scholarly journals Diagnosis and treatment of dysphonia at the present stage

2020 ◽  
pp. 72-76
Author(s):  
V. M. Svistushkin ◽  
G. N. Nikiforova ◽  
A. A. Pobivantseva
Keyword(s):  
Best Practice ◽  
Underlying Disease ◽  
Pathological Process ◽  
Diagnosis And Treatment ◽  
Smoking History ◽  
Present Stage ◽  
Best Practice Guidelines ◽  
Neoplastic Processes ◽  
Wide Range ◽  
Neck Lesion

The article discusses the main aspects of diagnosis and treatment of dysphonia at the present stage and provides best practice guidelines. There is a vast array of pathologies that can give rise to dysphonia. Neoplastic processes and neoplasms, which late diagnosis leads to higher mortality, are considered alarming in this context. If dysphonia persists for more than 4 weeks, it is required to make laryngoscopy to exclude serious larynx diseases. People whose work involves using their voice are the most susceptible to the development of dysphonia. It is important to identify risk factors in patients, which include recent operations in the head, neck and chest area, recent endotracheal intubation, the presence of neck lesion, voice and speech profession, smoking history, signs of respiratory failure. Treatment for dysphonia depends on the cause of the pathological process and may include management of the underlying disease, pharmacotherapy, non-drug treatment and surgical intervention. There are extremely few products among the health aids of allopathic medicine that specifically improve the quality of voice function. In this regard, homeopathic medicines play a large role in the treatment of voice disorders. Clinical studies showed the efficacy of these medicines, which have a wide range of indications and a minimal number of side effects. However, the use of traditional homeopathic medicines is limited by the need for homeopathy expertise. Complex homeopathic medicines have been developed to optimize the treatment of these patients. Any specialist without homeopathy expertise may use a combination of these medicines and conventional treatment.

Multidisciplinary work, multidisciplinary team

2019 ◽  
pp. 49-56
Author(s):  
Jean Hammond ◽  
Derek Hammond
Keyword(s):  
Mental Health ◽  
Multidisciplinary Team ◽  
Best Practice ◽  
Clinical Effectiveness ◽  
Fundamental Principle ◽  
Complex Needs ◽  
Inpatient Ward ◽  
Best Practice Guidelines ◽  
Individualized Care ◽  
Wide Range

Putting the patient at the centre of their care is a fundamental principle of the multidisciplinary team (MDT) approach. It is generally recognized as being an effective model for delivering individualized care to patients with complex needs and is promoted in a growing number of local and national policies and best practice guidelines, in a wide range of clinical specialities. While clinical staff seem clear on the assumed benefits of MDT working, there is surprisingly little written about its clinical effectiveness. This chapter briefly explores some of the challenges presented to effective MDT working within the acute mental health inpatient ward. The key principles and characteristics of MDT working are described with an exploration of the key roles and functions within the MDT and their application to acute mental health inpatients wards.

Symptomatic Management in Amyotrophic Lateral Sclerosis

2017 ◽  
Author(s):  
Matthew Gladman ◽  
Lorne Zinman
Keyword(s):  
Best Practice ◽  
Caloric Intake ◽  
Well Being ◽  
Best Practice Guidelines ◽  
Incurable Disease ◽  
Symptomatic Management ◽  
Increased Risk ◽  
Wide Range ◽  
Communication Devices ◽  
Evidenced Based

Although ALS remains an incurable disease, there are specific treatments that can significantly improve quality of life and some that can modify survival. Patients are best followed in multidisciplinary ALS clinics where a number of medical experts can address a wide range of symptoms. Additional studies are needed to develop evidenced-based best practice guidelines to further improve care for patients with ALS. Bulbar dysfunction eventually affects the vast majority of ALS patients, and progressive dysphagia results from weakness and spasticity of the muscles involved in swallowing. Dysphagia is associated with increased risk of aspiration and choking, as well as with long-term risk of malnutrition, weight loss, and dehydration. Appropriate measures to enhance caloric intake contribute to a greater sense of well-being. Augmentative communication devices and ventilator support can also be used to reduce suffering.

scholarly journals Participatory Design, Project Clients, and Healthcare User Groups

2020 ◽  
pp. 193758672094846
Author(s):  
Jane Carthey
Keyword(s):  
Group Process ◽  
Participatory Design ◽  
Best Practice ◽  
Healthcare Facility ◽  
User Group ◽  
Best Practice Guidelines ◽  
Wide Range ◽  
Research Findings ◽  
User Groups ◽  
Effective Decision Making

Aim: This study is the third in a series of investigations that explored the role of project user groups and how they impact on the design of a healthcare facility. Previous studies focused on a wide range of users, whereas this study sought the views of project clients. Background: The “project client” represents the organization responsible for the procurement of a healthcare facility. “Users” will work in or “use” that building. With the input of project clients, this research focused on the user group process required for Australian and New Zealand publicly funded healthcare projects. It sought lessons to improve the process for future projects. Methods: Previous research findings, and an expanded literature review examining participatory design, were used to develop questions for semistructured interviews with selected project clients. Responses were transcribed and analyzed in terms of themes and subthemes using reflexive thematic analysis to develop a narrative that reports and discusses the findings. Results: Although not all are recognized, many stakeholders influence design decisions. No history, rationale, terms of reference, or evaluations of the user group process were found, suggesting that although it is a “given,” the process could be enhanced. Useful suggestions for improving the user group process are offered. Conclusions: Evaluating the user group process, and learning from alternative approaches, may improve its outcomes. A project charter and terms of reference would support more effective decision making, while best practice guidelines and education for user group participants should be considered.

An investigation of adherence to best practice guidelines for autism diagnosis in New Zealand

Autism ◽  
2021 ◽  
pp. 136236132110157
Author(s):  
Lauren J Taylor ◽  
Matthew JF Eggleston ◽  
Hiran Thabrew ◽  
Larah van der Meer ◽  
Hannah Waddington ◽  
...  
Keyword(s):  
New Zealand ◽  
Health Professionals ◽  
Best Practice ◽  
Autism Spectrum ◽  
Diagnostic Process ◽  
Autism Diagnosis ◽  
Best Practice Guidelines ◽  
Wide Range ◽  
Adolescents And Adults ◽  
Consistent Support

Recent studies of autism diagnosis in New Zealand have revealed inconsistent implementation of best practice standards in autism assessment and high rates of parental dissatisfaction with the diagnostic process. These findings have arisen despite the development and dissemination of the New Zealand Autism Spectrum Disorder Guideline (the Guideline). In this study, we investigated current diagnostic processes, and adherence to the Guideline in New Zealand, for an opportunity sample of 117 health professionals who practice across a wide range of diagnostic services, health professionals and geographic regions in New Zealand. The results show considerable variability in practice, and suggest specific areas for improvement. These include the robustness of diagnostic evaluations conducted in private settings, the provision of specialist assessment services for youth and adults presenting for autism diagnosis, and the uniformity of post-diagnostic supports and services. These findings have implications for further implementation of the Guideline in New Zealand. Lay abstract Many clinicians in New Zealand do not follow guidelines for best practice in autism diagnosis. In this study, we investigated the processes that health professionals in New Zealand follow when diagnosing autistic children and adults. We asked 117 health professionals from a range of services and regions in New Zealand, how they identify and diagnose autism. We found that there are differences in the way that clinicians in New Zealand diagnose autism. We identified areas in which autism diagnosis in New Zealand could be improved, for example, by establishing more services to diagnose autism in adolescents and adults, and providing more consistent support after a person is diagnosed with autism. These findings will help to improve autism diagnosis in New Zealand.

Morphological features of endo- and myometrium in patients with uterine leiomyoma and infertility

2020 ◽  
pp. 33-37
Author(s):  
M.A. Flaksenberg ◽  
◽  
Keyword(s):  
Uterine Leiomyoma ◽  
Negative Impact ◽  
Reproductive Function ◽  
Cell Types ◽  
Underlying Disease ◽  
Reproductive Organs ◽  
Pathological Process ◽  
Simple Type ◽  
Morphological Examination ◽  
Blastocyst Implantation

The objective: determination of morphofunctional features of leiomatous nodes and endometrium in women with uterine leiomyoma and infertility to restore reproductive function and prevent recurrence of the underlying disease. Materials and methods. In order to restore reproductive function and prevent recurrence of the underlying disease, morphofunctional features of leiomatous nodes and endometrium in women with uterine leiomyoma and infertility were determined. Thirty samples of leiomyomatous nodes and endometrium were examined, among which 15 were obtained from women with multiple uterine leiomyoma and infertility and 15 samples from women with uterine leiomyoma with isolated uterine leiomyoma. During the study, a general-histological method was used for staining with hematoxylin-eosin and picrofuxin by van Gizon, as well as immunohistochemical methods. Histological examination of the endometrium was performed according to conventional protocol, taking into account the day of the menstrual cycle and R.W. Noyes criteria. Results. In the morphological examination of leiomyomatous nodes in the vast majority of cases the presence of uterine leiomyomas of simple and cell types or their combination was established. In women with multiple uterine leiomyoma, simple-type leiomyoma (53.3%) was predominant, and in patients with isolated leiomyoma the signs of cellular uterine leiomyoma (66.7%) were more frequently found. In 80.0% of women with uterine leiomyoma revealed pathology of the endometrium, such as glandular and glandular-fibrous polyps, simple and complex atypical endometrial hyperplasia, which confirms the theory about the only pathogenetic mechanisms of the emergence of hyperplastic processes of female organs. In 66.7% of women with multiple leiomyomas, signs of chronic endometritis have been found, which exacerbates the pathological process and can have a negative impact on the reproductive function, such as secretory endometrial transformation and impaired blastocyst implantation, and explains a much higher percentage of infertility in the group. Conclusion. In women with impaired reproductive function, patients with uterine leiomyoma, it is necessary to conduct a study of the receptivity of the reproductive organs, namely - the endometrium and leiomatous nodes. This will make it possible to use one or another method of treatment in order to restore reproductive function and prevent recurrence of the underlying disease. Keywords: infertility, uterine leiomyoma, endometrium, receptive apparatus.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

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