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NEW ONSET OF CARDIOMYOPATHY(FUNCTIONAL BLOCK) 1. LYME? 2.AUTOIMMUNE? 3.VIRAL SUMMARY AND RECOMMENDATIONS ● The diagnosis of early Lyme disease can be made solely on clinical grounds if the characteristic erythema migrans (EM) lesion is present in a patient who lives in or has recently traveled to an area that is endemic for Lyme disease ( picture 1 and  picture 2 ). The patient with a characteristic EM lesion will likely be seronegative, since the lesion appears prior to development of a diagnostic, adaptive immune response. Laboratory testing is neither required nor recommended. (See  'Approach to diagnosis'  above.) ● In contrast to the negative serology at the time of the appearance of the EM lesion, by the time the patient has findings of early disseminated extracutaneous disease (eg, lymphocytic meningitis, facial palsy, radiculoneuropathy, carditis with heart block), serologic tests are typically positive, as they are in patients with late Lyme disease.

https://www.isixsigma.com/tools-templates/hypothesis-testing/making-sense-two-sample-t-test/ SE의 존재는 왜 필요한가? 내가 구한 sample 의 mean or proportion 이! standardize 되는 과정을 거치는 것이다. 모집단과 비교가 가능한 '형태' 가 되도록 하는 것이다. 1. 왜냐하면 일단 모집단의 평균! 내가 샘플한 그룹의 모집단의 진짜 평균과 SD는 구할 수 없다. 2. 그래서 우리는 SE mean. 평균들간의 분포차이를 구해야 한다. 이 값은 샘플의 SD 분산값을 n값으로 나눈 값이라고 할 수 있다. 즉, 우리가 샘플링한 값이 존나 커지면, 샘플 평균으로부터 모평균의 차이가 거의 없어지는 것이다. SE: 평균들 간의 분포차이를 내가 가진 샘플 사이즈 수준(20개 채취?) 같은 걸로 어떻게 예측 가능한가? - 샘플 숫자에 반비례 - 실제 data의 SD에 비례 이 두 값으로, 샘플 평규들간의 분포를 말할 수 있는데, 그게 SE 이다. 내가 채취한 샘플사이즈로 모집단의 평균들간의 차이를 예측할 수 있는 방법인 것이다. 이 평균들간의 분포차이로! 평균값의 차이를 나눠주면, 그것이 t test의 statistic이 되는데 어떻게 그렇게 되나? 즉, t - test에서 평균간의 차이가 크면 당연히 t test 커지면서= 차이가 있다! 라고 말 할 수 있다. 그런데 ? 실제로 분포가 존나 다양하면, 그 차이는 크게 의미가 없어지는 것이라고 할 수 있다. 내가 구한 샘플이 존나 많은 것 중에 하나이며, 그것은 그렇게 정확한 값이 아니고, noise가 존나 함유된 놈이라고 할 수 있는 어쩌면 구석탱이의 놈이라 할 수 있는 것이다. 반면! 샘플들의 분포가 존나 narrow한 상태! 아주 noise가 없는 존나 적확한 상태(from large large sample size로부터 온 것이거나, 실제로 data가 별 차이

NON PARAMETRIC = DISTRIBUTION FREE TEST BUT Expected frequency >5 (at least more than 80% of all cells) ; for running valid test. cf) if it's not met, should use FISHER's EXACT TESTS 써야한다. 이 '5' 라는 숫자가 나온 이유는, 계산상의 문제때문이었나??????

CONSTIPATION MANAGEMENT 1. Determine usual bowel habits and use of laxatives 2. Encourage fluids, fruit and bran; maintain bowel movement diary Prescribe stool softener and contact laxative: Docusate sodium (Colace) 100 mg po OD to TID to a maximum of 300mg po OD to TID (usual range: 1-9 capsules) Sennosides A&B (Senekot) 1 or 2 tabs po QHS to BID. May be given as tabs or syrup. Note that 5 ml of syrup = 1 tab (Maximum 3 tabs po TID) If no bowel movement by 48 hours, add one of: Milk of Magnesia 30 to 60 ml po OD to BID (avoid in renal failure) Lactulose 15 to 45 ml po OD to BID (preferential use in liver failure) If no bowel movement by 72 hours, do rectal exam to rule out impaction. If not impacted, try relieving with one of: Bisacodyl suppository 10 mg pr OD or BID Magnesium citrate solution 15g/300 ml 150 ml po OD Sennosides (Senokot) syrup 1.7 mg/ml 75 ml po OD Phosphate enema (Fleet) PR Oral Fleet Phospha Soda 1 bottle = 45 ml. May give ½ bottle po BID or 45 ml po OD. If impa

T. no preprocedure reversal is warranted for platelet count >20 x 10 9 /L  and INR <3.0. T. In general, nontunneled catheterization at sites that are easy to monitor for bleeding are preferred in patients with coagulopathy. The subclavian approach is often avoided due to inability to effectively monitor or compress the venipuncture site, unless an alternative site is not suitable. Ultrasound guidance decreases the number of attempts required for successful cannulation and reduces complication rates, including bleeding. Whenever available, cannulation should be performed by an experienced provider using ultrasound guidance for patients with coagulopathy   In spite of common concern and practice, there is limited evidence supporting routine correction of coagulopathy prior to central venous cannulation.  We advocate consideration of administration of a preprocedure blood product (eg, platelets, fresh frozen plasma [FFP], plasma frozen within 24 hours [PF24], prothrombin complex

What is a Right Tailed Test? A right tailed test (sometimes called an upper test) is where your hypothesis statement contains a greater than (>) symbol. In other words, the inequality points to the right. For example, you might be comparing the life of batteries before and after a manufacturing change. If you want to know if the battery life is greater than the original (let’s say 90 hours), your hypothesis statements might be: Null hypothesis : No change (H 0  = 90). Alternate hypothesis : Battery life has increased (H 1 ) > 90. The important factor here is that the  alternate hypothesis (H 1 ) determines if you have a right tailed test,  not the  null hypothesis .

[WORKUP]  pneumonia on chest radiography, fluid collection on computed tomography of the abdomen. Abdomen CT - possible even without contrast ! IMAGE = Cholecystitis -> stone = op. ===============> MAIN is USG. (Not for this. but used for r/o other etiology) (or if it's not urgent = than USG. ) IMAGE = pyelonephritis -> mostly not. severely(72hours = later on!) IMAGE = diverticulitis ===========================> No GB, Kidney => than do this(Full contrast CT scan for diagnosis, possible surgical candidate !! )  (The authors' practice is to perform an abdominal CT scan with oral and intravenous (IV) contrast to establish the diagnosis of acute diverticulitis because it has a high sensitivity and specificity for acute diverticulitis and can exclude other causes of abdominal pain) US= ECHO = Caridology(not urgent) Brain CT = not meaningful, but possible(not urgent) LP = possible for meningitis. SO only diverticulitis(even without diarrhea, tender a

II: ordinary cause SOB III: less than ordinary cause SOB IIIb: even minimal activity cause SOB IV: resting SOB. IIIb:  NYHA class III patients who are symptomatic with a recent history of dyspnea at rest Mozaffarian D, 2004 40 IIIB or IV Dyspnea or fatigue at rest or with minimal exertion

Hemodynamic effects of combined digoxin and dopamine administration in postoperative patients with cardiac dysfunction ☆ Author links open overlay panel L.Scott Cook MD, PhD 1 Scott K. Lucas MD 1 Thomas Whitsett MD, FACP 1 James E. Doherty MD, FACC 1 Russell Postier MD, FACS 1 Ronald C. Elkins MD, FACS 1 Show more https://doi.org/10.1016/0002-9610(83)90347-1 Get rights and content Abstract In 10 patients with postoperative cardiac dysfunction which required dopamine for inotropic and hemodynamic support, we observed the cardiovascular effects of short-term digoxin administration. The average dosage of dopamine was 7.45 μg/kg per minute and was maintained while the patients were given 1 mg of digoxin over 8 hours. The dosage of dopamine was then tapered over the next 4 hours. We observed a significant increase in the cardiac index (4 hours) and a reduction in the heart rate (8 hours) before the dopamine dosage was reduced. After a reduction in dopamine dosage to 2.28