This document discusses medical errors and misdiagnosis. It notes that one in five medical errors are potentially serious or fatal, and that the most common reasons for medical malpractice claims are surgery errors and diagnostic errors. Diagnostic errors account for many preventable deaths annually in the US. Some of the leading causes of misdiagnosis discussed include lack of healthcare professionals, poor teamwork and follow up, human cognitive factors, and too much focus on one exam finding. The document also provides strategies to reduce errors such as thorough history taking, physical exams, using diagnostic aids, and always following up on concerning symptoms.
PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
Definitions of terminology related to Medical Error (ME)
Levels of severity of medical error
Types & Examples of medical errors
Causes of ME
Disclosure of ME
Prevention of Medical Error
At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.
Experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but “because they were afraid to open up a can of worms they couldn't close.
Discussion post reply APA Format2 references for each discussiLyndonPelletier761
Discussion post reply
APA Format
2 references for each discussion post with intext citation.
Make it short and simple.
Post # one
Misty B
I have chosen to become a Psychiatric Mental Health Nurse Practitioner. I chose this path because I feel God is calling me to help guide and mentor people through this age of transition. With the increase of the digital age, social media specifically, and the COVID Pandemic, peoples’ mental health needs need to be cared for in a better manner than how they are currently being managed. “The role of the PMHNP is to assess, diagnose and treat the mental health needs of patients. Many PMHNPs provide therapy and prescribe medication for patients who have mental health disorders or substance abuse problems.” (American Association of Nurse Practitioners, n.d.) I believe your overall health begins with a healthy mind. When your mental health is not healthy you can spiral out of control and turn to substances (illicit drugs, alcohol, food, etc.) or self-harm. This can lead to other health problems such as obesity, diabetes, cardiovascular disorders, liver disorders, kidney disorders, etc. I feel as a PMHNP I will be able to start with the root cause of a patient’s overall health. I waxed and waned with my decision between a PMHNP and FNP. I feel starting with PMHNP is the best option for me at the moment and continuing afterward to have a dual certification as an FNP.
Professional Organization
“Another factor essential to a nurse’s professional development is active membership in 1 or more professional organization. Memberships provide exposure and access to education resources (eg, websites, webinars, publications, and conferences) and rewarding networking opportunities with peers and colleagues.” (Cherry et all, 2019)
Having been a member of the Emergency Nurses Association (ENA) for 8 years, I too feel it is important to become a member of your of an association for your nursing specialty. I have chosen to become a member of the American Psychiatric Nurses Association. Their mission statement and beliefs are parallel to my own.
APNA is committed to the practice of psychiatric-mental health nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with mental health disorders. APNA champions psychiatric-mental health nursing and mental health care through the development of positions on key issues, the dissemination of current knowledge and developments in PMH nursing, and collaboration with stakeholders to promote advances in recovery-focused assessment, diagnosis, treatment, and evaluation of persons with mental health disorders. (American Psychiatric Nurses Association, n.d.)
Becoming a member was as easy as going to their website www.apna.org and selecting your membership type, fill in the required information, and pay the fee. Being a member will give me access to educational oppo ...
PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
Definitions of terminology related to Medical Error (ME)
Levels of severity of medical error
Types & Examples of medical errors
Causes of ME
Disclosure of ME
Prevention of Medical Error
At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.
Experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but “because they were afraid to open up a can of worms they couldn't close.
Discussion post reply APA Format2 references for each discussiLyndonPelletier761
Discussion post reply
APA Format
2 references for each discussion post with intext citation.
Make it short and simple.
Post # one
Misty B
I have chosen to become a Psychiatric Mental Health Nurse Practitioner. I chose this path because I feel God is calling me to help guide and mentor people through this age of transition. With the increase of the digital age, social media specifically, and the COVID Pandemic, peoples’ mental health needs need to be cared for in a better manner than how they are currently being managed. “The role of the PMHNP is to assess, diagnose and treat the mental health needs of patients. Many PMHNPs provide therapy and prescribe medication for patients who have mental health disorders or substance abuse problems.” (American Association of Nurse Practitioners, n.d.) I believe your overall health begins with a healthy mind. When your mental health is not healthy you can spiral out of control and turn to substances (illicit drugs, alcohol, food, etc.) or self-harm. This can lead to other health problems such as obesity, diabetes, cardiovascular disorders, liver disorders, kidney disorders, etc. I feel as a PMHNP I will be able to start with the root cause of a patient’s overall health. I waxed and waned with my decision between a PMHNP and FNP. I feel starting with PMHNP is the best option for me at the moment and continuing afterward to have a dual certification as an FNP.
Professional Organization
“Another factor essential to a nurse’s professional development is active membership in 1 or more professional organization. Memberships provide exposure and access to education resources (eg, websites, webinars, publications, and conferences) and rewarding networking opportunities with peers and colleagues.” (Cherry et all, 2019)
Having been a member of the Emergency Nurses Association (ENA) for 8 years, I too feel it is important to become a member of your of an association for your nursing specialty. I have chosen to become a member of the American Psychiatric Nurses Association. Their mission statement and beliefs are parallel to my own.
APNA is committed to the practice of psychiatric-mental health nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with mental health disorders. APNA champions psychiatric-mental health nursing and mental health care through the development of positions on key issues, the dissemination of current knowledge and developments in PMH nursing, and collaboration with stakeholders to promote advances in recovery-focused assessment, diagnosis, treatment, and evaluation of persons with mental health disorders. (American Psychiatric Nurses Association, n.d.)
Becoming a member was as easy as going to their website www.apna.org and selecting your membership type, fill in the required information, and pay the fee. Being a member will give me access to educational oppo ...
Assessment of the Genitalia and RectumStudent Na.docxgalerussel59292
Assessment of the Genitalia and Rectum
Student Name
University
Course
Instructor
Date of Submission
Assessing the Genitalia and Rectum
Overview
Regularly, care providers are faced with various challenges that require knowledge and skills to address. As indicated by McBain, Pullon, Garrett, and Hoare (2016), it is not easy to evaluate the genitalia and make use of the evaluation in making and influencing a medical conclusion. Genitalia assessment is challenging at the point when a client visits a care facility giving unclear subjective information. Care providers should be equipped with adequate assessment and communications capabilities to enable them to gather objective data which is critical it the determination of the correct diagnosis (McBain, Pullon, Garrett & Hoare, 2016). This assignment aims to disintegrate the subjective and objective data that is provided and recommending additional information that ought to be included in the SOAP note. The process ought to match the present-day intuitive literature. Besides, the current literature-based proof will be availed. Analytic evaluation that is critical in the evaluation process will be assessed, and the patient's subjective data will be documented. This is aimed at supporting or disproving the evaluation. The care provider will uphold an analytical test by making use of pertinent health support regarding the importance of making an appropriate diagnosis. Finally, the paper will distinguish practical conclusions to take into consideration and justify each outcome, including the current diagnosis.
Analysis of subjective data
In this part, I will assess the subjective data regarding the subject situation. Subjective information incorporates the data that is availed by the client regarding his or her symptoms. Under normal circumstances, it incorporates perceptions, feelings, and concerns. Subjective information is critical since it provides the care provider with the patient's background concerning the purpose of the presentation. The therapists can understand the whole matter by giving ear to the patient (Colby et al., 2017). When the client is giving subjective information, the therapist is expected to take notes to have a better understanding of the patient's problem. The notes enhance the illustration of the patient's account. Patients have a better understanding of them thus listening giving ear to their problems will potentially facilitate a better outcome. Listening enhances the therapist to promote for the patients' needs appropriately. The client's objective data is as indicated below:
. CC: “There are bumps in my bottom which is would like to be assessed”
• HPI: MD is aged 21, and she is a BB college student. She presents at the care facility complaining of external bumps around her genital region. As per her report, the bumps are not painful but they are firm. She expresses that she is active sexually and that she had been involved in numerous sexual relationships ov.
Assessment of the Genitalia and RectumStudent Na.docxfestockton
Assessment of the Genitalia and Rectum
Student Name
University
Course
Instructor
Date of Submission
Assessing the Genitalia and Rectum
Overview
Regularly, care providers are faced with various challenges that require knowledge and skills to address. As indicated by McBain, Pullon, Garrett, and Hoare (2016), it is not easy to evaluate the genitalia and make use of the evaluation in making and influencing a medical conclusion. Genitalia assessment is challenging at the point when a client visits a care facility giving unclear subjective information. Care providers should be equipped with adequate assessment and communications capabilities to enable them to gather objective data which is critical it the determination of the correct diagnosis (McBain, Pullon, Garrett & Hoare, 2016). This assignment aims to disintegrate the subjective and objective data that is provided and recommending additional information that ought to be included in the SOAP note. The process ought to match the present-day intuitive literature. Besides, the current literature-based proof will be availed. Analytic evaluation that is critical in the evaluation process will be assessed, and the patient's subjective data will be documented. This is aimed at supporting or disproving the evaluation. The care provider will uphold an analytical test by making use of pertinent health support regarding the importance of making an appropriate diagnosis. Finally, the paper will distinguish practical conclusions to take into consideration and justify each outcome, including the current diagnosis.
Analysis of subjective data
In this part, I will assess the subjective data regarding the subject situation. Subjective information incorporates the data that is availed by the client regarding his or her symptoms. Under normal circumstances, it incorporates perceptions, feelings, and concerns. Subjective information is critical since it provides the care provider with the patient's background concerning the purpose of the presentation. The therapists can understand the whole matter by giving ear to the patient (Colby et al., 2017). When the client is giving subjective information, the therapist is expected to take notes to have a better understanding of the patient's problem. The notes enhance the illustration of the patient's account. Patients have a better understanding of them thus listening giving ear to their problems will potentially facilitate a better outcome. Listening enhances the therapist to promote for the patients' needs appropriately. The client's objective data is as indicated below:
. CC: “There are bumps in my bottom which is would like to be assessed”
• HPI: MD is aged 21, and she is a BB college student. She presents at the care facility complaining of external bumps around her genital region. As per her report, the bumps are not painful but they are firm. She expresses that she is active sexually and that she had been involved in numerous sexual relationships ov ...
The failure of a planned action to be completed as intended, or as the use of a wrong plan to achieve an aim.
A preventable adverse effect of care, whether or not it is evident or harmful to the patient.
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
Johns Hopkins Hospital doctors report that 40%-80% of chronic pain patient are misdiagnosed, and that MRIs and CTs miss pathology 56%-78% of the time, Therefore, during extensive chart reviews of current medical data will produce a classic case of GIGO-garbage in giving garbage out. The need for accurate diagnoses and testing is critical for AI to work.
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
The first of a 2-day class on Geriatric issues for nursing staff at all 4 Piedmont hospitals funded by a HRSA Comprehensive Geriatric Education Grant 2009-2012.
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Jwh018 / Jwh210
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Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
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Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Assessment of the Genitalia and RectumStudent Na.docxgalerussel59292
Assessment of the Genitalia and Rectum
Student Name
University
Course
Instructor
Date of Submission
Assessing the Genitalia and Rectum
Overview
Regularly, care providers are faced with various challenges that require knowledge and skills to address. As indicated by McBain, Pullon, Garrett, and Hoare (2016), it is not easy to evaluate the genitalia and make use of the evaluation in making and influencing a medical conclusion. Genitalia assessment is challenging at the point when a client visits a care facility giving unclear subjective information. Care providers should be equipped with adequate assessment and communications capabilities to enable them to gather objective data which is critical it the determination of the correct diagnosis (McBain, Pullon, Garrett & Hoare, 2016). This assignment aims to disintegrate the subjective and objective data that is provided and recommending additional information that ought to be included in the SOAP note. The process ought to match the present-day intuitive literature. Besides, the current literature-based proof will be availed. Analytic evaluation that is critical in the evaluation process will be assessed, and the patient's subjective data will be documented. This is aimed at supporting or disproving the evaluation. The care provider will uphold an analytical test by making use of pertinent health support regarding the importance of making an appropriate diagnosis. Finally, the paper will distinguish practical conclusions to take into consideration and justify each outcome, including the current diagnosis.
Analysis of subjective data
In this part, I will assess the subjective data regarding the subject situation. Subjective information incorporates the data that is availed by the client regarding his or her symptoms. Under normal circumstances, it incorporates perceptions, feelings, and concerns. Subjective information is critical since it provides the care provider with the patient's background concerning the purpose of the presentation. The therapists can understand the whole matter by giving ear to the patient (Colby et al., 2017). When the client is giving subjective information, the therapist is expected to take notes to have a better understanding of the patient's problem. The notes enhance the illustration of the patient's account. Patients have a better understanding of them thus listening giving ear to their problems will potentially facilitate a better outcome. Listening enhances the therapist to promote for the patients' needs appropriately. The client's objective data is as indicated below:
. CC: “There are bumps in my bottom which is would like to be assessed”
• HPI: MD is aged 21, and she is a BB college student. She presents at the care facility complaining of external bumps around her genital region. As per her report, the bumps are not painful but they are firm. She expresses that she is active sexually and that she had been involved in numerous sexual relationships ov.
Assessment of the Genitalia and RectumStudent Na.docxfestockton
Assessment of the Genitalia and Rectum
Student Name
University
Course
Instructor
Date of Submission
Assessing the Genitalia and Rectum
Overview
Regularly, care providers are faced with various challenges that require knowledge and skills to address. As indicated by McBain, Pullon, Garrett, and Hoare (2016), it is not easy to evaluate the genitalia and make use of the evaluation in making and influencing a medical conclusion. Genitalia assessment is challenging at the point when a client visits a care facility giving unclear subjective information. Care providers should be equipped with adequate assessment and communications capabilities to enable them to gather objective data which is critical it the determination of the correct diagnosis (McBain, Pullon, Garrett & Hoare, 2016). This assignment aims to disintegrate the subjective and objective data that is provided and recommending additional information that ought to be included in the SOAP note. The process ought to match the present-day intuitive literature. Besides, the current literature-based proof will be availed. Analytic evaluation that is critical in the evaluation process will be assessed, and the patient's subjective data will be documented. This is aimed at supporting or disproving the evaluation. The care provider will uphold an analytical test by making use of pertinent health support regarding the importance of making an appropriate diagnosis. Finally, the paper will distinguish practical conclusions to take into consideration and justify each outcome, including the current diagnosis.
Analysis of subjective data
In this part, I will assess the subjective data regarding the subject situation. Subjective information incorporates the data that is availed by the client regarding his or her symptoms. Under normal circumstances, it incorporates perceptions, feelings, and concerns. Subjective information is critical since it provides the care provider with the patient's background concerning the purpose of the presentation. The therapists can understand the whole matter by giving ear to the patient (Colby et al., 2017). When the client is giving subjective information, the therapist is expected to take notes to have a better understanding of the patient's problem. The notes enhance the illustration of the patient's account. Patients have a better understanding of them thus listening giving ear to their problems will potentially facilitate a better outcome. Listening enhances the therapist to promote for the patients' needs appropriately. The client's objective data is as indicated below:
. CC: “There are bumps in my bottom which is would like to be assessed”
• HPI: MD is aged 21, and she is a BB college student. She presents at the care facility complaining of external bumps around her genital region. As per her report, the bumps are not painful but they are firm. She expresses that she is active sexually and that she had been involved in numerous sexual relationships ov ...
The failure of a planned action to be completed as intended, or as the use of a wrong plan to achieve an aim.
A preventable adverse effect of care, whether or not it is evident or harmful to the patient.
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
Johns Hopkins Hospital doctors report that 40%-80% of chronic pain patient are misdiagnosed, and that MRIs and CTs miss pathology 56%-78% of the time, Therefore, during extensive chart reviews of current medical data will produce a classic case of GIGO-garbage in giving garbage out. The need for accurate diagnoses and testing is critical for AI to work.
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
The first of a 2-day class on Geriatric issues for nursing staff at all 4 Piedmont hospitals funded by a HRSA Comprehensive Geriatric Education Grant 2009-2012.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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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
2. deviation of the doctor or medical
professional from a generally
accepted standard of care That
may cause harm to the patient or
loss.
Dr. mostafa al wakil
3. And patients are increasingly backed by favorable legal developments. .
Another major contributing factor is the substantial increase in costs of
health care.
Dr. mostafa al wakil
4. There was time when doctors were given
a ‗GODLIKE‘ status and were held in the
highest esteem; and patients were intended
to be, well patient; passive and submissive.
But this has changed and Doctors are no
longer regarded as infallible and beyond
questioning
ALL
Dr. mostafa al wakil
6. ONE IN FIVE MEDICAL ERRORS ARE POTENIALLY
SERIOUS OR FATAL
Source: ncbi.nim.nih.gov
Dr. mostafa al wakil
7. Most common reasons for medical
malpractice claims
34% -surgery errors
46% -diagnostic errors
Dr. mostafa al wakil
8. Johns Hopkins researchers reported
Findings
Diagnosis errors account for 160,000
deaths annually in the USA
Source: National Center for Policy Analysis
Dr. mostafa al wakil
9. About 195,000 patients in the U.S. die from
preventable Misdiagnosis accounts for an
estimated errors in-hospitals each year
David Newman-Toker, M.D., Ph.D.
Source: National Center for Policy Analysis
Dr. mostafa al wakil
10. 28%of 583 diagnostic mistakes reported
anonymously by doctors were life-
threatening or had resulted in death or
permanent disability
Source: National Center for Policy Analysis
Dr. mostafa al wakil
11. Egypt
In a study made
in 2015 in Dakhalia and Damietta Governorates: A 10
Year Evaluation The number of claims over the 10
years period was 1355 claims. there are significant
increases in reporting the medical error in private and
central hospitals than university hospitals
Distribution of Total Medical Claims
According to the Type of Hospital
Dr. mostafa al wakil
13. What is Diagnosis ?
Diagnosis is The identification by a medical provider of a condition, disease,
or injury made by evaluating the symptoms and signs presented by a patient.
Diagnostic errors can lead to patient harm from wrong or delayed
testing or treatment.
For example
Globally, misdiagnoses may contribute to the nearly 7 million children who die
each year, mainly from preventable causes
Misdiagnosis (erroneous diagnosis)
Definition of misdiagnosis
It is the failure to (a) establish an accurate and timely
explanation of the patient’s health problem(s)
or (b) communicate that explanation to the patient
Dr. mostafa al wakil
15. A cognitive system is a one that performs the cognitive work of knowing,
understanding, planning, deciding, problem solving, analyzing,
synthesizing, assessing, and judging as they are fully integrated with
perceiving and acting. and is consisting of two systems
System 1 and System 2 are two distinct modes of decision making: System 1 is an
automatic, fast and often unconscious way of thinking. It is autonomous and
efficient, requiring little energy or attention, but is prone to biases and systematic
errors. System 2 is an effortful, slow and controlled way of thinking
Inmedicine, most of our errors occur whilst in the intuitive (system 1)
mode of thinking…..
System 2
System 1 Dr. mostafa al wakil
16. Misdiagnosis has three major categories :
1-False positive : misdiagnosis of a disease that is not actually present
2-False negative : failure to diagnose a disease that is present
3-Equivocal results : inconclusive interpretations without a definite diagnosis
Overdiagnosis also has been described as “when a condition is
diagnosed that would otherwise not go on to cause symptoms or death”
(Welch and Black, 2010, p. 605).
it can lead to treatment that may cause harm.
Dr. mostafa al wakil
17. 1-Lack of sufficient, competent health care
professionals, for example, due to lack of training.
2-Poor teamwork, lack of learning and feedback when
errors occur.
3-Limited follow-up reduces the ability for diagnostic
impressions to evolve. Lack of follow up may lead to misdiagnosis as
some diseases start with symptoms or signs and after certain period may give
another symptoms or signs or even different picture even complications of
diseases or surgery or some procedures appears later
4-Human factors and cognitive issues
The work environment and systems may be
subject to distractions, interruptions and a lack of
organization of information.
5-Too much attention to one finding during the
examination
6-Influenced by similar case ( WHO 2016 )
causes of misdiagnosis
Dr. mostafa al wakil
18. 13,000 known diseases, syndromes, injuries
4,000 possible tests
6,000 medications, treatments, and surgeries
Complexity
in Medicine
The average limits of
human working memory:
7 discrete items
Dr. mostafa al wakil
19. At-risk categories of harmful diagnostic errors
Infections
Viral infections Often misdiagnosed as bacterial and result in unnecessary
antibiotics
Cardiovascular disease
Myocardial infarction, stroke
Subtle premonitory symptoms at first-contact settings often missed
Delays in diagnosis prevalent in predisposing conditions, including type 2
diabetes (median delay >2 years; 7% remained undiagnosed at 7.5 years)
and hypertension
Cancer
Several cancer types
Alarm symptoms often poorly predictive low signal-to-noise ratio. Cancer
can be in differential of many common symptoms including headache, weight
loss, bleeding, pain
Pediatrics
suggests meningitis, gastroenteritis, pneumonia, appendicitis, sepsis and malignancy
Meningococcal disease
Misdiagnoses may contribute to the nearly 7 million children who die each
year, largely from preventable causes
viral infections diagnosed as bacterial infections, appendicitis ,hypertension and psychiatric
disorders
Dr. mostafa al wakil
20. Outcomes
They are considered as missed opportunities to make a correct or timely
diagnosis based on available evidence. The missed opportunity may
result from cognitive or system factors or both. To reduce hindsight bias,
there should be evidence of omission (failure to do the right thing) or
commission (doing something wrong) at the point in time at which the
error occurred (5,6). Figure 1 depicts the relationship between diagnostic
errors, missed opportunities and patient harm. Opportunities could be
missed by providers, care teams, systems or the patient.
Figure 1. Conceptual model of missed opportunities in diagnosis
Dr. mostafa al wakil
21. History is the most important part of diagnosis.
Omission of certain points in the history can lead to a
confusing clinical situation and unnecessary
investigations.
It is told that the chief complaints are to be written
in the words of the patient. But always it will not be
possible. In fact in most of the situations it is not
possible. Our patients complain in their local
language not in scientific words. At times it becomes
difficult to understand their complaint even in the
local language. So physician should first try to
understand the complaint clearly and then convert it
into a scientifically meaningful word without altering
the meaning
Dr. mostafa al wakil
22. A careful physical exam can help a clinician
refine the next steps in the diagnostic
process, can prevent unnecessary diagnostic
testing, and can aid in building trust with
the patient.
Healthcare providers have a duty to provide
information in simple, clear, and plain language and
to check that patients have understood the
information before ending the conversation
Dr. mostafa al wakil
23. V ascular
I nfections & intoxications
T rauma & toxins
A uto-immune
M etabolic
I diopathic & iatrogenic
N eoplastic
C ongenital
C onversion (psychiatric)
D egenerative
Use mnemonics and tricks:
Dr. mostafa al wakil
24. postmortem exams play a critical role in
understanding the epidemiology of diagnostic
errors
Teamwork in the diagnostic process involves the
collaboration of patients and their families; diagnosticians,
such as physicians, physician assistants
(PAs), and advanced practice nurses (APNs);
and health care professionals who support the diagnostic
process, such as nurses, pharmacists, laboratory
scientists, radiology technologists, medical assistants, and
patient navigators
Dr. mostafa al wakil
25. Medical imaging is characterized not just by
the increasingly precise anatomic detail it
offers but also by an increasing capacity to
illuminate biology.
Lab investigations and imaging
Diagnostic Test and Screening Test
A diagnostic testis used to determine the presence or absence of a
disease when a subject shows signs or symptoms of the disease
A screening test identifies asymptomatic individuals who may
have the disease
The diagnostic test is performed after positive screening test to
establish a definitive diagnosis
Dr. mostafa al wakil
26. diagnostic endoscopies
An endoscopy (looking inside) is used in medicine to look inside
the body. The endoscopy procedure uses an endoscope to
examine the interior of a hollow organ or cavity of the body.
Unlike many other medical imaging techniques, endoscopes are
inserted directly into the organ. it is used to diagnose , and treat
, usually it gives a confirmatory diagnosis in case of highly
suspicious diseases Dr. mostafa al wakil
27. A patient saw a family NP for a complaint of discharge and constant scabbing
of one of her nipples, of several months duration. The NP ordered topical
and oral antibiotics and a mammogram, which was negative. The patient
return seven months later with continuation of pain and discharge from the
same nipple. The NP referred the patient to a dermatologist. The patient
did not see the dermatologist. Four months later, the patient saw her
gynecologist, who again treated her breast symptoms with antibiotics, and
assured her that she did not have cancer. The patient saw the NP several
more times the year following the first visit. Eighteen months after the first
visit, the patient came to the NP with unmistakable masses in her breast.
The NP referred the patient to a surgical oncologist who diagnosed Paget’s
disease. The cancer had metastasized and the patient died shortly after the
diagnosis. The court said all three providers breached the standard of care.
Q. What the NP can learn from this case?
A. Always follow up on symptoms from the past.
Dr. mostafa al wakil
28. A 35-year-old woman visited a primary care physician’s office for various ailments in
2001 and 2002. She saw a primary care physician twice and a NP four times. The
patient had a history of spleenectomy in 1985. She had received a pneumovax
following the procedure. She not receive Haemophilus or meningococcal vaccine.
Subsequent to 2002 the patient developed a pneumococcal infection which called
for a 3-month hospitalization and a 2-month stay in a rehab facility. During her
hospitalization she became septic, suffered organ failure, and necrosis of her toes.
She can now walk only short distances and suffered from chronic infections and
pain. The patient/plaintiff contended that the standard of care required the
defendants to revaccinate the patient with a pneumovax booster due to her
asplenia. The plaintiff contended that if the defendants had complied with the
accepted standard of care, then she would have avoided her subsequent
pneumococcal infection. The clinicians argued that the patient’s visits had all been
for acute sick visits, not annual preventive and wellness physicians, which did not
provide them with the opportunity to recommend or administer a pneumococcal
vaccination. The parties reached a $3M settlement.
Q. What the NP can learn from this case?
A. Always perform a health-maintenance screen after every visit.
Dr. mostafa al wakil
29. Use direct quotes to
demonstrate your attention
to the patient, highlight
main areas of concern, build
credibility into the record,
and accurately document a
patient’s competency,
affect, and attitude. For
example: “I have been to
12 doctors and no one can
help me”.
Dr. mostafa al wakil
30. 1. Be careful about establishing patient-
provider relationships. Giving medical
advice?exercise caution and use
reasonably ordinary care
2. Know the standard of care and practice
within it
3. Follow your practice guidelines
4. If in doubt use the conservative approach
5. Rule out the worst diagnoses early on
6. Know the limits of training and expertise
7. Follow up
Dr. mostafa al wakil
31. ‘Good doctors are not
those who don’t make
mistakes; good doctors
are those who expect to
make mistakes and act on
that expectation.’
James Reason
Dr. mostafa al wakil
32. Malpractice litigation is said to target “bad” physicians and to be a
necessary
adjunct to regulatory and professional discipline (11), yet nearly
one in five doctors reports a malpractice claim annually and one-
third to
one-half of high-risk specialists face a claim every year. Are they all
bad
doctors?
Ref
11. Nace BJ, Stewart LS. Straight talk on medical malpractice.
American Trial Lawyers
Association, 1994:20.
12. Harming Patient Access to Care: Implications of Excessive
Litigation. Subcommittee
on Health, Committee on Energy and Commerce, US House of
Representatives.
Washington, DC: U.S. Government Printing Office, 2002:160.
Dr. mostafa al wakil