2Nd Quarter 2001 Medicare Part a Bulletin
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Adult Tube Feeding
Guide to ADULT TUBE FEEDING Parents’ Practical Guide to Pediatric Tube Feeding | XX Contents Introduction 3 Finding Community Support 4 Understanding the Tube Feeding System 6 Monitoring Your Response to Tube Feeding 8 Taking Charge of Your Doctor Visits 18 Tube Feeding Monitoring Checklist 20 Medication Record 28 Notes 30 Glossary 32 Guide to Adult Tube Feeding | 1 Introduction We know that tube feeding brings major changes to your life. But you don’t have to face them alone. We hope you find this guide a useful, practical resource that can help you tube feed successfully at home. You’ll find step-by-step instructions on handling issues you face every day, from coping with infections to preparing for a doctor’s appointment. The guide includes worksheets (P. 20-31) that make it simple to record important information about your progress. We’ve also added a helpful glossary (P. 32-34) that you can refer to if you come across any unfamiliar terms. While technical and medical support form the foundation of tube-feeding success, we believe that emotional support is just as important. Hopefully, you’ll find resources in this guide that make your journey easier. Guide to Adult Tube Feeding | 3 Finding Community Support With support and guidance, you can take control of the tube-feeding process and adjust successfully to this new lifestyle change. Visit the link below to find educational resources, support groups and the opportunity to connect with others in your situation. The Oley Foundation The Oley Foundation is a nonprofit organization for people who depend on home enteral (tube) feeding or parenteral (intravenous) feeding. -
Wildlife Ophthalmology
Wildlife Ophthalmology DR. HEATHER REID TORONTO WILDLIFE CENTRE TORONTO, ON CANADA Why understand eyes? Wildlife need to have excellent vision to survive in the wild Eye related problems are common in wildlife admitted to rehabilitation centers What we will cover Anatomy of the eye Differences between birds and mammals The eye exam Recognizing common problems Prognosis Treatment options When to see the vet Anatomy Around the Eye: Muscles & nerves Skin Eye lids Nictitating eyelid Conjunctiva & sclera Tear glands & ducts Ossicles (birds) Anatomy Front of the Eye: Cornea Iris Pupil Ciliary body Anterior Chamber Aqueous humor Anatomy Back of the Eye: Lens Retina Optic nerve Choroid Pecten (birds) Posterior Chamber Vitreous humor Fundus of the Eye Mammal Eye Bird Eye The Avian Eye - Differences Small eye size in most birds and small pupil size makes it hard to examine Can control the size of their pupil Lower eyelid more developed The nictitating membrane spreads the tears allowing birds to blink less Moves horizontally across eye The Avian Eye - Differences Eyes are not as protected by skull Less muscles around eye so less eye movement Boney ossicles support the eye Three main eye shapes; flat, globose & tubular The Avian Eye - Differences Four different color receptors compared to the three in mammals means better color detail Can see in the ultraviolet range Higher flicker rate – can detect lights that flicker at more than 100 flashes per second (humans detect at 50) The Avian Eye - Differences In some species the eye -
A Study Op the Occupational Therapy Program of Aidmors Convalescent Home
A STUDY OP THE OCCUPATIONAL THERAPY PROGRAM OF AIDMORS CONVALESCENT HOME ATLANTA, GEORGIA A THESIS SUBMITTED TO THE FACULTY OF THE ATLANTA UNIVERSITY SCHOOL OF SOCIAL WORK IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK BY THEODOSIA RUSSELL JOHNSTON ATLANTA, GEORGIA AUGUST 1948 il TABLE OF CONTENTS Chapter Page I. INTRODUCTION 1 Purpose of this Study 4 Scope 4 Method of Procedure 4 II. THE HISTORY AND DEVELOPMENT OF OCCUPATIONAL THERAPY.. 5 III. THE HISTORY AND DEVELOPMENT OF AIDMORE 13 IV. THE OCCUPATIONAL THERAPY PROGRAM OF AIDMORE 21 V. SUMMARY AND CONCLUSION 31 APPENDIX 35 Schedule • 3 6 BIBLIOGRAPHY 38 CHAPTER I INTRODUCTION "An organic disability becomes an actual disability only when the individual senses a defect and feels a consciousness of that defect reflected in his environment."^ If we look around us, we see many fine persons who have some physical handicap which we fail to note after a first acquaintance because their engaging personalities erase their physiques from our minds. If we acquaint ourselves with the childhood of these individuals, we would perhaps find that they as children received the kind of love, attention and understanding which enabled them to take advantage of opportunities and substitute for handicaps. At one time or another, most normal children go through a period when they feel lonely, bitter and suspicious because of physical attributes which make them appear different from other children - a long nose, chubbiness, gawkiness or large ears. The personalities of these children are not permanently damaged, however, because these handicaps are not sufficient to cause continuous frustration, or because the children, in time, acquire a sense of values in which slight differences do not matter.2 ^Georgia Ball, "Case Work With Crippled Children," The Family. -
Left Ventricular Wall Findings in Non-Electrocardiography-Gated CE-CT After ECPR Might Be Useful for Diagnosis and Prognostic Prediction
Sugiyama et al. Critical Care (2019) 23:357 https://doi.org/10.1186/s13054-019-2624-1 RESEARCH Open Access Left ventricular wall findings in non- electrocardiography-gated contrast- enhanced computed tomography after extracorporeal cardiopulmonary resuscitation Kazuhiro Sugiyama1* , Masamichi Takahashi2, Kazuki Miyazaki1, Takuto Ishida1, Mioko Kobayashi1 and Yuichi Hamabe1 Abstract Background: Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis. Methods: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns. Results: A total of 74 patients (median age, 59 years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs. -
Resting Coronary Flow Velocity in The
European Heart Journal – Cardiovascular Imaging (2012) 13,79–85 CLINICAL/ORIGINAL PAPERS doi:10.1093/ehjci/jer153 Resting coronary flow velocity in the functional evaluation of coronary artery stenosis: study on sequential use of computed tomography angiography and transthoracic Doppler Downloaded from https://academic.oup.com/ehjcimaging/article/13/1/79/2397059 by guest on 30 September 2021 echocardiography Esa Joutsiniemi 1, Antti Saraste 1,2*, Mikko Pietila¨ 1, Heikki Ukkonen 1,2, Sami Kajander 2, Maija Ma¨ki 2,3, Juha Koskenvuo 3, Juhani Airaksinen 1, Jaakko Hartiala 3, Markku Saraste 3, and Juhani Knuuti 2 1Department of Cardiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland; 2Turku PET Centre, Kiinamyllynkatu 4-8, 20520 Turku, Finland; and 3Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland Received 10 March 2011; accepted after revision 2 August 2011; online publish-ahead-of-print 30 August 2011 Aims Accelerated flow at the site of flow-limiting stenosis can be detected by transthoracic Doppler echocardiography (TTDE). We studied feasibility and accuracy of sequential coronary computed tomography angiography (CTA) and TTDE in detection of haemodynamically significant coronary artery disease (CAD). ..................................................................................................................................................................................... Methods We prospectively enrolled 107 patients with intermediate (30–70%) pre-test likelihood of CAD. All patients under- and results went CTA using a 64-slice scanner. Using TTDE, the ratio of maximal diastolic flow velocity to pre-stenotic flow velocity (M/P ratio) was measured in the coronary segments with stenosis in CTA. In all patients, the results were compared with invasive coronary angiography, including measurement of fractional flow reserve when appropriate. -
Understanding Inpatient Brain Injury Rehabilitation
Understanding Inpatient Brain Injury Rehabilitation At the 18-bed Brain Injury Recovery Center (BIRC) at Penn Rehab, we help patients after they have been discharged from acute care, but before they are ready to return home. Our Brain Injury Recovery Center patients come from all walks of life and have experienced variety of conditions. Everyday we call attention to strategies to help prevent brain injury, advocate for the rights of those living with brain injury, and honor those who have traveled the long road to recovery following brain injury. As a Certified Brain Injury Specialist, I’ve walked that road with my patients, and believe me, it is a long one. At Penn Rehab, therapists make a big effort to get to the core of who that person is and we try to let that come through no matter what. If we can let that shine through and design interventions around what the core of that person is, then we can bring them back even when they have limitations once their inner self has emerged. Coaching is being able to see the big picture when the player doesn’t always. Through inpatient rehabilitation, people who have experienced a brain injury work alongside an entire team dedicated to helping them regain their independence so that they can return home and go back to doing the things they love. Our patients are beginning to respond to their environments and are on the road to recovery from conditions such as: Concussion Contusion Complicated Stroke Cerebral Hemorrhage Traumatic Brain Injury Spontaneous Hemorrhage Brain Tumor Anoxic Encephalopathy From the staff providing around-the-clock care on the unit, to the equipment used with patients, to the layout of the unit, the BIRC is designed to meet the unique cognitive, behavioral, medical, and mobility needs of patients following brain injury. -
Introduction to Neuroimaging
Introduction to Neuroimaging Aaron S. Field, MD, PhD Assistant Professor of Radiology Neuroradiology Section University of Wisconsin–Madison Updated 7/17/07 Neuroimaging Modalities Radiography (X-Ray) Magnetic Resonance (MR) Fluoroscopy (guided procedures) • MR Angiography/Venography (MRA/MRV) • Angiography • Diffusion and Diffusion Tensor • Diagnostic MR • Interventional • Perfusion MR • Myelography • MR Spectroscopy (MRS) Ultrasound (US) • Functional MR (fMRI) • Gray-Scale Nuclear Medicine ―Duplex‖ • Color Doppler • Single Photon Emission Computed Tomography (SPECT) Computed Tomography (CT) • Positron Emission Tomography • CT Angiography (CTA) (PET) • Perfusion CT • CT Myelography Radiography (X-Ray) Radiography (X-Ray) Primarily used for spine: • Trauma • Degenerative Dz • Post-op Fluoroscopy (Real-Time X-Ray) Fluoro-guided procedures: • Angiography • Myelography Fluoroscopy (Real-Time X-Ray) Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Digital Subtraction Angiography Indications: • Aneurysms, vascular malformations and fistulae • Vessel stenosis, thrombosis, dissection, pseudoaneurysm • Stenting, embolization, thrombolysis (mechanical and pharmacologic) Advantages: • Ability to intervene • Time-resolved blood flow dynamics (arterial, capillary, venous phases) • High spatial and temporal resolution Disadvantages: • Invasive, risk of vascular injury and stroke • Iodinated contrast and ionizing radiation Fluoroscopy (Real-Time X-Ray) Myelography Lumbar or -
Myelography in the Assessment of Degenerative Lumbar Scoliosis And
https://doi.org/10.14245/kjs.2017.14.4.133 KJS Print ISSN 1738-2262 On-line ISSN 2093-6729 CLINICAL ARTICLE Korean J Spine 14(4):133-138, 2017 www.e-kjs.org Myelography in the Assessment of Degenerative Lumbar Scoliosis and Its Influence on Surgical Management George McKay, Objective: Myelography has been shown to highlight foraminal and lateral recess stenosis more Peter Alexander Torrie, readily than computed tomography (CT) or magnetic resonance imaging (MRI). It also has the Wendy Bertram, advantage of providing dynamic assessment of stenosis in the loaded spine. The advent of weight-bearing MRI may go some way towards improving assessment of the loaded spine Priyan Landham, and is less invasive, however availability remains limited. This study evaluates the potential Stephen Morris, role of myelography and its impact upon surgical decision making. John Hutchinson, Methods: Of 270 patients undergoing myelography during 2006-2009, a period representing Roland Watura, peak utilisation of this imaging modality in our unit, we identified 21 patients with degenerative Ian Harding scoliosis who fulfilled our inclusion criteria. An operative plan was formulated by our senior author based initially on interpretation of an MRI scan. Subsequent myelogram and CT myelogram Department of Spinal Surgery, investigations were scrutinised, with any additional abnormalities noted and whether these im- Southmead Hospital, Bristol, United pacted upon the operative plan. Kingdom Results: From our 21 patients, 18 (85.7%) had myelographic findings not identified on MRI. Of Corresponding Author: note, in 4 patients, supine CT myelography yielded additional information when compared to George McKay supine MRI in the same patients. -
Fluorescein Angiography Findings in Both Eyes of a Unilateral Retinoblastoma Case During Intra-Arterial Chemotherapy with Melphalan
Int J Ophthalmol, Vol. 12, No. 12, Dec.18, 2019 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] ·Letter to the Editor· Fluorescein angiography findings in both eyes of a unilateral retinoblastoma case during intra-arterial chemotherapy with melphalan Cem Ozgonul1, Neeraj Chaudhary2, Raymond Hutchinson3, Steven M. Archer1, Hakan Demirci1 1Department of Ophthalmology and Visual Sciences, W.K. was inserted into the left femoral artery, advanced into the Kellogg Eye Center, MI 48105, USA internal carotid and up to the origin of the ophthalmic artery. 2Department of Radiology, University of Michigan, MI 48109, Once the catheter tip position was confirmed at the origin USA of the ophthalmic artery by fluoroscopy, 5 mg melphalan 3Department of Pediatric Hematology/Oncology, University of was infused in a pulsatile fashion over 30min. There was Michigan, MI 48109, USA no anatomical variant of orbital vascular structure. During Correspondence to: Hakan Demirci. Department of the 2nd IAC, following the infusion of melphalan, sodium Ophthalmology and Visual Science, W.K. Kellogg Eye Center, fluorescein dye at a dose of 7.7 mg/kg was injected through the 1000 Wall St, Ann Arbor, MI 48105, USA. hdemirci@med. same microcatheter. Real-time FA was recorded by using the umich.edu RetCam III (Clarity Medical Systems, Pleasanton, California). Received: 2018-11-01 Accepted: 2019-04-09 FA was repeated 4wk later during the 3rd IAC in the same manner, before infusion of the chemotherapy. In both sessions, DOI:10.18240/ijo.2019.12.24 there was no catheterization or injection of contrast material into the untreated carotid and ophthalmic artery. -
Cricothyrotomy
NURSING Cricothyrotomy: Assisting with PRACTICE & SKILL What is Cricothyrotomy? › Cricothyrotomy (CcT; also called thyrocricotomy, inferior laryngotomy, and emergency airway puncture) is an emergency surgical procedure that is performed to secure a patient’s airway when other methods (e.g., nasotracheal or orotracheal intubation) have failed or are contraindicated. Typically, CcT is performed only when intubation, delivery of oxygen, and use of ventilation are not possible • What: CcT is a type of tracheotomy procedure used in emergency situations (e.g., when a patient is unable to breathe through the nose or mouth). The two basic types of CcT are needle CcT (nCcT) and surgical CcT (sCcT). Both types of CcTs result in low patient morbidity when performed by a trained clinician. Compared with the sCcT method, the nCcT method requires less time to set up and is associated with less bleeding and airway trauma • How: Ideally, a CcT is performed within 30 seconds to 2 minutes by making an incision or puncture through the skin and the cricothyroid membrane (i.e., the thin part of the larynx [commonly called the voice box])that is between the cricoid cartilage and the thyroid cartilage) into the trachea –An nCcT is a temporary emergency procedure that involves the use of a catheter-over-needle technique to create a small opening. Because it involves a relatively small opening, it is not suitable for use in extended ventilation and should be followed by the performance of a surgical tracheotomy when the patient is stabilized. nCcT is the only type of CcT that is recommended for children who are under 10 years of age - A formal tracheotomy is a more complex procedure in which a surgical incision is made in the lower part of the neck, through the thyroid gland, and into the trachea. -
Nutrition Department This Booklet Has Been Developed by the Nutrition and Gastroenterology Department’S at Alfred Health, Melbourne
Nutrition Department This booklet has been developed by the Nutrition and Gastroenterology Department’s at Alfred Health, Melbourne. Inside you will find information on tube feeding at home CONTENTS 1. Your tube & feeding regime Tube details page 1 Feeding regime page 1 2. Important contact phone numbers page 1 3. Introduction What is tube feeding? page 2 Who receives tube feeding? page 2 4. The feeding tube Nasogastric tube page 3 Nasojejunal tube page 3 Gastrostomy tubes page 3—7 Jejunostomy tubes page 8 Trans-gastric jejunostomy tubes page 8 5. The formula Formula selection & feeding plan page 9 - 10 Formula storage & preparation page 10 6. Feeding methods Continuous OR Intermittent feeding using a pump page 11 - 12 Continuous OR Intermittent feeding using gravity drip page 13 - 14 Bolus feeding page 15 - 16 Oral feeding page 16 7. Medication Administration of medication page 17 8. Care during tube feeding Gastrostomy feeding tube care: Care immediately post tube insertion page 18 Daily tube & stoma care page 19 Jejunostomy, trans-gastric jejunostomy & PEG—J page 20 Nasogastric tube care page 20 Care of the tube feeding equipment page 21 Mouth care page 21 9. Possible problems & solutions Blocked Tube page 22 Constipation page 22 - 23 Diarrhoea page 23 - 24 Irritation, skin redness &/or oozing page 24 Leaking around tube page 24 Nausea & vomiting page 25 Reflux page 25 Tube dislodged or falls out page 25 Tube deteriorated or damaged page 25 What to do if your feeding tube has fallen out page 26 10. The Alfred Home Enteral Nutrition (HEN) program Requirements of the HEN Program page 27 The PEG/HEN Clinic page 28 Ordering formula & equipment pager 28 11. -
Risk Factors for Adverse Reactions of Fundus Fluorescein Angiography
Original Article Risk factors for adverse reactions of fundus fluorescein angiography Yi Yang1, Jingzhuang Mai2, Jun Wang1 1Department of Ophthalmology, 2Epidemiology Division, Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510080, China Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: Y Yang; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: Y Yang, JZ Mai; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Yi Yang. Department of Ophthalmology, Guangdong General Hospital, #106, Zhongshan Second Road, Guangzhou 510080, China. Email: [email protected]. Background: To explore the difference between the outcomes of correlations between a series of variables and adverse reactions (ARs) to fluorescein from univariate and multivariate analysis and to evaluate the nausea effects in different age groups. Methods: A retrospective study of patients undergoing consecutive fluorescein angiography between March 2010 and February 2012 was conducted. No patients were excluded on the ground of age, presence of atopy, allergy history, previous procedures without severe allergic ARs, asymptomatic hypertension and kidney failure with serum creatinine levels lower than 250 μmol/L or with renal dialysis. Results: A total of 829 patients were enrolled and 22.2% of them had ARs. The majority of reactions were nausea (12.1%) which occurred less when age became old (P<0.0001). When the correlations between a series of variables and ARs were assessed separately, age (P<0.0001), prior reactions (P<0.0001) and motion sickness (P=0.0062) were highly and cardio/cerebrovascular disease (P=0.0015), diabetes (P=0.0001) and renal disease (P=0.0219) were lowly related to ARs.