Prolonged anesthesia times of 8 hours or more, a history of hepatitis, and large-volume intraoperative fluid resuscitations predicted adverse outcomes. Special care must be taken in counseling these patients preoperatively and in caring for them during their operative and postoperative course.
DVANCES IN MAGNETIC RESOnance imaging (MRI) have led to faster and therefore less expensive examinations. Several groups, including ours, have reported the development of a rapid MRI examination for the lumbar spine. 1-6 Using rapid MRI early in the care of patients with low back pain might benefit patients by providing a swifter definitive diagnosis, obviating further imaging or referral, and reassuring both patient and physician that there is no serious disease. However, early imaging with rapid MRI risks discovering incidental anatomic findings. In studies of subjects without low back pain, disk herniations are seen in approximately one third, 7-10 disk bulges in half to two thirds, 7,8,10,11 and disk degeneration in
The Coronavirus Disease 2019 pandemic initially presented in the United States in the greater Seattle area, and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes and access must be optimized in preparation for the expected COVID-19 patient surges. This article discusses the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management.
Essentials Radiology policy goals are to reduce COVID-19-related morbidity and mortality through early diagnosis, appropriate treatment and prevention of disease dissemination. Imaging currently is not routinely used to screen for COVID-19 unless access to RT-PCR results for COVID-19 is limited. Postponing elective imaging and procedures will preserve resources and hospital beds, while also limiting patient population exposures. Determination of time-sensitivity of procedures and imaging tests is by consensus with input from radiologists, patients, and/or ordering clinicians. Radiology departments must prepare for patient surges through streamlined approaches to imaging that will limit exposures to healthcare workers and patients.
Based on a small number of studies, tricyclic and tetracyclic antidepressants appear to produce moderate symptom reductions for patients with chronic low back pain. This benefit appears to be independent of depression status. SSRIs do not appear to be beneficial for patients with chronic low back pain. There is conflicting evidence whether antidepressants improve functional status of patients with chronic low back pain.
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