Hepatic and renal disease and anaesthesia

2017 ◽  
Author(s):  
Komal Ray ◽  
Mark Bellamy
Keyword(s):  
Renal Disease ◽  
Therapeutic Agents ◽  
Clinical Implications ◽  
Single System ◽  
Patient Assessment ◽  
Detailed Understanding ◽  
Preoperative Optimization ◽  
Systemic Manifestations ◽  
The Individual ◽  
Practical Conduct

Anaesthesia for the patient with liver or renal disease may seem daunting, not least because of the multisystem nature of these seemingly single-system conditions. Both kidney and liver disease are associated with systemic manifestations, and often with multiple co-morbidities. There are inherent complexities in patient assessment and risk stratification. The process of preoperative optimization is a complex one, and has to be tailored to the individual, based on a detailed understanding both of the pathophysiology of the organ dysfunction, and its clinical implications. The practical conduct of anaesthesia is further complicated by unexpected or atypical reactions to therapeutic agents (pharmacodynamic effects) as well as unexpected durations of action and drug interactions (altered pharmacokinetics). This chapter is not an exhaustive treatise on the topic, nor can it be; it does, however, attempt to point towards important issues to be considered.

scholarly journals Inter-examiner reliability of the clinical parts of MRCPsych part II examinations

2007 ◽  
Vol 31 (9) ◽  
pp. 342-344 ◽  
Author(s):  
Femi Oyebode ◽  
Sanju George ◽  
Veena Math ◽  
Sayeed Haque
Keyword(s):  
Interrater Reliability ◽  
Patient Management ◽  
Point Of View ◽  
Clinical Implications ◽  
Patient Assessment ◽  
The Poor ◽  
Management Problems ◽  
Oral Examinations ◽  
The Individual

Aims and MethodThe aim of the study was to investigate the interrater reliability of the clinical component of the MRCPsych part II examinations, namely the individual patient assessment and the patient management problems. In the study period, there were 1546 candidates and 773 pairs of examiners. Kappa scores for pairs of examiners in both these assessments were calculated.ResultsThe kappa scores for exact numerical agreement between the pairs of examiners in both individual patient assessment and patient management problems were only moderate (0.4 –0.5). However, the kappa scores for agreement between pairs of examiners for the reclassified pass and fail categories were very good (0.8).Clinical ImplicationsThe poor reliability of the traditional long case and oral examinations in general is one of the most potent arguments against their use. Our finding suggests that the College clinical examinations are at least not problematic from this point of view, particularly if global pass or fail judgements rather than discrete scores are applied.

Protecting privacy to protect mental health: the new ethical imperative

2019 ◽  
Vol 45 (9) ◽  
pp. 604-607 ◽  
Author(s):  
Elias Aboujaoude
Keyword(s):  
Mental Health ◽  
Electronic Medical Records ◽  
Psychological Health ◽  
Medical Records ◽  
Personal Data ◽  
Psychological Development ◽  
Clinical Implications ◽  
Patient Relationship ◽  
Ethical Imperative ◽  
The Individual

Confidentiality is a central bioethical principle governing the provider–patient relationship. Dating back to Hippocrates, new laws have interpreted it for the age of precision medicine and electronic medical records. This is where the discussion of privacy and technology often ends in the scientific health literature when Internet-related technologies have made privacy a much more complex challenge with broad psychological and clinical implications. Beyond the recognised moral duty to protect patients’ health information, clinicians should now advocate a basic right to privacy as a means to safeguard psychological health. The article reviews empirical research into the functions of privacy, the implications for psychological development and the resigned sentiment taking hold regarding the ability to control personal data. The article concludes with a call for legislative, educational and research steps to readjust the equilibrium between the individual and ‘Big Data’.

scholarly journals The MRCPsych OSCE workshop: a new game to play?

2004 ◽  
Vol 28 (2) ◽  
pp. 62-65 ◽  
Author(s):  
Asim Naeem ◽  
Joan Rutherford ◽  
Chris Kenn
Keyword(s):  
Clinical Examination ◽  
Royal College ◽  
Clinical Competence ◽  
Reliability And Validity ◽  
Objective Structured Clinical Examination ◽  
Current Evidence ◽  
Consecutive Series ◽  
Patient Assessment ◽  
Good Reliability ◽  
The Individual

In line with the Royal College of Psychiatrists' commitment to improve its professional examinations based on the best current evidence, Spring 2003 has seen the introduction of the objective structured clinical examination (OSCE). This has replaced the individual patient assessment (IPA) in the MRCPsych Part I clinical examination. An OSCE consists of a series of time-limited clinical tasks that candidates have to perform in a consecutive series of ‘stations' or booths. They have the advantage of being able to test clinical competence using a number of different scenarios via a standardised format (Katona et al, 2000). Their use has become widespread over recent years, particularly in undergraduate psychiatry exams (Brewin & Cantwell, 1997), as they have good reliability and validity (Hodges et al, 1998). This was confirmed by the College's initial pilot OSCE, which had a κ score of around 0.8 for the examination as a whole (Oyebode, 2002).

scholarly journals Non-Helicobacter pylori Gastric Intestinal Metaplasia in Children: A Series of Cases and Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Sandra Mabel Camacho-Gomez ◽  
Anas Bernieh ◽  
Ali G. Saad ◽  
Neelesh Ajit Tipnis
Keyword(s):  
Helicobacter Pylori ◽  
Intestinal Metaplasia ◽  
Pediatric Population ◽  
Duodenogastric Reflux ◽  
Clinical Implications ◽  
Review Of The Literature ◽  
Gastric Intestinal Metaplasia ◽  
The Individual ◽  
Time Required

In the pediatric population, Gastric Intestinal Metaplasia (GIM) is a finding with unknown frequency and, more importantly, unknown clinical implications. The relationship between Helicobacter pylori (HP) infection and GIM is well documented, as well as an association between duodenogastric reflux and GIM. We present two cases of pediatric patients with GIM along with a review of the literature. The diagnosis of GIM may have adverse clinical implications and should be made with caution in a child. The association of GIM and adenoma/dysplasia and carcinoma is rarely seen in children, primarily because the time required for these to develop takes the individual into adulthood. Treatment, long-term consequences, and surveillance protocols are not well established in the pediatric population. Studies to evaluate the long-term natural history, treatment, and surveillance protocols in children with GIM are needed.

The Organization of Cooperative Effort by Multiple Hospitals, Exemplified by Testing of Therapeutic Agents in Rheumatoid Arthritis

1962 ◽  
Vol 01 (01) ◽  
pp. 06-09 ◽  
Author(s):  
Lee Herrera
Keyword(s):  
Clinical Investigation ◽  
Therapeutic Agents ◽  
Random Allocation ◽  
Patient Assessment ◽  
Cooperative Effort ◽  
Study Population ◽  
Advance Planning ◽  
Definition Of ◽  
Multi Center Study ◽  
The Cost

The advantage of a multi-center clinical investigation lies in the possibility of obtaining conclusive results on the basis of relatively few numbers of patients from each of the participating institutions. It has the disadvantage of a lack of uniformity of methods among centers, which must be overcome by careful advance planning, including the institution of a central coordinating unit, the biometrical unit. Its functions include (1) participation in the planning of all phases of the investigation, (2) editing and processing of the data, and (3) analysis of the data and evaluation of results.Three devices for promoting uniformity of methods are: (1) the protocal, (2) specially designed record forms, and (3) visits to participating centers by a team of observers, including the statistician. The protocol is the document which contains all important specification for the conduct of the investigation, including statement of purpose of the study, definition of the study population, and explicit instructions on methods of patient assessment.In a clinical trial, the biometrical unit prepares the random allocation of treatments to patients. Stratification may be used to make comparisons between strata, and/or increase the sensitivity of the experiment. Stratification by exclusion may increase sensitivity at the cost of restricting the generality of results.A well-planned multi-center study, in which the members really cooperate, may achieve objectives exceeding the scope of single-center studies and provide a setting for the fruitful exchange of knowledge and ideas.

Understanding the Mechanical Properties of Microalgae Using Atomic Force Microscopy

2013 ◽  
Author(s):  
Kristin M. Warren ◽  
Jeremiah Mpagazehe ◽  
C. Fred Higgs ◽  
Philip LeDuc
Keyword(s):  
Mechanical Properties ◽  
Atomic Force Microscopy ◽  
Energy Production ◽  
Industrial Processes ◽  
Force Measurements ◽  
Detailed Understanding ◽  
Force Microscopy ◽  
Atomic Force ◽  
Scenedesmus Dimorphus ◽  
The Individual

From consumer productions to energy production, algae is used in many industrial processes. Understanding the mechanical behavior of algae is important to optimize these processes. To obtain a better understanding of algae cell response, we mechanically characterized single, dried Scenedesmus dimorphus cells. To accomplish this, we used atomic force microscopy (AFM) to image S. dimorphus cells, which enabled us to map the AFM measurements to a location on the individual cells. We were then able to perform force measurements on the AFM to determine the Young’s modulus of S. dimorphus. These findings enable a more detailed understanding of the mechanical properties of a single S. dimorphus cell, which may be useful in many applications.

scholarly journals A survey of workplace bullying of psychiatric trainees in the West Midlands

2004 ◽  
Vol 28 (6) ◽  
pp. 225-227 ◽  
Author(s):  
Imthiaz A. Hoosen ◽  
Rhiannon Callaghan
Keyword(s):  
National Health Service ◽  
Workplace Bullying ◽  
Postal Survey ◽  
Clinical Implications ◽  
Junior Doctors ◽  
The West ◽  
West Midlands ◽  
The Individual ◽  
Problem Awareness ◽  
Foreign Doctors

Aims and MethodA postal survey was conducted to ascertain the prevalence of bullying behaviour experienced by psychiatric trainees in the West Midlands. Questionnaires were sent to 232 junior doctors, 76% of whom responded.ResultsIn the preceding year, 47% of trainees had experienced one or more bullying behaviours. Only 46% reported that they knew whom to contact if they were bullied. Foreign doctors were significantly less likely to take action when bullied than local doctors.Clinical ImplicationsWorkplace bullying is commonly experienced by psychiatric trainees and other junior doctors in the National Health Service. This behaviour could have adverse effects for both the individual and the employer. To tackle this problem, awareness needs to be raised, and action is required at a number of levels.

The Management of Dental Patients Taking New Generation Oral Anticoagulants

2014 ◽  
Vol 3 (4) ◽  
pp. 54-58 ◽  
Author(s):  
Alun Scott ◽  
John Gibson ◽  
Alexander Crighton
Keyword(s):  
Health Planning ◽  
Oral Anticoagulants ◽  
Invasive Procedure ◽  
Medical Practitioner ◽  
Therapeutic Agents ◽  
National Guidelines ◽  
Dental Patients ◽  
Dental Practitioners ◽  
The Individual ◽  
New Generation

Recently, new oral anticoagulants have been introduced as alternatives to warfarin. While national guidelines for treatment of dental patients taking warfarin as an anticoagulant are well-established, no such information is available for these novel therapeutic agents. At present, the local guidance available is contradictory between different health boards/health planning units, and liaison with the medical practitioner managing the individual patient's anticoagulation is imperative if any invasive procedure is proposed. This paper examines the available evidence regarding these drugs and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care.

scholarly journals Police and sniffer dogs in psychiatric settings

2008 ◽  
Vol 32 (7) ◽  
pp. 253-256 ◽  
Author(s):  
Najat Khalifa ◽  
Simon Gibbon ◽  
Conor Duggan
Keyword(s):  
Illicit Drugs ◽  
Illicit Drug ◽  
Response Rate ◽  
The Other ◽  
Self Report ◽  
Clinical Implications ◽  
Patient Response ◽  
Secure Unit ◽  
The Individual ◽  
The Impact

Aims and MethodTo study the views of staff and patients on the use of sniffer dogs to detect illicit drugs and the prosecution of in-patients suspected of taking illicit drugs. A 15-item self-report questionnaire was given to all in-patients and staff who had any contact with patients in a medium-secure unit. Responses to the individual statements were measured on a five-point Likert scale and staff and patients' responses were compared.ResultsWe achieved a response rate of 63% (patient response rate, 71.6%; staff response rate, 60.7%). Overall there were fewer differences than anticipated, although, as expected, staff viewed the impact of illicit drugs more negatively than patients, and on the other hand, patients viewed the use of sniffer dogs and police involvement more negatively than the staff did.Clinical ImplicationsNotice ought to be taken of the discordance between staff and patients' views (particularly in relation to consent and confidentiality) when attempting to detect and manage illicit drug use among psychiatric in-patients.

scholarly journals MORPHOMETRIC CHARACTERISTICS OF THE LONGITUDINAL PARAMETERS OF THE MIDDLE CRANIAL FOSSA OF ADULTS DEPENDING ON EXTREME TYPE OF SKULLS STRUCTURE

10.23856/4333 ◽  
2021 ◽  
Vol 43 (6) ◽  
pp. 256-262
Author(s):  
Iryna Chekanova
Keyword(s):  
Short Form ◽  
Middle Cranial Fossa ◽  
Anatomical Landmarks ◽  
Detailed Understanding ◽  
Extreme Type ◽  
Complex Anatomy ◽  
Cranial Fossa ◽  
Human Skulls ◽  
The Individual ◽  
Base Of The Skull

Surgical accesses through the middle cranial fossa (MCF) and their variations require the surgeons a detailed understanding of a complex anatomy of this site of the inner base of the skull (IBS) and an individual anatomical variability of the anatomical landmarks often used in their medical practice. The aim of this study is to establish individual anatomical variability of the longitudinal dimensions of MCF of mature age human. The research was carried out by studying 50 craniotomograms and 50 bone preparations of mature age human skulls with their further subdivision to extreme types of skulls groups. The examinations of the main longitudinal parameters were done for detailed MCF craniometry, namely: MCF lateral cranial length, MCF general length, MCF medial areas length. It was determined that all longitudinal dimensions increase from brachicephales to dolichocephales. This is due to the fact that for brachicrans (round-headedness) short form of the skull is inherent, for dolichocrans (narrow-headedness) – long and for mesocrans (moderate-headedness) average head size is inherent. According to the received data, MCF longitudinal parameters of mature age human regardless of the extreme types of the skull structure have the tendency to increase from medial sections of the investigated area to lateral. The results of this study substantially complete the existing information about the individual anatomical variability of MCF of mature age human and also make it possible to deeply use this data in practical medicine and for further research in morphology and in craniology in details.

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