Clinicians use three methods to determine response to treatment: 1. Checking to see if the patient has continued symptoms of TB. 2. Conducting bacteriologic examination of patient’s sputum or other specimens. Specimens should be examined at least every month until culture results have converted from positive to negative.
Full Answer
How do we decide if a treatment is even needed?
10.2. Monitoring the progress of treatment. Patients should be monitored closely for signs of treatment failure. Monitoring response to treatment is done through regular history taking, physical examination, chest radiograph and laboratory monitoring.
How do clinicians select the best scientific evidence relevant to patients?
For a mental health professional to be able to effectively help treat a client and know that the treatment selected worked (or is working), he/she first must engage in the clinical assessment of the client, or collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine the person’s problem and …
How do physicians assess the ability of adult patients to understand care?
· Criterion 4.0 Guidelines should consider available evidence regarding patient-treatment matching. Some individuals with a given problem may respond better to certain treatments than to others, whereas a different patient with the same problem may show a different pattern of response. Patient-treatment matching may maximize efficacy.
Why do patients choose not to receive certain treatments?
The clinician standardizes and routinizes what can be standardized and routinized, as exemplified by standardized blood pressure measurements, diagnoses, and even charting about the patient’s condition and treatment. 27 Procedural and scientific knowledge can often be formalized and standardized (e.g., practice guidelines), or at least made explicit and certain in practice, except …
How can clinicians determine whether a patient is responding to treatment TB?
Patient Medical Evaluation Treating TB disease with an LTBI treatment regimen can lead to drug resistance (see the Preventing Drug Resistance section in this Module). To rule out TB disease, clinicians should determine whether the patient has symptoms of TB disease and evaluate the patient with a chest x-ray.
How do you monitor treatment responses?
Monitoring response to treatment is done through regular history taking, physical examination, chest radiograph and laboratory monitoring. The classic symptoms of TB – cough, sputum production, fever and weight loss – generally improve within the first few weeks.
Which of the following tests should be used to monitor the success of treatment for a patient with pulmonary tuberculosis?
New pulmonary TB patients with positive sputum smears at the start of treatment. These patients should be monitored by sputum smear microscopy at the end of the fifth and sixth months. If results at the fifth or sixth month are positive, a sputum specimen should be obtained for culture and DST.
How do you know if TB treatment is not working?
Testing to Monitor Tuberculosis Treatment Examining the sputum at regular intervals lets your doctor know the condition of your lungs — to confirm that the active tuberculosis disease is regressing and treatment is progressing the way that it should.
What is response to therapy?
Response to treatment supposes that the therapeutic targets that have been defined a priori - either symptoms or a syndrome - have been significantly modified by treatment. If rating scales are used, it is generally accepted that a change of less than 50% in the initial score is significant.
What is clinical response of drug?
Clinical drug response represents a complex phenotype that emerges from the interplay of drug-specific, human body, and environmental factors.
What is MX test?
A Mantoux test is a skin test that is used to detect infection by Mycobacterium Tuberculosis (TB). It is used to determine any immune response in the skin, by any individual who could have been or is being exposed to the bacteria.
Which of the following symptoms is common in clients with active tuberculosis?
What Are the Symptoms of TB? The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood.
What is the full form of DOTS?
The full form of DOTS is the Directly Observed Therapy, Short-course. It is also known as TB – DOTS. It refers to a strategy aimed at curing and reducing the risk of TB (tuberculosis) cases.
When does TB treatment start working?
It may be several weeks before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB. After taking antibiotics for 2 weeks, most people are no longer infectious and feel better.
What is treatment failure in TB?
Treatment failure of TB, which is defined as a patient who is sputum smear or sputum culture positive at 5 months or later after the initiation of anti TB treatment, 3 is one of the threats to the control of TB.
How does TB treatment work?
TB drugs can kill all the TB bacteria in a person's body. This means that the person is then cured of TB. But TB bacteria die very slowly, and so the drugs have to be taken for several months. Even when a patient starts to feel better they can still have bacteria alive in their body.
What are the symptoms of TB relapse?
Typical symptoms such as fever, night sweats, and weight-loss occur among approximately 75, 45, and 55% of patients, respectively. The presence of a persistent nonremitting cough has been cited as the most common symptom, recorded in approximately 95% of patients with TB.
Can TB become active after treatment?
After an initial infection, the bacteria that causes TB often becomes dormant in the body. But if left untreated, it can become active and infectious. After an initial infection, the bacteria that causes TB often becomes dormant in the body. But if left untreated, it can become active and infectious.
Can tuberculosis come back after treatment?
Patients who have recently completed treatment for tuberculosis (TB) are at elevated risk of recurrent TB disease, either as a result of relapse or reinfection [1, 2].
Will I always test positive for TB after treatment?
Yes, this is true. Even after you finish taking all of your TB medicine, your TB skin test or TB blood test will still be positive.
Does receiving a diagnosis mean you need treatment?
Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors (APA, 2013).
What is clinical diagnosis?
Clinical diagnosis is the process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5 or I CD-10 (both will be described shortly). Any diagnosis should have clinical utility, meaning it aids the mental health professional in determining prognosis, the treatment plan, and possible outcomes of treatment (APA, 2013). Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors (APA, 2013). Likewise, a patient may not meet the full criteria for a diagnosis but require treatment nonetheless.
What are the three critical concepts of assessment?
The assessment process involves three critical concepts – reliability, validity, and standardization . Actually, these three are important to science in general. First, we want the assessment to be reliable or consistent. Outside of clinical assessment, when our car has an issue and we take it to the mechanic, we want to make sure that what one mechanic says is wrong with our car is the same as what another says, or even two others. If not, the measurement tools they use to assess cars are flawed. The same is true of a patient who is suffering from a mental disorder. If one mental health professional says the person suffers from major depressive disorder and another says the issue is borderline personality disorder, then there is an issue with the assessment tool being used (in this case, the DSM and more on that in a bit). Ensuring that two different raters are consistent in their assessment of patients is called interrater reliability. Another type of reliability occurs when a person takes a test one day, and then the same test on another day. We would expect the person’s answers to be consistent, which is called test-retest reliability. For example, let’s say the person takes the MMPI on Tuesday and then the same test on Friday. Unless something miraculous or tragic happened over the two days in between tests, the scores on the MMPI should be nearly identical to one another. What does identical mean? The score at test and the score at retest are correlated with one another. If the test is reliable, the correlation should be very high (remember, a correlation goes from -1.00 to +1.00, and positive means as one score goes up, so does the other, so the correlation for the two tests should be high on the positive side).
What is a psychological assessment?
Psychological tests assess the client’s personality, social skills, cognitive abilities, emotions, behavioral responses, or interests. They can be administered either individually or to groups in paper or oral fashion.
Can personality be assessed?
That said, personality cannot be directly assessed, and so you do not ever completely know the individual. 3.1.3.4. Neurological tests. Neurological tests are used to diagnose cognitive impairments caused by brain damage due to tumors, infections, or head injuries; or changes in brain activity.
What is the purpose of a CT scan?
Finally, computed tomography or the CT scan involves taking X-rays of the brain at different angles and is used to diagnose brain damage caused by head injuries or brain tumors. 3.1.3.5. Physical examination.
What is MRI imaging?
Images are produced that yield information about the functioning of the brain. Magnetic Resonance Imaging or MRI provides 3D images of the brain or other body structures using magnetic fields and computers. It can detect brain and spinal cord tumors or nervous system disorders such as multiple sclerosis.
What is the best position to be aware of the unique characteristics of individual patients?
Health care professionals are in the best position to be aware of the unique characteristics of individual patients. The treatment strategy most likely to succeed usually combines the most effective specific interventions with a strong therapeutic relationship and a mutual expectation of and framework for improvement.
What is treatment guidelines?
That is, treatment guidelines are patient directed or patient focused as opposed to practitioner focused, and they tend to be condition or treatment specific (e.g., pediatric immunizations, mammography, depression).
What is a health care guideline?
Generally, health care guidelines are pronouncements, statements, or declarations that suggest or recommend specific professional behavior, endeavor, or conduct in the delivery of health care services. Guidelines are promulgated to encourage high quality care.
Why are guidelines promulgated?
Guidelines are promulgated to encourage high quality care. Ideally, they are not promulgated as a means of establishing the identity of a particular professional group or specialty, nor are they used to exclude certain persons from practicing in a particular area.
What is the most likely treatment strategy to succeed?
The treatment strategy most likely to succeed usually combines the most effective specific interventions with a strong therapeutic relationship and a mutual expectation of and framework for improvement. Such factors, which are common to most treatment situations, can be powerful determinants of treatment success.
Can treatment guidelines reduce cost?
It is often assumed that the use of treatment guidelines will significantly reduce the cost of services. This is not necessarily true. It is possible that guideline implementation may cause some services to be discontinued because of evidence documenting an intervention's lack of efficacy.
What is the first dimension of a guideline?
The first dimension is treatment efficacy, the systematic and scientific evaluation of whether a treatment works.
What is clinical reasoning in nursing?
In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking. The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking.
What is the ability of a clinician to provide safe, high quality care?
The clinician’s ability to provide safe, high-quality care can be dependent upon their ability to reason, think, and judge, which can be limited by lack of experience. The expert performance of nurses is dependent upon continual learning and evaluation of performance. Critical Thinking.
What is the high performance expectation of nurses?
The high-performance expectation of nurses is dependent upon the nurses’ continual learning, professional accountability, independent and interdependent decisionmaking, and creative problem-solving abilities. Learning to provide safe and quality health care requires technical expertise, the ability to think critically, experience, ...
What is clinical judgment?
Clinical judgment requires clinical reasoning across time about the particular , and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments.
What is critical thinking?
Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes.
What is the final assessment of whether a patient has medical decision-making capacity?
The clinician's final assessment of whether a patient has medical decision-making capacity depends on whether the clinician believes that the patient is free of significant psychopathologic-impaired thinking and possesses sufficient abilities to make the specific decision in question.
Why do some patients refuse treatment?
Some patients refuse treatment for reasons that may be unusual or idiosyncratic but are not irrational when examined in more detail. Other patients consent to treatment without apparent consideration of risks and benefits because they have already decided to follow the recommendations of their physician.
What is the diagnosis of a 78 year old man with metastatic cancer?
A 78-year-old man has a recent diagnosis of metastatic cancer of unknown primary. He returned to the office today after having a computed tomography (CT) scan showing a pancreatic lesion that may be the primary cancer and is the only lesion accessible for biopsy. He requires large doses of narcotics for pain control and his level of consciousness fluctuates greatly. It is not clear if he understands his prognosis or that a tissue diagnosis will probably not affect treatment or outcome. When he is more lucid, he wants “the test”—a CT-guided pancreas biopsy. Does this patient have the capacity to consent to this procedure?
What are clinical scenarios?
Four clinical scenarios are described 1 that should alert physicians to assess a patient's decision-making capacity more carefully than usual. The first occurs when patients have an abrupt change in mental status. This change may be caused by hypoxia, infection, medication, metabolic disturbances, an acute neurologic or psychiatric process, ...
What causes a change in mental status?
This change may be caused by hypoxia, infection, medication, metabolic disturbances, an acute neurologic or psychiatric process, or other medical problem.
What are the ancillary tests?
Ancillary tests may be needed, depending on the individual circumstances, including history from therapists or other caregivers, physical assessment, laboratory evaluation and possibly even neuroimaging studies. These tests may all help clarify whether the current level of functioning and, possibly capacity, is likely to improve. Table 1 1, 4 – 6 outlines specific patient abilities to be assessed along with suggested questions to assess each ability during a directed clinical interview. After these abilities are assessed, a general mental status examination also must be performed to determine whether any serious psychopathologic factors may be unduly influencing patient thinking. The clinician's final assessment of whether a patient has medical decision-making capacity depends on whether the clinician believes that the patient is free of significant psychopathologic-impaired thinking and possesses sufficient abilities to make the specific decision in question.
Do local authorities have to be consulted?
Local authorities should be consulted for specific legal definitions and procedures. 8 Practically, most cases never reach the courts and, when they do, the court's legal “determination of competency” usually agrees with the physician's overall “assessment of capacity.”.
Is it a routine experience to receive a request for medical management from a colleague?
In the medical profession, receiving a request for medical management from a colleague is a routine experience. However, when the colleague is a family member of a patient and the desired or requested medical intervention is not medically indicated in the attending physician’s view, the situation becomes more complicated.
What are the barriers to access for a clinician?
Clinicians who become patients can also experience barriers to access, such as embarrassment, lack of time due to professional constraints, and minimization of symptoms due to clinical knowledge, which can affect the quality and timeliness of care [4].
What are ethical issues in medical management?
Ethical issues include respect for patient autonomy and social justice as well as nonmaleficence. Furthermore, interpersonal and professional relationships may be tested in this situation. Addressing the colleague’s concerns with empathy and respect, without compromising one’s own medical judgment, is critical in resolving these kinds of conflicts.
Is ordering a scan unethical?
Rose does not believe is appropriate), ordering a scan could be considered unethical.
Which medical organizations advise against caring for friends and family?
In fact, several medical organizations such as the American Medical Association, the American College of Physicians, and the American Academy of Pediatrics advise against caring for friends and family [10-12].
What are ethical issues in healthcare?
Ethical issues include respect for patient autonomy and social justice as well as nonmaleficence.
Can a psychiatrist evaluate capacity?
Any physician can evaluate capacity, and a structured approach is best. Several formal assessment tools are available to help with the capacity evaluation. Consultation with a psychiatrist may be helpful in some cases, but the final determination on capacity is made by the treating physician.
What is the role of decision making in medical?
Medical decision-making capacity has four key elements. Patients must be able to (1) demonstrate understanding of the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment); (2) demonstrate appreciation of those benefits, risks, and alternatives; (3) show reasoning in making a decision;
What is medical decision making capacity?
Medical decision-making capacity is the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment). Capacity is the basis of informed consent. Patients have medical decision-making capacity if they can demonstrate understanding of the situation, ...
What is the basis of informed consent?
Capacity is the basis of informed consent. Patients have medical decision-making capacity if they can demonstrate understanding of the situation, appreciation of the consequences of their decision, and reasoning in their thought process, and if they can communicate their wishes. Capacity is assessed intuitively at every medical encounter ...
What happens if a patient is not able to give consent?
If the patient is unable to give consent and identifying a surrogate decision maker will result in a delay that might increase the risk of death or serious harm, physicians can provide emergency care without formal consent. ...
What is clinical application?
References. If a physician determines that a patient does not have the capacity to make a treatment decision, consent for treatment must be obtained from other sources. If the patient has an advance directive applicable to the clinical situation, it should be used to guide decisions.
What happens if a patient has no power of attorney?
If not, the physician should determine whether the patient has designated a medical power of attorney. If there is no valid medical power of attorney, the closest relative usually becomes the surrogate. The priority of relatives varies by state, but the typical order is spouse, adult children, parents, siblings, and other relatives.
What is the obligation of a physician to obtain informed consent?
The corresponding obligation on the part of the physician is to obtain voluntary informed consent when a patient is to be subjected to surgery and, increasingly, to some nonsurgical interventions as well.
Is migraine a radiological diagnosis?
There are no reliable diagnostic markers or radiological findings. Nevertheless, in the United States, almost every patient who reports migraine headaches is subject to neuroimaging studies (CT or MRI) at some point, if only to exclude an underlying vascular lesion, space-occupying mass, or other treatable pathology.
What is the purpose of autonomy and informed decision making?
Autonomy and informed decision making are usually invoked in the context of positive coercion—an attempt on the doctor’s part to persuade a patient to agree to a certain course of action or to act in a certain way. Patient autonomy and informed decision making are protective principles.
Why is it important to move to a more accessible approach for all patients?
Since approximately half the population will have difficulty with health care information, it makes sense to move to a more accessible approach for all patients. That means consciously leaving time in the discussion with the patient to ensure his or her understanding of the information. One recent study found that physicians assess patients' understanding of their instruction only two percent of the time. This is clearly an area with room for improvement.
How can physicians learn effective communication strategies?
The AMA report states that physicians can learn effective communication strategies, such as making their instructions interactive by having patients do, write, say, or show something to demonstrate their understanding: this is sometimes referred to as having the patient "teach back" the information.
What percentage of Americans have reading and computational skills deficiencies?
At the start of the 21st century in one of the wealthiest and most sophisticated societies on earth, we have discovered a most unpalatable truth: approximately half of Americans have reading and computational skill deficiencies that could impede their participation ...
Is limited literacy a barrier to effective medical diagnosis and treatment?
In a report examining the scope of the problem of health literacy, the American Medical Association's (AMA) Council on Scientific Affairs found that "limited literacy is a barrier to effective medical diagnosis and treatment .". 13.
Why is the AMA report important?
The AMA report stresses the importance of physicians and other health professionals increasing their awareness of the widespread incidence of low literacy and the barriers it raises throughout the health care system.
What percentage of English speaking patients have inadequate health literacy?
81 percent of English speaking patients age 60 or older had inadequate health literacy. 2. A recent study of 3,260 new Medicare enrollees in a national managed care organization found that inadequate health literacy increased steadily with age, from 16 percent of those age 65–69, to 58 percent of those over age 85. 3.
How to contact AMA Foundation?
For more information on the AMA Foundation's health literacy education materials and initiatives, contact the author at 312-464-5355, or via e-mail to [email protected].
