...Suboptimal images, Patient size and body habitus, incorrect interpretations by physicians and incomplete visualization of the cervical spine from the skull base to T1. Some studies have also stated that NEXUS and CCR are inadequate and cervical spine fractures cannot be excluded without CT. CT imaging is the preferred method due to its high accuracy, speed, and ability to reconstruct images in the coronal...
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...patients with hip fracture Critical Appraisal In this quantitative research article, the authors have dealt with one of the most common clinical problem i.e. clamping of urinary catheter after hip surgery. Hip surgery is very common among the people of old age group especially above 75 years. Further, older women are more susceptible to hip fracture and commonly undergo hip injury (Johansson & Christensson, 2010). Bladder catheterization is a common clinical practice in surgeries. It helpful in monitoring urine output in patients. However, it is also associated with one of the major clinical problems, i.e. operative urinary retention (POUR). It can be defined as the inability of a patient to pass urine in spite of full bladder (Baldini, Bagry, Aprikian, & Carli, 2009). It is has been reported that patient of hip surgery are at higher risk of urinary retention (Balderi & Carli, 2010; Johansson & Christensson, 2010; Singh et al., 2010). In the case of hip replacement the incidence of POUR has been reported to be between 12- 84%. Similarly, in case of hip fracture the prevalence of POUR is 18% to 56% (Borghi et al., 2004; Oishi et al., 1995). The most effective intervention reported till date for reducing the risk of urinary retention is clamping of urinary catheter. The main objective of this paper was to investigate the efficacy of clamping of urinary catheter through randomized controlled trial in patients undergone hip surgery for fracture. Title: The title...
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...weakness increases the risk of occurrence of bone fracture. It is the most common reason for a bone fracture amongst the elderly people. Bones that commonly break are the vertebrae , the forearm bones, and the hip. Until a fracture occurs there are no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to perform normal activities may occur following a broken bone (Golob et al.,2015). Vertebral fractures are the most common osteoporotic fractures and they are associated with a less quality of life and higher long term mortality in patients (Moroni et al.,2009). The occurrence of one vertebral fracture...
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...Title Page : Name : Cherilyn Herbert Student Number : 13200152 Title of Article critique : Calcium plus Vitamin D Supplementation and the Risk of Fractures Authors : Title of Journal : The New England Journal of Medicine Volume : 354 Issue : 7 Year : 2006 Pages : 669-683 Literature Review There have been various studies performed from 1990-2006 of the effects of calcium plus vitamin D supplemental therapies on fractures. A 2 year study was conducted from February 1st 1999 to March 31st 2002 5292 participants were recruited across 21 hospitals in the UK and randomly allocated to four equal groups receiving 800 IU vitamin D3,1000mg calcium, vitamin D3 (8000 IU) combined with calcium (1000mg), or a placebo. Data was collected by postal questionnaire every 4 months with dietary intake of calcium and vitamin D monitored along with sun exposure. Time interval for follow up was between 24 and 62 months. There was difficulty with compliance concerning the allocated tablets as most patients were above the age of 70 limiting cognitive function as well as gastrointestinal complaints. This study measured dietary intake and sun exposure however participants above the age of 70 have a higher incidence of fractures form falls. Participants receiving supplemental therapy of intake of more than 200 IU vitamin D or more than 500 mg calcium supplements in the past 5 years were excluded. (Grant A.M., Anderson F.H., Avenell A.,Campbell M.K, Cooper...
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...A. Identify a current nursing practice within your healthcare setting that requires change. DEVELOPING OR CREATING AN INDEX TO MINIMIZE RISKS OFPRESSURE SORE 1. Describe the current nursing practice. An instrument specifically designed to aid health care workers evaluate the dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities...
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...Standardization of Nursing Protocol for Cardiac Arterial Bypass Patients Abstract Evidence-Based Practice (EBP) is an important factor in determining medical courses of action. Nurses have long used tradition rather than evidence in making decisions about beside care; to convince them to switch practice, it is useful to draw a comparison between the efficacy of these disparate routes. Our study designed a research question based on the PICOT model for the cardiac floors and designed procedures using the Kotter and Cohen’s Model of Change. In order to study the effect discussed in our PICOT question, a web search was conducted and the quality of each pertinent study reviewed. Introduction In the nursing staff of an adult Cardiac Surgical Care unit, how does the buy-in from the staff for Evidence-Based Practice (EBP) changes in a new Coronary Arterial Bypass Graft (CABG) pathway affect the decreases in infection rate among this patient population when compared to the old way of delivering patient care through nursing tradition in a six month time frame? The formation of a guideline for practice in nursing is not a new occurrence; books and manuals have been a reality for many years. However, in the past these resources lacked the evidence for standards of care, which traditionally have been based on professional consensus and tradition. The Joint Commission has recognized processes that can be measured regarding patient outcomes and care in order to meet standards for Medicare...
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...INTRODUCTION The antibacterial capsules are specifically designed to treat bacterial infections. That was literally means “against life”. On the other words, any oral dosage form that is capable to treat a disease caused by bacteria and microorganisms. Most instances. The antibacterial capsules they are ideally to be the drug of choice used for treating a specific bacterial infection. Such drug like penicillin are among the most widely effective anti-bacterial agent and also the least toxic drugs known that is in a form of oral route of administration in a capsule form. The Discovery of antibiotic and 1st antibacterial substances was in 1929 by Sir Alexander Fleming in which he discovers and describes the properties of antibiotic, penicillin. As he observed that the Bacterium Staphylococcus aureus was destroyed by the mold Penicillium notatum wherein it became more significant and widely used for treating soldiers with open wounds during World War II. Curing or treating battlefield wound infections and pneumonia. Today, the antibacterial capsules are routinely prescribed and the simple cure they provide for so many infectious diseases is often taken for granted. Unfortunately, the misuse of these life-saving medication is now becoming more occurring in the Philippine country side, other people might tend to use and prefer automatically antibacterial agents to treat any form of wounds & diseases as a medication for better relief while others also attempt to but a medicine...
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...Running Title: Acute posterior sternoclavicular fracture-dislocation in a 10-year-old boy Authors: Joseph Y. Choi, MD, PhD, Devin P. McFadden, MD, Vipul N. Nanavati, MD Corresponding Author: Francis G. O’Connor, MD Introduction A 10-year-old male was referred to the office after falling onto his left shoulder while playing football. At presentation, he denied any numbness, tingling or loss of sensation of his left upper extremity. Examination of his shoulder girdles revealed an internally rotated left shoulder and shortened clavicular distance. He did have a visible deformation of his left clavicle when compared to the contralateral, uninjured side and had excruciating pain to palpation of the clavicular and sternoclavicular area. The patient had full flexion and extension at the elbow. Shoulder deltoid was intact as were internal and external rotation of his shoulder. Furthermore, the patient denied being short of breath, feeling dizzy, or with difficulty swallowing. Radiographs of the left clavicle and sternoclavicular joint (SCJ) at the initial visit were remarkable for a posterior dislocation of the clavicle. A magnetic resonance imaging (MRI) study of the left clavicle and SCJ revealed that it was posteriorly displaced and edema was present at the fracture site. The physeal attachment to the manubrium was intact. Furthermore, the anterior portion of the clavicle was abutting the brachiocephalic and left subclavian vein (Figure 1). ...
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...Problems in Health Care University of Phoenix HCS/465 Shannon S. Smalls Loleater Casey-Evans The purpose of the paper is to show how to develop and understand methodology of the research process when pertaining to manage health care. The process consists of retrieving a peer-reviewed article and applying the research methodology to the article selected. The article selected for the research methodology was Managing Aging Patients written by Robert D’Ambrosia, Jennifer Kilpatrick, and Lene Juel Rasmussen written June 2003. Based on the information in the article will help determine the methods of defining the problem, the purpose of the study, research questions, hypothesis, study variables, conceptual model, the review of related literature and the study design of the selected article. Define the Problem The problem in this scenario is the need to be able to manage and being equipped with the up and coming baby boomers. It has been predicted that 20% of the population in US will be aged 65 years by 2030 it was predicted few years ago because of up and coming baby boomers. We are all aware that the aging Baby Boomer population and with increased life expectancy and more active lifestyles, then in the past generation is beginning and will continue to place a huge demand on medical resources, predominantly from the orthopedic doctors. There will be a quadruple need of orthopedic surgeons than before because of high risk and demand of patients. A lot of baby boomers...
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... 3. To prevent the delay of the diagnosis of inflammatory back pain (IBP) to avoid the long term disabilities. 2. DEFINITION Low back pain (LBP) is defined as pain, muscle tension or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain. Classification of LBP as acute or chronic is a useful aid for prognosis to guide management. It is classified as acute (less than 6 weeks), sub-acute (6–12 weeks), and chronic (more than 12 weeks). Table 1 shows some important definitions for some terminologies used in dealing with patients with LBP. (See Table 1) 3. PREVALENCE LBP is a major problem throughout the world and that it is most prevalent among females and persons ages 40–80 years. Literature shows that there has been an increase in the reported lifetime prevalence of LBP to become as high as 84%, and the in prevalence of chronic LBP which reached 23%, with 11–12% of the population progressing to a disability. 4. DIFFERENTIAL DIAGNOSIS As back pain is a very common symptom it could be due to many causes, both specific and non-specific as table 2 below shows. However, mechanical low back pain represents 97% of the causes. (See Table 2) 5. APPROACH TO DIAGNOSIS A focused history and physical examination are essential in evaluating patients presenting with LBP to assess them for serious symptoms of neurologic compromise, inflammatory, or medical conditions. Most of the patients can be evaluated by history and physical examination...
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...the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry's newly released Aging at Home Strategy.After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person's transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series.AGING IN THE COMMUNITY: Summary of Evidence-Based AnalysesPrevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based AnalysisBehavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based AnalysisCaregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based AnalysisSocial Isolation in Community-Dwelling Seniors: An Evidence-Based AnalysisThe Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and...
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...(2010). Report on the findings of the oral health component of the Canadian Health Measures Survey, 2007-2009. Ottawa: Minister of Health. McDonagh, M., Whiting, P., Wilson, P., Sutton, A., Chestnutt, I., Cooper, J., et al. (2000). Systematic review of water fluoridation. BMJ. 321(7265):855-9. McLaren, L. & McIntyre, Lynn. (2011). Drinking water fluoridation in Canada: Review and synthesis of published literature. University of Calgary Department of Community Health Sciences. Retrieved from http://www.albertahealthservices.ca/poph/hi-poph-surv-phids-drinking-water-fluoridation.pdf Rabb-Waytowich, D. (2009). Water fluoridation in Canada: past and present. Journal of the Canadian Dental Association, 75(6). Retrieved from https://www.cda-adc.ca/jcda/vol-75/issue-6/451.pdf Stoneman, J. (2014). Community water fluoridation in Canada: Trends, benefits, and risks. S.l.: National Collaborating Centre for Environmental Health. Taylor, G. & Taylor, J. (2016). Position Statement on Community Water Fluoridation. Government of Canada. Retrieved from https://www.canada.ca/e...
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...Luis Ayala Associate Professor of Petroleum and Natural Gas Engineering Associate Department Head for Graduate Education *Signatures are on file in the Graduate School ii ABSTRACT Three investigations of pore-scale single-phase and multiphase flow in fractured porous media and mixed-wet porous media are presented here. With an emphasis on validating and utilizing lattice Boltzmann models in conjunction with x-ray computed microtomography. The objective of the first study is to investigate fracture flow characteristics at the pore-scale, and evaluate the influence of the adjacent permeable matrix on the fracture’s permeability. We use X-ray computed microtomography to produce three-dimensional images of a fracture in a permeable medium. These images are processed and directly translated into lattices for single-phase lattice Boltzmann simulations. Three flow simulations are presented for the imaged volume, a simulation of the pore space, the fracture alone and the matrix...
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...There has been multiple studies over the years in the relationships between the staffinglevels in nursing homes and quality of care measures. Finding the best evidence for staffinglevels on the quality of care has become more and more difficult. In the research article“Systematic Review of Studies of Staffing and Quality in Nursing homes,” the results of thereview are based to three major categories, Staffing measures, Quality measures, and RiskAdjustment or Control Measures. Staffing measures are different nurse staffing calculations usedin the literature and range from numbers of staff per resident to staff turnover rates. Qualitymeasures indicate a measurement for quality care and are classified as either resident outcomesor facility outcomes....
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...Guidelines for the Use of Platelet Rich Plasma The International Cellular Medical Society Presented by DRAFT Version 1.0 Committee Members Kim Harmon, MD Ron Hanson, MD Jay Bowen, MD Scott Greenberg, MD Ed Magaziner, MD James Vandenbosch David Harshfield, MD Brian Shiple, MD David Audley The International Cellular Medical Society (ICMS) asserts that a need exists to create standards for platelet rich plasma (PRP) protocols, preparations, techniques and tracking. We believe that physicianled organizations will serve the needs and interests of both patients and physicians toward achieving the best outcomes. In order to advance PRP in particular (and autologous cellular medicine therapies in general), we have developed these guidelines to assist physicians in performing safe therapies, promote patient education, encourage robust clinical research and begin to define the scope and anticipated effects of these procedures. Platelet Rich Plasma: Historical Perspective The application of PRP has been documented in many fields. First promoted by M. Ferrari in 1987 (1) as an autologous transfusion component after an open heart operation to avoid homologous blood product transfusion, there are now over 5200 entries in the NCBI for PRP ranging in fields from orthopedics, sports medicine, dentistry, otolaryngology, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic and maxillofacial surgery. The initial popularity of PRP grew from its promise as a safe...
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