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4 episodes with outpatients
2 episodes with outpatients
8 episodes with outpatients
2 episodes with outpatients
2 episodes with outpatients
2 episodes with outpatients
3 episodes with outpatients
2 episodes with outpatients
2 episodes with outpatients
A Clare Oireachtas Health Committee member insists stagnating waiting lists at Ennis Hospital point to the need for an expansion of services at the facility. Outpatients waiting lists for adults at University Hospital Limerick have dropped by nearly 12% in the past year - while the number of adults waiting for a year and a half or more has halved. Problems appear to be persisting at Ennis Hospital however as the number of adults on the waiting list there has risen from 1,030 to 1,196. Ennistymon Fine Gael Senator Martin Conway has been telling Clare FM's Seán Lyons while reductions at UHL are welcome, the numbers waiting for an appointment in Ennis indicate more services and investment are required in the county town.
Contributor: Aaron Lessem MD Educational Pearls: Oseltamivir (Tamiflu) is an antiviral medication used commonly to treat influenza Trials show that the medication reduces the duration of illness by less than 1 day (~16 hours in one systematic review) Benefit only occurs if taken within 48 hours of symptom onset Must be taken for 5 days A 2024 meta-analysis reviewed 15 randomized-controlled trials for the risk of hospitalization No reduction in hospitalizations with oseltamivir in patients over the age of 12 No difference in high-risk patients over the age of 65 or those with comorbidities The authors note that the confidence interval in these populations is wide, indicating a need for subsequent studies in high-risk populations Oseltamivir is associated with adverse effects including nausea, vomiting, and neurologic symptoms The risk of adverse effects may outweigh the benefits of a small reduction in the duration of illness References 1. Hanula R, Bortolussi-Courval É, Mendel A, Ward BJ, Lee TC, McDonald EG. Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients with Influenza: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2024;184(1):18-27. doi:10.1001/jamainternmed.2023.0699 2. Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ. Oseltamivir for influenza in adults and children: Systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014;348(April):1-18. doi:10.1136/bmj.g2545 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit
Welcome back Rounds Table Listeners!We are back today with our Classic Rapid Fire Podcast!This week, Drs. Mike Fralick and Emily Hughes discuss two recent papers exploring the role of beta blockers after myocardial infarction when there is preserved ejection fraction and the utility of Paxlovid in vaccinated versus unvaccinated adult outpatients with symptomatic COVID-19. Two papers, here we go!Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with COVID-19 (0:00 – 14:02). Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction (14:02 – 27:24).And for the Good Stuff: A 65-Year-Old Woman with an Incorrect Operation on the Left Hand (27:24 – 31:04).Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old manQuestions? Comments? Feedback? We'd love to hear from you! @roundstable
Dr Gustavo Spolador discusses the paucity of data around palliative care in Inherited Metabolic Disease and some of his own observations in a Brazilian quaternary hospital. Pediatric palliative care for metabolic diseases: 20-year epidemiological survey of outpatients at a Brazilian quaternary hospital Gustavo Marquezani Spolador, et al https://doi.org/10.1002/jmd2.12417
The PM team welcome back Gary Foalle and Edwin Ammerlaan to take an in-depth look at Fish's "Suits" album. Hear tales of the "Toile", "Outpatients" and "Suits" tours, from the albums inception in 1992 through to the 1994 release. Along the way chat includes the split from Polydor records, the ill fated supergroup and the formation of Dick Brothers Records. Not to mention a track by track review and the return of "Just for the Record"!
The Association Between Diagnosis-to-limb Revascularization Time And Clinical Outcomes In Outpatients With Chronic Limb-threatening Ischemia
The Matt Brown show has decided to release all chapters of Amazon's #1 Best Seller Your Inner Game. In this podstorm, Matt does a live read of each chapter from the book. We also have an exclusive interview with Matt hosted by Entrepreneur Magz editor Nadine Todd, Matt talks about the amazing stories recounted on MBS116 with Cathy Davies and her time on Fox's Outpatients.Player: Cathy Davies, host of Outpatients – FOX LifePrinciple: I will develop a strong sense of characterTalent is a gift but character is a choice.– JOHN MAXWELLSupport the show
Substance abuse disorder recovery doesn't have to be a solo journey - join Avisa Recovery's outpatient program for addiction rehab with group therapy care. Call +1-732-724-0528 or click https://avisarecovery.com/ in New Jersey to learn more. Avisa Recovery City: Toms River Address: 25 West Water Street Website https://www.avisarecovery.com Phone +1 732 724 0528 Email info@avisarecovery.com
Dr. Jaclyn Ross, Ms. Jordan Barone, and Dr. Tory Eisenlohr-Moul (University of Illinois at Chicago) join AJP Audio to discuss the impact of the menstrual cycle on suicide ideation and planning in psychiatric patients with suicidality. Afterwards, American Journal of Psychiatry Editor-in-Chief Dr. Ned Kalin brings us up to date on the rest of the January issue of AJP. Transcript Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Podcasts, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. How authors may submit their work. Follow the journals of APA Publishing on Twitter. E-mail us at ajp@psych.org
Chinese health authorities say the number of outpatients for respiratory illnesses in the country is on the decline.
Addiction recovery doesn't have to be a solo undertaking - get the help you need in New Jersey from professionals who know addiction and rehab. Call Avisa Recovery at +1-732-724-0528 or click https://avisarecovery.com/addiction-treatment/ to learn more about its intensive outpatient program, covered by UMR. Avisa Recovery City: Toms River Address: 25 West Water Street Website https://www.avisarecovery.com Phone +1 732 724 0528 Email info@avisarecovery.com
NYC based Surf rock talent Guitarmy Of One is the solo project of Scott Helland, who combines the thrilling sounds of spy-themed instrumental surf guitar music with punk vitality. Taking listeners ona sonic adventure to the realms of intrigue, danger and surf-soaked excitement, Helland channels that raw and unconventional spirit into a quirky fusion of genres.He got his start playing bass guitar in the 80s-90s hardcore punk scene, first with Deep Wound which he formed with J Mascis and Lou Barlow (Dinosaur Jr) and later with East Coast hardcore and crossover thrash stalwarts Outpatients, School of Violence and Darkside NYC. Going solo in the mid 90s, he released numerous eclectic instrumental albums before forming post punk dark pop cabaret duo Frenchy and the Punk with Samantha Stephenson. His latest album is called The Wave Files https://guitarmyofone.com/Playlist and podcast: https://djnocturna.comhttps://djnocturna.comYouTube: https://www.youtube.com/c/DJNocturnaListen : http://modsnapradio.comQUEEN OF WANDS with DJ Nocturna Every Saturday on ModSnap RadioKMOD: San Antonio2pm (HST), 5pm (PST), 6pm (MST),7pm (CST), 8pm (EST)
Guitarmy of One is the solo project of guitarist Scott Helland, who combines the thrilling sounds of spy-themed instrumental surf guitar music with punk vitality. Taking listeners on a sonic adventure to the realms of intrigue, danger and surf-soaked excitement, Helland channels that raw and unconventional spirit into a quirky fusion of genres. Helland got his start playing bass guitar in the 80s-90s hardcore punk scene, first with Deep Wound, which he formed with J Mascis and Lou Barlow (of Dinosaur Jr.) and later with East Coast hardcore and crossover thrash stalwarts Outpatients, School of Violence and Darkside NYC. Going solo in the mid-90s, he released numerous eclectic instrumental albums before forming post-punk dark pop cabaret duo Frenchy and the Punk in 2005 with French singer Samantha Stephenson. "Kolchak Meets the Sea Mobster is inspired by the 70s thriller detective show Kolchak the Night Stalker. With its heavy dark surf rock vibe and spy noir riffing, the song conjures espionage on the open sea and the mystique of detectives on the case," says Scott Helland.
You know that I strongly believe that the future of hospitals isn't hospitals, it's outpatient facilities.
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief of JAMA, the Journal of the American Medical Association, for the March 21, 2023 issue.
Dr. Louise M. Klebanoff discusses her article, "Modern Neurology Training Is Failing Outpatients". Show references: https://jamanetwork.com/journals/jamaneurology/article-abstract/2802049
Read the related article in JAMA Neurology.
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief of JAMA, the Journal of the American Medical Association, for the January 24/31, 2023, issue. Related Content: Audio Highlights
The Matt Brown show has decided to release all chapters of Amazon's #1 Best Seller Your Inner Game. In this podstorm, Matt does a live read of each chapter from the book. We also have an exclusive interview with Matt hosted by Entrepreneur Magz editor Nadine Todd, Matt talks about the amazing stories recounted on MBS116 with Cathy Davies and her time on Fox's Outpatients.Player: Cathy Davies, host of Outpatients – FOX LifePrinciple: I will develop a strong sense of characterTalent is a gift but character is a choice.– JOHN MAXWELLAudiobook available on Audible. Mattbrownshow.com Support the showSupport the show
Howie and Harlan are joined by Lisa Sanders, the Yale internist who writes the "Diagnosis" column in the New York Times. Harlan reports on new studies demonstrating the ineffectiveness of ivermectin in treating COVID-19, and the effectiveness of the bivalent booster in improving outcomes. And Howie reacts to headlines about frequent misdiagnoses in emergency departments. Links: “Effect of Ivermectin 600 μg/kg for 6 days vs Placebo on Time to Sustained Recovery in Outpatients with Mild to Moderate COVID-19: A Randomized Clinical Trial” Katelyn Jetelina: “Fall bivalent boosters: Science update round 4” Eric Topol: “A quick update on the bivalent boosters” “DeSantis calls for grand jury to investigate Covid-19 vaccines” Diagnosis: Dr. Lisa Sanders on hard-to-solve medical mysteries “Introducing 'Diagnosis,' a New Show From The Times and Netflix” “Diagnostic Errors in the Emergency Department: A Systematic Review” “E.R. Doctors Misdiagnose Patients With Unusual Symptoms” “More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds”
Howie and Harlan are joined by Lisa Sanders, the Yale internist who writes the "Diagnosis" column in the New York Times. Harlan reports on new studies demonstrating the ineffectiveness of ivermectin in treating COVID-19, and the effectiveness of the bivalent booster in improving outcomes. And Howie reacts to headlines about frequent misdiagnoses in emergency departments. Links: “Effect of Ivermectin 600 μg/kg for 6 days vs Placebo on Time to Sustained Recovery in Outpatients with Mild to Moderate COVID-19: A Randomized Clinical Trial” Katelyn Jetelina: “Fall bivalent boosters: Science update round 4” Eric Topol: “A quick update on the bivalent boosters” “DeSantis calls for grand jury to investigate Covid-19 vaccines” Diagnosis: Dr. Lisa Sanders on hard-to-solve medical mysteries “Introducing 'Diagnosis,' a New Show From The Times and Netflix” “Diagnostic Errors in the Emergency Department: A Systematic Review” “E.R. Doctors Misdiagnose Patients With Unusual Symptoms” “More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds”
CME credits: 1.25 Valid until: 23-11-2023 Claim your CME credit at https://reachmd.com/programs/cme/rivaroxaban-to-reduce-the-risk-of-major-venous-and-arterial-thrombotic-events-hospitalization-and-death-in-medically-ill-outpatients-with-covid-19-primary-results-of-the-prevent-hd-randomized-clinical-trial/14429/ In this program, expert faculty review and discuss real-world applications of the latest, practice-changing data across different therapeutic areas within cardiovascular medicine presented at the American Heart Association Scientific Session 2022.
Frenchy and the Punk is made up of singer, percussionist, and lyricist Samantha Stephenson and guitarist and composer Scott Helland. Dark times make for dark songs. "Zen Ghost" was written and recorded from 2020 to 2021 where the duo's shadowy sound takes an even darker turn. An inward spin into the pair's previously unexplored personal planes and interpretations of the insanity of our increasingly tumultuous age. But despite its more pronounced moodiness, like the restof the band's oeuvre, "Zen Ghost" offers plenty of opportunities to dance in the darkness.French-born, but raised in England and America, Stephenson's early study of piano and dance ignited her eventual rejection of corporate conformity and fueled her quest to lead a truly autonomous life through art and music. A son of jazz-loving teachers, Helland grew up in Western Massachusetts, where he was a vital player on the region's famously fertile Deep Wound along Dinosaur Jr. founders J Mascis and Lou Barlow , as well as Outpatients. http://www.frenchyandthepunk.comhttp://www.frenchyandthepunk.bandcamp.comPlaylist and podcast: https://djnocturna.comYouTube: https://www.youtube.com/c/DJNocturna Listen : http://modsnapradio.comQUEEN OF WANDS with DJ Nocturna Every Saturday on Modsnap Radio2pm (HST), 5pm (PST), 6pm (MST), 7pm (CST), 8pm (EST)#Modsnap #postpunk #goth #industrialmusic #dark80s #darkwave
CME credits: 1.00 Valid until: 06-09-2023 Claim your CME credit at https://reachmd.com/programs/cme/treatments-for-outpatients-with-mild-to-moderate-covid-19/13441/ Normal functions of the immune system include defense against infections. As the immune system ages and these capabilities decline, however, there is increased susceptibility to infections. Individuals of any age can acquire SARS-CoV-2 infection, although adults of middle age and older are most commonly affected, and older adults are more likely to have severe disease. Older age is also associated with increased COVID-19-related mortality. There is a need for knowledge regarding the harmful effects of the aging immune system (immunosenescence) and the role of chronic inflammation among elderly populations to facilitate enhanced clinical monitoring of at-risk patients. As such, an educational activity is needed to provide up-to-date coverage of the knowledge regarding immunosenescence in the context of COVID-19 to help optimize patient outcomes.
CME in Minutes: Education in Rheumatology, Immunology, & Infectious Diseases
Please visit answersincme.com/TAC860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in infectious diseases discusses the early identification and treatment of patients with COVID-19 who are at a higher risk of progression to severe illness. Upon completion of this activity, participants should be better able to: Identify nonhospitalized patients with COVID-19 who have risk factors for progression to severe illness; Describe national guideline recommendations for the therapeutic management of nonhospitalized patients with COVID-19 who are at risk for progression to severe illness; and Outline a personalized management approach to enhance outcomes for nonhospitalized patients who are diagnosed with COVID-19 and are at risk for progression to severe illness.
Please visit answersincme.com/TAC860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in infectious diseases discusses the early identification and treatment of patients with COVID-19 who are at a higher risk of progression to severe illness. Upon completion of this activity, participants should be better able to: Identify nonhospitalized patients with COVID-19 who have risk factors for progression to severe illness; Describe national guideline recommendations for the therapeutic management of nonhospitalized patients with COVID-19 who are at risk for progression to severe illness; and Outline a personalized management approach to enhance outcomes for nonhospitalized patients who are diagnosed with COVID-19 and are at risk for progression to severe illness.
This episode features Dr. April Dyer from DASON. The article reviewed in this episode is available here: https://doi.org/10.1017/ice.2022.83. For more information about DASON, please visit: https://dason.medicine.duke.edu. Find out more at https://dason-digest.pinecast.co
Welcome back to the VTE Dublin Podcast where you'll find all the recent talks from the VTE Dublin Conference. Be sure to subscribe to the VTE Dublin Podcast Video: Audio:
Dr. Pierre Kory is joined by FLCCC physicians Dr. Fred Wagshul and Dr. Keith Berkowitz to discuss outpatient management of COVID-19 and effective ways to defeat the Delta variant and avoid hospitalization. Donate to the Front Line Covid-19 Critical Care Alliance, Inc To educate medical professionals and the public in safe and effective ways to prevent and treat COVID-19. Click here to make a donation: https://covid19criticalcare.com/network-support/support-our-work/ GoFundMe: https://charity.gofundme.com/donate/project/front-line-covid-19-critical-care-alliance/joyce-kamen Buy FLCCC gear at: https://theflcccstore.org/ Subscribe to our mailing list on our website: http://flccc.net/signup Follow us on Telegram: https://t.me/FLCCC_Alliance
Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Nirmatrelvir/ritonavir (Paxlovid) reduces risk of hospitalization in at-risk outpatients (EPIC-HR) '
Two new HCPCS code and one new product bring the total to six products classified as Car T-cell therapy.
This episode features Dr. Travis Jones from DASON. The article reviewed in this episode is available here: https://doi.org/10.1016/j.ijantimicag.2022.106560. For more information about DASON, please visit: https://dason.medicine.duke.edu.
Après avoir parlé du Paxlovid, on s'intéresse aux thérapies alternatives contre la COVID. Quelles sont les données d'efficacité concernant le remdésivir, la fluvoxamine et le budésonide inhalé? Quelles clientèles peuvent bénéficier de ces traitements? On en discute avec Jean-François Tessier, pharmacien à l'hôpital Maisonneuve-Rosemont du CIUSSS de l'Est-de-l'Ile de Montréal et président du RPE d'infectiologie de l'A.P.E.S. RÉFÉRENCES : Anil Gupta A, Gonzalez-Rojas Y, Juarez E et al. Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med 2021; 385:1941-1950. DOI: 10.1056/NEJMoa2107934. Hammond J, Leister-Tebbe H, Gardner A et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med 2022 (February). DOI: 10.1056/NEJMoa2118542. Lee T C, Morris M, Grover A S et al. Outpatient therapies for COVID-19: How do we choose? medRxiv 2021.12.17.21268007. DOI: 10.1101/2021.12.17.21268007 Canadian Treatments for COVID-19 for the Association of Medical Microbiology and Infectious Disease Canada Clinical Research Network and the Canadian Critical Care Trials Group. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial. CMAJ February 22, 2022 194 (7) E242-E251; DOI: 10.1503/cmaj.211698 Sanjay Ramakrishnan S, Nicolau Jr D V, Langford B et al. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. The Lancet Respiratory Medicine, volume 9, issue 7, p763-772, july 01, 2021. DOI: 10.1016/S2213-2600(21)00160-0 Robert L. Gottlieb, R, Vaca C E, Paredes R et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med 2022; 386:305-315. DOI: 10.1056/NEJMoa2116846. COVID-19 advisory for Ontario. Science table. https://covid19-sciencetable.ca
Did you know that 80% of antibiotic used are actually prescribed outside of the hospital setting? But how does one improve outpatient antibiotic use? Listen to this interview with Dr Gary Reuenson to find out. Read the article mentioned in the Intro https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext (here) – “Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis” by Christopher JL Murray et al YOUR FEEDBACK ON THIS EPISODE – https://forms.gle/ihyxxL7LML5DG11RA (HERE!) About our Guest: Gary is a Paediatric Infectious Diseases subspecialist based at Rahima Moosa Mother & Child Hospital, Johannesburg. He heads one of the General Paediatric units at the hospital. In addition, he holds representative positions with the Federation of Infectious Disease Societies of Southern Africa (FIDSSA), the Colleges of Medicine of South Africa (CMSA), the Ministerial Advisory Committee for Antimicrobial Resistance, the Ministerial Advisory Committee for COVID-19 Therapeutics, and the National Essential Medicines List Committee (NEMLC). He is passionate about practicing and teaching evidence-based medicine within the fields of Paediatrics and Infectious Diseases. Twitter:@garyreubenson LinkedIn: https://za.linkedin.com/in/gary-reubenson-6565a626 (https://za.linkedin.com/in/gary-reubenson-6565a626) Visit the Microbe Mail https://microbemail.captivate.fm/ (website) to sign up for updates E-mail: mail.microbe@gmail.com YouTube: https://www.youtube.com/channel/UCgaP3aUNkjrgOxR8Ei6UaEw (Microbe Mail) Instagram: https://instagram.com/https:/www.instagram.com/microbe_mail/ (Microbe_Mail)
CMS has established a HCPCS code for reimbursement when outpatients receive convalescent plasma.
Use of monoclonal antibodies restricted due to Omicron; Veklury given the go-ahead as an outpatient treatment; New data produces a reconsideration for Pepaxto withdrawal; And there's a new treatment approval for unresectable or metastatic uveal melanoma.
This episode features Dr. Travis Jones from DASON. Details regarding the FDA meeting on molnupiravir are available here: https://www.fda.gov/advisory-committees/advisory-committee-calendar/november-30-2021-antimicrobial-drugs-advisory-committee-meeting-announcement-11302021-11302021. For more information about DASON, please visit: https://dason.medicine.duke.edu.
This is an article summary of "Implementation of an Electronic Catheter Checklist in Outpatient Hemodialysis Facilities: Results of a Pilot Quality Improvement Project" by Michele Mokrzycki and Vandana Niyyar on behalf of their coauthors.
CAR T-cell therapy (Chimeric Antigen Receptor) is a new expensive immunotherapy used in the treatment of various cancers. Due to the high cost ($375,000-$500,000 per dose), it is important to ensure that billing and coding is correct and complete on outpatient claims.
On Wednesday, the University at Buffalo announced some good news for those who might be having a bad week. Researchers at the university are looking for people who just got diagnosed with COVID-19 to participate in an outpatient treatment study.
“Are your CFOs agitated by the increase of outpatients in inpatient beds because of the removal of total knee arthroplasty (TKA), total hip arthroplasty (THA), and hundreds of other procedures from Medicare’s Inpatient-Only List (IPO) list?” asked Julie Collins recently on the RAC Relief listserv. “If the surgeon’s office is securing the prior authorization, how are they doing with securing the proper classification (inpatient/outpatient)? Are they using a dartboard to determine which classification they request?”During the next live edition of Monitor Mondays, Collins, manager of utilization management at TriHealth in Cincinnati, Ohio, will report on how her healthcare system is addressing this crucial issue.Other segments to be featured during the live broadcast include the following:Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will report the Monitor Mondays lead story.
This week, we will discuss a potpourri of COVID studies: a large propensity score matched study of thromboprophylaxis in hospitalized patients, novel use of colchicine for COVID-19, and mortality associated with mutant SARS-CoV-2 strains.
Gold Coast Health piloted a shared governance business model in the orthopaedics department, granting clinical departmental leads with direct accountability for achieving agreed outcomes, supported by increased financial and HR delegations. This enabled them to more directly and efficiently manage the day-to-day operations of the department and improve its overall clinical and financial performance. Learn more To watch Kate and Kimberley's interview, visit the Clinical Excellence Showcase website. For information about the project, visit their page on our Improvement Exchange. Please subscribe to ‘Clinical Excellence Showcase' wherever you digest your podcasts, rate and review on iTunes and follow us on social media: Facebook, Twitter and Instagram.
Influenza outbreaks place a significant annual burden on the Australian healthcare system. There is well documented evidence that increasing rates of influenza vaccination, especially amongst high risk patients will decrease the number of confirmed cases of influenza, reduce hospital admissions, associated costs and death. Despite this, under usage of immunisation programs continues to be a significant public health concern with inadequate time to attend a venue for vaccination being identified as a significant contributor to less than ideal vaccination rates. The Royal Brisbane and Women's Hospital pharmacy service has input into ambulatory outpatient services, making it ideal for providing opportunistic vaccinations to patients in a hospital outpatient setting. The aim was to investigate the impact of such a service on increasing access for high-risk patients to receive their annual influenza vaccination. Learn more To watch Kim's interview, visit the Clinical Excellence Showcase website. For information about the project, visit their page on our Improvement Exchange. Please subscribe to ‘Clinical Excellence Showcase' wherever you digest your podcasts, rate and review on iTunes and follow us on social media: Facebook, Twitter and Instagram.
It's another Shotcast Saturday! This week, we're checking out Anxious Disease by the Outpatients. The last song ever recorded featuring Axl Rose and Slash together. --- Send in a voice message: https://anchor.fm/gunsnradio/message
The Matt Brown show has decided to release all chapters of Amazon's #1 Best Seller Your Inner Game. In this podstorm, Matt does a live read of each chapter from the book. We also have an exclusive interview with Matt hosted by Entrepreneur Magz editor Nadine Todd, Matt talks about the amazing stories recounted on MBS116 with Cathy Davies and her time on Fox's Outpatients.Player: Cathy Davies, host of Outpatients – FOX LifeEpisode: MBS116Principle: I will develop a strong sense of character Talent is a gift but character is a choice.– JOHN MAXWELLAudiobook available on Audible. Email us - hello@mattbrownshow.comMattbrownshow.com
Prior randomized trials of convalescent plasma in COVID-19 have had disappointing results. However, these trials included patients with severe illness who were many days (if not weeks) into the course of their illness. To date, it was hypothesized, but unknown, that the benefit would be in patients very early in the course of their illness. We cover an RCT by Libster et al in NEJM on convalescent plasma in older patients with mild COVID-19. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
This is an all-COVID-19 week. We discuss the WHO Solidarity trial of remdesivir and other antivirals, banlamivimab for outpatients, and an RCT of convalescent serum.
The purpose of this study was to evaluate the efficacy and safety of LY-CoV555 (bamlanivimab) in patients with recently diagnosed mild or moderate COVID-19 in the outpatient setting
Welcome to Teeth & Titanium Episode 7! On this episode we cover a number of topics including: -Current Events (theres a lot to discuss…) -TNT has a new logo! -Wendall is a…FATHER! -Update on NDSE/RCDC exams -Meet the new CAOMS and CRAOMS presidents -Resident Reminder on the basics of implant planning -Journal Club: We catch up on top articles from September, October, AND November! -Our viewing recommendations And more! Be sure to hit subscribe on your podcast app so you never miss an episode! Thanks to the CAOMS for their continued support. https://www.caoms.com If you would like to contact us, or would like to submit a topic for Resident Reminder or Journal club, please email us at: teethandtitaniumOMFS@gmail.com Rational Reminder Episode 65 ft. Wendall & Ben Felix https://rationalreminder.ca/podcast/65 Articles cited in this episode: 1) Durrani I, Ji YD, Peacock ZS. Do Speakers Fully Disclose Potential Conflicts of Interest in Oral and Maxillofacial Surgery? J Oral Maxillofac Surg. 2020 Oct;78(10):1669-1673. doi: 10.1016/j.joms.2020.03.010. Epub 2020 Mar 18. PMID: 32283077. 2) Granquist EJ, Bouloux G, Dattilo D, Gonzalez O, Louis PJ, McCain J, Sinn D, Szymela V, Warner M, Quinn PD. Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study. J Oral Maxillofac Surg. 2020 Sep;78(9):1499-1508. doi: 10.1016/j.joms.2020.04.021. Epub 2020 Apr 23. PMID: 32439381. 3) Lee CC, Lawler ME, Tannyhill RJ, Dodson TB, Peacock ZS. Can Patients With Isolated Mandibular Fractures Be Treated as Outpatients? J Oral Maxillofac Surg. 2020 Nov;78(11):2010-2017. doi: 10.1016/j.joms.2020.06.034. Epub 2020 Jul 8. PMID: 32735787. 4) Wang TT, Chuang SK. Power and Sample Size: An Opportunity to Optimize Randomized Controlled Trials in Oral and Maxillofacial Surgery Research. J Oral Maxillofac Surg. 2020 Nov;78(11):1880-1882. doi: 10.1016/j.joms.2020.06.020. Epub 2020 Jun 17. PMID: 32659274. 5) Alshahrani NS, Abu-Nada L, Ramirez Garcia-Luna JL, Al-Hamed FS, Alamri A, Makhoul NM, Tamimi F. Ranitidine Impairs Bone Healing and Implant Osseointegration in Rats' Tibiae. J Oral Maxillofac Surg. 2020 Nov;78(11):1943-1952. doi: 10.1016/j.joms.2020.06.027. Epub 2020 Jun 26. PMID: 32687794. 6) Gigliotti J, Ying Y, Morlandt AB. Titanium Alloy Cutting Guides in Craniomaxillofacial Surgery-A Minimally Invasive Alternative to Synthetic Polymer Guides. J Oral Maxillofac Surg. 2020 Nov;78(11):2080-2089. doi: 10.1016/j.joms.2020.06.010. Epub 2020 Jun 11. PMID: 32640210. Hosted by Dr. Wendall Mascarenhas and Dr. Oscar Dalmao
In this 24-minute podcast, Kurt Hong, MD, PhD, discusses a recent study he and his peers conducted, titled, “Nutrition Care for Poorly-Nourished Outpatients Reduces Resource Use and Lowers Costs.”
Researchers from the Department of Internal Medicine, University of Heidelberg, Germany, report in the September issue of the online, peer-reviewed journal Nutrients, an association between vitamin D deficiency and the severity/mortality of COVID-19 – which, they say, highlighs the need for interventional studies on vitamin D supplementation in SARS-CoV-2 infected individuals.The study - "Vitamin D Deficiency and Outcome of COVID-19" – said the clinical features of this SARS coronavirus can vary from those people, who present with no symptoms, to those people with upper respiratory tract symptoms, and patients with severe lung injury – yielding inflammation, multiorgan failure, and a fatal outcome.At present, there is no causal treatment for COVID-19, according to the study. Age, male gender, and underlying comorbidities, such as obesity, type 2 diabetes, cardiovascular and lung disease, have been associated with a severe COVID outcome.The patient population of this investigational study included 185, “consecutive symptomatic SARS-CoV-2-positive patients admitted to the Medical University Hospital Heidelberg, who were enrolled onto a prospective, non-interventional register. Included in the analysis were patients diagnosed and treated between 18 March and 18 June 2020, who had consented to study participation and had serum samples available for analysis.”The Germans point to a controversial association of a low vitamin D status with increased susceptibility to infectious disease. They reference the fact that the active form of vitamin D3, also known as calcitriol, is a “pluripotent” (capable of differentiating into one of many cell types) hormone, and an important modulator of both innate and adaptive immunity. The serum level of total 25-hydroxyvitamin D (25(OH)D) is commonly used to assess individual vitamin D status. The German researchers defined vitamin D deficiency, as serum total 25-hydroxyvitamin D level < 12 ng/mL (nanograms per milliliter of blood).The study patients were screened and diagnosed for the SARS-CoV-2 infection based on recognized diagnostic procedures and standards. The patient’s vitamin D status was assessed at the time of first presentation - using accredited laboratory methods. As noted in the study, “the decision for inpatient versus outpatient admission was based on the level of spontaneous oxygen saturation (SpO2 ≤ 93%), comorbidities, and the overall performance status.’With regard to established COVID-19 severity classifications, “all inpatients had severe disease, oxygen saturation ≤ 93% at rest, or critical disease – stated as respiratory failure, requiring mechanical ventilation, septic shock, or other organ dysfunction, or failure that requires intensive care.”From an outpatient standpoint, symptomatic disease presented with fever, cough, sore throat, myalgia, and/or fatigue. Outpatients, as noted, were visited in their home quarantine on a regular basis and their clinical conditions were regularly evaluated.In all cases, appropriate treatment modalities and care was administered. The researchers reported that, “the present study demonstrates an association between VitD deficiency and severity of COVID-19. VitD-deficient patients had a higher hospitalization rate, and required more (intensive) oxygen therapy and IMV (invasive mechanical ventilation).”“In our patients, when adjusted for age, gender, and comorbidities, VitD deficiency was associated with a 6-fold higher hazard of severe course of disease and a ~15-fold higher risk of death,” commented the Germans.The Germans stated, “prospective, randomized controlled studies on VitD supplementation in SARS-CoV-2 infected individuals are highly warranted.”Read the rest on Mackieshilstone.com
Darren and David are joined by Record Store Day regular Alan Jones. From home town Tenby, Wales to crate digging for vinyl in Europe, USA & Canada music has been at the centre of much of life. He was also a band member of the Outpatients.
Dr. Antoci is a Fellowship Trained Orthopaedic Surgeon with a focus in Adult Reconstruction, Hip and Knee Joint Replacement Surgery and a special interest in unicompartmental partial knee replacement, minimally invasive surgery, complex reconstructions, failed total joints, preservation techniques, and trauma. He is a graduate of the Jefferson Medical College in Philadelphia. Dr. Antoci a frequent lecturer, both locally and nationally, and has authored and coauthored over a dozen book chapters, many journal articles, and has over 100 presentations and talks at national and international meetings. He will discuss total joint replacements on outpatients.
Dr. Antoci is a Fellowship Trained Orthopaedic Surgeon with a focus in Adult Reconstruction, Hip and Knee Joint Replacement Surgery and a special interest in unicompartmental partial knee replacement, minimally invasive surgery, complex reconstructions, failed total joints, preservation techniques, and trauma. He is a graduate of the Jefferson Medical College in Philadelphia. Dr. Antoci a frequent lecturer, both locally and nationally, and has authored and coauthored over a dozen book chapters, many journal articles, and has over 100 presentations and talks at national and international meetings. He will discuss total joint replacements on outpatients.
Alok Khorana, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to break down the latest recommendations from the American Society of Clinical Oncology on venous thromboembolism (VTE) prophylaxis in cancer patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares her answer to a frequent question from cancer patients: What should I eat? This Week in Oncology What is the role of thromboprophylaxis in patients with cancer in the outpatient setting? Key change in ASCO recommendations: Thromboprophylaxis with apixaban, rivaroxaban, or low-molecular-weight heparin (LMWH) may be offered to select high-risk outpatients with cancer. Prophylactic anticoagulation should not be given to every patient with malignancy. Khorana score predicts the venous thromboembolism in patients with malignancy. Influenced by type of malignancy, hemoglobin, platelet count, leukocyte count, and BMI. High risk = Khorana score of 2 or higher may be offered prophylaxis. Patients with pancreatic cancer and gastric cancer are particularly coagulopathic. Does the presence of a CNS lesion(s) preclude anticoagulation for a DVT/PE? All CNS lesions have a risk of hemorrhage. A CNS lesion hemorrhage is not significantly greater when anticoagulated Among high-risk cancer patients who undergo surgery, is there a role for postoperative prophylaxis with LMWH? Data show a persistent risk of VTE up to 4 weeks following abdominal/pelvic surgery. Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. References: Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update ascopubs.org/doi/pdf/10.1200/JCO.19.01461 Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer nejm.org/doi/full/10.1056/NEJMoa1814630 Apixaban to prevent venous thromboembolism in patients with cancer nejm.org/doi/full/10.1056/NEJMoa1814468 For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Respiratory Physician Professor Colin Robertson discusses outpatient management of child and adolescents with asthma with Dr Amy Gray. Professor Robertson discusses what we are talking about when we refer to asthma, the need to ensure our diagnosis is correct, and reflects on when we may consider different types of preventative treatment. Resources:The RCH Asthma Clinical Practice GuidelinesThe RCH patient education videos PODCAST DISCLAIMER:This podcast has been produced by The Education Hub, a collaboration between the Royal Children's Hospital and the University of Melbourne Department of Paediatrics. The producers have made considerable efforts to ensure the information contained in the podcast is accurate, evidence-based and up to date at the time of publication however the information and advice offered is intended as a guide only and does not replace the need for clinical expertise and the application of clinical judgment to each individual presentation. This podcast should not be reproduced without the written permission of The Education Hub (education.hub@rch.org.au).
Alchemists struggled without success for centuries attempting to turn lead into gold.
GLIB, OUTPATIENTS, SUBDUED, VINTAGE CROP.
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=2s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=2s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=2s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=2s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=2s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS (Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=1s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS(Episode116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=1s
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. Taken From MBS (Episode 116): https://www.youtube.com/watch?v=ozMbXqENWD8&t=1s
This week we listen to Buzzcocks, Murphy’s Law, Evil Engine, Incisions, Snuffed, Stretch Marks, Outpatients, and more! It’s a bittersweet show, as we celebrate departed legends while also discovering new artists ready to make their imprint on hardcore.
Half of outpatient antibiotics prescribed with no infectious disease code.https://www.mdedge.com/internalmedicinenews/article/176602/practice-management/half-outpatient-antibiotics-prescribed-no How to vaccinate patients on biologics.https://www.mdedge.com/internalmedicinenews/article/176611/vaccines/how-vaccinate-patients-biologics Opiate use tied to hepatitis C risk in youth.https://www.mdedge.com/internalmedicinenews/article/176570/hepatitis/opiate-use-tied-hepatitis-c-risk-youth In rosacea, a single treatment may not be enough.https://www.mdedge.com/internalmedicinenews/article/176604/rosacea/rosacea-single-treatment-may-not-be-enough
Hey guys, so entrepreneurs must deal with pain more than most. You know, the pain of cash flow, the pain of failure, and the pain of just well, having to make it on your own. And so, when the proverbial shit hits the fan, it’s easy to think we’re suffering more than most – but that’s just not the truth or reality. You see, regardless of how bad things get in your life, there is always someone who is worse off than you are. In today’s episode, I chat to Cathy Davies, an entrepreneur who the transforms the lives of ordinary people and celebrities. In her new reality TV show called Outpatients on FOX Life she shares the real stories of ordinary people who are dealt some really unbelievably bad blows and yet despite everything have the strength inside of them to push through incredible pain and despair to achieve their dreams. This particular episode of the Matt Brown Show is really one about perspective – because sometimes the right perspective makes things possible. So without
Episode 23 is a conversation with Scott Helland. Scott has been playing music for over 30 years, getting his start as a teenager forming the hardcore bands Deep Wound and Outpatients. We talk about both of those bands, as well as his various musical projects he's been involved in through the years and ones that are still very active. Scott is an extremely passionate and intense guy, especially talking about music, so of course he was the perfect guest for the show. Scott talks about the things behind his drive to play music, including a tragic event when he was a teenager that fueled a lifelong motivaton to live life to the fullest. This episode is named after a record by the heavy metal band Accept, which ties into the early part of Scott's musical journey.
Children the world over are fascinated with what can possibly “fit” in their orifices. Diagnosis is often delayed. Anxiety abounds before and during evaluation and management. Most common objects:1,2 Food Coins Toys Insects Balls, marbles Balloons Magnets Crayon Hair accessories, bows Beads Pebbles Erasers Pen/marker caps Button batteries Plastic bags, packaging Non-pharmacologic techniques Set the scene and control the environment. Limit the number of people in the room, the noise level, and minimize “cross-talk”. The focus should be on engaging, calming, and distracting the child. Quiet room; calm parent; “burrito wrap”; guided imagery; have a willing parent restrain the child in his or her lap – an assistant can further restrain the head. Procedural Sedation Most foreign bodies in the ear, nose, and throat in children can be managed with non-pharmacologic techniques, topical aids, gentle patient protective restraint, and a quick hand. Consider sedation in children with special health care needs who may not be able to cooperate and technically delicate extractions. Ketamine is an excellent agent, as airway reflexes are maintained.3 Remember to plan, think ahead: where could the foreign body may be displaced if something goes wrong? You may have taken away his protective gag reflex with sedation. Position the child accordingly to prevent precipitous foreign body aspiration or occlusion. L’OREILLE – DAS OHR – вухо – THE EAR – LA OREJA – 耳 – L'ORECCHIO Essential anatomy: The external auditory canal. Foreign bodies may become lodged in the narrowing at the bony cartilaginous junction.4 The lateral 1/3 of the canal is flexible, while the medial 2/3 is fixed in the temporal bone – here is where many foreign bodies are lodged and/or where the clinician may find evidence of trauma. Pearls: Ask yourself: is it graspable or non-graspable?5 Graspable: 64% success rate, 14% complication rate Non-graspable: 45% success rate, 70% complication rate5 If there is an insect in the external auditory canal, kill it first. They will fight for their lives if you try to dismember or take them out. “In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.”5,6 Use lidocaine jelly (preferred), viscous lidocaine (2%), lidocaine solution (2 or 4%), isopropyl alcohol, or mineral oil. Vegetable matter? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection. Pifalls: Failure to inspect after removal – is there something else in there? Failure to assess for abrasions, trauma, infection – if any break in skin, give prophylactic antibiotic ear drops Law of diminishing returns: probability of successful removal of ear foreign bodies declines dramatically after the first attempt LE NEZ – DIE NASE – ніс – THE NOSE – LA NARIZ – 鼻 – IL NASO Essential anatomy: Nasopharyngeal and tracheal anatomy. Highlighted areas indicate points at which nasal foreign bodies may become lodged.4 Pearls: Consider using topical analgesics and vasoconstrictors to reduce pain and swelling – and improve tolerance of/cooperation with the procedure. Use 0.5% oxymetolazone (Afrin) spray and a few drops of 2 or 4% Pros: as above. Cons: possible posterior displacement of the foreign body.7 Be ready for the precipitous development of an airway foreign body Pitfalls: Beware of unilateral nasal discharge in a child – strongly consider retained foreign body.8 Do not push a foreign body down the back of a patient's throat, where it may be aspirated into the trachea. Be sure to inspect the palate for “vacuum effect”: small or flexible objects may be found on the roof of the mouth, just waiting to be aspirated. LA GORGE – DER HALS – горло – THE THROAT – LA GARGANTA – 喉 – LA GOLA Before we go further – Remember that a foreign body in the mouth or throat can precipitously become a foreign body in the airway. Foreign body inhalation is the most common cause of accidental death in children less than one year of age.9,10 Go to BLS maneuvers if the child decompensates. Infants under 1 year of age – back blows: head-down, 5 back-blows (between scapulae), 5 chest-thrusts (sternum). Reassess, repeat as needed. Children 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. The thumb side of one fist should be placed on the abdomen below the xiphoid process. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. This maneuver should be repeated if the airway remains obstructed. Alternatively, if patient is supine, open the airway, and if the object is readily visible, remove it. Abdominal thrusts: place the heel of one hand below the xiphoid, interlace fingers, and use sharp, forceful thrusts to dislodge. Be ready to perform CPR. Children 1 year and up, unconscious – CPR: start CPR with chest compressions (do not perform a pulse check). After 30 chest compressions, open the airway. If you see a foreign body, remove it but do not perform blind finger sweeps because they may push obstructing objects further into the pharynx and may damage the oropharynx. Attempt to give 2 breaths and continue with cycles of chest compressions and ventilations until the object is expelled. Chest films are limited: 80% of airway foreign bodies are radiolucent.11 Look for unilateral hyperinflation on expiratory films: air trapping. Essential anatomy: Most esophageal foreign bodies in children occur at the level of the thoracic inlet / cricopharyngeus muscle (upper esophageal sphincter). Other anatomically narrow sites include the level of the aortic arch and the lower esophageal sphincter. Coin en face – in the esophagus – lodged at the thoracic inlet.12 The pliable esophagus accommodates the flat coin against the flat aspect of the vertebra.11 Beware the “double-ring” sign: this is a button battery13 This is an emergency: the electrolyte-rich mucosa conducts a focal current from the narrow negative terminal of the battery, rapidly causing burn, necrosis, and possibly perforation. Emergent removal is required. Button batteries that have passed into the stomach do not require emergent intervention – they can be followed closely. Not a button battery, not a sharp object, not a long object? If there is no obstruction, consider revaluation the next day – may wait up to 24 hours for passage.14 Sharieff et al.15 found that coins found in the mid to distal esophagus within 24 hours all passed successfully. What conditions prompt urgent removal? Size Infants: objects smaller than 2 cm wide and 3 cm long will likely pass the pylorus and ileocecal valve10 Children and adults: objects smaller than 2 cm wide and 5 cm long will likely pass the pylorus and ileocecal valve9 Character Sharp objects have a high rate of perforation (35%)1 Pearls: History is essential. Believe the parents and assume there is an aspirated/ingested foreign body until proven otherwise. History of choking, has persistent symptoms and/or abnormal xray? Broncoscopy! Cohen et al.16 found that of 142 patients evaluated at a single site university hospital, 61 had a foreign body. Of the 61 patients, 42 had abnormal physical exams and radiographs and 17 had either abnormal physical exams or radiographs, and 2 had normal physical exams and radiographs, but both had a history of persistent cough. Bottom line: history of choking PLUS abnormal exam, abnormal films, or persistent symptoms, evaluate with bronchoscopy. For patients with some residual suspicion of an aspirated foreign body (mild initial or improving symptoms; possibly abnormal chest x-ray; low but finite risk), consider chest CT with virtual bronchoscopy as a rule-out strategy.17,18 Outpatients who have passed a small and non-concerning object into the stomach or beyond: serial exams and observing stools – polyethylene glycol 3350 (MiraLAX) may be given for delayed passage19 Pifalls: A single household magnet will likely pass through the GI tract, with the aforementioned dimensional caveats. Two or more magnets, however, run the risk of attraction and trans-bowel wall pressure necrosis. Not all magnets are created equal. Neodymium magnet toys (“buckyballs”) were recalled in 2014 (but are still out there!) due to their highly attractive nature. These magnets must be removed to avoid bowel wall ischemia. 19–21 Patients should avoid wearing belt buckles or metallic buttons in case of single magnet ingestion while waiting for the single magnet to pass DES OUTILS DU MÉTIER – DIE HANDWERKSZEUG – Знаряддя праці – TOOLS OF THE TRADE – LAS HERRAMIENTAS DEL OFICIO – GLI ATTREZZI DEL MESTIERE – 仕事のツール It’s best to keep your armamentarium as large as you can. Curette A small foreign body in the lateral 1/3 of the auditory canal may be amenable to a simple curettage. Hair beads (if the central hole is accessible) may be manipulated out with the angled tip of a rigid curette. Steady the operating hand by placing your hypothenar eminence on the child’s zygoma or temporal scalp, to avoid jutting the instrument into the ear canal with sudden movement. There is a large selection of disposable simple and lighted curettes on the market. Right-angle Hook Various eponymous hooks are available for this purpose; one in popular use is the Day hook, which may be passed behind the foreign body.22 An inexpensive and convenient alternative to the commercially available right-hooks is a home-made version: make your own by straightening out a paperclip and bending it to a right angle23 at 2-3 mm from the end (be sure not to use the type that have a friable shiny metallic finish, as the residue may be left behind in the ear canal). If it is completely lodged, use of a right-angle hook will likely only cause trauma to the canal. Alligator forceps Alligator forceps are best for grasping soft objects like cotton or paper. Smooth, round or oval objects are not amenable to extraction with alligator forceps. When using them, be sure to get a firm, central grip on the object, to avoid tearing it into smaller, less manageable pieces. Pro tip: Look before you grip! Be careful to visualize the area you are gripping, to avoid pulling on (and subsequently avulsing) soft tissue in the ear canal. Cyanoacrylate (Dermabond®, SurgiSeal®) Apply cyanoacrylate to either side of a long wooden cotton swab (the lecturer prefers the cotton tip side, for improved grip/molding around object). Immediately apply the treated side to the object in the ear canal in a restrained patient. Steady the hypothenar eminence on the child’s face to avoid dislodgement of the cotton swab with sudden movement. Apply the treated swab to the foreign body for 30-60 seconds, to allow bonding. Slowly pull out the foreign body. Re-visualize the ear canal for other retained foreign bodies and abrasion or ear canal trauma. Did the cyanoacrylate drip? Did the swab stick to the ear canal? No problem – use 3% hydrogen peroxide or acetone.24 Pour in a sufficient amount, allow to work for 10 minutes. Both agents help to dissolve ear wax, the compound, or both. Repeat if needed to debond the cyanoacrylate from the ear canal.24,25 Irrigation Irrigation is the default for non-organic foreign bodies that are not amenable to other extraction techniques. Sometimes the object is encased in cerumen, and the only “instrument” that will fit behind the foreign body is the slowly growing trickle of water that builds enough pressure to expulse it. Do not use if there is any organic material involved: the object will swell, causing much more pain, difficulty in extraction, and possibly setting up conditions for infection. Position the child either prone or supine, gently restrain (as above). Let gravity work for you: don’t irrigate in decubitus position with the affected ear up. It may be more accessible to you, but you may never get the foreign body out. To use a butterfly needle: use a small gage (22 or 24 g) butterfly set up, cut off the needle, connect the tubing to a 30 mL syringe filled with warm or room-temperature water. Insert the free end of the tubing gently, and “secure” the tubing with your pinched fingers while irrigating (think of holding an ETT in place just after intubation and before taping/securing the tube). Gently and slowly increase the pressure you exert as you irrigate. To use an IV or angiocatheter: use a moderate size (18 or 20 g) IV, remove the needle and attach the plastic catheter to a 20 mL syringe, and irrigate as above. Acetone Acetone has been used successfully to remove chewing gum, Styrofoam, and superglue from the ear canal24,26,27 Use in cases where there is no suspicion of perforation of the tympanic membrane. Docusate Sodium (Colace®) Cerumen is composed of sebaceous ad ceruminous secretions and desquamated skin. Genetic, environmental, and anatomical factors combine to trap a foreign body in the external canal. Use of a ceruminolytic such as docusate sodium may help to loosen and liberate the foreign body.28 Caveat medicus: Adding docusate sodium will make the object more slippery – this may or may not be an issue given the nature of the foreign body. In the case where loosening the ear wax may aid extraction (and will not cause a slippery mess), consider filling the ear canal will docusate sodium (Colace), having the child lie with the affected side up, waiting 15 minutes, and proceeding. This is especially helpful when planning for irrigation. Magnets Rare earth magnets (a misnomer, as their components are actually abundant) such as neodymium can be useful in retrieving metallic foreign bodies (e.g. button batteries in the nose or ears).29,30 Magnetic “pick-up tools” – used by mechanics, engineers, and do-it-yourselfers – are inexpensive and readily available in various sizes, shapes, and styles such as a telescoping extender. Look for a small tip diameter (to fit in the ear canal as well as the nose) and a strong “hold” (at least a 3-lb hold). Alternatively, you may purchase a strong neodymium bar magnet (30- to 50-lb hold) to attach to an instrument such as an alligator forceps, pick-up forceps, or small hemostat (a pacemaker magnet may also work). The magnetic bar, placed in your palm at the base of the instrument, will conduct the charge (depending on the instrument) and allow you to retrieve many metallic objects.31 Although stainless steel is often said to be “non-magnetic”, it depends on the alloy used, and some may actually respond to the strong rare earth magnet. Most stainless steel has a minimum of 10.5% chromium, which gives the steel its 'stainless' properties (essentially corrosion resistance). A basic stainless steel has a “ferritic” structure and is magnetic. Higher-end stainless steel such as in kitchen cutlery have an “austenitic” structure, with more chromium added, and so less magnetic quality. (Ironically, the more “economical” instruments in the typical ED suture kit have less chromium, and so are more magnetic – use these with your neodymium bar magnet to conduct the magnetic charge and extract the metallic foreign body.) Bottom line: if it’s metal, it’s worth a try to use a magnet. Even if the metal is very weakly magnetic, the strong neodymium magnet may still be able to exert a pull on it and aid in extraction. Snare Technique A relatively new method, described by Fundakowski et al.32 consists of using a small length of 24-gauge (or similar) wire (available inexpensively online, and kept in your personal “toolkit”; see Appendix B below) to make a loop that is secured by a hemostat (the 24-gauge wire is easily cut into strips with standard trauma scissors). After treatment with oxymetolazone (0.05%) and lidocaine (1 or 2%) topically, the loop is passed behind the foreign body (in the case report, a button battery). Pull the loop toward you until you feel that it is sitting up against the button battery. Now, turn the hemostat 90° to improve your purchase on the foreign body. Pull gently out. This technique is especially useful when the foreign body has created marked edema, either creating a vacuum effect or making it difficult for other instruments to pass. Balloon Catheters (Katz extractor®, Fogarty embolectomy catheter) Small-caliber devices (5, 6, or 8 F) originally designed for use with intravascular or bladder catheterization may be used to extract foreign bodies from the ear or nose.7,33 A catheter designed specifically for foreign body use is the Katz extractor. Inspect the ear or nose for potential trauma and to anticipate bleeding after manipulation (especially the nose). Deflate the catheter and apply surgical lubricant or 2% lidocaine jelly. Insert the deflated catheter and gently pass the device past the foreign body. Inflate the balloon and slowly pull the balloon and foreign body out. Re-inspect after extraction. NB, from the manufacturer of the Katz extractor, InHealth: “the Katz Extractor oto-rhino foreign body remover is intended principally for extraction of impacted foreign bodies in the nasal passages. This device may also be used in the external ear canal, based upon clinical judgment.” Mother’s kiss The mother’s kiss was first described in 1965 by Vladimir Ctibor, a general practitioner from New Jersey.34 “The mother, or other trusted adult, places her mouth over the child’s open mouth, forming a firm seal as if about to perform mouth-to-mouth resuscitation. While occluding the unaffected nostril with a finger, the adult then blows until feeling resistance caused by closure of the child’s glottis, at which point the adult gives a sharp exhalation to deliver a short puff of air into the child’s mouth. This puff of air passes through the nasopharynx, out through the non-occluded nostril and, if successful, results in the expulsion of the foreign body. The procedure is fully explained to the adult before starting, and the child is told that the parent will give him or her a “big kiss” so that minimal distress is caused to the child. The procedure can be repeated a number of times if not initially successful.”34 Positive Pressure Ventilation with Bag Valve Mask This technique is an approximation of the above mother’s kiss technique – useful for unwilling parents or unsuccessful tries.10,25 The author prefers to position the child sitting up. A self-inflating bag-mask device is fitted with a very small mask: use an abnormally small mask (otherwise inappropriately small for usual resuscitative bag-mask ventilation) to fit over the mouth only. Choose an infant mask that will cover the child’s mouth only. Occlude the opposite nostril with your finger while you form a tight seal with the mask around the mouth. Deliver short, abrupt bursts of ventilation through the mouth – be sure to maintain good seals with the mask and with your finger to the child’s nostril – until the foreign body is expulsed through the affected nostril. Beamsley Blaster (Continuous Positive Pressure) Technique For the very uncooperative child with a nasal foreign body amenable to positive pressure ventilation who fails the mother’s kiss and bag-mask technique, a continuous positive pressure method may be used. Connect one end of suction tubing to the male adaptor (“Christmas tree”) of an air or oxygen source. Connect the other end of the suction tubing to a male-to-male adaptor (commonly used for chest tube connections or connecting / extending suction tubes). Insert the end of the device into the child’s unaffected nostril. The air flow will deliver positive pressure ventilation continuously. With this technique there is a theoretical risk of barotrauma to the lungs or tympanic membranes. However, there is only one case reported in the literature of periorbital subcutaneous emphysema. To minimize this risk, some authors recommend limiting to a maximum of four attempts using any positive pressure method.10 Nasal speculum Optimize your visualization with a nasal speculum. The nostrils, luckily, will accommodate a fair amount of distention without damage. Hold the speculum vertically to avoid pressure on and damage to the vessel-and-nerve-rich nasal septum. Hold the handle of the speculum in the palm of your hand comfortably and while placing your index finger on the patient’s ala. This will help to control the speculum and your angle of sight. Your other hand is then free to use a hook or other tool for extraction. Lighting is especially important when using the nasal speculum: a focused procedure light or head lamp is very helpful. The author keeps a common camping LED headlamp in his bag for easy access. Suction tips / catheters Various commercial and non-commercial suction devices are on the market for removal of foreign bodies. All connect to wall suction, and vary by style, caliber of suction, and tip end interface. A commonly available suction catheter is the Frazier suction tip (right), a single-use device used in the operating room. A modification to suction can be made with the Schuknecht foreign body remover (left; not to be confused with the suction catheter of the same name): a plastic cone-shaped tip placed on the end of the suction catheter to increase vacuum surface area and seal. Laryngoscope and Magill Forceps If a child aspirates and occludes his airway, return to BLS maneuvers (as above). If the child becomes obtunded, use direct laryngoscopy to visualize the foreign body and remove with the Magill forceps. Hold the laryngoscope in your left hand as per usual. Hold the Magill forceps in your right hand – palm side down – to grasp and remove the foreign body. Take-home Points Beware the “vacuum palate”: a flat (especially clear plastic) foreign body hiding on the palate Take seriously the complaint of foreign body without obvious evidence on initial inspection – believe that something is in there until proven otherwise Control the environment, address analgesia and anxiolysis, have a back-up plan Motto Like a difficult airway: plan through the steps MERCI – DANKE – Дякую – THANK YOU – GRACIAS – ありがとう— GRAZIE Appendix A: Prevention At the end of the visit, after some rapport has been established, counsel the caregivers about age-appropriate foods and “child-proofing” the home. This is a teachable moment – and only you can have this golden opportunity! Age-appropriate foods 0-6 months: breastmilk or formula 6-9 months: introduce solid puree-consistency foods 9-12 months: small minced solids that require no chewing (well cooked, soft, chopped foods) Although molars (required for chewing) erupt around 18 months, toddlers need to develop coordination, awareness to eat hard foods that require considerable chewing. Not until 4 years of age (anything that requires chewing to swallow): Hot dogs Nuts and seeds Chunks of meat or cheese Whole grapes Hard or sticky candy Popcorn Chunks of peanut butter Chunks of raw vegetables Chewing gum Child-proofing the home Refer parents to the helpful multi-lingual site from the American Academy of Pediatrics: http://www.healthychildren.org/English/safety-prevention/at-home/Pages/Childproofing-Your-Home.aspx An abbreviated list: use age-appropriate toys and “test” them out before giving them to your child to verify that there are no small, missing, or loose parts. Secure medications, lock up cabinets (especially with chemicals), do not store chemicals in food containers, secure the toilet bowl, and unplug appliances. Parents should understand that “watching” their child alone cannot prevent foreign body aspiration: a recent review found that in 84.2% of cases, incidents resulting in an airway foreign body occurred in the presence of an adult.35 Best overall tip: get down on all fours and inspect your living area from the child’s perspective. It is amazing what you will find when you are least expecting it. Appendix B: The Playbook's ENT Foreign Body Toolkit Although your institution should supply you with what you need to deal with routine problems, we all struggle with having just what we need when we need it. High-volume disposable items such as cyanoacrylate (Dermabond), curettes, supplies for irrigation, alligator forceps, and the like certainly should be supplied by the institution. However, some things come in very handy as our back-up tools. NB: we should be cognizant of the fact that tools that must be sterilized or autoclaved are not good candidates for our personal re-usable toolkits. These items can all be found inexpensively – shop around online, or in home improvement stores: Head lamp, LED camping style: $5-15 Neodymium magnet “pick-up tool”: $5-15 Neodymium bar magnet: $6-20 Wire, 24-gauge, spool of 25 yards (for snare technique): $6 Day hook: $15-20 References Chapin MM, Rochette LM, Annest JL, Haileyesus T, Conner KA, Smith GA. Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009. Pediatrics. 2013;132(2):275-281. doi:10.1542/peds.2013-0260. Committee on Injury V. Policy Statement—Prevention of Choking Among Children. Pediatrics. 2010:peds.2009-2862. doi:10.1542/peds.2009-2862. Brown L, Denmark TK, Wittlake WA, Vargas EJ, Watson T, Crabb JW. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med. 2004;22(4):310-314. Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007;76(8):1185-1189. DiMuzio J, Deschler DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. 2002;23(4):473-475. Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Ann Emerg Med. 1993;22(12):1795-1798. Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care. 2008;24(11):785-792; quiz 790-792. doi:10.1097/PEC.0b013e31818c2cb9. Kadish HA, Corneli HM. Removal of nasal foreign bodies in the pediatric population. Am J Emerg Med. 1997;15(1):54-56. Tahir N, Ramsden WH, Stringer MD. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr. 2009;168(3):289-295. doi:10.1007/s00431-008-0751-9. Rempe B, Iskyan K, Aloi M. An Evidence-Based Review of Pediatric Retained Foreign Bodies. Pediatr Emerg Med Pract. 6(12). Digoy GP. Diagnosis and management of upper aerodigestive tract foreign bodies. Otolaryngol Clin North Am. 2008;41(3):485-496, vii - viii. doi:10.1016/j.otc.2008.01.013. Loren Yamamoto, Inaba A, DiMauro R. Radiologic Cases in Pediatric Emergency Medicine; University of Hawaii. Radiol Cases Emerg Med. http://www.hawaii.edu/medicine/pediatrics/pemxray/zindex.html. Accessed February 20, 2015. Painter K. Energizer makes button battery packages safer for kids. USA Today. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085-1091. doi:10.1016/j.gie.2010.11.010. Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA. Acute esophageal coin ingestions: is immediate removal necessary? Pediatr Radiol. 2003;33(12):859-863. doi:10.1007/s00247-003-1032-4. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected Foreign Body Inhalation in Children: What Are the Indications for Bronchoscopy? J Pediatr. 2009;155(2):276-280. doi:10.1016/j.jpeds.2009.02.040. Haliloglu M, Ciftci AO, Oto A, et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol. 2003;48(2):188-192. doi:10.1016/S0720-048X(02)00295-4. Jung SY, Pae SY, Chung SM, Kim HS. Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol. 2011;269(1):223-228. doi:10.1007/s00405-011-1567-1. Hussain SZ, Bousvaros A, Gilger M, et al. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687be0. Brown JC, Otjen JP, Drugas GT. Too attractive: the growing problem of magnet ingestions in children. Pediatr Emerg Care. 2013;29(11):1170-1174. doi:10.1097/PEC.0b013e3182a9e7aa. Brown JC, Otjen JP, Drugas GT. Pediatric magnet ingestions: the dark side of the force. Am J Surg. 2014;207(5):754-759; discussion 759. doi:10.1016/j.amjsurg.2013.12.028. Menner AL. Pocket Guide to the Ear: A Concise Clinical Text on the Ear and Its Disorders. Thieme; 2011. Colina D, Dudek S, Lin M. Tricks of the Trade: ENT Dilemmas - How Do I Get That Out of There? ACEP News. http://www.acep.org/Clinical---Practice-Management/Tricks-of-the-Trade--ENT-Dilemmas---How-Do-I-Get-That-Out-of-There-/?__taxonomyid=118010. Published July 2009. Accessed February 5, 2015. Abadir WF, Nakhla V, Chong P. Removal of superglue from the external ear using acetone: case report and literature review. J Laryngol Otol. 1995;109(12):1219-1221. Kadish H. Ear and Nose Foreign Bodies “It is all about the tools.” Clin Pediatr (Phila). 2005;44(8):665-670. doi:10.1177/000992280504400803. Chisholm EJ, Barber-Craig H, Farrell R. Chewing gum removal from the ear using acetone. J Laryngol Otol. 2003;117(4):325. doi:10.1258/00222150360600995. White SJ, Broner S. The use of acetone to dissolve a Styrofoam impaction of the ear. Ann Emerg Med. 1994;23(3):580-582. Singer AJ, Sauris E, Viccellio AW. Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Ann Emerg Med. 2000;36(3):228-232. doi:10.1067/mem.2000.109166. Bledsoe RD. Magnetically adherent nasal foreign bodies: a novel method of removal and case series. Am J Emerg Med. 2008;26(7):839.e1-e839.e2. doi:10.1016/j.ajem.2008.01.036. Dolderer JH, Kelly JL, Morrison WA, Penington AJ. FOREIGN-BODY RETRIEVAL USING A RARE EARTH MAGNET: Plast Reconstr Surg. 2004;113(6):1869-1870. doi:10.1097/01.PRS.0000119869.01081.1C. Yeh B, Roberson JR. Nasal magnetic foreign body: a sticky topic. J Emerg Med. 2012;43(2):319-321. doi:10.1016/j.jemermed.2010.02.013. Fundakowski CE, Moon S, Torres L. The snare technique: a novel atraumatic method for the removal of difficult nasal foreign bodies. J Emerg Med. 2013;44(1):104-106. doi:10.1016/j.jemermed.2012.07.070. Chan TC, Ufberg J, Harrigan RA, Vilke GM. Nasal foreign body removal. J Emerg Med. 2004;26(4):441-445. doi:10.1016/j.jemermed.2003.12.024. Cook S, Burton M, Glasziou P. Efficacy and safety of the “mother’s kiss” technique: a systematic review of case reports and case series. Can Med Assoc J. 2012;184(17):E904-E912. doi:10.1503/cmaj.111864. Gregori D, Morra B, Snidero S, et al. Foreign bodies in the upper airways: the experience of two Italian hospitals. J Prev Med Hyg. 2007;48(1):24-26. This post and podcast are dedicated to Linda Dykes, MBBS(Hons) for her can-do attitude and collaborative spirit. Thank you for sharing your knowledge, experience, and heart with the world.
Gimme TOAP ROCK! This week on the show we are joined by the great Lou Barlow! Join Damian as he sits down with Lou Barlow to discuss how hearing the Dead Kennedys over a CB Radio led of one of indie rock’s most impressive careers. Also discussed. -Interviewing Lou: 4th time is the charm! -Devo on SNL -The town formally known as Devon -The B-52s -Transistor Radio Love -Holiday in Cambodia emerging from the static -Jimi Hendrix formerly words wildest musician -The NY Rocker -Mail Ordering from Dischord -The other Vandals -Going to the porn theatre for your first show -8th Route Army: The Rock of Punk Rock -The Stupids: Proto Hardcore weirdness -Outpatients -Main Street Records rules! -Meeting J -Lou had better US HC but J had the imports on lock. -No direct questions -Byron Coley reviews matter -The Ramones -Gerard compliment from episode 5 is dissected -Being terrified to perform but fear is a great motivators -The Boston: true nastiness -“Fuck You Fuck Society and Fuck Everything” -Loving John Lydon -Sebadoh: a true unruly history -Gang Green = Freedom -Slapshot -Never seeing Mission To Burma -“Where are those guys? Cool, I stay over here then.” -Raw Power -Finnish Hardcore -Lou sells out the edge -Being disillusioned by (and still into) the second 7 Seconds 7” -Loving Minor Threat but knowing that they were streamlining hardcore -Smog: from crap lo fi to brilliant song writer -Royal Trux -Suckdog -Being mean to Superchunk -Finding kindred spirits in Pavement -The story behind the Kids soundtrack -Harmonie’s great taste in music -AND MORE!!!!!!
This week on Dying Scene Radio, Bob Noxious interviews Joe Que3r, guitarist and lead singer of the legendary American punk rock band The Queers on their co-headlining ticket with The Dwarves at BackBooth in Orlando, FL. And Bobby Pickles slurs through his end of this week’s podcast drunk on whiskey. Dwarves’ frontman Blag Dahlia denies Noxious’ allegations of conspiracy to expel Bobby Pickles from The Bowery Electric on this two-part series concerning “some obscure dude from New York”.SYNOPSIS OF BANTER:Bobby asks Bob about how he got his start in radio. Bob explains his humble beginnings on a local Pirate Radio Station and growing up the son of a 70's A.M. Radio "Hot Jock" DJ.Bobby declares, “pop-anything sucks”, including but not limited to pop-country and pop-hip-hop and pop-punk; he then continues on with a news story about Blink 182. Bob continues to be amazed that the aforementioned band remains seemingly relevant to the patrons of dyingscene.com and quickly dismisses them.Bob asks Joe Que3r why punk rock legends are so much more accessible than the untouchable rock heroes of yesteryear. Joe tells Bob about meeting Joey Ramone and eventually working with him on his solo record. Legendary! (There’s that word again). Later, Blag baba-booeys the interview, asking Joe about "the blow and all that stuff".Bob discusses his deep seething hatred of the "emo/kid/bubblegum/pop" bands who are continually signed to Epitaph, explaining further that the only relevant band still left on the label is Bad Religion (not true, see: Rancid, Pennywise, Millencolin, Propagandhi, The Descendents...and the list goes on and on). Talk turns to all of the different silly names that record labels are naming themselves.Bobby mentions looking forward to seeing Less Than Jake in New Haven, then gloats that there are no Florida dates for Bob to catch. Bob informs Bobby that LTJ's frontman, Chris DeMakes, lives in the same Florida city as he, continuing that they play roughly eight local shows per year. Bobby, once again, invites Bob to New York for a yearly shindig, then accuses him of being “too pushy” when Bob suggests an interview request with NJ hardcore band, Bigwig. Passive-aggressive puns are passed around playfully as Bob chastises Bobby for a slow news week at DyingScene.com when his supposed “jouralist” co-host covers a story about "some dude’s record collection" - Bobby waxing on about Minor Threat’s Filler EP.THIS WEEK’S HEADLINESSome of the topics reported herein, include, but are not limited to the following: Keep the Manspeaker Family together - Green Jellÿ frontman, and loving father, Bill Manspeaker starts a GoFundMe campaign to raise $5000 to retain a lawyer for his embattled court proceedings, attempting to remove custody rights from his daughter; Contest: Sweet Baby “It’s A Girl” LP reissue, new Sweet Baby 7-inch & more; Video: “The Making of Fat Mike’s Punk Rock Musical” (Part 2); more Matt Skiba and Blink 182 news (Bob yawns); The World Is A Beautiful Place & I Am No Longer Afraid To Die sign to Epitaph Records; Mest announces reunion with classic lineup; Less Than Jake announce more US/Canada dates with Reel Big Fish; Live Video: Bigwig perform “Flavor Ice” at Natefest; Watch Scott Helland (Deep Wound, Outpatients) gush about record collection.THIS WEEK’S PLAYLISTMoral Decline - Habitual Line CrosserKnockin Bones - WarriorsBand Mango - Sinking ShipsBlag Dahlia InterviewStabbed In Back - Dead InsideThe Queers Interview (Pt 1)The Queers - I Can’t Stop FartingFrank Turner - Get BetterFools Gold - OCMDThe Decline - Growing Up Is A Gateway DrugDrunken Logic - (The Good News Is) Nobody Gives A DamnThe Queers Interview (Pt. 2)This week’s sponsor is FAT ENZO.BobNoxious@DyingScene.comTwitter @BobNoxiousIG @BobNoxiousBobbyPickles@DyingScene.comTwitter @TheBobbyPicklesIG @BobbyPicklesInstagram: @DyingSceneRadioLike us on Facebook.com/DyingSceneRadioFollow the link for this week’s FULL INTERVIEW with Joe Queer.Call the hotline – (347)754-PUNK
This week on Episode 65 of Bobby Pickles' Podcast (Dying Scene Radio #10), Bob Noxious interviews Joe Queer, guitarist and lead singer of the legendary American punk rock band The Queers on their co-headlining ticket with The Dwarves atBackBooth in Orlando, FL. And Bobby Pickles slurs through his end of this week’s podcast drunk on whiskey. Dwarves’ frontman Blag Dahlia denies Noxious’ allegations of conspiracy to expel Bobby Pickles from The Bowery Electric on this two-part series concerning “some obscure dude from New York”. SYNOPSIS OF BANTER: Bobby asks Bob about how he got his start in radio. Bob explains his humble beginnings on a local Pirate Radio Station and growing up the son of a 70's A.M. Radio "Hot Jock" DJ. Bobby declares, “pop-anything sucks”, including but not limited to pop-country and pop-hip-hop and pop-punk; he then continues on with a news story about Blink 182. Bob continues to be amazed that the aforementioned band remains seemingly relevant to the patrons of dyingscene.com and quickly dismisses them. Bob asks Joe Queer why punk rock legends are so much more accessible than the untouchable rock heroes of yesteryear. Joe tells Bob about meeting Joey Ramone and eventually working with him on his solo record. Legendary! (There’s that word again). Later, Blag baba-booeys the interview, asking Joe about "the blow and all that stuff". Bob discusses his deep seething hatred of the "emo/kid/bubblegum/pop" bands who are continually signed to Epitaph, explaining further that the only relevant band still left on the label is Bad Religion (not true, see: Rancid, Pennywise, Millencolin, Propagandhi, The Descendents...and the list goes on and on). Talk turns to all of the different silly names that record labels are naming themselves. Bobby mentions looking forward to seeing Less Than Jake in New Haven, then gloats that there are no Florida dates for Bob to catch. Bob informs Bobby that LTJ's frontman,Chris DeMakes, lives in the same Florida city as he, continuing that they play roughly eight local shows per year. Bobby, once again, invites Bob to New York for a yearly shindig, then accuses him of being “too pushy” when Bob suggests an interview request with NJ hardcore band,Bigwig. Passive-aggressive puns are passed around playfully as Bob chastises Bobby for a slow news week at DyingScene.com when his supposed “jouralist” co-host covers a story about "some dude’s record collection" - Bobby waxing on about Minor Threat’sFiller EP. THIS WEEK’S HEADLINESSome of the topics reported herein, include, but are not limited to the following:Keep the Manspeaker Family together - Green Jellÿ frontman, and loving father, Bill Manspeaker starts a GoFundMe campaign to raise $5000 to retain a lawyer for his embattled court proceedings, attempting to remove custody rights from his daughter;Contest: Sweet Baby “It’s A Girl” LP reissue, new Sweet Baby 7-inch & more; Video: “The Making of Fat Mike’s Punk Rock Musical” (Part 2); more Matt Skiba and Blink 182news (Bob yawns); The World Is A Beautiful Place & I Am No Longer Afraid To Die sign to Epitaph Records; Mest announces reunion with classic lineup; Less Than Jake announce more US/Canada dates with Reel Big Fish; Live Video: Bigwig perform “Flavor Ice” at Natefest; Watch Scott Helland (Deep Wound, Outpatients) gush about record collection. THIS WEEK’S PLAYLIST Moral Decline - Habitual Line Crosser Knockin Bones - Warriors Band Mango - Sinking Ships Blag Dahlia Interview Stabbed In Back - Dead Inside The Queers Interview (Pt 1) The Queers - I Can’t Stop Farting Frank Turner - Get Better Fools Gold - OCMD The Decline - Growing Up Is A Gateway Drug Drunken Logic - (The Good News Is) Nobody Gives A Damn The Queers Interview (Pt. 2) This week’s sponsor is FAT ENZO. BobNoxious@DyingScene.com Twitter @BobNoxious IG @BobNoxious BobbyPickles@DyingScene.com Twitter @TheBobbyPickles IG @BobbyPickles Instagram: @DyingSceneRadio Like us on Facebook.com/DyingSceneRadio Follow the link for this week’s FULL INTERVIEW with Joe Queer. Call the hotline – (347)754-PUNK
Pat exposes the dangers of outpatient care. The hazards are not just in hospitals so beware. Two lovely gals from Solia Spa join the show to share skin and beauty safety tips. Plus the boys enjoy another round of Shocking News (scream) from Around the World. Where else can you stay safe and look beautiful all at the same time?This show is broadcast live on W4CY Radio (www.w4cy.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/).
Interview with Alexis L. Beatty, MD, author of High-Sensitivity Cardiac Troponin T Levels and Secondary Events in Outpatients With Coronary Heart Disease From the Heart and Soul Study, and Patrick G. O’Malley, MD, MPH, author of Is There a Role for Further Risk Stratification of Patients With Stable Coronary Artery Disease?
Background: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a well defined risk factor for subsequent bacteremia and death in various groups of patients, but its impact on outcome in patients receiving long-term hemodialysis (HD) is under debate. Methods: This prospective interventional cohort study (performed 2004 to 2010) enrolled 289 HD outpatients of an urban dialysis-unit. Nasal swab cultures for MRSA were performed in all patients upon first admission, at transfer from another dialysis facility or readmission after hospitalisation. Nasal MRSA carriers were treated in a separate ward and received mupirocin nasal ointment. Concomitant extra-nasal MRSA colonization was treated with 0.2% chlorhexidine mouth rinse (throat) or octenidine dihydrochloride containing antiseptic soaps and 2% chlorhexidine body washes (skin). Clinical data and outcome of carriers and noncarriers were systematically analyzed. Results: The screening approach identified 34 nasal MRSA carriers (11.7%). Extra-nasal MRSA colonization was observed in 11/34 (32%) nasal MRSA carriers. History of malignancy and an increased Charlson Comorbidity Index were significant predictors for nasal MRSA carriers, whereas traditional risk factors for MRSA colonization or markers of inflammation or malnutrition were not able to discriminate. Kaplan-Meier analysis demonstrated significant survival differences between MRSA carriers and noncarriers. Mupirocin ointment persistently eliminated nasal MRSA colonization in 26/34 (73.5%) patients. Persistent nasal MRSA carriers with failure of this eradication approach had an extremely poor prognosis with an all-cause mortality rate >85%. Conclusions: Nasal MRSA carriage with failure of mupirocin decolonization was associated with increased mortality despite a lack of overt clinical signs of infection. Further studies are needed to demonstrate whether nasal MRSA colonization represents a novel predictor of worse outcome or just another surrogate marker of the burden of comorbid diseases leading to fatal outcome in HD patients.
Interview with Carla M. Perissinotto, MD, MHS, author of Loneliness in Older Persons: A Predictor of Functional Decline and Death, Jacob A. Udell, MD, MPH, author of Living Alone and Cardiovascular Risk in Outpatients at Risk of or With Atherothrombosis, and Emily M. Bucholz, MPH, author of Loneliness and Living Alone: What Are We Really Measuring?: Comment on "Loneliness in Older Persons" and "Living Alone and Cardiovascular Risk in Outpatients at Risk of or With Atherothrombosis"
ABSTRACT: All buildings modify their sites, some radically. There will be other sites from which material came and to which it goes. Carbon and other costs now reward a strategy of incorporating all excavation into the design. The talk will explore the history of this practice, from work by Rem Koolhaas to ancient Indian temples, particularly tracing the connection between Rafael Moneo's Kursaal at San Sebastian, Jorn Utzon's Sydney Opera House and Frank Lloyd Wright's Taliesin West. BIOGRAPHY: John Sergeant is an Architect, former Lecturer in the Dept. of Architecture and Emeritus Fellow of Robinson College. He was a Visiting Professor at CEPT University, Ahmedabad, India in 2009-10 and led a Symposium on Wright at the University of Tokyo in December 2009. His research is best known for Frank Lloyd Wright's Usonian Houses and his local practice for recycling Adden-Brooke's Outpatients' Department into Brown's Restaurant. His orientation has always been toward organic, or sustainable, architecture. He is currently working on a book on recent Responsive Architecture.
The relationship between coping styles and mental health has received considerable attention, but the state effects on coping measures in a clinical sample are not well known. This study investigated changes in scores on the Coping Inventory for Stressful Situations between two treatment phases (acute and remitted phase) in 49 outpatients with major depression or anxiety disorders. Task-oriented coping changed significantly between the treatment phases in both depressive and anxious patients, as analyzed by two-way multivariate analysis of variance. Results from repeated measures of multivariate analysis of covariance indicated that task-oriented coping was influenced by depression and emotion-oriented coping was influenced by anxiety. Avoidance-oriented coping did not change significantly over time in either depressive or anxiety disorders controlled for depressive and anxiety symptoms. The results of this study suggest that depressive or anxiety symptoms and treatment phase affect coping measurement. Copyright (C) 2002 S. Karger AG, Basel.
Diabetic patients under multiple injection insulin therapy (i.e., intensified insulin therapy, IIT) usually start this treatment during hospitalization. We report here on the logistics, efficacy, and safety of IIT, started in outpatients. Over 8 months, 52 type I and type II diabetics were followed up whose insulin regimens consecutively had been changed from conventional therapy to IIT. Two different IIT strategies were compared: free mixtures of regular and intermediate (12 hrs)-acting insulin versus the basal and prandial insulin treatment with preprandial injections of regular insulin, and ultralente (24 hrs-acting) or intermediate insulin for the basal demand. After 8 months HbA1 levels had decreased from 10.6%±2.4% to 8.0%±1.3% (means±SD). There was no difference between the two regimens with respect to metabolic control; but type II patients maintained the lowered HbA1 levels better than type I patients. Only two patients were hospitalized during the follow-up time because of severe hypoglycemia. An increase of body weight due to the diet liberalization during IIT became a problem in one-third of the patients. Our results suggest that outpatient initiation of IIT is safe and efficacious with respect to near-normoglycemic control. Weight control may become a problem in IIT patients.
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