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1
Clinical echocardiography review: A self-assessment tool. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2011.
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2
Commission for Health Improvement (Great Britain). Self assessment tool for child protection for clinical teams. Norwich: TSO, 2004.
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3
Riegel, Fernando, Maria da Graça Oliveira Crossetti, and Peter A. Facione. Modelo teórico para mensuração do pensamento crítico holístico no ensino do processo diagnóstico de enfermagem. Brazil Publishing, 2021. http://dx.doi.org/10.31012/978-65-5861-321-3.
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The theoretical model book for measuring holistic critical thinking (PCH) in the teaching of the nursing diagnostic process (PDE) highlights the complexity of the PDE based on the application of the PCH of nursing students in face of the requirement of making accurate clinical decisions; in addition, it demonstrates the applicability of the Holistic Critical Thinking Scoring Rubric (HCTSR) instrument authored by professors Peter A. Facione and Noreen Facione; for the assessment of holistic critical thinking in nursing and health, becoming an important diagnostic and formative assessment tool at different levels of education, which can contribute to the advancement of nursing science with regard to the training of critical nurses and reflective in the application of the nursing diagnostic process that is structured in the stages of investigation, interpretation and nursing diagnoses with a view to making accurate nursing decisions. To reach these stages, the nurse must develop skills of holistic critical thinking (PCH), in order to make decisions focused on the best results. Based on this theoretical model, it will be possible to implement different strategies to develop holistic critical thinking in teaching the diagnostic process according to the students' PCH level.
4
Grisso, Thomas, and Paul S. Appelbaum. Macarthur Competence Assessment Tool for Clinical Research. Professional Resource Press, 2001.
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5
Basic to Advanced Clinical Echocardiography. A Self-Assessment Tool for the Cardiac Sonographer. LWW, 2020.
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6
Mike, Slade, and Royal College of Psychiatrists, eds. CAN: Camberwell assessment of need : a comprehensive needs assessment tool for people with severe mental illness. London: Gaskell, 1999.
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7
Chu, Larry. Clinical Anesthesiology Board Review: A Test Simulation and Self-Assessment Tool (McGraw-Hill Specialty Board Review). McGraw-Hill Medical, 2005.
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8
Clinical Anesthesiology Board Review: A Test Simulation and Self-Assessment Tool (McGraw-Hill Specialty Board Review). McGraw-Hill Medical, 2005.
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9
Kalsi-Ryan, Sukhvinder. The Quadriplegia Hand Assessment Tool (Q-HAT): The development of a clinical assessment measure of the hand for the cervical spinal cord injured individual. 2006.
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10
Barthélémy, Romain, Etienne Gayat, and Alexandre Mebazaa. Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter). Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0014.
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Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography often helps to assess the mechanism of cardiac dysfunction, it cannot be considered as a monitoring tool. In some cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), pulmonary artery catheter can help to assess and monitor cardiovascular status and to evaluate response to treatments. Last, macro- and microvascular dysfunctions are also important determinants of haemodynamic instability.
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Piel, Jennifer L., and Ronald Schouten. Violence Risk Assessment. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199387106.003.0003.
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The problem of violence in our society has received increasing attention from the public and mental health professions in recent years, and assessing the risk of violence has become a core skill for mental health clinicians and forensic specialists alike. In fact, mental health practitioners in all clinical settings are tasked with assessing and managing their patients’ risk of violence. Although research on the nature of violence and factors that increase the likelihood that a person will commit violent acts has grown in the past several decades, there is no single standard protocol or tool for assessing the risk of violence. This chapter reviews the key risk factors for violence that are supported by research, examines the relationship between mental disorders and violence, and describes approaches that mental health professionals can use to assess the risk of violence.
12
Howell, Simon J. Clinical trial designs in anaesthesia. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0030.
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A clinical trial is a research study that assigns people or groups to different interventions and compares the impact of these on health outcomes. This chapter examines the design and delivery of clinical trials in anaesthesia and perioperative medicine covering the issues outlined below. The features of a high-quality clinical trial include well-defined inclusion and exclusion criteria, a control group, randomization, and blinding. Outcome measures may be broadly divided into counting the number of people who experience an outcome and taking measurements on people. The outcome measures selected for a clinical trial reflect the purpose of the study and may include ‘true’ clinical measures such as major postoperative complications or surrogate measures such as the results of a biochemical test. Outcome measures may be combined in a composite outcome. Assessment of health-related quality of life using a tool such as the SF-36 questionnaire is an important aspect of many clinical trials in its own right and also informs the economic analyses that may be embedded in a trial. Determining the number for recruits needed for a clinical trial requires both clinical and statistical insight and judgement. The analysis of a clinical trial requires a similarly sophisticated approach that takes into account the objectives of the study and balances the need for appropriate subgroup analyses with the risk of false-positive results. The safe and effective management of a clinical trial requires rigorous organizational discipline and an understanding of the ethical and regulatory structures that govern clinical research.
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Lameire, Norbert, Raymond Vanholder, and Wim Van Biesen. Clinical approach to the patient with acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0222_update_001.
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The prognosis of acute kidney injury (AKI) depends on early diagnosis and therapy. A multitude of causes are classified according to their origin as prerenal, intrinsic (intrarenal), and post-renal.Prerenal AKI means a loss of renal function despite intact nephrons, for example, because of volume depletion and/or hypotension.There is a broad spectrum of intrinsic causes of AKI including acute tubular necrosis (ATN), interstitial nephritis, glomerulonephritis, and vasculitis. Evaluation includes careful review of the patient’s history, physical examination, urinalysis, selected urine chemistries, imaging of the urinary tree, and eventual kidney biopsy. The history should focus on the tempo of loss of function (if known), associated systemic diseases, and symptoms related to the urinary tract (especially those that suggest obstruction). In addition, a review of the medications looking for potentially nephrotoxic drugs is essential. The physical examination is directed towards the identification of findings of a systemic disease and a detailed assessment of the patient’s haemodynamic status. This latter goal may require invasive monitoring, especially in the oliguric patient with conflicting clinical findings, where the physical examination has limited accuracy.Excluding urinary tract obstruction is necessary in all cases and may be established easily by renal ultrasound.Distinction between the two most common causes of AKI (prerenal AKI and ATN) is sometimes difficult, especially because the clinical examination is often misleading in the setting of mild volume depletion or overload. Urinary chemistries, like calculation of the fractional excretion of sodium (FENa), may be used to help in this distinction. In contrast to FENa, the fractional excretion of urea has the advantage of being rather independent of diuretic therapy. Response to fluid repletion is still regarded as the gold standard in the differentiation between prerenal and intrinsic AKI. Return of renal function to baseline or resuming of diuresis within 24 to 72 hours is considered to indicate ‘transient, mostly prerenal AKI’, whereas persistent renal failure usually indicates intrinsic disease. Transient AKI may, however, also occur in short-lived ATN. Furthermore, rapid fluid application is contraindicated in a substantial number of patients, such as those with congestive heart failure.‘Muddy brown’ casts and/or tubular epithelial cell casts in the urine sediment are typically seen in patients with ATN. Their presence is an important tool in the distinction between ATN and prerenal AKI, which is characterized by a normal sediment, or by occasional hyaline casts. There is a possible role for new serum and/or urinary biomarkers in the diagnosis and prognosis of the patient with AKI, including the differential diagnosis between pre-renal AKI and ATN. Further studies are needed before their routine determination can be recommended.When a diagnosis cannot be made with reasonable certainty through this evaluation, renal biopsy should be considered; when intrarenal causes such as crescentic glomerulonephritis or vasculitis are suspected, immediate biopsy to avoid delay in the initiation of therapy is mandatory.
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Jeffery, Rachel, Pradip Nandi, and Kenny Sunmboye. Investigation in rheumatological disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0265.
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In suspected rheumatological disease, the findings on careful clinical assessment are crucial to the interpretation of test results. Investigation should not be used as a screening tool, but rather to clarify the differential diagnosis. In established disease, investigation is also be used to assess the extent and severity of organ involvement, establish prognosis and guide treatment choices.
15
Gomes, William A. Neuroimaging of Epilepsy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0045.
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Neuroimaging is essential for clinical care and basic research in epilepsy. MRI is the primary tool, but adjunctive techniques are commonly employed including MRS, PET, SPECT, and MEG. These techniques facilitate localization and characterization of seizure foci prior to epilepsy surgery, and also allow preoperative assessment of risk to eloquent brain regions. Evaluation of patients with MRI-negative epilepsy remains a major clinical challenge and motivation for contemporary research.
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Wigginton, Mark, Miguel Garcia, Timothy J. Draycott, and Neil A. Muchatuta. Simulation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0053.
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Simulation can be a powerful tool in obstetric anaesthesia, driving forwards the education of clinicians for the benefit of patients. Simulation has been closely linked with obstetrics since its inception. Today’s modern technology and educational theory have combined to make it a more powerful and accessible learning tool than ever, allowing both clinical skills and human factors to be effectively taught and assessed in combination. Since becoming more widely validated, simulation is also being used in research, to identify latent threats and for summative assessment. Setting up a simulation programme, whether in situ or at a dedicated centre, requires preparation, planning, and an appreciation of its limitations. The simulation should be evidence based, target the learner’s needs, and be of benefit to patients. The challenge for trainers and trainees is to ensure both that the training provided achieves these goals, and that they can deliver evidence to demonstrate that it has.
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Holden, Melanie A., Martin J. Thomas, and Krysia S. Dziedzic. Miscellaneous physical therapies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0026.
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Miscellaneous physical therapies, such as assistive devices, thermotherapy, manual therapy, and electrotherapy are commonly used to treat patients with osteoarthritis (OA) in addition to written information and exercise. However, the evidence underpinning specific miscellaneous physical therapies is often limited, with small study sizes, heterogeneous populations, and differing study designs making it difficult to draw firm conclusions about their effectiveness. One or more miscellaneous physical therapies feature within 15 current clinical guidelines for OA. The specific types of physical therapies addressed are variable, as are their recommendations. There is most agreement for miscellaneous physical therapies in hand OA, with multiple guidelines addressing and consistently recommending joint protection, splinting, and thermotherapy in addition to core treatment. However these recommendations are predominantly based on a small number of randomized controlled trials (RCTs). Use of walking aids and footwear is commonly addressed and recommended for patients with hip and knee OA, although recommendations are predominantly based on expert opinion. Other physical therapies recommended for hip and knee OA range from orthoses to less conventional leech therapy. When a recommendation for a miscellaneous physical therapy is not made, it is commonly due to limited clinical evidence, rather than evidence of harm. Due to limited evidence and lack of consensus between clinical guidelines, for some therapies, use of specific miscellaneous physical therapies in clinical practice should be based upon the best available evidence, a holistic, individualized clinical assessment and shared decision-making with the patient. Further large-scale, high-quality RCTs would be useful to inform future guideline recommendations and clinical practice.
18
Doherty, Michael, Johannes Bijlsma, Nigel Arden, David J. Hunter, and Nicola Dalbeth. Introduction: the comprehensive approach. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0020.
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This introductory chapter to the section on management of osteoarthritis (OA) emphasizes the need for a full assessment of the patient, not just in terms of joint symptoms and examination findings but a full holistic assessment of the person, including the impact of OA on their life, their illness perceptions of OA, and the presence of comorbidities. An individualized package of care can then be developed. Patients should be fully informed about OA and fully involved in all management decisions. Apart from education, which is an ongoing not one-off process, other core treatments to be considered in every person with OA are exercise (both strengthening and aerobic) and strategies to reduce adverse mechanical factors, including weight loss if overweight or obese. Topical non-steroidal anti-inflammatory drugs are the safest analgesic drug to try first for peripheral joint OA. Other treatments can be selected as required from a wide range of drug and non-pharmacological options, to address the needs of the individual. The patient requires regular follow-up for reassessment and re-adjustment of management as required. Currently there are sparse data on predictors of response to treatment, limiting a stratified medicine approach. Caveats to the research evidence for OA and its transition to clinical practice are discussed, and one way of improving this (reporting overall treatment effect and the proportion attributable to placebo in clinical trials) is presented. Optimizing contextual effects, which are an integral part of any treatment and which may explain the majority of improvement that a patient experiences for their OA, is emphasized as a key aspect of care.
19
Shippey, Ben, and Graham Nimmo. Simulation training for critical care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0014.
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Simulation in various guises can be an extremely useful educational methodology. Its use should be planned carefully to maximize educational efficiency and minimize disruption to patient care. It requires the facilitator to enable the participants to behave as they would in the real clinical environment. Fidelity is one aspect of the simulated clinical environment that helps participants engage with the clinical material. The participants should be debriefed after the simulated experience. Video-assisted debriefing facilitates reflection on elements of behaviour that affect patient safety. Many styles of debriefing exist, but there are common elements. Debriefing should be carefully facilitated by faculty with the necessary skills. Simulation is increasingly being used as an assessment tool, but the validity of summative assessments using simulation is unclear.
20
McCabe, Candy, Richard Haigh, Helen Cohen, and Sarah Hewlett. Pain and fatigue. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0012.
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Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.
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McCabe, Candy, Richard Haigh, Helen Cohen, and Sarah Hewlett. Pain and fatigue. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199642489.003.0012_update_001.
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Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.
22
Pereira, Araída Dias, Bárbara Paixão de Gois, and Jussara Maysa Silva Campos. Oncologia: uma visão interdisciplinar. Brazil Publishing, 2021. http://dx.doi.org/10.31012/978-65-5861-216-2.
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This book, comprising 24 chapters, proposes in an interdisciplinary way to present updated technical content from different areas such as nutrition, nursing, psychology, pharmacy and occupational therapy. The main objective of this work is to contribute to the clinical professional practice in oncology, as well as, to the training of students in the health field. The contents were carefully selected, compiled and approached in a didactic way, so that they provide an intuitive and pleasant reading. Starting from the molecular basis, risk and nutrition factors and cancer prevention, going through screening and nutritional assessment, since diet therapy treatment, symptom control, main nutritional problems and palliative care, and even spirituality, with the nutritional approach for adults and pediatric patients as one of its strengths. This way, readers are invited to enjoy the knowledge shared by experienced health professionals and researchers, who work in oncology. In addition to these experiences, valuable reports are presented from patients who have experienced (or are experiencing) cancer treatment, with the aim of bringing the reader closer to a different perspective of this multidimensional reality. It is known that the experience of an oncological treatment is accompanied by varied emotions and feelings for everyone involved, both for the team of professionals and for family members, in addition to the role of the patients themselves. And that is why, from the different spectrums covered, it is expected to help the professional performance in this ascending area of health to occur even more in a holistic and humanized way.
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Rosen, David H., and Uyen B. Hoang. The Patient-Centered Interview. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190628871.003.0005.
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In this chapter, the focus is on the patient-centered interview as a basic tool that uses inherent principles of the biopsychosocial model to talk to patients. There are four key approaches to patient interviewing: the science of observation, following the affect, the concept of process, and the A.R.T. of interviewing. Observational skills can be refined to yield valuable clinical data. Follow-the-affect helps to guide the interview in relation to what the patient is feeling, and it acknowledges the importance of students’ abilities to keep track of their own feelings. The interview process segment holds there is a process level to all communication between people. The A.R.T. of interviewing attempts to offer a conceptual link between process and content. The mnemonic device refers to three components: assessment, rankings, and transition. Last, there is a section that offers clinical pearls, mnemonics, and tricks of the trade.
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Wells, Toby, and Simon J. Freeman. Ultrasound. Edited by Michael Weston. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0132.
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Ultrasound is an invaluable tool in the diagnosis and management of many urological disorders. It has the advantages of not involving ionizing radiation, allowing rapid real time imaging and being relatively inexpensive. It can also be performed at the patient’s bedside if necessary. There are limitations, however, and it is best used as an adjunct to clinical assessment, often alongside other complementary imaging modalities. While many ultrasound studies are undertaken by urological surgeons, it is often performed by imaging specialists; close liaison between these two groups is essential. A brief, clinically relevant, introduction to ultrasound physics is included and the use of Doppler techniques and ultrasound contrast agents will be discussed. It is not possible to cover all the urological conditions for which ultrasound is used in one chapter, so some recommended texts are included in the reading list for further study.
25
Pizza, Fabio, and Carlo Cipolli. Other sleep laboratory procedures (MSLT, MWT, and actigraphy). Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0009.
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Sleep medicine practice requires different objective procedures apart from nocturnal polysomnography (PSG) to quantify sleep patterns and daytime sleepiness. Two approaches are available to measure daytime sleep propensity and vigilance: the multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT). Both tests require multiple nap opportunities under online dynamic PSG monitoring; however, in the MSLT, the subject is asked to try to fall asleep (and sleep 15 minutes to document sleep onset REM periods), but in the MWT to remain awake. The MSLT is the gold standard test for the differential diagnosis of central disorders of hypersomnolence after careful clinical assessment, while the MWT is useful to document vigilance levels for safety reasons. Rest–activity patterns can be documented for prolonged periods by actigraphy to measure circadian sleep distribution. Actigraphy is therefore a useful objective tool for insomnia, circadian rhythm, and sleepiness assessment and to track treatment response.
26
Hardy, Janet R., Paul Glare, Patsy Yates, and Kathryn A. Mannix. Palliation of nausea and vomiting. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0202.
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Nausea and vomiting (NV) are unpleasant symptoms reported as highly distressing by sufferers and have a significant impact on activities of daily living. The prevalence of nausea is 6-68% in people with advanced cancer, 17-48% in heart disease, 30-43% in renal disease, and 43-49% in people with AIDS and is not always associated with vomiting. Several multifactorial clinical syndromes can contribute to NV in patients with advanced illness. Two strategies have been proposed for the management of nausea and vomiting: the mechanistic and the empirical approach. Most of the evidence supporting the use of antiemetic drugs in palliative care has been extrapolated from trials of chemotherapy- and radiotherapy-induced NV. An ideal measurement tool for the assessment of NV and retching has yet to be developed. Inherent in the management of NV is to maximize treatment of those symptoms commonly associated with NV.
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Bandettini, Peter A., and Hanzhang Lu. Magnetic Resonance Methodologies. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0008.
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Magnetic resonance imaging is a noninvasive tool for assessing brain anatomy, perfusion, metabolism, and function with precision. In this chapter, the basics and the most cutting edge examples of MRI-based measures are described. The first is measurement of cerebral perfusion, including the latest techniques involving spin-labelling as well as the tracking of exogenous contrast agents. Functional MRI is then discussed, along with some of the cutting edge methodology that has yet to make it into routine clinical practice. Next, resting state fMRI is described, a powerful technique whereby the entire brain connectivity can be established. Diffusion-based MRI techniques are useful for diagnosing brain trauma as well as understanding the structural connections in healthy and pathological brains. Spectroscopy is able to make spatially specific and metabolite-specific assessment of brain metabolism. The chapter ends with an overview of structural imaging with MRI, highlighting the developing field of morphometry and its potential for differentially assessing individual brains.
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Fine, Perry G. The Hospice Companion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190456900.001.0001.
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The Hospice Companionis a guide to best practices in end-of-life care, informed by the most current evidence-based literature in the field. It is intended to be used “at the bedside” and during interdisciplinary team meetings to efficiently and effectively improve patient care and provide useful family and caregiver support. It should be thought of as a “decision support tool” to be used by all members of the hospice interdisciplinary team, including nurses, physicians, counselors, and social workers. This is the third edition of this clinical guide and it includes forty chapters allotted into three sections (General Processes; Personal, Social, and Environmental Processes; Clinical Processes and Symptom Management) plus five appendices. The symptom management chapters are arranged alphabetically, covering the gamut of common and highly burdensome problems encountered in caring for patients with far-advanced illness, from agitation and anxiety to xerostomia. Chapters are concise, averaging 1,000 to 1,500 words (the exception is the chapter on pain, in view of its complexity). Each is organized around the specific clinical issue of concern by defining the problem and its usual causes, findings, and differential diagnosis. This is followed by outlining salient features of assessment and management according to practical, psychosocial, biomedical, and spiritual categories. Each chapter concludes with a list of goals that should be defined in establishing a plan of care and what should be documented in the clinical record as well as a list of recommended readings from the contemporary literature.
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Kane, David, and Philip Platt. Ultrasound. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0067.
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Musculoskeletal ultrasound (MSUS) is rapidly becoming a standard part of many rheumatologists' daily clinical practice. MSUS is safe, increasingly widely available, relatively low cost, non-invasive, and hence very acceptable to the patient. Current problems with availability of training, mentoring, and accreditation procedures need to be overcome for MSUS to reach its full potential for rheumatologists. MSUS is capable of improving clinical diagnosis and the accuracy of intervention. MSUS is more sensitive than clinical examination in the detection of synovitis and effusion and is capable of rapid targeted assessment of widely spaced joints coupled with clinical correlation. MSUS has advantages over other imaging modalities; the ability to display dynamic real-time movement makes it the imaging modality of choice for tendon problems. It is significantly more sensitive than plain radiology in the demonstration of early erosive changes, and although its sensitivity is less than that of MRI for the detection of erosions it is far more practical, timely, and available. The combination of sensitivity in detection of synovitis, tenosynovitis, and erosions makes it an ideal imaging modality in the context of an early arthritis clinic. Power Doppler has been shown to be an effective way of evaluating synovitis and hence is of value in early diagnosis and monitoring of inflammatory arthritides. The accuracy of placement of local injection therapies is enhanced by MSUS, and it significantly increases the diagnostic success rate of aspiration of joints and bursas. The flexibility of ultrasound as a tool for rheumatologists is shown by its application in the assessment of vasculitides, peripheral nerve pathology, salivary glands, and skin lesions.
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Kane, David, and Philip Platt. Ultrasound. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0067_update_002.
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Musculoskeletal ultrasound (MSUS) is rapidly becoming a standard part of many rheumatologists’ daily clinical practice. MSUS is safe, increasingly widely available, relatively low cost, non-invasive, and hence very acceptable to the patient. Current problems with availability of training, mentoring, and accreditation procedures need to be overcome for MSUS to reach its full potential for rheumatologists. MSUS is capable of improving clinical diagnosis and the accuracy of intervention. MSUS is more sensitive than clinical examination in the detection of synovitis and effusion and is capable of rapid targeted assessment of widely spaced joints coupled with clinical correlation. MSUS has advantages over other imaging modalities; the ability to display dynamic real-time movement makes it the imaging modality of choice for tendon problems. It is significantly more sensitive than plain radiology in the demonstration of early erosive changes, and although its sensitivity is less than that of MRI for the detection of erosions it is far more practical, timely, and available. The combination of sensitivity in detection of synovitis, tenosynovitis, and erosions makes it an ideal imaging modality in the context of an early arthritis clinic. Power Doppler has been shown to be an effective way of evaluating synovitis and hence is of value in early diagnosis and monitoring of inflammatory arthritides. The accuracy of placement of local injection therapies is enhanced by MSUS, and it significantly increases the diagnostic success rate of aspiration of joints and bursas. The flexibility of ultrasound as a tool for rheumatologists is shown by its application in the assessment of vasculitides, peripheral nerve pathology, salivary glands, and skin lesions.
31
Hayashi, Daichi, Ali Guermazi, and Frank W. Roemer. Radiography and computed tomography imaging of osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0016.
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Osteoarthritis (OA) is the most prevalent joint disorder in the elderly worldwide and there is still no effective treatment, other than joint arthroplasty for end-stage OA, despite ongoing research efforts. Imaging is essential for assessing structural joint damage and disease progression. Radiography is the most widely used first-line imaging modality for structural OA evaluation. Its inherent limitations should be noted including lack of ability to directly visualize most OA-related pathological features in and around the joint, lack of sensitivity to longitudinal change and missing specificity of joint space narrowing, and technical difficulties regarding reproducibility of positioning of the joints in longitudinal studies. Magnetic resonance imaging (MRI) is widely applied in epidemiological studies and clinical trials. Computed tomography (CT) is an important additional tool that offers insight into high-resolution bony anatomical details and allows three-dimensional post-processing of imaging data, which is of particular importance for orthopaedic surgery planning. However, its major disadvantage is limitations in the assessment of soft tissue structures compared to MRI. CT arthrography can be useful in evaluation of focal cartilage defects or meniscal tears; however, its applicability may be limited due to its invasive nature. This chapter describes the roles and limitations of both conventional radiography and CT, including CT arthrography, in clinical practice and OA research. The emphasis is on OA of the knee, but other joints are also mentioned where appropriate.
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Williams, George W., Navneet Kaur Grewal, and Marc J. Popovich, eds. Anesthesiology Critical Care Board Review. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190908041.001.0001.
Full textAbstract:
Focused preparation for Critical Care Certification is needed to ensure success. The Anesthesiology Critical Care Certification examination in particular provides an objective assessment from the perspective of physicians who have a keen perioperative mindset and skillset, while simultaneously demonstrating comfort in caring for patients from every background and co-morbidity as all such patients frequently eventually require pre-operative or post-operative management. The Anesthesiology Critical Care board review provides Critical Care Examination style stems with an emphasis on being oriented toward Anesthesiology Critical Care certification, though examination preparation for the Internal Medicine (Pulmonary Critical Care), Neurocritical Care and Surgical Critical Care could easily be achieved with this text as part of one’s preparation strategy. The authors provide clinical vignettes with realistic images and values to test one’s diagnostic and critical thinking approach to the perioperative patient. Furthermore, every chapter is authored by a physician board certified in critical care medicine. While most authors are anesthesiologists, our text includes content from intensivists with core training in Surgery and Neurology in order to provide a well-rounded perspective on the cases in this book. Much like ICU rounds, this book is systems based and covers the keywords listed by the American Board of Anesthesiology for certification in Critical Care Medicine. Finally, as each area of content is covered, reference materials are available for the reader to gain further expertise in each topical area. The author’s goal is the impart this text to the reader as a formidable tool for Critical Care Examination Preparation.