Chronic limb ischaemia: case study and clinical literature review

2021 ◽  
Vol 30 (14) ◽  
pp. 846-851
Author(s):  
Liz Farrington ◽  
Gerri Mortimore
Keyword(s):  
Clinical Decision Making ◽  
Treatment Options ◽  
Survival Rates ◽  
Clinical Decision ◽  
Lifestyle Changes ◽  
Care Plan ◽  
Limb Ischaemia ◽  
Clinical Literature ◽  
Artery Disease

This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.

Integrative Nursing Management of Anxiety

2018 ◽  
pp. 221-239
Author(s):  
Pamela Lusk ◽  
Michelle Kahn-John
Keyword(s):  
Symptom Management ◽  
Clinical Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Management Strategies ◽  
Clinical Decision ◽  
Nursing Management ◽  
Emotional Wellbeing ◽  
Patient Centered

Anxiety is a sense of perceived threat to one’s physical safety or emotional wellbeing, and symptoms are experienced in body, mind, and spirit. This chapter focuses on anxiety as a normal reaction to stressors—external, internal, or existential. Everyone experiences anxiety, both trait anxiety and state anxiety at multiple points in their lives; however, prolonged and severe symptoms of anxiety can evolve into a clinical form of anxiety, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder. This chapter reviews assessment of anxiety, including evidence-based screening measures and the patient-centered interview. Symptom identification and management incorporating integrative nursing principles are presented, including patient self-management strategies as well as provider-directed treatment options. In clinical decision-making for anxiety symptom management, concordance with the patient in establishing a treatment plan is emphasized. A case study highlights a patient-centered and culturally sensitive approach to the management of anxiety.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Clinical decision making in spastic bilateral CP – Planning interventions using clinical gait analysis: A case study

2015 ◽  
Vol 42 ◽  
pp. S37
Author(s):  
M. Alvela ◽  
M. Bergmann ◽  
M.-L. Ööpik ◽  
Ü. Kruus ◽  
K. Englas ◽  
...  
Keyword(s):  
Decision Making ◽  
Gait Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Clinical Gait Analysis

scholarly journals My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter?

2018 ◽  
Vol 39 (04) ◽  
pp. 356-370 ◽  
Author(s):  
Hope Gerlach ◽  
Naomi Rodgers ◽  
Patricia Zebrowski ◽  
Eric Jackson
Keyword(s):  
Decision Making ◽  
Young People ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hypothetical Case ◽  
Clinical Tool ◽  
Goal Development ◽  
Internal Experience

AbstractStuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people who stutter respond to anticipation in a variety of ways. At the same time as anticipation occurs and develops internally, for many individuals the “knowing” or “feeling” that they are about to stutter is a primary contributor to the chronicity of the disorder. In this article, we offer a roadmap for both understanding the phenomenon of anticipation and its relevance to stuttering development. We introduce the Stuttering Anticipation Scale (SAS)—a 25-item clinical tool that can be used to explore a client's internal experience of anticipation to drive goal development and clinical decision making. We ground this discussion in a hypothetical case study of “Ryan,” a 14-year-old who stutters, to demonstrate how clinicians might use the SAS to address anticipation in therapy with young people who stutter.

Mesenchymal stem cell-derived extracellular vesicles in the failing heart: past, present, and future

2021 ◽  
Author(s):  
Catherine Karbasiafshar ◽  
Frank W. Sellke ◽  
M. Ruhul Abid
Keyword(s):  
Stem Cell ◽  
Extracellular Vesicles ◽  
Treatment Options ◽  
Current Treatment ◽  
Lifestyle Changes ◽  
Challenges And Opportunities ◽  
Artery Disease ◽  
New Treatment

Cardiovascular disease (CVD) is the leading cause of death globally. Current treatment options include lifestyle changes, medication, and surgical intervention. However, many patients are unsuitable candidates for surgeries due to comorbidities, diffuse coronary artery disease or advanced stages of heart failure. The search for new treatment options has recently transitioned from cell-based therapies to stem-cell derived extracellular vesicles (EVs). A number of challenges remain in the EV field, including the effect of comorbidities, characterization, and delivery, However, recent revolutionary developments and insight into the potential of 'personalizing' EV contents by bioengineering methods to alter specific signaling pathways in the ischemic myocardium hold promise. Here, we discuss the past limitations of cell-based therapies, and recent EV studies involving in vivo, in vitro, and omics, and future challenges and opportunities in EV-based treatments in CVD.

Aortoiliac Reconstruction

2017 ◽  
Author(s):  
Mark K. Eskandari ◽  
Michael J Nooromid
Keyword(s):  
Clinical Decision Making ◽  
Preoperative Evaluation ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Clinical Decision ◽  
Occlusive Disease ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Atherosclerotic Occlusive Disease ◽  
Aortoiliac Reconstruction

This review outlines the preoperative evaluation, clinical decision making, and surgical treatment options for patients with aortoiliac occlusive disease. It also details the open surgical techniques for the treatment of aortoiliac occlusive disease and reviews endovascular treatment options. The discussion of treatment options includes the potential complications and expected outcomes, as well as steps that can be taken to optimize surgical results. Key words: aortobifemoral bypass, aortoiliac reconstruction, atherosclerotic occlusive disease, endovascular reconstruction, femoral endarterectomy, iliac angioplasty, iliac stenting, peripheral vascular disease 

Implementation of Semantic Search to Support Clinical Decision-Making

2015 ◽  
pp. 270-286
Author(s):  
Andrew Tawfik ◽  
Karl Kochendorfer
Keyword(s):  
Human Performance ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Decision ◽  
Human Performance Technology ◽  
The United States ◽  
Semantic Search ◽  
Current Case ◽  
Performance Technology

The current case study is situated within a large, land grant hospital located in the Midwestern region of the United States. Although the physicians had seen an increase in medical related human performance technology (HPTs) within the organization (e.g. computer physician ordered entry) some challenges remained as the hospital sought to improve the productivity of the electronic health record (EHRs). Specifically, physicians had difficulty finding information embedded within the chart due to usability problems and information overload. To overcome the challenges, a semantic search within the chart was implemented as a solution for physicians to retrieve relevant results given the conceptual semantic pattern. The case study will discuss many elements of the implementation based on our experience and feedback from clinicians. The case will specifically highlight the importance of training and change agents within an organization.

scholarly journals Strategies in Abduction: Generating and Selecting Diagnostic Hypotheses

2020 ◽  
Vol 45 (2) ◽  
pp. 159-178
Author(s):  
Donald E Stanley ◽  
Rune Nyrup
Keyword(s):  
Medical Diagnosis ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hypothesis Generation ◽  
Clinical Case Study ◽  
Diagnostic Hypothesis ◽  
Threshold Approach ◽  
Selection Of

Abstract We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning.

Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment

2020 ◽  
Vol 91 (8) ◽  
pp. 879-888 ◽  
Author(s):  
Clemens Gstoettner ◽  
Johannes A Mayer ◽  
Stephanie Rassam ◽  
Laura A Hruby ◽  
Stefan Salminger ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Clinical Decision ◽  
Neuralgic Amyotrophy ◽  
Positive Effects ◽  
Nerve Surgery

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.

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