The document provides guidance for medical residents on handling on-call duties, including tips for sign-out, answering calls, and protocols for managing the five most common and five scariest call scenarios. It outlines approaches for prioritizing tasks, responding to and triaging calls, and standardized processes for issues like insomnia, nausea, pain, constipation, high blood pressure, NPO restrictions, patients leaving AMA, abnormal heart rhythms, and managing insulin. The goal is to equip residents with effective strategies and decision-making frameworks for their on-call responsibilities.
This document outlines the structure and approach for presenting and discussing a patient case, including defining the problem representation, generating a differential diagnosis, presenting pertinent history, exam findings, labs/imaging, investigations, diagnosis, and management. Key aspects include updating the problem representation and differential with each new piece of information, and separating the diagnostic "signal" from irrelevant "noise".
This document provides guidance on various trauma and critical care topics. It discusses:
1. The benefits of early tourniquet use and ketamine for pain control in trauma patients.
2. Recommendations for use of TEG/Rotem, TXA, and fluid resuscitation in massive transfusion patients.
3. Tips for estimating burn severity and fluid resuscitation in burn patients.
This document discusses challenges related to rationing care and crisis standards during the COVID-19 pandemic. It presents two cases where a hospital is at capacity and needs to decide whether to remove a patient from a ventilator or withhold intubation to reallocate the ventilator to other patients with better prognoses. It also discusses the ethics of prioritizing the needs of individual patients versus the wider population and proposes establishing crisis triage teams to make difficult resource allocation decisions impartially. The document further examines precedents for rationing healthcare resources like dialysis and transplants as well as who should receive priority for scarce COVID vaccines. It also outlines Utah's crisis standards of care plan implemented by the governor during public health emergencies
perio mngmnt in pts with cardiac diseases.pptxAshokKp4
This document discusses the management of periodontal treatment for patients with cardiac diseases. It begins with an introduction noting the increased prevalence of medically compromised dental patients. It then covers the classification of patients based on American Society of Anesthesiologists guidelines. Several cardiac conditions are discussed, including hypertension, ischemic heart disease, congestive heart failure, and arrhythmias. Guidelines are provided for managing dental treatment for patients with these conditions, focusing on reducing stress and risk of infection. The document concludes that periodontal disease is a risk factor for cardiovascular disease, and treating periodontal disease can reduce this risk.
Acute care physical therapy involves treating patients in hospitals for short term care due to illness, trauma, surgery or accidents. The goal is timely discharge once medically stable. While fewer PTs/PTAs work in acute care compared to outpatient, salaries average $48,590 annually. Common diagnoses include joint replacements, cardiac disorders and stroke. Treatments focus on musculoskeletal, neuromuscular and cardiopulmonary systems. Acute care requires quick evaluation and treatment due to short patient stays.
1. The document discusses hypertension in young patients from an endocrinologist's perspective and presents 5 case studies.
2. Case 1 involves a 25-year-old male with high blood pressure found on a pre-employment checkup, prompting evaluation for secondary causes of hypertension.
3. Case 2 is a 35-year-old male with signs and symptoms of Cushing's syndrome, which can cause high blood pressure.
This document outlines the structure and approach for presenting and discussing a patient case, including defining the problem representation, generating a differential diagnosis, presenting pertinent history, exam findings, labs/imaging, investigations, diagnosis, and management. Key aspects include updating the problem representation and differential with each new piece of information, and separating the diagnostic "signal" from irrelevant "noise".
This document provides guidance on various trauma and critical care topics. It discusses:
1. The benefits of early tourniquet use and ketamine for pain control in trauma patients.
2. Recommendations for use of TEG/Rotem, TXA, and fluid resuscitation in massive transfusion patients.
3. Tips for estimating burn severity and fluid resuscitation in burn patients.
This document discusses challenges related to rationing care and crisis standards during the COVID-19 pandemic. It presents two cases where a hospital is at capacity and needs to decide whether to remove a patient from a ventilator or withhold intubation to reallocate the ventilator to other patients with better prognoses. It also discusses the ethics of prioritizing the needs of individual patients versus the wider population and proposes establishing crisis triage teams to make difficult resource allocation decisions impartially. The document further examines precedents for rationing healthcare resources like dialysis and transplants as well as who should receive priority for scarce COVID vaccines. It also outlines Utah's crisis standards of care plan implemented by the governor during public health emergencies
perio mngmnt in pts with cardiac diseases.pptxAshokKp4
This document discusses the management of periodontal treatment for patients with cardiac diseases. It begins with an introduction noting the increased prevalence of medically compromised dental patients. It then covers the classification of patients based on American Society of Anesthesiologists guidelines. Several cardiac conditions are discussed, including hypertension, ischemic heart disease, congestive heart failure, and arrhythmias. Guidelines are provided for managing dental treatment for patients with these conditions, focusing on reducing stress and risk of infection. The document concludes that periodontal disease is a risk factor for cardiovascular disease, and treating periodontal disease can reduce this risk.
Acute care physical therapy involves treating patients in hospitals for short term care due to illness, trauma, surgery or accidents. The goal is timely discharge once medically stable. While fewer PTs/PTAs work in acute care compared to outpatient, salaries average $48,590 annually. Common diagnoses include joint replacements, cardiac disorders and stroke. Treatments focus on musculoskeletal, neuromuscular and cardiopulmonary systems. Acute care requires quick evaluation and treatment due to short patient stays.
1. The document discusses hypertension in young patients from an endocrinologist's perspective and presents 5 case studies.
2. Case 1 involves a 25-year-old male with high blood pressure found on a pre-employment checkup, prompting evaluation for secondary causes of hypertension.
3. Case 2 is a 35-year-old male with signs and symptoms of Cushing's syndrome, which can cause high blood pressure.
This document provides an overview of preeclampsia and eclampsia. It begins with definitions of preeclampsia, classifications, risk factors and pathophysiology. It then discusses specific conditions like HELLP syndrome and eclampsia in more detail, providing their definitions, symptoms, management and complications. The document concludes with introducing topics that will be covered in more depth, including prediction and prevention of preeclampsia, investigations and management approaches for non-severe and severe preeclampsia.
The document summarizes updates made to the 2016 Southwest Ohio Pre Hospital Protocol by the Protocol Subcommittee of the Academy of Medicine of Cincinnati. It includes minor grammatical changes, additions of new protocols for infectious disease and pain management, updates to trauma and cardiac arrest protocols, additions of medications for conditions like asthma and heart failure, and clarification of procedures. It provides direction on renewing the drug license and finalizing approval of the updated protocols.
This document is a clerkship manual for house officers at the Hospital Tengku Ampuan Rahimah in Klang, Malaysia. It provides guidance on clerking skills and outlines questions to ask patients based on their main presenting complaints. The manual emphasizes the importance of both history taking and physical examination skills. It also stresses taking a comprehensive history, including premorbid conditions, medications, allergies, family history, and social/personal details. The goal is to help house officers improve patient care, learning, and ability to reach accurate diagnoses by considering all relevant information.
The document discusses gum disease (periodontitis) and provides information about its stages and characteristics. It defines key terms like plaque, inflammation, and periodontal pockets. It then describes the four stages of periodontitis from mild to very severe, noting clinical characteristics like bleeding, pocket depth, and bone loss for each stage. Finally, it discusses grading the rate of periodontitis progression and providing a diagnosis statement addressing extent, stage, grade, and identified risk factors.
Family Medicine Mini-OSCE exams juh.pptxAlaaJaibat1
This document contains a summary of a family medicine archive from May 5, 2023 containing 13 questions on various medical topics. The questions cover diabetes mellitus screening and diagnosis criteria, signs of abdominal pain, diagnosis and management of vestibular neuritis, initial management of hypertension in a doctor, diagnosis and treatment of inferior STEMI, management of chronic fatigue syndrome, management of dyslipidemia in a patient with a history of heart attack, diagnosis and aggravating factors of cluster headaches, recommended adult vaccines and cancer screenings, use of the Timed Up and Go test in geriatric patients, explanation of the Katz index scoring system for functional impairment, risk factors and prevention of osteoporosis, diagnosis of epiglott
This document presents the case of a 31-year-old female patient who presented with symptoms of systemic lupus erythematosus (SLE) including malar rash, joint pains, and fever for 2 months, as well as depression for 3 months. On examination, she was found to have malar rash and macular erythema. Laboratory tests confirmed positive ANA and anti-dsDNA antibodies. She was diagnosed with SLE with depression and treated with intravenous methylprednisolone followed by oral prednisone, azathioprine, and clonazepam. Her symptoms improved but she reported alopecia and GI symptoms at follow up, so her medications were continued and escitalop
This document provides guidance on various topics for managing hospitalized patients including:
- Hypertensive urgency vs. emergency and appropriate treatment approaches
- Evaluating and treating chest pain
- Managing pain while hospitalized
- Addressing patients who want to leave against medical advice
- Assessing and treating agitation, delirium, electrolyte imbalances, nausea/vomiting, and seizures
The document emphasizes using oral medications when possible, thorough evaluation of new symptoms, reviewing medications that could be causing issues, and consulting with seniors/experts as needed for more complex cases.
This document provides guidance on writing admission orders for patients to the hospital. It outlines the key components of admission orders, labeled as ADCVANDIML, that should be included. These components are: admitting service, diagnosis, condition, vitals, activity, nursing orders, diet, IV fluids, medications, labs, and "Call HO" with parameters to notify the physician of changes. The document emphasizes including rationale for tests and only ordering those that will change treatment. It stresses communication and respect between physicians and nursing staff.
Dr. KEN-LIAO LIU 劉耿僚 Pitfalls & Modifications of FDG PET-CT in Head & Neck...Ken Liao Liu
1. The document discusses common pitfalls of 18F-FDG PET/CT in head and neck oncology such as inflammation, infection, and partial volume averaging effects.
2. It provides modifications to avoid pitfalls including using a neck collar, keeping the patient quiet and warm, massaging salivary glands, and having head and neck surgeons interpret scans.
3. Proper patient preparation before PET/CT and being aware of common pitfalls are emphasized.
This document provides information on ischemic stroke through a case study format. It discusses the types and causes of stroke, risk factors, signs and symptoms, diagnostic studies, treatment goals, and methods for prevention. The key points are:
- Ischemic stroke is caused by a blockage in a brain blood vessel and accounts for 87% of strokes. Common causes are fatty deposits forming blood clots or traveling particles blocking small vessels.
- Risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, obesity, and oral contraceptive use.
- Symptoms vary depending on the affected area of the brain but may include weakness, confusion, visual issues, difficulty walking, and severe
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
1) A 50-year-old female patient presented with left orbital edema and pain in the nose and head after a fall from a motorcycle. Examination revealed maxillary trauma with a left maxillary sinus cortical cyst.
2) She underwent rhinoplastic surgery and was discharged on medications after three days with instructions to follow-up after one week.
3) Facial trauma treatment involves ensuring the airway is open, administering antibiotics and pain killers, setting fractures, and sometimes surgery depending on the type and severity of injuries.
A case study on appendicitis / a case presentation on appendicitismartinshaji
A condition in which the appendix becomes inflamed and filled with pus, causing pain.
The appendix is a pouch-like structure attached at the start of the large intestine that has no known purpose.
Appendicitis begins with fever and pain near the belly button and then moves toward the lower-right side of the abdomen. This is often accompanied by nausea, vomiting, loss of appetite, fever and chills.
Appendicitis is usually treated with antibiotics and surgery is required within 24 hours of its diagnosis. If untreated, the appendix can rupture and cause an abscess or systemic infection (sepsis).
i have already done a detailed study on appendicitis , and giving the link below
https://www.slideshare.net/martinshaji/appendix-appendicitis-medical-information
please comment
thank u
The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with shock.
- Criteria for diagnosing myocardial infarction on ECGs.
- Adverse skin reactions to medications.
- Factors that can contribute to surgical errors.
- A charity that connects doctors with people who have disabilities.
The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with illnesses like malaria.
- Criteria for diagnosing STEMI using EKG findings.
- Severe cutaneous adverse reactions to drugs like allopurinol and anti-epileptics.
- Factors to consider when assessing prognosis after cardiac arrest and resuscitation.
- Avoiding supplemental oxygen for STEMI patients.
- A charity that connects doctors with people who have disabilities.
This baby needs prostaglandin infusion urgently.
The chest X-ray shows oligemic lung fields suggesting decreased pulmonary blood flow. The clinical features of cyanosis, tachycardia, weak pulses and metabolic acidosis point towards ductal dependant circulation.
Prostaglandin infusion will help open the ductus arteriosus and improve pulmonary blood flow which is critical for survival in this neonate. Ventilator support, inotropes and antibiotics/antifungals may also be needed. An urgent echocardiogram will help identify the underlying cardiac lesion.
The key is to recognize this is not pneumonia but a ductal dependant cardiac lesion and start prostaglandin without delay.
This document provides an overview of preeclampsia and eclampsia. It begins with definitions of preeclampsia, classifications, risk factors and pathophysiology. It then discusses specific conditions like HELLP syndrome and eclampsia in more detail, providing their definitions, symptoms, management and complications. The document concludes with introducing topics that will be covered in more depth, including prediction and prevention of preeclampsia, investigations and management approaches for non-severe and severe preeclampsia.
The document summarizes updates made to the 2016 Southwest Ohio Pre Hospital Protocol by the Protocol Subcommittee of the Academy of Medicine of Cincinnati. It includes minor grammatical changes, additions of new protocols for infectious disease and pain management, updates to trauma and cardiac arrest protocols, additions of medications for conditions like asthma and heart failure, and clarification of procedures. It provides direction on renewing the drug license and finalizing approval of the updated protocols.
This document is a clerkship manual for house officers at the Hospital Tengku Ampuan Rahimah in Klang, Malaysia. It provides guidance on clerking skills and outlines questions to ask patients based on their main presenting complaints. The manual emphasizes the importance of both history taking and physical examination skills. It also stresses taking a comprehensive history, including premorbid conditions, medications, allergies, family history, and social/personal details. The goal is to help house officers improve patient care, learning, and ability to reach accurate diagnoses by considering all relevant information.
The document discusses gum disease (periodontitis) and provides information about its stages and characteristics. It defines key terms like plaque, inflammation, and periodontal pockets. It then describes the four stages of periodontitis from mild to very severe, noting clinical characteristics like bleeding, pocket depth, and bone loss for each stage. Finally, it discusses grading the rate of periodontitis progression and providing a diagnosis statement addressing extent, stage, grade, and identified risk factors.
Family Medicine Mini-OSCE exams juh.pptxAlaaJaibat1
This document contains a summary of a family medicine archive from May 5, 2023 containing 13 questions on various medical topics. The questions cover diabetes mellitus screening and diagnosis criteria, signs of abdominal pain, diagnosis and management of vestibular neuritis, initial management of hypertension in a doctor, diagnosis and treatment of inferior STEMI, management of chronic fatigue syndrome, management of dyslipidemia in a patient with a history of heart attack, diagnosis and aggravating factors of cluster headaches, recommended adult vaccines and cancer screenings, use of the Timed Up and Go test in geriatric patients, explanation of the Katz index scoring system for functional impairment, risk factors and prevention of osteoporosis, diagnosis of epiglott
This document presents the case of a 31-year-old female patient who presented with symptoms of systemic lupus erythematosus (SLE) including malar rash, joint pains, and fever for 2 months, as well as depression for 3 months. On examination, she was found to have malar rash and macular erythema. Laboratory tests confirmed positive ANA and anti-dsDNA antibodies. She was diagnosed with SLE with depression and treated with intravenous methylprednisolone followed by oral prednisone, azathioprine, and clonazepam. Her symptoms improved but she reported alopecia and GI symptoms at follow up, so her medications were continued and escitalop
This document provides guidance on various topics for managing hospitalized patients including:
- Hypertensive urgency vs. emergency and appropriate treatment approaches
- Evaluating and treating chest pain
- Managing pain while hospitalized
- Addressing patients who want to leave against medical advice
- Assessing and treating agitation, delirium, electrolyte imbalances, nausea/vomiting, and seizures
The document emphasizes using oral medications when possible, thorough evaluation of new symptoms, reviewing medications that could be causing issues, and consulting with seniors/experts as needed for more complex cases.
This document provides guidance on writing admission orders for patients to the hospital. It outlines the key components of admission orders, labeled as ADCVANDIML, that should be included. These components are: admitting service, diagnosis, condition, vitals, activity, nursing orders, diet, IV fluids, medications, labs, and "Call HO" with parameters to notify the physician of changes. The document emphasizes including rationale for tests and only ordering those that will change treatment. It stresses communication and respect between physicians and nursing staff.
Dr. KEN-LIAO LIU 劉耿僚 Pitfalls & Modifications of FDG PET-CT in Head & Neck...Ken Liao Liu
1. The document discusses common pitfalls of 18F-FDG PET/CT in head and neck oncology such as inflammation, infection, and partial volume averaging effects.
2. It provides modifications to avoid pitfalls including using a neck collar, keeping the patient quiet and warm, massaging salivary glands, and having head and neck surgeons interpret scans.
3. Proper patient preparation before PET/CT and being aware of common pitfalls are emphasized.
This document provides information on ischemic stroke through a case study format. It discusses the types and causes of stroke, risk factors, signs and symptoms, diagnostic studies, treatment goals, and methods for prevention. The key points are:
- Ischemic stroke is caused by a blockage in a brain blood vessel and accounts for 87% of strokes. Common causes are fatty deposits forming blood clots or traveling particles blocking small vessels.
- Risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, obesity, and oral contraceptive use.
- Symptoms vary depending on the affected area of the brain but may include weakness, confusion, visual issues, difficulty walking, and severe
Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
1) A 50-year-old female patient presented with left orbital edema and pain in the nose and head after a fall from a motorcycle. Examination revealed maxillary trauma with a left maxillary sinus cortical cyst.
2) She underwent rhinoplastic surgery and was discharged on medications after three days with instructions to follow-up after one week.
3) Facial trauma treatment involves ensuring the airway is open, administering antibiotics and pain killers, setting fractures, and sometimes surgery depending on the type and severity of injuries.
A case study on appendicitis / a case presentation on appendicitismartinshaji
A condition in which the appendix becomes inflamed and filled with pus, causing pain.
The appendix is a pouch-like structure attached at the start of the large intestine that has no known purpose.
Appendicitis begins with fever and pain near the belly button and then moves toward the lower-right side of the abdomen. This is often accompanied by nausea, vomiting, loss of appetite, fever and chills.
Appendicitis is usually treated with antibiotics and surgery is required within 24 hours of its diagnosis. If untreated, the appendix can rupture and cause an abscess or systemic infection (sepsis).
i have already done a detailed study on appendicitis , and giving the link below
https://www.slideshare.net/martinshaji/appendix-appendicitis-medical-information
please comment
thank u
The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with shock.
- Criteria for diagnosing myocardial infarction on ECGs.
- Adverse skin reactions to medications.
- Factors that can contribute to surgical errors.
- A charity that connects doctors with people who have disabilities.
The document discusses various medical topics including:
- Studies on fluid resuscitation in children in Africa with illnesses like malaria.
- Criteria for diagnosing STEMI using EKG findings.
- Severe cutaneous adverse reactions to drugs like allopurinol and anti-epileptics.
- Factors to consider when assessing prognosis after cardiac arrest and resuscitation.
- Avoiding supplemental oxygen for STEMI patients.
- A charity that connects doctors with people who have disabilities.
This baby needs prostaglandin infusion urgently.
The chest X-ray shows oligemic lung fields suggesting decreased pulmonary blood flow. The clinical features of cyanosis, tachycardia, weak pulses and metabolic acidosis point towards ductal dependant circulation.
Prostaglandin infusion will help open the ductus arteriosus and improve pulmonary blood flow which is critical for survival in this neonate. Ventilator support, inotropes and antibiotics/antifungals may also be needed. An urgent echocardiogram will help identify the underlying cardiac lesion.
The key is to recognize this is not pneumonia but a ductal dependant cardiac lesion and start prostaglandin without delay.
This document provides an overview of arrhythmias for medical residents. It outlines an approach to classifying arrhythmias based on rate, regularity, and QRS width. Specific arrhythmias covered include sinus bradycardia, atrial fibrillation, atrial flutter, AV nodal reentrant tachycardia, ventricular tachycardia, and various types of heart block. The document also discusses how to determine if a wide complex tachycardia requires cardioversion or defibrillation versus medical treatment. Examples of EKGs are provided for different arrhythmias.
This document provides an introduction to EKG interpretation and outlines the systematic approach of evaluating an EKG. It covers the key components to assess, including rate, rhythm, axis, conduction abnormalities, and morphology. Specific conditions are reviewed such as sinus rhythm, bundle branch blocks, AV blocks, ischemia, and infarction. Examples are provided throughout to demonstrate application of the principles. The overall goal is to understand the fundamentals of the EKG and systematically analyze it following the standard approach of rate, rhythm, axis, conduction, morphology.
This document provides an overview of congestive heart failure, including definitions, types, classification, time course, and treatment strategies. It defines CHF as a syndrome most commonly caused by cardiomyopathy. It describes types as right or left heart failure, and with reduced or preserved ejection fraction. Treatment objectives for acute CHF are to decrease congestion and increase perfusion, while chronic CHF aims to slow functional decline. Key medications that improve mortality in chronic CHF include ACE inhibitors, beta blockers, aldosterone antagonists, and ARNI.
This document discusses key concepts for understanding medical tests, including sensitivity, specificity, predictive values, and how to construct a contingency table. It begins by defining sensitivity as the percentage of true positives among those with the disease, and specificity as the percentage of true negatives among those without the disease. Prevalence affects the numbers in the contingency table. Positive and negative predictive values depend on prevalence in addition to sensitivity and specificity. Examples are used to illustrate these concepts for different diseases and testing scenarios.
This document provides an overview of an evidence-based medicine seminar. It discusses using medical literature to help make better clinical decisions. The learning objectives are to understand EBM, ask clinical questions, understand different types of medical literature and validity, apply Bayes' theorem to diagnosis, understand metrics for treatment effects, and access secondary sources. It emphasizes using a structured approach to ask, acquire, assess, and apply evidence to answer clinical questions.
This document provides guidance to residents on productive scholarly work and mentorship. It outlines the scholarly activity requirement, importance of mentorship, timeline for research projects, and types of projects residents should consider. These include case reports, quality improvement projects, retrospective research, reviews, editorials, and education/teaching projects. Choosing a project aligned with career goals and that has support from a mentor will maximize the chances of a successful scholarly experience.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
This document discusses SARS-CoV-2 transmission and characteristics. It addresses how the virus can spread through small aerosols or large droplets, and the protective measures appropriate for each. It also examines the virus's ability to spread before symptoms appear and challenges for contact tracing. Additionally, it covers the reproductive number of the virus and importance of identifying mild and asymptomatic cases.
This document provides a guide to COVID-19 testing. It discusses PCR testing and its sensitivity of over 85%. Sensitivity measures how often a test correctly identifies those with the disease, while positive predictive value depends on disease prevalence. Likelihood ratios are used to determine pre-test and post-test probability. Examples are given of using test results and likelihood ratios to determine the probability a patient has COVID-19. CT scans are not recommended for diagnosing COVID-19 due to their low sensitivity. Symptoms and risk factors should be used to determine pre-test probability to correlate with test results.
The document provides guidance on using imaging for COVID-19, including when it is useful, what findings to look for on chest x-ray and CT scan, and why clinical history is important. It discusses that imaging is not recommended for screening but can help evaluate symptoms. Chest x-ray may show patchy, peripheral, bilateral opacities while CT scan commonly shows peripheral ground glass opacities. Radiologists need full clinical history to properly interpret imaging studies.
This document discusses the analysis and management of pleural fluid and pancreaticopleural fistulas. It outlines criteria for distinguishing transudative, exudative, and lymphatic pleural effusions. It notes that amylase-rich pleural fluid could indicate a pancreatic or cancerous origin, and diagnostic testing of pleural fluid has about a 50% yield for detecting cancer. Management options for pancreaticopleural fistulas include observation for spontaneous resolution in 40-60% of cases within 6 weeks, octreotide to lower output, enteral feeding, and stent placement which can resolve the fistula in 55-90% of cases.
A 74-year-old woman on immunosuppressive medications for oral lichen planus presented with worsening respiratory failure after being treated for hypercalcemia. Initial tests showed increased oxygen needs and abnormal chest x-ray. She was diagnosed with Pneumocystis jirovecii pneumonia (PJP) based on a positive PCR test of her lungs. PJP is a fungal infection that causes pneumonia in immunocompromised patients. While her symptoms began with hypercalcemia, it is possible the underlying cause was an atypical infection like PJP leading to abnormal vitamin D activation. She was treated successfully for PJP with antibiotics and steroids.
This document describes efforts at the University of Utah and George E Wahlen VA Medical Center to decrease time to treatment for acute stroke patients. It outlines the previous disorganized stroke response process and near misses. The new standardized "Brain Attack" order set and protocol aims to promptly activate the on-call neurology team, contact the radiology reading room for after-hours imaging, and streamline the workflow to reduce delays. It provides an overview of the updated stroke response steps to recognize symptoms, activate the order set, perform assessments, image interpretation, and determine treatment. The goal is to improve reliability and allow for potential reperfusion therapies.
The Effect of OSA Severity and CPAP Adherence on Weight Regain After Bariatri...Brian Locke
This study examined whether weight regain after bariatric surgery is correlated with the severity of obstructive sleep apnea (OSA) or adherence to continuous positive airway pressure (CPAP) therapy. The study reviewed data from 116 patients who underwent bariatric surgery and had preoperative OSA testing. On average, patients lost over 35 kilograms initially but regained around 8 kilograms. There was no significant difference in weight regain between those who used CPAP and those who did not. Additionally, the severity of preoperative OSA was not correlated with the amount of initial weight loss or subsequent weight regain.
University of Utah Internal Medicine - Journal Club CurriculumBrian Locke
This document describes changes made to a medical residency journal club to make it more useful and enjoyable for trainees. The changes included: 1) Framing discussions around a clinical practice guideline and supporting literature as they relate to a patient case; 2) Having two residents critically appraise the guideline and literature using worksheets; 3) Creating facilitator guides to help prepare teaching points for different study designs; and 4) Repeating the same topic for successive resident cohorts. A survey found residents rated the new format as more effective for learning across different domains compared to the traditional format.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
ESA/ACT Science Coffee: Diego Blas - Gravitational wave detection with orbita...Advanced-Concepts-Team
Presentation in the Science Coffee of the Advanced Concepts Team of the European Space Agency on the 07.06.2024.
Speaker: Diego Blas (IFAE/ICREA)
Title: Gravitational wave detection with orbital motion of Moon and artificial
Abstract:
In this talk I will describe some recent ideas to find gravitational waves from supermassive black holes or of primordial origin by studying their secular effect on the orbital motion of the Moon or satellites that are laser ranged.
Sexuality - Issues, Attitude and Behaviour - Applied Social Psychology - Psyc...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Debated question: How in-depth? 15 second summary -> all 60 patients x-covering for (reasonable on medicine) => 15 minutes of straight signout. You can’t keep that straight. You need to prioritize. This is hard at first.
3 Objectives:
communicate who is sick and has the potential to decompensate
Communicate tasks that need to be completed overnight
Give a chance for questions on the plan.
My suggestion:
Tell me about folks might get sick, I need to do something on, and then visually scan through the rest to make sure if/thens make sense and you understand why.
A chance to double check:
Prns should be ordered by the day team for pain, sleep, nausea - if not, clarify why not.
Anything your following up on, there should be a plan for the expected results. This is the day teams job. No requests to followup without an if, then statement. They have 6-8 patients, you have 60 – it’s their job to think through as much as possible. NF should be like executing a control-flow diagram as above.
Take notes on EVERYTHING you do.
-write notes on the chart whenever you start a medication
-write symptoms prns as 1x overnight, then tell the day team you had to order it
Rule #1: if a nurse is worried about a patient, you need to see them even if the RN’s explanation is not convincing… it may be that they just can’t articulate why they are worried, but the patient is sick. It’s on YOU to make sure this isn’t the case.
Rule #2: You will get stupid pages, but you CANNOT discourage nurses from paging you. If a nurse is dissuaded from paging you, eventually they are going to not page out of fear when it is important for them to page you. If you have a relationship of trust with the RN it may be OK to eventually give feedback (e.g. you don’t need to page for this) if they know you actually care and are coming at it from understanding. That’s not night 1
Rule 3#: You CANNOT, ever lie (or ‘fib’ / fudge), if you forgot something, or you didn’t check it – just say as much. If people (either RNs or day team) don’t trust you, you cannot function. This goes without saying, but is definitely more of an issue on night float.
Is this (potentially) emergent => initial instructions and go to the patient immediately
If this is (potentially) urgent => deal with now. Depending how straightforward, may be appropriate to record RN’s number and look into it then call back.
This is not urgent => record on todo list, manage when it fits into your workflow. Warn RN of possible delay.
Used closed loop communication to ensure that you understand what their concern or need is. If it is not clear, ask directly / teachback (“So, am I right that X is the your main concern?”)
Early in intern year (and forever), nobody is perfect…. But the only way people can improve is if they know when they need to change. Be diplomatic and understanding about it, but don’t let it slide.
Patients will have unexpected issues where the day teams plan for each of these doesn’t work – that’s OK, but fixing those is beyond the scope of this talk.
Part of the early night float experience is learning what things you can include in your signouts / plans that will help your colleagues at night.
2g APAP ok in cirrhosis, but avoid APAP in acute liver failure.
We’re going to focus on 5 common calls that aren’t totally straight forward
Schema:
Do they have symptoms / end-organ dysfunction because of the HTN?
Subset, is it making something worse, but not the cause?
Do they have a condition that requires a particular BP target? (stroke, dissection, aneurysm)
IV medications +/- transfer of care
If they have none of the above: goal is to lower BP over the next days to weeks.
Resume home antihypertensives if safe
Defer to day team
Reasoning? High BP does not significantly increase the risk of adverse outcomes over the short term. Known, real harms from rapid intensification of BP
No IV hydralazine. (? Pregnancy where fewer options are available)
Does this patient w/ a procedure in the morning need to be NPO? If general anesthesia, regional anesthesia, or Monitored anesethsia care aka MAC-done by anesthesia- or procedural sections – done by proceduralist(=things like IR, cardioversion, joint reduction – no endotracheal tube, but all increase risk of aspiration) light meal – six hours, Heavy / fatty meal / tube feeds– 8 hours.
Note: assume ALL cases will be bumped up to first available slot 7-8a
Can this NPO patient have meds? If for procedure – yes, with small sip of water. If hole, blockage, or disconnection in GI track – no.
Can this NPO patient have sips/chips, clear liquids? Small amounts clear liquids up to 2h before. This includes coffee (w/ up to 50% milk) - https://annals.org/aim/fullarticle/2664126/annals-consult-guys-fasting-before-anesthesia-cappucino-call
Note: restraints = has to be done by a resident (=has license) legally
Does this patient have capacity is underlying question. However, practical approach is different
Approach: trouble shoot why –
-why do they want to leave? Can this be addressed?
-why does the primary team want them to stay? (how bad would this be if they leave?)
Capacity assessment
4 things required:
Communicate choice
Understand the relevant information
Appreciate situation and consequences
Reason about treatment options
= specific to an individual questions (as in, you can have capacity to make a simple choice, but simultaneously not have capcity to make a consequential or nuanced decision). Competency is a legal issuef
= does NOT mean they have to ‘win’ an argument with you. If they have a reasoning based on an accurate and can communicate it
AMA does NOT influence billing
Involve seniors, approach to ‘harm mitigation’ differs unfortunately.
Key approach: make sure this isn’t something dangerous. Otherwise, no intervention. (CAST trial)
Classify: How long (longer = worse), how fast (faster = worse), and what morphology (polymorphic = worse)
Symptoms: Chest pain? (ischemia), Lightheadedness? (perfusion)
Causes of NSVT:
-ischemia (esp polymorphic)
--eval w/ EKG, +/- troponin (never troponin without EKG – that tells you about what was going on in the heart 6h ago. We’re interested in now)
(ideal if can also capture the NSVT on EKG to help differentiate SVT w/ aberrancy)
-Long qt (esp polymorphic, called TdP)
--eval w/ EKG +/- medlist check
Electrolyte abnormalities
--eval with BMP (K, Ca), magnesium
Structural heart disease (?CHF exacerbation) – are they otherwise decompsnating?
Patient is NPO – do you still want to give the insulin?
In theory, should be able to continue for all (because meals shouldn’t effect basal rate). However, most people are dosed slightly too high on their long acting (because it’s easier to take, and easier for MDs to titrate) and it’s hard to predict ahead ot time. Because hypoglycemia is worse than hyper, we hedge. If managed closely and long acting <60% of Total Daily Dosage, can move toward upper end of spectrum.
Hold mealtime
T1DM – never hold long acting insulin. - Give long acting at 0.75 to 1.0 of reg dose.
T2DM - .5 to .75
Patient is Hyperglycemic – what to do?
1. Why – did they miss a dose (usually) vs some unrecognized process (e.g. infection)?
2. Get BMP if 300+ in T1DM, 450+ in T2DM to exclude ketoacidosis
3. Estimate insulin needed (this is conservative):
if not on insulin as OP, TDD = 0.5 weight. If on, use their TDD
1650 / TDD = the amnt you expect 1u insulin to decrease their BG, called CF
If goal is 150. (Current – Goal) / CF = dose. Regular insulin is usually best here pk wise.
100 kg patient not on insulin = 50u estimate TDD. 1650 / 50 = 33 CF. 450 – 150 = 300 goal amnt to lower. 300 / 33 => 10u regular.
Pt on 80u insulin daily -> 1850 / 80 = 20 CF. 450 - 150 = 300 goal to lower. 300 / 20 => 15u regular
With all of these – you will often want to involve your residents. No shame in that - it is much, much easier as an upper level to manage an overly cautious intern than an overly confident one.