This document provides an overview of older driver safety risks and the physician's role in assessing driving ability. It discusses how age-related medical conditions like dementia can increase crash risk. Physicians should screen for vision, strength, and cognitive issues, and use tools like the Assessment of Driving-Related Skills to evaluate skills. The document reviews reporting requirements in California for conditions that may cause loss of consciousness. Physicians are advised to counsel patients on alternatives to driving and document any concerns about ability.
Distracted Driving is a growing problem not only in Maryland but across the country. Today auto drivers are constantly under the threat of being distracted whether by phone calls, text messages or simply by tuning the radio. This slide presentation exhibits the most common dangers associated with distracted driving and the laws in Maryland that attempt to prevent it and further fatalities.
Distracted Driving is a growing problem not only in Maryland but across the country. Today auto drivers are constantly under the threat of being distracted whether by phone calls, text messages or simply by tuning the radio. This slide presentation exhibits the most common dangers associated with distracted driving and the laws in Maryland that attempt to prevent it and further fatalities.
Successful organizations have the ability to deliver quality, timely service to their clients all the while making safety a core value in their business. While these organizations take managing their risk very seriously, the scary reality is that they may have an exposure to risk that has them completely in the dark.
If there was a glaring gap in your safety and risk management strategy wouldn’t you want to know about it?
During this webinar we will explore the impact of cognitive impairment on driver performance, why it is often left undetected and what your organization can proactively do to protect your business, your driver and your community.
Approach to evaluating patients' fitness to drive during an ED encounter.
Review of health advocacy and legal obligations from a Quebec standpoint
Audience: Medical students and residents in a small group environment
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Running head Physician’s Ability to Address Driving Safety with T.docxglendar3
Running head: Physician’s Ability to Address Driving Safety with Their Patients 1
8
Physician’s Ability to Address Driving Safety with Their Patients
The University of Toledo
Juliane Johnson
11/30/2011
Scope of the Problem
Injury and death due to motor vehicle accidents are serious, but often neglected issues globally. According to the U.S. Census, there are about 312,689,471 people in the United States and about 196,165,666 of them have driver’s licenses(Bureau, 2011). With so many drivers on the road education and awareness of driving safety are key factors in decreasing the risk of accidents and deaths among those driving. The amount of accidents due to distracted driving, driving under the influence and other driving errors is overwhelming and there many things that can be done to decrease the amount of accidents, injuries, and fatalities. There have been advances in the prevention of motor vehicle crash rates and over the past few decades the volume of motor vehicle accident fatalities has decreased for every age group. In 1985, there were about 17.8 deaths per 100,000 people between the ages of 35-69 and in 2009 that number dropped to about 12.5(Safety, 2008). Over time, new education programs, safer vehicles, safer roads and many other factors have contributed to these decreases in deaths, but the problem has not vanished completely. Motor vehicle accidents still account for more deaths between the ages 5-34 than any other cause. As of 2008, unintentional motor vehicle traffic deaths were the leading cause of death for all people between the ages 5-34 and accounted for 37,985 deaths in all people("Injury Prevention & Control: Data & Statistics," 2010). One of the most crucial aspects of intervention programs is beginning to reach the individuals who are at the highest risk of accidents along with finding new venues to reach all populations(McEvoy, Stevenson, & Woodward, 2007).
Specifically, distractions while driving are a leading cause of motor vehicle accidents that can be addressed with a change of behavior. According to the Fatality Analysis Reporting System (FARS), there were a total of 51,857 fatalities caused by crashes involving distractions in 2008 (Wilson & Stimpson, 2010). Drivers are more frequently using distracting devices like cell phones, GPS units and complex stereos while in cars than ever before. These devices may even be built directly into new models as a standard package, which can sometimes give the misconception that the devices can be used safely while driving and this is not a healthy message to send drivers.(Jacobson & Gostin, 2010). The most recent statistics even suggest that up to 21% of all traffic accidents are due to distractions while driving. Finding out how to stop this critical trend is very important to decreasing the amount of fatalities reported. One clear answer is passing legislation that can prohibit or reduce these distracted behaviors. “Since 2007, 34 states have ena.
Running head Physician’s Ability to Address Driving Safety with T.docxtodd581
Running head: Physician’s Ability to Address Driving Safety with Their Patients 1
8
Physician’s Ability to Address Driving Safety with Their Patients
The University of Toledo
Juliane Johnson
11/30/2011
Scope of the Problem
Injury and death due to motor vehicle accidents are serious, but often neglected issues globally. According to the U.S. Census, there are about 312,689,471 people in the United States and about 196,165,666 of them have driver’s licenses(Bureau, 2011). With so many drivers on the road education and awareness of driving safety are key factors in decreasing the risk of accidents and deaths among those driving. The amount of accidents due to distracted driving, driving under the influence and other driving errors is overwhelming and there many things that can be done to decrease the amount of accidents, injuries, and fatalities. There have been advances in the prevention of motor vehicle crash rates and over the past few decades the volume of motor vehicle accident fatalities has decreased for every age group. In 1985, there were about 17.8 deaths per 100,000 people between the ages of 35-69 and in 2009 that number dropped to about 12.5(Safety, 2008). Over time, new education programs, safer vehicles, safer roads and many other factors have contributed to these decreases in deaths, but the problem has not vanished completely. Motor vehicle accidents still account for more deaths between the ages 5-34 than any other cause. As of 2008, unintentional motor vehicle traffic deaths were the leading cause of death for all people between the ages 5-34 and accounted for 37,985 deaths in all people("Injury Prevention & Control: Data & Statistics," 2010). One of the most crucial aspects of intervention programs is beginning to reach the individuals who are at the highest risk of accidents along with finding new venues to reach all populations(McEvoy, Stevenson, & Woodward, 2007).
Specifically, distractions while driving are a leading cause of motor vehicle accidents that can be addressed with a change of behavior. According to the Fatality Analysis Reporting System (FARS), there were a total of 51,857 fatalities caused by crashes involving distractions in 2008 (Wilson & Stimpson, 2010). Drivers are more frequently using distracting devices like cell phones, GPS units and complex stereos while in cars than ever before. These devices may even be built directly into new models as a standard package, which can sometimes give the misconception that the devices can be used safely while driving and this is not a healthy message to send drivers.(Jacobson & Gostin, 2010). The most recent statistics even suggest that up to 21% of all traffic accidents are due to distractions while driving. Finding out how to stop this critical trend is very important to decreasing the amount of fatalities reported. One clear answer is passing legislation that can prohibit or reduce these distracted behaviors. “Since 2007, 34 states have ena.
Integrating Behavioral Health into Primary Care – Thought Leaders in Populati...Epstein Becker Green
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. Drs. Daviss and Coleman will discuss the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual.
In addition, the speakers will:
* Identify the clinical, legal, social, and financial impacts of behavioral health disorders on chronic medical conditions.
* Describe the challenges involved in improving clinical and financial outcomes in patients with chronic medical conditions who also have behavioral health symptoms and/or conditions.
* Demonstrate the rewards for implementing new information technology applications and analysis for better clinical and financial outcomes for these specific populations.
Moderator
* Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green's Board of Directors
Speakers
* Charles A. Coleman, PhD, Senior Sponsor of IBM's Population Health Insights and Programs Management of IBM's Healthcare Solutions Board
* Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, a DC-based mobile mental health information technology company that developed the peer-reviewed multi-dimensional, patient-centered mental health screening tool, M3Clinician
Epstein Becker Green Webinar - Moderated by Mark E. Lutes - http://www.ebglaw.com/events/the-challenges-and-rewards-of-integrating-behavioral-health-into-primary-care-%E2%80%93-thought-leaders-in-population-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Hosted by Professor Priscilla Harries and Professor Carolyn Unsworth.
Including talks by Professor Desmond O'Neill, Dr Tadhg Stapleton, Ed Passant, Professor Priscilla Harries, Professor Carolyn Unsworth, Dr Carol Hawley, Dr Kate Radford, Dr Britta Lang and Dr Elizabeth White.
This event took place at Brunel University on 23/6/2016.
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
A Guide to Reducing Falls in the PACE PopulationGrane Rx
Grane Rx offer a wide range of patient services and benefits throughout the United States. Our LTC pharmacy consultants help your clinical program keep pace. Our team of nurses and specialty trained pharmacists will guide medication management.
As we are getting further from the 20th century many historical facts become clearer and clearer. Looking at the past century in perspective helps us to figure out our way forward. Jung and Frankl urged humanity to assimilate the devastation of the two World Wars by taking personal responsibility, and become aware of our projections, such as nationalism. They insist that reason is not enough to prevent future tragedies. These post-World War issues were never dealt with by humanity, just swept under the rug, as in the second half of the 20th century psychiatry identified
with psychopharmacology. Moreover, psychology's self-imposed limitation to the cognitive domain alone, neglecting the study of emotion or introspection is setting the stage for the 21st century repetition of history. The idea is that the current trajectories of both psychiatry and psychology are unsustainable as they direct us towards polarization, thus opening the way for the terrible enantiodromia. The events world-wide such as geographical fragmentation and failure of the nation states are proofs that we, humans have not dealt with our dormant demons.
Successful organizations have the ability to deliver quality, timely service to their clients all the while making safety a core value in their business. While these organizations take managing their risk very seriously, the scary reality is that they may have an exposure to risk that has them completely in the dark.
If there was a glaring gap in your safety and risk management strategy wouldn’t you want to know about it?
During this webinar we will explore the impact of cognitive impairment on driver performance, why it is often left undetected and what your organization can proactively do to protect your business, your driver and your community.
Approach to evaluating patients' fitness to drive during an ED encounter.
Review of health advocacy and legal obligations from a Quebec standpoint
Audience: Medical students and residents in a small group environment
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Running head Physician’s Ability to Address Driving Safety with T.docxglendar3
Running head: Physician’s Ability to Address Driving Safety with Their Patients 1
8
Physician’s Ability to Address Driving Safety with Their Patients
The University of Toledo
Juliane Johnson
11/30/2011
Scope of the Problem
Injury and death due to motor vehicle accidents are serious, but often neglected issues globally. According to the U.S. Census, there are about 312,689,471 people in the United States and about 196,165,666 of them have driver’s licenses(Bureau, 2011). With so many drivers on the road education and awareness of driving safety are key factors in decreasing the risk of accidents and deaths among those driving. The amount of accidents due to distracted driving, driving under the influence and other driving errors is overwhelming and there many things that can be done to decrease the amount of accidents, injuries, and fatalities. There have been advances in the prevention of motor vehicle crash rates and over the past few decades the volume of motor vehicle accident fatalities has decreased for every age group. In 1985, there were about 17.8 deaths per 100,000 people between the ages of 35-69 and in 2009 that number dropped to about 12.5(Safety, 2008). Over time, new education programs, safer vehicles, safer roads and many other factors have contributed to these decreases in deaths, but the problem has not vanished completely. Motor vehicle accidents still account for more deaths between the ages 5-34 than any other cause. As of 2008, unintentional motor vehicle traffic deaths were the leading cause of death for all people between the ages 5-34 and accounted for 37,985 deaths in all people("Injury Prevention & Control: Data & Statistics," 2010). One of the most crucial aspects of intervention programs is beginning to reach the individuals who are at the highest risk of accidents along with finding new venues to reach all populations(McEvoy, Stevenson, & Woodward, 2007).
Specifically, distractions while driving are a leading cause of motor vehicle accidents that can be addressed with a change of behavior. According to the Fatality Analysis Reporting System (FARS), there were a total of 51,857 fatalities caused by crashes involving distractions in 2008 (Wilson & Stimpson, 2010). Drivers are more frequently using distracting devices like cell phones, GPS units and complex stereos while in cars than ever before. These devices may even be built directly into new models as a standard package, which can sometimes give the misconception that the devices can be used safely while driving and this is not a healthy message to send drivers.(Jacobson & Gostin, 2010). The most recent statistics even suggest that up to 21% of all traffic accidents are due to distractions while driving. Finding out how to stop this critical trend is very important to decreasing the amount of fatalities reported. One clear answer is passing legislation that can prohibit or reduce these distracted behaviors. “Since 2007, 34 states have ena.
Running head Physician’s Ability to Address Driving Safety with T.docxtodd581
Running head: Physician’s Ability to Address Driving Safety with Their Patients 1
8
Physician’s Ability to Address Driving Safety with Their Patients
The University of Toledo
Juliane Johnson
11/30/2011
Scope of the Problem
Injury and death due to motor vehicle accidents are serious, but often neglected issues globally. According to the U.S. Census, there are about 312,689,471 people in the United States and about 196,165,666 of them have driver’s licenses(Bureau, 2011). With so many drivers on the road education and awareness of driving safety are key factors in decreasing the risk of accidents and deaths among those driving. The amount of accidents due to distracted driving, driving under the influence and other driving errors is overwhelming and there many things that can be done to decrease the amount of accidents, injuries, and fatalities. There have been advances in the prevention of motor vehicle crash rates and over the past few decades the volume of motor vehicle accident fatalities has decreased for every age group. In 1985, there were about 17.8 deaths per 100,000 people between the ages of 35-69 and in 2009 that number dropped to about 12.5(Safety, 2008). Over time, new education programs, safer vehicles, safer roads and many other factors have contributed to these decreases in deaths, but the problem has not vanished completely. Motor vehicle accidents still account for more deaths between the ages 5-34 than any other cause. As of 2008, unintentional motor vehicle traffic deaths were the leading cause of death for all people between the ages 5-34 and accounted for 37,985 deaths in all people("Injury Prevention & Control: Data & Statistics," 2010). One of the most crucial aspects of intervention programs is beginning to reach the individuals who are at the highest risk of accidents along with finding new venues to reach all populations(McEvoy, Stevenson, & Woodward, 2007).
Specifically, distractions while driving are a leading cause of motor vehicle accidents that can be addressed with a change of behavior. According to the Fatality Analysis Reporting System (FARS), there were a total of 51,857 fatalities caused by crashes involving distractions in 2008 (Wilson & Stimpson, 2010). Drivers are more frequently using distracting devices like cell phones, GPS units and complex stereos while in cars than ever before. These devices may even be built directly into new models as a standard package, which can sometimes give the misconception that the devices can be used safely while driving and this is not a healthy message to send drivers.(Jacobson & Gostin, 2010). The most recent statistics even suggest that up to 21% of all traffic accidents are due to distractions while driving. Finding out how to stop this critical trend is very important to decreasing the amount of fatalities reported. One clear answer is passing legislation that can prohibit or reduce these distracted behaviors. “Since 2007, 34 states have ena.
Integrating Behavioral Health into Primary Care – Thought Leaders in Populati...Epstein Becker Green
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. Drs. Daviss and Coleman will discuss the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual.
In addition, the speakers will:
* Identify the clinical, legal, social, and financial impacts of behavioral health disorders on chronic medical conditions.
* Describe the challenges involved in improving clinical and financial outcomes in patients with chronic medical conditions who also have behavioral health symptoms and/or conditions.
* Demonstrate the rewards for implementing new information technology applications and analysis for better clinical and financial outcomes for these specific populations.
Moderator
* Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green's Board of Directors
Speakers
* Charles A. Coleman, PhD, Senior Sponsor of IBM's Population Health Insights and Programs Management of IBM's Healthcare Solutions Board
* Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, a DC-based mobile mental health information technology company that developed the peer-reviewed multi-dimensional, patient-centered mental health screening tool, M3Clinician
Epstein Becker Green Webinar - Moderated by Mark E. Lutes - http://www.ebglaw.com/events/the-challenges-and-rewards-of-integrating-behavioral-health-into-primary-care-%E2%80%93-thought-leaders-in-population-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Hosted by Professor Priscilla Harries and Professor Carolyn Unsworth.
Including talks by Professor Desmond O'Neill, Dr Tadhg Stapleton, Ed Passant, Professor Priscilla Harries, Professor Carolyn Unsworth, Dr Carol Hawley, Dr Kate Radford, Dr Britta Lang and Dr Elizabeth White.
This event took place at Brunel University on 23/6/2016.
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
A Guide to Reducing Falls in the PACE PopulationGrane Rx
Grane Rx offer a wide range of patient services and benefits throughout the United States. Our LTC pharmacy consultants help your clinical program keep pace. Our team of nurses and specialty trained pharmacists will guide medication management.
As we are getting further from the 20th century many historical facts become clearer and clearer. Looking at the past century in perspective helps us to figure out our way forward. Jung and Frankl urged humanity to assimilate the devastation of the two World Wars by taking personal responsibility, and become aware of our projections, such as nationalism. They insist that reason is not enough to prevent future tragedies. These post-World War issues were never dealt with by humanity, just swept under the rug, as in the second half of the 20th century psychiatry identified
with psychopharmacology. Moreover, psychology's self-imposed limitation to the cognitive domain alone, neglecting the study of emotion or introspection is setting the stage for the 21st century repetition of history. The idea is that the current trajectories of both psychiatry and psychology are unsustainable as they direct us towards polarization, thus opening the way for the terrible enantiodromia. The events world-wide such as geographical fragmentation and failure of the nation states are proofs that we, humans have not dealt with our dormant demons.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
COGNITION AND DRIVING
1. Carolina Osorio, MD
Geriatric Psychiatry Fellow
UCLA Semel Institute of Neuroscience and Human Behavior
March 26 2012
2. OBJECTIVES
Understand the safety risks of older drivers
Indentify conditions that may put older drivers at
risk
Indentify the role of the physician
Demonstrate familiarity with the law as well as
California DMV reporting methods and
requirements
4. Taxonomy of Older Driver
Behaviors and Crash Risk from
NHTSA Feb 2012
Identify risky behaviors, driving habits
and exposure patterns that have been
showed to increase the likelihood of
crash involvement
Crash types where older drivers were
most strongly overrepresented
2002-2006 using database from FARS
and NASS
5. Taxonomy of Older Driver Behaviors and Crash
Risk from NHTSA Feb 2012
Older people were increasingly less likely to be driving the striking
vehicle in a two vehicle crash
High – speed two lane roadways and multilane roads with speed limits
of 40-45 mph were associated with heightened older driver crash
involvement
In two vehicle crashes, failure to yield was the most frequently cited
factor
Starting at age 70, old drivers were specially likely to crash at
intersections
With respect to single vehicles crashes , older drivers were somewhat
more likely to be identified as ill or blacking out, drowsy or asleep, using
medications or drugs ( other than alcohol), and having some other
physical impairments ( hearing loss)
6. Annual Crashes per 1,000
Licensed Vehicle Drivers by Age
of Driver (Source: Cerrelli, 1998)
Crashes per Million Miles
Traveled by Age of Driver
(Source: Cerrelli, 1998)
7. Percent of Persons with Dementia
by Age Group
50
45
40
% of Aged 35
Population 30
with 25
Dementia 20
15
10
5
0
65 - 70 70 - 75 75 - 80 80 - 85 85 - 90 90 - 95
Age
8. Problems related to age can include
Reduced vision
Decreased strength
Medications
Cognitive impairment Impaired
California 3.1 M
license drivers
Over 65 years
9. Older drivers have an increased likelihood of being injured or
killed in a crash.
L. Evans Traffic Safety (2004), Bloomfield Hills, MI: “Science Serving Society”
11. Automobile crashes are the third leading cause of
death and injury in the United States with 40,000 to 50,
000 people killed in about 2 million accidents per year
Drivers over age 75 had a higher rate of fatal accidents
nationwide in 2001- 2002. This problem is expected to
grow because by 2024, one in four U.S. drivers will be
over age 65
National Older Driver Research and Training Center
Physicians are in a unique position to anticipate the impact
of physical and mental conditions on driving
impairment.
12. The privilege of driving is a source of freedom and
empowerment for many individuals. Removing this
privilege has its risks.
The loss of ability to be independently mobile can be a
devastating psychological blow for an elderly patient. It
also may restrict a patient access to meet medical and
social services or to employment venues.
14. CEJA of the AMA report on impaired drivers and
their physicians: I-99
Physicians have an ethical responsibility to assess patients’
physical or mental impairments that might adversely affect
driving abilities
Each case must be evaluated separately since not all
impairments may give rise to an obligation on the part of the
physician
The physician must be able to identify and document
physical or mental impairments that clearly relate to the
ability to drive
The driver must pose a clear risk to the public safety
15. Recommendations
1. Physicians should assess patients’ physical or mental
impairments
3. Before reporting, there are a number of initial steps
physicians should take
5. Physicians should use their best judgment when determining
when to report impairments that could limit a patient’s ability
to drive safely.
7. The physicians role is to report medical conditions that would
impair safe driving. The determination of the inability to drive
safely should be made by the states DMV.
16. Recommendations
1. Physicians should disclose and explain to their patients this
responsibility to report
3. Physician should protect patient confidentiality by ensuring
that only the minimal amount of information is reported
5. Physicians should work with their state medical societies to
create statues that uphold the best interests of patients and
community, and that safeguards physicians from liability
when reporting in good faith.
17. AMA PHYSICIAN’S GUIDE
American Medical Association &
National Highway Traffic Safety
Administration (NHTSA)
“Physician’s Guide to Assessing
and Counseling Older Drivers”
Quick screening and referral tool
Available at:
www.ama-assn.org/go/olderdrivers
18. Office visit
Medical History: OSA are 2-6 time more likely
to be involved in a MVA (Berger et al. 2000).
ROS
Family concerns
AGE ALONE IS NOT A RED FLAG
Remember to address driving safety as needed.
19. Assessment of driving related
skills (ADReS)
Working
Memory
Executive
Functioning
Spatial
Skills
Elaboration of rapid decision making
20. Assessment of driving related skills
(ADReS)
COGNITION
Trail B: Lafont confirmed a high correlation between increasing
age and poor attentional and executive performance, as
measured by Trail-Making B, to be correlated with both crashes
and driving cessation (Lafont, 2008).
N = 81 sec
MCI = 136 sec
Dementia = 190
sec
Ashendorf, 2008
21. Clock drawing test using Freund Scoring Criteria
YES NO
Only the numbers 1-12 are included
Number inside the clock
Numbers are spaced equally from each other
Numbers are spaced equally from the edge
One clock hand correctly points to 2
There are only 2 clock hands
There are no intrusive marks, writing or hands
indicating incorrect time
The scoring is based on seven “principal components” which
were derived by analyzing the clock drawing of 88 drivers 65
and older against their performance on a driving simulator
(Freund 2005).
22. Counseling the patient / family
Physicians are influential in a patient’s decision to
stop driving; in fact advice from a doctor is the most
frequently cited reason that a patient stops driving.
Persson, D. (1993)
3 Transportation options:
http://beverlyfoundation.org/
u Reinforce driving cessation:”Driving retirement”
g Follow up letter
g Follow up in a month
23. Driving Rehabilitation Specialist
One who plans develops coordinates
and implements driving services for
individuals with disabilities
Work with people who have strokes,
low vision, limb amputation
www.ADED.net
24. What do with a difficult patient?
i Encourage patient to complete the self screening
tool
t Counsel your pt on Successful aging tips and tips
for safe driving
o Roadwise review
http://www.seniordrivers.org/driving/driving.cfm?button=roadw
r DOCUMENT your concerns and support this with
relevant information. Document patient reactions
along with any counseling you have provided.
28. California Code of regulations (CCR) title 17 sub-chapter 2.5
“Disorders characterized by lapses of consciousness” sections
2800-2812.
“Reporting the local health authority” the non-communicable disease or
conditions – AD- and related conditions and disorders characterized by
lapses of consciousness .
2802 AD and related disorders. Means those illnesses that damage the brain
causing irreversible, progressive, confusion, disorientation, loss of memory
and judgment
2806 Disorders characterized by lapses of consciousness.
Loss of consciousness or a marked reduction of alertness or responsiveness to
external stimuli
inability to perform one or more ADLs
the impairment of the sensory motor functions used to operate a motor vehicle
EX: OSA, abnormal metabolic states (DM)
29. Important issues about the regulations:
They are specific to physicians and surgeons per section
103900 of the Health and Safety Code
The physicians who reports a patient diagnosed with a
disorder characterized by lapses of consciousness,
according to the Health and Safety code 103900, shall not
be civilly or criminally liable to any patient for making the
report.
30. Liability
Physicians are considered negligent if they do not inform
patients of medications and medical conditions that can
impair driving
○ Physicians may be held liable for civil
damages if they clearly failed to report an
impaired driver who causes a MVC
○ Immunity is granted to the physician if the
patient is reported prior to a MVC
○ Document all referrals, recommendations,
conversations, and reports (e.g. copy of a
driver retirement letter and “do not drive”
prescription)
31. California
Individuals 70 years of age and older
Must renew license in-person
License is renewed for five years if vision and written tests are
passed and there are no signs of cognitive impairment
A “limited term” license may be issued for one to two years if a
medical problem exists but is not severe enough to stop driving
(e.g. mild dementia)
Dementia moderate-severe = DL revoked
Dementia early or mild = Reexamination
In this manner, the California DMV hopes to balance the need for
public safety and with the perseveration of personal independence .
32. Reporting…….
In California in 1988 , healthy and safety code section 410
added AD and related disorders to the list of conditions that
physicians are required to report to their local health
departments, which then forward this information to CA
DMV.
Based on the results of these examinations as well as a
physician completed written driver medical evaluation (DME)
form the DMV could allow the driver to:
Continue driving unrestricted
Continue driving with restrictions
Revoke or suspend DL.
34. Safety, mobility and cost are critically important
Physician role is difficult: caseloads, poor training
Limited alternatives to driving
Recognize rights and feelings of older people
Many obvious solutions may not work very well
We started addressing this problem too late
35. "Above all, we must work together to ensure that
older adults can remain mobile and productive
even when they have to give up driving.“
Thomas Meuser, Ph.D.
Research associate professor of neurology at Washington University.
THANK YOU
Editor's Notes
National highway traffic safety administration A notable data found on the data reviewed were crash involvement ratios for older age groups that did not bear out conventional wisdom about certain situations being especially risky for these drivers, such as merging, changing lanes, driving on I Highways and driving in bad weather. VERY MIXED BAG, VERY SICK AND VERY HEALTHY
On a licensed driver basis, older adults are among the safest on the road. The average annual number of crashes in the United States is 68 per 1,000 licensed drivers, while the corresponding rate for drivers aged 65 and older is only 37. The picture changes somewhat when crash rates are calculated on the basis of miles traveled. Using this measure of exposure, older adults are at increased crash risk . The increase in risk is evident for 65-74 year olds, but becomes even more pronounced with increased age.
Coincides with the increase in incidence of dementia
Council on ethical and judicial affairs
2. Ex : referrals, restrictive driving 3. Clear evidence and where the advice of to discontinue driving is ignored
First edition was published on 7/30/2003 and updated on 2/3/2010. The information on this guide is provided to assist physicians in evaluating the ability of older patients to operate motor vehicle safely as part of their everyday personal activities. Is not intended as a standard of medical care, nor should it be used as a substitute for physicians clinical judgment. It reflects the scientific literature and views of experts as of December 2009.
You may counsel your patient about driving when you Prescribe a new medication or change doses, treat Unstable medical condition or work up a new onset
The specific functional deficits related to crashes in the older adult were attention and cognition
The interpretation of Trail Making is very simple: a time of greater than 180 seconds is a failure. However, screening tests for dementia can result in false positives due to depression, visual impairment or metabolic disorders such as hypoglycemia. Medications can also interfere with cognitive function on a temporary basis . But if other false positives don ’t exist, dementia is likely and the patient may need to be reported to the DMV with or without further testing.
Not timed. Assess LTM, STM, visual perception, visuospatial skills , selective attention and executive skills Sensitivity and Specificity: 85% If used in combination with the three-word delayed-recall, sensitivity and specificity reach 93% Depression has little effect on clock drawing, although false positives can occur from depression or medication
2. ensure your patient understands the reasons (legal, healthy and safety).Use the term “driving retirement” vs “giving up”. Pt may benefit from the visual reinforcement of a rx with the words “Do Not Drive.” 4. . Asses pt ability to comply , transportation resources your patient has identified and look for signs of isolation or depression
Out of pocket money
Patient case. 77 yr old w/vascular dementia after stroke 3 yrs ago. MMSE 17/30.
Oct 2 2000
MENTION THE DRIVING MEDICAL EVALUATION FORM. Primarily used by Driver Safety, this five-page document assists hearing officers to evaluate the physical and/or mental condition(s) of the driver and to determine what action, if any, to take with regard to the driving privilege. :