...Use of Intravenous Heparin by North American Neurologists Do the Data Matter? Ahmad Al-Sadat, MD; Mohammad Sunbulli, MD; Seemant Chaturvedi, MD Background and Purpose—Our aim was to determine current usage patterns of intravenous heparin for patients with acute ischemic stroke. Methods—A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results—US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P0.001), vertebrobasilar stroke (30% versus 8%, P0.001), carotid territory stroke (31% versus 4%, P0.001), and multiple transient ischemic attacks (47% versus 9%, P0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88% and 84%, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33% versus 10%, P0.001). Conclusions—In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists...
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...experience in terms of self in relation to self and also to the world. For the purpose of the reflection, this essay shall be written in the first person. In accordance with the NMC (2002) code of professional conduct, confidentiality shall be maintained and all names have been replaced to protect identity. Case Study Janet is a 67 year-old lady admitted a week ago for chest infection. We also discovered that Janet had developed a mild form of Type II diabetes mellitus from the levels of sugar in her urine and her blood sugar levels were mildly elevated. Soon after she responded to the treatment, we discovered that Janet is suffering from a mild stroke leaving her with expressive dysphasia. For her plan, we referred her to physiotherapist for her mobilization, speech therapist for her dysphasia and dietician for her dietary control of her type II DM. After 5 days of treatment, we noticed there is improvement in Janet’s condition. However, we...
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...NOT involved- usually due to small vessel disease(if ischaemic) POCS- posterior circulation stroke- could be embolic or small vessel disease Why is this important? TACS- worst prognosis, poorer rehab potential, longer hospital stay as opposed to LACS History Is it acute onset, time of onset of symptoms essential for thrombolysis, witness account if possible Current symptoms (assess if focal or not) Past medical history- Diabetes, HTN, Dyslipidaemic, Ischaemic heart disease, atrial fibrillation Smoking, lifestyle, medications(esp warfarin), intolerances Social history Examination Evidence of heart failure, AF, peripheral pulses Higher mental fns involved?- suggests cortical involvement Dominant- some variant of dysphasia Non dominant- neglect, dyspraxia, spatial disorientation, emotional lability, inattention Motor, sensory, hemianopia Cerebellar or brainstem signs Case 1 YD 60/F Right face,arm and leg weakness and aphasia. Time of onset...
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...Nightingale Executive Summary Western Governor’s University Nightingale Executive Summary Nightingale Community Hospital is a 180 bed hospital that provides acute care and a range of services to their community. Nightingale has four core values that consist of safety, community, teamwork, and accountability. Communication is a key concept in achieving and defining those values. According to the National Patient Safety Goal Data in regards to communication for Nightingale Community Hospital there is not consistency and goals are not being met for the following: reporting critical results within 60 minutes as evidenced by documentation, verbal orders/read-backs, unacceptable abbreviations, and time out hospital wide. Critical Results Within 60 Minutes Nightingale Hospital has showed variations in compliance with reporting critical results within 60 minutes for the months of January through December. Compliance went from 63% in January to 80% in December. In between this time there have been significant variances. As noted there from the data there was only 56% and 57% compliance for the months of June and July. Reporting of Critical Results with 60 minutes should be at 100% compliance. Verbal Orders/Read-Backs The ED met 100% compliance with verbal order/read-back audits for the fiscal year to date. Ortho is at 62% compliance. The other departments at Nightingale Hospital are ranging from 91% to 99%. For JCAHO standards the departments should be at 100%. ...
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...therapist, speech therapist, and administrators) in and out of the classroom. It leaves not much time for learning because the toileting, hygiene, and eating do take a big part of the day. The teachers usually have a full time assistant in the classroom or two depending on the need in the classroom; this helps the Special Education teacher complete tasks in the classroom. The teacher can work on a student one on one and the assistant can help with the other students needs. (Severe Intellectual Disabilities and Multiple Diablites, 2007) Some of the intellectual disabilities that teachers may encounter I have found are ADHD (Attention Deficit hyperactivity Disorder), Angel man syndrome, Aspersers Syndrome, Autism, Cri Du Char, Down Syndrome, Dysphasia, Dyspraxia, Epilepsy, Fragile X, Klinefelter Syndrome, Pervasive Developmental Disorder, Prader-willi Syndrome, Rett Syndrome, Trismoy, Soto’s Syndrome, Tourette Syndrome, Tuberous Sclerosis, and Williams Syndrome. (Activ, 2001) References Activ (2001) Types of Intellectual Disabilities. Retrieved on July 13, 2001 from http://www.activ.asn.au/3/3017/8/types_of_intellectual_disability.pm Severe Intellectual Disabilities and Multiple Disabilities. Pat Mimms. Retrieved from Special Education for Today’s Teachers: An Introduction, by Michael S. Rosenberg, D avid L. Westling, and James M cLeskey....
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...Running head: LEARNING DISABILITY REPORT Learning Disability Report Tammie Johnson Grand Canyon University: SPE 226 April 28, 2012 Learning Disability Report Definition Chart | Learning Disabilities: Learning disabilities affect the ability to understand language that is spoken or written, it can relate to mathematics, and or direct attention. | Types | Dyslexia | Definition: Dyslexia is a learning disability where one has difficulty reading | | Characteristics & Causes: There are several different types of dyslexia and they can be caused by a brain trauma, hormonal development, and has been linked to the chromosome gene number 6 (Medicine Net.com, 1996-2012). | | Teaching Strategies: The best strategy is the use of multi-sensory to help students learn how to use their other senses such as hearing and sight (auditory sensation) to aide in their comprehension. | Examples: trouble pronouncing or writing words backwards | | | | | Dyscalculia | Definition: Dyscalculia is a learning disability where one has difficulty with mathematics | | Characteristics & Causes: To date there has been no information on what really causes this disability but think it could be caused due to alcohol exposure or the Fragile X Syndrome. | | Teaching Strategies: Best strategy is to provide one on one support to aide the student in the least restricted learning...
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...Dysphagia - A Greek word that means disordered eating. - Typically refers to difficulty in eating as a result of disruption in the swallowing process - Can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. DISRUPTION -A disruption in the ability to move food or liquid from the mouth through the pharynx and esophagus into the stomach safely and efficiently. -Swallowing disorders can occur at any point in the life span from infancy through old age but this can be seen mostly in the older age. SYMPTOMS >Gag, choke, or cough when you swallow. >Have pain or pressure in your chest or have heartburn. >Have problems getting food or liquids to go down on the first try. >Have food or liquids come back up through your throat, mouth, or nose after you swallow. >Have pain when you swallow. >Feel like foods or liquids are stuck in some part of your throat or chest. CAUSES * Muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have: 1. Certain problems with nervous system, such as muscular dystrophy or Parkinson’s disease. 2. Esophageal spasm - the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach. 3. Had a stroke or a...
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...Professional Regulation’s for Occupational Therapy In Mississippi Occupational therapists provide skilled care to clients of all ages with dysphasia. Occupational therapists are trained professional that help individuals achieve independence in all aspects of their lives. A few of the health conditions that benefit from occupational therapy include: work-related injuries including lower back problems, limitations following a stroke or heart attack, arthritis, multiple sclerosis, or other serious chronic conditions, birth injuries, learning problems, or developmental disabilities, mental health or behavioral problems including Alzheimer's, schizophrenia, and post-traumatic stress, problems with substance use or eating disorders, burns, spinal cord injuries, or amputations, broken bones or other injuries from falls, sports injuries, or accidents and vision or cognitive problems that threaten the ability to drive. For you to be a licensed Occupational Therapist, you have to submit an application for licensure at least thirty days prior to any admissions to work in any facility. Various educational requirements serve as a qualification to a career as a physical therapist. A person must earn a minimum of two degrees from accredited universities, perform volunteer service and comply with certification requirements to complete the educational requirements toward a career in physical therapy. First, the interested person must complete an undergraduate degree with either a...
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...can be able to walk . You might not seen this to other Babies because some of them skips one or two ontegenic rule. Rood's treatment principle is to use the reflexes in the nect and in the body. When you put a baby into prone position and do fast stroking, you will see an atonic reflex where the neck goes to extension. It also use sensory receptors like heat, muscle coordination and the action of the large muscle first then followed by the synergist. It involves Cutaneous similation that facilitate light moving touch, fast brushing and icing . The other one is Proprioceptive stimulation. It instigate voluntary joint and muscle receptors. It facilitates quick stretch like pulling the flexed arm down. Tapping on the chin if the client had Dysphasia . Vibration on the area. And last Joint compression, usually used in the shoulder to activate the receptors....
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...Review for Head, Neck, Lymphatics, Eye, Ear, Nose, Mouth, Throat NR302 unit 3 eyes= should be in line how.. if not in line.. Sutures- Fontanels-should be- if bulging = if sucken = * -closes around= * -closes around= pregnant- what may occur.. what does it look like.. enlargment of what.. headachs occur beacue of.. preeclampsia syndrome is.. what increases.. this can .. lymphatics- are.. provides.. by producing.. picks up what.. Lymph nodes- should be- if they are this may be .. * * * * * * * * * enlargment of lymph nodes is called.. PIH-headaches- mostly due to = * -evertyhing is= -pain is= -ocurrs with= * -lasts= -by= -causes= -pain is= -located= * -lasts= -pain is= -there is no= -located= bloody nose Bruit= sound like -due to= -which will= =and will= -use what part to listen= Crepitation/ TMJ syndrome= may indcate= TMJ= Causes of tracheal shift=it is maybe to due to * * * * * -is a = -what happens with the trachea= Hyperthyroidism= is the gland is= person is= weight= bowel movement= dieases= eyes= hair= feels= hypothyroidism= is lowers the- loss of- deficiency of- mostly in- person is- weight- feels- dieases- temperal artery should feel= should not be- can lead to if it is- thyroid gland is the must be- palpating for- if there is may indicate- enlargment of the thyroid will appear when.. neck ROM should not - if there is- carotid artery should...
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...The topic of death first caught my attention as I am interested in what death means beyond bodily death and how the norms of death are changing because of the internet era. Particularly the way people react to death, the sociology of death and how these have changed the individuals or society in the internet age. In the paper by Walter et al. (2011), they addressed the challenges in the sequestration of death and how the prominence of the internet changes our patterns of grieving for the dead. This writing helps me gain a better understanding of the reaction to death and how these behaviours vary depending on the relationship one has with that dead person. In addition, it also highlights the potential that of overcoming grieving through online forum and their implication. Besides that I am also interested in the sociology of death, the development, structure and how the human society functions with respect to death like in the book by Kearl (1989), it analyses how we are shaped by death, in the sense of discovering our purpose, having our ethos moulded and also how our speech reflects how we view death. In addition to this, I am also keen on know how this sociology concepts are relevant or altered in the internet age which is almost 20 years after the publication of the book by Kearl. This drew such attraction to me as I am currently a nursing student and as a nurse I have to deal with death of patients at some point in my nursing career. Furthermore with my interest in the...
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...and the carers on recognizing common patterns of children with similar difficulties. The child can be assessed more objectively using criteria from formal tests, identifying problems that could get missed and then receives targeted intervention. Labeling is beneficial for research too, as it is needed to know how many children are affected and then being able to generalize across groups. Last but not least, through labeling the condition, the communication across professionals is being facilitated. SLI definition Specific language impairment (SLI) is a disorder that has not a specific definition at all. Laurence (2000) reported that, there have been given many different terms to describe SLI the most important ones are childhood dysphasia or developmental childhood disorder. Webster (2004) adds that despite the difficulty researchers face in defining SLI, they agree that SLI affects mostly language rather than other non-linguistic domains. Bishop (2009) described SLI as “a complex multifactorial disorder that is usually caused by the combined influence of many genetic and environmental risk factors of small effect”. Leonard (1998) then again, talked about the combination of normal intelligence and language impairment, on SLI. Therefore the greater difficulty of children with SLI is to understand and produce language (I can, n.d.). In order to identify SLI we need to consider its characteristics. Researchers talk about several characteristics that people with SLI...
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...progressive deterioration of end stage motor neuron disease that was diagnosed two years ago. Coupled with a medical history of Alzheimer's disease, renal stones, enlarged prostate, hypertension, and an esophageal rupture, Mr. Khoury's health has continued to deteriorate as evidenced by weight loss, lack of appetite, decreased mobility, muscle wasting, poor oral intake and dysphasia. Prior to his admission to hospital, Mr. Khoury was cared for at home by his wife, however due to severe cognitive disturbances together with motor neuron features, his wife can no longer take care of him at home as she cannot determine his needs or understand his complaints. Mr. Khoury and his wife have both accepted his poor prognosis and deterioration as reflected by orders not to resuscitate, intubate or ventilate. His reason for admission is not an acute illness but to determine which palliative measures can be taken to relieve discomfort whilst correcting his fluid imbalance. A combination of reasons exists as to why Mr. Khoury's fluid and electrolyte imbalance has occurred. Firstly, as a result of Mr. Khoury growing dysphasia, his difficulty in comprehending language combined with decreased communication has led to an inadequate oral intake of medications. Furthermore, coupled with the chronic, degenerative disease of the brain known...
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...The purpose of this essay is to describe an example of communication from my recent clinical placement and discuss the factors that contributed to its outcome. A communication theory can be dated back to 300 BC, when Aristotle provided an explanation of oral communication through his ‘rhetoric’ theory. Here he stated that there were three elements to communicating; the speaker – the message – and the listener, and it is the person at the end of this chain that holds the key to whether or not communication takes place (Roberts, 1924). These underlying principles still remain in today’s modern models of communication, as the essay will demonstrate from looking at Berlo’s (1960) model of communication. The essay will also focus on the importance of communication within the nurse patient relationship. As Riley (2008) states, “communication is the heart of nursing”. (p.3) Firstly the essay will give two definitions of communication and a brief history of the expectations of the nurse over the centuries and how the role has developed to the professional nurse as we know today, and one that is expected by the public. It will then lead on to some examples of methods of communication and a brief explanation of their importance within nursing. I will briefly discuss Berlos (1960) communication theory and demonstrate how the model was used effectively to communicate with a patient with language impairment, which is a deficit in comprehension, production and use of language (Newman...
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...In this assignment, I will discuss a patient scenario and reflect on cultural differences in particular how they may impact on establishing effective communication and engagement with the patient. As a nurse, my duty is to respect patients right to confidentiality; ensuring people are informed about how and why information is shared by those who will be providing their care and also about disclosing information if I believe someone may be at risk of harm (Nursing & Midwifery Council 2008). Therefore to maintain confidentiality, I will be giving the name Mrs. B to my patient. Mrs. B is a 72 year old Indian lady. She is a diabetic with poor oral intake, who also recently suffered from a stroke, which resulted in dysphasia. She is a patient who is nursed in bed due to poor mobility and unable to stand unaided. In the case of Mrs. B the main cultural differences was the language barrier. Mrs. B spoke Punjabi and no English so this posed as a challenge to caring for her and had a significant impact on my ability to communicate and engage effectively with this patient. Following her stroke, she now suffers from slurred speech, and can only speak a minimal amount of words. Although she can understand what is being said to her, she was finding it difficult to express herself at times. She refused to eat or take her medications and we had to communicate with her through her husband at times when he was present, as an interpreter was not available at the present time. Mrs...
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