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Gestalt pain

Shawn M Varney, Crystal A Perez, Allyson A Araña, Katherine R Carey, Victoria J Ganem, Lee A Zarzabal, Rosemarie G Ramos, Vikhyat S Bebarta
Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients' opioid misuse risk...
March 3, 2018: Internal and Emergency Medicine
Vijay Kata, Matthew B Novitch, Mark R Jones, Best O Anyama, Erik M Helander, Alan D Kaye
PURPOSE OF REVIEW: The primary cause of overdose death in the United States is related to pharmaceutical opioids. A few particular populations that struggle with adverse outcomes related to opioid abuse are those in palliative care, those with chronic pain, and those receiving pain treatments secondary to cancer or chemotherapy. RECENT FINDINGS: There have been massive efforts to decrease the use of opioid abuse in patient care in a gestalt manner, but palliative care provides unique challenges in applying these reduction tactics used by other specialties...
February 19, 2018: Current Opinion in Supportive and Palliative Care
Champica K Bodinayake, L Gayani Tillekeratne, Ajith Nagahawatte, Vasantha Devasiri, Wasantha Kodikara Arachchi, John J Strouse, October M Sessions, Ruvini Kurukulasooriya, Anna Uehara, Shiqin Howe, Xin Mei Ong, Sharon Tan, Angelia Chow, Praveen Tummalapalli, Aruna D De Silva, Truls Østbye, Christopher W Woods, Duane J Gubler, Megan E Reller
BACKGROUND: Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. METHODOLOGY/PRINCIPAL FINDINGS: The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians' subjective clinical diagnosis (gestalt clinical impression) in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness...
February 9, 2018: PLoS Neglected Tropical Diseases
Pamela Douglas, Donna Geddes
BACKGROUND: breastfeeding optimises health outcomes for both mothers and infants. Although most women want to breastfeed, they report commencing infant formula because of nipple pain, unsettled infant behaviour, and infant growth concerns. To date, existing approaches to fit and hold ('latch and positioning') have been demonstrated not to help breastfeeding outcomes, and women report widespread dissatisfaction with the quality of support and conflicting advice they receive. Breast and nipple pain, difficulty with latching and sucking, fussing at the breast, back-arching, marathon feeds, excessively frequent feeds, poor weight gain, breast refusal, and crying due to poor satiety often signal suboptimal positional instability and impaired milk transfer, but may be misdiagnosed as medical conditions...
March 2018: Midwifery
Chin Pang Wong, Chun Tat Lui, Jonathan Gabriel Sung, Ho Lam, Hin Tat Fung, Ping Wa Yam
BACKGROUND: Assessment of patients with chest pain is a regular challenge in the emergency department (ED). Recent guidelines recommended quantitative assessment of ischemic risk by means of risk scores. OBJECTIVE: Our aim was to assess the performance of Thrombosis in Myocardial Infarction (TIMI); Global Registry of Acute Coronary Events (GRACE); history, electrocardiogram, age, risk factors, and troponin (HEART) scores; and the North America Chest Pain Rule (NACPR) without components of clinical gestalt in predicting 30-day major adverse cardiac events (MACE)...
February 2018: Journal of Emergency Medicine
Lorin R Browne, Hamilton Schwartz, Fahd A Ahmad, Michael Wallendorf, Nathan Kuppermann, E Brooke Lerner, Julie C Leonard
BACKGROUND: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions. OBJECTIVES: The objective was to determine the interobserver agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma...
December 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Andreas Venhorst, Dominic Micklewright, Timothy D Noakes
The Central Governor Model (CGM) ignited a paradigm shift from concepts of catastrophic failure towards central regulation of exercise performance. However, the CGM has focused on the central integration of afferent feedback in homeostatic control. Accordingly, it neglected the important role of volitional self-regulatory control and the integration of affective components inherently attached to all physiological cues. Another limitation is the large reliance on the Gestalt phenomenon of perceived exertion...
August 23, 2017: British Journal of Sports Medicine
Jonathan Chan, Ismail Sari, David Salonen, Mark S Silverberg, Nigil Haroon, Robert D Inman
OBJECTIVES: There is an increasing emphasis on early identification and treatment of ankylosing spondylitis (AS) of which the hallmark is sacroiliitis. Patients with inflammatory bowel disease (IBD) are at increased risk of AS and often receive CT scans of their abdomen affording clinicians the opportunity to determine the presence of sacroiliitis. Previous studies using CT have relied only on radiologist's gestalt or a non-validated adaptation of the mNY criteria. Our aim is to assess the prevalence of sacroiliitis in IBD using a validated screening tool and to determine how frequently these patients are referred for rheumatologic evaluation...
July 21, 2017: Arthritis Care & Research
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...
August 2017: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
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
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...
September 2017: American Journal of Emergency Medicine
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
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...
September 2017: American Journal of Emergency Medicine
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
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
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
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
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
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
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
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