This document discusses "long haulers" or patients experiencing persistent symptoms after acute COVID-19 infection. It provides epidemiological data showing a significant portion of patients reporting ongoing symptoms weeks or months after initial infection. Two case presentations are provided - one with a 73F experiencing dyspnea, fatigue and loss of taste months after hospitalization and found to have diastolic dysfunction. The second case is a 51F with intermittent cough and dyspnea for months with abnormal CT findings suggestive of organizing pneumonia. Management strategies are discussed for post-COVID headaches.
New treatment trends in alzheimer diseaseSarath Menon
This document summarizes new treatment trends in Alzheimer's disease. It discusses current treatments for mild-moderate Alzheimer's like donepezil, rivastigmine, and galantamine which are cholinesterase inhibitors. Memantine is used for more severe Alzheimer's as an NMDA receptor antagonist. Experimental therapies discussed include vaccines, secretase inhibitors, and stem cell therapy. Lifestyle factors like diet, exercise, and social support are also reviewed for prevention and management of Alzheimer's symptoms.
Criticism of drug promotional literature(dpl)souravpharma
This document discusses drug promotional literature and provides guidelines for its evaluation. It begins with an introduction on the large amount of drug information physicians receive. It then discusses the methods companies use to promote drugs, including detailing, literature, and gifts. Key points made are that drug promotion aims to induce prescription over educate and often includes inaccurate information. The document reviews sources physicians use, regulatory codes from WHO and India, and criteria for promotional materials. It emphasizes the need for physicians to critically evaluate promotional claims using scientific evidence.
This document presents a consensus approach for the differential diagnosis of suspected multiple sclerosis (MS) developed by an international panel of MS experts. The panel sought to 1) define clinical and paraclinical "red flags" that suggest alternative diagnoses to MS, 2) more precisely define clinically isolated syndromes often the first presentation of MS, 3) provide diagnostic algorithms for common clinically isolated syndromes, and 4) propose consensus criteria for differentiating MS from other inflammatory demyelinating disorders. The panel conducted a literature review and developed consensus recommendations to aid in excluding alternative diagnoses and distinguishing MS from non-MS conditions.
Pharmacovigilance aims to review and study the concept of monitoring drug safety. The objectives are to understand the concept of pharmacovigilance, important considerations for clinical trials, and to study the appendices of Schedule Y. The document will cover the introduction, need, historical background, terminology, process, program in India, and applications of pharmacovigilance.
This document discusses restless leg syndrome (RLS) and its prevalence and treatment in chronic kidney disease (CKD) patients on hemodialysis. It summarizes a study that found switching CKD patients from conventional hemodialysis to short daily hemodialysis (SDHD) resulted in significant and sustained improvements in RLS symptoms and sleep quality over 12 months, especially for those with moderate to severe RLS initially. The improvements were greater than typically seen with RLS medication alone. However, the study was limited by potential selection bias and lack of a control group.
Drug induced liver disease can have a variety of presentations, from acute hepatitis to chronic cholestatic conditions. Making an accurate diagnosis requires correlating the clinical presentation and liver injury pattern with the temporal relationship to suspected medications, exclusion of alternative causes, and considering factors like dechallenge/rechallenge responses and precedents of the drug causing hepatotoxicity. International criteria provide guidance on evaluating suspected cases and assigning levels of certainty regarding causality.
New treatment trends in alzheimer diseaseSarath Menon
This document summarizes new treatment trends in Alzheimer's disease. It discusses current treatments for mild-moderate Alzheimer's like donepezil, rivastigmine, and galantamine which are cholinesterase inhibitors. Memantine is used for more severe Alzheimer's as an NMDA receptor antagonist. Experimental therapies discussed include vaccines, secretase inhibitors, and stem cell therapy. Lifestyle factors like diet, exercise, and social support are also reviewed for prevention and management of Alzheimer's symptoms.
Criticism of drug promotional literature(dpl)souravpharma
This document discusses drug promotional literature and provides guidelines for its evaluation. It begins with an introduction on the large amount of drug information physicians receive. It then discusses the methods companies use to promote drugs, including detailing, literature, and gifts. Key points made are that drug promotion aims to induce prescription over educate and often includes inaccurate information. The document reviews sources physicians use, regulatory codes from WHO and India, and criteria for promotional materials. It emphasizes the need for physicians to critically evaluate promotional claims using scientific evidence.
This document presents a consensus approach for the differential diagnosis of suspected multiple sclerosis (MS) developed by an international panel of MS experts. The panel sought to 1) define clinical and paraclinical "red flags" that suggest alternative diagnoses to MS, 2) more precisely define clinically isolated syndromes often the first presentation of MS, 3) provide diagnostic algorithms for common clinically isolated syndromes, and 4) propose consensus criteria for differentiating MS from other inflammatory demyelinating disorders. The panel conducted a literature review and developed consensus recommendations to aid in excluding alternative diagnoses and distinguishing MS from non-MS conditions.
Pharmacovigilance aims to review and study the concept of monitoring drug safety. The objectives are to understand the concept of pharmacovigilance, important considerations for clinical trials, and to study the appendices of Schedule Y. The document will cover the introduction, need, historical background, terminology, process, program in India, and applications of pharmacovigilance.
This document discusses restless leg syndrome (RLS) and its prevalence and treatment in chronic kidney disease (CKD) patients on hemodialysis. It summarizes a study that found switching CKD patients from conventional hemodialysis to short daily hemodialysis (SDHD) resulted in significant and sustained improvements in RLS symptoms and sleep quality over 12 months, especially for those with moderate to severe RLS initially. The improvements were greater than typically seen with RLS medication alone. However, the study was limited by potential selection bias and lack of a control group.
Drug induced liver disease can have a variety of presentations, from acute hepatitis to chronic cholestatic conditions. Making an accurate diagnosis requires correlating the clinical presentation and liver injury pattern with the temporal relationship to suspected medications, exclusion of alternative causes, and considering factors like dechallenge/rechallenge responses and precedents of the drug causing hepatotoxicity. International criteria provide guidance on evaluating suspected cases and assigning levels of certainty regarding causality.
HCV MANAGEMENT IN PATIENT WITH KIDNEY DISEASE..reuploadedPratap Tiwari
HCV infection is associated with an increased risk of chronic kidney disease and renal impairment. Treatment of HCV in patients with renal disease prior to direct-acting antivirals was not very effective due to significant side effects of interferon-based regimens. The introduction of direct-acting antivirals such as sofosbuvir provided more effective and tolerable treatment options, though patients with severe renal impairment still experienced worse side effects and lower response rates. Effective treatment of HCV in patients with renal disease is important given their risk of faster liver disease progression and greater liver-related morbidity and mortality compared to those with normal renal function.
This document summarizes information about vaccine clinical trials and tick-borne encephalitis (TBE). It discusses the history and development of vaccines. It then describes the phases of clinical trials and provides examples of specific vaccine trials including for TBE. Key details about the TBE virus, epidemiology, vaccines, and a recent clinical trial comparing two TBE vaccines in children are summarized. The trial evaluated safety, immunogenicity and reactions to the vaccines. The document concludes that vaccination is an effective way to prevent TBE and current vaccines have shown good safety profiles.
This document discusses diabetic neuropathy, including its definition, prevalence, risk factors, clinical presentations, investigations, and types. Some key points:
- Diabetic neuropathy is nerve dysfunction in people with diabetes after other causes have been excluded. It has a prevalence of 5-100% and is the most common neuropathy in developed countries.
- Risk factors include poor glycemic control, hypertension, smoking, alcohol, and longer duration of diabetes. Clinical presentations include distal symmetrical polyneuropathy, proximal diabetic neuropathy, truncal neuropathy, and mononeuropathies.
- Investigations include blood tests to assess glucose levels, vitamin deficiencies and organ function. Types include chronic sensorimotor neuropathy, autonomic neuropathy
If you are marketing your product in India you should comply these area of regulation.We give Services in getting manufacturing licences
ACCREDITED CONSULTANTS PVT.LTD
info@acplgroupindia.co.in
+919310040434
The document presents a case study of a 70-year-old male patient admitted with symptoms of giddiness and generalized weakness for 15 days. After examination and investigations, he was diagnosed with acute idiopathic parkinsonism and type 2 diabetes mellitus. He was treated with levodopa, carbodopa, pramipexole, and insulin during his 4-day hospital stay and counselled on lifestyle modifications. His symptoms improved with treatment and he was discharged on medications with follow-up in the neurology outpatient department.
Drug use evaluation (DUE) is a quality improvement process that reviews prescribing patterns to promote appropriate drug use. It involves identifying a drug or therapeutic area, developing criteria and standards, collecting data, evaluating results, providing feedback, and implementing interventions. The process then reevaluates drug use and revises the DUE program as needed. The presented document outlines the 11 steps of a DUE process focusing on monitoring renal function during aminoglycoside therapy.
This document discusses hyperphosphatemia, which occurs when phosphate levels in the blood are abnormally high. It provides information on the causes of hyperphosphatemia, which include kidney disease, and discusses guideline target levels and treatment options. Treatment involves phosphate restriction, phosphate binders such as aluminum hydroxide, calcium salts, and newer non-calcium binders. Novel therapies being researched include nicotinamide and iron-based compounds. The goal is to manage phosphate levels through diet, medication and dialysis to prevent complications in patients with chronic kidney disease.
This document summarizes the management of painful diabetic peripheral neuropathy. It discusses the different types of diabetic neuropathies including acute painful neuropathies, symmetrical polyneuropathies, and focal neuropathies. The management involves treating any underlying causes, optimizing glycemic control, controlling cardiovascular risk factors, and using drug treatments such as tricyclic antidepressants, anticonvulsants like gabapentin and pregabalin, or opioids. Non-pharmacological options including TENS, acupuncture, and electrical cord stimulation are also mentioned.
This document discusses hospital pharmacoepidemiology, which involves tracking drugs administered to patients during their hospital stay and systematically recording adverse drug reactions (ADRs). It notes challenges like patients receiving care in multiple departments and from various providers, making complete drug exposure data difficult to obtain. Other challenges include uncertain validity of drug and diagnosis information in medical records. Solutions discussed include intensive hospital surveillance programs and use of integrated inpatient databases. The document also describes a new adverse drug monitoring program aimed at improving patient care and safety through activities like maintaining ADR reports, preventing drug interactions, and educating staff.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
The patient is an 80-year-old male who was brought to the hospital due to complaints of memory loss from his wife. She noticed he had been experiencing gradual onset memory loss over the past 15 days, including an inability to remember daily tasks and financial duties. On examination, he was conscious and oriented but demonstrated memory impairment. A diagnosis of Alzheimer's disease was suspected given his age and symptoms.
This document discusses dose adjustment in patients with renal impairment. It covers several key topics:
1. The kidney's role in regulating fluids, electrolytes, waste removal, and drug excretion. Impaired kidney function affects drug pharmacokinetics.
2. Approaches for dose adjustment based on estimating remaining renal function and drug clearance. Dose, dosing interval, or both may be adjusted to maintain therapeutic drug levels.
3. Methods for estimating glomerular filtration rate and measuring kidney function using markers like inulin, creatinine, and urea. Creatinine clearance is commonly used in clinical practice.
4. Considerations for dose adjustment in patients on dialysis, as
Prescription event monitoring and record linkage systemRumana Hameed
PEM is a method of pharmacovigilance that studies drug safety in real-world clinical practice. It involves collecting prescription data for new drugs and surveying prescribers about patient outcomes. Advantages include a large national scale and obtaining real-world safety data. Record linkage systems combine different healthcare records to efficiently study relationships between drug exposure and health outcomes. Claims databases contain prescription and medical claims information but may lack clinical details, while medical record databases provide more clinical data but only for illnesses that were medically attended to.
17 february lupus nephritis prof ashraf foudaFarragBahbah
This document discusses key points about lupus nephritis. It notes that 35% of adults with SLE have clinical evidence of nephritis at diagnosis, and 50-60% develop nephritis within 10 years. Lupus nephritis reduces survival at 10 years to 88% compared to 92% for SLE alone. Renal biopsy is recommended for confirmed proteinuria over 0.5 g/24h or active urine sediment. Repeat biopsy may be considered for worsening renal function or unexplained changes. Treatment typically involves steroids like prednisone combined with immunosuppressants like MMF or cyclophosphamide. While initial response rates are similar, steroids alone is associated with more relapses. Long term
This document summarizes several hematological disorders and their drug-induced causes. It begins with an introduction to anemia, describing it as a deficiency of red blood cells or hemoglobin. Deep vein thrombosis is defined as a blood clot forming in a deep vein, most commonly in the legs. Various drug-induced hematological disorders are then outlined affecting red blood cells, white blood cells, and platelets. Causes, symptoms, diagnoses, and treatments are discussed for disorders like anemia, deep vein thrombosis, aplastic anemia, hemolytic anemia, neutropenia, and thrombocytopenia.
Drug utilization studies aim to evaluate prescribing and usage of medications in a systematic way. They describe patterns of drug use, identify irrational use, help improve drug use, and provide quality control of the drug use process. Data on drug use comes from various sources like large databases, regulatory agencies, suppliers, and practice and community settings. Conducting drug utilization studies involves 11 steps - from identifying drugs/therapeutic areas to study, to designing the study, collecting and evaluating data, providing feedback, and continually reassessing the program.
This document provides information on acute kidney injury (AKI) for nursing students. It begins with learning objectives about the renal system, causes and stages of AKI, and the nurse's role in management. It then reviews anatomy and physiology of the kidneys, normal function, causes of AKI including pre-renal, intrinsic and post-renal, stages of AKI, assessment findings, and nursing interventions for each stage. The goal is for students to understand AKI, recognize patients at risk, implement preventive measures, and provide evidence-based care to optimize outcomes.
The kidney plays an important role in regulating fluids, electrolytes, and removing waste from the body. Impairment of kidney function affects drug pharmacokinetics. Common causes of kidney failure include disease, injury, drug toxicity, infections, diabetes, toxins, and reduced blood flow. Acute kidney problems or trauma can lead to uremia where filtration is impaired, causing excess fluid and waste to accumulate. Uremic patients may have changes in drug absorption, distribution, and clearance. Dosage adjustments are often needed based on a patient's kidney function and drug properties to safely treat uremic patients.
1) An 80-year-old male patient presented with a 2-month history of fever and was diagnosed with Enterococcus faecalis native valve endocarditis.
2) Transesophageal echocardiogram revealed a large vegetation on the posterior tricuspid leaflet. Blood cultures grew E. faecalis.
3) The patient was treated with a double beta-lactam regimen of ampicillin and ceftriaxone for 4 weeks along with anticoagulants and monitoring. Symptoms improved and the patient was discharged in a stable condition.
It is about detailed management of dengue and malaria in adults and children with brief review of clinical history and diagnosis.
reference:
-latest WHO and CDC guidelines
-Nelson 21st edition
-Ghai-Essential Paediatrics 9th edition
-Harrison
HCV MANAGEMENT IN PATIENT WITH KIDNEY DISEASE..reuploadedPratap Tiwari
HCV infection is associated with an increased risk of chronic kidney disease and renal impairment. Treatment of HCV in patients with renal disease prior to direct-acting antivirals was not very effective due to significant side effects of interferon-based regimens. The introduction of direct-acting antivirals such as sofosbuvir provided more effective and tolerable treatment options, though patients with severe renal impairment still experienced worse side effects and lower response rates. Effective treatment of HCV in patients with renal disease is important given their risk of faster liver disease progression and greater liver-related morbidity and mortality compared to those with normal renal function.
This document summarizes information about vaccine clinical trials and tick-borne encephalitis (TBE). It discusses the history and development of vaccines. It then describes the phases of clinical trials and provides examples of specific vaccine trials including for TBE. Key details about the TBE virus, epidemiology, vaccines, and a recent clinical trial comparing two TBE vaccines in children are summarized. The trial evaluated safety, immunogenicity and reactions to the vaccines. The document concludes that vaccination is an effective way to prevent TBE and current vaccines have shown good safety profiles.
This document discusses diabetic neuropathy, including its definition, prevalence, risk factors, clinical presentations, investigations, and types. Some key points:
- Diabetic neuropathy is nerve dysfunction in people with diabetes after other causes have been excluded. It has a prevalence of 5-100% and is the most common neuropathy in developed countries.
- Risk factors include poor glycemic control, hypertension, smoking, alcohol, and longer duration of diabetes. Clinical presentations include distal symmetrical polyneuropathy, proximal diabetic neuropathy, truncal neuropathy, and mononeuropathies.
- Investigations include blood tests to assess glucose levels, vitamin deficiencies and organ function. Types include chronic sensorimotor neuropathy, autonomic neuropathy
If you are marketing your product in India you should comply these area of regulation.We give Services in getting manufacturing licences
ACCREDITED CONSULTANTS PVT.LTD
info@acplgroupindia.co.in
+919310040434
The document presents a case study of a 70-year-old male patient admitted with symptoms of giddiness and generalized weakness for 15 days. After examination and investigations, he was diagnosed with acute idiopathic parkinsonism and type 2 diabetes mellitus. He was treated with levodopa, carbodopa, pramipexole, and insulin during his 4-day hospital stay and counselled on lifestyle modifications. His symptoms improved with treatment and he was discharged on medications with follow-up in the neurology outpatient department.
Drug use evaluation (DUE) is a quality improvement process that reviews prescribing patterns to promote appropriate drug use. It involves identifying a drug or therapeutic area, developing criteria and standards, collecting data, evaluating results, providing feedback, and implementing interventions. The process then reevaluates drug use and revises the DUE program as needed. The presented document outlines the 11 steps of a DUE process focusing on monitoring renal function during aminoglycoside therapy.
This document discusses hyperphosphatemia, which occurs when phosphate levels in the blood are abnormally high. It provides information on the causes of hyperphosphatemia, which include kidney disease, and discusses guideline target levels and treatment options. Treatment involves phosphate restriction, phosphate binders such as aluminum hydroxide, calcium salts, and newer non-calcium binders. Novel therapies being researched include nicotinamide and iron-based compounds. The goal is to manage phosphate levels through diet, medication and dialysis to prevent complications in patients with chronic kidney disease.
This document summarizes the management of painful diabetic peripheral neuropathy. It discusses the different types of diabetic neuropathies including acute painful neuropathies, symmetrical polyneuropathies, and focal neuropathies. The management involves treating any underlying causes, optimizing glycemic control, controlling cardiovascular risk factors, and using drug treatments such as tricyclic antidepressants, anticonvulsants like gabapentin and pregabalin, or opioids. Non-pharmacological options including TENS, acupuncture, and electrical cord stimulation are also mentioned.
This document discusses hospital pharmacoepidemiology, which involves tracking drugs administered to patients during their hospital stay and systematically recording adverse drug reactions (ADRs). It notes challenges like patients receiving care in multiple departments and from various providers, making complete drug exposure data difficult to obtain. Other challenges include uncertain validity of drug and diagnosis information in medical records. Solutions discussed include intensive hospital surveillance programs and use of integrated inpatient databases. The document also describes a new adverse drug monitoring program aimed at improving patient care and safety through activities like maintaining ADR reports, preventing drug interactions, and educating staff.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
The patient is an 80-year-old male who was brought to the hospital due to complaints of memory loss from his wife. She noticed he had been experiencing gradual onset memory loss over the past 15 days, including an inability to remember daily tasks and financial duties. On examination, he was conscious and oriented but demonstrated memory impairment. A diagnosis of Alzheimer's disease was suspected given his age and symptoms.
This document discusses dose adjustment in patients with renal impairment. It covers several key topics:
1. The kidney's role in regulating fluids, electrolytes, waste removal, and drug excretion. Impaired kidney function affects drug pharmacokinetics.
2. Approaches for dose adjustment based on estimating remaining renal function and drug clearance. Dose, dosing interval, or both may be adjusted to maintain therapeutic drug levels.
3. Methods for estimating glomerular filtration rate and measuring kidney function using markers like inulin, creatinine, and urea. Creatinine clearance is commonly used in clinical practice.
4. Considerations for dose adjustment in patients on dialysis, as
Prescription event monitoring and record linkage systemRumana Hameed
PEM is a method of pharmacovigilance that studies drug safety in real-world clinical practice. It involves collecting prescription data for new drugs and surveying prescribers about patient outcomes. Advantages include a large national scale and obtaining real-world safety data. Record linkage systems combine different healthcare records to efficiently study relationships between drug exposure and health outcomes. Claims databases contain prescription and medical claims information but may lack clinical details, while medical record databases provide more clinical data but only for illnesses that were medically attended to.
17 february lupus nephritis prof ashraf foudaFarragBahbah
This document discusses key points about lupus nephritis. It notes that 35% of adults with SLE have clinical evidence of nephritis at diagnosis, and 50-60% develop nephritis within 10 years. Lupus nephritis reduces survival at 10 years to 88% compared to 92% for SLE alone. Renal biopsy is recommended for confirmed proteinuria over 0.5 g/24h or active urine sediment. Repeat biopsy may be considered for worsening renal function or unexplained changes. Treatment typically involves steroids like prednisone combined with immunosuppressants like MMF or cyclophosphamide. While initial response rates are similar, steroids alone is associated with more relapses. Long term
This document summarizes several hematological disorders and their drug-induced causes. It begins with an introduction to anemia, describing it as a deficiency of red blood cells or hemoglobin. Deep vein thrombosis is defined as a blood clot forming in a deep vein, most commonly in the legs. Various drug-induced hematological disorders are then outlined affecting red blood cells, white blood cells, and platelets. Causes, symptoms, diagnoses, and treatments are discussed for disorders like anemia, deep vein thrombosis, aplastic anemia, hemolytic anemia, neutropenia, and thrombocytopenia.
Drug utilization studies aim to evaluate prescribing and usage of medications in a systematic way. They describe patterns of drug use, identify irrational use, help improve drug use, and provide quality control of the drug use process. Data on drug use comes from various sources like large databases, regulatory agencies, suppliers, and practice and community settings. Conducting drug utilization studies involves 11 steps - from identifying drugs/therapeutic areas to study, to designing the study, collecting and evaluating data, providing feedback, and continually reassessing the program.
This document provides information on acute kidney injury (AKI) for nursing students. It begins with learning objectives about the renal system, causes and stages of AKI, and the nurse's role in management. It then reviews anatomy and physiology of the kidneys, normal function, causes of AKI including pre-renal, intrinsic and post-renal, stages of AKI, assessment findings, and nursing interventions for each stage. The goal is for students to understand AKI, recognize patients at risk, implement preventive measures, and provide evidence-based care to optimize outcomes.
The kidney plays an important role in regulating fluids, electrolytes, and removing waste from the body. Impairment of kidney function affects drug pharmacokinetics. Common causes of kidney failure include disease, injury, drug toxicity, infections, diabetes, toxins, and reduced blood flow. Acute kidney problems or trauma can lead to uremia where filtration is impaired, causing excess fluid and waste to accumulate. Uremic patients may have changes in drug absorption, distribution, and clearance. Dosage adjustments are often needed based on a patient's kidney function and drug properties to safely treat uremic patients.
1) An 80-year-old male patient presented with a 2-month history of fever and was diagnosed with Enterococcus faecalis native valve endocarditis.
2) Transesophageal echocardiogram revealed a large vegetation on the posterior tricuspid leaflet. Blood cultures grew E. faecalis.
3) The patient was treated with a double beta-lactam regimen of ampicillin and ceftriaxone for 4 weeks along with anticoagulants and monitoring. Symptoms improved and the patient was discharged in a stable condition.
It is about detailed management of dengue and malaria in adults and children with brief review of clinical history and diagnosis.
reference:
-latest WHO and CDC guidelines
-Nelson 21st edition
-Ghai-Essential Paediatrics 9th edition
-Harrison
Earlier in the month, the National Institute for Clinical Excellence issued a new guideline on bacterial meningitis and meningococcal disease in children. At the symposium we had two members of the Guideline Development Group. As well as our own Linda Glennie, we were joined by Dr Nelly Ninis, consultant paediatrician at St Mary's Hospital, who was able to explain the implications of this important guideline on the early recognition and treatment of septicaemia.
COVID-19 is caused by SARS-CoV-2 virus and has developed into a worldwide pandemic. The virus can affect the cardiovascular system by directly infecting heart cells or causing inflammation. For those with congenital heart disease, risk of serious illness from COVID-19 is higher for those over 70, with complex heart conditions, lung disease, or other health problems. While little is known about effects on those with CHD, children may be less severely affected than adults. Treatment focuses on symptoms, and most cases can be managed at home with self-care.
Bilateral limb gangrene in an HIV patient due to vasculopathy: Managing the d...Ahmad Ozair
Patients with human immunodeficiency virus (HIV) have been reported to experience a spectrum of homeostatic dysregulation and resulting manifestations in their vascular system. This may be due to either disruption in the coagulation-anticoagulation pathways or due to damage to vessels from either HIV or other opportunistic infections. However, gangrene in an HIV-infected patient is an uncommon phenomenon. We herein report a case of a 30-year-old female, who had been taking antiretrovirals irregularly for 10 years, developing bilateral limb gangrene during her hospitalization for cryptococcal meningitis. Unfortunately, her condition continued to deteriorate and her attendants took her from the hospital against medical advice, with her death soon after. We illustrate how several biopsychosocial factors came together here to result in poor outcomes. To note, peripheral arterial disease (PAD) in HIV can rapidly lead to critical limb ischemia, resulting in limb gangrene. Aggravating risk factors for the same include smoking, poor glycemic control, and/or low CD4 T-cell count (<200 cells/mm3). General practitioners should be aware that HIV patients are far more prone to PAD than the normal population. Early recognition of at-risk patients, both medically and psychosocially, by family physicians is thus critical.
Weitzman ECHO Presentations of COVID-19 in Specialty CareCHC Connecticut
This document provides information on COVID-19 presentations in specialty care from infectious disease and hematology perspectives. It discusses a case study of possible COVID-19 in a mother and child presenting with respiratory and gastrointestinal symptoms. It also summarizes research showing increased risk of clotting and thromboembolic events in COVID-19 patients, the use of anticoagulants for prevention and treatment, and managing related care through telemedicine. The document aims to help specialists better understand and address COVID-19 complications involving clotting and considers implications for patient management and care continuity.
This document provides a summary of a continuing medical education event on COVID-19 clinical updates and addressing frequent questions. It discusses CME credit information, the virus and transmission, typical and atypical symptoms, risk factors, testing, treatment, prevention strategies, and considerations for vaccine catch-up efforts. It also reviews a case study of a COVID-19 patient and includes slides on topics like the spectrum of illness, comorbidities of concern, prevention through proper hygiene and distancing, and vaccine development efforts.
Thrombophylia and COVID-19. A case report of young man 53 years old whith acu...komalicarol
A 57-year-old male was admitted to our Hospital on March 2020
for SARS-Cov2 related interstitial pneumonia. Chest x-ray showed
a bilateral interstitial-alveolar pneumonia and Blood gas analysis
(BGA) in room air highlighted a severe respiratory failure (pO2 46
mmHg, pH 7.41). Due to clinical and biohumoral worsening (stable CRP at 24 mg/dL), tocilizumab (800mg) was performed after
acquiring patient’s informed consensus. In the evening, after 96
hours of hospitalization, the patient presented a clear hyposthenia
/ hemiparesis of the right hemisome whit hyperreflexia, confusion
and slowed speech
UCMS:Final Integrated medical quiz 2018 Illuminous
The document describes the rules and format for an integrated medical quiz finals round consisting of 12 total questions divided into 2 questions per team. Teams have 1 minute to answer each question they receive before it bounces to the next team, and can pounce within 30 seconds to steal a question. Correct answers earn points while incorrect answers during a pounce result in negative points, with scores announced at the end.
The document provides the details of a quiz competition involving 12 total medical questions that will be divided among teams to answer within time limits, with opportunities to earn or lose points depending on correct or incorrect responses when pouncing to answer another team's question. S
This document provides an annual refresher training on bloodborne pathogens. It reviews national and local disease numbers from 2010-2012, including cases of AIDS, hepatitis, tuberculosis, influenza and more. It discusses concepts of infection control and specific diseases like MRSA, HIV, hepatitis B and C, and influenza. It emphasizes prevention through immunizations, hygiene practices like handwashing, and cleaning/disinfection of surfaces and equipment to reduce disease transmission risks.
This is a lecture I gave for the Upstate Nurse Practitioner's Association September 29, 2020. Parts may no longer be valid, because the topic is changing so rapidly. I did the best I could.
This was a lecture I gave for the Upstate Nurse Practitioners Association. This is a comprehensive overview. I would to thank all health care professionals for doing their jobs as well as they can.
This document provides information on dengue case management in West Bengal for 2023. It discusses the epidemiology of dengue in the state, including that multiple serotypes are present and cases have increased in recent years. It also describes the clinical course and presentation of dengue, including the three phases (febrile, critical, recovery). Warning signs and potential complications are outlined. Guidance is provided on evaluating patients and assessing disease severity.
1. Use the pre-ART and ART registers to fill out measures on the monthly summary sheet, including the number of new patients enrolled in HIV care, cumulative patients ever enrolled, patients eligible but not started on ART, and patients started on ART or PEP this month.
2. The number of patients eligible but not started on ART is found by counting those in the pre-ART register with an eligibility date but no ART start date.
3. The number currently on ARVs is found by counting patients in the ART register with an ARV regimen listed for the terminal month.
4.
Sepsis & Hospice Eligibility: Natural History, Prognosis & Role of HospiceVITAS Healthcare
The goal of this webinar is to educate healthcare clinicians about the history, incidence, impact and identification of sepsis in the acute-care setting. Hospice care is inadequately utilized for patients with sepsis, a serious condition that results in 250,000 US deaths each year and an annual $3.5 billion in hospital readmission costs.
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
This document discusses COVID-19, caused by SARS-CoV-2. It defines the virus and outlines its origin in Wuhan, China in December 2019. Clinical features include fever, cough and dyspnea. Diagnosis involves travel history screening and PCR testing of respiratory samples. Management involves supportive care, with oxygen and ventilation for severe cases. Specific antivirals like remdesivir are under investigation but no vaccine currently exists. Prognosis is best for non-critical cases without comorbidities, with a overall fatality rate of 2.3%.
This patient presents with diarrhea, abdominal pain, and symptoms consistent with Clostridium difficile colitis. Stool culture confirms C. difficile infection. The patient is started on IV fluids and antibiotics with plans to admit to the medical unit. Nursing priorities include fluid management, pain control, and infection prevention given risk of complications like dehydration, electrolyte imbalances, and sepsis from C. difficile colitis.
Similar to Weitzman ECHO COVID-19 “Long Haulers” (20)
The COVID-19 pandemic has created several challenges for our country’s health care infrastructure, and the community health center workforce is no exception. Join us as we describe strategies to get patients back into dental care. Along with these strategies, participants will learn how to recognize challenges in dental practices, as well as how to engage the interdisciplinary care team through role redesign and integration to increase access to comprehensive care.
NTTAP Webinar Series - June 7, 2023: Integrating HIV Care into Training and E...CHC Connecticut
In order for health centers to provide compassionate and respectful HIV prevention, care, and treatment in comprehensive primary care settings, the clinical workforce must be knowledgeable, confident, and competent in their ability to do so.
We’ll explore the need to integrate HIV care into training and education for the clinical care team, as well as educational models to train the next generation. Using Community Health Center Inc.’s Center for Key Populations Fellowship for Nurse Practitioners (NPs) as a framework for best practices, experts will discuss how to implement specialty care for key populations in your training programs. Additionally, participants will gain awareness of the importance of training the clinical workforce on key population competencies in HIV programs (e.g. HCV, MOUD, LGBTQI+ health, homelessness, and harm reduction).
Utilizing the Readiness to Train Assessment Tool (RTAT™) To Assess Your Capac...CHC Connecticut
Improve educational training experiences at your health center by assessing your capacity and infrastructure to host health professions students.
Join the upcoming hands-on interactive activity session to learn how to utilize the Readiness to Train Assessment Tool (RTAT™). This tool was developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at Community Health Center, Inc. (CHC) to understand organizational readiness to host health professions student training programs.
NTTAP Webinar Series - May 18, 2023: The Changing Landscape of Behavioral Hea...CHC Connecticut
The COVID-19 pandemic has resulted in significant shifts in the mode of care from face-to-face to virtual interactions. Join us as we discuss the challenges currently facing behavioral health care and at least one strategy for each. Along with these strategies, panelists will go over what integrated behavioral health care was and is before and following COVID-19, as well as what actions should be taken going forward to increase access to comprehensive care.
Panelists:
• Dr. Tim Kearney, PhD, Chief Behavioral Health Officer, Community Health Center, Inc.
• Melinda Gladden, LCSW, PMHC, Behavioral Health Clinician, Community Health Center, Inc.
• Jodi Anderson, LMFT, Virtual Telehealth Group Coordinator, Community Health Center, Inc.
Newborn screening involves testing newborns for treatable genetic and metabolic disorders through methods like dried bloodspot testing, hearing screening, and pulse oximetry. The goals are to identify at-risk newborns early before symptoms present, when treatment is most effective. Abnormal screening results require follow up diagnostic testing, education of families, and treatment if a condition is confirmed. Future directions may include expanded screening panels and genomic newborn screening, though these raise additional complex issues to consider.
Health Professions Student Training Webinar: Assessing Organizational CapacityCHC Connecticut
This document provides information about a webinar on assessing organizational capacity for health professions student training. It includes details about continuing education credits, speakers, objectives, and an overview of key aspects of assessing capacity. These include identifying willing and available faculty members, maintaining a spreadsheet of available preceptors, conducting a secondary review of space, training, and onboarding needs, and negotiating placements with academic affiliations. It also discusses best practices for clinical observation and feedback forms, and introduces some preceptor panelists. Finally, it provides an overview of the Readiness to Train Assessment Tool (RTAT) and how it can be used to understand an organization's capacity based on survey results.
Training the Next Generation: Investing in Workforce TrainingCHC Connecticut
This document provides information about an upcoming webinar on workforce training. The webinar will discuss why health centers should invest in health professions education and training programs, how to assess organizational readiness to implement such programs, and best practices for developing replicable training models. Attendees will learn how workforce development planning makes business sense by reducing costs from employee turnover and increasing access to care. A tool called the Readiness to Train Assessment can help organizations evaluate their capacity and motivation to engage in training programs. Successful training requires identifying qualified preceptors and building a culture of learning in the organization.
NTTAP Webinar Series - April 13, 2023: Quality Improvement Strategies in a Te...CHC Connecticut
Join us for a webinar on quality improvement in team-based care!
Building a quality improvement (QI) infrastructure within team-based care is an organizational strategy that will establish a culture of continuous improvement across departments and improve quality in all domains of performance.
Participants will learn about:
• QI infrastructure
• Facilitating QI committees
• Coach training within health centers
Faculty will also provide an example of how trained coaches use QI tools to test and implement changes within an organization.
Addressing Genetics Workforce Shortage - April 11, 2023CHC Connecticut
The document discusses the shortage of geneticists and genetic counselors in the United States. It notes that there are currently only around 1,240 medical geneticists and 4,700 genetic counselors serving the population, below the recommended levels. Many states have fewer than the recommended number of geneticists per population. The document explores ways primary care physicians can help address gaps, such as playing a more active role in selected genetic situations like cancer risk assessment. It also identifies growing the educational opportunities in genetics as important for increasing the workforce.
Implementation of Timely and Effective Transitional Care Management ProcessesCHC Connecticut
Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams.
Experts will share how their teams respond to patients to identify care gaps and support the transition of care. Workflow descriptions will provide participants with the tools to support their work to adapt specific steps into their model of team-based care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, FAAN, Chief Nursing Officer, Community Health Center, Inc.
• Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc.
• Bibian Ladino-Davis, Behavioral Health Coordinator, Weitzman Institute
Direct to Consumer Test and Ancestry Testing - March 14, 2023CHC Connecticut
Direct to Consumer Genetic and Ancestry Testing
This document discusses direct-to-consumer (DTC) genetic and ancestry testing. It defines DTC testing as testing that can be ordered by consumers without a health care provider. The document outlines the types of information provided by DTC tests, including ancestry, traits, disease risks, and results for some Mendelian conditions. However, it notes limitations like low predictive value without family history and risks of false positives. It provides examples of patients impacted by DTC testing results and emphasizes the need for confirmation of pathogenic variants by clinical genetics. The document also discusses privacy and legal issues related to DTC testing.
Implement Behavioral Health Training Programs to Address a Crucial National S...CHC Connecticut
Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway.
Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors' role, and required resources.
Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway.
Genetic Connections to Breast Cancer - February 14, 2023CHC Connecticut
This document discusses genetic connections to breast cancer. It begins by outlining the learning objectives, which are to understand the importance of collaboration between genetics and non-genetics experts for hereditary breast cancer patients, emphasize obtaining accurate family histories, and discuss benefits and limitations of next generation sequencing panel tests. It then discusses genetic counselors' role in oncology, hereditary cancer risks and patterns, BRCA genes, obtaining family histories, genetic testing options like multi-gene panels, interpreting results, cancer screening recommendations, and prophylactic surgery options. Resources and established risk models are also referenced.
Connective Tissue Disorders Slides - January 17, 2023CHC Connecticut
This document discusses several genetic connective tissue disorders including Ehlers Danlos syndromes, Marfan syndrome, Loeys-Dietz syndrome, Stickler syndrome, Shprintzen Goldberg syndrome, Cutis Laxa, and Osteogenesis Imperfecta. It highlights the importance of identifying these disorders to allow for timely detection of serious complications and management by multiple medical specialists. Connective tissues are the most abundant tissues in the body and connect, support, bind or separate other tissues. Identification of a connective tissue disorder through genetic diagnosis guides appropriate care.
Implementation of Facial Recognition Software for Clinical Genetics Practice...CHC Connecticut
This document discusses the potential uses of facial recognition software in clinical genetics practice and education. It provides 3 examples of how facial recognition software could help in rare disease identification and interpreting genetic testing results. The document also outlines learning objectives about identifying medical uses of facial recognition, using facial grids to match patterns to syndromes, and the importance of diverse training data.
HIV Prevention: Combating PrEP Implementation ChallengesCHC Connecticut
Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.,
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
NTTAP Webinar Series - December 7, 2022: Advancing Team-Based Care: Enhancing...CHC Connecticut
Join us as expert faculty outline the differences between case management, care coordination and complex care management to frame up a discussion on strategies to leverage effective models for both in-person and remote services.
Expert faculty will discuss the role of the medical assistant and the nurse in care management, as well as how standing orders and delegated orders support this work. This session will discuss how telehealth and remote patient monitoring enhancements can support complex care management for patients with chronic conditions.
Participants will leave this session with the knowledge and tools to begin or enhance implementation of chronic care management by enhancing the role of the medical assistant, nurse and the technology that supports the clinical care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, Chief Nursing Officer, Community Health Center, Inc.
• Tierney Giannotti, MPA, Senior Program Manager, Population Health, Community Health Center Inc.
Genetics Cases and Resources Webinar Slides - November 8, 2022CHC Connecticut
The document discusses various metabolic diseases, including those that cause muscle symptoms like long chain hydroxyacyl CoA dehydrogenase (LCHAD) deficiency and Pompe disease. It provides information on fatty acid oxidation defects, describing how the body metabolizes fatty acids and the consequences of defects in breaking down different chain length fatty acids. Symptoms of long chain fatty acid oxidation defects are discussed, including fasting intolerance, encephalopathy, liver dysfunction, and muscle involvement. The diagnosis and treatment of these conditions is also summarized.
NTTAP Webinar: Postgraduate NP/PA Residency: Discussing your Key Program Staf...CHC Connecticut
This document discusses a webinar presented by Community Health Center, Inc. on their postgraduate nurse practitioner and physician assistant residency and fellowship programs. It provides an agenda for the webinar which will discuss the key program staff and their responsibilities, including the program director, clinical director, preceptors, mentors and other faculty. The webinar objectives are to identify drivers for implementing such programs, describe the implementation process, discuss program structure and highlight the roles of program staff.
Training the Next Generation within Primary CareCHC Connecticut
This document summarizes a presentation about training the next generation within primary care. It discusses Community Health Center Inc.'s various workforce development programs, including clinical and non-clinical fellowships and student programs. Specifically, it focuses on administrative fellowships, outlining their purpose and key factors to consider when establishing one, such as the fellow's access and experiences. It also describes other opportunities at the Weitzman Institute for training students, such as research programs with Wesleyan University and health policy fellowships. The presentation emphasizes that community health centers are important training grounds and considers how to structure diverse programs to support succession planning.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech 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!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.
8. COVID-19 Vaccinations – Too Slow?
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
9. News Headlines
-4.6 million in the US received a
COVID-19 vaccine, far short of ~ 20
million before the end of Dec
-Federal health officials: rollout had a slower-
than-expected start and “did not have a clear
understanding as to why”
- CDC reported 365,294 people in nursing
homes and long-term-care centers had
been given shots through a federal
program, though more than 2.5 million
doses had been distributed for those
facilities
Highly contagious COVID-19 strain
found in upstate New York, Gov.
Cuomo says
COVID-19 Live Updates: Virus Cases
in U.S. Prisons Top 500,000Source: New York Times
11. COVID-19 “Long Haulers”
Emma Kaplan-Lewis, MD - Infectious Disease Attending,
Elmhurst Hospital Center, NYC Health and Hospitals
Jesse Durrance, MD - Pulmonology and Critical Care Fellow,
Elmhurst Hospital Center, NYC Health and Hospitals
12. Agenda
• Discuss epidemiology of post acute symptoms
related to COVID-19
• Case Presentation: Infectious Disease Perspective
• Case Presentation: Pulmonology/Critical Care
Perspective
• Key Takeaways
• Discussion/Q+A
13. Terminology and Epidemiology
• Post acute sequelae or ‘Long COVID’ or ‘Long Hauler’: persistent symptoms beyond 3 weeks
from initial symptom onset
• ‘Chronic COVID’: Symptoms extending beyond 12 weeks from symptom onset
• Pathophysiology: Permanent organ damage from the acute infection, ongoing inflammation
Difficult to discern from deconditioning and sequelae from overall pandemic (lifestyle
changes, social isolation, more sedentary)
• Frequency:
Mild disease: 35% adult patients with + COVID test in outpatient setting reported ongoing
symptoms median of 16 days after positive test
Moderate-Severe: post hospitalization, mean 60 days since symptom onset (36 days since
hospital discharge), 87.4% reported persistent symptoms, 44.1% reported worsened QOL.
Most common symptoms: fatigue, dyspnea, joint pain, chest pain
14. Terminology and Epidemiology (cont.)
Most Common Reported Symptoms:
– Fatigue
– Dyspnea
– Cough
– Arthralgia
– Chest pain
– Ongoing smell/taste dysfunction
– Headache
– ‘Brain fog’ (cognitive dysfunction, memory impairment)
– Depression/anxiety, mood changes
– Other important sequelae: Metabolic disruption: new or worse diabetes,
Organizing pneumonia, Permanent kidney injury, PTSD, Myocarditis
15. Long Term Symptoms
Carfì A, Bernabei R, Landi F, et al. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603-605
16. Case #1
73 F w/ Osteogenesis Imperfecta type 3, osteoporosis, HIV (CD4 > 1000, VL UD), HTN
3/31-4/9: Hospitalized with COVID-19 pneumonia, needed 02, no intubation. Symptoms: cough, shortness
of breath, fever, loss smell and taste. Discharged on home 02 for ~ 2 weeks
4/24 post d/c follow up: Mild dyspnea, not using 02 very much, still impaired taste and smell, traumatized
by hospital experience but relieved she survived, has 2 friends who passed away from COVID-19
6/26: Reports chronic sore throat post COVID and ongoing loss of taste, decreased appetite.
Deconditioned and frail. Referred to PM&R for PT
10/7: Feels COVID symptoms have returned- cough at night, shortness of breath worse at night and
exertion, ongoing decreased smell/taste impacting appetite. CXR and TTE ordered. Recommended r/p
COVID testing. Rx Mirtazapine 7.5mg QHS
11/18: CXR clear with cardiomegaly, TTE w/ diastolic dysfunction. Reports hard to walk b/c of shortness of
breath, slowly progressive. No chest pain/pressure. Extreme fatigue on some days
11/24: Televisit - worse dyspnea, advised to go to ED, declined but will come to clinic next day
11/25: Seen in clinic, afebrile, 99% room air but desaturated 82-85% after ambulating 1-2 min. HR to 110s
while ambulating. RR 28 at rest. Lungs clear, Cardiac exam with tachycardia (regular) and faint systolic
murmur, no LE edema or JVD. Sent to ED
17. DDX
• PE
• Unstable angina
• CHF
• Pneumonia
• Interstitial lung disease/diffusion abnormality
• ? Other
19. Case #1: TTE
• TTE - impaired left ventricular relaxation pattern with
elevated left atrial pressure, grade II diastolic
dysfunction. Small partially organized pericardial
effusion
20. Case #1 Continued
11/26-12/2: Hospitalized
• TTE bedside with moderate pericardial effusion, no
tamponade
• CTA with no PE, D-dimer negative, r/p COVID PCR negative
• Monitored in CCU then medical floor
• 02 sat remained stable and weaned off 02
• Discharged without 02 and recommended outpatient PFTs
Current status: Referred to cardiology and pulmonology,
continue PT for deconditioning and trying to get outpatient 02
covered
21. Case #2
51 F with HIV, (CD4 600, VL UD) non- IDDM, epilepsy, HTN, prior smoker (quit 10 y prior)
Admitted 1/15-1/30 for leg weakness, UTI and pneumonia. Reports ‘couldn’t walk’ and shortness of breath and fever,
required supplemental 02 no intubation. No COVID test done. CT report (no imaging because outside hospital) with
bibasilar ground glass opacities)
3/18: Non productive cough for weeks, no dyspnea, MSK pain- back and ribs, ? Pleuritic
6/24: Ongoing MSK pain- L. rib , waxing and waning cough and shortness of breath (mild)
COVID IGG + , PCR negative
8/26: Left upper back pain worse on inspiration, cough has improved
Sent for CTA: diffuse ground glass opacities bilateral with bibasilar alveolar airspace opacities.
9/25: Pulmonology apt for ongoing intermittent mild dyspnea and cough and abnormal CT findings, ddx: viral infection,
post COVID syndrome (ab +), plan for TTE and r/p CT chest 3 mo
Dobutamine stress echo- negative for ischemia, normal contractility and EF
9/30: Complaints of dry cough, intermittent sore throat. No fevers
12/22: Ongoing intermittent cough, energy improved, on and off mild dyspnea
COVID PCR negative
Repeat CTA: Stable LLL subpleural predominant groundglass opacities with reticulation/interlobular
thickening. Interval increase in the extent of the RLL subpleural predominant groundglass opacities with
reticulation/intralobular thickening. No honeycombing. Findings nonspecific and can represent interstitial
disease/organizing pneumonia
24. Case #2
Current status: repeat CT with ? Organizing
pneumonia- to see pulmonology next month
(? Tx steroids). Ongoing intermittent sore throat and
dry cough, generally improving.
25. Case # 3
64 F with insomnia, no other medical history
PCR+ for COVID 12/1, managed outpatient, repeat PCR negative 12/19
Frequent headaches, described as if someone ‘grabbing her head and pain
behind eyes’. Not improved with Tylenol or OTC NSAIDS
Waiting for neurology referral, no prior history of chronic headache
syndrome, in meantime getting NCHCT
26. Post-COVID Headaches Management
• If less than 8d/m: treat as needed with OTCs
• If more than 8-10d/m, daily preventative medication needed to avoid medication
overuse:
– Cut down on OTCs if taking >10d/m as that can cause worsening of headache
frequency/severity.
– Topiramate: start 25mg QHS and increase by 25mg weekly to 100mg daily (typically 50mg
BID). Better for migraine headaches (photo/phonophobia, nausea). Can cause grogginess/may
worsen brain fog so I'd avoid if that's a major issue. Don't use if prior kidney stones, glaucoma.
– Amitriptyline: start 10-25mg QHS and can increase up to 50-75mg QHS as needed. Good
option if poor sleep/insomnia. Generally avoid if on other anti-depressants, but such a low
dose that it's generally ok to add on if needed.
– Duloxetine: start 30mg daily but good dose is 60mg daily. Helpful for paresthesias and this is
full anti-depressant dose so good if there's untreated depression but avoid if on other anti-
depressants. Also activating so take in daytime, and take with food as it can cause some
nausea.
– Valproate/Depakote: 250mg daily to BID. Can cause nausea, weight gain, tremors etc. Second
line because of side effect profile but a good headache medication so worth a try if other
options limited. Avoid in anyone with liver issues.
27. Post-COVID Headaches Management (cont.)
• If constant headache/"status" headache:
– Start daily preventative.
– Can also provide short course of steroids (Medrol Dose Pack) to try and break headache. Anecdotally not
much luck with steroids and Post-COVID patients but still worth a try. Avoid if contraindications to steroids.
– If steroids not an option, can also do a 3-5 day course of diclofenac 50mg BID. Since its a longer acting NSAID,
it can also break the headache cycle. Take with food, monitor for GI issues (standard NSAID concerns).
• Other things:
– Tizanidine can be helpful if taken daily, especially if there seems to be a tension component or neck pain.
Typically start lower dose at bedtime and increase as needed since its sedating.
– Other things/non medication environmental modification:
• Sleep: if poor sleep that can worsen headaches. Can treat as above with meds that help headaches and
also sleep (i.e. amitriptyline) or can try melatonin
• Water: recommend at least 2-3L daily
• Caffeine: can help with headache but can also cause headache if drinking a lot. Recommend cutting
down if excessive use.
• Preventatives can take up to 4 weeks to really start working, so don’t stop them if no
immediate improvement. Only to stop if experience side effects that are really bothersome.
If mild side effects, encourage to try continuing and see if they go away since there's
only so many medication options.
28. Management of Post-Acute and
Chronic COVID
• Diagnostic (depending on symptoms reported and history): PFTs, TTE, CTA,
D-dimer, troponin, pro-BNP, CRP
• CXR at 12 weeks post discharge, also for new or worsening symptoms
• A1c, close glucose monitoring for diabetics
• Ambulatory 02 saturation
• Consider pulmonology/ pulmonary rehab, cardiology referral if ongoing
severe symptoms
31. Case #4
53 y.o. Hispanic male with PMH of HTN presented with 2 weeks progressive SOB
associated with cough and fever
• 3/26/20 - 9/4/20: admitted with Severe COVID-19 Pneumonia: requiring intubation
on hospital day 2 after failing NIPPV – subsequent prolonged mechanical ventilation.
• Course complicated by:
– Tension pneumothorax x 2 (different sides)
• Persistent pulmonary-pleural fistula and loculated pneumothorax
– Septic Shock with empyema
– Renal failure requiring RRT
– MDRO infection in lung
• 5/28/20 – Trach done
• Decannulation 7/27/20
• Discharged Home 9/4/2020 on 4L NC, using walker, to care of wife with
VNS/Rehab/DME arranged.
32. Case #4 Follow Up
• 9/10/20: Scheduled for follow up at primary care clinic – no show
• 11/18/20 : Pulmonary follow up
– Tolerating 1L NC on ambulation- no O2 at rest (keeps it on)
– Persistent tachycardia
– Mild sore throat persists
• Issues:
– Exercise tolerance vs O2 demand (real and perceived)
– Assuming personal / family life
– Nagging worry – Post-Traumatic Stress Disorder
– Cultural / Language Barriers to ongoing care
33. Case #4 Follow Up
• Pulmonary Function Tests:
– Moderate Restriction
– No obstruction
• 6-minute walk test
– Off O2
– 66% of predicted
– Saturation >92% on RA
– HR to >140
35. Case #4 Follow Up
• Psychiatry:
– 12/2/20: no show
• Neurology:
– Frequent luxation of shoulders (reportedly had this from prior)
– Sent for tests / tele-medicine visit
– 12/21/20: in-person visit for PMR regarding rehab therapy of B/L upper extremities
• Cardiology: Follow up as needed
• Pulmonary: continues to follow up in outpatient clinic
– Anti-fibrotics are under study
– Inhalers: On ICS/LABA therapy (evidence limited and indeterminate)
– PT / Rehab / O2 supplementation
– PFT Trend- under study
36. Post-Intensive Care Syndrome:
COVID Patients
• PICS (Post-intensive care syndrome)
• Constellation of health issues that linger after critical illness – after discharge
(wide range of incidence =/?? Detection)
• Cognitive Impairment occurs in up to 25% of patients
– Associated with delirium during hospitalization (sedation and COVID)
• Psychological Health Impairment
– PTSD, Anxiety, Depression
• Functional Impairment (>25% of patients)
– ICU Acquired neuromuscular weakness
– Prolonged mechanical ventilation / Sedation / Paralytics / MOF
• Family / Caregiver PICS - beyond just the patient
Rawal G, Yadav S, Kumar R. Post-intensive care syndrome: An overview. J Transl Intern Med. 2017;5: 90–92.
37. Post-Intensive Care Syndrome
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from
intensive care unit: Report from a stakeholders’ conference. Crit Care Med. 2012;40: 502–509.
38. PICS in COVID-19 Patients
• PICS: patients have an elevated rate of re-admission
– Those with ALI/ARDS have higher rate of readmission (80%)
– Longer index admission associated with higher healthcare cost after index
admission
– Degree of inflammation associated with development of PICS
– Significant impact on home finances and ability to re-enter the workplace
• In COVID:
– Oxygen Demand: has the capacity to decrease
• 6MW test and PFTs help with objectivity
– Physical Therapy Remains extremely important
– Totality of PICS in COVID-19 patients is not yet fully appreciated
-Ruhl AP, Lord RK, Panek JA, Colantuoni E, Sepulveda KA, Chong A, et al. Health care resource use and costs of two-year survivors of acute
lung injury: An observational cohort study. Ann Am Thorac Soc. 2015;12: 392–401.
-Bangash MN, Owen A, Alderman JE, Chotalia M, Patel JM, Parekh D. COVID-19 recovery: potential treatments for post-intensive care
syndrome. Lancet Respir Med. 2020;8: 1071–1073.
39. Case #5
51 y.o. Male, no significant PMH, previously admitted for severe COVID-19 PNA at OSH-
Ventilated – Trach – Decannulated
• Course c/b failed extubation x 3, MRSA-VAP- Trach / PEG
• Admitted 3/18/20 for COVID-19 PNA – Trach (4/23/20) – Decannulated (5/15/20) - Discharged
(5/18/20) Home
• 6/18- admitted at OSH for acute exacerbation of “Asthma” discharged on steroids and inhalers
• 6/24- ED Visit at OSH for Dyspnea: duo-nebs – steroids, H1 blocker, inhalers- discharged
• 6/26- ED Visit at OSH for Dyspnea: duo-nebs – steroids, discharged with 5 day steroid course
• 6/28- admitted for Dyspnea, Hypoxia- stridor identified- underwent tracheal balloon dilation
(7/1)- steroid taper, discharged with improved symptoms (7/2) with follow up scheduled
42. Case #5 Continued
• 7/23: Re-admitted with
progressive Dyspnea
Noted to have voice
change
• 7/25: Repeat balloon
dilation with temporary
improvement
Quickly relapsed with
O2 demand (5L NC
constantly)
No obvious stridor on
exam
PFTs post dilation
43. Case #5 Follow Up
• 8/3: Patient underwent tracheal
ring resection
Trach placed during procedure
Quickly decannulated (before
discharge)
• 8/10: Discharged home
• Follow up with Speech for
rehab therapy
Continues to have
improvement. Mild raspy
voice, otherwise asymptomatic
No requirement for
supplemental oxygen
44. Post-COVID “Long Hauler”
Take-Home Messages
• Oxygen supplementation: titration (as much physiologically as
psychologically)
– 6MW test / PFTs should be done at baseline and to monitor disease evolution
• Inhalers: individual patient decision (LABA/ICS)
• Anti-fibrotics: under investigation
• Rehab therapy: extremely important- facilitation is key
• PICS: weakness / cognition / depression / anxiety / PTSD / caretakers
• Dyspnea: keep a broad differential in mind
• Follow-up: elimination of barriers to healthcare access
45. Barriers to Follow-Up Care
• Disproportionate burden on racial / ethnic minority groups in hospitalization
and death rates
– Heavy Disease Burden on groups already vulnerable by traditional determinants
of health indexes
• Post-index hospitalization and Access to Care:
– Language and Cultural Barriers
• Navigation of the health system for testing / follow-up appointments
• Insurance navigation
– Economic Barriers:
• Rehabilitation
• DME – access to oxygen, prescriptions / refills
• Home care : burden of care falls on family
• Bread-winners: significant compromise in familial access to income
46. COVID-19 for the
“Long Haul”
Questions Regarding Each Patient:
1. What ongoing issues are they facing?
— Biological
— Psychological
— Social
2. Who is best-suited to address those issues?
3. What are the barriers the patient / family face
in meeting their needs (from HCP perspective)?
4. How can we (individual providers / system)
anticipate and help meet those demands?
47. References
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae accessed 12/28/20
• Carfì A, Bernabei R, Landi F, et al. Persistent symptoms in patients after acute COVID-19. JAMA.
2020;324(6):603-605.
• del Rio C, Collins LF, Malani P. Long-term health consequences of COVID-19. JAMA. 2020.
doi:10.1001/jama.2020.1971
• Fraser E. Long term respiratory complications of covid-19. BMJ. 2020;370:m3001.
doi:10.1136/bmj.m3001
• Greenhalgh T, Knight M, A’Court C, et al. Management of post-acute covid-19 in primary care. BMJ.
2020;370:m3026
• Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to
usual health among outpatients with COVID-19 in a multistate health care systems network—
United States, March-June 2020. MMWR Morb Mortal Wkly Rep. 2020;69:993-998.
• Sardari A, Tabarsi P, Borhany H, et al. Myocarditis detected after COVID-19 recovery, European
Heart Journal – Cardiovascular Imaging. 2020. https://doi.org/10.1093/ehjci/jeaa166external icon
• Lambert NJ and Survivor Corps. COVID-19 “Long Hauler” Symptoms Survey Report. Indiana
University School of Medicine; 2020. https://dig.abclocal.go.com/wls/documents/2020/072720-
wls-covid-symptom-study-doc.pdf
• Halpin, SJ, McIvor, C, Whyatt, G, et al. Postdischarge symptoms and rehabilitation needs in survivors
of COVID‐19 infection: A cross‐sectional evaluation. J Med Virol. 2020; 1– 10
• UK COVID Symptom study: https://covid.joinzoe.com/post/covid-long-
term?fbclid=IwAR1RxIcmmdL-EFjh_aI- accessed 12/28/20
48. Thank You!
To learn more about The Path Forward series
WeitzmanLearning.org/the-path-forward
To view previous COVID-19 sessions:
WeitzmanLearning.org/coronavirus