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Given the considerable evidence for the antiviral activity of coconut oil, lauric acid and its derivatives and their general safety, and the absence of a cure for nCoV-2019, we urge that clinical studies be conducted in patients who have been infected with nCoV-2019 (see below). This treatment is affordable and virtually risk-free, and the potential benefits are enormous. Effect of fatty acids on arenavirus replication: inhibition of virus production by lauric acid. Sodium dodecyl sulfate as a viral inactivator and future perspectives in the control of small ruminant lentiviruses. Virucidal activities of medium- and long-chain fatty alcohols and lipids against respiratory syncytial virus and parainfluenza virus type 2: comparison at different pH levels. Evaluation of vaginal drug levels and safety of a locally administered glycerol monolaurate cream in Rhesus macaques. Development and evaluation of microbicidal hydrogels containing monoglyceride as the active ingredient. Sodium lauryl sulfate, a microbicide effective against enveloped and nonenveloped viruses. In Vitro and In Vivo Evaluations of Sodium Lauryl Sulfate and Dextran Sulfate as Microbicides against Herpes Simplex and Human Immunodeficiency Viruses. Inactivation of Enveloped Viruses and Killing of Cells by Fatty Acids and Monoglycerides. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in 2 humans and its potential bat origin. Other pertinent literature is also presented, but is described in less detail than the key studies. Each profile includes the following: (A) the examination, summary, and interpretation of available toxicologic information and epidemiologic evaluations on a hazardous substance to ascertain the levels of significant human exposure for the substance and the associated acute, subacute, and chronic health effects; (B) A determination of whether adequate information on the health effects of each substance is available or in the process of development to determine levels of exposure that present a significant risk to human health of acute, subacute, and chronic health effects; and (C) Where appropriate, identification of toxicologic testing needed to identify the types or levels of exposure that may present significant risk of adverse health effects in humans. The principal audiences for the toxicological profiles are health professionals at the Federal, State, and local levels; interested private sector organizations and groups; and members of the public. Staff of the Centers for Disease Control and Prevention and other Federal scientists have also reviewed the profile. Each profile reflects a comprehensive and extensive evaluation, summary, and interpretation of available toxicologic and epidemiologic information on a substance. Health care providers treating patients potentially exposed to hazardous substances will find the following information helpful for fast answers to often-asked questions. Chapter 2: Relevance to Public Health: the Relevance to Public Health Section evaluates, interprets, and assesses the significance of toxicity data to human health. Please refer to the Public Health Statement to identify general health effects observed following exposure. Pediatrics: Four new sections have been added to each Toxicological Profile to address child health issues: Section 1. Managing Hazardous Materials Incidents is a three-volume set of recommendations for on-scene (prehospital) and hospital medical management of patients exposed during a hazardous materials incident. The Health Effects Review Committee examines the health effects chapter of each profile for consistency and accuracy in interpreting health effects and classifying end points. The Research Implementation Branch reviews data needs sections to assure consistency across profiles and adherence to instructions in the Guidance. Maryce Jacobs, President, Health Sciences Institute, Incorporated, Solomons, Maryland; and Dr. James Withey, Environmental Health Center Canada, Retired, Ottawa, Ontario, Canada. Releases to the Environment from Facilities that Produce, Process, or Use Hydrogen Cyanide. Releases to the Environment from Facilities that Produce, Process, or Use Cyanide Compounds. This information is important because these sites may be sources of exposure and exposure to this substance may harm you. When a substance is released either from a large area, such as an industrial plant, or from a container, such as a drum or bottle, it enters the environment. You may be exposed by breathing, eating, or drinking the substance, or by skin contact. If you are exposed to cyanide, many factors will determine whether you will be harmed.
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Tier 2: this plan may require the employee to contribute $100 per month toward his coverage, but the physician copay amounts are only $25, the annual deductible is $1,000, and the plan pays 80 percent of covered expenses. Employees who choose this option pay more for coverage, but that coverage is slightly more comprehensive. Tier 3: For this plan, the employee contributes $200 per month toward his coverage, but the copay is now $10 for a doctor visit. This is really good coverage, but the employee is paying for the additional benefits through the higher monthly contribution. And so on: Depending on what the employer offers, these tiers can be extended to include $0 copayment amounts and $0 deductible plans. In all cases, the options available to the employee depend on what the employer offers. Identifying the carriers the commercial insurance world revolves on an axis of variety. In fact, an insurance plan seems to exist for just about every situation, and providers see a variety of plans in their daily practices: preferred provider option plans; point of service plans; exclusive provider option plans; health maintenance organizations; high deductible plans; discount plans; and ultra-specific plans that provide only prescription coverage, vision coverage, or other specialized coverage. In the following sections, I take a look at some of the more common of these commercial plans. The commercial insurance carrier is the company that writes the check to the provider, but the carrier may or may not be the one who prices the claim. To find out more about these entities, head to the later sections "Tuning in to networks" and "Choosing third-party administrators. The network contracts define reimbursement terms for all levels of service for the providers in the network. In this case - and depending on the provisions of the plan - the cost for the out-of-network services provided may fall on the healthcare provider or the patient. They also require referrals if the services of a specialist are necessary, and the specialists must also be a network-contracted provider. The only exception is in the event of an emergency when a network provider is unavailable. High-deductible plans the rising cost of healthcare has given birth to the high-deductible health plan. These plans are a smart choice for the young, healthy adult who rarely visits a doctor. Discount plans Probably the plan with the fewest advantages for both patient and provider are discount plans. These plans require patients to pay a monthly fee, which gives them access to participating providers. The problem is that the patients pay for the services, supposedly at a discounted price. These plans are not true health insurance, and plan members are usually shocked when they need to use their "insurance. A network is essentially a middleman that functions as an agent for commercial payers. If a provider is contracted with a network and the insurance carrier is also part of that same network, then the network prices the claim, and the payer (carrier) pays the claim according to the network pricing. If the individual makes monthly payments and a payment is late, a submitted claim may be rejected. If that happens, check with the patient to see whether she paid the premium and then follow up with the payer to have the claim resubmitted. Some carriers participate with several different networks and have the claim priced according to the network that is most advantageous to them. An easy way to find this information is to look at the insurance card to see whether it shows various network symbols, which represent a pricing network that the payer accesses for pricing claims. Regardless of the billed amount, the remaining dollar amount is contractually obligated to be written off by the billing provider. By self-insuring - which means that the company actually pays the healthcare providers from a company account - the small company is, in theory, able to save money. Typically, a small group health plan costs a company about $450 per month per employee.
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In this regard, various luminescent nanoscale probes have been explored for advancing in vivo imaging of biological entities. An intense near-infrared emission and a long-lived afterglow (over 15 days) distinguish these biocompatible nanoparticles from persistent luminescent nanoscale counterparts. This structural design allows for energy transfer from Nd3+ (sensitizer excited at 795 nm) to Yb3+ and Yb3+ to the activator A3+ (Tm, Er, Ho), while maintaining a spatial separation between Nd3+ in the shell and A3+ in the core of nanoparticles. An ultrathin structured light sheet (blue-green, center) excites fluorescence (orange) in successive planes as it sweeps through a specimen (gray) to generate a 3D image. The speed, noninvasiveness, and high spatial resolution of this approach make it a promising tool for in vivo 3D imaging of fast dynamic processes in cells and embryos, as shown here in five surrounding examples. It was shown that the kinetics of folding and unfolding processes are affected by parameters such as temperature, pH, and viscosities of media. This temperature-dependent quenching behavior allows use of these materials as H2O2 sensors. In this study, static and time-resolved X-ray absorption spectroscopy combined with molecular dynamics simulations were used to understand the photoluminescence quenching mechanism. While many manuscripts in this review period covered detection of nitroaromatic compounds, Ganiga et al. With nearly 800 publications during this review period, this research has focused on various analytes including ions, explosives, and others. In this review, we have selected a small number of articles that represent the most interesting findings in terms of analytes, sensing systems, and observed response times and limits of detection. Detection of explosives, particularly nitroaromatics, continues to be important subject matter during this review period. Contrasting stacking patterns in the nanodroplets at different pH values produced drastic changes in spectral characteristic. Similar to our last review, considerable attention has been given to development of fluorescent sensors for detection of ionic species. Reports on zinc and copper sensors were the most abundant, obviously driven by their utility in intracellular imaging. The spontaneous localization of the sensor in the endoplasmic reticulum of different cell types allowed for zinc level monitoring specific to that organelle. This behavior was useful for studying the connection between various cellular phenomena and Zn2+ in the endoplasmic reticulum. The detection of potassium ions using a fluorescent sensor has been reported by Liu and coauthors. The fluorescence enhancement in this sensor was produced by rotational restrictions of the benzothiazole and dimethylaminobenzene rings in the excited state G-quadruplexthioflavin T complex. The authors proposed a molecular rotor mechanism and confirmed this hypothesis by using a nonrotor analogue of thioflavin T. A fluorescent sensor based on a metal-ion indicator displacement assay has been developed for detection of sulfur mustard simulants in water. A similar concept relying on the displacement of quencher from an indicator complex was developed for detection of copper ion (Cu2+). However, in the presence of Cu2+, O2 oxidation of cysteine occurs and the displacement does not occur, leading to quantitative detection of Cu2+ with a detection limit of 0. Biological thiols including cysteine, homocysteine, and glutathione play crucial roles in maintaining redox balance of biological systems. These thiols replace the thiolate to form amino-substituted products that afford discrimination of cysteine from homocysteine and other thiols which the authors used for imaging cysteine in living cells. This research group has also advanced a solution to the same problem using a ratiometric fluorescent sensor selective in sensitivity to cysteine over homocysteine and glutathione. Fluorescence imaging of living HeLa cells with various thiols was demonstrated using this system. Thus, several practical applications of data analyses and data processing strategies for instrumental calibration, classifications, and pattern recognitions of complex data, and analyses of samples of pharmaceutical, bioanalytical, biomedical, food, agricultural, environmental, energy, and fuel interest have been published during this review period. The first and second derivative ratios of the emission data along with their convolution using 8-point sin xi or cos xi polynomials (discrete Fourier functions) were subsequently used for data analysis. The study is particularly interesting because it combined the advantages of convolution of derivative ratio curves using discrete Fourier functions and the reliability and efficacy of nonparametric analysis of data.
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Havingarangeofbasicmedicaldevicescanbeaforcemultiplierforthecaregiverinan 589 Survival and Austere Medicine 3rd ed 2017 austereenvironmentandwhilerequiringsomeextraplanningandresources,thesecanbeeffectively usedandmaintained. Suchasolarsystemwouldbecomprisedof:solarpanel, 590 Survival and Austere Medicine 3rd ed 2017 chargecontroller,12voltbattery(i. Caremustbetakento 591 Survival and Austere Medicine 3rd ed 2017 ensurethatthecorrectvoltagesareusedandthatthecorrectpolarityfortheconnectionsaremadeor thedevicemaybepermanentlydamaged. Exampleoftest"T"piece: 597 Survival and Austere Medicine 3rd ed 2017 Commonproblemsandissues · Damagedconnectors(checkOrings! SomecommonSpO2accessoriesare: · Fingerprobe · Earprobe · Multi-siteprobe · Reflectanceprobe · Extensioncables TestingSpO2Accessories PhysicalCheck · Checkfordamagedconnectorsonbothendsoftheprobeorcableincludingmissingorbent pins,missingcovers,etc. Respiratory-Cephalexin,Augmentin,Sulfa/trim,Ciprofloxacin Tick-bornedisease-Doxycyclinefor2weeks Acuteswellingfrominsectbiteorforitching-Benadryl(diphenhydramine) Intestinalparasites-Pyrantelpamoate,Fenbendazole Pain-Aspirin MedicationList Thedoseslistedareprimarilyfordogs. Examinees should consult the latest edition of the Blueprint and Study Guide for the most up-to-date information regarding the examination. Knowledge of both the biomedical sciences and the clinical sciences is necessary to ensure that the candidate for licensure has the knowledge necessary to practice safely. The Blueprint section contains a list of competencies on which items are based and a list of conditions on which cases are based. The list of competencies is not meant to be a literal structure for the examination. Questions might be asked on the examination that do not fit into a single body system, and items on the examination will not be in the same order as on the list of competencies. There are two facets to testing in the context of naturopathic board-level examinations: what is necessary as a foundation for clinical training, and what will be clinically relevant after the student has graduated. Some of the knowledge necessary to perform the tasks required for entering the clinical phase of naturopathic medical training may not be specified here; this basic knowledge should be assumed to be necessary both for safe practice and for passing this examination. On the list of competencies that follows, the percentages for each system (in parentheses) are approximate, but provide a valid representation for study focus. Listed below are a few competencies from the cardiovascular section of this study guide along with examples of the types of information covered by the competency. The following examples do not cover the scope or breadth of the questions on the integrated examination; they are provided for illustration purposes only. In general, the student who is entering her/his third year in naturopathic medical school should be able to: Competency: Describe the location, function, autonomic regulation, and electrical measurement of the conduction system of the heart. Example: the student should know the structures and understand the mechanisms that are involved in normal and abnormal cardiac rhythms. Example: the student should understand how hypertension affects the afterload of the heart, and how it impacts cardiac output. Competency: Explain the biochemistry of proteins, carbohydrates, lipids, vitamins, minerals, and co-factors as they relate to cardiovascular function and pathology. Example: the student should understand lipid transport in normal physiology and in pathological conditions such as atherosclerosis. Example: the student should understand how abnormal heme synthesis can result in the development of porphyria. Competency: Explain the pathogenesis and be able to identify the etiology, risk factors, complications, and clinical characteristics of congestive heart failure. Describe the embryological development of the cardiovascular system, including the valves and chambers of the heart and the blood vessels. Describe the location, characterize the structure, and delineate the boundaries of the heart, the major vessels, and the pericardium. Describe the location and explain the function of the heart valves in relation to the cardiac cycle. Describe the location, function, autonomic regulation, and electrical measurement of the conduction system of the heart. Describe the location and branching patterns of coronary arteries, and trace the circulatory pathways of the blood supply of the heart. Describe the anatomical patterns of blood distribution to the somatic and visceral areas of the body.
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In the following sections, I explain some of the things that make working remotely so enjoyable. But before you decide that working from home is for you, keep these important points in mind: You must be able to ensure patient privacy. When you work remotely, your office has less control over what you do and the environment in which you do it. You must strictly follow policies and procedures to protect the privacy of the patients. For example, you need a private workspace that ensures that no one else - like guests and family members - can access patient information. You must be able to work independently without supervision and still meet the company quotas that are normally imposed. Companies that allow coders to work from home have the same expectations for their remote employees as they do for those working in the office. The remote worker normally is more productive if he or she exercises the same discipline that would be expected in the traditional office environment. So take stock of your remote environment and your comfort level with shouldering that responsibility. If you feel comfortable that you can do both of the preceding, you may just find that working at home works for you! Many offices have relaxed dress codes, but only within the confines of your own home is working in a robe and slippers even an option. As pleasant as that sounds, keep in mind that you may have to dress like a grown-up every now and again. Most companies still require remote coders to attend office meetings, workshops, and other professional functions. The no-commute commute: Arranging a suitable workspace One obvious perk to remote coding is that it eliminates the daily commute to an office, which saves energy, time, and money. The money you save on gas, clothes, lunches out, and wear and tear on your car (or a subway card) can go straight into the bank! As a biller/coder, you need to make sure your workspace is equipped with a comfortable chair and a desk or table with room to spread out, a computer with Internet access, the appropriate software, and a telephone. Although some companies supply all the materials you need, including the paper and toner (and paying part of your Internet and phone bills), others expect you to provide these things on your own. Some payers also allow people working in patient and provider support positions to work from home. Candidates for these positions must be able to maintain a professional demeanor from home, which means no barking dogs, crying babies, or other unprofessional background noises. If you have small children at home or you cannot secure a quiet room within your house (like a home office), then seriously consider setting up shop elsewhere. Working from home also does not offer the opportunity to crosstrain in larger offices, which can affect your future employment options. The employee with the most knowledge of office procedures and who is able to assist in other departments is a greater asset to the company. When you work remotely, you have fewer opportunities to prove your mettle within the office community. If you do choose to work remotely, try to find ways that you can keep that personal connection; otherwise, you may find yourself the first to be let go. Initially you may think that abstracting billable procedural and diagnosis codes is clear-cut. Because many providers document in conversational format, coders often need clarification on what exactly was done. Experienced coders need less clarification and normally have developed a method for performing a physician query with finesse, thus allowing them to get the information they need. When you work in an office, you have access to an experienced coder who can often assist you in understanding the verbiage in the documentation. Part of your responsibility as a coder is to make sure that the documentation supports the claim being submitted for payment. So if you do choose to fly the coop and ride solo, make sure you have strong support at the home office in case accuracy issues pop up. Chapter 3: Weighing Your Employment Options 39 Other Work Options: Freelance, Temping, and More A well-seasoned coder may carve out a reputation that enables him to work on his own in a freelance or consultant capacity. As a freelancer, you may be hired by companies for particular projects or by individual providers who need temporary help.
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In the following sections, I go over some of the most common pros and cons of technical school programs. The pros of a technical school Attending a vocational or technical school program offers certain advantages: the programs are usually more subject specific and take less time to complete. The more specialized vocational programs usually focus on subject matter that is directly related to the program, such as medical terminology, anatomy, how to use coding materials, understanding insurance, and an introduction of various coding and billing software programs. They also tend to cycle more often (that is, the programs are offered more frequently), which eliminates a longer waiting time to begin a program. The specialized curriculum makes for smaller classes and promotes more interaction with the instructors. This represents a significant out-of-pocket savings (the cost of a typical certification exam is $300 - $260 for students with student memberships - and the books at a bundled price are about $160). Unlike community colleges, vocational schools are purely self-supporting and for-profit institutions. Programs may cost closer to $10,000 (this cost usually includes material costs and the fees to sit for a certification examination). Make sure exam fees are included in your tuition and that, at the end of the program, you can take the certification exam as an inclusive part of your paid program. If you need financial aid, you need to seek grants, scholarships, and loans on your own. Unfortunately, as the field of medical coding and billing rapidly grows, so do the number of scams and diploma mills. The onus is on you to seek out accredited programs that require study in the necessary topics. To find out how to tell good programs from bad, head to the later section "Caveat Emptor: Watching Out for Diploma Mills. Like the community college and vocational school programs, online study has advantages and disadvantages, which I explain in the following sections. Online education is no substitute for student-instructor interaction, but it is a good alternative for people who already have a billing and coding knowledge base and want to go it alone. This 12-course program is broken down into clusters that are made up of specific courses. The program is more in-depth than other online programs and is structured closely to instructorled classrooms. Although a novice is eligible to enroll in either of these programs, the programs are really a better choice for individuals who are already familiar with healthcare. Pros of online programs Here are the advantages that an online program has to offer: Scheduling flexibility: the biggest advantage online study provides is flexibility. Access to programs regardless of your location: Online programs are not geographically restrictive. Fewer needs for physical facilities, resources, and higher faculty salaries help lower the costs for online programs. Plus, many online programs are a cog in the wheel of a larger bricks-and-mortar institution, so on-campus or commuter student tuition already covers much of the overhead, allowing for lower costs for online participants. Cons of online programs Although saving big bucks and going to class in your jammies are real boons, online programs have some obvious drawbacks: You have limited access to educational support: Online students must be able to work independently and without the structure provided by a traditional classroom. It can be especially frustrating for a student who is unfamiliar with the healthcare industry. Online instruction is probably a better choice for a student who is already working in healthcare. Online students need to be able to correct the myriad issues that arise when working online. If locating the Power button is the extent of your technical knowledge, you may want to steer clear of the online option. The same organizations that lend credibility to vocational programs also have tools that allow you to verify the credibility of online programs, and the same organization accreditation standards apply to online programs as classroom training. They also allow students to communicate directly with the instructor, either through live chat sessions or e-mail.
- Upper GI series
- Leakage of liquid or sudden episodes of watery diarrhea in someone who has chronic constipation
- Avoid strenuous activity 2 hours before going to bed.
- Erythrocyte sedimentation rate (ESR)
- Do not take naps during the day.
- Bronchoscopy -- camera down the throat to see burns in the airways and lungs
- Trouble walking
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Most commercial solutions contain zinc, copper, chromium, selenium, and manganese. Electrolytes, minerals, vitamins, micronutrients, and water are added to the base solution to satisfy daily requirements. Lipids may be given as a separate solution or as an admixture with dextrose and amino acids. Also called 3:1 solution, it combines lipids with other parenteral solution components. Advantages the benefits of total nutrient admixture include: · less need to handle the bag (lower risk of contamination) · less time required · less need for infusion sets and electronic infusion devices · lower hospital costs · increased patient mobility · easier adjustment to home care. Disadvantages the disadvantages of total nutrient admixture include: · use of certain infusion devices precluded because of their inability to accurately deliver large volumes of solution · 1. To allow the pancreas to establish and maintain the necessary increased insulin production, start with a slow infusion rate and increase it gradually as ordered. Abruptly stopping the infusion may cause rebound hypoglycemia, which calls for an infusion of dextrose. Glucose balance may be further thrown off by: · sepsis · stress · shock · liver or kidney failure · diabetes · age · pancreatic disease · concurrent use of certain medications, including steroids. Lipid emulsions In an oral diet, lipids or fats are the major source of calories, usually providing about 40% of the total calorie intake. As a nearly isotonic emulsion, concentrations of 10% or 20% can be safely infused through peripheral or central veins. Lipid emulsions prevent and treat essential fatty acid deficiency and provide a major source of energy. Administering parenteral nutrition You may deliver parenteral nutrition in one of two ways: continuously cyclically. This type of delivery may prevent complications such as hyperglycemia caused by a high dextrose load. Do this by reducing the flow rate by one-half for 1 hour before stopping the infusion. Draw a blood glucose sample 1 hour after the infusion ends, and observe the patient for signs of hypoglycemia, such as sweating, shakiness, and irritability. Not-so-vicious cycle A patient undergoing cyclic therapy receives the entire 24-hour volume of parenteral nutrition solution over a shorter period, perhaps 8, 10, 12, 14, or 16 hours. Preparing the patient To increase compliance, make sure that the patient understands the purpose of treatment and enlist his help throughout the course of therapy. To help prevent glucose imbalance, teach the home care patient receiving his first I. Explain that a gradual increase in the flow rate allows the pancreas to establish and maintain the increased insulin production necessary to tolerate this treatment. Finally, review the details of the administration schedule, the equipment the patient will use and, to avoid incompatibilities, the prescribed and over-the-counter medications he takes. To maintain glucose balance, teach your home care patient to increase the flow rate gradually. Be a compliance booster To safely maintain this therapy, the prescribed regimen must be adhered to by the home care patient and his caregivers. Checking the order Check the written order against the label on the bag or bottle. Make sure that the volumes, concentrations, and additives are included in the solution. Any of these phenomena could indicate contamination, problems with the integrity of the solution, or a pH change. If the patient has no adverse reactions to the test dose, begin the infusion at the prescribed rate. Be alert for increased body temperature - one of the earliest signs of catheter-related sepsis. This record is a diagnostic tool that you can use to assure prompt, precise replacement of fluid and electrolyte deficits. Weigh him at the same time each morning (after voiding), in similar clothing, using the same scale.
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Clean technique, on the other hand, can be used to reduce the overall number of microorganisms present. While both aseptic technique and clean technique involve meticulous hand hygiene, they are separate and distinct in the following ways30: Aseptic technique requires the use of various barriers, such as sterile gloves, sterile gowns, sterile drapes, and masks, to prevent the transfer of microorganisms from health care personnel and the environment to the patient during a procedure. Aseptic technique also involves antiseptic skin preparation of the patient at the time of the procedure, as well as the use of sterile instruments, equipment, and devices. Environmental controls that are part of aseptic technique include keeping doors closed during operative procedures, minimizing traffic into and out of operating rooms, and excluding unnecessary personnel during procedures. In aseptic technique, only sterile-to-sterile contact is allowed; sterile-to-nonsterile contact must be avoided. In contrast, clean technique involves reducing the numbers of microorganisms in order to minimize the risk of transmission from the environment or health care personnel, and it includes appropriate hand hygiene. For example, clean gloves are worn by health care personnel when inserting peripheral intravenous catheters. As described in the 43 Preventing Central LineAssociated Bloodstream Infections: A Global Challenge, A Global Perspective sections that follow, health care personnel should be attentive to maximal sterile barrier precautions, skin preparation, catheter selection, and use of catheter kits or carts. In contrast, the control group had onset of infection within 12 days of insertion in one third of the patients, with the remaining two thirds detected within 6 weeks; 83% of the bloodstream infections in this group were caused by skin organisms. While iodophors (for example, povidone-iodine, tincture of iodine) have been frequently used in the United States, a number of studies have shown that chlorhexidine gluconate preparations are superior to both iodophors and alcohol for skin antisepsis. In continental Europe, octenidine is increasingly being used as a substitute for chlorhexidine in water- or alcohol-based skin, mucosa, and wound antiseptics, though it is not available in the United States. If there is a contraindication to chlorhexidine, apply tincture of iodine, an iodophor, or alcohol as an alternative. It should be noted, however, than in some countries, chlorhexidine availability may be an issue, in which case povidone-iodine should be used. Preventing Central LineAssociated Bloodstream Infections: A Global Challenge, A Global Perspective microbial colonization, active primarily against Grampositive microorganisms. There is three times the amount of chlorhexidine on the external luminal surface and extended release of the surface-bound antiseptics than that of the first-generation catheters. No comparative studies with the second-generation chlorhexidine/silver sulfadiazine catheters have been published. Procedures should be established for used carts to be switched out in a timely manner for newly cleaned and stocked carts. Carts and kits can be assembled by health care organizations, using the supplies they prefer, or ready-made kits can be purchased. Carts and kits must contain all supplies recommended by evidencebased practices-for example, a large sterile drape for insertion procedures (rather than a small drape); chlorhexidine for skin antisepsis; and cap, mask, and sterile gloves for inserters and those assisting with the procedure. Use a subclavian site rather than a jugular site to minimize infection risks in adult patients. Femoral catheters are also associated with a greater risk for deep venous thrombosis than are the subclavian or internal jugular veins. In pediatric patients, however, femoral catheters have a lower rate of mechanical complications and seem to have an equivalent infection rate to nonfemoral catheters. Keep in mind that studies have shown that, unlike in adults, in pediatric patients femoral catheters have a low incidence of mechanical complications and might have an equivalent infection rate to that of nonfemoral catheters. There are generally two types of dressings that can be used to cover and protect the insertion site: (1) sterile gauze and tape and (2) sterile, semipermeable "transparent" polyurethane dressings. Transparent dressings permit continuous visual inspection of the insertion site, help to secure the device, and do not need to be changed as often as gauze and tape dressings. If the patient is diaphoretic or the insertion site is oozing blood, gauze dressings are recommended. Replace semipermeable dressings every seven days, except with pediatric patients, for whom the risk of dislodgement may outweigh the benefit of changing the dressing. If there is fever without an obvious source, tenderness at the insertion site, or other symptoms suggesting either local or bloodstream infection, the dressing should be removed and the site thoroughly inspected.
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List the endocrinopathies, both exogenous and endogenous, that may interfere with the normal testicular axial relationship and specify the nature of these alterations. Describe the anatomy, physiology and pathophysiology of the male reproductive tract, spermatogenesis, sperm transport and capacitation. Identify the sequence of sperm maturation, the cell types found within and between the seminiferous tubules and the time sequence of spermatogenesis. Identify disease states that interfere with ejaculation and the manner in which these states disrupt normal ejaculatory mechanisms. List the important components of a historical review in males presenting with infertility. Identify exogenous drugs that may suppress fertility, ejaculation and erectile function. Geographic distribution of urinary calculus incidence in this country and the world b. Describe the crystalline architecture of urinary calculi and theoretical factors affecting crystallization. Describe the part played by matrix in the architecture and possible prevention or initiation of stone formation. Iatrogenic urolithiasis Goal 2: During the junior urology year, the resident will become proficient in the evaluation and diagnosis of a patient with urolithiasis Objectives: 1. Elicit a history compatible with stone disease from a patient including a list of pertinent problems referable to stone formation. Describe the role of stone analysis in the diagnosis and treatment of patients with stone disease. Have an in-depth knowledge of the radiographic evaluation of patients with stone disease including the use of both plain film radiography and Spiral Computed Tomography. Discuss in detail and perform various procedures used in the treatment of stone disease to include at least the following: (1,3-6) a. Describe the physics of shock wave stone fragmentation including the absorption of energy at the acoustical interface, internal reflections of shock wave within the stone and cavitation bubbles. Be familiar with pre-lithotripsy management including the indications for pretreatment stents and selection of methods of anesthesia. Describe the surface relationships of the kidney and the structures traversed when a needle is passed into the renal pelvis through a posterior calyx. Discuss the equipment used commonly in endourology including guide wires, balloon dilators, stents, stone baskets and lithotriptors. Demonstrate knowledge of the various types of fluoroscopy equipment and the risks of fluoroscopy. Discuss various methods of power lithotripsy including ultrasound, electrohydraulic and laser lithotripsy. Know the complication of percutaneous stone removal and understand methods for their management. Demonstrate ability to perform both rigid and flexible ureteroscopy in the treatment of ureteral and renal stones. Understand the use of baskets, forceps and other devices for ureteroscopic stone removal. Identify and discuss the gross and histopathologic features of the various types of renal tumors. Know the paraneoplastic syndromes that may be associated with renal cell carcinoma. Discuss the evaluation and plan a course of therapy for selected patients with various stages of renal cell carcinoma. Demonstrate the ability to select the best surgical approach (radical versus partial versus laparoscopic nephrectomy) in patients with kidney cancer. Discuss adjuvant therapy for patients with renal cancer including the roles of radiotherapy, chemotherapy and use of biologic response modifier therapies. Identify and discuss the appropriate follow-up, including the role of radiographic imaging, of patients after radical or partial nephrectomy for renal cancer. Discuss the theories regarding the etiology of cancer of the renal pelvis and ureter, and know the natural history and risk factors for tumor progression. Know the histopathologic features of transitional cell carcinoma of the upper urinary tract, including evaluation of urinary cytology. Demonstrate ability to elicit a history compatible with cancer of the upper urinary tract and discuss findings on physical examination.