DOCSLIB.ORG

Putting the Mouth Back in the Head: HEENT to HEENOT

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Putting the Mouth Back in the Head: HEENT to HEENOT COMMENTARY Putting the Mouth Back in the Head: HEENT to HEENOT Improving oral health is Judith Haber, PhD, APRN, BC, Erin Hartnett, DNP, CPNP, BC, Kenneth Allen, DDS, MBA, Donna Hallas, PhD, a leading population health CPNP, BC, Caroline Dorsen, MSN, FNP, BC, Julia Lange-Kessler, DNP, CM, RN, Madeleine Lloyd, MS, FNP, BC, goal; however, curricula pre- PMHNP, BC, Edwidge Thomas, DNP, ANP, BC, and Dorothy Wholihan, DNP, ANP, BC, PCNP, BC paring health professionals have a dearth of oral health DURING THE DECADE FOLLOW- have untreated dental caries. The base nor a set of oral health content and clinical experi- ing publication of the Surgeon survey data further reveal that clinical competencies.12---16 The ences. ’ We detail an educational General s Report, Oral Health in 19% of non-Hispanic Black chil- PA programs have generally fol- and clinical innovation transi- America, health professionals, dren aged 3 to 5 years and 26% lowed medical school curricula and tioning the traditional head, physicians (MDs), nurse practi- of Hispanic children aged 6 to 9 have not required curricular oral ears, eyes, nose, and throat tioners (NPs), nurse---midwives years had untreated dental caries health content or competencies.17 (HEENT) examination to the (NMs), and physician assistants compared with non-Hispanic The recent publication of sev- addition of the teeth, gums, (PAs) began to align with the White children aged 3 to 5 years eral important national reports, mucosa, tongue, and palate dental profession to heed Satcher’s (11%) and 6 to 9 years (14%).6 two oral health reports by the examination (HEENOT) for call to “view the mouth as a win- Although national statistics show Institute of Medicine,10,18 the list- assessment, diagnosis, and dow to the body.”1 The most signif- an improvement in access to oral ing of oral health as one of the treatment of oral–systemic icant interprofessional movement health care for children aged 5 Healthy People 2020 Leading health. Many New York Uni- 19 versity nursing, dental, and that followed this report occurred years and older, the data reveal Health Indicators, the release of fi medical faculty and students with family practice and pediatric signi cant disparities in access to the Health Resources and Services have been exposed to in- physicians coming together to care for children aged 2 to 4 Administration document “Inte- terprofessional oral health work on preventive oral health years.7 gration of Oral Health and Pri- HEENOT classroom, simula- initiatives for children in which In the adult population, oral mary Care Practice,”20 and the tion, and clinical experiences. those professionals would provide cancer morbidity and mortality dissemination of “Oral Health This was associated with in- screenings, fluoride varnish, and rates have not declined over the Care During Pregnancy: A Na- creased dental–primary care 21 referrals for children to find dental past 10 years, at least in part tional Consensus Statement” referrals. homes. related to absent or inadequate all reaffirm oral health as a popu- This innovation has po- Mobilization of the overall oral examinations,8 and human lation health issue of importance tential to build interprofes- sional oral health workforce health community to work collab- papillomavirus is associated with for primary care providers with capacity that addresses a oratively has been slower. Devel- the recent rise in the incidence of all data emphasizing the links significant public health is- opment of “Smiles for Life: A oropharyngeal cancer.9 Among between oral health and overall sue, increases oral health National Oral Health Curriculum”2 adults aged 65 years and older, health and the magnitude of the care access, and improves represented an important interpro- only 30% have a dental benefit.10 national oral health access di- oral–systemic health across fessional “tipping point” for engag- Primary care providers have been lemma. The interprofessional ed- Am J Public the lifespan. ( ing health professionals focused challenged by the Institute of ucation competencies22 provided Health. Publishedonlineahead on treating populations across the Medicine to play a significant role significant momentum for inter- of print January 20, 2015: e1–e5. lifespan in considering oral health in improving these oral health professional oral health leaders to doi:10.2105/AJPH.2014.302495) and its relationship to overall disparities by building interpro- capitalize on the “perfect storm” health as an integral component fessional oral health workforce created by the confluence of of their practice. capacity.10 seminal reports to propose that Yet, evidence from national da- One important component of oral---systemic health is a perfect tabases monitoring oral health the problem is that the majority population health exemplar to data continue to reveal a high in- of curricula for preparing health illustrate the interprofessional cidence and prevalence of dental professionals have a dearth of oral competency domains across caries, especially in lower socio- health content and clinical experi- health professions curricula.23,24 economic and minority group ences. Approximately 70% of However, the science of per- populations.3,4 Data from the medical schools include 4 hours or forming a physical examination, 2009---2012 National Health and less on oral health in their curric- initially established by Hippo- Nutrition Examination Survey5 ulum; 10% have no oral health crates more than 3000 years ago reveal that approximately one in content at all.11 Similarly, NPs and and refinedinthe13thcenturywith four children (14%) aged 3 to 5 NMs have also not had a defined the resumption of the dissection of years living at the poverty level oral health curricular knowledge human bodies for education, does Published online ahead of print January 20, 2015 | American Journal of Public Health Haber et al. | Peer Reviewed | Commentary | e1 COMMENTARY not focus on the oral examination.25 health workforce capacity by Health care providers have per- “putting the mouth back in the Interprofessional Oral Health Core Competencies formed physical assessment of the head.” Building on the Health as Identified by New York University College of Nursing head, ears, eyes, nose, and throat Resources and Services Adminis- (HEENT)inthesamefashionsince tration report, “Integrating Oral Demonstrate inclusion of oral health in the HEENT components of the comprehensive its inception centuries ago. For the Health and Primary Care Prac- history and physical examination (HEENOT). majority of primary care providers, tice,”20 we have identified inter- Develop a risk profile that includes oral and oral–systemic health problems. the traditional HEENT examination professional oral health core Develop a patient-centered management plan that includes oral health interventions excludes examination of the oral competencies for our NP and NM related to overall health. cavity, as well as omitting oral health primary care students, introducing Smoking cessation and its linkages to overall health in an oral health knowledge base Tooth brushing and flossing the health history.1,10---12 and clinical competencies (see the Fluoride varnish application A simple solution to this prob- box on this page) early in the Oral cancer screening lem is to introduce a paradigm shift curriculum that are consistently Engaging patients in behavioral change by using motivational interviewing to teaching the HEENT examina- built on and reinforced in diagnosis Parental anticipatory guidance tion by using the “HEENOT” ap- and management courses and clin- Lifestyle counseling proach. Incorporating “O,” for oral ical rotations. Our innovation is the d Eating disorders cavity assessment, adds a compre- transformation from HEENT to d Diabetes hensive focus on the oral---systemic HEENOT, so that oral health and d Hypertension history and examination of the its relation to overall health is in- d Sexually transmitted diseases teeth, gums, mucosa, tongue, and tegrated in the history, physical d Dentures palate. The HEENOT approach examination, risk assessment, and Symptom management means that educators and clinicians management plan completed by d Xerostomia can “NOT” omit oral health and primary care NP and NM students. d Mucositis intraoral assessment from the his- This innovation is applicable in d Oral lesions tory and physical examination per- MD, PA, and pharmacy programs. Collaboration and referral formed by NPs, NMs, MDs, PAs, Notes. HEENOT = head, ears, eyes, nose, oral, throat examination; HEENT = head, ears, and other health professionals. This Oral Health and Advanced eyes, nose, and throat examination. The oral examination includes examination of the strategy will increase oral health Health Assessment Courses teeth, gums, mucosa, tongue, and palate. screenings, detection of oral health The advanced health assess- comorbidities, and preventive in- ment courses taken by NP and NM terventions, including referrals to students are designed to develop dental colleagues by primary care interprofessional oral health core the clinical simulation learning involving intraoral inspection, as providers in community-based set- competencies that are integrated center as they practice their oral well as placing hands inside the tings for acute or chronic health into the comprehensive health examination skills as a component oral cavity, are frequently un- problems commonly seen in pri- history and physical examination of the HEENOT assessment and, familiar occurrences for patients; mary
Load more

Recommended publications
  • Coding for Musculoskeletal System and Connective Tissue Diseases
    Chapter 11 Coding for Musculoskeletal System and Connective Tissue Diseases Chapter Outline Objectives Musculoskeletal Disorders . Describe the pathology of common Arthritic Disorders musculoskeletal and connective tissue diseases. Chronic Versus Traumatic Joint Derangements . Recognize the typical manifestations, Pathologic Versus Traumatic Bone Fractures complications, and treatments of common Osteomyelitis musculoskeletal and connective tissue diseases in Necrotizing Fasciitis terms of their implications for coding. Costochondritis . Correctly code common musculoskeletal and Back and Spine Disorders connective tissue diseases by using the ICD-9-CM Connective Tissue Diseases and medical reports. Systemic Lupus Erythematosus Systemic Sclerosis Testing Your Comprehension Coding Practice I: Chapter Review Exercises Coding Practice II: Medical Record Case Studies Musculoskeletal and connective tissue diseases are classified in code section 710 to 739 of chapter 13 of the Disease Tabular of the ICD-9-CM, which includes diseases of the bones, muscles, joints, soft tissues, ligaments, tendons, and cartilage. To assist in your understanding, Table 11.1 reviews word parts and meanings of medical terms related to common musculoskeletal and connective tissue diseases. 283 284 Part II: Coding for Specific Diseases and Disorders Table 11.1 Word Parts and Meanings of Musculoskeletal and Connective Tissue Terms Word Part Meaning Example Definition of Example arthr/o joint arthritis Inflammation of a joint oste/o bone osteoarthritis Inflammation of
    [Show full text]
  • Practice Description –Institutional Setting (Hsc) – Internal Medicine
    NOTE: REMEMBER TO HIGHLIGHT CHANGES YOU MAKE TO THIS DOCUMENT IN BLUE SCHEDULE A PRACTICE DESCRIPTION –INSTITUTIONAL SETTING (HSC) – INTERNAL MEDICINE AREAS HIGHLIGHTED IN GREEN ARE FOR GUIDANCE IN COMPLETING THIS DOCUMENT. THESE AREAS WILL BE DELETED WHEN THE DOCUMENT IS IN ITS FINAL FORM. AMEND/MODIFY AREAS HIGHLIGHTED IN YELLOW AS APPROPRIATE – ENSURE ALL CONTENT YOU ADD IS HIGHLIGHTED IN BLUE SO THE REGISTRAR CAN EASILY IDENTIFY CHANGES DO NOT CHANGE OR DELETE CONTENT THAT IS NOT HIGHLIGHTED WITHOUT PRIOR WRITTEN APPROVAL FROM CPSM Clinical Assistant: INSERT NAME (hereinafter “Clinical Assistant”) Designated Primary Supervisor: INSERT NAME Date Practice Description approved by Registrar: [Insert date] Practice Location(s): INSERT LOCATION(S) Contents 1. Overview of the Practice Setting ......................................................................................... 2 2. Professional Practice of Clinical Assistant ............................................................................ 2 3. Prescribing and medications .............................................................................................. 22 4. Education and training ....................................................................................................... 23 5. Evaluation and assessment of performance ..................................................................... 24 6. College Reporting Requirements ....................................................................................... 29 Be advised that nothing in this document
    [Show full text]
  • BASIC Approach to the Acutely Ill and Injured and Ill Acutely the to Approach
    PARTICIPANT WORKBOOK PARTICIPANT BASIC EMERGENCY CARE: Approach to the acutely ill and injured APPROACH TO THE ACUTELY ILL AND INJURED BASIC EMERGENCY CARE APPROACH TO THE ACUTELY ILL AND INJURED Basic emergency care: approach to the acutely ill and injured ISBN (WHO) 978–92–4-151308–1 ISBN (ICRC) 978–2-940396–58–0 © World Health Organization (WHO) and the International Committee of the Red Cross (ICRC), 2018. Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO or the International Committee of the Red Cross logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO) or the International Committee of the Red Cross (ICRC). WHO and ICRC are not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/ mediation/rules).
    [Show full text]
  • Podcast to Teach Clinical Reasoning to First
    Brown S, Wood E, McCollum D, Pelletier A, Rose J, Wallach P MedEdPublish https://doi.org/10.15694/mep.2018.0000132.1 Description of a new education method or tool Open Access “Doctors’ Lounge” podcast to teach clinical reasoning to first-year medical students Shilpa Brown[1], Elena Wood[2], Daniel McCollum[3], Allen Pelletier[4], Jennifer Rose[5], Paul Wallach[6] Corresponding author: Dr Shilpa Brown [email protected] Institution: 1. Medical College of Georgia at Augusta University, 2. Medical College of Georgia at Augusta University, 3. Medical College of Georgia at Augusta University, 4. Medical College of Georgia at Augusta University, 5. Augusta University, 6. Indiana University School of Medicine Categories: Educational Strategies, Students/Trainees, Teaching and Learning Received: 06/06/2018 Published: 14/06/2018 Abstract In the first year of medical school, our students have a comprehensive course in history taking, physical examination skills, clinical reasoning, and patient-centered care. We have observed that first year students struggle to conduct a focused history and perform a focused physical examination on a given chief complaint. We developed an innovative program to address this concern in our Essentials of Medicine- Physical Diagnosis course. We created an online outline and audio podcast for students to review illustrating the key elements of the history of presenting illness, review of systems, other historical patient information, and focused physical examination for 3 specific chief complaints to assist them in their approach to these patients. This resource also included the discussion of the work up and treatment plans and was created in collaboration of Internal, Family, and Emergency Medicine to account for the various approaches to the same chief complaint within the various specialites of medicine.
    [Show full text]
  • Open Wide – Mouth Is the Window to the Body. HEENT to HEENOT
    Open Wide –Mouth is the window to the body. HEENT to HEENOT Dr. Vinod Miriyala BDS, MPH, CAGS, DDS Dr. Anna Novais DMD Objectives Make the case that oral health is an essential component of primary care. Present a practical framework for how to deliver preventive oral healthcare as a component of routine medical care. Share resources and information about existing practice in the state to implement this in your health center. Understanding the problem Lack of access to basic dental services contributes to profound and enduring oral health disparities in the United States. Millions of children and adults do not receive needed clinical and preventive dental services. In 2011, 6.1 percent of children and 16.4 percent of adults under the age of 65, did not receive needed dental care because their families could not afford it. Children are only one of the many vulnerable and underserved populations that face persistent, systemic barriers to accessing oral health care. Understanding the Problem Dental caries (cavities) and periodontal disease (gum disease) are largely preventable. Yet nationwide, among all ages, incomes, and life experiences, we have an unacceptably high burden of these chronic diseases. We’ve seen little improvement in oral health status over the past 20 years, and pervasive disparities remain: Poor and near‐ poor 5‐year‐olds are more than two times as likely to have tooth decay than their middle‐income peers. The Burden of Oral Disease: Children Decay: Tooth decay is the most common chronic disease of childhood. • Pain and infection can result in impaired nutrition and growth.
    [Show full text]
  • Soldier's Manual and Trainer's Guide
    STP 8-68W13-SM-TG 3 May 2013 SOLDIER’S MANUAL AND TRAINER’S GUIDE MOS 68W HEALTH CARE SPECIALIST SKILL LEVELS 1/2/3 HEADQUARTERS, DEPARTMENT OF THE ARMY DISTRIBUTION RESTRICTION: Distribution authorized to US Government agencies and their contractors only to protect technical and operational information from automatic dissemination under the International Exchange Program or by other means. This determination was made on 12 September 2011. Other requests for this documentation will be referred to MCCS-IN, 3630 Stanley Rd Ste 101 Ft Sam Houston, TX 78234-6100. DESTRUCTION NOTICE: Destroy by any approved method, i.e., shredding, pulping, or pulverizing, that will prevent disclosure of contents or reconstruction of this document.. This publication is available at Army Knowledge Online (https://armypubs.us.army.mil/doctrine/index.html). To receive publishing updates, please subscribe at http://www.apd.army.mil/AdminPubs/new_subscribe.asp. STP 8-68W13-SM-TG 1SOLDIER TRAINING PUBLICATION HEADQUARTERS No. 8-68W13-SM-TG DEPARTMENT OF THE ARMY Washington, DC 3 May 2013 SOLDIER’s MANUAL and TRAINER’S GUIDE MOS 68W Health Care Specialist Skill Levels 1, 2 and 3 TABLE OF CONTENTS PAGE Table of Contents………………………………….…………………………………………….i Preface………………………………………………………………..……………………….…..v Chapter 1. Introduction ........................................................................................................... 1-1 1-1. General .............................................................................................................. 1-1 1-2.
    [Show full text]
  • Rads Newsletter 10/18
    “DOCENDO DECIMUS” VOL 5 NO 10 October 2018 DCMC Emergency Department Radiology Case of the Month These cases have been removed of identifying information. These cases are intended for peer review and educational purposes only. Welcome to the DCMC Emergency Department Radiology Case of the Month! In conjunction with our Pediatric Radiology specialists from ARA, we hope you enjoy these monthly radiological highlights from the case files of the Emergency Department at DCMC. These cases are meant to highlight important chief complaints, cases, and radiology findings that we all encounter every day. PEM Fellowship If you enjoy these reviews, we invite you to Conference Schedule: October 2018 check out Pediatric Emergency Medicine 3rd - 9:00 Bioterrorism…………………………………Dr Remick Fellowship Radiology rounds, which are offered 10:00 Immunocompromised Child……Drs Gillon & Allen quarterly and are held with the outstanding 11:00 Patient Handoffs………………Drs McClung & Iyer support of the Pediatric Radiology specialists at 10th - 9:00 Patient Safety……………………Drs Schwarz & Iyer 10:00 Basic Peds for EM Folks…………..……Dr Vezzetti Austin Radiologic Association. 11:00 Adult Emergencies in the Peds ED……….Dr Berg 17th - 9:00 Radiology: Limping…..Drs Lonergan/Schunk/Vezzetti If you have and questions or feedback regarding 10:00 Biostats 2: Inferential Statistics…….Dr Wilkinson 12:00 ED Staff Meeting the Case of the Month format, feel free to email Robert Vezzetti, MD at 24th - 8:00 Board Review: GU Emergencies…….Dr Whitaker [email protected]. 31st - 8:00 Pediatric Multisystem Trauma…………Dr Vezzetti 9:00 Sim: ATLS/Trauma……..Dr Floyed and Sim Faculty This Month: Bumps on the head.
    [Show full text]
  • Appendix 1. Study Instrument: Letter of Introduction and Clinical Case Histories
    Online Supplementary Material Temte JL, Zinkel AR. The primary care differential diagnosis of inhalational anthrax. Ann Fam Med. 2004;2:438-444. http://www.annfammed.org/cgi/content/full/2/5/438/DC1 Appendix 1. Study Instrument: Letter of Introduction and Clinical Case Histories Department of Family Medicine University of Wisconsin 777 South Mills Street Madison, Wisconsin 53715 Primary Care Bioterrorism Study Group Dear Family Physician: We invite you to participate in a research study of alternative diagnoses for diseases of public health importance. Inhalation anthrax is a very rare medical condition with significant patient and public health consequences. In the event of a covert intentional release of anthrax spores, family physicians will be among the first clinicians to encounter cases. We are interested in determining which clinical diagnoses may overlap with, and, thus, be confused with, inhalation anthrax. This study is being conducted at the University of Wisconsin Department of Family Medicine. Should you choose to participate, you will be one of up to 665 physicians randomly selected from a national sample of 93,000 American Academy of Family Physician members. Your participation is entirely voluntary and your responses are confidential. An identification code, used to facilitate repeat mailings if necessary, will be discarded following no more than three distributions of this study packet. There is a slight risk of breach of confidentiality due the design allowing for repeat mailings, but such a breach is not expected. There are no direct benefits associated with your involvement with this study. Full participation will take less than five minutes of your time, requiring responses to five key questions regarding each of three brief case vignettes.
    [Show full text]
  • 2 Longitudinal Clinical Experience (LCE) Student Handbook 2019-2020 University of Illinois
    Foundations of Clinical Medicine – 2 Longitudinal Clinical Experience (LCE) Student Handbook 2019-2020 University of Illinois College of Medicine at Urbana-Champaign Foundations of Clinical Medicine Assistant Course Director & LCE Coordinator: Dr. Grace Park Contact: [email protected] LCE Administrative Assistant: Kirsten Lawhead Fax: 217-383-3121 Email: [email protected] Longitudinal Clinical Experience (LCE) The Longitudinal Clinical Experience is an opportunity to provide the student with an exposure to an outpatient generalist's practice. The experience is intended to be an avenue to integrate medical knowledge, clinical skills, and professionalism in your journey towards your identity formation as a physician. You will be assigned an M-2 Primary Care Preceptor and will meet with the preceptor for a total of 8 half-day sessions during the year. Preceptors are located both in urban and rural settings. Some may be in large hospital practices and some in small private clinics. Primary care physicians see a wide variety of patients and patient problems. They represent the disciplines of Family Medicine, General Internal Medicine, and Medicine/Pediatrics. During each half-day session, you will practice the components of the H&P, observe the clinical responsibilities of a primary care physician, observe the complexities of the medical office system, and correlate basic science knowledge with clinical medicine. General Goals and Objectives 1. Understand and describe the breadth and depth of the generalist's practice content. 2. Correlate your medical knowledge in the basic sciences with your clinical skills in clinical practice. 3. Describe the clinical and intellectual challenges of the generalist’s practice.
    [Show full text]
  • Headache Pain Generators Extracranial 1
    Objectives Headache Pain Generators Extracranial 1. Define the major categories of headache. Musculoskeletal (spine, muscle) 2. Take a history directed at characterizing a headache pattern in an individual patient and identify the cause or triggers of the Oral (dental) headache. 3. Understand the distinguishing features and patterns of migraine Ocular headache. Ear 4. Know first line treatments for tension versus migraine headaches. Vascular: branches of extracranial carotid, e.g. 5. Recognize warning signs for secondary headache syndromes due to intracranial structural lesions or increased intracranial pressure. temporal arteritis Intracranial Dural and pial sensory fibers Trigeminovascular pathways Intracranial: Dural and pial sensory fibers Primary Headache Disorders 1. Migraine Headache • With or without aura 2. Tension-type Headache 3. Trigeminal Autonomic Cephalgias Secondary Headache Disorders Primary or Secondary Headache 1. Increased Intracranial Pressure headaches • Mass lesions • Chronic Daily Headache • Idiopathic Intracranial Hypertension (IIH) • Tension-type Headache 2. Vascular • Medication Overuse Headache • Inflammation – example: Temporal Arteritis • “Transformed” Migraine • Thrombosis – example: Cerebral Venous Thrombosis • New Daily Persistent Headache • Sub-arachnoid hemorrhage (“worst headache of life”) 3. Cervicogenic (spine, nerve roots) • Rule out Secondary Headache 4. Temporal Mandibular Joint (TMJ) 5. Medication Overuse Headache Headache Exam: History Headache Exam: History Headache onset aura or warning? Triggers:
    [Show full text]
  • Diverticulitis
    MALPRACTICE COUNSEL Commentary by Francis L. Counselman, MD Diverticulitis 44-year-old woman presented to the ED complaining of crampy lower abdomi- nal pain with nausea and vomiting. The patient described gradual onset 2 days prior, with symptoms worsening over the previous 12 hours. She denied diar- A rhea, constipation, or blood in her stool. She did admit to frequency of urination, but no dysuria or hematuria. She was gravida 2, para 2, aborta 0, with a last menstrual period 3 weeks prior. She denied vaginal bleeding or discharge. Her past medical history was unremarkable, she was on no medications, and denied alcohol use. She did admit to smoking one pack of cigarettes per day. On physical examination, the patient’s vital signs were: blood pressure, 132/68 mm Hg; heart rate, 96 beats/min; respiratory rate, 18 breaths/min; and temperature, 99.8°F. Oxygen saturation was 99% on room air. The head, ears, eyes, nose, and throat (HEENT) examination was completely normal, as was the heart and lung examination. The patient was tender to palpation in the lower abdomen, but without guarding or rebound. Bowel sounds were present and normoactive. A pelvic examination, including a bimanual examination, demonstrated mild left ovarian tenderness but without mass or cervical motion tenderness. The patient did not exhibit any costovertebral angle tenderness bilaterally. No rectal examination was performed. The emergency physicians (EPs) ordered a complete blood count (CBC), basic meta- bolic profile (BMP), urinalysis, urine pregnancy test, and a vaginal wet preparation. In addition, the patient was administered 500 cc’s of normal saline intravenously (IV) and ondansetron (Zofran) 4 mg IV.
    [Show full text]
  • Statistical Analysis Plan for Interventional Studies
    CCI NCT03697252 6WDWLVWLFDO$QDO\VLV3ODQIRU,QWHUYHQWLRQDO6WXGLHV 6SRQVRU1DPHKaruna Pharmaceuticals, Inc. 3URWRFRO1XPEHUKAR-004 3URWRFRO7LWOHA Phase 2, Randomized, Double-blinded Study to Assess the Safety, Tolerability, and Efficacy of KarXT in Hospitalized Adults with DSM-5 Schizophrenia 3URWRFRO9HUVLRQDQG'DWH ''0PP<<<< Version 4.0 Amendment 3/11Dec2018 Version 3.0 Amendment 2/24Aug2018 Version 2.0 Amendment 1/13Jun2018 Version 1.0 Final/17May2018 CCI $XWKRUVPPD , PPD Biostatistician PPD , Pharmacometrician 1RWLFHRI&RQILGHQWLDODQG3URSULHWDU\,QIRUPDWLRQ The information contained in this document is confidential belonging to Karuna Pharmaceuticals, Inc. Acceptance of this document constitutes agreement by the recipient that no information contained herein will be published or disclosed without prior written authorization from an official of Karuna Pharmaceuticals, Inc. However, this document may be disclosed to appropriate Institutional Review Board and Ethics Committees or duly authorized representatives of a national regulatory authority under the condition that they are requested to keep it confidential. In the event of an actual or suspected breach of this obligation, CCI should be notified promptly. SAP Version: Final v1.1 CCI , Effective Date 30-Apr-2018 Page of 6WDWLVWLFDO$QDO\VLV3ODQIRU,QWHUYHQWLRQDO6WXGLHV Sponsor: Karuna Pharmaceuticals, Inc.; Protocol No.: KAR-004 5HYLVLRQ+LVWRU\ 'DWH 9HUVLRQ (DD-Mmm-YYYY) 'RFXPHQW2ZQHU 5HYLVLRQ6XPPDU\ PPD Biostatistician V0.1 PPD PPD Initial Release Version PPD Biostatistician Address
    [Show full text]