scholarly journals Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments

2021 ◽  
pp. 014556132199250
Author(s):  
Ibrahim Sayin ◽  
Zahide Mine Yazıcı ◽  
Mehmet Akif Abakay ◽  
Filiz Gülüstan ◽  
İbrahim Devecioğlu ◽  
...  
Keyword(s):  
Physical Examination ◽  
Paradigm Shift ◽  
Poor Performance ◽  
Analog Scale ◽  
Airborne Transmission ◽  
Closed Chamber ◽  
Feasible Method ◽  
Laryngoscopic Examination ◽  
Perception Of Safety ◽  
Protective Environment

Objective: To evaluate the attitudes of physicians and patients toward physical examination in physically separated environments using a laryngoscopic examination model. Materials and Methods: Six experienced laryngologists performed laryngoscopic examinations in 30 patients in a closed-chamber examination unit. The physicians and patients were asked to compare all domains with their previous standard laryngoscopic examination experience using a 10-point visual analog scale (0, poor performance; 10, good performance), including effectiveness of communication, difficulty of examination, perception of safety against airborne transmission of COVID-19, applicability of the unit for future examinations, perception of protective environment, and overall comfort. Results: All laryngoscopic examinations were performed successfully. Effectiveness of communication, difficulty of examination, perception of protective environment, and overall comfort did not differ between physicians and patients ( P > .05 for all comparisons). However, both physicians and patients found the examination to be difficult. While physicians evaluated the system as safe against airborne transmission of COVID-19, patients were not confident that the system was safe (8.70 ± 1.93 vs 2.87 ± 2.37, respectively, P = .001). Physicians also gave a higher score to future applicability of the unit for examinations than patients (8.90 ± 1.42 vs 7.10 ± 2.62, respectively, P = .001). Conclusion: Physically separating the physician and patient is a feasible method of physical examination in aerosol-contaminated environments.

scholarly journals The Prevalence of Pain in People With Chronic Ankle Instability: A Systematic Review

2019 ◽  
Vol 54 (6) ◽  
pp. 662-670 ◽  
Author(s):  
Saeed Al Adal ◽  
Fereshteh Pourkazemi ◽  
Martin Mackey ◽  
Claire E. Hiller
Keyword(s):  
Physical Examination ◽  
Visual Analog Scale ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Self Report ◽  
Functional Impairments ◽  
Ankle Pain ◽  
Analog Scale ◽  
Eligibility Criteria ◽  
Prevalence Of Pain

ObjectiveTo identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI.Data SourcesWe searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017.Study SelectionEligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded.Data ExtractionStudies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance.Data SynthesisOf the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies.ConclusionsPain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.

scholarly journals Blockchain-Enabled Trade Finance Innovation: A Potential Paradigm Shift on Using Letter of Credit

2019 ◽  
Vol 12 (1) ◽  
pp. 188 ◽  
Author(s):  
Shuchih Ernest Chang ◽  
Hueimin Louis Luo ◽  
YiChian Chen
Keyword(s):  
Paradigm Shift ◽  
Business Processes ◽  
Poor Performance ◽  
Future Application ◽  
Trade Finance ◽  
Letter Of Credit ◽  
Blockchain Technology ◽  
Distributed Ledger ◽  
Smart Contract

This paper explores a potential paradigm shift in trade finance utilizing blockchain technology. Traditionally, the centralized operating model has governed trade finance and the manner in which traders handle business processes. However, such heavy reliance on centralized authorities has made for poor performance, the lack of flexibility and transparency, and vulnerability to malicious alteration. The blockchain, as a distributed ledger technology (DLT), has attracted growing attention and has the potential to disrupt legacy finance procedures such as payment by letter of credit (L/C). International trade players may benefit from the technological reengineering of financial processes through the implementation of blockchain- and smart contract-based platforms. From the conceptual perspective of a paradigm shift, this study analyzes the feasibility of blockchain innovation in trade finance through modern blockchain-based L/C initiatives. Moreover, this study also explores blockchain applications in terms of logistics tracking and how it integrates with trade finance procedures. This study contributes to the understanding of a blockchain paradigm shift with a multi-case study. The results may illuminate the potential future application of blockchain finance and provide researchers with an illustrative example of other finance-related capabilities. Studies of trade-related topics such as customs clearances, insurance, and logistics applications need to be addressed in the future to create a comprehensively trustless environment and facilitate the automation of trade.

scholarly journals Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Susan Shenoi ◽  
Kristen Hayward ◽  
Megan L. Curran ◽  
Elizabeth Kessler ◽  
Jay J. Mehta ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Physical Examination ◽  
Paradigm Shift ◽  
Pediatric Rheumatology ◽  
Multidisciplinary Care ◽  
Rapid Expansion ◽  
Health Record ◽  
Global Pandemic ◽  
Multidisciplinary Care Team ◽  
Virtual Visits

Abstract Background The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. Body This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. Conclusion This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.

scholarly journals Evaluation of Different Parameters Responsible for Perception of a Pleasing Profile - A Photographic Silhouette Study from Vadodara, India

2021 ◽  
Vol 10 (37) ◽  
pp. 3272-3276
Author(s):  
Romil Bharatkumar Shah ◽  
Manisha Dipakbhai Bhanushali ◽  
Santoshkumar Goje
Keyword(s):  
Soft Tissue ◽  
Paradigm Shift ◽  
Dental Students ◽  
Tissue Analysis ◽  
Height Ratio ◽  
Analog Scale ◽  
Lower Lip ◽  
Nasolabial Angle ◽  
Vertical Height

BACKGROUND Orthodontics has witnessed a paradigm shift in the perception of aesthetics. Soft tissue assessment and correction has become a greater concern when compared with dental and skeletal correction. In the current era, pleasing profile is a prime requisite. The purpose of this study is to evaluate different parameters responsible for perception of a pleasing profile. METHODS Hundred dental students with well-balanced faces were selected. Profile photographs of participants were taken by DSLR camera maintaining standardized photography protocol. The principal investigator had measured ten soft tissue parameters for each profile photograph. These profile photographs were further converted into profile silhouettes. 10 laypersons appraised each profile silhouette using visual analog scale (VAS). The obtained scores were again correlated with photographic measurements of each individual to identify role of different parameters responsible for pleasing profile. RESULTS When comparing the data statistically, significant differences were found amongst the parameters between less attractive and more attractive profile; parameters include facial convexity angle, naso-labial angle, protrusion of lip relative to each other, vertical lip to chin ratio and vertical height ratio. CONCLUSIONS It was clear from this study that, amongst individuals with normal overjet, overbite and a pleasing profile, those subjects with more obtuse facial convexity angle, obtuse nasolabial angle, slightly more protruded upper lip than lower lip, equivalent vertical height ratio, and smaller lip-chin ratio vertically, were found to be more attractive, as perceived by laypersons. KEY WORDS Parameters, Photographic Soft Tissue Analysis, Silhouette Study, Pleasing Profile

Increasing Hemoglobin Levels with Epoetin Alfa in Anemic Hematologic Cancer Patients Receiving Chemotherapy Correlates Significantly with Improved Quality of Life.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2213-2213
Author(s):  
Jean-Luc Harousseau ◽  
Pierre Fumoleau ◽  
Winand Lange ◽  
Manfred Welslau
Keyword(s):  
Quality Of Life ◽  
Total Population ◽  
Poor Performance ◽  
Epoetin Alfa ◽  
Analog Scale ◽  
Open Label ◽  
Linear Analog ◽  
The Mean ◽  
Clinically Significant

Abstract The majority of patients (pts) with hematologic malignancies (HM) are anemic and often have poor performance scores (Ludwig H et al. Blood.2002;100:234a). The correlation between increases in hemoglobin (Hb) with epoetin alfa and improvements in quality of life (QOL) was evaluated in this open-label, multicenter study that enrolled 736 adult pts with various solid tumors and HM (n = 122) who were receiving cytotoxic chemotherapy and had Hb levels <12 g/dL. Epoetin alfa was administered 150 IU/kg or 10,000 IU 3 times weekly (TIW) for a maximum 28 weeks (wks); dose was increased to 300 IU/kg or 20,000 IU TIW if Hb was not increased >1 g/dL above baseline within 4 wks. Results for pts with HM are compared to results from a similar 16-wk trial that included pts with HM (n = 488) and used the 40,000 IU once-weekly (QW) dose, increased to 60,000 IU QW if Hb did not increase ≥1 g/dL within 4 wks (Gabrilove J et al. Int J Hematol.2000;72:55). In the TIW study, the primary efficacy endpoint was change in QOL as measured by the Functional Assessment of Cancer Therapy-General (FACT-G), including subscales for anemia (FACT-An) and fatigue; the FACT was administered at study entry, at 8–9 wks, and at 12 wks. QOL was additionally measured by the Cancer Linear Analog Scale (CLAS; also known as the Linear Analog Scale Assessment [LASA]) administered at every study visit. Dose increases were similar in both studies (33.6% of pts in the TIW study; 36.7% of pts in the QW study). In the TIW study, mean baseline Hb was 9.6 g/dL; mean Hb increased at 4–6 wks (1.35 g/dL), 8–9 wks (2.09 g/dL) and 12 wks (2.46 g/dL) to a mean Hb of 12.0 g/dL. Almost half the HM patients in the TIW study (48.1%) had a complete response (Hb increase ≥2 g/dL without blood transfusion). Hematologic results are similar to those reported in the QW study where mean Hb increased 1.96 g/dL by end of study (P = .0001). QOL improvements were also similar between studies. Mean FACT-An scores for the total population in the TIW study increased 6.7 points after 12 wks, which is clinically significant (Patrick DL et al. Eur J Cancer.2003;39:335–345). The mean increase for overall FACT-G correlated significantly with increased Hb at 12 wks (P <.0001; r = .262). Mean CLAS scores for the total population increased steadily throughout the study. At 12 wks mean increases (based on the 100-mm scale) were clinically significant (Patrick et al): 10.9 mm for Energy, 11.2 mm for Daily Activity, and 10.3 mm for Overall QOL. Mean change for FACT-An for patients from the total population in the QW study (n = 2,230) was 6.0 points (P <.001), which is comparable to the mean changes in the TIW study and the HM population of the QW study (6.59 points, P <.0001). No unexpected adverse events were reported. Epoetin alfa TIW or QW was shown to steadily increase Hb, which significantly correlated with clinically significant improvements in QOL.

Orosensory Perception, Speech Production, and Deafness

1973 ◽  
Vol 16 (2) ◽  
pp. 257-266 ◽  
Author(s):  
Milo E. Bishop ◽  
Robert L. Ringel ◽  
Arthur S. House
Keyword(s):  
High School ◽  
Speech Production ◽  
Poor Performance ◽  
Normal Hearing ◽  
The Other ◽  
Functional Disorders ◽  
Form Discrimination ◽  
School Subjects ◽  
Oral Form ◽  
Similarities And Differences

The oral form-discrimination abilities of 18 orally educated and oriented deaf high school subjects were determined and compared to those of manually educated and oriented deaf subjects and normal-hearing subjects. The similarities and differences among the responses of the three groups were discussed and then compared to responses elicited from subjects with functional disorders of articulation. In general, the discrimination scores separated the manual deaf from the other two groups, particularly when differences in form shapes were involved in the test. The implications of the results for theories relating orosensory-discrimination abilities are discussed. It is postulated that, while a failure in oroperceptual functioning may lead to disorders of articulation, a failure to use the oral mechanism for speech activities, even in persons with normal orosensory capabilities, may result in poor performance on oroperceptual tasks.

Tools and Resources: Web Sites of Interest

2001 ◽  
Vol 6 (2) ◽  
pp. 6-8
Author(s):  
Christopher R. Brigham
Keyword(s):  
Informed Consent ◽  
Physical Examination ◽  
Functional Status ◽  
Web Sites ◽  
Satisfaction Survey ◽  
High Quality ◽  
Diagnostic Studies ◽  
Physician Relationship ◽  
Complete History

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, explains that independent medical evaluations (IMEs) are not the same as impairment evaluations, and the evaluation must be designed to provide the data to answer the questions asked by the requesting client. This article continues discussions from the September/October issue of The Guides Newsletter and examines what occurs after the examinee arrives in the physician's office. First are orientation and obtaining informed consent, and the examinee must understand that there is no patient–physician relationship and the physician will not provide treatment bur rather will send a report to the client who requested the IME. Many physicians ask the examinee to complete a questionnaire and a series of pain inventories before the interview. Typical elements of a complete history are shown in a table. An equally detailed physical examination follows a meticulous history, and standardized forms for reporting these findings are useful. Pain and functional status inventories may supplement the evaluation, and the examining physician examines radiographic and diagnostic studies. The physician informs the interviewee when the evaluation is complete and, without discussing the findings, asks the examinee to complete a satisfaction survey and reviews the latter to identify and rectify any issues before the examinee leaves. A future article will discuss high-quality IME reports.

The Therapist’s Reaction to a Patient’s Suicide

Crisis ◽  
2011 ◽  
Vol 32 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Friedrich Martin Wurst ◽  
Isabella Kunz ◽  
Gregory Skipper ◽  
Manfred Wolfersdorf ◽  
Karl H. Beine ◽  
...  
Keyword(s):  
Emotional Responses ◽  
Well Being ◽  
Emotional Reaction ◽  
Emotional Reactions ◽  
Analog Scale ◽  
General Hospitals ◽  
Item Questionnaire ◽  
Retrospective Nature ◽  
The Impact ◽  
Over Time

Background: A substantial proportion of therapists experience the loss of a patient to suicide at some point during their professional life. Aims: To assess (1) the impact of a patient’s suicide on therapists distress and well-being over time, (2) which factors contribute to the reaction, and (3) which subgroup might need special interventions in the aftermath of suicide. Methods: A 63-item questionnaire was sent to all 185 Psychiatric Clinics at General Hospitals in Germany. The emotional reaction of therapists to patient’s suicide was measured immediately, after 2 weeks, and after 6 months. Results: Three out of ten therapists suffer from severe distress after a patients’ suicide. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. The emotional responses immediately after the suicide explained 43.5% of the variance of total distress in a regression analysis. Limitations: The retrospective nature of the study is its primary limitation. Conclusions: Our data suggest that identifying the severely distressed subgroup could be done using a visual analog scale for overall distress. As a consequence, more specific and intensified help could be provided to these professionals.

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