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Pediatric Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Michael Teik Chung Lim, Mahesh babu Ramamurthy, Daniel Yam-Thiam Goh
Optimal management control comprises of parent/patient education, environment control and pharmacotherapy. It can be visualized as a tripod, with each leg having to be addressed to gain good control of chronic disease.
Communication as a competence?
Published in Peter Tate, Francesca Frame, The Doctor's Communication Handbook, 2019
The most common method of recording currently used is digital, either with webcams, computer-mounted cameras or camcorders. Modern equipment is sensitive to low light, so will work in the dingiest of outpatient suites or surgeries. The on-camera microphones are now quite good, but if you want better sound quality (and it is poor sound quality that ruins more recordings than anything else), you should use an external microphone. Many general practices now have fixed camera brackets in surgeries, but some will need a tripod. A wide-angle lens is very helpful, as many consulting areas are fairly cramped. The aim must be to have both patient and doctor in shot with a clear view of their facial expressions. If you can only get one clearly, go for the patient.
The respiratory system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Manifestations may include: Tachypnea with prolonged expirations. Because a compensatory increase in respiratory rate in patients with emphysema is often effective in maintaining arterial blood gases, one does not usually see hypoxia or cyanosis until the end stages of the disease. Patients with emphysema often exhale through “pursed lips,” which increases the resistance to expired air and generates a backpressure that helps keep the airways inflated. Patients may also sit in a “tripod” posture to enhance the efficiency of the respiratory muscles (see Table 8.13)Dyspnea may occur at rest, worsened with exertionBarrel chest from prolonged expiration and air trappingDecreased breath sounds
Deep brain stimulation: new programming algorithms and teleprogramming
Published in Expert Review of Neurotherapeutics, 2023
Renato Puppi Munhoz, Ghadh Albuainain
As DBS became a solidly established treatment option in mainstream medicine, its indications and scope of use broadened, leading the estimated number of worldwide DBS systems implants to reach 208,000 in 2021 [3]. On the other hand, with increased experience and scientific knowledge, indications, limitations, caveats, and realistic expectations needed to be constantly tailored. Thereupon, it is clear today that the best outcomes depend on a tripod whose legs are rigorous patient, target and device selections, precise surgical technique, and expertise in programming for targeting individual symptoms and signs [4]. Programming involves not only several potential combinations related to waveform variables (amplitude, pulse width [PW], and frequency) but also multiple contact configurations and an increasing number of basic and advanced programming features and techniques [2,4]. This complexity continues to grow at the same pace with recent developments in hardware and software that accelerated substantially over the past decade due to a combination of advancing technology, understanding of stimulation mechanisms, and a more competitive and mature market share.
Risk Model Development and Validation in Clinical Oncology: Lessons Learned
Published in Cancer Investigation, 2023
Gary H. Lyman, Pavlos Msaouel, Nicole M. Kuderer
A Risk Score represents a composite measure that represents a weighted combination of the prognostic variables included in the final multivariable model. Such a score is intended to simplify the often-complex covariate estimates from the model into a useful framework often for clinical application. Often the Risk Score is categorized for clinically useful application and decision making. It is essential that such Risk Scores are independently and externally validated for acceptance and utilization. Finally, the transparent reporting of multivariable risk models is critical. The TRIPOD statement aims to improve the transparency of the reporting of prognostic risk and diagnostic models (63). In addition, the STROBE Statement has provided a reporting checklist for cohort studies, that includes many of the data quality domains discussed in this commentary (64).
COPD in SARS-CoV-2 pandemic. baseline characteristics related to hospital admissions
Published in Expert Review of Respiratory Medicine, 2022
Cristóbal Esteban, Ane Villanueva, Susana García-Gutierrez, Amaia Aramburu, Inmaculada Gorordo, Jose María Quintana, the Covid-19-Osakidetza Working Group
The main limitation of this study is that all the data were extracted from the health database of the Health Department of the Basque Government, and we have therefore been unable to ensure complete information about certain clinical parameters for some patients registered. We are not able to address questions such as whether specific aspects of COPD (e.g. pulmonary function) had any influence on the rate of hospitalization, but we can assess the general burden of COPD together with other comorbidities. Regarding strengths, this study includes a relatively large cohort of COPD patients based on which we have been able to derive a clinical prediction rule, following the recommendations of the TRIPOD statement [44]. Our risk score for hospital admission has good sensitivities and specificities which warrant its use, in combination with additional individual clinical information, to guide the clinical decision-making process. Therefore, we can suggest that patients with a score <5 can stay at home, if no other risk factors are present, while those with a score of ≥10 are quite likely to require hospital admission. Patients with intermediate scores should be evaluated with more specific information obtained by the physician in charge, though the rate of hospitalization in these patients is always very high. Nevertheless, further validation in other settings is required.