Articles: cations.
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J Hosp Palliat Nurs · Feb 2021
Supporting Interprofessional Engagement in Serious Illness Conversations: An Adapted Resource.
Communication is vital to quality palliative care nursing particularly when caring for someone with a chronic life-limiting illness and their family. Conversations about future decline and preferred care are considered challenging and difficult and are often avoided, resulting in missed opportunities for improving care. To support more, earlier, better conversations, health care organizations in British Columbia, Canada, adopted the Serious Illness Care Program inclusive of the Serious Illness Conversation Guide developed by Ariadne Labs. ⋯ Specifically challenging has been prognosis communication that falls within the scope of practice for each profession. Informed by workshop feedback, an expert team of nurse clinicians and educators tailored an interprofessional clinician reference guide to optimize the guide's use across health care settings. In this article, we present the adaptations focusing on (1) the role of nurses and allied health in serious illness communication, (2) prognosis communication, and (3) a range of role-play scenarios specific to nonphysician practice for serious illness conversations that may arise within the process of care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
[Perthes Syndrome after Roll-Over Trauma].
Roll-over trauma and associated traumatic entrapments frequently result in serious polytraumatisation. In rare cases, severe extrathoracic compressions and a protracted entrapment period can lead to Perthes syndrome, also known as traumatic asphyxia. The Perthes syndrome manifests itself by a triad of craniocervical cyanosis, facial petechiae and subconjunctival haemorrhages, enabling a rapid diagnosis based on these typical clinical features. ⋯ An early identification of this condition, the elevation of the upper body to allow adequate venous drainage in addition to ensuring sufficient oxygenation are essential for optimal therapy. In general, no long-term complications are to be expected for Perthes syndrome. The stasis usually disappears completely within a few months.
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There was rapid growth of telehealth practice during the COVID-19 outbreak in 2020. In surgery, there were beneficial effects in terms of saving time and avoiding physical contact between healthcare professionals and patients when using telehealth in the delivery of perioperative care. ⋯ With reference to the "Ethical Guidelines on Practice of Telemedicine" issued by the Medical Council of Hong Kong and some published court and disciplinary cases from other common law jurisdictions, this article discusses relevant ethical and medico-legal issues in telehealth practice with emphasis on the following areas: duty of care; communication and contingency; patient-centred care and informed consent; limitations and standard of care; keeping medical records, privacy, and confidentiality; and cross-territory practice. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in-person care, telehealth practitioners are advised to familiarize themselves with the ethical guidelines, to keep abreast of the medico-legal developments in this area, and to observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.
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Case Reports
Application of Advanced Technology During Resection of Posterior Fossa AVMs: Two Sister Cases.
Various advanced imaging and intraoperative technologies can be used during resection of posterior fossa arteriovenous malformations (AVMs) in a hybrid neurovascular operating room. These technologies include transradial intraoperative angiography with post-processing of angiographic data for navigation (in combination with stereotactic magnetic resonance imaging) (Figure 1). Advanced semiautomated processing allows magnetic resonance imaging, computed tomography angiography, and angiography fusion for enhanced localization of the AVM. ⋯ While these technologies are potentially useful in certain circumstances, they may not be necessary in the case of relatively straightforward vascular lesions. Keeping this in mind is of particular importance, as the use of these technologies may require extended time with the patient under anesthesia. These sister cases of cerebellar AVMs illustrate the spectrum of the advanced technologies that are potentially available to surgeons during posterior fossa AVM resection (Video 1).