Successful Transabdominal Removal of Penetrating Iron Rod in the Rectum: A Case Report

Foreign bodies in the anus and rectum are not uncommon presentations globally. Reasons for foreign bodies in the rectum can be trauma, assault, psychiatric reasons but the most common reason documented is sexual pleasure, and objects range from sex toys to tools to packed drugs. Regardless of the reason, health care providers must maintain nonjudgmental composure and express empathy. Numerous cases have been reported of anorectal foreign body due to various causes. Removal of the objects has mostly been through rectally but some does need surgical intervention. A multidisciplinary approach and radiologic investigations are important to guide in the management outline. Establishment of guidelines for anorectal foreign bodies are needed to guide surgeons and emergency physicians on the course of treatment. We present a case of an eleven-year old school boy slid and fell on an iron rod that penetrated his rectum through his anal canal. Presented with clinical features of peritonitis, where emergency laparotomy was done and the iron rod was extracted abdominally with primary repair of the rectum. The boy recovered well and was discharged four days after with no complications.

Download Full-text

Patients’ Views on Self-Management of Chronic Musculoskeletal Pain

Izzivi prihodnosti ◽

10.37886/ip.2020.015 ◽

2020 ◽

Vol 5 (4) ◽

pp. 254-266

Author(s):

Barbka Huzjan ◽

Ivana Hrvatin

Keyword(s):

Health Care ◽

Chronic Pain ◽

Musculoskeletal Pain ◽

Health Care Providers ◽

Multidisciplinary Approach ◽

Research Question ◽

Chronic Musculoskeletal Pain ◽

Self Management ◽

Care Providers ◽

The Individual

Research Question (RQ): Chronic musculoskeletal pain is a complex condition and one of the most important causes of suffering of modern times. Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. The research question is; what is the view on the selfmanagement of chronic musculoskeletal pain from the patient's perspective? Purpose: The purpose of this literature review was to review original articles that reported how selfmanagement educational programmes are viewed from the patient’s perspective. Method: We used an integrative review of the literature. The search was conducted from November 2019 to March 2020 on the PubMed, PEDro and OTseeker databases. We included original studies, written in English that examined the patients’ point of view on self-management. The included studies, needed to be conducted on adult patients of both sexes, that were suffering from chronic pain and were educated on self-management of their pain. Two authors independently searched for original studies. Results: Nine article were included in the review. Most of the studies included a multidisciplinary approach. Patients reported they more frequently used passive strategies to manage their pain. They want to be included in the management and be able to communicate with the provider of selfmanagement. There are several positive aspects of a multidisciplinary and groups approach. Organization: Health care providers can encourage an individual to proactively behave through ongoing processes of communication, partnerships and the creation of appropriate self-management plans over time. Society: We assume that the analysis will help to identify the social responsibility of the individual and society in the common concern for the health of the population and the individual within it. Originality: The research provides an up-to-date, new overview of the patients' perspective on self management on chronic pain. The review can be helpful to health care providers s they can compare their expectations with patients's. Limitations / further research: Further research would focus on high quality studies, and specific forms of multidisciplinary approach, and finding what patients use at a home setting and how to help them continue in the self management of their pain. Limitations of this review include the lack of risk of bias assessment and the fact that this is not a systematic review.

Download Full-text

EMTALA: OIG/HCFA Special Advisory Bulletin Clarifies EMTALA, American College of Emergency Physicians Criticizes it

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2000.tb00324.x ◽

2000 ◽

Vol 28 (1) ◽

pp. 90-92 ◽

Cited By ~ 1

Author(s):

Jeffey Rowes

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Financing ◽

Care Providers ◽

Emergency Physicians ◽

Emergency Rooms ◽

Active Labor ◽

Public Emergency ◽

Health Care Law ◽

Managed Care Organizations

In December 1998, the Office of Inspector General (OIG) and the Health Care Financing Administration (HCFA) solicited comments from health care providers regarding the federal anti-patient dumping statute, the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 USCA §1395dd). EMTALA is a federal health care law of unprecedented breadth—the first universal benefit guaranteed by the federal government. It requires Medicare-participating hospitals with public emergency rooms, emergency physicians, and ancillary surgical and medical specialists to render adequate stabilizing treatment to whoever requests it. The 1998 Special Advisory Bulletin (63 FR 67486-01) sought input on four principal dimensions of EMTALA: (1) the statutory obligation to furnish adequate medical screening to anyone who visits an emergency room; (2) the responsibilities of health care providers towards enrollees of managed care organizations (MCOs); (3) the prior authorization and payment rules for Medicare and Medicaid; and (4) what practices would promote hospital compliance with EMTALA.

Download Full-text

Sex Education on TikTok: A Content Analysis of Themes

Health Promotion Practice ◽

10.1177/15248399211031536 ◽

2021 ◽

pp. 152483992110315

Author(s):

Leah R. Fowler ◽

Lauren Schoen ◽

Hadley Stevens Smith ◽

Stephanie R. Morain

Keyword(s):

Health Care ◽

Content Analysis ◽

Sexual Health ◽

Sex Education ◽

Health Care Providers ◽

Gender Diversity ◽

Sexual Pleasure ◽

Sexual Practices ◽

Future Research ◽

Care Providers

Leading medical and public health societies endorse comprehensive sex education, but only 20 states and Washington, D.C., currently require information about contraception when sex education is taught, and even fewer require the inclusion of topics such as gender diversity or consent. At the same time, social media use, especially the video-sharing app TikTok, is increasing among teens. TikTok, therefore, offers a novel opportunity to make up for shortcomings in sex education and convey sexual health information to adolescents. To describe the availability and content of sexual education on TikTok, we conducted a content analysis of themes for 100 sex education–focused videos. We found that female anatomy was the most frequently addressed topic. Sexual pleasure was the second most common theme, within which discussions of the female orgasm and arousal constituted the most common subtheme. Other common themes include contraception and sexual health. These sought-after topics may be incongruent with those presented in standard school- or home-based sex education or interactions with health care providers, and this disconnect suggests opportunities for health care providers and educators to initiate conversations or offer resources on these themes as part of routine interaction. We conclude with recommendations for future research to consider the factual accuracy of sex education on TikTok and determine how exposure to this content affects adolescents’ understanding of the risks and benefits of intercourse, sexual practices, age- and gender-based sexual norms, and other health behaviors.

Download Full-text

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

CJEM ◽

10.2310/8000.2011.110402 ◽

2011 ◽

Vol 13 (05) ◽

pp. 333-338 ◽

Cited By ~ 9

Author(s):

Shawn K. Dowling ◽

Ian Wishart

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Pediatric Emergency ◽

Ankle Fractures ◽

Care Providers ◽

Emergency Physicians ◽

Ottawa Ankle Rules ◽

Clinically Significant

ABSTRACT: Introduction: A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear. Objectives: The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant. Methods: A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research. Results: Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon. Conclusions: The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.

Download Full-text

Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000820 ◽

2016 ◽

Vol 31 (6) ◽

pp. 643-647 ◽

Cited By ~ 10

Author(s):

Bhakti Hansoti ◽

Dylan S. Kellogg ◽

Sara J. Aberle ◽

Morgan C. Broccoli ◽

Jeffrey Feden ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Disaster Preparedness ◽

Disaster Response ◽

Grey Literature ◽

Care Providers ◽

Emergency Physicians ◽

The Us ◽

Disaster Training ◽

Training Opportunities

AbstractStudy ObjectiveThis study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.MethodsA comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.ResultsA comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.ConclusionThere is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.HansotiB, KelloggDS, AberleSJ, BroccoliMC, FedenJ, FrenchA, LittleCM, MooreB, SabatoJJr., SheetsT, WeinbergR, ElmesP, KangC. Preparing emergency physicians for acute disaster response: a review of current training opportunities in the US. Prehosp Disaster Med. 2016;31(6):643–647.

Download Full-text

Quality of sex life and perceived sexual pleasure of PrEP users in the Netherlands

10.31219/osf.io/kmhf3 ◽

2020 ◽

Author(s):

Mart van Dijk ◽

John de Wit ◽

Thomas Guadamuz ◽

Joel Eduardo Martinez ◽

Kai Jonas

Keyword(s):

Health Care Providers ◽

Sexual Pleasure ◽

Care Providers ◽

Positive Effects ◽

Quality Of Sex Life ◽

Psychosocial Benefits ◽

Promotion Campaigns ◽

Preventive Effects

Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP, but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.

Download Full-text

Common Rheumatic Diseases in the Elderly

10.1093/med/9780190466268.003.0022 ◽

2018 ◽

Author(s):

Nisha J. Manek ◽

George Muñoz

Keyword(s):

Health Care Providers ◽

Rheumatic Diseases ◽

Multidisciplinary Approach ◽

Geriatric Patients ◽

The Elderly ◽

Evidence Base ◽

Care Providers ◽

Comorbid Conditions ◽

Integrative Therapies ◽

Perfect Storm

With increasing longevity, the prevalence and impact of rheumatic diseases are projected to rise dramatically in the coming decades. Common rheumatic diseases such as osteoarthritis typically arise among the elderly. For diseases such as rheumatoid arthritis and gout, patients diagnosed at earlier ages carry the burden into their later years. Gout is associated both with comorbid conditions whose prevalence rises with age as well as with medications commonly prescribed in older people. These factors, along with the unique challenges associated with optimal diagnosis and treatment of arthritides in the elderly, suggest we can expect a “perfect storm” of health challenges for older patients and their health care providers. The chapter reviews the most common rheumatic diseases in geriatric patients and the evidence base for complementary and integrative therapies. In most cases, a multidisciplinary approach is beneficial.

Download Full-text

LO033: Attitudes of emergency physicians towards homeless and substance using patients

CJEM ◽

10.1017/cem.2016.70 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S41-S41

Author(s):

J.J. Nicol ◽

S. Dowling ◽

S. Crawford ◽

J.G. Chow ◽

K. Dong

Keyword(s):

Health Care ◽

Medical Care ◽

Health Care Providers ◽

Social Needs ◽

Physician Attitudes ◽

Care Providers ◽

Emergency Physicians ◽

Addiction Medicine ◽

Positive Attitudes ◽

Over Time

Introduction: Patients who are homeless and/or using substances rely heavily on emergency departments (ED) for medical care, and present with complex medical and social needs. Negative physician attitudes towards this population undermine the therapeutic relationship, compromising the quality of medical care provided. The objective of this study was to determine the attitudes of emergency physicians towards homeless and substance-using patients. Methods: Using a Modified Total Design approach, we conducted a cross-sectional survey of emergency physicians at five different healthcare locations in Calgary, Alberta, Canada. Attitudes were assessed using two validated measures, the Health Care Providers Attitudes Towards the Homeless Inventory (HPATHI), and the Short Understanding of Substance Use Scale (SUSS). Surveys were self-administered by respondents between March and December 2013. Results: A total of 117 physicians completed the survey (response rate 48%). 28% of respondents resented the amount of time it takes to see homeless patients, and 32% believed caring for homeless patients was not financially viable; 57% felt overwhelmed by the complexity of problems that homeless people have. Physicians with extra training in addiction medicine or health care for the homeless had more positive attitudes than physicians with no extra training; physician attitudes worsened over time towards both populations. Conclusion: Physicians feel overwhelmed when caring for patients who are homeless and/or substance using and negative attitudes worsened over time. Extra training in addiction medicine or healthcare for the homeless is associated with more positive attitudes. Possible strategies to improve attitudes should include a multifaceted approach addressing individual physician knowledge deficits, as well as expanded access to resources in the ED and community, designed to deal with the complex needs of these populations.

Download Full-text

Blast Eye Injuries: A Review for First Responders

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.v4n2.hra10003 ◽

2010 ◽

Vol 4 (2) ◽

pp. 154-160 ◽

Cited By ~ 26

Author(s):

Michael G. Morley ◽

Jackie K. Nguyen ◽

Jeffrey S. Heier ◽

Bradford J. Shingleton ◽

Joseph F. Pasternak ◽

...

Keyword(s):

Health Care Providers ◽

Foreign Bodies ◽

Vision Loss ◽

Injured Patient ◽

Ocular Injury ◽

Blast Injuries ◽

Care Providers ◽

Eye Injuries ◽

Open Globe ◽

Severe Vision Loss

ABSTRACTAs the rate of terrorism increases, it is important for health care providers to become familiar with the management of injuries inflicted by blasts and explosions. This article reviews the ocular injuries associated with explosive blasts, providing basic concepts with which to approach the blast-injured patient with eye trauma. We conducted a literature review of relevant articles indexed in PubMed between 1948 and 2007. Two hundred forty-four articles were reviewed. We concluded that ocular injury is a frequent cause of morbidity in blast victims, occurring in up to 28% of blast survivors. Secondary blast injuries, resulting from flying fragments and debris, cause the majority of eye injuries among blast victims. The most common blast eye injuries include corneal abrasions and foreign bodies, eyelid lacerations, open globe injuries, and intraocular foreign bodies. Injuries to the periorbital area can be a source of significant morbidity, and ocular blast injuries have the potential to result in severe vision loss.(Disaster Med Public Health Preparedness. 2010;4:154-160)

Download Full-text

“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome

CJEM ◽

10.2310/8000.2013.131042 ◽

2014 ◽

Vol 16 (02) ◽

pp. 171-176 ◽

Cited By ~ 5

Author(s):

Christine Hall ◽

Christopher Heyd ◽

Chris Butler ◽

Mark Yarema

Keyword(s):

Health Care Providers ◽

Treatment Strategies ◽

Synthetic Cathinones ◽

Health Concern ◽

Recreational Drug ◽

Care Providers ◽

Emergency Physicians ◽

Bath Salts ◽

Public Health Concern ◽

Laboratory Confirmation

ABSTRACT It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. “Bath salts,” which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers.

Download Full-text