The Myth of Medical Clearance

2017 ◽  
pp. 105-114
Author(s):  
Libet Lev ◽  
Balan Yener ◽  
Thomas Seth
Keyword(s):  
Medical Clearance

Application of Components of the Massachusetts’ Sports Concussion Regulations to All Students With Concussion: A Survey of School Nurses

2018 ◽  
Vol 36 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Holly Hackman ◽  
Jonathan Howland ◽  
Alyssa Taylor ◽  
Linda Brown ◽  
Mary Ann Gapinski ◽  
...  
Keyword(s):  
High School ◽  
Confidence Interval ◽  
Focus Groups ◽  
Odds Ratio ◽  
School Nurses ◽  
Sports Concussion ◽  
Medical Clearance ◽  
Return To Learn ◽  
Two Measures ◽  
Academic Implications

Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state’s sports concussion regulations to all students with concussion, not just student athletes. We surveyed high school nurses in Massachusetts to examine (1) the extent of this practice and (2) the extent to which protocols for all students with concussion are included in school policies. Of 168 (74%) responding, 94% applied the return-to-learn and play, and medical clearance requirements to all students with concussion, regardless of how or where the concussion occurred and 77% reported their school’s policy required these protocols for all students with concussion. A significant association (odds ratio: 13.3, 95% confidence interval [2.4, 72.8], p <.01) existed between the two measures. These findings have important clinical and academic implications.

scholarly journals Covid-19 y cetoacidosis diabética erróneamente diagnosticadas como ansiedad primaria: Reporte de un caso acerca de causas médicas versus psiquiátricas de ansiedad.

2021 ◽  
Vol 84 (1) ◽  
pp. 51-57
Author(s):  
Jamie Rodríguez-León ◽  
Lorena Lucía Ortiz-Pinillos ◽  
Lizardo Cruzado
Keyword(s):  
Medical Clearance

Los trastornos de ansiedad tienen gran importancia en la psiquiatría de urgencias, tanto por la frecuencia con la que se presentan, como por la relevancia de las enfermedades somáticas que pueden subyacer a un cuadro ansioso. Resulta imperativo determinar desde el abordaje diagnóstico inicial si los signos y síntomas de la ansiedad constituyen una plena respuesta a situaciones de estrés, son manifestaciones de una patología somática subyacente, o se pueden explicar como síntomas de un trastorno psiquiátrico primario específico. En el momento actual, la pandemia de COVID-19 –en la que el Perú ha llegado a tener la mayor tasa de mortalidad mundial-- desborda los servicios de salud con abigarrados cuadros en los que se combinan tanto los síntomas de la infección viral por sí misma, como los de reacciones ansiosas y respuestas al estrés. A propósito de un caso ilustrativo, en el que el proceso de tamizaje médico fue deficitario y se etiquetó al paciente como un caso primario de “ansiedad”, con un desenlace lamentablemente ominoso, se revisa brevemente la literatura acerca del proceso de medical clearance  (o descarte de condiciones  médicas) y se reafirma concluyentemente la importancia de una consideración diagnóstica inicial abarcadora, no sesgada, y basada en criterios clínicos sólidamente elaborados y sustentados. Es evidente, por otro lado, que el psiquiatra requiere estar permanentemente actualizado sobre las formas de presentación psicopatológica asociadas a la sintomatología de COVID-19.

Controversies Surrounding Medical Clearance in Psychiatry Patients: evidence, recommendations, and potential approach

2021 ◽  
Vol 17 ◽  
Author(s):  
Walid Alam
Keyword(s):  
Laboratory Testing ◽  
Medical Illness ◽  
Routine Laboratory ◽  
Suggested Approach ◽  
Routine Testing ◽  
Diagnostic Uncertainty ◽  
Medical Clearance ◽  
The Impact ◽  
Adequate Communication ◽  
Rule Out

Background: Despite the evidence and guidelines recommending otherwise, routine testing remains pervasive in the management of patients presenting to the Emergency Department (ED) for behavioral complaints, under the guise of medical clearance (MC). The aim of this review is to highlight the evidence available concerning routine laboratory testing in psychiatry patients presenting to the ED, underline available guidelines, list possible reasons for over-testing, and propose a possible approach based on all the evidence and recommendations. Methods: Electronic database searches were carried out in Medline/PubMed and Google Scholar with the period set from January 1, 1990 to March 1, 2021. The search process was focused on studies where MC was evaluated in the management of patients presenting for psychiatric complaints to the ED. The references listed in each identified article were also screened and manually searched. Results: 14 relevant studies were found with the majority evaluating the impact of routine laboratory testing on the management and disposition of adults in the ED presenting for an acute psychiatric condition. Two studies investigated the use of a screening tool to rule out the presence of acute medical illness. Conclusion: While ED physicians are faced with many challenges such as litigation and fear of diagnostic uncertainty, few solutions have been proposed. A suggested approach relies on history taking, physical examination, and assessment of mentation to evaluate for the presence of an organic etiology requiring further testing. Adequate communication between the ED physician and psychiatrist, along with shared decision-making are also key to optimizing care.

Medical clearance of the gut in children

2012 ◽  
Vol 10 (6) ◽  
pp. 26-30
Author(s):  
Morris Gordon
Keyword(s):  
Medical Clearance

Medical Clearance

1990 ◽  
Vol 31 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Michelle Riba ◽  
Mahlon Hale
Keyword(s):  
Medical Clearance

scholarly journals A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion

2020 ◽  
Vol 35 (5) ◽  
pp. 627-627
Author(s):  
K M Petit ◽  
A J Zynda ◽  
M Anderson ◽  
C P Tomczyk ◽  
T Covassin
Keyword(s):  
College Students ◽  
Symptom Severity ◽  
Recovery Time ◽  
Cognitive Activity ◽  
Symptom Reporting ◽  
Future Research ◽  
Symptom Scale ◽  
Post Injury ◽  
Medical Clearance ◽  
The Relationship

Abstract Objective To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion. Method Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05. Results Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86). Conclusions Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.

scholarly journals Association of Leukocytosis with Amphetamine and Cocaine Use

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
John R. Richards ◽  
Valeria F. Farias ◽  
Chris S. Clingan
Keyword(s):  
Emergency Department ◽  
Psychiatric Patients ◽  
Drug Screen ◽  
Asymptomatic Patients ◽  
Medical Clearance ◽  
Emergency Department Stay ◽  
Testing Cost ◽  
Wbc Count ◽  
Lower Ratio ◽  
Unnecessary Testing

Objective. Determining the etiology of unexplained leukocytosis in asymptomatic patients may incur unnecessary testing, cost, and prolonged emergency department stay. The objective was to delineate if use of amphetamines and/or cocaine is a factor.Methods. For two years we reviewed all psychiatric patients presenting for medical clearance with exclusions for infection, epilepsy, trauma, or other nonpsychiatric medical conditions.Results. With a total of 1,206 patients, 877 (72.7%) amphetamines/cocaine-negative drug screen controls had mean WBC8.4±2.6×103/µL. The 240 (19.9%) amphetamines-positive, cocaine-negative, patients had WBC9.4±3.3×103/µL (P<0.0001). The 72 (6.0%) amphetamines-negative, cocaine-positive, patients had WBC7.1±1.8×103/µL (P<0.0001). The remaining 17 (1.4%) amphetamines/cocaine-positive patients had WBC10.0±4.2×103/µL (P=0.01). Amphetamines-positive patients had a supranormal WBC ratio significantly higher than controls (23.8% versus 14.8%,P=0.001), whereas only one cocaine-positive patient had a supranormal WBC count, with significantly lower ratio (1.4%,P=0.0003).Conclusion. Use of amphetamines, not cocaine, may be associated with idiopathic leukocytosis. This may be explained by unique pharmacologic, neuroendocrine, and immunomodulatory differences.

Sign in / Sign up

Export Citation Format

Share Document