COVID-19: Challenging Clinical Questions

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

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Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide

Perfusion ◽

10.1177/0267659120986532 ◽

2021 ◽

pp. 026765912098653

Author(s):

Hafiz Naderi ◽

Shaun Robinson ◽

Martin J Swaans ◽

Nina Bual ◽

Wing-See Cheung ◽

...

Keyword(s):

Viral Load ◽

Potential Role ◽

Assessment Tool ◽

High Viral Load ◽

First Line ◽

Scanning Time ◽

Contagious Disease ◽

Core Dataset ◽

Clinical Questions

The COVID-19 pandemic has altered our approach to inpatient echocardiography delivery. There is now a greater focus to address key clinical questions likely to make an immediate impact in management, particularly during the period of widespread infection. Handheld echocardiography (HHE) can be used as a first-line assessment tool, limiting scanning time and exposure to high viral load. This article describes a potential role for HHE during a pandemic. We propose a protocol with a reporting template for a focused core dataset necessary in delivering an acute echocardiography service in the setting of a highly contagious disease, minimising risk to the operator. We cover the scenarios typically encountered in the acute cardiology setting and how an expert trained echocardiography team can identify such pathologies using a limited imaging format and include cardiac presentations encountered in those patients acutely unwell with COVID-19.

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Musculoskeletal Disorders’ Classification Proposal for Application in Occupational Medicine

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158223 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8223

Author(s):

Pablo Monteiro Pereira ◽

João Amaro ◽

Bruno Tillmann Ribeiro ◽

Ana Gomes ◽

Paulo De De Oliveira ◽

...

Keyword(s):

Musculoskeletal Disorders ◽

Development Process ◽

Clinical Pathology ◽

Clinical Activity ◽

Occupational Physicians ◽

Work Related ◽

Therapeutic Measures ◽

Clinical Questions ◽

Four Levels ◽

Tissue Alterations

Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was developed and proposed, covering criteria applicable to daily clinical activity. It was considered that the disorder development process is the same across all work-related MSDs (WRMSDs). Concepts of clinical pathology were applied to the characteristics of WRMSDs pathophysiology, cellular and tissue alterations. Then, the correlation of the inflammatory mechanisms with the injury onset mode was graded into four levels (MSDs 0–3). Criteria of legal, occupational and internal medicine, semiology, physiology and orthopaedics, image medicine and diagnostics were applied. Next, the classification was analysed by experts, two occupational physicians, two physiatrists and occupational physicians and one orthopaedist. This approach will allow WRMSD prevention and improve therapeutic management, preventing injuries from becoming chronic and facilitating communication between occupational health physicians and the other specialities. The four levels tool relate aetiopathogenic, clinical, occupational and radiological concepts into a single classification. This allows for improving the ability to determine a WRMSD and understanding what preventive and therapeutic measures should be taken, avoiding chronicity. The developed tool is straightforward, easy to understand and suitable for WRMSDs, facilitating communication between occupational physicians and physicians from other specialities.

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Evaluating Mechanisms: Mapping Weekly Dynamics between Experiential Avoidance and SAD Symptoms

Journal of Psychopathology and Behavioral Assessment ◽

10.1007/s10862-021-09899-8 ◽

2021 ◽

Author(s):

Laurel D. Sarfan ◽

Joshua C. Magee ◽

Elise M. Clerkin

Keyword(s):

Experiential Avoidance ◽

Change Score ◽

Avoidance Task ◽

Symptom Change ◽

Empirically Supported ◽

Task Training ◽

Clinical Questions ◽

Pilot Intervention ◽

Future Work

AbstractWidely-used, empirically-supported treatments focus on reducing experiential avoidance (EA) as a mechanism of social anxiety disorder (SAD) symptom change. However, little is known about how EA and SAD symptoms bidirectionally interrelate from session to session, or throughout the course of an intervention—a gap that raises significant theoretical and clinical questions about the mechanistic role of EA. Participants (N = 78) with elevated EA and SAD symptoms completed a 3-session pilot intervention (Approach-Avoidance Task training plus psychoeducation) designed to target EA. Bivariate latent change score modeling was then used to map the bidirectional, temporal interrelationships between EA and SAD symptoms from session to session. Analyses accounted for the overall trajectory of change in both variables (i.e., EA and SAD) and both variables’ preceding measurement. Findings suggested that changes in SAD symptoms preceded and predicted changes in EA from session to session. Contrary to hypotheses, this effect was not bidirectional, as changes in EA did not precede and predict changes in SAD symptoms from session to session. The use of a relatively small analogue sample limit the external validity of the present findings. Nevertheless, these novel findings advance our understanding of the dynamic interrelationships between EA and SAD symptoms throughout treatment. Moreover, given that many leading treatments target EA, this study highlights a need for future work to continue evaluating whether EA is indeed a mechanism of SAD symptom change.

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Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

Health Research Policy and Systems ◽

10.1186/s12961-020-00628-3 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Samantha Chakraborty ◽

Bianca Brijnath ◽

Jacinta Dermentzis ◽

Danielle Mazza

Keyword(s):

Qualitative Research ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Best Practice ◽

International Guideline ◽

Novel Approach ◽

Clinical Questions ◽

Key Questions

Abstract Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

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