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https://www.readbyqxmd.com/read/28614671/gestalt-breastfeeding-helping-mothers-and-infants-optimize-positional-stability-and-intraoral-breast-tissue-volume-for-effective-pain-free-milk-transfer
#1
Pamela Douglas, Renee Keogh
In the past decade, biological nurturing and activation of maternal and infant instincts after birth have constituted a major advance in clinical breastfeeding support. Yet, physiologic breastfeeding initiation is not enough to ensure ongoing pain-free and effective breastfeeding for many pairs. Current interventions, including "hands-off" mammalian approaches, do not improve breastfeeding outcomes, including in randomized controlled trials. Back-arching, difficulty latching or staying on the breast, and fussing at the breast are common signs of infant positional instability during breastfeeding...
June 1, 2017: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
https://www.readbyqxmd.com/read/28611898/utility-of-the-history-and-physical-examination-in-the-detection-of-acute-coronary-syndromes-in-emergency-department-patients
#2
REVIEW
Zachary Dw Dezman, Amal Mattu, Richard Body
Chest pain accounts for approximately 6% of all emergency department (ED) visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS). This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28554588/pathologic-c-spine-fracture-with-low-risk-mechanism-and-normal-physical-exam
#3
Andrew Hunter, Jolion McGreevy, Judith Linden
Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings...
May 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28400920/accuracy-of-gestalt-perception-of-acute-chest-pain-in-predicting-coronary-artery-disease
#4
Cláudio Marcelo Bittencourt das Virgens, Laudenor Lemos, Márcia Noya-Rabelo, Manuela Campelo Carvalhal, Antônio Maurício Dos Santos Cerqueira Junior, Fernanda Oliveira de Andrade Lopes, Nicole Cruz de Sá, Jéssica Gonzalez Suerdieck, Thiago Menezes Barbosa de Souza, Vitor Calixto de Almeida Correia, Gabriella Sant'Ana Sodré, André Barcelos da Silva, Felipe Kalil Beirão Alexandre, Felipe Rodrigues Marques Ferreira, Luís Cláudio Lemos Correia
AIM: To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain. METHODS: We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically...
March 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28363616/an-end-user-s-guide-to-the-heart-score-and-pathway
#5
Brit Long, Joshua Oliver, Matthew Streitz, Alex Koyfman
BACKGROUND: Chest pain accounts for a significant percentage of emergency department (ED) presentations. The HEART score and pathway have demonstrated an ability to appropriately risk stratify and discharge from the ED a significant proportion of patients. OBJECTIVE: This review evaluates vital components of the HEART score and pathway, while discussing important considerations for current and future use. DISCUSSION: Chest pain is a common ED presentation, and several conditions associated with chest pain result in patient morbidity and mortality...
March 21, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27294087/the-clinics-of-acute-coronary-syndrome
#6
REVIEW
Gianfranco Cervellin, Gianni Rastelli
Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt...
May 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27150104/pilot-study-of-the-importance-of-factors-affecting-emergency-department-opioid-analgesic-prescribing-decisions
#7
Adam C Pomerleau, Justin D Schrager, Brent W Morgan
INTRODUCTION: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers. METHODS: This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale...
September 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/26935714/prospective-evaluation-of-the-ability-of-clinical-scoring-systems-and-physician-determined-likelihood-of-appendicitis-to-obviate-the-need-for-ct
#8
Sean K Golden, John B Harringa, Perry J Pickhardt, Alexander Ebinger, James E Svenson, Ying-Qi Zhao, Zhanhai Li, Ryan P Westergaard, William J Ehlenbach, Michael D Repplinger
OBJECTIVE: To determine whether clinical scoring systems or physician gestalt can obviate the need for computed tomography (CT) in patients with possible appendicitis. METHODS: Prospective, observational study of patients with abdominal pain at an academic emergency department (ED) from February 2012 to February 2014. Patients over 11 years old who had a CT ordered for possible appendicitis were eligible. All parameters needed to calculate the scores were recorded on standardised forms prior to CT...
July 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/25992314/diagnostic-values-of-chest-pain-history-ecg-troponin-and-clinical-gestalt-in-patients-with-chest-pain-and-potential-acute-coronary-syndrome-assessed-in-the-emergency-department
#9
Arash Mokhtari, Eric Dryver, Martin Söderholm, Ulf Ekelund
In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included...
2015: SpringerPlus
https://www.readbyqxmd.com/read/25662380/use-of-an-accelerated-diagnostic-pathway-allows-rapid-and-safe-discharge-of-70-of-chest-pain-patients-from-the-emergency-department
#10
Andrew R Munro, Tom Jerram, Tom Morton, Suzanne Hamilton
INTRODUCTION: The majority of patients who present to the Emergency Department (ED) with chest pain, do not have Acute Coronary Syndrome (ACS). Rapid, safe discharge home for this large group is hampered by clinical uncertainty. A pragmatic Accelerated Diagnostic Pathway (ADP) used in our ED achieves this goal. AiIM: To demonstrate the safety and utility of a locally developed ADP. The primary outcome for patients who were identified as non-high risk by our ADP was death or acute myocardial infarction (AMI) at 30 days...
January 30, 2015: New Zealand Medical Journal
https://www.readbyqxmd.com/read/25217099/heart-score-and-clinical-gestalt-have-similar-diagnostic-accuracy-for-diagnosing-acs-in-an-unselected-population-of-patients-with-chest-pain-presenting-in-the-ed
#11
Anniek Visser, Albert Wolthuis, Rob Breedveld, Ewoud ter Avest
BACKGROUND: Acute coronary syndrome (ACS) can be a diagnostic challenge in the emergency department (ED). Recently, the HEART score was developed, a simple bedside scoring system that quantifies risk of ischaemic events in patients with undifferentiated chest pain presenting in the ED. OBJECTIVE: In this prospective cohort study, we compared the diagnostic accuracy of HEART score and clinical gestalt (clinical judgement) for diagnosing ACS in an unselected population of patients with chest pain presenting to the ED...
August 2015: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/25163735/are-patient-self-report-questionnaires-as-scientific-as-biomarkers-in-treat-to-target-and-prognosis-in-rheumatoid-arthritis
#12
Theodore Pincus, Isabel Castrejón
Information from patients traditionally is regarded as "subjective," in contrast to "objective," "scientific" laboratory data. However, patient questionnaire scores for physical function are more significant to predict severe outcomes of rheumatoid arthritis (RA), such as work disability and mortality, than radiographs or laboratory tests. Furthermore, the 3 RA Core Data Set patient self-report measures of physical function, pain, and patient global estimate are as effective as radiographs or laboratory tests to distinguish active from control treatments in clinical trials...
2015: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/25022275/decreased-facial-expression-variability-in-patients-with-serious-cardiopulmonary-disease-in-the-emergency-care-setting
#13
Jeffrey A Kline, Dawn Neumann, Melissa A Haug, David J Kammer, Virginia A Krabill
BACKGROUND AND OBJECTIVE: The hypothesis of the present work derives from clinical experience that suggests that patients who are more ill have less facial expression variability in response to emotional cues. METHODS: Prospective study of diagnostic accuracy from a convenience sample of adult patients with dyspnoea and chest pain in an emergency department. Patients viewed three stimulus slides on a laptop computer that were intended to evoke a change in facial affect...
January 2015: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/25016388/can-emergency-physicians-rule-in-and-rule-out-acute-myocardial-infarction-with-clinical-judgement
#14
Richard Body, Gary Cook, Gillian Burrows, Simon Carley, Philip S Lewis
OBJECTIVE: To determine the diagnostic accuracy of emergency physician gestalt in emergency department (ED) patients with suspected cardiac chest pain, both alone and in combination with initial troponin level and ECG findings. METHODS: We prospectively included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded their 'gestalt' at the time of presentation using a five-point Likert scale, blinded to outcome. Troponin T and high-sensitivity troponin T (hs-cTnT; both Roche Diagnostics Elecsys) levels were measured in admission blood samples...
November 2014: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/24907640/effects-of-feldenkrais-method-on-chronic-neck-scapular-pain-in-people-with-visual-impairment-a-randomized-controlled-trial-with-one-year-follow-up
#15
RANDOMIZED CONTROLLED TRIAL
Lars-Olov Lundqvist, Christina Zetterlund, Hans O Richter
OBJECTIVE: To determine whether the Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment. DESIGN: Randomized controlled trial with an untreated control group. SETTING: Low vision center. PARTICIPANTS: Patients (N=61) with visual impairment (mean, 53.3 y) and nonspecific chronic (mean, 23.8 y) neck/scapular pain. INTERVENTIONS: Participants were randomly assigned to the Feldenkrais method group (n=30) or untreated control group (n=31)...
September 2014: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/24239339/value-and-evidence-based-medicine-a-call-for-shared-responsibility
#16
EDITORIAL
Judd E Hollander
No abstract text is available yet for this article.
March 2014: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/24070658/clinician-gestalt-estimate-of-pretest-probability-for-acute-coronary-syndrome-and-pulmonary-embolism-in-patients-with-chest-pain-and-dyspnea
#17
MULTICENTER STUDY
Jeffrey A Kline, William B Stubblefield
STUDY OBJECTIVE: Pretest probability helps guide diagnostic testing for patients with suspected acute coronary syndrome and pulmonary embolism. Pretest probability derived from the clinician's unstructured gestalt estimate is easier and more readily available than methods that require computation. We compare the diagnostic accuracy of physician gestalt estimate for the pretest probability of acute coronary syndrome and pulmonary embolism with a validated, computerized method. METHODS: This was a secondary analysis of a prospectively collected, multicenter study...
March 2014: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/23931425/associations-between-presence-of-relevant-information-in-referrals-to-radiology-and-prevalence-rates-in-patients-with-suspected-pulmonary-embolism
#18
Charlotta Hedner, Pia C Sundgren, Aine Marie Kelly
RATIONALE AND OBJECTIVES: The purpose of this study was to assess if the presence of information including the pretest probability (Wells score), other known risk factors, and symptoms given on referrals for computed tomography (CT) pulmonary angiography correlated with prevalence rates for pulmonary embolism (PE). Also, to evaluate for differences between a university and a regional hospital setting regarding patient characteristics, amount of relevant information provided on referrals, and prevalence rates for pulmonary embolism...
September 2013: Academic Radiology
https://www.readbyqxmd.com/read/23669797/mdhaq-rapid3-to-recognize-improvement-over-2-months-in-usual-care-of-patients-with-osteoarthritis-systemic-lupus-erythematosus-spondyloarthropathy-and-gout-as-well-as-rheumatoid-arthritis
#19
Isabel Castrejón, Martin J Bergman, Theodore Pincus
OBJECTIVE: To analyze whether MDHAQ (Multidimensional Health Assessment Questionnaire) scores for physical function (FN), pain, Patient Global Estimate (PATGL), and RAPID3 (Routine Assessment of Patient Index Data, a composite of these 3 measures) document improvement in patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, similarly to rheumatoid arthritis. METHODS: In a solo rheumatology practice, every patient completes an MDHAQ/RAPID3 and is assigned a Physician Global Estimate (DOCGL) at every visit...
June 2013: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/23351571/sixteen-year-old-athlete-with-chest-pain-and-shortness-of-breath-due-to-pulmonary-emboli
#20
Ann H Tsung, Justin B Williams, Allen C Whitford
BACKGROUND: Pulmonary embolism (PE) is a life-threatening condition that is extremely uncommon in the healthy pediatric population. OBJECTIVE: Because pediatric PE is rarely on the Emergency Physician's differential diagnosis, with this case we hope to increase the clinical suspicion for PE in children who present to the Emergency Department (ED). CASE REPORT: This is a case of bilateral pulmonary embolism in a 16-year-old basketball player whose only risk factor is oral contraceptive medication...
May 2013: Journal of Emergency Medicine
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