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Jeff will tell you his feelings and stick to them, which is why you can always trust that he means what he says. Jeff has lived in our community his whole life and raised his family here.
He cares about large-scale commercial development in our area and small projects such as walking trails and sporting fields that make our community a great place to live. Nate Vojtech Lino Lakes. For several years, he worked for the Minnesota Department of Revenue and before that, for the government in Illinois. Most of us in the private sector have gone through two recessions in a dozen years.
Staufferhahn, who has been on the pro-government side for years, has little understanding of the real world for most of us. My vote will be to reelect Sen. Roger Chamberlain, a citizen legislator who knows personally the struggles most of us endure to support a family, educate kids and build a nest egg!
Steve King Centerville. For the last plus years I have been able to serve on local boards, commissions and councils to serve the residents of our community to the best of my abilities. On Nov. We have been represented by a commissioner who cares and who puts our area as a priority. I do not want to see that change. I feel Jeff Reinert is the person for.
He will not just conform to a group because it is easy, he will voice his opinions and will make sure our area is heard.
We may not be as populated as the districts to our west, but we are as important. I have had the chance to work with Mr. Reinert in his role as mayor, as a professional and as a resident.
He has the knowledge and passion for the job. He treats people with respect and is always willing to listen. He has ideas that may not fall in line with conformity but will always make this county a priority. He is honest and straightforward and will make the right choices for our district and the county. Please get out and vote Nov. Matthew Montain Centerville. Roger Chamberlain has shown he truly cares about his community and his state. He has done so in many ways.
Over the years he has been in every neighborhood and every precinct and has met with people where they live, learn and work. Several years ago, people from Minnesota Asian American communities called Sen. Chamberlain and asked him to meet with us about data disaggregation. He responded, listened to us and carried our concerns to the state Capitol. During 10 years serving as state senator, Sen.
Chamberlain has gotten things done. He pushed through the TCE ban; he championed rail repair and jobs in Hugo. On taxes, he delivered a middle-class tax cut and Social Security tax cuts. He fought for literacy and attention to dyslexia. Chamberlain, you are a senator of whom I am proud. You are more than platitudes. You listen, you act and you deserve our votes for reelection.
Jennifer Zhao Lino Lakes. Montain said he voted against the project, not because he was against the project itself, but to be a fiscally conservative voice when it came to spending taxpayer money. The money for the project will come from the stormwater utility fund. To date, city staff has been relying on estimated flows. City staff has found.
The change order also accounts for some minor piping changes due to field conditions discovered during construction. These two items were not included in the original bid because staff had not agreed upon a preferred vendor. Customarily, Centerville and Circle Pines, the two participating cities, ratify that decision by having their respective councils vote to accept the proposed budget.
The three participating cities, Centerville, Circle Pines and Lexington, customarily ratify the CLPD decision by having their respective city councils vote to. The council next meets at p. The Centerville City Council took the following action at its Sept.
At its Sept. Included in the new office design are touchless faucets at sinks and other touchless facilities, such as a water bottle filler. To learn why consolidating your retirement accounts to Edward Jones makes sense, call my office today. Tips for dementia caregivers during the pandemic risk factor for dementia.
Face masks or cloth coverings should be worn when tending to dementia patients. This includes when preparing meals for dementia patients or cleaning their homes. The CDC urges caregivers to wear personal protective equipment when providing personal or medical services to people with dementia, including when helping them bathe.
Caregivers should have a backup caregiver lined up in case they feel ill or if they are exhibiting. Support older adults or children starting school this fall via phone or video chat. Virtual training is provided. Frequent handwashing can help dementia caregivers keep their patients safe. If visitors arrive, insist they follow the same handwashing routine. If you cough or sneeze during the day, wash your hands immediately, and always wash hands before preparing meals.
Virtual gatherings have become the new normal as people try to maintain connections with family and friends while respecting social distancing guidelines.
Caregivers play vital roles in the lives of the people they look after. Despite social distancing guidelines and recommendations to reduce interactions with those vulnerable to COVID, including the elderly, dementia caregivers must continue to help patients in need.
That puts dementia caregivers in difficult positions, as data from the World Health Organization indicates that age is the strongest known.
Until recently, private funds or long-term care insurance have been the only ways to finance long-term care like skilled nursing homes, assisted living facilities or home health aides, which are not covered by traditional health insurance. However, a new option is now available. This results in a reduced death benefit, depending on how much of the long-term care benefit was used. Some policies even guarantee a small percentage of the death benefit, even if all the money allocated for longterm care was used.
The American Association of Long-Term Care Insurance said that more than , Americans purchased long-term care coverage in and roughly 84 percent of these purchases were for hybrid or combination life insurance. A much smaller percentage were traditional long-term care policies, showing the trend toward this growing insurance market. Hybrid products may have lower premiums, and they can be paid in a lump sum or over several years.
For those who do not tap into the long-term care savings, the policy will still pay out a death benefit to beneficiaries. Facebook Twin City Underwriters is an independent insurance agency that represents the leading Medicare insurance companies. Our experienced and licensed agents are knowledgeable about the different types of Medicare health plans available to you.
Making sure your plan matches your life to today and tomorrow. Lions Park community workshop at 7 p. City Council meeting at 7 p. EDA meeting at p. Parks Commission meeting at 7 p.
Annual clean up day from 8 a. Special meetings are posted in the City Hall lobby. Public notices are now published in The Citizen; read them at www. Fairview Health Services announced Oct. As a result, approximately positions systemwide will be eliminated by the end of the year. Joseph Hospital are undergoing significant changes and 14 primary care clinics in Minnesota will be consolidated into other locations by the beginning of December.
Sites to be consolidated by Dec. The name and street address of all persons conducting business under the above Assumed Name, including any corporation that may be conducting this business. In fact, most Centerville residents will barely notice any increase on their property tax statements come November, DeJong said.
DeJong said. For some properties, the tax increase may be almost imperceptible, or near zero, he said. DeJong called city leaders responsible both in the short term. DeJong told council members. Because the state of Minnesota is experiencing financial challenges of its own, he expects a move to reduce LGA payments to cities and counties. The city is not highly dependent on LGA from the state; it amounts to about 2.
DeJong said the city has a strong cash flow and has made good investments spread out at decent rates. The council unanimously chose the name Arcand Park. See full story on pages It was the consensus of the council that the preliminary tax levy provide for no increase in the urban tax rate.
The voucher is for work certified through Sept. Monday, Oct. Attendees are invited to attend the workshop in person with masks and social distancing or via videoconference. If not needed for capital projects, these funds can cover shortterm drops in property tax payments if residents are unable to make their payments on time.
The city also has healthy reserves in its general fund, water fund and sewer fund, he added. An opportunity for the public to see a budget presentation and comment on it will be available during the truth-in-taxation hearing, scheduled for Dec. The preliminary levy adopted at the Sept. Dining servers for breakfast, lunch, and dinner shifts.
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God Bless. Jerry - For more info and to apply online, go to shoreviewmn. Deadline: 12 noon, Monday, October 19, Housecleaners Needed! What if you were given the opportunity to make a difference in a Stable Essential Business! International Paper is working to supply critical shipping and packaging needs.
Our Twin Cities locations are seeking full-time employees to be part of their team. Online paintingsbypambrown. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
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Did you know? Brought to you by WeathermanWatson. Uncovered plants and vegetables were hit hard. Email watsonwx aol. Weather data and observation are from his weather station and trips around the area. Frank can be found on the internet at WeathermanWatson. Common request 5.
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The case Patient JJ is a year-old high-functioning girl without significant past medical history who was initially brought to a community hospital emergency department ED following parental concerns of two days of intermittent agitation and confusion.
Her parents noted that she had random episodes of crying and screaming alongside auditory hallucinations and writhing movements of her hands. Of note, the episodes. Following the episodes, she was slightly confused but then returned to her baseline.
In the ED, a head CT was obtained which was reported as normal. Basic labs were also drawn and were normal. She was referred to a psychiatric facility for further evaluation. Following a psychiatric evaluation, she was diagnosed with stress and told to make an outpatient appointment for counseling. As a result, she was brought to an academic medical center ED for further assessment.
She was consulted on by the psychiatry service in the ED and, while they thought she was likely suffering from acute psychosis, they recommended inpatient medical admission to first rule out neurological etiologies. Following admission to the adolescent unit, she experienced a generalized convulsive seizure that was described as the turning of her head to the left followed by whole body convulsions lasting approximately 30 seconds.
Following the witnessed seizure, she was placed on video EEG monitoring and a lumbar puncture was performed. The differential showed a lymphocytic predominance. She was subsequently placed on broad spectrum antibiotics as well as acyclovir to cover for potential herpes simplex virus HSV infection.
A brain MRI was obtained and was normal. At the time of the clinical seizure, the neurology service was consulted and recommended sending various infectious markers as well as serum and CSF testing for antibodies to the NMDA receptor.
Over the next few days, JJ developed dyskinesias of her mouth and hands and, given her prior symptoms, there was consensus among the neurologists that the diagnosis was anti-NMDA receptor encephalitis and that treatment with immunosuppression should begin. A pelvic ultrasound was performed to look for an ovarian teratoma and was negative. Over the course of her treatment, she remained agitated and required antipsychotic medication as well as a sitter.
She also developed difficult to treat insomnia, hyperphagia, and weight gain. She continued to have clinical seizures requiring aggressive anti-seizure management until stability was achieved with topiramate.
A second round of immunosuppressive therapy was given because of her continued encephalopathy. After approximately four weeks, she achieved a degree of clinical stability and was transferred to an inpatient cognitive rehabilitation facility.
As she had already been given two rounds of therapy with steroids and IVIG, it was determined that she required more aggressive medical therapy. She was then placed on a cyclical regimen of rituximab infusion therapy alongside dexamethasone.
After four rounds of therapy, her encephalopathy improved dramatically and she was at approximately 90 percent of her mental status baseline. Over the next year, she continued to improve and eventually completed her high school studies and enrolled in community college. She was tapered off topiramate and continues to be seizure-free. Repeated tumor surveillance was negative. Besides the aforementioned symptoms, there is also a link to ovarian teratomas in woman and testicular tumors in men. In a study by University of Pennsylvania researchers, 38 percent of patients with anti-NMDA receptor encephalitis were diagnosed with a tumor.
Of those diagnosed with a tumor, 97 percent were women. Interestingly, it. Therefore, patients who present with psychiatric symptoms in the absence of symptoms like seizure, movement disorder, or autonomic instability, are unlikely to have anti-NMDA receptor encephalitis. Lumbar puncture is.
There have been a few studies that have attempted to define the borders on this decision. The University of Pennsylvania study, for example, revealed that only 4 percent of the individuals studied displayed two or fewer symptoms within the first month of diagnosis versus 87 percent showing four or more symptoms. Additionally, a study of patients with new-onset schizophrenia did not reveal. Discussion The story of anti-NMDA receptor encephalitis began in following the discovery by Josep Dalmau and colleagues at the University of Pennsylvania of a clinical syndrome involving the tetrad of encephalitis, psychiatric symptoms, hypoventilation, and an ovarian teratoma.
By studying the CSF and serum of women with the syndrome, they discovered that each patient had developed extracellular neuronal antibodies. The NMDA receptor is a post-synaptic cell surface receptor that is involved in the regulation of excitatory glutamate neurotransmission. The antibodies bind to the receptor, leading to their endocytosis and subsequently decreasing electrical activity. The emergence of the neurologic and psychiatric symptoms is hypothesized to occur as an effect of the decreased electrical activity of these neurons.
There has been an occasional. Who does it affect? This disease encompasses all age groups, from childhood through late adulthood. The median age of onset in the aforementioned University of Pennsylvania study was 21, with a range from eight months to 85 years. There is a female predisposition 81 percent versus 19 percent. Notably, while the disease is present in all age groups, the initial manifestations differ between younger children and adolescents and adults.
A majority of children younger than 12 50 percent were brought to medical attention secondary to seizures or movement disorders whereas a majority of people age 12 or older presented with behavioral changes. Most of the children are noted to have cognitive or behavioral changes as the disease progresses and it remains a possibility that subtle behavioral changes were missed earlier simply because of age.
Diagnosis Given the association of both neurological and psychiatric symptoms in anti-NMDA receptor encephalitis, it can be difficult for medical professionals to decide when seeing a patient with psychiatric symptoms whether those symptoms.
Find it at M ST. According to the Minnesota Department of Human Services, the number of people living in nursing homes in Minnesota, not including those in a transitional care unit, is approximately 29, The number in long-term care settings other than nursing homes, such as assisted living, is significantly higher.
Rough estimates are that well over , individuals reside in an assisted living, group home, or other long-term care setting in Minnesota. Given the vulnerability and volume of residents, staff alone cannot meet all of the social, physical, spiritual, and psychological needs.
Family involvement Involved family members are a good thing for residents and providers, and should be seen. Family advocates in long-term care Understanding their role By Suzanne M. Scheller, JD as such. For instance, family members generally allow for a substitute decision maker when health care decisions need to be made for a client with diminished capacity. Involved family members may be able to transport their loved one to the doctor, provide input on their care given their extensive knowledge of the resident, and communicate messages back and forth.
Family members provide social interaction and facilitate outings that promote overall quality of life and minimize depression, which often accompanies longterm care. In addition, most family members ensure that bills to the provider get paid. While there are always outliers who require provider intervention, the vast majority of family members support and speak up appropriately when necessary. Advocates need to continue to speak up and providers need to continue to listen, for the good of the elder.
Effective family advocacy. A family member can effectively advocate for their loved one and work with the provider to ensure quality care.
In general, there are a few important themes for family advocates to keep in mind: visit the resident; take the time to read documents prior to signing them, even if the facility says that they must be signed right away; document any concerns; and periodically review medical records to ensure that concerns are incorporated and that the records are accurate and complete. Family members are advised to read admission agreements and resist the urge to simply sign under pressure.
Family can ask for one or two days to review the language before signing. No signature is actually required for admission. By not signing, the family is not precluding arbitration in the future, if both parties agree. However, in a non-nursing home setting the resident will likely be asked to sign two agreements, one as a lease under landlord-tenant law for the physical space and the other for home care services. Family members should read the agreement for home care services carefully see Minn Stat.
See Minn. Advocates should make sure that any concerns they raised are documented. This document dictates what staff will be doing when caring for a resident. Reminding a nursing assistant or perhaps even an LPN that the care plan is. If the records are in error, advocates should ask for an amendment to the record, which is allowed under HIPAA laws and regulations. This is considered a last resort option and must be weighed against the detrimental effects of moving the resident.
Most providers of long-term care are welcoming of family members, but may not fully understand the value of the family advocate and may perceive them as a source of difficulty. Here are some tips. Guarantee your seat today.
Health care professionals are there to provide care, support, and guidance, but there are other services available to patients and their families to help with the transition.
One such service that must be completed before the patient goes to a nursing home is pre-admission screening PAS. Unless an admission meets an exemption or exception, the screening must be completed prior to admission. The physician who determined the need for nursing home admission and wrote the admission orders must request the screening.
However, staff working directly with the physician, such as nurses, case aides, and administrative support staff within the hospital or clinic, as well as nursing facility staff, may also complete.
If the physician requesting the screening does not have enough information to complete the PAS referral online, he or she, or their designated staff, can complete the online form to the best of his or her ability.
Staff at the Senior LinkAge Line will then determine whether a face-to-face assessment with the county, tribe, or managed care plan is needed.
To assist with this effort it is important that the PAS contains as much information as possible. These required fields are necessary to process the screening and if they are not filled out, it will result in a call to the hospital or clinic worker that submitted the form;. This is your proof of completion, which can help your patient and the nursing home avoid delays. The faceto-face assessment must be completed within 20 calendar days of the initial request for screening, and prior to admission.
Please note: Step-by-step instructions are available on the referral site. Click the question mark next to the form submission option on the start page to access this information. The importance of assessments Rose was considering a permanent move to a nursing home because she was worried that her family thought she was a burden. A trained county staff person met with Rose and discussed housing options to help her make an informed decision.
In addition, the county was able to connect the patient back to the Senior LinkAge Line for additional assistance. Please note that if a patient is being admitted to a nursing facility outside of Minnesota, a PAS must be completed for the state where the nursing facility is located.
Similarly, if a patient is in a. North Dakota hospital, clinic, or nursing facility, but will be admitted to a Minnesota nursing facility, the PAS process for Minnesota must be followed using the online referral site. However, if a nursing facility admission cannot be prevented, the admission must be approved by the Department. There may be times when a physician determines that a nursing home admission must occur immediately.
It is important to note that for all individuals aged 20 or younger, a face-to-face assessment is required before admission, regardless of projected length of stay, admission source, or result of the screening.
The physician or their staff should still complete the online referral to facilitate the scheduling of this assessment. The Senior LinkAge Line will contact the appropriate lead agency for the next steps. During this assessment all community alternatives must be explored and.
Transferring to another state If the transfers occur to a nursing facility in another state, a new PAS must be submitted. There may be times when a physician determines that a nursing home admission must occur immediately, resulting in an emergency admission.
A screening must still be submitted, however it can be done the next working day. For purposes of PAS, an emergency admission is permitted when all of the following criteria are met: The pre-admission screening process to page After discovering I needed hearing aids, I wanted the best-trained, most competent and experienced audiologist I could find.
I also wanted the widest selection of quality products and finest follow-up services. After information-seeking visits with several recommended audiologists, Dr. Paula Schwartz easily rose to the top of my list.
Paula and her excellent group of audiologists, all with doctorates, have given me outstanding care over the past eight years. They are changing from paper-based systems to electronic health records EHRs for reasons that include improved care coordination and care transitions, as well as better data sharing and analytics.
There are now three stages of these incentives that must be met by clinical providers who wish to receive maximum reimbursement for serving people on public programs. Stage 1 focuses on capturing and sharing data,. Personal health records Improving care coordination By Tom Gossett, MM, PMP, and Rolf Hage Stage 2 on advancing clinical processes, and Stage 3 on improving outcomes additional information about meaningful use can be found online at www.
According to data compiled by that office, meaningful use incentives have contributed greatly to the adoption of EHR technology in clinical settings.
As of , percent of Minnesota hospitals and 93 percent of clinics have adopted EHR technology. While hospitals and clinics have progressed in adopting EHR systems, achieving interoperability between clinical systems remains challenging.
Adopting EHR technology has been slower in parts of the health care system where meaningful use incentives are not available. Based on its most recent data, the Office of Health Information Technology reports that in , 69 percent of Minnesota nursing homes had adopted EHRs.
Reliable data on adoption rates of EHRs in the home and community-based service HCBS provider community are not available but, given the limited size and resources of these organizations, it is logical to assume they lag behind nursing homes. Long-term services. RSVP jsg jsgalleries. Grantees were challenged to demonstrate the use of a personal health record PHR system with beneficiaries of community-based long-term services and supports LTSS.
Medical Assistance waiver programs pay for long-term services and supports in community settings to help eligible seniors and people with disabilities avoid more expensive institutional forms of care. Community-based services include home health care, homemaker and chore services, home delivered meals, transportation, respite care, case management, and mental health services.
Medical Assistance also pays for long-term care in nursing homes and assisted living facilities. While PHRs appear to be a good idea, they have not been enthusiastically adopted by most users. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process.
For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up to date is not useful and thus will not be used. Populating the PHR with data from state systems will require efforts by DHS IT and program staff to identify data about beneficiaries, their care plans and the services they receive, aggregate that data, and securely transmit it to an outside system.
It will also display data from clinical providers that serve the beneficiary. The county and LTSS providers will help identify beneficiaries who will test the PHR for accessibility and usability during the demonstration period. This includes determining what data about beneficiaries DHS currently collects and where that information is stored within DHS systems. It also includes deciding what parts of that data would be of interest to beneficiaries or their legal representatives.
Waiver recipients may not know they have a case manager or, if they do, how to contact them. If that information is included in the PHR, the beneficiary or legal representative will be able to more readily contact their case manager when they need to, and will be able to easily share the name and phone number of their case manager with others who need to know, including clinical providers.
Legitimate concerns about data security including compliance with HIPAA and the Minnesota Data Practices Act and the limitations inherent in older DHS technology have made passing information to beneficiaries electronically a challenge.
This project will provide DHS with an opportunity to test the concept of securely transmitting data out of its systems to beneficiaries. Currently, beneficiaries receive copies of service agreements, explanations of benefits, and eligibility reminders from DHS through the mail.
The sheer volume of letters and the inherent complexity of the information communicated can lead to confusion. Letters are often misplaced, discarded, or ignored by beneficiaries. An electronic repository of this information would make it easier for beneficiaries to track, review, and share this information with others within their circle of care.
As devices become more sophisticated and application developers design mobile-ready solutions, the mobile phone may also serve as an important entry point for consumers to access their PHRs. The mobile phone also introduces an important opportunity to support consumers in a behavior change through direct and customized text reminders. Time will tell whether the demonstration will expand to other counties or even statewide in the future.
Ultimately, the demonstration is another effort on the part of DHS to provide and enhance person-centered supports to beneficiaries. A person-centered approach requires that the PHR be easy to access and use.
DHS will work to ensure that the information included in the PHR is as simple as possible, so users can understand and act upon the information they receive. The Health Affairs article referred. Conclusion The PHR for long-term services and supports community collaborative is projected to launch in one geographically.
Grant project manager for the Minnesota Department of Human Services. The Physical Therapy and Occupational therapy teams were knowledgeable and nurturing. They know exactly what I needed to do to recover and challenged me to do it. The cleaning staff kept the floor of my room and bathroom spotless. Your facility helps to make the world a better, brighter, more hopeful place with the outstanding care you provide each patient and resident.
He is an otherwise healthy teen who participates in basketball yearround. A physical exam shows significant effusion and tenderness to palpation along the medial joint line. Plain radiographs show lucency along the medial femoral condyle. An MRI finds a large piece of bone and cartilage displaced from its native location along the weight-bearing aspect of the medial knee.
The diagnosis becomes clear: osteochondritis dissecans OCD. The family is anxious about what the future may hold and the young athlete is concerned about his upcoming season.
Fortunately, there are key symptoms and technologies to help diagnose the condition, as well as numerous treatment options. Symptoms Osteochondritis dissecans of the knee is a disease of both the subchondral bone as well as the overlying articular cartilage.
The affected bone is sequestered from the surrounding subchondral bone. This sequestered fragment, as well as its overlying cartilage, is termed the progeny fragment. With time, instability of the progeny fragment from the surrounding bone will develop and the overlying cartilage will become soft and fissured as its underlying support is.
Juvenile OCD is frequently diagnosed in the early adolescent athlete. The age of presentation seems to have become younger in recent years which is particularly true in girls.
Researchers attribute this early onset to an increase in competitive sports, single sport specialization, and loss of free play.
In advanced stages of OCD, the progeny fragment can become completely displaced from its native location leaving a cavitary defect within the weight-bearing zone. The cause While the exact etiology is unknown, OCD is thought to arise from the interplay of genetic predisposition and repetitive micro trauma, which leads to an insult in the small vessels that service the bone and cartilage.
Multidisciplinary researchers at the University of Minnesota Veterinary School, Center for Magnetic Resonance Research CMRR , and the Department of Orthopaedic Surgery have furthered this research though their work with advanced imaging of young patients with symptomatic OCD lesions and histological samples in an animal model.
Patients with OCD frequently present with complaints of activity-related knee pain. Swelling is an important physical exam finding and should be diligently evaluated. Persistent swelling in a young athlete should be evaluated by physical exam and radiography to confirm that an OCD lesion is not present. The overall incidence of OCD is thought to be approximately 20 in , individuals with a male predominance of It is present bilaterally in approximately 25 percent of patients.
OCD can be classified as adult or juvenile depending on the status of the distal femoral physis. The juvenile form, characterized by an open distal femoral physis and a cartilage surface that is frequently intact, has a higher potential to heal with a course of rest and activity modification. Adult OCD, which is thought to be an unresolved juvenile lesion, will not heal spontaneously. Its course is frequently progressive and.
Plain radiography is the initial diagnostic test. A knee series—AP, lateral, and sunrise views are frequently obtained; however, consideration to obtaining a flexed notch view in place of or in addition to the AP view may allow improved visualization of posterior-based lesions.
Lucency along the weight-bearing surface is how early lesions present; whereas, later lesions will often present with a rim of sclerotic bone and a well-circumscribed progeny fragment. We can utilize proton density and fluid sensitive sequences to evaluate the overlying cartilage and predict stability of the progeny fragment to the underlying bone.
Interposition of high signal behind the progeny fragment suggests instability. Treatment The treatment of OCD lesions depends on whether the patient is an adult or juvenile.
The juvenile variety of OCD those with open distal femoral physes can frequently be treated with a period of rest and activity modification. Crutches as well as an unloader brace to decrease forces across the affected compartment can also be considered. Experts recommend three months of rest and avoidance of running or pounding sports. At this time, radiographs are frequently repeated and re-initiation of sports in a gradual manner is started.
If pain, swelling, or other symptoms return, then surgical intervention should be considered. Providers should be careful to avoid the rest-improvement-pain-rest-improvement-pain cycle because it can be hard to tell if the patient is making progress. For this reason, experts recommend one period of definitive rest and if this fails, providers should explore surgical intervention. The surgical management of juvenile OCD depends upon the stability of the bone fragment as determined by arthroscopy.
Stable progeny fragments can be treated with drilling as a way to increase local blood flow, release marrow elements, and initiate healing. Progeny OCD fragments that are unstable at the time of arthroscopy require fixation. This can be completed utilizing an open or arthroscopic approach and is. An adult OCD lesion may be treated by fixation and bone grafting of the progeny fragment, but these lesions are often unrepairable. In this situation, excision of the progeny fragment and debridement of the unstable flaps of cartilage is.
After there are enough cartilage cells, they are re-implanted where they continue to grow and mature. Osteochondral allograft transplantation is a procedure where a piece of bone and cartilage is transplanted from a cadaver donor to the recipient, reconstructing the cartilage defect in the process.
OCD is thought to arise from the interplay of genetic predisposition and repetitive micro trauma. If symptoms persist, providers should consider cartilage reconstruction. The results The clinical outcomes of juvenile patients treated with surgery are good overall with a healing rate of greater than 80 percent.
No consensus has yet been reached on the specific techniques of marrow stimulation, the need for bone grafting, or the specific type of implant. The University of Minnesota is part of a multicenter study group called Research in Osteochondritis of the Knee ROCK , whose members are looking to answer these questions with prospective studies and creation of an OCD registry. Cartilage reconstructive surgery for the treatment of adult OCD lesions is also filled with promise and innovation.
This finding has led experts to use other techniques such as autologous chondrocyte implantation ACI or osteochondral allograft transplantation. Then, cartilage cells. The medical field has made great improvements in the treatment of OCD. Future studies will focus on early detection with MRI specific sequences to better predict healing potential in early OCD lesions as well as controlled studies to determine.
These future breakthroughs make this an exciting time in the treatment of osteochondritis dissecans of the knee. Jeffrey Macalena, MD, is an orthopedic surgeon specializing in sports medicine at the University of Minnesota. His clinical interests include ligament and cartilage reconstruction in the knee, patellofemoral disorders in both children as well as adults. He is the team physician for the University of Minnesota baseball and softball teams.
His clinical interests include ligament and cartilage reconstructions in children and adults as well as shoulder instability. As medical director for the University of Minnesota Department of Athletics, he is responsible for the care of Gopher athletes and is a team physician for the Minnesota Wild.
Understandably, health care providers often do not feel comfortable addressing the topic, or they may feel it borders on being unethical. However, a article in Professional Psychology: Research and Practice by Saunders, Miller, and Bright, describes the levels at which spirituality might be considered in mental health care. Voecks, MA; Lucas P.
Hansen; and J. Quality Transcription located in Minnesota maintains a professional office environment, thus the confidentiality of your work is strictly maintained. We provide medical transcription services on a contract or overload basis. Our equipment is state of the art with 24 hour dictation lines and nationwide accessibility. We are experts in our field. We deliver on time. We have experienced staff.
We monitor the quality of our work. We provide services tailored to your needs and will do whatever it takes to get the job done. Quality Transcription, Inc. Although this may seem obvious, it is important to clarify the differences. First, it is considered spiritual because the therapist has an awareness of complex matters ranging from undisputed truths, to personal beliefs. Second, this is a psychological approach, in that spiritually integrated care is not rooted in religious authority.
Therapists do not operate like clergy; they make no assumptions of religious truths, or deliver any type of religious rituals. In this same vein, research is a guiding principle of this approach, as it would be with any approach to psychotherapy.
Constant observation and measurement of clinical outcomes are fundamental in the evolution of spiritually integrated care. Pargament goes on to state that spiritually integrated care is not a competitor but a supplement to traditional psychotherapy.
Most important, spiritually integrated psychotherapy is a means to understand and engage a patient in a more complete way. There are ethical concerns to address when providing. In every case, it is vital that the patient provide informed consent to the type of care with which they feel most comfortable; spiritually integrated care should not be forced on clients who are not interested in this approach. Practitioner competence is also important.
Most often, this type of therapy is provided by a mental health practitioner who has a history of specialized experience, training, or research in spiritual aspects of mental health. Another approach is to use providers who are clergy with a history of specialized experience or training in mental health. In many VA settings, this type of care is provided by a team of co-therapists, one mental health provider and one chaplain.
Adherence to the disciplinary scope of practice is an important ethical concern in spiritually integrated care as well. Because mental health providers are not trained in theology, it is imperative that they do not teach theology in therapy.
The therapist should address psychopathology as it. For example, a client who belongs to a faith that teaches about a loving and forgiving Higher Power, but believes that they are unforgivable or unacceptable to their Higher Power, can benefit from education about the ways that symptoms.
Spiritually integrated therapy then includes education on the role symptoms play in relationships with a Higher Power or community of faith i. Spiritually-integrated care in the VA Like all hospitals, VA medical centers are required by the Joint Commission to provide spiritually-sensitive care. Two common spiritually involved mental health concerns within VA are post-traumatic stress disorder PTSD and the somewhat newer concept of moral injury.
A growing number of studies are documenting relationships between spiritual distress and clinical outcomes in PTSD and moral injury. According to Litz and colleagues, symptoms of moral injury may include guilt, shame, anger, emotional distress, and poor self-care. Often, soldiers are put in morally and ethically ambiguous situations where it is necessary to make quick decisions in order to survive or maintain the integrity of their unit and fellow soldiers. There are many examples of morally injurious events from each war era where, for example, a soldier may have to use lethal force to eliminate a perceived threat only to find out later that there was no threat at all.
Although the moral conflicts that service members face may seem obvious, morally injurious events are not exclusive to the military. Moral injury may be present wherever a person witnessed, engaged in, or observed an action that. This is exciting a waiting list for such a group. For instance, there was effectiveness with minority poping an active control group, is a young woman in New York ulations.
Finally, while research underway at the Minneapolis who was driving, when a child in the field of moral injury is VA Health Care System, inentered the street. An that concern. Research in this There are a number of poevent such as this can precipifield is still comparatively new, tential advantages of using BSS tate many of the symptoms of and further studies will be necand similar therapies. Many moral injury similar to those essary to determine the reliabilveterans avoid mental health reported by combat veterans.
Lucas P. Hansen, is a mental health collaborate research coordinator at the Minneapsettings, the in research olis VA Health Care System. Irene intervention on spirituHarris, PhD, LP, is a psychologist and provides a more socially acally integrated approaches to clinician-investigator at the Minnepost-traumatic stress and moral ceptable and accessible route to apolis VA Health Care System.
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