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Musculoskeletal Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Management of the amputated part aims to reduce the warm ischaemia time. Urgent transfer of the patient and the amputated part must be organized unless the patient is already in a specialist centre. The temperature of the part should be lowered as much as possible, without allowing it to freeze. This is best achieved by taking the following steps: Gross contamination is gently removed, but damage caused by rubbing is avoidedThe part is covered in a single layer of damp (not dripping-wet) gauzeThe covered part is placed in a plastic bag and the bag is sealedThe sealed bag is placed in a container of water/ice mix The amputated part should never be allowed to come into direct contact with ice as this will cause frostbite.
Estimands and How to Define Them
Published in Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch, Estimands, Estimators and Sensitivity Analysis in Clinical Trials, 2019
Craig Mallinckrodt, Geert Molenberghs, Ilya Lipkovich, Bohdana Ratitch
It is also important to collect information about the ICE themselves. For any estimand where distinction is drawn between types of ICEs, it is important that categorizations of type are accurate, predefined, and as objective as possible. Some distinctions are based on changes in treatment, and it is important to record patient medication usage and post-ICE outcomes. Other distinctions between ICEs may be based on the reason for study drug or study discontinuation; for instance, discontinuation due to lack of efficacy may constitute a different ICE than discontinuation due to a serious adverse event and discontinuation for reasons unrelated to treatment (such as logistical reasons) treated in yet another manner.
Chapter 1 Introduction
Published in Emily Blount, Helen Kirby-Blount, Liz Moulton, The Complete CSA Casebook, 2017
Emily Blount, Helen Kirby-Blount, Liz Moulton
Although this isn’t a model of the consultation, Cecil Helman, a medical anthropologist, described six ques- tions that any patient might have in his head when coming to see the doctor. It is well worth bearing these in mind when data gathering, particularly around ICE (ideas, concerns and expectations) and in clinical management, when you are explaining to the patient. Armed with the patient’s own thoughts, fears and hopes, the answers to these questions could provide a useful framework for your explanation. What has happened?Why has it happened?Why to me?Why now?What would happen if nothing was done about it?What should I do about it or whom should I consult for further help?
Heart transplantation as salvage treatment of intractable infective endocarditis
Published in Infectious Diseases, 2023
Pierre Tattevin, Patricia Muñoz, Asuncion Moreno, Guillaume Hékimian, François Delahaye, Xavier Duval, María Ángeles Castel, Barbara Hasse, Natalia Jaramillo, Josip Vincelj, Dannah Wray, Silvia Limonta, María Carmen Fariñas, Carlos A. Mestres, Jose M. Miro
The ICE is an international network of physicians with expertise in the field of IE. Through the ICE, investigators working in 25 countries from Europe, America, Asia, Oceania and Africa, enrolled patients with IE [5]. Participating sites had to meet the following criteria: (i) minimum enrolment of 12 cases per year, with access to cardiac surgery; (ii) consecutive enrolment of cases; (iii) high-quality data, including query resolution; (iv) institutional review board, ethics committee approval or waiver, based on local standards. The ICE prospective cohort has been approved by the Duke University Medical Centre institutional review board (Durham, North Carolina, USA) #2004-01-060, and patients were informed that their data, once anonymised, may be used in future observational studies.
The estimand framework and its application in substance use disorder clinical trials: a case study
Published in The American Journal of Drug and Alcohol Abuse, 2021
Jessica K. Roydhouse, Lysbeth Floden, Rachel L. Tomko, Kevin M. Gray, Melanie L. Bell
In a recent trial, the Achieving Cannabis Cessation – Evaluating N-acetylcysteine Treatment (ACCENT) trial, low adherence was cited as a possible reason for a finding of lack of efficacy (23). ACCENT compared N-acetylcysteine (NAC) plus contingency management (CM) to placebo plus CM for treating cannabis use disorder (CUD). The primary outcome was abstinence, as measured by weekly UCTs (23). Other outcomes included participant-reported measures such as craving (24), measured with the validated short form of the Marijuana Craving Scale (MCQ-SF) (25,26); the score range for this instrument is 12–84 (higher = more craving) (27). The primary paper, written prior to the estimand framework, highlighted both low adherence and high levels of missing data arising from missed visits as well as discontinuation. Discontinuation and non-adherence are both ICEs, whereas unavailable data as a result of missed visits are not necessarily an ICE. Depending on the scientific question, different strategies may be helpful for addressing these challenges.
Health care and social justice implications of incarceration for pregnant people who use drugs
Published in International Review of Psychiatry, 2021
Carolyn B. Sufrin, Andrea Knittel
It is helpful for understanding care of pregnant, incarcerated people with SUD to know more about health care service delivery and status of general pregnancy care behind bars. People who are incarcerated are the only group of people in the U.S. with a constitutionally protected right to health care. This mandate for institutions of incarceration to provide access to health care is based on the 1976 Supreme Court case Estelle v. Gamble, in which the court determined that ‘the deliberate indifference to the serious medical needs’ of incarcerated people amounts to cruel and unusual punishment, a violation of the eighth amendment (Estelle v. Gamble, 1976). Despite the constitutional mandate, there are no required standards for what health care services must be provided, and no requirements for accreditation or oversight (Rold, 2008). This leads to discretionary interpretation of what counts as a ‘serious medical need.’ Following standards of care for pregnant people defined by the American College of Obstetrics and Gynaecology (ACOG), and compliance with the voluntary health care accreditation programs designed by the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA) are all optional (American College of Obstetricians & Gynecologists, 2020; APHA Task Force on Correctional Health Care Standards, 2006; Sufrin, 2018). For people who are incarcerated in facilities operated by ICE, compliance with the health and safety regulations published by the Department of Homeland Security is monitored internally (United States Immigration & Customs Enforcement, 2016).