Nasal Endoscopy: Its Role in Office Diagnosis

1997 ◽  
Vol 11 (2) ◽  
pp. 177-180 ◽  
Author(s):  
Michael S. Benninger
Keyword(s):  
Treatment Plan ◽  
Septal Deviation ◽  
Diagnosis And Treatment ◽  
Nasal Endoscopy ◽  
Nasal Sinus ◽  
Anterior Rhinoscopy ◽  
Choanal Polyp ◽  
Before And After ◽  
Treatment Plans

To clarify the role of nasal endoscopy in the diagnosis and treatment planning for patients with nasal or sinus complaints, 100 consecutive new patients were evaluated. Patients were excluded if their only complaint was obstruction and they had a septal deviation as the only clinical finding. Each patient underwent a thorough history and head and neck examination, including anterior rhinoscopy before and after decongestion, and the diagnosis and treatment plans were documented. Each then underwent nasal endoscopy, and the diagnosis and treatments were compared. The most common diagnoses after anterior rhinoscopy were allergic rhinitis (21), nonallergic rhinitis (12), chronic sinusitis with polyps (19) or without polyps (9), and nonsinus pain (13). Nasal endoscopy played a role in 11% of patients, although in no case did endoscopy change the diagnosis or treatment plan. Endoscopy allowed visualization past an enlarged turbinate or septal deviation in six patients, confirmed a suspected diagnosis in three by visualization of the middle meatus, and detected the site of a large choanal polyp in one. In one case, endoscopy identified a paradoxical turbinate on the side opposite the symptoms and radiological findings. Routine nasal endoscopy need not be part of the evaluation of all patients with nasal sinus disorders but is particularly valuable in confirming diagnoses, particularly in patients where anterior rhinoscopy is limited by anatomic vobstruction.

Evaluation of electronic health record implementation on pharmacist interventions related to oral chemotherapy management

2016 ◽  
Vol 23 (8) ◽  
pp. 563-574 ◽  
Author(s):  
Anastasia Finn ◽  
Carolyn Bondarenka ◽  
Kathy Edwards ◽  
Rebekah Hartwell ◽  
Cathy Letton ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Oral Chemotherapy ◽  
Pharmacist Interventions ◽  
Before And After ◽  
Treatment Plans ◽  
Implementation Time ◽  
Chemotherapy Agents ◽  
Beacon Period

Background With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. Objective To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program. Methods This was a single-center retrospective chart review of documented pharmacy interventions for oral chemotherapy prescriptions during three months prior to as well as three months following Epic Beacon implementation. Time periods for data inclusion were October–December 2013 (pre-Beacon) and October–December 2014 (post-Beacon). Patients included in the study had one or more oral chemotherapy orders during the pre-Beacon period, the post-Beacon period, or both pre- and post-Beacon. Our analysis did not include oral chemotherapy orders that were placed outside of a treatment plan in the post-Beacon period. Results A total of 240 patients with 450 total oral chemotherapy orders were assessed over the duration of the study. Beacon implementation allowed a greater number of oral chemotherapy orders to be reviewed, with 134 oral chemotherapy orders reviewed in the study period prior to Beacon implementation and 316 orders reviewed in the post-Beacon period. Additionally, there were 660% more pharmacist interventions (89 interventions pre-Beacon versus 681 interventions post-Beacon), with an increased focus on coordination of care, chemotherapy calendar coordination, and assistance with treatment plans. Furthermore, implementation of Epic Beacon allowed identification of over 500% more chemotherapy order errors (41 total errors identified pre-Beacon versus 250 total errors identified post-Beacon). Pharmacists were also able to identify more significant, serious, or potentially lethal errors following implementation. The time associated with oral chemotherapy review and intervention also increased accordingly with number of orders reviewed. Conclusion Implementation of an electronic workflow for oral chemotherapy dramatically increased pharmacist review of orders, resulting in improved documentation of interventions and errors, decreased need for clarification of orders, as well as increased volume of prescriptions at our on-site pharmacy. This study demonstrates a comprehensive approach to maximize safety when oral chemotherapy is utilized as a component of the treatment regimen.

scholarly journals The value of bilateral simultaneous nasal spirometry in the assessment of patients undergoing septoplasty

2011 ◽  
Vol 49 (3) ◽  
pp. 297-303
Author(s):  
G. Fyrmpas ◽  
D. Kyrmizakis ◽  
V. Vital ◽  
J. Constantinidis
Keyword(s):  
Nasal Obstruction ◽  
Septal Deviation ◽  
Subjective Measures ◽  
Noninvasive Technique ◽  
Patient Dissatisfaction ◽  
Normal Limits ◽  
Preoperative Selection ◽  
Depth Analysis ◽  
Before And After

PROBLEM: There is no consensus regarding the best approach to select patients for septoplasty. Patient dissatisfaction after septoplasty implies that clinical examination alone is inadequate to detect a clinically relevant nasal septal deviation (NSD). Objective testing provides an in-depth analysis of nasal obstruction and its underlying anatomic causes but it is effort consuming, requires training and it is not widely available. AIM: We studied the role of bilateral simultaneous nasal spirometry (BSNS) in the preoperative selection of patients for septoplasty. PATIENTS, SUBJECTS AND METHODS: Thirty patients with nasal obstruction and NSD were assessed by subjective measures and BSNS before and after septoplasty. The decongested nasal partitioning ratio (NPR) was used as a measure of the degree of NSD. Thirty healthy controls were recruited for providing a normal range of NPR values. RESULTS: All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits had a significant reduction of NPR. Patients with unilateral symptoms and NPR beyond normal limits were also able to identify the more obstructed side preoperatively. For this group of patients, physicians were able to identify the convex side of NSD preoperatively. No correlation between subjective measures of nasal obstruction or airflow asymmetry and NPR was observed. CONCLUSION: BSNS is a rapid, easily interpretable, noninvasive technique, which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BSNS is not applicable in cases with a septal perforation or an S type septal deviation, it cannot detect an insufficient nasal valve and it does not substitute rhinomanometry or acoustic rhinometry.

Impact and Cost Effectiveness of Videonystagmography

2020 ◽  
pp. 000348942096887
Author(s):  
Garrett Ni ◽  
Christine Kim ◽  
Lakshmi Nair ◽  
Alexander G. Bien ◽  
Daohai Yu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Treatment Plan ◽  
Cost Effective ◽  
Diagnosis And Treatment ◽  
Medicare Reimbursement ◽  
Treatment Plans ◽  
Vestibular Symptoms ◽  
The Cost ◽  
Evidence Based Guidelines ◽  
The Impact

Objective: Videonystagmography (VNG) is a commonly ordered test to evaluate patients with vestibular complaints. To date, there are no evidence-based guidelines for evaluating patients presenting with vestibular symptoms. This study evaluates the cost effectiveness of VNG and the impact of VNG findings on patient management. Methods: Patient charts were reviewed from 3 institutions to collect the pre- and post-VNG ICD-9/10 diagnosis and treatment plan. VNG findings were recorded to calculate the incidence of abnormal findings and the incidence of change in diagnosis and/or treatment plan. The cost effectiveness of VNG was estimated based on these calculations. Results: A total of 120 patient charts were reviewed. 69/120 (57.5%; 95% CI: 48.2%-66.5%) patients had abnormal findings on their VNG. A change in diagnosis was noted in 24/120 (20.0%; 95% CI: 13.3%-28.3%) patients. A change in treatment plan was noted in 62/120 (51.7%; 95% CI: 42.4%-60.9%) patients, and 11/120 (9.2%; 95% CI: 4.7%-15.8%) had a change in diagnosis that led to change in treatment plan. Using the average Medicare reimbursement for VNG, the cost effectiveness analysis showed a cost of $869.57 per VNG with abnormal findings and a cost of $5454.55 per VNG that lead to a change in diagnosis and treatment plan. Conclusions: VNG findings may not result in changes in clinical diagnosis. However, VNG is impactful at influencing treatment plan changes. VNG results are beneficial for counseling patients, guiding treatment plans, and managing patient expectations. When there is a clear indication, VNG testing can be cost effective in managing patients presenting with vestibular symptoms.

Is Understanding Why Necessary for Treatment Choices?

2011 ◽  
Vol 27 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Chantal Berens ◽  
Cilia L. M. Witteman ◽  
Monique O. M. van de Ven
Keyword(s):  
Experimental Study ◽  
Clinical Practice ◽  
Conduct Disorder ◽  
Treatment Plan ◽  
Clinical Psychologists ◽  
Treatment Choices ◽  
Appropriate Treatment ◽  
Treatment Plans

Models of the psychodiagnostic process prescribe that clinicians should analyze explanations for their clients’ problems and subsequently use this information to decide upon the most appropriate treatment plan. However, studies of clinical practice suggest that the role of explanations is minimal, and that considering only symptoms gives clinicians enough information to plan treatment. In this experimental study we tested whether different explanations for the same problem are related to different treatment plans. Analyses of the responses given by 151 psychologists for cases of anorexia and conduct disorder in which the explanations were manipulated, suggest that explanations matter. Different explanations for the same constellation of symptoms were related to different treatment plans. This implies that clinical psychologists do not propose a treatment based on symptoms only. Implications of our findings are discussed.

scholarly journals Role of chest imaging in the diagnosis and treatment of COVID-19

2021 ◽  
Vol 64 (10) ◽  
pp. 655-663
Author(s):  
Yong Shik Kwon ◽  
Jin Young Kim
Keyword(s):  
Imaging Finding ◽  
Treatment Plan ◽  
Diagnosis And Treatment ◽  
Chest Imaging ◽  
Asymptomatic Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Polymerase Chain ◽  
Severity Of The Disease

Background: Thousands of new patients are diagnosed with coronavirus disease 2019 (COVID-19) daily worldwide. We reviewed the role of chest imaging in the diagnosis and treatment of patients with COVID-19.Current Concepts: Chest imaging is not recommended as a primary diagnostic tool for COVID-19. However, when real-time polymerase chain reaction is difficult to perform or when COVID-19 is strongly suspected, chest imaging can assist in the diagnosis. Thus, chest imaging is recommended for high-risk patients and patients with worsening respiratory symptoms, but not for asymptomatic patients. Bilateral peripheral pneumonia is a typical imaging finding in patients with COVID-19. However, there are cases where chest imaging shows atypical findings or appears normal. The extent of COVID-19 pneumonia on chest imaging is related to the severity of the disease. The presence and extent of pneumonia on chest imaging can help monitor patients, select appropriate treatment agents, determine whether the patient should be hospitalized, and predict the prognosis.Discussion and Conclusion: Appropriate use of chest imaging is needed for clinicians to help triage patients with COVID-19 and decide on the treatment plan.

scholarly journals Profil Pasien Rinosinusitis Kronik di Poliklinik THT-KL RSUP DR.M.Djamil Padang

2015 ◽  
Vol 4 (3) ◽  
Author(s):  
Hesty Trihastuti ◽  
Bestari Jaka Budiman ◽  
Edison Edison
Keyword(s):  
General Hospital ◽  
Clinical Symptom ◽  
Chronic Rhinosinusitis ◽  
Nasal Obstruction ◽  
Middle Turbinate ◽  
Inferior Turbinate ◽  
Septal Deviation ◽  
Nasal Endoscopy ◽  
Nasal Discharge ◽  
Anterior Rhinoscopy

Abstrak Rinosinusitis kronik adalah inflamasi kronik pada mukosa hidung dan sinus paranasal yang sering terjadi, tetapi belum ada data mengenai profil pasien rinosinusitis kronik di RSUP Dr.M.Djamil Padang. Penelitian ini merupakan penelitian deskriptif dengan mengambil data rekam medis THT-KL RSUP Dr.M.Djamil periode 1 Januari – 31 Desember 2012 dengan metode total sampling. Terdapat 63 kasus rinosinusitis kronik di poliklinik THT-KL RSUP Dr.M.Djamil Padang periode 1 Januari – 31 Desember 2012. Kasus rinosinusitis kronik paling banyak terjadi pada kelompok usia 46 – 55 tahun (22,22%) dan banyak terjadi pada perempuan (60,32%). Berdasarkan tanda dan gejala yang ditemukan paling banyak adalah deviasi septum (41,27%). Gejala klinik paling banyak adalah hidung tersumbat (88,89%). Berdasarkan pemeriksaan rinoskopi anterior dan nasoendoskopi ditemukan kelainan pada kavum nasi, konka inferior, konka media, dan sekret. Disimpulkan bahwa rinosinusitis kronik banyak terjadi pada usia dewasa, jenis kelamin perempuan, tanda dan gejala yang ditemukan deviasi septum, gejala berupa hidung tersumbat, sertaditemukan kelainan berdasarkan pemeriksaan rinoskopi anterior dan nasoendoskopi.Kata kunci: rinosinusitis kronik, pemeriksaan rinoskopi anterior, pemeriksaan nasoendoskopi AbstractChronic rhinosinusitis is a common chronic inflammation of the nose and paranasal sinuses mucosa, but there  is no data about profile of chronic rhinosinusitis patients at ENT clinic Dr.M.Djamil general hospital Padang. This research uses descriptive method by taking the data from the medical records at ENT clinic of Dr.M.Djamil general hospital during 1 January – 31 December 2012 with the method is total sampling. There are 63 chronic rhinosinusitis cases at ENT clinic Dr.M.Djamil Padang general hospital during 1 January – 31 December 2012. Most cases of chronic rhinosinusitis occurred in the age group 46 – 55 years old (22.22%) and higher in female (60.32%). The most sign and symptom finding is septal deviation (41.27%). The most clinical symptom is nasal obstruction (88.89%). Fromanterior rhinoscopy and nasoendoscopy examination, there are founded abnormalility of nasal cavity, inferior turbinate, middle turbinate, and nasal discharge. The conclusion is chronic rhinosinusitis often happened at adult ages, female, septal deviation as the most sign and symptom finding, nasal obstruction as the clinical symptom, and abnormal findings from anterior rhinoscopy and nasal endoscopy examination.Keywords: chronic rhinosinusitis, anterior rhinoscopy examination, nasal endoscopy examination

1763: Stage Migration of upper Tract Transitional Cell Carcinoma: An Argument for the Continued Role of Endourologic Diagnosis and Treatment

2004 ◽  
Vol 171 (4S) ◽  
pp. 466-466
Author(s):  
Stephen A. Boorjian ◽  
Casey K. Ng ◽  
Ravi Munver ◽  
R. Ernest Sosa ◽  
E. Darracott Vaughan ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
Diagnosis And Treatment ◽  
Stage Migration ◽  
Upper Tract

Child and Adolescent Suicides in Bosnia and Herzegovina Before and After the War (1992–1995)

Crisis ◽  
2010 ◽  
Vol 31 (3) ◽  
pp. 160-164 ◽  
Author(s):  
Almir Fajkic ◽  
Orhan Lepara ◽  
Martin Voracek ◽  
Nestor D. Kapusta ◽  
Thomas Niederkrotenthaler ◽  
...  
Keyword(s):  
Bosnia And Herzegovina ◽  
Age Differences ◽  
Suicide Risk ◽  
Child And Adolescent ◽  
Youth Suicide ◽  
Southeastern Europe ◽  
Suicide Rates ◽  
Before And After ◽  
Sex And Age Differences

Background: Evidence on youth suicides from Southeastern Europe is scarce. We are not aware of previous reports from Bosnia and Herzegovina, which experienced war from 1992 to 1995. Durkheim’s theory of suicide predicts decreased suicide rates in wartime and increased rates afterward. Aims: To compare child and adolescent suicides in Bosnia and Herzegovina before and after the war. Methods: Data on youth suicide for prewar (1986–90) and postwar (2002–06) periods were analyzed with respect to prevalence, sex and age differences, and suicide methods. Suicide data from 1991 through 2001 were not available. Results: Overall youth suicide rates were one-third lower in the postwar than in the prewar period. This effect was most pronounced for girls, whose postwar suicide rates almost halved, and for 15–19-year-old boys, whose rates decreased by about a one-fourth. Suicides increased among boys aged 14 or younger. Firearm suicides almost doubled proportionally and were the predominant postwar method, while the most common prewar method had been hanging. Conclusions: The findings from this study indicate the need for public education in Bosnia and Herzegovina on the role of firearm accessibility in youth suicide and for instructions on safe storage in households. Moreover, raising societal awareness about suicide risk factors and suicide prevention is needed.

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

Neuromyelitis optica spectrum: novel concept of pathogenesis, diagnosis and treatment of Devic’s disease

2009 ◽  
Vol 150 (46) ◽  
pp. 2101-2109 ◽  
Author(s):  
Péter Csécsei ◽  
Anita Trauninger ◽  
Sámuel Komoly ◽  
Zsolt Illés
Keyword(s):  
Neuromyelitis Optica ◽  
Water Channel ◽  
Diagnostic Procedures ◽  
Diagnosis And Treatment ◽  
Clinical Settings ◽  
Permanent Disability ◽  
Therapeutic Decisions ◽  
Novel Concept ◽  
The Brain

The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.

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