Using antibiotics on various surgeries

The risk emitted from the usage of antibiotic agents on surgery for prevention and treatment was hardly debated for the past decade. Controlling the source of infection is the main subject who almost all physicians are aware of it, although most of them underestimate the problem and overuse antibiotics on prescription. For that, many strategies need to be planned and the systematic antibiotic treatment must to be improved and the threat of resistant bacteria is an essential factor on the clinical decision-making procedure. This present article aimed to understand the usage of antimicrobials agents on general and most common medical surgery, in addition to the risks and the consequences of the overuse of these drugs on long-term.

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The complex relationship between viruses and inflammatory bowel disease – review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820988198 ◽

2021 ◽

Vol 14 ◽

pp. 175628482098819

Author(s):

Klaudia Farkas ◽

Daniella Pigniczki ◽

Mariann Rutka ◽

Kata Judit Szántó ◽

Tamás Resál ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Patient Management ◽

Clinical Decision Making ◽

Viral Infections ◽

Clinical Decision ◽

The Past ◽

Rapid Changes ◽

Inflammatory Bowel ◽

Practical Recommendations

The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.

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Opioid Analgesia: Perspectives on Right Use and Utility

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/479 ◽

2007 ◽

Vol 3;10 (5;3) ◽

pp. 479-491 ◽

Cited By ~ 2

Author(s):

Jane C. Ballantyne

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Side Effects ◽

Clinical Decision Making ◽

Analgesic Efficacy ◽

Clinical Decision ◽

Opioid Analgesia ◽

Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

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Blood transfusion prescribing in the ACT: an insight into clinical decision making

Australian Health Review ◽

10.1071/ah050240 ◽

2005 ◽

Vol 29 (2) ◽

pp. 240 ◽

Cited By ~ 2

Author(s):

Philip J Crispin ◽

Bethany J Crowe ◽

Anne M McDonald

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Early Discharge ◽

Organisation Of Care ◽

Metropolitan Hospital ◽

Loss Of Appetite ◽

Insight Into ◽

Structured Questionnaire

This study aimed to determine the perspectives of a group of patients categorised as ?long-stay outliers? at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

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CLINICAL DECISION MAKING FOR THE HEMODYNAMIC GRAY ZONE (FFR 0.75-0.80) AND IMPACT ON LONG TERM OUTCOMES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30380-1 ◽

2016 ◽

Vol 67 (13) ◽

pp. 379 ◽

Cited By ~ 2

Author(s):

Shiv Kumar Agarwal ◽

Mohan Edupuganti ◽

Ahmed Almomani ◽

Naga Venkata Pothineni ◽

Jason Payne ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Gray Zone ◽

Long Term Outcomes

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Home Telecare, Medical Implant, and Mobile Technology

Advances in Healthcare Information Systems and Administration - Research Perspectives on the Role of Informatics in Health Policy and Management ◽

10.4018/978-1-4666-4321-5.ch013 ◽

2013 ◽

pp. 222-237

Author(s):

Vishaya Naidoo ◽

Yedishtra Naidoo

Keyword(s):

Mobile Technology ◽

Long Term Care ◽

Clinical Decision Making ◽

Clinical Decision ◽

Technological Solution ◽

Term Care ◽

Mobile Wireless ◽

Global Aging ◽

Mobile Wireless Technology

With a rapidly expanding global aging population, alternatives must be developed to minimize the inevitable increase in acute and long-term care admissions to the health care system. This chapter explores the use of home telecare as an alternative medical approach to managing this growing trend, while also providing superior care to geriatric patients. To address some of the emergent disadvantages of home telecare concerning usability, self-management, and confinement to the home, the use of a cardiac implant in conjunction with a mobile device—to assist in the management of chronic heart failure in seniors—is proposed as a promising technological solution to overcoming these limitations. Ultimately, it seems that the growth of home telecare, as well as the great potential to enhance its services with the use of mobile wireless technology, stands to drastically improve clinical decision-making and management of health services in the future.

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Current Role of Surgery in Pancreatic Cancer With Synchronous Liver Metastasis

Cancer Control ◽

10.1177/1073274820976593 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482097659

Author(s):

Wentao Zhou ◽

Dansong Wang ◽

Wenhui Lou

Keyword(s):

Pancreatic Cancer ◽

Liver Metastasis ◽

Clinical Decision Making ◽

Clinical Decision ◽

Synchronous Liver Metastasis ◽

Long Term Outcomes ◽

Short And Long Term ◽

Current Guidelines

Pancreatic cancer with synchronous liver metastasis has an extremely poor prognosis, and surgery is not recommended for such patients by the current guidelines. However, an increasing body of studies have shown that concurrent resection of pancreatic cancer and liver metastasis is not only technically feasible but also beneficial to the survival in the selected patients. In this review, we aim to summarize the short- and long-term outcomes following synchronous liver metastasectomy for pancreatic cancer patients, and discuss the potential criteria in selecting appropriate surgical candidates, which might be helpful in clinical decision-making.

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A Re-assessment of the Safety and Efficacy of Interleukin-2 for the Treatment of Renal Cell Carcinoma

Clinical Medicine Therapeutics ◽

10.4137/cmt.s2037 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S2037 ◽

Cited By ~ 1

Author(s):

Anthony Jarkowski ◽

Michael K.K. Wong

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Clinical Decision Making ◽

Interleukin 2 ◽

Clinical Decision ◽

High Dose ◽

Perceived Morbidity

Interleukin-2 (IL-2) can provide long term durable remissions for patients with advanced or metastatic renal cell carcinoma. The perceived morbidity and the difficulties in delivering this treatment hampered its widespread use in these patients. This review aims to place IL-2 in the modern milieu by reviewing the pharmacology, efficacy and toxicity of this drug. These will be contrasted and compared with the new targeted-agents. The methodology of providing high dose IL-2 treatment, follow-up care and its impact on patient quality of life will be discussed. Importantly, the ability of these agents to provide durable, complete remissions for RCC patients will be placed in context. The goal is to provide the perspective and framework for the reader to balance the important attributes of each of these drugs during the clinical decision making process.

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Communication Support for People with ALS

Neurology Research International ◽

10.1155/2011/714693 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 58

Author(s):

David Beukelman ◽

Susan Fager ◽

Amy Nordness

Keyword(s):

Augmentative And Alternative Communication ◽

Clinical Decision Making ◽

Clinical Decision ◽

Alternative Communication ◽

Motor Speech ◽

Motor Speech Disorder ◽

Speech Performance ◽

Communication Needs ◽

Almost All ◽

Lateral Sclerosis

Almost all people with amyotrophic lateral sclerosis (ALS) experience a motor speech disorder, such as dysarthria, as the disease progresses. At some point, 80 to of people with ALS are unable to meet their daily communication needs using natural speech. Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate augmentative and alternative communication (AAC) intervention; therefore, appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision-making issue. AAC acceptance and use have increased considerably during the past decade. Many people use AAC until within a few weeks of their deaths.

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