This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
This document summarizes two cases of radiation therapy accidents and their consequences. Case 1 involved a miscalculation of treatment time in Costa Rica in 1996 that led to an overexposure and the deaths of 17 patients. Case 2 occurred in Panama in 2000 when a treatment planning system incorrectly calculated treatment times after a change in data entry, overexposing 28 patients and killing 5. Accidental underexposure can lead to tumor mismanagement while overexposure causes early complications like necrosis and late complications in slowly-dividing tissues. Establishing quality assurance programs, training, and safety protocols can help prevent such accidents.
This thesis aimed to optimize an image-guided radiation therapy (IGRT) protocol for advanced stage lung cancer. Deformable image registration was used to quantify target coverage throughout treatment and evaluate the effects of various IGRT parameters. The analysis revealed that the clinical 10 mm planning target volume (PTV) margin could be safely reduced by at least 2 mm in each direction. Simulations were performed to investigate the influence of matching strategies and rotational tolerance levels on target and organ-at-risk coverage. Appropriate combinations of IGRT parameters resulted in improved geometrical accuracy, while inappropriate combinations led to sub-optimal coverage. Various optimized IGRT protocol recommendations were provided based on the results.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
La costante tentazione dei trattamenti ipofrazionati: breve cronistoria dei modelli biologici e degli effetti clinici
This document discusses how radiation oncology centers can thrive in the modern era through advances like surface guided radiation therapy (SGRT). SGRT allows for accurate initial patient positioning, continuous monitoring of intrafraction motion, and automatic beam holds if motion exceeds thresholds. It can help centers by reducing costs through more efficient treatments, improving quality outcomes by mitigating adverse events, and enhancing patient experience through reduced toxicity and more comfortable treatments without skin marks. SGRT fits into a center's needs by supporting evidence-based hypofractionated treatments, total cost of care, quality outcomes, patient experience, and shared decision making.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
This document summarizes two cases of radiation therapy accidents and their consequences. Case 1 involved a miscalculation of treatment time in Costa Rica in 1996 that led to an overexposure and the deaths of 17 patients. Case 2 occurred in Panama in 2000 when a treatment planning system incorrectly calculated treatment times after a change in data entry, overexposing 28 patients and killing 5. Accidental underexposure can lead to tumor mismanagement while overexposure causes early complications like necrosis and late complications in slowly-dividing tissues. Establishing quality assurance programs, training, and safety protocols can help prevent such accidents.
This thesis aimed to optimize an image-guided radiation therapy (IGRT) protocol for advanced stage lung cancer. Deformable image registration was used to quantify target coverage throughout treatment and evaluate the effects of various IGRT parameters. The analysis revealed that the clinical 10 mm planning target volume (PTV) margin could be safely reduced by at least 2 mm in each direction. Simulations were performed to investigate the influence of matching strategies and rotational tolerance levels on target and organ-at-risk coverage. Appropriate combinations of IGRT parameters resulted in improved geometrical accuracy, while inappropriate combinations led to sub-optimal coverage. Various optimized IGRT protocol recommendations were provided based on the results.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
La costante tentazione dei trattamenti ipofrazionati: breve cronistoria dei modelli biologici e degli effetti clinici
This document discusses how radiation oncology centers can thrive in the modern era through advances like surface guided radiation therapy (SGRT). SGRT allows for accurate initial patient positioning, continuous monitoring of intrafraction motion, and automatic beam holds if motion exceeds thresholds. It can help centers by reducing costs through more efficient treatments, improving quality outcomes by mitigating adverse events, and enhancing patient experience through reduced toxicity and more comfortable treatments without skin marks. SGRT fits into a center's needs by supporting evidence-based hypofractionated treatments, total cost of care, quality outcomes, patient experience, and shared decision making.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
This document discusses radiation-induced dysphagia in head and neck cancers and strategies for prevention. It outlines the anatomy and physiology of swallowing and describes how radiation can damage swallowing structures. Studies are reviewed that aim to reduce dose to the dysphagia-associated structures (DARS) like the pharyngeal constrictors through improved radiation techniques like IMRT. While sparing these structures may prevent late dysphagia, coverage of the tumor (PTV) must remain the priority. Ongoing research seeks to further delineate dose constraints for the DARS and validate rehabilitation exercises to potentially decrease dysphagia. The overall goal is to minimize radiation doses to the DARS without compromising tumor control
Robotic Radiosurgery Treatment for Eye Tumours duttaradio
Robotic radiosurgery treatment is an excellent treatment option for eye tumours. This presentation explains in detail the application of CyberKinfe as a treatment option.
Radioiodine therapy uses radioactive iodine to treat hyperthyroidism and thyroid cancer. Iodine concentrates in the thyroid gland where it delivers radiation to ablate residual or cancerous thyroid tissue. For therapy, patients prepare with a low iodine diet and medication withdrawal before receiving doses ranging from 5-200 mCi orally. Strict radiation safety precautions are required during and after treatment due to iodine excretion. Whole body imaging with 1-5 mCi I-131 or I-123 sodium iodide is performed 48-72 hours later to identify residual thyroid tissue or cancer metastases and guide further treatment. Sources of error include contamination, stunning from prior I-131 doses, and saliv
12:25 Vano - Decreasing X-ray exposure in CTO proceduresEuro CTO Club
This document discusses decreasing x-ray exposure in complex coronary total occlusion (CTO) procedures. It notes that CTO procedures can result in several grays of radiation exposure to the skin of patients, increasing their risk of radiation injury. It also notes that without proper protection, interventional staff could receive milligrays of exposure per procedure to the lens of their eyes, increasing their risk of radiation-induced cataracts. The document recommends maintaining radiation doses as low as reasonably achievable for both patients and staff by following diagnostic reference levels, avoiding injuries through clinical follow-up of high dose procedures, and using protective equipment to reduce staff occupational exposures.
Current concepts in management of metastatic brain tumourLiew Boon Seng
1) Brain metastases occur in 25% of cancer patients and are most commonly diagnosed from lung cancer, breast cancer, and melanoma. Surgery is the preferred treatment for single, accessible brain metastases while radiosurgery and whole brain radiation therapy are options for multiple metastases.
2) Surgical resection provides the best chance of survival and neurological function for carefully selected patients with single brain metastases. Factors such as the patient's overall health, tumor size and location, and control of the primary cancer help determine treatment.
3) While whole brain radiation can effectively treat multiple brain metastases, it carries risks of neurocognitive side effects. Combined treatment with surgery or radiosurgery followed by whole brain radiation may improve outcomes
Nuclear medicine procedures use small amounts of radioactive materials, called radiopharmaceuticals, to diagnose and treat diseases. The nuclear medicine technologist is responsible for correctly identifying the patient, verifying the physician's order, preparing the patient, administering the radiopharmaceutical, collecting imaging or non-imaging data, ensuring technical quality, presenting results to the physician, and discharging the patient. Common nuclear medicine procedures include bone scans, renal scans, thyroid scans, and cardiac stress tests.
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
NTCP MODELLING OF ACUTE TOXICITY IN CARCINOMA CERVIX TREATED WITH CONCURRENT ...Dr. Rituparna Biswas
1. The study aimed to develop a predictive nomogram and dose constraints for hematological toxicity in cervical cancer patients treated with chemoradiation including IMRT.
2. Thirty-seven patients were treated with IMRT and cisplatin, and bone marrow was re-delineated to include the entire marrow volume.
3. Dose-volume histograms were combined with toxicity data to create a nomogram from which hematological toxicity probabilities can be estimated based on bone marrow dosimetry.
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
This document discusses simulation techniques and tips for pancreatic malignancy radiosurgery. It covers the workflow from planning to delivery and various techniques for motion management including gating, tracking, abdominal compression and breath holds. Imaging protocols including triple phase CT and PET scans are described for target and organ at risk visualization. Steps for patient preparation, positioning, immobilization and counseling are also outlined.
This document provides an overview of CT simulation components and processes. It discusses the key elements of a CT simulator, including the CT scanner components like bore size and image quality, virtual simulation software features like contouring and image display, and other essentials like laser positioning and DICOM connectivity. CT simulation has advanced radiation therapy planning by providing detailed volumetric patient images to design customized treatment plans while reducing dose to healthy tissues.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
This document discusses the role of pulmonologists and thoracic surgeons in lung cancer radiosurgery. It begins by defining radiosurgery and comparing it to conventional radiation therapy. It then outlines potential roles for pulmonologists such as patient identification, fiducial marker placement for tracking tumor motion, and patient follow-up. Thoracic surgeons could also be involved in patient selection for clinical trials comparing radiosurgery to surgery. Both specialties require training to learn techniques like fiducial placement and participate in treatment planning. When trained, pulmonologists and surgeons can be reimbursed for their contributions to lung radiosurgery treatment.
Gaudreault et al-2015-anesthesia_&_analgesiasamirsharshar
The study evaluated the reliability of current perception threshold (CPT) measurements for assessing sensory block in two investigations. In the first study, CPT measurements in healthy volunteers showed good within-day reliability but more variable between-day reliability. In the second study with patients receiving femoral nerve blocks, CPT values significantly increased after local anesthetic administration and paralleled the loss of cold sensation, suggesting CPT can characterize sensory onset of peripheral nerve blocks. The study supports using CPT in future regional anesthesia research.
This document analyzes the rate of normal vs abnormal findings from trauma CT scans performed at AAH over a 4 month period. The study found that 55% of scans were on men under 35, while 8% were on women under 35 and 6.5% were on children. The high percentage of normal findings raises concerns about unnecessary radiation exposure. The document recommends developing trauma CT guidelines to help determine appropriate cases and reduce avoidable scans by 20-40%. It also suggests exploring alternatives like Statscan machines to reduce initial radiation doses.
Radical brachytherapy for early stage external auditory canalKanhu Charan
1) Early stage squamous cell carcinoma of the external ear canal is rare and current treatment options like surgery can result in poor cosmesis or loss of function. 2) Brachytherapy provides a high dose to the target area while sparing surrounding organs but traditional applicators are costly. 3) The author proposes using a simple plastic earbud as a low-cost applicator for brachytherapy of the external ear canal. Dosimetry studies showed the earbud dimensions are comparable to catheter applicators and it can be stabilized using a stethoscope earpiece, providing a reproducible method of brachytherapy.
This document discusses strategies for developing an innovative mobile eye care service business. It outlines plans to create and market products like a mobile eye care unit, spider light device, ambulance equipment holders, and a nasal tube removal tool. It presents a SWOT analysis and discusses marketing strategies to promote the business through various channels. Financial projections in the form of an income statement estimate revenues and profits will steadily increase over five years as the business expands.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
This document discusses radiation-induced dysphagia in head and neck cancers and strategies for prevention. It outlines the anatomy and physiology of swallowing and describes how radiation can damage swallowing structures. Studies are reviewed that aim to reduce dose to the dysphagia-associated structures (DARS) like the pharyngeal constrictors through improved radiation techniques like IMRT. While sparing these structures may prevent late dysphagia, coverage of the tumor (PTV) must remain the priority. Ongoing research seeks to further delineate dose constraints for the DARS and validate rehabilitation exercises to potentially decrease dysphagia. The overall goal is to minimize radiation doses to the DARS without compromising tumor control
Robotic Radiosurgery Treatment for Eye Tumours duttaradio
Robotic radiosurgery treatment is an excellent treatment option for eye tumours. This presentation explains in detail the application of CyberKinfe as a treatment option.
Radioiodine therapy uses radioactive iodine to treat hyperthyroidism and thyroid cancer. Iodine concentrates in the thyroid gland where it delivers radiation to ablate residual or cancerous thyroid tissue. For therapy, patients prepare with a low iodine diet and medication withdrawal before receiving doses ranging from 5-200 mCi orally. Strict radiation safety precautions are required during and after treatment due to iodine excretion. Whole body imaging with 1-5 mCi I-131 or I-123 sodium iodide is performed 48-72 hours later to identify residual thyroid tissue or cancer metastases and guide further treatment. Sources of error include contamination, stunning from prior I-131 doses, and saliv
12:25 Vano - Decreasing X-ray exposure in CTO proceduresEuro CTO Club
This document discusses decreasing x-ray exposure in complex coronary total occlusion (CTO) procedures. It notes that CTO procedures can result in several grays of radiation exposure to the skin of patients, increasing their risk of radiation injury. It also notes that without proper protection, interventional staff could receive milligrays of exposure per procedure to the lens of their eyes, increasing their risk of radiation-induced cataracts. The document recommends maintaining radiation doses as low as reasonably achievable for both patients and staff by following diagnostic reference levels, avoiding injuries through clinical follow-up of high dose procedures, and using protective equipment to reduce staff occupational exposures.
Current concepts in management of metastatic brain tumourLiew Boon Seng
1) Brain metastases occur in 25% of cancer patients and are most commonly diagnosed from lung cancer, breast cancer, and melanoma. Surgery is the preferred treatment for single, accessible brain metastases while radiosurgery and whole brain radiation therapy are options for multiple metastases.
2) Surgical resection provides the best chance of survival and neurological function for carefully selected patients with single brain metastases. Factors such as the patient's overall health, tumor size and location, and control of the primary cancer help determine treatment.
3) While whole brain radiation can effectively treat multiple brain metastases, it carries risks of neurocognitive side effects. Combined treatment with surgery or radiosurgery followed by whole brain radiation may improve outcomes
Nuclear medicine procedures use small amounts of radioactive materials, called radiopharmaceuticals, to diagnose and treat diseases. The nuclear medicine technologist is responsible for correctly identifying the patient, verifying the physician's order, preparing the patient, administering the radiopharmaceutical, collecting imaging or non-imaging data, ensuring technical quality, presenting results to the physician, and discharging the patient. Common nuclear medicine procedures include bone scans, renal scans, thyroid scans, and cardiac stress tests.
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
NTCP MODELLING OF ACUTE TOXICITY IN CARCINOMA CERVIX TREATED WITH CONCURRENT ...Dr. Rituparna Biswas
1. The study aimed to develop a predictive nomogram and dose constraints for hematological toxicity in cervical cancer patients treated with chemoradiation including IMRT.
2. Thirty-seven patients were treated with IMRT and cisplatin, and bone marrow was re-delineated to include the entire marrow volume.
3. Dose-volume histograms were combined with toxicity data to create a nomogram from which hematological toxicity probabilities can be estimated based on bone marrow dosimetry.
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
This document discusses simulation techniques and tips for pancreatic malignancy radiosurgery. It covers the workflow from planning to delivery and various techniques for motion management including gating, tracking, abdominal compression and breath holds. Imaging protocols including triple phase CT and PET scans are described for target and organ at risk visualization. Steps for patient preparation, positioning, immobilization and counseling are also outlined.
This document provides an overview of CT simulation components and processes. It discusses the key elements of a CT simulator, including the CT scanner components like bore size and image quality, virtual simulation software features like contouring and image display, and other essentials like laser positioning and DICOM connectivity. CT simulation has advanced radiation therapy planning by providing detailed volumetric patient images to design customized treatment plans while reducing dose to healthy tissues.
The management of painful bone metastases requires multidisciplinary care, with external beam radiation therapy (EBRT) providing relief that is effective and time efficient.
In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation(EBRT) remains open and will be clarified only with further randomized clinical trials.
This document discusses the role of pulmonologists and thoracic surgeons in lung cancer radiosurgery. It begins by defining radiosurgery and comparing it to conventional radiation therapy. It then outlines potential roles for pulmonologists such as patient identification, fiducial marker placement for tracking tumor motion, and patient follow-up. Thoracic surgeons could also be involved in patient selection for clinical trials comparing radiosurgery to surgery. Both specialties require training to learn techniques like fiducial placement and participate in treatment planning. When trained, pulmonologists and surgeons can be reimbursed for their contributions to lung radiosurgery treatment.
Gaudreault et al-2015-anesthesia_&_analgesiasamirsharshar
The study evaluated the reliability of current perception threshold (CPT) measurements for assessing sensory block in two investigations. In the first study, CPT measurements in healthy volunteers showed good within-day reliability but more variable between-day reliability. In the second study with patients receiving femoral nerve blocks, CPT values significantly increased after local anesthetic administration and paralleled the loss of cold sensation, suggesting CPT can characterize sensory onset of peripheral nerve blocks. The study supports using CPT in future regional anesthesia research.
This document analyzes the rate of normal vs abnormal findings from trauma CT scans performed at AAH over a 4 month period. The study found that 55% of scans were on men under 35, while 8% were on women under 35 and 6.5% were on children. The high percentage of normal findings raises concerns about unnecessary radiation exposure. The document recommends developing trauma CT guidelines to help determine appropriate cases and reduce avoidable scans by 20-40%. It also suggests exploring alternatives like Statscan machines to reduce initial radiation doses.
Radical brachytherapy for early stage external auditory canalKanhu Charan
1) Early stage squamous cell carcinoma of the external ear canal is rare and current treatment options like surgery can result in poor cosmesis or loss of function. 2) Brachytherapy provides a high dose to the target area while sparing surrounding organs but traditional applicators are costly. 3) The author proposes using a simple plastic earbud as a low-cost applicator for brachytherapy of the external ear canal. Dosimetry studies showed the earbud dimensions are comparable to catheter applicators and it can be stabilized using a stethoscope earpiece, providing a reproducible method of brachytherapy.
This document discusses strategies for developing an innovative mobile eye care service business. It outlines plans to create and market products like a mobile eye care unit, spider light device, ambulance equipment holders, and a nasal tube removal tool. It presents a SWOT analysis and discusses marketing strategies to promote the business through various channels. Financial projections in the form of an income statement estimate revenues and profits will steadily increase over five years as the business expands.
The document discusses guidelines for emergency triage in Thailand. It introduces a modified Emergency Severity Index (ESI) triage system with 5 levels to assess patients. The levels are described in a table with corresponding vital sign thresholds for temperature, heart rate, respiratory rate, and oxygen saturation. The system is meant to guide prioritization of care with ESI level 1 being the most urgent and 5 the least. Overall the document provides an overview of Thailand's adopted emergency triage guidelines and modified ESI triage scale to standardized patient assessment in emergency departments.
The document discusses characteristics of an emergency room (ER) and awards given to Chinese nurses. It covers topics like emergency medical services (EMS), triage levels in an ER from 1 to 5, treatments like rapid sequence intubation (RSI), and creating a mass casualty plan and patient evacuation plan. It also mentions tests like PCT that can help determine conditions like ear pain or hypoxia.
This document is a curriculum vitae for a radiographer. It includes personal details like date of birth and nationality. It outlines the applicant's educational background including a diploma in general radiology. Work experience is described at several hospitals over 12 years using various radiology equipment like MRI, CT scans, x-rays, and fluoroscopy. Training courses are listed covering areas like life support, imaging management, computer skills, and English. Duties and responsibilities are provided for areas like CT scanning, MRI, radiation safety, communication, and policy adherence. Languages known and interests are also included.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
User Acceptance Scheermesser Kosow Tampereguestd6b375
This document summarizes the key findings from two case studies on user acceptance of pervasive computing in healthcare. [1] The studies examined factors like perceived usefulness, ease of use, and subjective norms that can facilitate or inhibit acceptance. [2] Across both studies, perceived usefulness and medical benefit were found to be decisive for user acceptance, but usability needed improvement to account for healthcare environments and abilities. [3] Subjective norms around changing roles could also inhibit implementation if social roles or job images felt threatened.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
The document outlines the history and development of Advanced Trauma Life Support (ATLS). It describes the initial assessment process for trauma patients, including the primary and secondary surveys, with a focus on identifying and treating life-threatening injuries immediately. Specific types of injuries are discussed such as head trauma, thoracic trauma, abdominal/pelvic trauma. The goal of ATLS is to provide a standardized approach to trauma care through systematic assessment and simultaneous resuscitation to reduce mortality from traumatic injuries.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
The document provides an overview of the Advanced Trauma Life Support (ATLS) program. It describes how ATLS was developed in the 1970s by Dr. James Styner after a plane crash left him realizing the need for standardized trauma care. The summary describes the goals of ATLS to provide a systematic approach to trauma resuscitation and management. It also summarizes the primary and secondary survey process in ATLS which focuses on rapid assessment and stabilization of airway, breathing, circulation, disability and exposure followed by a full head-to-toe examination.
Yes, we're ready to go on bypass.
Perfusionist: Yes, I'm ready for bypass.
Surgeon: Okay, let's go on bypass.
Hospital B
Surgeon: Heparin please.
Anaesthetist: Heparin going in now. *administers heparin*
Perfusionist: Heparin level is therapeutic, I'm ready for bypass.
Surgeon: Okay, let's go on bypass.
Learning: Explicit verbal confirmation of key steps improves safety.
Catchpole K, 2011, in press
Human Factors in Healthcare
l Design of equipment, tasks, jobs, and environments
l Understanding human
Risk Management and Patient Safety Evolution and Progress. Charles Vincent. Match Safety critical component of quality (Madrid, Ministry of Health and Consumer Affairs, 2005)
1) The ICU at Reinier de Graaf Hospital in Delft works to ensure patient safety through protocols, guidelines, and an intensivist-led closed format.
2) To further increase safety outside the ICU, the hospital introduced a Medical Emergency Team (MET) in 2004 composed of ICU professionals who provide rapid response to patients experiencing medical emergencies.
3) Evidence on the impact of METs is inconclusive but most studies show benefits to patient outcomes and mortality reduction. The hospital believes early detection and treatment of deteriorating patients can prevent serious adverse events.
Masjid Nabawi is the dream destination for any believer. The document includes prayers and blessings for Prophet Muhammad. It emphasizes visiting the mosque and sending prayers and blessings to the Prophet with each step. The vision is to provide the right care for every person every time through various strategies to lower the rate of bile duct injuries during laparoscopic cholecystectomy.
BILE DUCT INJURY DURING LAPAROSCOPIC cholecystectomy- causes-detection;manage...fiaz fazili
Bile duct injuries (BDI) take place in a wide spectrum of clinical settings. The mechanisms of injury, previous attempts of repair, surgical risk and general health status importantly influence the diagnostic and therapeutic decision-making pathway of every single case. A multidisciplinary approach including hepatobiliary surgeon , endoscopy and interventional radiology specialists is required to properly manage this complex disease-the best treatment is prevention--do no more harm-have low threshold for conversion;call for help of seniors or expertise or refer to higher center
Basic concept & management of Traumatology.pptDrRabbabImmul
1. The document discusses the basic concepts of traumatology and trauma management. It outlines the trimodal distribution of death following severe injuries, with immediate, early, and late deaths.
2. It describes the Advanced Trauma Life Support (ATLS) approach to trauma management, including the primary and secondary surveys to identify life-threatening injuries, resuscitate the patient, and develop a management plan.
3. Key aspects of the primary survey and resuscitation discussed are airway management, breathing/ventilation, hemorrhage control, and neurological examination to address the most serious threats and stabilize the patient.
The document describes creating a just culture of safety in healthcare. It discusses influences on advancing safety culture including professional accountability and a just culture approach. A just culture emphasizes quality and safety over blame, promotes error reporting to uncover root causes, and uses coaching rather than punishment for unintentional errors. Examples of errors are provided to distinguish intentional reckless behavior from mistakes. The document also summarizes Massachusetts General Hospital's approach to developing a just culture including robust safety reporting, data analysis, and leadership involvement.
The document provides guidance on the role of general practitioners in managing trauma cases. It discusses that trauma is a major global health problem, causing over 5 million deaths per year. The "golden hour" after injury is critical, as 80% of trauma deaths occur in the first hour. The document then outlines the steps for trauma assessment and management based on the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach. It emphasizes the need for rapid identification and treatment of life-threatening injuries during the primary survey before moving to the secondary survey and evaluation for other injuries. The role of general practitioners is to stabilize the patient and identify critical injuries requiring emergency treatment or transfer to a higher level of care.
The document summarizes the impact of the AFHCAN telehealth project in Alaska over 8 years. It discusses how telehealth has helped address Alaska's unique geographic challenges by enabling healthcare access for remote communities. Key points include:
- Telehealth has helped prevent unnecessary patient travel in about 80% of specialty consultations and 20% of primary care cases, saving an estimated $14 million in travel costs annually.
- Wait times for specialty consults have been reduced from over 4 months to within a few weeks on average.
- Telehealth has enabled improved care coordination and post-operative follow-up for remote patients.
- It has also helped address provider shortages in rural areas and reduce costs associated with provider recruitment
Introduction to the science of improving patient safetyht3
The document introduces the topics of improving patient safety through a just culture approach, comprehensive unit-based safety programs, and safe patient handling and mobility. It discusses how medical errors can be reduced by understanding human fallibility and designing safer systems, and presents principles of safe design that can be applied to both technical processes and teamwork. Examples of assistive devices and national standards for safe patient handling and mobility are also reviewed.
This document discusses hybrid operating theaters/environments for treating hemorrhage in trauma patients. It provides an overview of endovascular techniques like transcatheter arterial embolization and balloon occlusion that can be used to treat hemorrhage. Trauma applications like treatment of spleen, liver, kidney and pelvic fractures are mentioned. The role of trauma surgeons working with interventional radiologists is discussed. The document also describes the process of developing a hybrid operating room called RAPTOR at a hospital in Canada, including securing funding, designing the space, and implementing protocols for its use. An analysis found it benefited around 6% of severely injured patients with persistent hemorrhage.
The document discusses the value of information in healthcare and analyzing temporal patterns in patient care and health services. It provides examples of studies that analyzed patterns in test follow-up rates and mortality rates for weekend hospital admissions. While the studies found issues like high rates of unreviewed tests and higher mortality for weekend admissions, further analysis of temporal patterns provided insights into potential causative factors and opportunities for intervention. The value of information is realized when it leads to changes in decisions and care processes that improve outcomes.
This document summarizes guidelines for treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) from the American Diabetes Association (ADA) and Joint British Diabetes Societies Inpatient (JBDS IP). Key points include:
1) Bedside beta-hydroxybutyrate testing is now the best way to monitor treatment response in DKA.
2) For DKA, guidelines recommend fixed rate insulin infusion of 0.1 unit/kg/hr without a priming dose and adjustments to meet metabolic targets.
3) For HHS, the goal of initial therapy is to expand intravascular volume and restore perfusion by replacing approximately 50
This document discusses simulation in medical education. It defines simulation as presenting problems authentically to allow trainees to respond as they would in real situations while receiving feedback. Simulation provides controlled, safe practice opportunities and helps develop clinical skills. Factors driving increased simulation use include problems with clinical teaching, new medical technologies, assessing competence, improving patient safety, and enabling deliberate practice. Effective simulation provides feedback, repetitive practice of varying difficulty, integration into the curriculum, and clearly defined learning outcomes.
This document discusses the use of point-of-care ultrasound in emergency and critical care settings. It provides an overview of using ultrasound to diagnose pneumothorax, pulmonary edema, and other conditions. Examples are given of ultrasound findings for a pneumothorax including the lack of lung sliding and presence of a lung point. Signs of pulmonary edema on ultrasound include A-lines and B-lines. The document emphasizes that ultrasound is a rapid, noninvasive tool that can help clinicians diagnose and treat patients, but should be used along with medical history, exams, and clinical judgment.
ACTEP2014: Therapeutic hypothermia for ACTEP 2014taem
This document discusses therapeutic hypothermia after cardiac arrest and suggests starting it in the emergency department. It defines therapeutic hypothermia and reviews studies showing improved neurological outcomes when mild hypothermia is induced after cardiac arrest. The benefits of therapeutic hypothermia are explained. Methods for inducing hypothermia in the emergency department are presented, including cold intravenous fluids and surface cooling techniques. The document recommends inducing therapeutic hypothermia for comatose cardiac arrest patients with initial rhythms of ventricular fibrillation or pulseless ventricular tachycardia.
This document discusses sepsis markers and their clinical use. It summarizes several biomarkers that show potential for diagnosing and monitoring sepsis, including procalcitonin (PCT), C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST). sCD14-ST shows diagnostic value in distinguishing infection from SIRS and sepsis from severe sepsis. Studies found sCD14-ST levels correlated with severity of illness and organ dysfunction in sepsis patients. The document reviews several clinical trials and studies that evaluated these biomarkers for diagnosing and predicting outcomes in sepsis, abdominal infections, febrile neutropenia, and burns.
ACTEP2014: Sepsis management has anything change taem
This document discusses sepsis management and what has changed. It begins with an introduction to the pathophysiology of sepsis, severe sepsis, and septic shock. It then discusses early goal directed therapy (EGDT) and landmark studies like Rivers 2001 that promoted protocolized resuscitation to targets like central venous pressure, mean arterial pressure, ScvO2, and transfusion thresholds. However, later large trials like ProCESS 2014 found no difference in mortality between EGDT, standard therapy, and usual care. Targets like CVP are not accurate predictors of fluid responsiveness. Studies also found no difference in outcomes between higher and lower blood pressure or hemoglobin transfusion thresholds. There remains uncertainty around optimal fluid type, vas
ACTEP2014: How to maximise resuscitation in trauma 2014taem
This document discusses various strategies for optimizing resuscitation of trauma patients, including permissive hypotension, bedside monitoring, and hemostatic resuscitation. It provides details on the Bickell study which found delayed fluid resuscitation improved outcomes for patients with penetrating torso injuries. Bedside monitoring techniques like focused assessment with sonography for trauma (FAST) and limited trauma ultrasound exam (LTTE) can help guide fluid management. Hemostatic resuscitation involving balanced use of blood products aims to address coagulopathy often seen in severe trauma. Target blood pressures of 60 mmHg may optimize outcomes with hypotensive resuscitation.
1) A medic responds to an IED explosion where his convoy was attacked. The person next to him has bilateral mid-thigh amputations with heavy bleeding from one leg. 2) The medic's top priority is to return fire and take cover since they are still under attack. 3) Once there is suppressive fire from the rest of the convoy, the medic applies a tourniquet to the leg with arterial bleeding to control the life-threatening hemorrhage.
This document discusses the use of hemodynamic ultrasound in critical care. It describes how ultrasound can be used to diagnose various types of shock such as hypovolemic, distributive, cardiogenic, and obstructive shock. Specific conditions that can be identified include tamponade, pulmonary embolism, and reduced left or right ventricular function. The document provides guidance on assessing volume responsiveness and fluid management in critically ill patients.
The document discusses the roles and responsibilities of an emergency department director. It covers topics such as developing leadership and communication skills, implementing effective peer review and physician profiling, dealing with problem physicians, improving customer relations and patient satisfaction, managing physician and hospital contracts, recruiting and orienting new physicians, measuring productivity and compensation, managing staffing and scheduling, conducting meetings, and managing risk. The emergency department director must balance both leadership and management functions to effectively run the emergency department.
This document discusses Mindray's ceiling supply units used in emergency rooms. It provides an overview of Mindray as a company and their products, including several models of ceiling supply units or "pendants" used in ERs and ICUs. The pendants are designed to organize medical devices at the patient bedside and provide benefits like easier patient access and care, cable management, and hygiene. Customization options and features are described such as suspension systems, finishes, outlets, and accessories. 3D design services are also mentioned for visualizing hospital layouts.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
6. 2. PPP
(Public)
Up to 95% of
expenses by
Government
costs of
Leadership, Techn
ology
(Process, Medical
7. Is not Charisma, Public
Relations, Showmanship
Is performance consistent behavior and
trustworthiness
Is Thinking, Doing and Communicating
Is setting Direction, Aligning and Motivating
Is creating an environment of continuous
learning
Learning doesn‟t end with school or college
You must learn throughout you life - never
cease to be a student
8. Single toll free number „1-6-6-9‟ accessible
on land and mobile phones
9. Unique Emergency Response Center staffed
with trained Communication, Medical and
Police personnel
10. Computer Telephony Integration
Voice Loggers
GIS / Maps
GPS / AVLT
Mobile Communication
Application software for Sense, Reach and
Care
ePCR (Electronic Patient Case Record) Form
14. Pre-hospital Care / Emergency Medicine
Training in collaboration
15.
16. 1 in 5 people visited the emergency department
in 2007 (Centers for Disease Control and Prevention, 2010)
Emergency care represents less than 3% of the
nation's $2.1 trillion in health care expenditures
caring for 120 million annually
Emergency physicians expect ER visits to increase
with health care reform, due to growing
physician shortages (ACEP, 2010)
17. NPs in EDs for over 4 decades
◦ Emergency Departments
◦ Fast Tracks
◦ Urgent Cares
NPs/PAs cared for 13% of all ED patients
(Am J Emerg Med, 2005)
New Models of Care
◦ Rapid Triage
◦ Rapid Exams
◦ Rapid Disposition
18. 2006 - Emergency Nurses Association embarked on Delphi Study
(52 participants completed all three rounds)
Competencies include knowledge, behaviors, and skills an entry-
level NP should have in order to practice in emergency care.
Competencies are intended to supplement the NONPF core
competencies for all nurse practitioners as well as population-
focused NP competencies
NP practice may differ due to:
◦ variations in state regulation
◦ practice setting
◦ employment arrangement
◦ as a result of increases knowledge and/or experience
19. 2008 - Consensus Panel
◦ American Association of Colleges of Nursing (AACN)
◦ American Academy of Emergency Medicine (AAEM)
◦ American Academy of Nurse Practitioners (AANP)
◦ American College of Emergency Physicians (ACEP)
◦ American College of Nurse Practitioners (ACNP)
◦ American Nurses Association (ANA)
◦ American Nurses Credentialing Center (ANCC)
◦ Board of Certification for Emergency Nursing (BCEN)
◦ Commission on Collegiate Nursing Education (CCNE)
◦ Emergency Nurses Association (ENA)
◦ National Council of State Boards of Nursing (NCSBN)
◦ National Organization of Nurse Practitioner Faculties (NONPF)
(In press: Nurse Practitioner Delphi Study: Competencies for Practice
in Emergency Care. Journal of Emergency Nursing Sept 2010)
47. 1. Triages patients‟ health needs/problems.
2. Completes specified medical screening
examination.
3. Responds to the rapidly changing
physiological status of emergency care
patients.
4. Uses current evidence-based knowledge and
skills in emergency care for the assessment,
treatment, and disposition of acute and
chronically ill and injured patients.
48. 5. Specifically assesses and initiates appropriate
interventions for violence, neglect, and abuse.
6. Specifically assesses and initiates appropriate
interventions and disposition for suicide risk.
7. Assesses patient and family for levels of
comfort and initiates appropriate interventions.
8. Recognizes, collects, and preserves evidence
as indicated
49. 9. Orders and interprets diagnostic tests.
10. Orders pharmacologic and non-pharmacologic
therapies.
11. Orders and interprets electrocardiograms.
12. Orders and interprets radiographs.
13. Assesses response to therapeutic
interventions.
14. Documents assessment, treatment, and
disposition.
50. 15. Functions as a direct provider of emergency care services.
16. Directs and clinically supervises the work of nurses and other
health care providers.
17. Participates in internal and external emergencies, disasters,
and pandemics.
18. Maintains awareness of known causes of mass casualty
incidents and the treatment modalities required for
emergency care.
19. Acts in accordance with legal and ethical professional
responsibilities (e.g., patient management, documentation,
advance directives).
51. 20. Assesses and manages a patient in
cardiopulmonary arrest.
21. Assesses and manages airway.
22. Assesses and obtains advanced circulatory
access.
23. Assesses and manages patients with disability.
24. Assesses and manages procedural sedation
patients.
◦ (See ENA/ACEP joint position statement – www.ena/org)
52. 25. Performs ultraviolet examination of skin
and secretions.
26. Treats skin lesions.
27. Injects local anesthetics.
28. Performs nail trephination.
29. Removes toe nail(s).
53. 30. Performs a nail bed closure.
31. Performs closures (e.g., single
layer, multiple, staple, adhesive).
32. Revises a wound for closure.
33. Debrides minor burns (e.g., non-adhering
blister).
34. Incises, drains, irrigates, and packs wounds.
57. 45. Incises and drains a Bartholin‟s cyst.
46. Assists with imminent childbirth and
post-delivery maternal care.
47. Removes fecal impactions.
48. Incises thrombosed hemorrhoids.
49. Performs sexual assault examination.
58. 50. Performs digital nerve block.
51. Reduces fractures of small bones.
52. Reduces fractures of large bones with
vascular compromise.
53. Reduces dislocations of large and small
bones.
60. 58. Performs radio communication with
prehospital units.
59. Interprets patient diagnostics as
communicated by prehospital personnel.
60. Removes foreign bodies.
61. Graduate Programs (Masters, Post
"
Masters, DNP)
Programs with Emergency Concentration
◦ Uni of Southern Alabama – Mobile, AL
◦ Emory – Atlanta, GA
◦ Loyola – Chicago, IL
◦ Uni of Florida - Jacksonville, FL
◦ Uni of Texas, Houston, TX
◦ Uni of Texas, Arlington, TX
◦ Uni of Virginia – Charlottesville, VA
◦ Vanderbilt – Nashville, TN
63. GRADUATE PROGRAM
◦ FNP Program – Consensus Model Document 2008
EDs require “family across the life span”
ACNP Program– usually no pediatric component
CERTIFICATION
◦ FNP (e.g. ANCC, AANP)
AANP does not support the DNP equivalency exam – this is an academic
degree not a “clinical” option
◦ Specialty Certification
BCEN Needs Assessment completed – to ENA BOD Summer 2010 for final
recommendations (cert and/or portfolio)
PREVIOUS EXPERIENCE
◦ Staff nurse (with BLS, ACLS, TNCC, ENPC)
◦ Certified Emergency Nurse (CEN) certified
◦ On-the-job training (e.g., suturing, minor procedures)
◦ Relevant continuing education
64. Graduation from an accredited program
◦ Emergency concentration preferred
FNP Certification Exam
◦ Specialty certification and/or portfolio option (TBA)
◦ Competency skills checklist (graduate program)
Application Process
◦ Resume Submitted
RN License/NP License
Prescriptive Authority/DEA License
Panel Interview – EDMDs/NPs/PAs and Staff
Medical Staff Privileges – may take up to 6 mo
65. (n = 6279)
NP – avg. 9 yrs NP experience
Most Common Specialties
◦ FNP (54.5%)
◦ Adult (20.4%)
Practice
◦ Community practice < 25,000 (17%)
◦ Communities of > 250,000 (39%)
Settings
◦ Private physician practices (30.3%)
◦ Hospital-based outpatient clinics (11.6%)
◦ Hospital inpatient settings (9.8%)
Goolsby, M.J. (2009) Journal of the American
Academy of Nurse Practitioners, 21, 186–188.
66. RN/Tech (vital signs)
NP/PA medically screens patient and
then determines level
(5-level triage)
B. High risk situation is a
patient you would put in
your last open bed
C. Resources: Count the number of different
A. Immediate life-saving intervention Severe pain is determined types of resources, not the individual tests or
required by clinical observation x-rays (examples: CBC, electrolytes and coags
(apneic, pulseless, severe respiratory and/or patient rating of equals one resource; CBC plus chest x-ray
distress, SPO2<90, acute mental status greater than or equal to 7 equals two resources).
changes, or unresponsive) on 0-1/distress is 0 pain
scale SOME PATIENTS WILL BE MEDICALLY SCREENED
ABCDs - TO ED and SENT TO THE FAMILY WAITING ROOM –
NP/PA ASSESSES, INITIATE (e.g. UTI) THEN DISCHARGED
ORDER SETS – TO FAST
TRACK – THEN
DISCHARGED
67. Hospital vs. physician group role utilization
Scope of practice (support to the physician with
higher acuity patients)
Resourcing of the role (add personnel to fast track)
Ensuring medical staff at large is supportive and
understanding of the role and scope of NPs/PAs.
Compliance with medical staff oversight including
Performance Improvement (PI) and Peer Review (PR).
68. 32 million newly insured Americans by 2014
Predicted 40,000 primary care physician shortfall by
2020
Not enough emergency medicine residency trained
MDs (Academic Emergency Medicine, 2008)
Market forces virtually guarantee that more health
providers will be using NPs and other "physician
extenders" (Bauer, 2010)
69. The full integration of NPS... in many clinical areas
will also enhance access.
Decades of experience with NPs and several studies
indicate that quality is not a problem with reforms
that would allow NPs to provide more services.
Patients like the care they receive from NPs at least
as much as the care they receive from physicians.
Consumers' overall appreciation of NPs is
extremely high.
(Bauer, 2010; Edmunds, 2010; Office of Technology Assessment 1998; Safriet, 1992)
70. Peer-reviewed journal articles reinforce the Office of
Technology Assessment's conclusions in 1981NPs can be
utilized in a significant portion of medical services ranging
from 25% in some specialty areas to 90% in primary care with
at least similar outcomes.
Collaborative, team-based approaches to care including
teams led by NPs should be actively promoted to reduce
overall spending on healthcare.
NPs can reduce costs without diminishing quality in the
process.
(Bauer, 2010; Edmunds, 2010; Office of Technology Assessment 1998; Safriet, 1992)