Countless physicians, medical students, and therapists can describe a similar experience at one time or another during their training: a patient is behind the door in an examination room and the daily schedule has the words “shoulder pain” listed as the chief complaint. Depending on one’s experience or comfort level, many questions may immediately flood one’s mind regarding how to approach the patient: What are the various causes of shoulder pain? Is the pain really coming from the shoulder? What structures are important in the shoulder? What aspects of the physical examination will help distinguish one shoulder problem from another? The physical examination of musculoskeletal and peripheral nervous system problems is essential knowledge for broad areas of healthcare, as these problems are among the leading reasons for medical encounters. This pocket reference offers instant access to a wide array of clinical pearls to guide the physical examination and diagnosis. Whether one can choose to keep the print copy handy or use the digital version on our phone or tablet, our answer is quickly within reach. In this updated and refreshed second edition, one can search by body part or suspected diagnosis and find detailed descriptions of physical examination maneuvers, along with associated evidence of sensitivity and specificity, to help us with our diagnosis. Additionally, the reader will find all new colorized illustrations, high-resolution photos demonstrating the maneuvers, and corresponding videos that bring the examination to life. Video icons throughout chapters indicate which tests include an accompanying video. There is no substitute for excellent physical diagnosis skills. The authors hope that one will find this book useful as one develop and fine-tune their skills in order to give patients the very best care.
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Communion, defined as a shared journey of honoring each other’s being in and with the world, becomes a scared relational space for Professional Self-Hood. Professional Self-Hood has been defined as an internal embodiment and an external expression of nursing, the compilation of influences of being in and being with the world. Entering into communion to stretch in uncomfortableness begins the movement to unlearn, relearn, reaffirm, and recommit to the ongoing evolution of a just and caring version of ourselves as professionals, embodied and made visible as our Professional Self-Hood.
In this study, survival analysis is used to examine time to rearrest for both domestic violence and nondomestic violence crimes among a cohort of domestic violence offenders (N = 286) over a 10-year period. In addition, risk factors for rearrest such as demographic, offending history, and batterer treatment variables are examined to determine their influence on domestic and nondomestic violence recidivism. Overall, the results suggest that approximately half of domestic violence offenders are rearrested. Furthermore, among those who are rearrested, they are rearrested fairly quickly and for generalized (both domestic and nondomestic violence offenses) versus specialized offending. Risk factors associated with both types of rearrest included age, marriage, and domestic violence offense history. Several additional risk factors were unique to rearrest type. Study limitations are explicitly stated and policy implications are discussed.Source:
The firearm mortality rate in West Virginia (WV) increased over the past four years and is currently 50% higher than the national rate. These alarming statistics, combined with the urban-to-rural shift in firearm injuries, prompted this 10-year epidemiologic overview. To the best of the authors’ knowledge, the current study stands alone as the only report of its kind on firearm injuries in the rural setting of southern WV. Firearm injuries were common in White males within the age range of 20–49 years. Assault, which is typically identified as an urban problem, was found to be the most common injury in the study population. In our data series, injury severity score was the strongest predictor of mortality, followed by self-inflicted cause of injury and trauma to the neck/head region.Source:
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An 18-Year-Old Woman Who Attacked a Policeman With a Knife: Our Memorable Lesson on Treatable Causes of Dystonia
This chapter discusses the case of an 18-year-old woman, who had dystonia. She was sent to a psychiatric facility. She received low doses of haloperidol and a tricyclic antidepressant and after 2 weeks developed drooling, twisting of the neck to the right, and trouble walking. At that point, the psychiatrist consulted the movement disorders neurologist. She had drooling and cervical dystonia with laterocollis to the right with a mild rotational component. She presented an interesting diagnostic and treatment challenge. At the outset, the differential diagnosis consisted of primary psychiatric disorder and a possibility of drug-induced movement disorder versus a spontaneous movement disorder with psychiatric manifestations as seen in Wilson’s disease (WD). Her tests confirmed the diagnosis of WD, and she was treated with Penicillamine with the knowledge that it can cause further drop in platelets. Over the next several months, her eye movement became normal and the cervical dystonia disappeared.
College counseling has entered an era that promises to be radically different than any time in its previous 100-year history. College students in this 21st century are more technologically advanced than previous generations and more likely to take virtual classes than previous generations of college students. Traditional services provided by the college counseling center are: individual and group counseling, psychoeducational groups, evaluation and assessment, career counseling, consultation to faculty and staff, medication management and resident advisor (RA) training. Nontraditional services are defined as virtual counseling, advising, and related services offered via distance technology. College counseling centers have long offered types of self-instructional services. They will need to address social media in ways that are both ethically sound and also able to effectively engage college students in seeking counseling services. The counselor can administer the Dimensions of a Healthy Lifestyle Scale (DHLS) to the client and then discuss the findings.
The purpose of the study was to develop an institutional care model that reflected staff nurses’ perceptions of what nursing means to them. Swanson’s (1991) care theory concepts were compared to the nurses’ responses to evaluate if this middle-range theory could support a theoretically based institutional care model. It was discovered that the theoretical concepts of knowing, being with, enabling, doing for, and maintaining belief found in Swanson’s (1991) care theory were expressed by the nurses. A care model was created that provided a visual display and guided nursing practice at this institution.