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Author's Clinical Experience (author + clinical_experience)
Selected AbstractsCurrent Approaches to Venous Ulcers and CompressionDERMATOLOGIC SURGERY, Issue 7 2001FRCPC, Tania J. Phillips MD Background. Venous ulcers affect as many as 2.5 million people in the United States and can cause substantial pain and loss of function. Objective. To review current approaches to venous ulcers and compression. Method. Treatment options that have been proposed in the literature are discussed utilizing the Cochrane library database, Medline, and the author's clinical experience. Results. Diagnostic findings and management strategies for venous ulcers are reviewed. Conclusion. Good wound care and compression therapy will heal the majority of small venous ulcers of short duration. For ulcers that are slow to heal, other approaches such as venous surgery and grafting with conventional or bioengineered skin substitutes should be considered. [source] The science and art of hyaluronic acid dermal filler use in esthetic applicationsJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2009Michael Gold MD Summary Background, The number of dermal fillers has expanded dramatically; clinicians can benefit from practical information on their optimal use. Aims, To review key determinants of dermal filler performance, to discuss technical considerations, and to illustrate these factors based on the author's clinical experience. Methods, Current literature pertaining to the physicochemical properties of hyaluronic acid (HA) dermal fillers and implications for clinical use was reviewed. The author provides clinical guidelines for optimizing outcomes, illustrated with three case examples. Results, Hyaluronic acids are nonimmunogenic, versatile, reversible, and have excellent benefit,risk profiles, making them near-ideal filling agents. They differ in their manufacturing processes, viscosity, hardness, cohesivity, ease of injection, and ideal uses. Patient counseling and education with individualized selection of the appropriate agent is critical to provide satisfactory outcomes. Conclusions, Clinicians must be technically proficient, balance esthetic need with facial anatomy, and consider HA properties to provide optimal outcomes. [source] Utilizing Ericksonian Hypnosis in Psychiatric-Mental Health Nursing PracticePERSPECTIVES IN PSYCHIATRIC CARE, Issue 1 2002Rothlyn P. Zahourek PhD TOPIC. Ericksonian hypnosis conceptual framework. PURPOSE. To acquaint psychiatric-mental health nurses with hypnotic principles and how these can be integrated into their practice. SOURCES. Published literature and author's clinical experience. CONCLUSIONS. Ericksonian hypnosis offers an array of potential interventions for psychiatric-mental health nurses to integrate into their practices in a framework familiar to nurses: holism, honoring and respecting individuality, and capitalizing on an individual's strengths. [source] Implications of Prognostic Factors and Risk Groups in the Management of Differentiated Thyroid Cancer,THE LARYNGOSCOPE, Issue 3 2004Ashok R. Shaha MD Abstract Objectives/Hypothesis The outcome in differentiated thyroid cancer generally depends on the stage of the disease at the time of presentation; prognostic factors such as age, grade, size, extension, or distant metastasis; and risk groups (eg, low or high risk). The author has reviewed a large number of patients with differentiated thyroid cancer to analyze their hypothesis and to confirm that various risk groups have a major implication in relation to extent of the treatment and outcome. Differentiated thyroid cancers make up 90% of all thyroid tumors. The prognostic factors are well defined, such as age, size of the tumor, extrathyroidal extension, presence of distant metastasis, histological appearance, and grade of the tumor. The author has previously divided the risk groups into low-, intermediate-, and high-risk categories based on prognostic factors. The study describes the author's treatment approach related to the extent of thyroidectomy and adjuvant therapy based on various risk groups and the long-term survival. Study Design Retrospective. Methods In a retrospective review of 1038 patients with differentiated thyroid carcinoma, various prognostic factors were studied by univariate and multivariate analysis. The significant prognostic factors were studied in detail and, based on these prognostic factors, the patients were divided into low-, intermediate- and high-risk groups. The survival curves were plotted by Kaplan-Meier method. Results The long-term survivals in low-, intermediate- and high-risk groups were 99%, 87%, and 57% respectively. Based on these risk groups, a decision tree was made regarding extent of thyroidectomy and adjuvant treatment. In the high-risk group and selected patients in the intermediate-risk group, aggressive surgery including removal of all gross disease and extrathyroidal extension with postoperative radioactive iodine ablation is recommended. In the low-risk group and selected patients in the intermediate-risk group, lobectomy appears to be satisfactory with excellent long-term outcome. The surgical treatment offers the best long-term results in low-risk patients, and the role of adjuvant treatment in this group is questionable. Conclusion The decisions in the management of well-differentiated thyroid cancer should be based on various prognostic factors and risk groups. The long-term survival in the low-risk group is excellent, and consideration should be given to conservative surgical resection depending on the extent of the disease. In the high-risk group and selected patients in the intermediate-risk group, total thyroidectomy with radioactive ablation is warranted. A consideration may be given to external-beam radiation therapy in selected high-risk patients. It is apparent, based on the author's clinical experience and critical retrospective analysis, that the author's hypothesis that risk groups are extremely important in the long-term outcome of patients with differentiated thyroid cancer is correct. Based on various risk groups, the author currently is able to guide the treatment policies for thyroid cancer. [source] Submental intubation in complex craniomaxillofacial traumaANZ JOURNAL OF SURGERY, Issue 5 2004Charles Davis The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. A submental intubation has been used in 11 selected cases amongst 190 consecutively treated patients with craniomaxillofacial trauma over a 3-year period. These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described. [source] Narrative Methods and Children: Theoretical Explanations and Practice IssuesJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2008Lorna Bennett RN TOPIC:,The Narrative approach is an innovative way of working with children and adolescents experiencing mental health problems. This approach can be effectively integrated with the expressive arts and other nonverbal ways of accessing the life world of children. In addition, the approach promotes respect for and collaboration with the child in working towards healing and growth. PURPOSE:,In this paper core features of the narrative approach are described; the theoretical and philosophical and evidence base for this approach as well as its congruence with the special nature and needs of children will be explored. Finally, the benefits and challenges of this approach in relation to a specific clinical situation will be highlighted. SOURCES USED:,Published literature and the author's clinical experiences. CONCLUSION:,Narrative methods are ideally suited for addressing needs of children experiencing mental health problems and can enhance therapeutic effectiveness. Some of the challenges associated with its use include: finding creative ways to apply specific narrative concepts and methods with diverse clinical issues/problems; learning to collaborate with children and respect them as experts in their own lives; and shifting the nursing focus from a problem-focused orientation to a strength-oriented and child-centered approach. [source] Culturally Competent Care of Patients with Acute Chest PainJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2005Mary Sobralske PhD Purpose To inform nurse practitioners (NPs) about the influence of culture on patients' responses to pain using the example of acute chest pain. Data sources Selected clinical and research articles on pain and culture and the authors' clinical experiences providing care across a variety of cultures. Conclusions There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment. [source] The Acute, Nontraumatic Scrotum: Assessment, Diagnosis, and ManagementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2004FAANP, Frank L. Cole PhD Purpose This article reviews the acute, nontraumatic scrotal conditions of testicular torsion, torsion of an epididymal or testicular appendage, and epididymitis in order to assist the nurse practitioner (NP) with arriving at a diagnosis. Primary and emergency care management are presented. Data Sources Selected published literature in refereed journals and the authors' clinical experiences. Conclusions Signs and symptoms of testicular pathologies can overlap, making diagnosis problematic. However, key features can raise the NP's index of suspicion for a particular diagnosis and can assist in selecting the most appropriate management strategy. Implications for Practice Although these conditions are rarely fatal, they may carry a risk of morbidity in the form of testicular necrosis, infarction, or atrophy with concomitant infertility. Any patient with scrotal or testicular pain should be presumed to have testicular torsion until proven otherwise, as this condition carries a high degree of morbidity. The information gained through a thorough history and physical examination can assist in arriving at the proper diagnosis. [source] | |||||||||||||||||||