Controversies Surrounding Medical Clearance in Psychiatry Patients: evidence, recommendations, and potential approach

2021 ◽  
Vol 17 ◽  
Author(s):  
Walid Alam
Keyword(s):  
Laboratory Testing ◽  
Medical Illness ◽  
Routine Laboratory ◽  
Suggested Approach ◽  
Routine Testing ◽  
Diagnostic Uncertainty ◽  
Medical Clearance ◽  
The Impact ◽  
Adequate Communication ◽  
Rule Out

Background: Despite the evidence and guidelines recommending otherwise, routine testing remains pervasive in the management of patients presenting to the Emergency Department (ED) for behavioral complaints, under the guise of medical clearance (MC). The aim of this review is to highlight the evidence available concerning routine laboratory testing in psychiatry patients presenting to the ED, underline available guidelines, list possible reasons for over-testing, and propose a possible approach based on all the evidence and recommendations. Methods: Electronic database searches were carried out in Medline/PubMed and Google Scholar with the period set from January 1, 1990 to March 1, 2021. The search process was focused on studies where MC was evaluated in the management of patients presenting for psychiatric complaints to the ED. The references listed in each identified article were also screened and manually searched. Results: 14 relevant studies were found with the majority evaluating the impact of routine laboratory testing on the management and disposition of adults in the ED presenting for an acute psychiatric condition. Two studies investigated the use of a screening tool to rule out the presence of acute medical illness. Conclusion: While ED physicians are faced with many challenges such as litigation and fear of diagnostic uncertainty, few solutions have been proposed. A suggested approach relies on history taking, physical examination, and assessment of mentation to evaluate for the presence of an organic etiology requiring further testing. Adequate communication between the ED physician and psychiatrist, along with shared decision-making are also key to optimizing care.

scholarly journals Clinical laboratory practices for the detection of rotavirus in England and Wales: can surveillance based on routine laboratory testing data be used to evaluate the impact of vaccination?

2009 ◽  
Vol 14 (20) ◽  
Author(s):  
C J Atchison ◽  
B A Lopman ◽  
C J Harris ◽  
C C Tam ◽  
M Iturriza Gómara ◽  
...  
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Age Groups ◽  
Surveillance Data ◽  
Enzyme Linked Immunosorbent Assay ◽  
Routine Laboratory ◽  
England And Wales ◽  
Rotavirus Vaccines ◽  
Testing Data ◽  
The Impact

Two rotavirus vaccines have recently been licensed in Europe. Rotavirus surveillance data in many European countries are based on reports of laboratory-confirmed rotavirus infections. If surveillance data based on routine laboratory testing data are to be used to evaluate the impact of vaccination programmes, it is important to determine how the data are influenced by differences in testing practices, and how these practices are likely to affect the ability of the surveillance data to represent trends in rotavirus disease in the community. We conducted a survey of laboratory testing polices for rotavirus gastroenteritis in England and Wales in 2008. 60% (94/156) of laboratories responded to the survey. 91% of reporting laboratories offered routine testing for rotavirus all year round and 89% of laboratories offered routine rotavirus testing of all stool specimens from children under the age of five years. In 96% of laboratories, rotavirus detection was presently done either by rapid immunochromatographic tests or by enzyme-linked immunosorbent assay. Currently, rotavirus testing policies among laboratories in England and Wales are relatively homogenous. Therefore, surveillance based on laboratory testing data is likely to be representative of rotavirus disease trends in the community in the most frequently affected age groups (children under the age of five years) and could be used to help determine the impact of a rotavirus vaccine.

Routine Laboratory Testing Data for Surveillance of Rotavirus Hospitalizations to Evaluate the Impact of Vaccination

2007 ◽  
Vol 26 (10) ◽  
pp. 914-919 ◽  
Author(s):  
Manish M. Patel ◽  
Jacqueline E. Tate ◽  
Rangaraj Selvarangan ◽  
Irini Daskalaki ◽  
Mary Anne Jackson ◽  
...  
Keyword(s):  
Laboratory Testing ◽  
Routine Laboratory ◽  
Testing Data ◽  
The Impact

Modernism, Empiricism, and Rationalism

2016 ◽  
Vol 46 (1) ◽  
pp. 38-47
Author(s):  
Geoffrey Squires
Keyword(s):  
Twentieth Century ◽  
The Other ◽  
Modern Poetry ◽  
Philosophical Perspective ◽  
Irish Poetry ◽  
Dimensional Spectrum ◽  
Culture History ◽  
The World ◽  
The Impact ◽  
Rule Out

Modernism is usually defined historically as the composite movement at the beginning of the twentieth century which led to a radical break with what had gone before in literature and the other arts. Given the problems of the continuing use of the concept to cover subsequent writing, this essay proposes an alternative, philosophical perspective which explores the impact of rationalism (what we bring to the world) on the prevailing empiricism (what we take from the world) of modern poetry, which leads to a concern with consciousness rather than experience. This in turn involves a re-conceptualisation of the lyric or narrative I, of language itself as a phenomenon, and of other poetic themes such as nature, culture, history, and art. Against the background of the dominant empiricism of modern Irish poetry as presented in Crotty's anthology, the essay explores these ideas in terms of a small number of poets who may be considered modernist in various ways. This does not rule out modernist elements in some other poets and the initial distinction between a poetics of experience and one of consciousness is better seen as a multi-dimensional spectrum that requires further, more detailed analysis than is possible here.

scholarly journals Modeling and Optimization Sustainable Forest Supply Chain Considering Discount in Transportation System and Supplier Selection under Uncertainty

Forests ◽  
2021 ◽  
Vol 12 (8) ◽  
pp. 964
Author(s):  
Komeyl Baghizadeh ◽  
Dominik Zimon ◽  
Luay Jum’a
Keyword(s):  
Supply Chain ◽  
Working Hours ◽  
Mixed Integer ◽  
Forest Industry ◽  
Northern Iran ◽  
Suggested Approach ◽  
Tactical Decisions ◽  
Environmental Goals ◽  
Forest Supply Chain ◽  
The Impact

In recent decades, the forest industry has been growingly expanded due to economic conditions, climate changes, environmental and energy policies, and intense demand changes. Thus, appropriate planning is required to improve this industry. To achieve economic, social and environmental goals, a supply chain network is designed based on a multi-period and multi-product Mixed-Integer Non-Linear Programming (MINLP) model in which the objective is to maximize the profit, minimize detrimental environmental effects, improve social effects, and minimize the number of lost demands. In addition, to improve forest industry planning, strategic and tactical decisions have been implemented throughout the supply chain for all facilities, suppliers and machinery. These decisions significantly help to improve processes and product flows and to meet customers’ needs. In addition, because of the presence of uncertainty in some parameters, the proposed model was formulated and optimized under uncertainty using the hybrid robust possibilistic programming (HRPP-II) approach. The -constraint technique was used to solve the multi-objective model, and the Lagrangian relaxation (LR) method was utilized to solve the model of more complex dimensions. A case study in Northern Iran was conducted to assess the efficiency of the suggested approach. Finally, a sensitivity analysis was performed to determine the impact of important parameters on objective functions. The results of this study show that increasing the working hours of machines instead of increasing their number, increasing the capacity of some facilities instead of establishing new facilities and expanding the transport fleet has a significant impact on achieving predetermined goals.

scholarly journals Analysis of the Viscoelastic Sphere Impact against a Viscoelastic Uflyand-Mindlin Plate considering the Extension of Its Middle Surface

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Yury A. Rossikhin ◽  
Marina V. Shitikova ◽  
Phan Thanh Trung
Keyword(s):  
Contact Force ◽  
Middle Surface ◽  
Hertzian Contact ◽  
Mindlin Plate ◽  
Strong Discontinuity ◽  
Time Duration ◽  
Suggested Approach ◽  
Viscoelastic Sphere ◽  
The Impact ◽  
Contact Domain

In the present paper, the problem on impact of a viscoelastic sphere against a viscoelastic plate is considered with due account for the extension of plate’s middle surface and local bearing of sphere and plate’s materials via the Hertz theory. The standard linear solid models with conventional derivatives and with fractional-order derivatives are used as viscoelastic models, respectively, outside and within the contact domain. As a result of impact, transient waves (surfaces of strong discontinuity) are generated in the plate, behind the wave fronts of which up to the boundaries of the contact domain the solution is constructed in terms of one-term ray expansions due to short-time duration of the impact process. The motion of the contact zone occurs under the action of extension forces acting in the plate’s middle surface, transverse force, and the Hertzian contact force. The suggested approach allows one to find the time-dependence of the impactor’s indentation into the target and the Hertzian contact force.

Research on Biological Materials by Applied Technology with an Algorithm for Identifying and Counting Cells in Microscopic Particle Image

2014 ◽  
Vol 540 ◽  
pp. 352-355
Author(s):  
Sui Yuan Zhang ◽  
Rui Wang ◽  
Xian Qiao Chen ◽  
Ze Wu Jiang ◽  
Xiang Cai
Keyword(s):  
Particle Image ◽  
Dynamic Threshold ◽  
Biological Cells ◽  
Edge Detecting ◽  
Applied Technology ◽  
Channel Information ◽  
High Level ◽  
The Impact ◽  
Fundamental Units ◽  
Rule Out

Cells are fundamental units of life, and the key point in the field of biomaterial. Biological cells are always with high density, small nucleus and much impurities. Based on the technology of image processing, we propose a new method to count cells on the image of microscopic cells with high level of recognition. To precisely count the number, our method includes edge detecting and marking, efficient usage of three channel information of enhanced nucleus, binaryzation of dynamic threshold in separated areas and finally denoising. The experiment shows that the method is precise and quickly-reacted, moreover it can effectively rule out the impact of impurities. With little adjustment, it can apply to some other fields, not only decrease the labor involved, but the budget as well.

scholarly journals The health and relationship dynamics of late-life couples: a systematic review of the literature

2009 ◽  
Vol 29 (3) ◽  
pp. 455-480 ◽  
Author(s):  
RUTH B. WALKER ◽  
MARY A. LUSZCZ
Keyword(s):  
Systematic Review ◽  
Marital Quality ◽  
Late Life ◽  
The United States ◽  
Health It ◽  
Social Emotional ◽  
Marital Relations ◽  
The Impact ◽  
The Relationship ◽  
Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

Low First Wave COVID-19 cases and health seeking behaviors across the six geopolitical zones of Nigeria

2021 ◽  
Vol 42 (1) ◽  
pp. 1-8
Author(s):  
C.N. Ukaga ◽  
S.O. Sam-Wobo ◽  
R.H. Muhammed ◽  
H.O. Mogaji ◽  
O.A. Surakat ◽  
...  
Keyword(s):  
Laboratory Testing ◽  
Management Strategies ◽  
Demographic Characteristics ◽  
Community Level ◽  
Health Seeking ◽  
Routine Testing ◽  
Home Management ◽  
Health Seeking Behaviors ◽  
Very High ◽  
Age Category

This study was carried out across the six geopolitical zones to assess knowledge and health seeking behaviors of Nigerians during the first wave of COVID-19 pandemic lockdown in order to understand the seemingly low cases of COVID-19 in Nigeria. Structured and pretested short questionnaires were employed to obtain information electronically and physically across the six geopolitical zones on socio-demographic characteristics of participants; the knowledge of participants on COVID-19 disease; availability and accessibility to testing and isolation centers in the communities, attitudes and health seeking behaviors. Atotal of 1023 respondents; 705 (68.9%) males and 318 (31.1%) females across the six geopolitical zones in Nigeria participated in this study with 477(46.6%) within the 26-45 years age category, and 6(0.6%) above 66 years. Atotal of 985(96.3%) had heard about COVID-19 at the time of survey while a total of  859(84.0%) of the respondents were aware of the presence of COVID-19 laboratory testing centers. Across the geopolitical zones, majority of the respondents 487(47.6%) claimed there are no routine testing for COVID-19 at their community level, while 303 (29.6%) affirmed otherwise and 216(21.1%) did not know if there were routine testing going on or not. On health seeking behaviors across the  country, majority of the respondents 558(54.5%) affirmed they would visit the hospital as the first point of contact if the opportunitypresented itself, 244(23.9%) claimed they would call the NCDC toll line, 2(0.2%) said they would use prayers, while 1(0.1%) respectively claimed they would use home management strategies through visiting chemist stores and checking the internet for solutions. Findings from this study confirm that there is very high awareness of the COVID-19 disease across the country, and limited number of testing centers at the community level. The implications include the possibility of unreported COVID19 cases in the cities as well as in the  communities. Keywords: COVID-19, knowledge, health seeking behaviors, community level 

Editorial

2006 ◽  
Vol 5 (1) ◽  
Author(s):  
Chris Roseveare
Keyword(s):  
Psoas Abscess ◽  
Special Section ◽  
Hospital Medicine ◽  
Regular Feature ◽  
Acute Medicine ◽  
The Past ◽  
Hospital Referral ◽  
Working Practices ◽  
The Impact ◽  
Rule Out

Few will deny that the past 6 months have been particularly challenging for all clinicians working in hospital medicine. The pressures of ward closures, which many acute hospitals have faced recently, have undoubtedly increased the ‘bottle-neck’ effect at the front door. Any ‘slack’ which might have existed in the past has now disappeared – 82% occupancy, which was once touted as the Holy Grail of bed-crisis prevention now seems a forlorn hope. One of the Government’s solutions is that chronic disease will be managed without admission to hospital. In reality, this will require dramatic changes in the attitudes of patients, carers and general practitioners and will not happen quickly. The impact of any pre-emptive reduction in capacity will be felt long before any such changes take effect. In the meantime it will up to those of us working in the AMU to ‘sort-out’ and ‘turf-out’, where appropriate. Looking on the bright side, at least when the next round of consultant redundancies is announced we should have little difficulty in justifying our existence…. The request to ‘rule-out serious pathology’ is a frequent justification for hospital referral. When the problem is that of a sudden onset of headache the need to rule-out subarachnoid haemorrhage becomes paramount. Most readers will not make the mistake I made once as an SHO, in assuming that negative CT brain scanning is adequate in this context. However, CSF analysis is not always straightforward. Stephen Hill and Ashwin Pinto’s excellent review of this subject will help unravel some of the complexities in this area. Hopefully the reviews of the acute management of chronic liver disease, psoas abscess and sickle cell disease will also be helpful in your day-to-day working practices. I would also draw your attention to the postcard, which Dr Snape has kindly submitted from a collection donated to him by a patient. Referring to the 1918 Avian Inf luenza outbreak the postcard’s author provides a chilling reminder of the impact of this pandemic. If ‘rule-out avian ‘f lu’ becomes a reason for referral to hospital in the future, we will hopefully be well prepared. Finally in a slight change to the previous format there is now a special section of the journal relating to the Society for Acute Medicine. I am aware that a large proportion of readers are members of the society and this needs to be ref lected in the journal’s content. The ‘Society Pages’ will become a regular feature in the journal, hopefully providing readers with useful information and updates on developments within Acute Medicine. In this edition I have included the abstracts from the Free Paper session at the recent meeting in Hull, along with a summary of the meeting and programme for the next meeting in the Royal College of Physicians. Submissions for this section could include summaries of working practices within different acute medicine units around the country, as well as experiences of trainees undertaking the new acute medicine training programmes. All would be gratefully received.

scholarly journals The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England

2018 ◽  
Vol 73 (2) ◽  
pp. 168-175 ◽  
Author(s):  
Sotiris Vandoros ◽  
Mauricio Avendano ◽  
Ichiro Kawachi
Keyword(s):  
Mental Health ◽  
Relative Increase ◽  
Control Group ◽  
Unexpected Result ◽  
Physical And Mental Health ◽  
Drug Classes ◽  
Defined Daily Doses ◽  
The Impact ◽  
Rule Out ◽  
The Eu

BackgroundPrevious research has highlighted the impact of economic conditions and uncertainty on physical and mental health. The unexpected result of the Brexit referendum in 2016 triggered high levels of economic uncertainty.ObjectiveTo examine whether prescriptions for antidepressants increased after the referendum result, benchmarking them against other drug classes.MethodsWe used GP practice prescribing data to compile the number of defined daily doses per capita every month in each of the 326 voting areas in England over the period 2011–2016. We used a difference-in-differences (DID) approach to identify the effects of Brexit on antidepressant prescriptions, compared with trends in a control group (antigout and iron preparations) that were unlikely to be associated with uncertainty and depression.ResultsAntidepressant prescribing continued to increase after the referendum but at a slower pace. Therapeutic classes used as controls showed a decrease. The DID approach shows that there was a relative increase of 13.4% in antidepressants compared with other therapeutic classes (DID coeff: 0.134; 95% CI 0.093 to 0.174).ConclusionOur results are open to different interpretations and should be treated with caution. This relative increase in antidepressant prescribing after the referendum may be attributed to increased uncertainty for certain parts of the population, but does not rule out an improvement in mood for others. Alternatively, some other factor—for example, distraction, might have contributed to a decrease in the control therapeutic classes. A possible policy implication is that programmes for the promotion of mental health may need to be intensified during periods of uncertainty.

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