The Clinical Management subsection describes appropriate interventions, including behavioral, pharmacological, surgical, and prosthetic. Topics covered in MITECD include cochlear implants for children and adults, pitch perception, tinnitus, alaryngeal voice and speech rehabilitation, neural mechanisms of vocalization, holistic voice therapy techniques, computer-based approaches to children's speech and language disorders, neurogenic mutism, regional dialect, agrammatism, global aphasia, and psychosocial problems associated with communicative disorders.
Call Number: John C. C4 D B5 M64 online only. C87 online only. P76 Gen Coll. The journal covers research, theory, and the application of psychological principles to address recognized disorders, including schizophrenia, mood, anxiety, childhood, substance use, cognitive, and personality disorders.
Table of Contents
Articles also address broader issues cross-cutting the field, such as diagnosis, treatment, social policy, and cross-cultural and legal issues. Textbook of Psychotherapeutic Treatments by [PsychiatryOnline]. Manual of Clinical Psychopharmacology by [PsychiatryOnline]. B4 E Reference. E35 Gen Coll. RC Immunologic diseases. A34 online only. A44 Gen Coll. H36 online only. H43 online only.
RC Diseases of the endocrine glands. B3 online only. T46 online only. J6 online only. H88 online only. E5 G online only. E5 L45 Gen Coll. U5 B online only. T48 Gen Coll. RC Diseases of the digestive system. T48 online only. L online only.
RC Diseases of the genitourinary system. C33 online only. S5 online only. K53 online only. T49 online only. A64 online only. The results indicate that remote assessment is feasible.
Critical Care | Intensive Care Medicine | Intensive Care Unit
According to Dr Thompson, for such a system to enter into widespread use, a number of factors must be dealt with. The concept of 'build it and they will come' simply will not work; a champion of this kind of technology is required. Relationships need to be built up between health care providers, and a skilled system administrator is vital.
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Probably the most important consideration is the need for the system to be easy to use by the doctor. Dr Sand's talk, entitled 'Clinical use of email with patients: perils and promises' provided an assessment of the use of this technology in patient care. The important properties of email are its asynchronous nature, informality, permanence and lack of richness. Security is probably not a real problem. There are admittedly clumsy encryption programs available, but the greatest security is simply the volume of email traffic being transmitted. Aside from a malicious individual deliberately attempt to target a particular physician's email, the biggest threat comes from leaving email available on the computer screen.
This is little different from leaving a patient's confidential notes open on a desk for all to read. Legal liability is a more interesting issue. In the US to date, there have been no legal rulings in this area, however Dr Sands argues that email is an excellent tool for defence against medical malpractice suits because, unlike a poorly documented phone call, email is permanent. When considering the demand for such a service, Dr Sands noted that 22 million Americans regularly look for health information via the Internet; just because they haven't asked about email communication, doesn't mean they aren't interested.
He then asked how many used their PDAs in clinical applications; two hands were raised. These have run a database called Handbase which will interface with Microsoft Access , and have been used successfully to collect patient data. There are other applications as well. Hospital protocols and guidelines can be stored, searched and recalled when required.
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Handheld computers have only recently been available, doubtless many new applications will become available for critical care practitioners. One of the final sessions was dedicated to the particular problems of critical care in space. Interestingly, it transpires that to date the most serious health problems have been minor burns during the fire on the Mir space station and a case of suspected appendicitis; there has never been a serious injury in space. Telemedicine is vital for the success of the international space station ISS , and for the planned, manned missions to Mars where hospitalisation will not be remotely practicable.
Whether by design or by accident, the satellite link used to clearly demonstrate the issue of time delay initially behaved somewhat unpredictably, illustrating the need for a clear understanding between the Earth based physician and the orbiting astronauts. Even after the bird has had time to gather its strength and calm down, it may only be strong enough to handle diagnostics and treatment in stages.
The avian history must be detailed and includes not only signalment and recent medical history, but also source of the pet, complete dietary history, caging history—including whether or not the pet is always supervised outside of the cage—exposure to other pets, as well as recent illnesses or deaths of other birds in the household. Refer to the podcast The Exotic Animal History for additional information. Proper restraint of birds, that does not lead to patient or veterinary staff injury, requires training and practice.
Prey species or wild birds will undergo a stress response that can cause catecholamine release and even death due to handling and treatment alone. Never restrain the avian patient for a prolonged period. Always plan a procedure that requires restraint and gather all equipment that may possibly be needed beforehand. House avian patients in a quiet area away from the sight and sound of predator species like cats, dogs, and ferrets.
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The cage setup should also physically block the view of one animal from another. Many birds will also benefit from some form of visual security. Drape a towel over part of the incubator or tape newspaper or some other opaque material over part of a treatment cage door. Dim light levels as needed to calm the nervous patient. A rapid metabolic rate means that small birds have a greater susceptibility to hypothermia.
Debilitated birds should be kept warm. Carefully observe the patient for signs of overheating, such as flat, sleek feathers, outstretched wings, and open-mouth breathing. Use particular caution in overweight birds. All but the weakest perching birds will be much more comfortable if provided with perch material. Place perches on the cage floor or elevate perches only slightly to minimize the risk of falls. Even loss of small volumes of blood can leave a tiny animal critically hypovolemic.
For these small patients, use small-volume fluid resuscitation with frequent reassessment rather than large fluid boluses. Vascular access sites are limited in the bird. Peripheral veins can be difficult to access, especially during shock, and the vessels are also prone to hematoma formation.
Intraosseous catheter placement is generally faster and easier in birds and should be used as a first choice in an emergency situation. Subcutaneous fluids are an excellent way to provide maintenance fluids to stable avian patients and to correct mild dehydration.
Subcutaneous fluids may also be the safest route initially for extremely debilitated patients as well as those with respiratory distress or coelomic distension.