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CDS Systems: Past, Present, and Future
Published in Paul Cerrato, John Halamka, Reinventing Clinical Decision Support, 2020
UpToDate. This searchable database, from Wolters Kluwer, is widely used by clinicians around the world. The company recently released UpToDate Advanced, which provides a more interactive approach to CDS, offering diagnostic and treatment pathways to help clinicians navigate the complexities of patient care (Figure 4.5). Pathways have been developed for anesthesiology, cardiovascular medicine, hypertension, emergency medicine, endocrinology, gastroenterology, hepatology, infectious disease, primary care, and other specialties. If one chooses the pathway for low back pain, for example, UpToDate initially lists a series of exclusions that are not being considered in the pathway. Nor is pain that persists for more than 4 weeks part of the pathway. The pathway is limited to adults with acute, non-traumatic pain and focuses on spinal pain. The decision tree then takes the reader through a series of Yes/No decision splits to help determine the best course of action, walking us through various diagnostic options and their implications.
Controlled Drug Delivery in Photodynamic Therapy and Fluorescence-Based Diagnosis of Cancer
Published in Mary-Ann Mycek, Brian W. Pogue, Handbook of Biomedical Fluorescence, 2003
Besides the enhanced penetration of ALA into the interstitial space of tissue, in PDT and PD of cancer it is often important to physically deliver the drug to a particular site of interest. In these cases, that drug has to be homogeneously distributed throughout the entire area and a good contact between the tissue and the drug must be warranted for sufficient time. However, in medical practice these two basic requirements are often difficult to accomplish due to the architecture of the organ in which PDT and/or PD will be performed. In gynecology, the prolonged retention of aqueous solutions of ALA after intravaginal delivery can be difficult due to the limited tightness of this organ. In other cases, such as gastroenterology or otorhinolaryngology, the esophagus or the bronchial tree is not easily accessible for topical drug administration in a minimally invasive way.
Regulatory Environment
Published in Gennadi Saiko, Bringing a Medical Device to the Market A Scientist's Perspective, 2022
Alternatively, you can perform the search through the panel. FDA has classified and described over 1,700 distinct types of devices and organized them into 16 medical specialties or “panels” (anesthesiology, cardiovascular, chemistry, dental, ear, nose, and throat, gastroenterology and urology, general and plastic surgery, general hospital, hematology, immunology, microbiology, neurology, obstetrical and gynecological, ophthalmic, orthopedic, pathology, physical medicine, radiology, and toxicology). So, you can go directly to an appropriate panel and perform a search there.
World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease
Published in Archives of Environmental & Occupational Health, 2023
Ruth A. Lin, Geoffrey M. Calvert, Iris G. Udasin
GERD is characterized by symptoms of heartburn (i.e., a substernal burning sensation starting in the epigastrium and moving upwards toward the neck), food regurgitation, chest pain, and dysphagia. Atypical or extra esophageal reflux symptoms include chronic dry cough, pharyngitis with or without dysphagia, hoarseness, and bronchospasm.13 A single unifying clinical definition of GERD is difficult, and instead requires a blend of definitions. A consensus document of The American College of Gastroenterology defines GERD as reflux of gastric contents into the esophagus resulting in symptoms and/or complication.13 GERD is objectively defined by the characteristic mucosal injury seen on reflux monitoring study (pH or impedance-pH) and/or abnormal esophageal acid exposure demonstrated on a reflux monitoring study.13 Importantly, the reflux disorders observed in WTC-exposed persons are heterogeneous, and sometimes cannot be objectively documented (e.g., when the disorder is consistent with hypersensitive esophagus syndrome or functional heartburn, or other disorders9) Note that the presence of GERD appears to adversely affect the quality of life. Among Japanese workers who received a routine checkup at a clinic in Osaka, Japan, patients with GERD were found to have a poorer quality of life compared to clinic patients who did not have GERD, functional dyspepsia nor irritable bowel syndrome.14
Does occupational ionizing radiation exposure in healthcare workers affect their hematological parameters?
Published in Archives of Environmental & Occupational Health, 2023
Nejdiye Güngördü, Seher Kurtul, Ayşenur Özdil, Mehmet Sarper Erdoğan
The total number of participants was 339; of these, 169 (49.9%) were radiation workers (the IR group), and 170 (50.1%) were in the control group. The mean age was 41.6 ± 9.7 years for the former group and 42.6 ± 7.8 years for the latter. Females constituted 50.9% of the IR group (n = 86) and 42.9% of the control group (n = 73), and there was no significant difference between the groups in terms of age or gender. The rate of smokers was similar in the two groups (52.1% (n = 88) and 52.9% (n = 90), respectively. No significant difference was observed between the groups regarding the years of work experience; 41.3% (n = 70) of the IR group had less than 10 years of experience, and 47% (n = 80) of the control group had less than 10 years of experience. Of the IR group, 39.1% (n = 66) were technicians, 35.5% (n = 60) were physicians, 18.9% (n = 32) were nurses, and 6.5% (n = 11) were from other positions (caregiver, physicist). In this group, 53.3% (n = 90) worked in the radiology department, 11.8% (n = 20) in nuclear medicine, 14.2% (n = 24) in radiation oncology, 8.3% (n = 14) in cardiology, 7.7% (n = 13) in surgical branches, 3.6% (n = 6) in gastroenterology, and 1.2% (n = 2) in the operating room (Table 1).
Medical specialty choice and well-being at work: Physician's personality as a moderator
Published in Archives of Environmental & Occupational Health, 2019
Sari Mullola, Christian Hakulinen, David Gimeno Ruiz de Porras, Justin Presseau, Markus Jokela, Jukka Vänskä, Tiina Paunio, Marko Elovainio
Medical specialty was self-reported in 2006, 2010, and 2015. In Finland, a medical specialist degree requires five to six years of medical practice, including at least nine months of service in public health centers, theoretical and administrative courses, and a passing grade on a national written exam. If they had more than one specialty, they were advised to report the most recent one. Specialties were categorized into 12 different specialties according to the classification used by FMA57: (1) Anesthesiology and Intensive Care Medicine; (2) Surgery (including all surgeon sub-specialties); (3) Pediatrics (including Child neurology and Children's disease); (4) Obstetrics and Gynecology; (5) Psychiatry (including Child Psychiatry, Adolescent Psychiatry, and Forensic Psychiatry); (6) Radiology; (7) Internal Medicine and Oncology; (8) Ophthalmology and Otorhinolaryngology; (9) Other specialties of Internal Medicine (e.g., Endocrinology, Gastroenterology, Dermatology and Allergology); (10) Occupational Health; (11) General Practice; (12) Hospital Service Specialties (e.g., Clinical Microbiology, Forensic Medicine, Clinical genetics). The most recent specialty between study intervals was chosen for analyses purposes.