DOCSLIB.ORG

Physician Examination Procedures Manual

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Physician Examination Procedures Manual National Health and Nutrition Examination Survey PHYSICIAN EXAMINATION PROCEDURES MANUAL Original January 1999 (Revised August 2000) TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY ............................................................................ 1-1 1.1 History of the National Health and Nutrition Examination Programs ............................................................................................. 1-1 1.2 Overview of the Current NHANES .................................................... 1-3 1.2.1 NHANES Pilot and Dress Rehearsal .................................. 1-4 1.2.2 Data Collection for NHANES Main Survey ....................... 1-4 1.3 Sample Selection................................................................................. 1-6 1.4 Field Organization for NHANES ....................................................... 1-7 1.5 Exams and Interviews in the Mobile Examination Center (MEC) ..... 1-10 1.6 Confidentiality and Professional Ethics.............................................. 1-20 2 OVERVIEW OF THE PHYSICIAN’S EXAMINATION .............................. 2-1 2.1 Medical Policy Regarding the Examination ....................................... 2-1 2.2 The Role of the Physician in NHANES.............................................. 2-2 2.2.1 Presence in MEC during MEC Examinations..................... 2-2 2.2.2 Response to Medical Emergencies...................................... 2-2 2.2.3 Maintenance of Emergency Equipment and Supplies......... 2-3 2.3 The Physician’s Examination ............................................................. 2-3 2.3.1 Measurement of Blood Pressure and Pulse ......................... 2-3 2.3.2 Review for Exclusion and Inclusion of Cardiovascular Fitness Treadmill Testing.................................................... 2-3 2.3.3 Counseling for STD and HIV ............................................. 2-4 2.3.4 Referrals .............................................................................. 2-4 2.4 Maintenance of Physician’s Examination Room ................................ 2-4 3 EQUIPMENT AND SUPPLIES...................................................................... 3-1 3.1 Description of Equipment ................................................................... 3-1 3.2 Sphygmomanometer ........................................................................... 3-1 3.2.1 The Baumanometer® Calibrated Manometer ..................... 3-1 3.2.2 Calibrated® V-Lok® Cuff .................................................. 3-2 3.2.3 Littman™ Classic II S.E. Stethoscope ................................ 3-3 iii TABLE OF CONTENTS (continued) Chapter Page 3.3 Maintenance of Equipment ................................................................. 3-3 3.3.1 Mercury Sphygmomanometer............................................. 3-3 3.3.2 Littman Stethoscope............................................................ 3-4 3.3.3 Blood Pressure Cuffs........................................................... 3-5 3.4 Mercury Spills or Leaks...................................................................... 3-5 3.4.1 Required Procedure for Handling Spilled or Leaking Mercury ............................................................................... 3-5 4 PHYSICIAN PROTOCOL .............................................................................. 4-1 4.1 General Overview ............................................................................... 4-1 4.2 Blood Pressure, Heart Rate, and Pulse Measurements ....................... 4-1 4.2.1 SPs Included for Blood Pressure, Heart Rate, and Pulse Measurements............................................................ 4-2 4.2.2 SPs Excluded from Blood Pressure, Heart Rate, and Pulse Measurements............................................................ 4-2 4.2.3 Procedures for Measuring Blood Pressures, Heart Rates, and Pulses ................................................................. 4-2 4.3 SP Exclusion from Cardiovascular Fitness Examination (CV Fitness)........................................................................................ 4-11 4.3.1 Conditions for Exclusion from Cardiovascular Fitness Testing .................................................................... 4-12 4.4 Sexually Transmitted Disease and Human Immunodeficiency Virus Information (STD and HIV) ..................................................... 4-14 4.4.1 Guidelines Affecting STD and HIV Test Result Reporting............................................................................. 4-15 4.4.2 Informing SPs of STD and HIV Results ............................. 4-16 4.5 Data Entry Screens.............................................................................. 4-17 4.5.1 Reviewing SP Medications from Household Interview ...... 4-18 4.5.2 Reviewing SP History ......................................................... 4-22 4.5.3 Child Heart Rate, Pulse ....................................................... 4-24 4.5.4 Blood Pressure Data Entry .................................................. 4-27 iv TABLE OF CONTENTS (continued) Chapter Page 4.5.5 Exclusion from CV Fitness Based on Pulse and Irregular Beats..................................................................... 4-29 4.5.6 Blood Pressure Measurement Screens ................................ 4-35 4.5.7 Blood Pressure Edit Limits ................................................. 4-42 4.5.8 Blood Pressure Component Status and Comments ............. 4-43 4.5.9 Exclusion from CV Fitness Based on Systolic Blood Pressure ............................................................................... 4-45 4.5.10 Exclusion from CV Fitness Based on Diastolic Blood Pressure ............................................................................... 4-46 4.5.11 Shared Exclusion Questions................................................ 4-48 4.5.12 CV Safety Exclusion Questions .......................................... 4-57 4.5.13 CV Exclusion Status ........................................................... 4-79 4.5.14 STD and HIV Discussion of Tests and Obtaining Results ................................................................................. 4-82 4.5.15 Physician Look-up Table .................................................... 4-90 4.5.16 Pausing an Examination ...................................................... 4-92 4.5.18 Room Log ........................................................................... 4-93 4.5.19 Session Preview .................................................................. 4-94 4.5.20 SP Examinations ................................................................. 4-95 4.5.21 End of Section ..................................................................... 4-97 4.5.22 Close Examination Button .................................................. 4-98 5 REFERRALS................................................................................................... 5-1 5.1 Medical Referrals................................................................................ 5-1 5.2 Referral Levels.................................................................................... 5-1 5.2.1 Level 1 Referrals ................................................................. 5-2 5.2.2 Level 2 Referrals ................................................................. 5-2 5.2.3 Level 3 Referrals ................................................................. 5-2 5.3 Basis for Referral ................................................................................ 5-2 5.3.1 Examination Data Related Referrals ................................... 5-3 5.3.2 Blood Pressure Referrals – Adults ...................................... 5-5 5.3.3 Blood Pressure Referrals – Children ................................... 5-7 5.3.4 Lower Extremity Disease (LED) Referrals ......................... 5-8 5.3.5 Laboratory Values ............................................................... 5-11 5.3.6 Tuberculosis Skin Test Referrals ........................................ 5-14 5.4 Observation Referrals ......................................................................... 5-15 5.5 Sessions Requiring Review ................................................................ 5-15 v TABLE OF CONTENTS (continued) Chapter Page 5.6 Data Entry Screens for Referrals ........................................................ 5-16 5.6.1 Review Menu ...................................................................... 5-17 5.6.2 Review in Box..................................................................... 5-17 5.6.3 Review Other Sessions........................................................ 5-18 5.6.4 Sessions Requiring Review................................................. 5-19 5.6.5 Reviewing all Sessions in Stand ......................................... 5-19 5.6.6 Viewing Home All Day Sessions........................................ 5-20 5.6.7 Sorting Sessions .................................................................. 5-23 5.6.8 Referral Review Screen....................................................... 5-23 5.6.9 ISIS Message....................................................................... 5-25 5.6.10 NHANES Release Form for SPs Refusing Referrals .......... 5-26 5.6.11 Selecting SP for Detailed Referral Review ......................... 5-27 5.6.12 Review in Box for Pregnancy Details ................................. 5-28 5.6.13 Review in Box for CBC Details
Load more

Recommended publications
  • General Physical Examination Skills for Ahps
    General Physical Examination Techniques for the Rheumatology Clinic This manual has been developed as an overview of the general examination of the rheumatology patient. Certain details have been specifically omitted because they have no relevance when examining a stable out patient in the rheumatology clinic. Vital Signs 1. Heart rate 2. Blood pressure 3. Weight 1. Heart Rate There are two things you want to document when assessing heart rate: The actual rate and the rhythm. Rate: count pulse for at least 15 – 30 seconds (e.g., if you count the rate for 15 seconds, multiply this result by 4 to determine heart rate). The radial pulse is most commonly used to assess the heart rate. With the pads of your index and middle fingers, compress the radial artery until a pulsation is detected. Normal 60-100 bpm Bradycardia <60 bpm Tachycardia >100 bpm 2. Heart Rhythm The rhythm should be regular. A regularly irregular rhythm is one where the pulse is irregular but there is a pattern to the irregularity. For example every third beat is dropped. An irregularly irregular rhythm is one where the pulse is irregular and there is no pattern to the irregularity. The classic example of this is atrial fibrillation. 3. Blood Pressure Blood pressure should be measured in both arms, and should include an assessment of orthostatic change How to measure the Brachial Artery Blood Pressure: • Patient should be relaxed, in a supine or sitting position, with the arms positioned correctly(at, not above, the level of the heart) • Remember that measurements should be taken bilaterally • Choice of appropriate cuff size for the patient is important to accuracy of measured blood pressure.
    [Show full text]
  • Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY
    Essentials of Bedside Cardiology CONTEMPORARY CARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR Aging, Heart Disease and Its Management: Facts and Controversies, edited by Niloo M. Edwards, MD, Mathew S. Maurer, MD, and Rachel B. Wellner, MD, 2003 Peripheral Arterial Disease: Diagnosis and Treatment, edited by Jay D. Coffman, MD, and Robert T. Eberhardt, MD, 2003 Essentials ofBedside Cardiology: With a Complete Course in Heart Sounds and Munnurs on CD, Second Edition, by Jules Constant, MD, 2003 Primary Angioplasty in Acute Myocardial Infarction, edited by James E. Tcheng, MD,2002 Cardiogenic Shock: Diagnosis and Treatment, edited by David Hasdai, MD, Peter B. Berger, MD, Alexander Battler, MD, and David R. Holmes, Jr., MD, 2002 Management of Cardiac Arrhythmias, edited by Leonard I. Ganz, MD, 2002 Diabetes and Cardiovascular Disease, edited by Michael T. Johnstone and Aristidis Veves, MD, DSC, 2001 Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, edited by William B. White, MD, 2001 Vascular Disease and Injury: Preclinical Research, edited by Daniell. Simon, MD, and Campbell Rogers, MD 2001 Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease, edited by JoAnne Micale Foody, MD, 2001 Nitric Oxide and the Cardiovascular System, edited by Joseph Loscalzo, MD, phD and Joseph A. Vita, MD, 2000 Annotated Atlas of Electrocardiography: A Guide to Confident Interpretation, by Thomas M. Blake, MD, 1999 Platelet Glycoprotein lIb/IlIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff, MD, and Eric J. Topol, MD, 1999 Minimally Invasive Cardiac Surgery, edited by Mehmet C. Oz, MD and Daniel J. Goldstein, MD, 1999 Management ofAcute Coronary Syndromes, edited by Christopher P.
    [Show full text]
  • Blood Pressure (BP) Measurements in Adults
    Page 5 Blood Pressure (BP) Measurements in Adults Ramesh Khanna, MD Karl D. Nolph, MD Chair in Nephrology Professor of Medicine Director, Division of Nephrology University of Missouri-Columbia Uncontrolled high blood pressure is present in every 3rd person in the American community and is attributed to be a major risk factor for progression of chronic kidney disease, coronary artery disease, and stroke. Therefore, blood pressure recording is the most common measurements at home and by healthcare professionals in all of clinical medicine. It might come as a surprise that majority of recordings are done in a less than ideal circumstances and consequently performed inaccurately. BP measurements using mercury sphygmomanometer by a trained health care professional is the gold standard for clinical assessment of blood pressures. The appearance of the 1st Korotkoff sound signals the systolic blood pressure and the disappearance of the 5th sound denotes the diastolic blood pressure. The hypertension experts believe and have increasing evidence to suggest that this method frequently either over diagnose hypertension or fail to recognize masked hypertension (blood pressure that is normal in the physician’s office setting but high at other times including at home). The four commonly recognized reasons for this are: Avoidable inaccuracies in the methods, The inherent variability of blood pressure; and The tendency for blood pressure to increase in the presence of a health care professional (the so-called white coat effect). Failure to standardize blood pressure measurement dos and don’ts. It is believed and also to some extent evidence based that the health care providers including physicians often do not follow established guidelines for blood pressure measurement.
    [Show full text]
  • Blood Pressure Year 1 Year 2 Core Clinical/Year 3+
    Blood Pressure Year 1 Year 2 Core Clinical/Year 3+ Do Do • Patient at rest for 5 minutes • Measure postural BP and pulse in patients with a • Arm at heart level history suggestive of volume depletion or • Correct size cuff- bladder encircles 80% of arm syncope • Center of cuff aligns with brachial artery -Measure BP and pulse in supine position • Cuff wrapped snugly on bare arm with lower -Slowly have patient rise and stand (lie them down edge 2-3 cm above antecubital fossa promptly if symptoms of lightheadedness occur) • Palpate radial artery, inflate cuff to 70 mmHg, -Measure BP and pulse after 1 minute of standing then increase in 10 mmHg increments to 30 mmHg above point where radial pulse disappears. Know Deflate slowly until pulse returns; this is the • Normally when a person stands fluid shifts to approximate systolic pressure. lower extremities causing a compensatory rise in • Auscultate the Korotkoff sounds pulse by up to 10 bpm with BP dropping slightly -place bell lightly in antecubital fossa • Positive postural vital signs are defined as -inflate BP to 20-30mmHg above SBP as determined symptoms of lightheadedness and/or a drop in by palpation SBP of 20 mmHg with standing -deflate cuff at rate 2mmHg/second while auscultating • Know variations in BP cuff sizes -first faint tapping (Phase I Korotkoff) = SBP; • A lack of rise in pulse in a patient with an Disappearance of sound (Phase V Korotkoff)=DBP orthostatic drop in pressure is a clue that the Know cause is neurologic or related or related to -Korotkoff sounds are lower pitch, better heard by bell medications (eg.
    [Show full text]
  • Does This Patient Have Aortic Regurgitation?
    THE RATIONAL CLINICAL EXAMINATION Does This Patient Have Aortic Regurgitation? Niteesh K. Choudhry, MD Objective To review evidence as to the precision and accuracy of clinical examina- Edward E. Etchells, MD, MSc tion for aortic regurgitation (AR). Methods We conducted a structured MEDLINE search of English-language articles CLINICAL SCENARIO (January 1966-July 1997), manually reviewed all reference lists of potentially relevant You are asked to see a 59-year-old articles, and contacted authors of relevant studies for additional information. Each study woman with liver cirrhosis who will be (n = 16) was independently reviewed by both authors and graded for methodological undergoing sclerotherapy for esopha- quality. geal varices. When she was examined by Results Most studies assessed cardiologists as examiners. Cardiologists’ precision for her primary care physician, she had a detecting diastolic murmurs was moderate using audiotapes (k = 0.51) and was good pulse pressure of 70 mm Hg. The pri- in the clinical setting (simple agreement, 94%). The most useful finding for ruling in mary care physician is concerned about AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8- the possibility of aortic regurgitation 32.0 [95% confidence interval {CI}, 2.8-32 to 16-63] for detecting mild or greater AR (AR) and asks you whether endocardi- and 4.0-8.3 [95% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 tis prophylaxis is necessary for sclero- grade A studies). The most useful finding for ruling out AR is the absence of early di- astolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to 0.2-0.4) for mild or greater therapy.
    [Show full text]
  • A Review of Pericardial Diseases: Clinical, ECG and Hemodynamic Features and Management
    REVIEW SHAM IK AIKAT, MD SASAN GHAFFARI, MD Department of Cardiology, Cleveland Clinic Department of Cardiology, Cleveland Clinic A review of pericardial diseases: Clinical, ECG and hemodynamic features and management ABSTRACT ECAUSE PERICARDIAL DISEASES are com- mon and often misdiagnosed, physi- Pericardial diseases are common, have multiple causes, and cians need to he familiar with their presenta- are often misdiagnosed. Physicians need to recognize the tions and distinguishing features. characteristic and distinguishing features of the three most This article reviews the clinical features, important pericardial conditions: acute pericarditis, cardiac diagnosis, and management of acute pericardi- tamponade, and constrictive pericarditis. In these tis, cardiac tamponade, and constrictive peri- conditions, proper diagnosis and appropriate management carditis. can significantly reduce morbidity and mortality. • THE PERICARDIUM KEY POINTS The pericardium envelopes the heart, extend- ing on to the adventitia of the great vessels. It Acute pericarditis is an important part of the differential is 1 to 2 mm thick and consists of an outer and diagnosis of chest pain syndromes and needs to be an inner layer. The tough, fibrous outer layer is distinguished from acute myocardial infarction both called the parietal pericardium, and the serous clinically and electrocardiographically. inner layer is called the visceral pericardium. The parietal and visceral pericardium are sep- Suspect pericardial tamponade in any patient with acute arated by fluid: 15 to 50 mL of an ultrafiltrate dyspnea, especially in the presence of a pericardial rub, of plasma that acts as a lubricant.1-2 elevated jugular venous pressure, and hypotension. The pericardium limits excessive cardiac movement and acute cardiac distension.
    [Show full text]
  • Arxiv:1911.09312V2 [Cs.CR] 12 Dec 2019
    Revisiting and Evaluating Software Side-channel Vulnerabilities and Countermeasures in Cryptographic Applications Tianwei Zhang Jun Jiang Yinqian Zhang Nanyang Technological University Two Sigma Investments, LP The Ohio State University [email protected] [email protected] [email protected] Abstract—We systematize software side-channel attacks with three questions: (1) What are the common and distinct a focus on vulnerabilities and countermeasures in the cryp- features of various vulnerabilities? (2) What are common tographic implementations. Particularly, we survey past re- mitigation strategies? (3) What is the status quo of cryp- search literature to categorize vulnerable implementations, tographic applications regarding side-channel vulnerabili- and identify common strategies to eliminate them. We then ties? Past work only surveyed attack techniques and media evaluate popular libraries and applications, quantitatively [20–31], without offering unified summaries for software measuring and comparing the vulnerability severity, re- vulnerabilities and countermeasures that are more useful. sponse time and coverage. Based on these characterizations This paper provides a comprehensive characterization and evaluations, we offer some insights for side-channel of side-channel vulnerabilities and countermeasures, as researchers, cryptographic software developers and users. well as evaluations of cryptographic applications related We hope our study can inspire the side-channel research to side-channel attacks. We present this study in three di- community to discover new vulnerabilities, and more im- rections. (1) Systematization of literature: we characterize portantly, to fortify applications against them. the vulnerabilities from past work with regard to the im- plementations; for each vulnerability, we describe the root cause and the technique required to launch a successful 1.
    [Show full text]
  • Proceedings of the Nimbus Program Review
    X-650-62-226 J, / N63 18601--N 63 18622 _,_-/ PROCEEDINGS OF THE NIMBUS PROGRAM REVIEW OTS PRICE XEROX S _9, ,_-_ MICROFILM $ Jg/ _-"/_j . J"- O NOVEMBER 14-16, 1962 PROCEEDINGS OF THE NIMBUS PROGRAM REVIEW \ November 14-16, 1962 GODDARD SPACE FLIGHT CENTER Greenbelt, Md. NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GODDARD SPACE FLIGHT CENTER PROCEEDINGS OF THE NIMBUS PROGRAM REVIEW FOREWORD The Nimbus program review was conducted at the George Washington Motor Lodge and at General Electric Missiles and Space Division, Valley Forge, Pennsylvania, on November 14, 15, and 16, 1962. The purpose of the review was twofold: first, to present to top management of the Goddard Space Flight Center (GSFC), National Aeronautics and Space Administration (NASA) Headquarters, other NASA elements, Joint Meteorological Satellite Advisory Committee (_MSAC), Weather Bureau, subsystem contractors, and others, a clear picture of the Nimbus program, its organization, its past accomplishments, current status, and remaining work, emphasizing the continuing need and opportunity for major contributions by the industrial community; second, to bring together project and contractor technical personnel responsible for the planning, execution, and support of the integration and test of the spacecraft to be initiated at General Electric shortly. This book is a compilation of the papers presented during the review and also contains a list of those attending. Harry P_ress Nimbus Project Manager CONTENTS FOREWORD lo INTRODUCTION TO NIMBUS by W. G. Stroud, GSFC _o THE NIMBUS PROJECT-- ORGANIZATION, PLAN, AND STATUS by H. Press, GSFC o METEOROLOGICAL APPLICATIONS OF NIMBUS DATA by E.G. Albert, U.S.
    [Show full text]
  • Simbaby™ Specs
    SimBaby™ Specs Normal & Difficult Airway • Airway opening acquired by head tilt, chin lift and jaw trust • Oropharyngeal and nasopharyngeal airways • Bag-Valve-Mask ventilation • Orotracheal and nasotracheal intubation • Sellick Maneuver • LMA insertion • Endotracheal tube insertion • Fiberoptic intubation • Gastric tube insertion • Variable lung compliance • Variable airway resistance • Tongue edema • Laryngospasm • Pharyngeal swelling • Decreased lung compliance • Right mainstem intubation • Gastric distention Pulmonary System • Spontaneous breathing with variable rate, depth and regularity • Bilateral and unilateral chest rise and fall • CO2 exhalation • Normal and abnormal breath sounds – bilateral • Lung Sounds: Normal, course crackles, fine crackles, stridor, wheezes and rhonchi • Oxygen saturation • See-saw respiration • Retractions • Pneumothorax • Unilateral chest movement • Unilateral breath sounds • Unilateral needle thoracentesis mid-clavicular • Unilateral chest tube insertion Cardiovascular System • Extensive ECG library with rate from 20-360 • CPR compressions generate palpable pulses, blood pressure waveform, and generate artifacts on ECG • Heart Sounds:Normal, systolic murmur, holosystolic murmur, diastolic murmur, continuous murmur and gallop • Blood pressure (BP) measured manually by auscultation of Korotkoff sounds • Pulses: Unilateral radial and brachial pulse and bilateral femoral pulses synchronized with ECG • Pulse strength variable with BP • Display of cardiac rhythms via 3-lead ECG monitoring • 12-lead dynamic
    [Show full text]
  • Blood Pressure Measurement Standardization Protocol
    Blood Pressure Measurement Standardization Protocol www. hearthighway.org 801-538-6141 We would like to extend a special Thank You to Dr. Roy Gandolfi for his help in editing this manual. This manual was funded in part by the Centers for Disease Control and Prevention through the Utah Heart Disease and Stroke Prevention Program, cooperative agreement number U50/CCU821337-05. The contents of this report are solely the responsibility of the authors and do not represent the opinions of the CDC Revised July 2006 Table of Contents 1. What is Blood Pressure? 2 2. Hypertension Overview 4 3. Non-Modifiable Risk Factors 5 4. Modifiable Risk Factors 6 5. Importance of Accuracy 8 6. Knowing the Equipment 9 7. Automated Blood Pressure Cuffs 11 8. Mercury Manometers 12 9. Pulse Obliteration Technique 13 10. Treatment and Referral for Adults 19 11. Treatment and Referral for Individuals over age 60 21 12. Treatment and Referral for Children 23 13. References 26 Appendices A: Following the DASH Diet B: Weigh In For Better Health C: Algorithm for Treatment of Hypertension D: Blood Pressure Levels by Gender, Age and Height Percentile E: CDC Growth Chart for Boys F: CDC Growth Chart for Girls G: Blood Pressure Management Quiz H: Blood Pressure Practicum 1 What is Blood Pressure? Key Abbreviations BP- Blood Pressure SBP- Systolic Blood Pressure DBP- Diastolic Blood Pressure JNC7- Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure CVD- Cardiovascular Disease BMI- Body Mass Index ABPM- Ambulatory Blood Pressure Monitoring ACE- Angiotensin-converting enzyme β-blockers- Beta-blockers LVH- Left Ventricular Hypertrophy Definitions Blood Pressure- measurement of the force exerted by blood against the walls of the arteries.
    [Show full text]
  • Physician Examination Procedures Manual
    Physician Examination Procedures Manual September 2011 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF PHYSICIAN EXAMINATION .......................................... 1-1 1.1 The Role of the Physician in NHANES .............................................. 1-1 1.2 Medical Policy Regarding the Examination ....................................... 1-2 1.2.1 Presence in MEC during MEC Examinations ..................... 1-2 1.2.2 Response to Medical Emergencies ...................................... 1-3 1.2.3 Maintenance of Emergency Equipment and Supplies ......... 1-3 1.3 Physician Examination ....................................................................... 1-3 1.4 Maintenance of Physician’s Examination Room ................................ 1-4 2 EQUIPMENT AND SUPPLIES ...................................................................... 2-1 2.1 Description of Equipment & Supplies ................................................ 2-1 2.2 Inventory ............................................................................................. 2-1 2.3 Blood Pressure .................................................................................... 2-1 2.3.1 Blood Pressure Equipment .................................................. 2-2 2.3.2 Blood Pressure Supplies ...................................................... 2-3 2.3.3 Description of Blood Pressure Equipment and Supplies .... 2-3 2.3.4 Blood Pressure Supplies – Description ............................... 2-5 2.3 HPV Supplies .....................................................................................
    [Show full text]
  • Identifying Open Research Problems in Cryptography by Surveying Cryptographic Functions and Operations 1
    International Journal of Grid and Distributed Computing Vol. 10, No. 11 (2017), pp.79-98 http://dx.doi.org/10.14257/ijgdc.2017.10.11.08 Identifying Open Research Problems in Cryptography by Surveying Cryptographic Functions and Operations 1 Rahul Saha1, G. Geetha2, Gulshan Kumar3 and Hye-Jim Kim4 1,3School of Computer Science and Engineering, Lovely Professional University, Punjab, India 2Division of Research and Development, Lovely Professional University, Punjab, India 4Business Administration Research Institute, Sungshin W. University, 2 Bomun-ro 34da gil, Seongbuk-gu, Seoul, Republic of Korea Abstract Cryptography has always been a core component of security domain. Different security services such as confidentiality, integrity, availability, authentication, non-repudiation and access control, are provided by a number of cryptographic algorithms including block ciphers, stream ciphers and hash functions. Though the algorithms are public and cryptographic strength depends on the usage of the keys, the ciphertext analysis using different functions and operations used in the algorithms can lead to the path of revealing a key completely or partially. It is hard to find any survey till date which identifies different operations and functions used in cryptography. In this paper, we have categorized our survey of cryptographic functions and operations in the algorithms in three categories: block ciphers, stream ciphers and cryptanalysis attacks which are executable in different parts of the algorithms. This survey will help the budding researchers in the society of crypto for identifying different operations and functions in cryptographic algorithms. Keywords: cryptography; block; stream; cipher; plaintext; ciphertext; functions; research problems 1. Introduction Cryptography [1] in the previous time was analogous to encryption where the main task was to convert the readable message to an unreadable format.
    [Show full text]