 | | HIV and Aids Part 2 | HIV and Aids Part 2
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. All patients who are diagnosed with HIV should be initiated on ART as soon as possible.
Exceptions to this include patients presenting with cryptococcal meningitis (CM) or central nervous system tuberculosis (tuberculous meningitis (TBM) or tuberculoma).
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome). | 3 | | R210.00 |  |
| | HIV and Aids Part 1 | HIV and Aids Part 1
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. Symptoms vary depending on the stage of infection and these include: - Acute stage, which resembles the flu, with fever, malaise, and a generalized rash.
- Asymptomatic stage which generally, has no symptoms.
- Lymphadenopathy, which presents with swelling of lymph nodes, which can be a primary symptom.
- AIDs, which is the advanced stage marked by severe infections or cancers.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrom | 3 | | R210.00 | |
| | Ebola Virus Infection | Ebola Virus Infection
Overview
Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. The genus Ebolavirus currently is classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus. The outbreak of Ebola virus disease in West Africa from 2014 to 2016, involving Zaire ebolavirus, was the largest outbreak of Ebola virus disease in history.
As of September 17, 2019, an active outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) had resulted in 3,034 confirmed and 111 probable cases of Ebola virus disease, including 2,103 attributable deaths. An experimental vaccine has been credited with limiting the outbreak’s scope.
| 3 | | R250.00 | |
| | Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: ventilation targets and mortality—a retrospective analysis of 308 patients | Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: ventilation targets and mortality—a retrospective analysis of 308 patients
Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: ventilation targets and mortality—a retrospective analysis of 308 patients
Overview Traumatic brain injury (TBI) remains one of the main causes of mortality and long-term disability worldwide. Maintaining physiology of brain tissue to the greatest extent possible through optimal management of blood pressure, airway, ventilation, and oxygenation, improves patient outcome. We studied the quality of prehospital care in severe TBI patients by analysing adherence to recommended target ranges for ventilation and blood pressure, prehospital time expenditure, and their effect on mortality, as well as quality of prehospital ventilation assessed by arterial partial pressure of CO2 (PaCO2) at hospital admission. Normocapnia at hospital admission was strongly associated with reduced probability of mortality. Prehospital and on scene times had no impact on mortality. Conclusions PaCO2 at hospital admission is strongly associated with mortality risk, but normocapnia is achieved only in a minority of patients. Therefore, the time required for placement of an arterial cannula and prehospital blood gas analysis may be warranted in severe TBI patients requiring on-scene tracheal intubation.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Volume 31 Issue 46
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| | Predictors of Post-Intubation Hypotension in Trauma Patients following Prehospital Emergency Anaesthesia: a multi-centre observational study | Predictors of Post-Intubation Hypotension in Trauma Patients following Prehospital Emergency Anaesthesia: a multi-centre observational study
Predictors of Post-Intubation Hypotension in Trauma Patients following Prehospital Emergency Anaesthesia: a multi-centre observational study
Overview
Post-intubation hypotension (PIH) is common after prehospital emergency anaesthesia (PHEA) and is linked to increased mortality in trauma patients. A multi-centre retrospective study in the UK found that clinician judgment and provider intuition are the most reliable predictors of PIH, often influencing the administration of reduced doses of induction medications for high-risk patients.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
| 3 | | R210.00 | |
| | Risk Stratification Tools for Patients with Syncope in Emergency Medical Services and Emergency Departments: a scoping review | Risk Stratification Tools for Patients with Syncope in Emergency Medical Services and Emergency Departments: a scoping review
Risk Stratification Tools for Patients with Syncope in Emergency Medical Services and Emergency Departments: a scoping review
Overview Risk stratification for patients experiencing syncope presents a significant challenge in (prehospital) emergency care. Emergency Medical Services (EMS) and Emergency Department (ED) professionals must quickly distinguish between high-risk and low-risk syncope patients, often under time constraints and with limited resources. Researchers conducted a comprehensive review to identify risk stratification tools for patients experiencing syncope in prehospital and emergency care settings. They reviewed 5385 studies, selecting 38 that discussed 19 distinct tools, mainly developed for Emergency Department (ED) use. One tool was designed specifically for Emergency Medical Services (EMS). Most tools lack thorough validation, though they typically include history, physical examination, electrocardiogram, and additional tests to assess risk. The study highlights the importance of developing validated risk stratification tools to improve the management of syncope patients in emergency settings.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
| 3 | | R200.00 | |
| | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Overview
Pain is a common prehospital symptom in trauma patients and requires timely management. Recent studies have indicated that up to 43% of trauma patients experience inadequate analgesia after prehospital treatment, suggesting the need for improvement. Evidence supports the prehospital use of oral transmucosal fentanyl citrate (OTFC) in military settings.
This observational cohort study examined the use of oral transmucosal fentanyl citrate (OTFC) for prehospital trauma care in remote and challenging environments. Conducted at three ski and bike resorts in Switzerland, the study involved 177 patients treated by trained EMS providers. Results indicated that OTFC is safe, effective, and practical for managing severe pain without the need for intravenous lines. Side effects were rare and mild.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Journal 31 Issue 2
| 3 | | R200.00 | |
| | Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h | Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h
Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h
Overview Rapid treatment of stroke is critical for patient outcomes. This study examined glial fibrillary acidic protein (GFAP) alone and with the Prehospital Stroke Score (PreSS) for identifying acute stroke within 4.5 hours of symptom onset. Clinical data and serum samples were collected from Treat-NASPP. Patients with suspected stroke and symptoms lasting = 4.5 hours had blood samples taken and were evaluated using NIHSS. NIHSS was later translated into PreSS, and GFAP was measured with SIMOA. Results showed GFAP alone identified ICrH in unselected patients. When combined with PreSS, GFAP identified subgroups with high proportions of stroke mimics, ICrH, LVO, and AIS (non-LVO strokes). Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2023 31:1
| 3 | | R200.00 | |
| | Understanding and Addressing Older Adults’ Loneliness: The Social Relationship Expectations Framework | Understanding and Addressing Older Adults’ Loneliness: The Social Relationship Expectations Framework
Understanding and Addressing Older Adults’ Loneliness: The Social Relationship Expectations Framework
Overview
Loneliness is an experience resulting from a perceived discrepancy between expected and actual social relationships. Although this discrepancy is widely considered the “core mechanism” of loneliness, previous research and interventions have not sufficiently addressed what older adults specifically expect from their social relationships.
The consensus psychological definition of loneliness is a feeling that results from a perceived discrepancy between desired and achieved levels of social relationships (Peplau & Perlman, 1982). This gap between expected and actual social relationships may be considered the “core mechanism” of loneliness. To address this gap and to help situate research on older adults’ loneliness within broader life span developmental theories, we propose a theoretical framework that outlines six key social relationship expectations of older adults based on research from psychology, gerontology, and anthropology: availability of social contacts, receiving care and support, intimacy and understanding, enjoyment and shared interests, generativity and contribution, and being respected and valued. We further argue that a complete understanding of loneliness across the life span requires attention to the powerful impacts of contextual factors (e.g., culture, functional limitations, social network changes) on the expression and fulfilment of older adults’ universal and age-specific relationship expectations.
The proposed Social Relationship Expectations Framework may fruitfully inform future loneliness research and interventions for a heterogeneous aging population
Journal Perspectives on Psychological Science Volume 18 Issue 4 | 3 | | R485.00 | |
| | Psychology of Abusive Human Behaviour | Psychology of Abusive Human Behaviour
Psychology of Abusive Human Behaviour
Overview
The aim of this article is to explore the psychology of abusive human behaviour with special attention to gaslighting, defamation of character, mockery, bullying, and mobbing, based on the so-far published scientific literature, and my own experience and observations. Abusive human behaviour can have various forms, but the motivation is almost always the same: power and control over the victim.
Abusive human behaviour can have various forms. The most common motivation for abusive behaviour is power and control over the victim. Abusers are possessive, although they usually deny their actions of blaming and controlling the victim, and on the other hand, are insecure and suffer from untreated mental health problems, including depression and suicidal ideation psychological abuse, especially if longer lasting, can cause serious psychological and even physical damage to the victim. Society should be more aware of the detrimental effects of abusive human behaviour in its variety of forms and be ready to offer adequate medical, psychological and legal help for the victim.
Journal Open Journal of Medical Psychology Volume 11 Issue 2 | 3 | | R485.00 | |
| | Factors influencing streaming to general practitioners in emergency departments: A qualitative study | Factors influencing streaming to general practitioners in emergency departments: A qualitative study
Factors influencing streaming to general practitioners in emergency departments: A qualitative study
Overview Emergency Department (ED) attendance is rising globally, with many cases that could be managed in general practice. In England, policies require some patients in EDs to be "streamed" or directed to general practitioners (GPs) working within or alongside EDs. However, evidence for this approach is limited, and the processes involved lack thorough exploration. This study investigates patient streaming to GPs across 10 sites in England. Using qualitative data from 186 observations and 226 interviews with healthcare professionals, six key themes were identified that influence streaming success: structural support, personnel development, effective protocols, negotiation of primary/secondary care boundaries, interprofessional relationships, and patient safety concerns. The study found that the skills of streaming nurses and the collaboration between streamers and GPs were critical for safe and effective streaming. However, there was no single streaming model linked to success. Instead, various factors contributed to good practice, and the issue of "inappropriate" streaming—where patients were misdirected—was identified as a challenge. The study offers key recommendations to improve streaming practices and highlights the importance of tailored solutions across different sites to enhance the effectiveness of streaming in EDs.
Journal: International Journal of Nursing Studies Volume 120 Issue 10 | 3 | | R485.00 | |
| | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Overview Obstructive upper GI cancer commonly uses feeding jejunostomy as a standard procedure. Surgeons implemented laparoscopic feeding jejunostomy via minimally invasive surgery, employing a variety of techniques. This study assessed the perioperative results, safety, and costs associated with laparoscopic versus open jejunostomy surgeries. We used only Witzel’s tunnel and standard laparoscopic instruments. We collected data from all patients who underwent feeding jejunostomy between January 2016 and June 2018. We recorded pertinent data on baseline, surgical outcomes, postoperative results, complications, and costs. The study excluded patients with jejunostomy as a conversion or an addition. It was concluded that Laparoscopic jejunostomy feeding was safe, and postoperative morphine consumption was lower. Increasing operational costs did not have a significant impact on overall expenditures. Witzel’s tunnel may reduce jejunostomy site infections.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Overview Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. This study describes a 20-year single-center experience in Colombia, analysing postoperative outcomes after splenectomy with a focus on 30-day, 90-day, and 1-year follow-up periods. Splenectomy, often performed for trauma, abscesses, aneurysms, and malignant conditions, can lead to serious complications. The findings align with international data on postoperative complications and overwhelming post-splenectomy syndrome (OPSI). Further research is recommended to improve management strategies and outcomes, especially for high-risk groups.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Impact of early surgical complications on kidney transplant outcomes | Impact of early surgical complications on kidney transplant outcomes
Impact of early surgical complications on kidney transplant outcomes
Overview
Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. This article sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions. Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, offering improved survival and quality of life for the vast majority of patients when compared to other renal replacement therapies. Despite improving patient and graft survival rates over time, the morbidity and mortality associated with postoperative complications remain a significant clinical concern. Early postoperative surgical complications (SC) vary in severity and can be classified according to Clavien Grades. The main categories of SC associated with KT are vascular, urological, peri-graft fluid collections, and surgical site complications. It was concluded that early SC following KT are common and have a significant influence on long-term patient outcomes.
Journal BMC Surgery
| 3 | | R485.00 | |
| | Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience | Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience
Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience
Overview Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The incidence and etiology of pediatric cancer-related thrombosis is still not well understood. The aim of this study was to evaluate the prevalence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inherited thrombophilia in the development of thrombosis in a pediatric oncology population.
Forty-seven children (36 treated for haematological malignancies and 11 for solid tumours) with a median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden (G1691A), prothrombin G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis.
It was concluded that thrombosis is an important complication of childhood cancer. The risk of thrombosis may be increased in patients with Factor V Leiden. In the absence of consensus guidelines, our results support the recommendation for thrombophilia screening in children with cancer.
Journal
Acta Medica Academica | 3 | | R485.00 | |
| | Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial | Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial
Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial
Overview
Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance.
In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine). Design In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed.
According to the results, it was concluded that flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patient.
Journal
Acta medica academica
| 3 | | R485.00 | |
| | Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt | Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt
Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt
Overview Early laparoscopic cholecystectomy (ELC) for acute calculous cholecystitis (ACC) should be done by skilled surgeons to avoid complications. This study aims to identify preoperative factors predicting difficult ELC in ACC patients. Approximately 40% of patients with gallstones may experience complications like ACC, which presents primarily in 10-15% of cases. Performing ELC within 7 days of admission and 10 days of symptom onset is safer and preferred over intermediate or delayed procedures, offering shorter hospital stays, fewer re-admissions, and lower costs. However, it requires experienced surgeons in hepatobiliary and minimally invasive surgery, and advanced surgical centers with necessary support staff and equipment. The major complication of LC is iatrogenic bile duct injury due to inflamed gallbladder anatomy. Junior surgeons must assess ACC patients carefully before ELC to identify those at risk of difficult procedures, reducing postoperative complications. If risks are found, experienced biliary and laparoscopic surgeons should assist, or patients should be transferred to advanced centers. Bail-out procedures should be considered during difficult operations to prevent further damage.
Journal BMC Surgery Volume 24 Issue 1
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| | Associations of Symptom Severity of Mentally ill parents on family functioning and children’s mental health | Associations of Symptom Severity of Mentally ill parents on family functioning and children’s mental health
Associations of Symptom Severity of Mentally ill parents on family functioning and children’s mental health
Overview Parental mental illness has a negative impact on children’s mental health. Often, the entire family structure suffers from the consequences of parental illness. The consequences of mental illness impact not only the affected persons themselves, but also the family environment (Perez et al., 2018). Especially children of mentally ill parents have been studied regarding their risk for psychopathology. Children of families with parents with mental illness also use a broad spectrum of mental health care, school-based support, and youth welfare services even if they are not yet diagnosed as having a mental disorder. Parental mental health problems constitute a significant risk for children’s mental health. Children of mentally ill parents have a significantly increased risk of developing a mental illness over the course of their childhood or adolescence compared to the general population. If a parent suffers from mental illness, the child is two to three times more likely to be mentally ill as well, with the risk elevating to a fivefold when both parents are affected The results of this study s underline the importance of personalized interventions in terms of parental symptom severity to minimize negative outcomes for children and the whole family.
Journal: Psychology 2024
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| | Effect of group sand play therapy on psychopathologies of adolescents with delinquent behaviours | Effect of group sand play therapy on psychopathologies of adolescents with delinquent behaviours
Effect of group sand play therapy on psychopathologies of adolescents with delinquent behaviours
Overview Adolescence is a period in which drastic changes occur in physiological, emotional, and cognitive aspects of development. Adolescents often express diverse conflicts and confusions stemming from physical changes, identity establishment, and environmental adaptation processes, which manifest as various problematic behaviours. These developmental conflicts often make adolescents vulnerable to delinquency and deviant behaviours. Glueck and Glueck investigated the differences between 500 delinquent adolescents and 500 typical adolescents from Boston, along parameters including relationship with parents, personality, and temperament, and suggested that individual traits such as defiance, impulsiveness, and emotional instability are predictors of delinquency. Prior research has established adolescent vulnerability to delinquent behaviour. This single arm, noninterventional, observational study investigated the effect of sand play therapy on the psychopathologies of adolescents with delinquent behaviour. A total of 68 adolescents participated in the study. Results of this study showed that group sand play therapy is effective in improving internalizing problems such as depression and anxiety, as well as externalizing problems of ADHD features and impulsiveness among adolescents with deviant behaviours.
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| | Urinary Tract Infection in Women | Urinary Tract Infection in Women
Urinary Tract Infection in Women
Overview
Urinary tract infections (UTIs) occur far more commonly in women, accounting for at least 8 million visits to various types of healthcare facilities in the United States per year. Cystitis (bladder infection) represents most of these infections (see the image below). 20% of women suffer from at least one UTI in their lifetime. Related terms include pyelonephritis, which refers to upper UTI, and bacteriuria or funguria, which describe findings of bacteria or yeast, respectively, in the urine.
Formulation of a successful diagnostic and treatment plan is based on determining the location of the UTI; underlying physical impairments of the patient, such as diabetes; complicating factors such as nephrolithiasis; prostatic abnormalities; and the presence of resistant organism’s Urinary tract infections (UTIs) occur far more commonly in women, accounting for at least 8 million visits to various types of healthcare facilities in the United States per year. Cystitis (bladder infection) represents most of these infections. 20% of women suffer from at least one UTI in their lifetime. Related terms include pyelonephritis, which refers to upper UTI, and bacteriuria or funguria, which describe findings of bacteria or yeast, respectively, in the urine.
Formulation of a successful diagnostic and treatment plan is based on determining the location of the UTI; underlying physical impairments of the patient, such as diabetes; complicating factors such as nephrolithiasis; prostatic abnormalities; and the presence of resistant organisms
Author: Sharespike | 3 | | R420.00 | |
| | Relationship between chronic disease and depression: the mediating effect of pain | Relationship between chronic disease and depression: the mediating effect of pain
Relationship between chronic disease and depression: the mediating effect of pain
Overview The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working. Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated.
The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). In conclusion the degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.
| 3 | | R485.00 | |
| | Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour | Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour
Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour
Overview
Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups.
Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. Dental anxiety and current negative dental experiences reduced participants’ dental self-efficacy perceptions as well as the self-inspection of one’s teeth. While parental care positively influenced the attitude towards one’s teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one’s teeth and parental care.
Dental anxiety, dental experiences, parents’ care for their children’s oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one’s own oral cavity as well as the autonomous control of one’s own dental health.
Journal
PLoS ONE
| 3 | | R165.00 | |
| | Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work | Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work
Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work
Overview
Organizational culture is a central concept in research due to its importance in organizational functioning and suffering of employees. To better manage suffering, it is necessary to better understand the intrinsic characteristics of each type of culture and its relationships with the environment.
According to the study by Schein (2010), the organizational culture is a pattern of basic values and presuppositions that are shared and learned by a group while resolving the problems of external adaptation and internal integration. Each culture represents a different set of values and presuppositions. All organizations have all four types but in different proportions. This is a typological model because it aims to identify archetypes using different effectiveness criteria.
Contrary to what most of the literature suggests, we found almost no relationship between the environmental variables and the culture types. Strategy and competencies, in contrast, do have a significant predictive capacity, showing 9 links with the Clan culture, 7 with the Hierarchy culture, and 10 with the Market culture. In conclusion, this study has found the important characteristics of the types of organizational culture that could be useful to better manage the suffering of employees.
| 3 | | R489.00 | |
| | Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors | Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors
Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors
Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors’ mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.
Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.
Journal International Journal of Clinical Health Psychology Volume 23 Issue 1 | 3 | | R465.00 | |
| | Exercise Interventions in Child and Adolescent Mental Health Care: An overview of the evidence and recommendations for implementation | Exercise Interventions in Child and Adolescent Mental Health Care: An overview of the evidence and recommendations for implementation
Exercise Interventions in Child and Adolescent Mental Health Care: An overview of the evidence and recommendations for implementation
Overview
The poor physical health of people with mental illness has long been established. A 15–20-year mortality gap arises from factors such as the likelihood of developing noncommunicable diseases, unhealthy lifestyle behaviors, reduced access to and provision of physical health care, and side-effects of medication.
This has been labeled an international human rights scandal, since a large proportion of this risk is preventable. In recognition of these disparities, international health bodies have produced guidance to address poor physical health, including the World Health Organization, World Psychiatric Association, and a Lancet Psychiatry Commission.
The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real-world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date.
The key conclusions from this article, suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large-scale dissemination of such interventions across various care and cultural contexts.
The Association for Child and Adolescent Mental Health JCPP Advances | 3 | | R485.00 | |
| | COVID-19 in Pediatrics | COVID-19 in Pediatrics
Overview In 2019, a novel coronavirus emerged called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). Initially identified in Wuhan, China, COVID-19 spread internationally and became a global pandemic. Most pediatric COVID-19 cases were milder than in adults, but in the early Spring of 2020, a new inflammatory syndrome emerged in children who had evidence of prior SARS CoV-2 infection, called Multisystem Inflammatory Syndrome in Children (MIS-C). As of March 2021, there were approximately 2,592,619 cases of COVID-19 in people under 18 in the United States and 300 deaths. Of all American cases, 2.1% were in children aged 0 to 4 years old, and another 10.2% were in those aged 5 to 17. Prevalence varies by age, with estimates ranging from 17% for children under 2 years old to 25% of children ages 6 to 10 years old, and 23% in 10 to 14 years old. The severity of the disease is generally lower for children, with only 1% to 5% of pediatric cases qualifying as severe versus to 10% to 20% in adults. This finding is thought to reflect the lower levels of angiotensin-converting enzyme 2 expression in alveolar cells, which is the mechanism by which SARS-CoV-2 enters cells. Being older than 12 years and having a high initial C-reactive protein (CRP) are risk factors for admission to a pediatric intensive care unit, and high CRP, leukocytosis, and thrombocytopenia are risk factors for organ dysfunction. Viral load and young age, specifically children under 1 year of age, are other risk factors for more severe disease. This study describes the features, diagnosis, and treatment of pediatric COVID-19 and MIS-C based on the data available at the time of publication.
Authors Case SM, Son MB
Journal Rheumatic Disease Clinics of North America | 3 | | R165.00 | |
| | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Overview The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. This study aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. A national cohort study was conducted in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Patients were excluded if they did not have a neurological consultation or neurological investigations or both or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR or respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall.
Authors Stephen T J Ray et al
Journal The Lancet Child & Adolescent Health | 3 | | R195.00 | |
| | Hypertension Part 3 | Hypertension Part 3
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike | 3 | | R145.00 | |
| | Hypertension Part 2 | Hypertension Part 2
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike | 3 | | R145.00 | |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike | 3 | | R135.00 | |
| | Amebiasis | Amebiasis
Overview Amebiasis is caused by Entamoeba histolytica, a protozoan that is found worldwide. The highest prevalence of amebiasis is in developing countries where barriers between human faeces and food and water supplies are inadequate.
Although most cases of amebiasis are asymptomatic, dysentery and invasive extraintestinal disease can occur. Amebic liver abscess is the most common manifestation of invasive amebiasis, but other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. In developed countries, amebiasis primarily affects migrants from and travellers to endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals.
The National Institute of Allergy and Infectious Diseases (NIAID) has classified E histolytica as a category B biodefense pathogen because of its low infectious dose, environmental stability, resistance to chlorine, and ease of dissemination through contamination of food and water supplies.
E histolytica is transmitted via ingestion of the cystic form (infective stage) of the protozoa. Viable in the environment for weeks to months, cysts can be found in soil contaminated with faecal, fertilizer, or water or on the contaminated hands of food handlers. Faecal-oral transmission can also occur in the setting of anal sexual practices or direct rectal inoculation through colonic irrigation devices.
Author Sharespike | 3 | | R179.00 | |
| | Asthma Exacerbation Part 2 | Asthma Exacerbation Part 2
Asthma Exacerbation Part 2
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents.
Author Sharespike | 3 | | R145.00 | |
| | Asthma Exacerbation Part 1 | Asthma Exacerbation Part 1
Asthma Exacerbation Part 1
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents. Author Sharespike | 3 | | R145.00 | |
| | Ischemic Stroke Part 2 | Ischemic Stroke Part 2
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R135.00 | |
| | Ischemic Stroke Part 1 | Ischemic Stroke Part 1
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R135.00 | |
| | Vertigo, Dizziness and Imbalance | Vertigo, Dizziness and Imbalance
Vertigo, Dizziness and Imbalance
Overview
Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems.
Mild hearing loss is the most common disability worldwide. The incidence of hearing loss is 25% in people younger than 25 years, and it reaches 40% in persons older than 40 years. About 25% of the population report tinnitus.
Primary care physicians evaluate most cases of dizziness and related symptoms. Their role and that of neurologists in this setting has increased over the past decade. This article outlines the clinical approach to dizziness with emphasis on differentiating peripheral from central dizziness and on office management of the most common diseases. It also addresses indications for referral to an otolaryngologist or neuro-otologist and for specialized auditory and vestibular testing.
To diagnose dizziness, physicians must use the essential tools of history, clinical examination, and follow-up. The etiology in most of these patients mainly involves a vestibular disorder, such as BPPV, Ménière disease, or bilateral vestibular hypofunction. Appropriate management and follow-up are necessary to improve the well-being of these patients.
Authors
Sharespike
| 3 | | R135.00 | |
| | Ventricular Tachycardia Part 2 | Ventricular Tachycardia Part 2
Ventricular Tachycardia Part 2
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R135.00 | |
| | Ventricular Tachycardia Part 1 | Ventricular Tachycardia Part 1
Ventricular Tachycardia Part 1
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author: Sharespike
| 3 | | R135.00 | |
| | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
Overview:
Considering the high socio-economic costs related to the increasing number of dementia patients and their poor quality of life and that of their families, it is important to identify the condition early on and provide an appropriate intervention. This study organized a recollection-based occupational therapy program: a nonpharmacological intervention consisting of five categories of activities (physical, horticultural, musical, art, and instrumental activity of daily living; IADL) and applied it to those having a mild stage of Alzheimer’s disease. The experimental group participated in a total of 24 sessions––five times per week for one hour per session––while the control group took part in regular activities offered by the existing facilities. The experimental group presented improved cognitive functions, reduced depression, and enhanced quality of life; the two groups showed a statistically significant difference in every category. This study is meaningful in that it made a cognitive stimulation program concerning five different categories, implemented it for people suffering mild dementia, and confirmed positive outcomes. If a systemic version of the program is offered in dementia care facilities, it is expected to make a considerable contribution to the care of dementia patients.
Acknowledgements:
Authors:
DeokJu Kim
Journal: Occupational Therapy International | 3 | | R130.00 | |
| | The eye ''An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic | The eye ''An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic
The eye ''An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic
Overview The coronavirus family is a group of zoonotic viruses with some recognized reservoirs particularly some bats. A novel coronavirus emerged in the province of Wuhan (China) in December of 2019.The number of infected patients with serious respiratory infection quickly spread around the world to become a global pandemic. The clinical presentation and viral pathogenesis of the coronavirus disease named COVID-19 indicated that the virus is transmitted from person to person through infected droplets entering the respiratory mucosa. Close contact with infected individuals particularly in crowded environments has characterized the rapid spread of the infection. Clinical manifestations of the viral infection have mentioned the presence of some ocular findings such as conjunctival congestion, conjunctivitis and even corneal injury associated with the classical COVID-19 infection. Some animal models of different coronaviruses eye infection shave described the viral pathogenesis through tear and conjunctival sampling. On the other hand, we are recommended protective measure to prevent contagion and limit the spread of the virus in health care professionals and contact lenses wearers.
ACKNOWLEDGMENTS Authors Sandra C. Durán C, Diana C. Mayorga G Journal Journal of Optometry (2020)
| 3 | | R130.00 | |
| | Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care | Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care
Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care
Overview:
The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection.
This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection.
Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.
Authors: Amber Ather, BDS, DDS, Biraj Patel, BDS, Nikita B. Ruparel, MS, DDS, PhD, Anibal Diogenes, DDS, MS, PhD, and Kenneth M. Hargreaves, DDS, PhD
Journal: JOE – Journal of Endodontics
| 3 | | R130.00 | |
| | Wide Complex Tachycardia | Wide Complex Tachycardia
Overview
Correct diagnosis of wide complex tachycardia (WCTs) can be challenging. With EMS providers' ever-expanding scope of practice, it is no longer safe to label any rhythm that is wide and fast as ventricular tachycardia (VT). Though many paramedic curricula do not address advanced cardiac dysrhythmias and treatments, several EMS departments have protocols that require advanced training in 12-lead ECG interpretation and treatment of specific cardiac dysrhythmias. One must possess the proper diagnostic tools and knowledge to decide whether a WCT is VT or SVT with aberrant conduction. EMS providers should be able to differentiate VT and SVT with aberrant conduction with confidence and a high degree of certainty. In order to understand the visual differences between VT and SVT with aberrant conduction, one must first understand the basic pathophysiology behind the two dysrhythmias. The first steps are maintenance of the patient’s airway with assisted breathing if necessary, cardiac monitoring to identify the heart rhythm, monitoring of blood pressure and oximetry, and establishing intravenous access. In the emergency setting, a wide-complex tachycardia always should be considered as ventricular tachycardia unless proven otherwise, as treatment must be initiated immediately to avoid degeneration into ventricular fibrillation.
| 3 | | R135.00 | |
| | Unstable Angina | Unstable Angina
Overview
Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie, cardiac biomarkers of myocardial necrosis —such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
With unstable angina, symptoms may (1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitro-glycerine. Symptoms of unstable angina are similar to those of myocardial infarction (MI).
The traditional term unstable angina was meant to signify the intermediate state between myocardial infarction (MI) and the more chronic state of stable angina. The old term pre-infarction angina conveys the clinical intent of intervening to attenuate the risk of MI or death. Patients with this condition have also been categorized by presentation, diagnostic test results, or course over time; these categories include new-onset angina, accelerating angina, rest angina, early postinfarct angina, and early post-revascularization angina.
This course deals with the causes and management of unstable angina.
| 3 | | R135.00 | |
| | Severe Distress - COVID 19 | Severe Distress - COVID 19
Severe Distress - COVID 19
Overview Since the emergence of the 2019 novel coronavirus (SARS-CoV-2) infection in December 2019, the coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. The clinical spectrum of patients with COVID-19 ranges from asymptomatic or mild symptoms to critical disease with a high risk of mortality. Coronavirus disease 2019 (COVID-19) is the illness associated with the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was initially noted during an outbreak of respiratory illness in the population of Wuhan, the capital of Hubei province, China. The first cases were seen in November 2019, with COVID-19 quickly spreading throughout the city. The World Health Organization (WHO) was notified of the outbreak on December 31, 2019. The cases continued to spread outside of the area and then across the world. COVID-19 was reported as a global health emergency by the end of January 2020. As the worldwide case numbers increased, the WHO declared on March 11, 2020, that COVID-19 had reached the pandemic stage.
The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
| 3 | | R135.00 | |
| | Septic Shock Part 2 | Septic Shock Part 2
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike | 3 | | R135.00 | |
| | Septic Shock Part 1 | Septic Shock Part 1
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R135.00 | |
| | Respiratory Stress Syndrome | Respiratory Stress Syndrome
Respiratory Stress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike | 3 | | R135.00 | |
| | Preeclampsia for EMS | Preeclampsia for EMS
Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema.
Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.).
In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia.
Eclampsia is defined as seizures that cannot be attributable to other causes in a woman with preeclampsia. HELLP syndrome (haemolysis, elevated liver enzyme, low platelets) may complicate severe preeclampsia.
Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing preeclampsia may not be straightforward. Preeclampsia without severe features may be asymptomatic. Many cases are detected through routine prenatal screening.
Authors
Sharespike | 3 | | R110.00 | |
| | Medical Laboratory Phlebotomists Part 2 | Medical Laboratory Phlebotomists Part 2
Medical Laboratory Phlebotomists Part 2
Overview Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture to obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment for certain blood disorders. Phlebotomy that is part of treatment (therapeutic phlebotomy) is performed to treat polycythemia vera, a condition that causes an elevated red blood cell volume (haematocrit). Phlebotomy is also prescribed for patients with disorders that increase the amount of iron in their blood to dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C. Patients with pulmonary edema may undergo phlebotomy procedures to decrease their total blood volume. This course, Part 2 discusses Urinalysis, Body Fluids, Clinical Immunology, Professional Authority, Society Authorisation, Code of Ethics, Special Culture, Professional Organisations and Professionalism are discussed.
Sharespike
| 3 | | R110.00 | |
| | Medical Laboratory Phlebotomists Part 1 | Medical Laboratory Phlebotomists Part 1
Medical Laboratory Phlebotomists Part 1
Overview
Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture to obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment for certain blood disorders. Phlebotomy is also used to remove blood from the body during blood donation and for analysis of the substances contained within it. Phlebotomy is performed by a nurse or a technician known as a phlebotomist. Blood is usually taken from a vein on the back of the hand or just below the elbow. Some blood tests, however, may require blood from an artery. Properly performed, phlebotomy does not carry the risk of mortality. It may cause temporary pain and bleeding, but these are usually easily managed. Phlebotomy is a necessary medical procedure and is required for a wide variety of other procedures. This course discusses such procedures in more detail and also Urinalysis and Microbiology as a matter of interest. In part 2 of this course Urinalysis, Body Fluids, Clinical Immunology, Professional Authority, Society Authorisation, Code of Ethics, Special Culture, Professional Organisations and Professionalism are discussed.
Authors Sharespike | 3 | | R110.00 | |
| | Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals | Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals
Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals
Overview: This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors.
The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach’s a and Cohen’s kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which were collected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman’s rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results.
In conclusion, an analysis of the results of the CDS tested on the inpatient ward and in the out-patient clinic revealed a high level of internal consistency. A significant, moderate correlation was observed between the CDS and Barthel Index results. The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.
Authors: Nursiswati Nursiswati, Ruud J.G. Halfens, Christa Lohrmann Journal: International Journal of Nursing Sciences | 3 | | R120.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions.
The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities.
Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R145.00 | |
| | Emphysema Chronic obstructive pulmonary disease (COPD) Asthma | Emphysema Chronic obstructive pulmonary disease (COPD) Asthma
Emphysema Chronic obstructive pulmonary disease (COPD) Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R145.00 | |
| | Hypertension Part 1 | Hypertension Part 1
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R145.00 | |
| | Burn Resuscitation and Early Management | Burn Resuscitation and Early Management
Burn Resuscitation and Early Management
Overview Burn resuscitation refers to the replacement of fluids in burn patients to combat the hypovolemia and hypoperfusion that can result from the body’s systemic response to burn injury. The history of modern burn resuscitation can be traced back to observations made after large urban fires at the Rialto Theatre (New Haven, Conn) in 1921 and the Coconut Grove nightclub (Boston, Mass) in 1942. At the time, physicians noted that some patients with large burns survived the event but died from shock in the observation periods. Underhill and Moore identified the concept of thermal injury–induced intravascular fluid deficits in the 1930s and 1940s, and Evans soon followed with the earliest fluid resuscitation formulas in 1952. Up to that point, burns covering as little as 10-20% of total body surface area (TBSA) were associated with high rates of mortality.
Burns are a serious cause of human suffering and mortality globally. As many as 5% of burn victims will die as a result of their injuries, and many others will suffer disability, disfigurement, or scarring. This course addresses vital information regarding burn resuscitation and the early management thereof.
| 3 | | R140.00 | |
| | Convulsions and Seizures | Convulsions and Seizures
Overview
Emergency services attend patients who are having a seizure on almost a daily basis. Consequently, they should understand the disease processes related to seizures and be confident in their prehospital management. In general, with the exception of a patient in Status Epilepticus, seizure management should be relatively straight forward.
So, what is a seizure and what causes it? Basically, a seizure is any unusually excessive neuronal firing from the brain which manifests as changes in a patient’s motor/sensory control, sensory perception, behaviour and autonomic function. At a chemical level a seizure occurs when there is a sudden biochemical imbalance between the excitatory neurotransmitters and inhibitory neurotransmitters. The primary excitatory neurotransmitter found in the human central nervous system is called N-Methyl D Aspartate (NMDA); whereas the primary inhibitory neurotransmitter is called gamma-amino butyric acid (GABA). When there is an imbalance between these chemical mediators repeated firing and excitations of the neuronal cells occur.
Depending on the area of the brain in which this occurs, the seizure will manifest as a focal seizure, sensory change, behaviour disturbance, or complete tonic and clonic muscular activity. This course addresses important aspects relating to convulsions and seizures
| 3 | | R140.00 | |
| | Bradycardia | Bradycardia
Overview Anaphylaxis is a life-threatening emergency that requires immediate prehospital care, but to date all treatment guidelines have been based on an in-hospital treatment. At EMS World Expo Peter Taillac, MD, detailed the process of an expert panel to research and publish an evidence-based guideline (EBG) for the recognition and treatment of anaphylaxis. The expert panel attempted to answer a series of questions about anaphylaxis assessment and treatment through literature research and review. The guideline is intended to serve as the scientific basis for future EMS anaphylaxis protocols.
Good evidence suggests that physicians under-prescribe epinephrine and that patients (or their parents) fail to use epinephrine as quickly as possible. Accordingly, at discharge, all patients should be provided an epinephrine autoinjector and should receive proper instruction on how to self-administer it in case of a subsequent episode.
| 3 | | R120.00 | |
| | Anaphylactic Reaction Protocol | Anaphylactic Reaction Protocol
Anaphylactic Reaction Protocol
Overview Anaphylaxis is a life-threatening emergency that requires immediate prehospital care, but to date all treatment guidelines have been based on an in-hospital treatment. At EMS World Expo Peter Taillac, MD, detailed the process of an expert panel to research and publish an evidence-based guideline (EBG) for the recognition and treatment of anaphylaxis. The expert panel attempted to answer a series of questions about anaphylaxis assessment and treatment through literature research and review. The guideline is intended to serve as the scientific basis for future EMS anaphylaxis protocols.
Good evidence suggests that physicians under-prescribe epinephrine and that patients (or their parents) fail to use epinephrine as quickly as possible. Accordingly, at discharge, all patients should be provided an epinephrine autoinjector and should receive proper instruction on how to self-administer it in case of a subsequent episode.
| 3 | | R120.00 | |
| | Catastrophe in Radiology: Considerations Beyond Common Emergencies | Catastrophe in Radiology: Considerations Beyond Common Emergencies
Catastrophe in Radiology: Considerations Beyond Common Emergencies
Overview Organizations around the world increasingly prepare for the “what ifs” of our environments. Regulating and certifying agencies mandate organizational plans for threat management to include risk factor identification, threat mitigation, prevention (when possible), response to, and recovery from the event.
Disasters often occur without warning and have the potential to affect large numbers of people. Those in the radiology environment experience unique effects on them, their equipment, and their ability to provide quality patient care. Lessons can be learned by reviewing events and their impact on imaging departments around the world. Radiology departments need to be actively involved in the disaster planning and the management of disasters when they occur. Common themes emerge regardless of the type of disaster, and these themes should be included in all planning.
Even with an ever-increasing amount of information available and regulations to comply with, radiology departments are still often excluded from a hospital's disaster management plan and drills. Often, it is not until an organization experiences a catastrophic event that the identification of a plan for radiology's role during a disaster comes to mind.
Authors Valerie Aarne Grossman Journal Journal of Radiology Nursing (2020) | 3 | | R165.00 | |
| | COVID-2019 – A comprehensive pathology insight | COVID-2019 – A comprehensive pathology insight
COVID-2019 – A comprehensive pathology insight
Overview Corona virus disease-2019 (COVID-19) caused by severe acute respiratory syndrome corona virus-2 (SARS CoV- 2), a highly contagious single stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Occasionally patient may present with gastro-intestinal, cardiac and neurologic symptoms with or without lung involvement. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. Other organs like liver and kidneys may be involved secondarily. Currently the treatment is principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. During the pandemic there is paucity of literature on pathological features including pathogenesis, hence in this review we provide the current pathology centred understanding of COVID-19. Furthermore, the pathogenetic pathway is pivotal in the development of therapeutic targets.
Authors Chandrakumar Shanmugam, Abdul Rafi Mohammed, Swarupa Ravuri, Vishwas Luthra, Narasimhamurthy Rajagopal, Saritha Karre
Journal Pathology - Research and Practice 216 (2020) 153222 | 3 | | R130.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R110.00 | |
| | Diabetes Mellitus Part 3 | Diabetes Mellitus Part 3
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori
| 3 | | R110.00 | |
| | Diabetes Mellitus Part 2 | Diabetes Mellitus Part 2
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R110.00 | |
| | Diabetes Mellitus Part 1 | Diabetes Mellitus Part 1
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori, MD
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004).
The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis.
Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Pediatric Gastroenteritis | Clinical Practice Guidelines: Pediatric Gastroenteritis
Clinical Practice Guidelines: Pediatric Gastroenteritis
Overview
Infective gastroenteritis in young children is characterised by the sudden onset of diarrhoea, with or without vomiting. Most cases are due to an enteric virus, but some are caused by bacterial or protozoal infections. The illness usually resolves without treatment within days; however, symptoms are unpleasant and affect both the child and family or carers. Severe diarrhoea can quickly cause dehydration, which may be life threatening (National Institute for Health and Care Excellence, 2009). Oral rehydration therapy is replacement of fluids and electrolytes, such as sodium, potassium, and chloride necessary for normal physiological functions and is effective in 95% of cases of mild to moderate dehydration. Oral rehydration therapy is less invasive, less expensive, is associated with less morbidity and can be dispensed outside of the hospital setting, while being as effective as IV treatment (Medical Services Commission, 2010).
Acknowledgement
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Pain and Procedural Sedation | Clinical Practice Guidelines: Pain and Procedural Sedation
Clinical Practice Guidelines: Pain and Procedural Sedation
Overview “The management of acute traumatic pain is a crucial component of pre-hospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols” (Gausche-Hill et al., 2014). Pain management is also frequently based on the assessment of need by a provider, rather than the requirements of patients. Historically only Entonox and morphine have been available for pre-hospital pain management in the local setting with the more recent introduction of ketamine. Availability of appropriate and effective treatment options, especially for non-ALS providers, remains a challenge.
Situations requiring procedural sedation and analgesia in the pre-hospital setting are common and may range from alignment of fracture to extrication and complex disentanglement during medical rescue. Until recently South African pre-hospital providers did not have agents suitable for this purpose, particularly in the setting of severe trauma and hypotension. As ketamine has been introduced into some scopes of practice providing safe and effective dissociative procedural analgesia has become a possibility. However, the use of procedural sedation and analgesia is not without risks and, at this time, no uniform practice has been suggested in the South African pre-hospital setting. Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 4 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 4
Clinical Practice Guidelines: Obstetrics and Gynecology Part 4
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2 | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2
Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Acknowledgement
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Neonatal Resuscitation | Clinical Practice Guidelines: Neonatal Resuscitation
Clinical Practice Guidelines: Neonatal Resuscitation
Overview
Monitoring equipment for neonates and infants may not be uniformly available to all EMS providers. All ALS providers should have monitoring equipment appropriate for neonates. It is recommended that oximetry be used when resuscitation can be anticipated, when PPV is administered, when central cyanosis persists beyond the first 5 to 10 minutes of life, or when supplementary oxygen is administered. In summary, from the evidence reviewed in the 2010 CoSTR and subsequent review of delaying cord clamping and cord milking in preterm new-borns in the 2015 ILCOR systematic review, delaying cord clamping for longer than 30 seconds is reasonable for both term and preterm infants who do not require resuscitation at birth. It is recommended that the temperature of newly born non-asphyxiated infants be maintained between 36.5°C and 37.5°C after birth through admission and stabilisation. Targeted temperature management requires specific equipment and well established systems and protocol and system wide clinical governance. In neonates it may also require the establishment of dedicated, specialized and equipped retrieval teams.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Fever and Sepsis | Clinical Practice Guidelines: Fever and Sepsis
Clinical Practice Guidelines: Fever and Sepsis
Overview
Feverish illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. Despite advances in healthcare, infections remain a leading cause of death in children under the age of 5 years. Fever in young children can be a diagnostic challenge for healthcare professionals because it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting viral infection. However, fever may also be the presenting feature of serious bacterial infections such as meningitis and pneumonia. A significant number of children have no obvious cause of fever despite careful assessment. These children with fever without apparent source are of concern to healthcare professionals because it is especially difficult to distinguish between simple viral illnesses and life-threatening bacterial infections in this group.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Overview
There is growing evidence that good early stroke management can reduce damage to the brain and minimise the effects of stroke. Because of this early recognition of stroke, the subsequent response of individuals to having a stroke, and the timing and method by which people are transferred to hospital are important to ensure optimal outcomes. In this hyperacute phase of care, the ambulance service provides a central, coordinating role (Australian Government Health and Medical Research Council, 2007). Appropriate diagnosis of stroke and immediate referral to a stroke team is vital given advances in hyperacute treatments (Australian Government Health and Medical Research Council, 2007).
As in all scene responses, EMS personnel must assess and manage the patient’s airway, breathing, and circulation. Most patients with acute ischemic stroke do not require emergency airway management or acute interventions for respiratory and circulatory support (Jauch et al., 2013).
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Airway Part 2 | Clinical Practice Guidelines: Airway Part 2
Clinical Practice Guidelines: Airway Part 2
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 3 | Clinical Practice Guidelines: Adult Resuscitation Part 3
Clinical Practice Guidelines: Adult Resuscitation Part 3
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a)
Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 2 | Clinical Practice Guidelines: Adult Resuscitation Part 2
Clinical Practice Guidelines: Adult Resuscitation Part 2
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a)
Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 1 | Clinical Practice Guidelines: Adult Resuscitation Part 1
Clinical Practice Guidelines: Adult Resuscitation Part 1
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a)
Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Airway Part 1 | Clinical Practice Guidelines: Airway Part 1
Clinical Practice Guidelines: Airway Part 1
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008)
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2 | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa. The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 1 | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 1
Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 1
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa.
The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 | |
| | Tuberculosis Part 2 | Tuberculosis Part 2
Overview Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors:
Thomas E Herchline,Thomas E Herchline, Judith K Amorosa, Judith K Amorosa. | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Respiratory | Clinical Practice Guidelines: Respiratory
Clinical Practice Guidelines: Respiratory
Overview
Asthma is a common condition which produces a significant workload for general practice, hospital outpatient clinics and inpatient admissions. Much of this morbidity relates to poor management (British Thoracic Society, 2014). Chronic obstructive pulmonary disease (COPD) is a group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible. COPD should be distinguished from asthma because it is a progressive, disabling disease with increasingly serious complications and exacerbations. The symptoms, signs and physiology of these conditions can overlap with asthma and differentiation can be difficult, particularly in middle-aged smokers presenting with breathlessness and cough. This difficulty is compounded by the fact that most COPD patients exhibit some degree of reversibility with bronchodilators. Patients with severe chronic asthma, chronic bronchiolitis, bronchiectasis and cystic fibrosis may also present with a similar clinical pattern and partially reversible airflow limitation (The Thoracic Society of Australia and New Zealand, 2002). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Seizures | Clinical Practice Guidelines: Seizures
Clinical Practice Guidelines: Seizures
Overview
Paediatric and adult seizures are managed in essentially the same way, with the focus on identification, injury prevention, rapid termination and prevention of ongoing seizures; ongoing attention must be paid to reversal of the cause of the seizure. Important differences in children relate to febrile seizures (covered in section 3: Fever & Sepsis) and easily correctable causes such as hypoglycaemia. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Clinical Practice Guidelines: Trauma Part 1 | Clinical Practice Guidelines: Trauma Part 1
Clinical Practice Guidelines: Trauma Part 1
Overview
“Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R110.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pnViral Pneumonia Part 3eumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R110.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R110.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R110.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
| 3 | | R110.00 | |