-the-counter medications and supplements.

scholarly journals Herlyn-Werner-Wunderlich Syndrome: Comparison of Two Cases

2020 ◽  
Vol 17 (19) ◽  
pp. 7173
Author(s):  
Mateusz Kozłowski ◽  
Katarzyna Nowak ◽  
Dominika Boboryko ◽  
Sebastian Kwiatkowski ◽  
Aneta Cymbaluk-Płoska
Keyword(s):  
Abdominal Pain ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Clinical Situation ◽  
Uterus Didelphys ◽  
History Of ◽  
Rare Malformation ◽  
Obstructed Hemivagina

Background: Herlyn-Werner-Wunderlich Syndrome is a rare malformation syndrome characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. Symptoms appear most often after menarche and are secondary to hematocolpos. We compare clinical symptoms, diagnosis and treatment of two patients, a 13-year-old and a 17-year-old. Case report: Despite the non-uniform clinical symptoms, it should be noted that in both patients, the 13-year-old and the 17-year-old, hematocolpos, which was probably the cause of lower abdominal pain, was diagnosed with ultrasound. The diagnosis was complemented by laparoscopy, which determined the diagnosis of malformation of uterus didelphys with obstructed hemivagina. The patients had a history of kidney agenesis, which, after gynecological diagnosis, turned out to be ipsilateral. In the 13-year-old, agenesis was diagnosed by uroscintigraphy, while in the 17-year-old it was diagnosed by urography. Incision and drainage of the residual vagina was performed in the course of therapeutic management. In both cases, the clinical situation required a repeated widening of the orifice. Conclusions: Lower abdominal pain accompanying hematocolpos suggested Herlyn-Werner-Wunderlich Syndrome (HWWS) as the cause of symptoms. 3D transvaginal ultrasound enabled the determination of a congenital uterine defect with high probability, although inconclusive cases required confirmation by laparoscopy. Incision of the blocked vagina and drainage of hematocolpos were the key components of treatment. The treatment of HWWS is a multi-step process.

scholarly journals Perspectives on the History of Bovine TB and the Role of Tuberculin in Bovine TB Eradication

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Margaret Good ◽  
Anthony Duignan
Keyword(s):  
Test Performance ◽  
Bovine Tuberculosis ◽  
Accurate Determination ◽  
Tuberculin Test ◽  
Eradication Programme ◽  
History Of ◽  
Epidemiological Profile ◽  
Significant Disease

Tuberculosis remains a significant disease of animals and humans worldwide. Bovine tuberculosis is caused by Mycobacteria with an extremely wide host range and serious, although currently probably underdiagnosed, zoonotic potential. Where bovine tuberculosis controls are effective, human zoonotic TB, due toMycobacterium bovisorM. caprae, is uncommon and clinical cases are infrequent in cattle. Therefore, the control and ultimate eradication of bovine tuberculosis is desirable. Tuberculin tests are the primary screening tool used in bovine eradication. The choice of tuberculin test is dependent on the environment in which it is to be used. Tuberculin potency is critical to test performance, and the accurate determination of potency is therefore particularly important. The design of a control or eradication programme should take into consideration the fundamental scientific knowledge, the epidemiological profile of disease, the experience of other eradication programmes, and the presence, in the same ecosystem, of maintenance hosts, in which infection is self-sustaining and which are capable of transmitting infection. A control or eradication programme will necessarily require modification as it progresses and must be under constant review to identify the optimal desirable goals, the efficacy of policy, and constraints to progress.

scholarly journals Variables That Best Differentiate In-Patient Acute Stroke from Stroke-Mimics with Acute Neurological Deficits

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
P. Natteru ◽  
M. R. Mohebbi ◽  
P. George ◽  
D. Wisco ◽  
J. Gebel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Indirect Costs ◽  
Altered Mental Status ◽  
Neurological Deficits ◽  
Prior History ◽  
Stroke Mimics ◽  
Emergency Department Setting ◽  
History Of ◽  
Stroke Mimic ◽  
One Year

Introduction. Strokes and stroke-mimics have been extensively studied in the emergency department setting. Although in-hospital strokes are less studied in comparison to strokes in the emergency department, they are a source of significant direct and indirect costs. Differentiating in-hospital strokes from stroke-mimics is important. Thus, our study aimed to identify variables that can differentiate in-hospital strokes from stroke-mimics. Methods. We present here a retrospective analysis of 93 patients over a one-year period (2009 to 2010), who were evaluated for a concern of in-hospital strokes. Results. About two-thirds (57) of these patients were determined to have a stroke, and the remaining (36) were stroke-mimics. Patients with in-hospital strokes were more likely to be obese (p=0.03), have been admitted to the cardiology service (p=0.01), have atrial fibrillation (p=0.03), have a weak hand or hemiparesis (p=0.03), and have a prior history of stroke (p=0.05), whereas, when the consults were called for “altered mental status” but no other deficits (p<0.0001), it is likely a stroke-mimic. Conclusion. This study demonstrates that in-hospital strokes are a common occurrence, and knowing the variables can aid in their timely diagnosis and treatment.

scholarly journals Manajemen Sejarah Berbasis Komunitas: Pengembangan Kawasan Kauman sebagai Living Museum

Bakti Budaya ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 101
Author(s):  
Nur Aini Setiawati
Keyword(s):  
Collective Memory ◽  
Community Services ◽  
Cultural Tradition ◽  
Cultural Traditions ◽  
Development History ◽  
Intangible Heritage ◽  
History Of ◽  
One Year ◽  
Village Society

One of the community services developed by the Faculty of Cultural Sciences provides an assistance to the community of Kauman village in preparation for Kauman village development as Yogyakarta living museum. In this case, Kauman area will serve as a kind of village that has a sustainable cultural tradition since the founding of Ngayogyokarto Hadiningrat Sultanate. In accordance with the concept of the living museum, many kinds of ideas will be implemented to regain the old cultural traditions that were taken from interviews with Kauman elders, community fgures, and young people about the history of Kampung Kauman. Te interviews are basically an intangible heritage which its narrative was attached to the landscape of Kauman village. Te results obtained from the interviews is a collective memory of Kauman village society to the development history of Kauman village. Te compilation and determination of the location, the building, the narrative house of historical formation, and the tradition that is carried out regularly in one year is the initial basis for the implementation of the historical living museum.

scholarly journals 597 Counting on You to do The Count: An Unusual Case Report of a Delayed and Missed Gossypiboma Secondary to Swiss Cheese Model Failings

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Amin ◽  
T Chan
Keyword(s):  
Abdominal Pain ◽  
Human Error ◽  
Alternative Methods ◽  
Swiss Cheese ◽  
Surgical Safety ◽  
Complete Alignment ◽  
Surgical History ◽  
History Of ◽  
One Year ◽  
Operative Findings

Abstract Introduction Gossypiboma is a term describing a retained surgical swab which is a serious complication following any surgical intervention. The incidence of these cases is wholly under reported, partly due to medicolegal aspects, but also due to the misnomer of diagnosis. In this case, we discuss the multifactorial deficiencies which led to a significant morbidity in a patient who had remained asymptomatic for nine years since index surgery. Case Presentation A 40-year-old woman presented to the emergency department febrile with a one week history of abdominal pain, on a background of a one year history of chronic pain. The patient’s surgical history demonstrated an ovarian fibroid excision and a subtotal hysterectomy nine and six years ago, respectively. It was later noted the chronic abdominal pain had been previously investigated with positive findings on imaging and biopsy, however, she was lost to follow up. A year later, she presented with an acute abdomen and operative findings of a large abscess cavity, containing a retained swab, with small bowel fistulation were noted. Conclusions This reiterates the importance of surgical safety checklists, and often despite this there are many factors that can eventually lead to complete alignment of the holes in the Swiss Cheese leading to unfavourable outcomes. It is imperative to remain hypervigilant during checkpoints, particularly in emergencies where the unpredictability of the operation leads to human error. Gossypiboma remains a serious cause for morbidity and mortality, thus the potential for modified safety checklists or alternative methods for surgical counts.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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