Additional Medical Evaluations

At a minimum, the company must provide additional medical evaluations that comply with the requirements of this regulation if 

An employee reports medical signs or symptoms that are related to their ability to use a respirator. 

A physician, supervisor, or the respirator program administrator should inform the company that an employee needs to be re-evaluated. 

Information from the respiratory protection program, including observations made during fit testing and program evaluation, indicates a need for employee re-evaluation. 

A change occurs in workplace conditions (e.g., physical work effort, protective clothing, or temperature) that may result in a substantial increase in the physiological burden placed on an employee. 

At a minimum, the company must provide additional medical evaluations that comply with the requirements of this regulation if 1. An employee reports medical signs or symptoms that are related to their ability to use a respirator. 

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Additional medical evaluations. At a minimum, the employer shall provide additional... 

The 300 pg/g CRTU level for B2MU proposed in the above Paragraph has support among researchers as the threshold level that distinguishes between cadmium-exposed workers with and without kidney dysfunction. For example, in the guide for physicians who must evaluate cadmium-exposed workers written for the Cadmium Council by Dr. Lauwerys, levels of B2M greater than 200-300 pg/g CRTU are considered to require additional medical evaluation for kidney dysfunction (exhibit 8-447,... 

Two Army medical doctors, one of whom was a psychiatrist, interviewed the soldier under sodium pentothal on 26 May 1961. Later, they repeated the interview using voluntary hypnosis, followed by several additional psychiatric evaluations. One of the doctors suggested that a tension method aggravated by tension-producing drugs might be useful. ... 

Although all patients with depression should undergo a thorough medical evaluation, no specific tests are required before SSRI therapy is initiated. The usual starting doses of SSRIs are summarized in Table 2-1. These standard doses should be decreased by 50% in patients with hepatic disease and in elderly persons. In addition, patients with panic disorder or significant anxiety symptoms are often intolerant of the initial stimulating side effects that commonly occur with SSRI use. In these cases, the initial dose should be decreased... 

Several factors must be considered if antidepressant therapy is to be optimized in this age group. In addition to a thorough medical evaluation, as outlined earlier in this chapter as well as in Chapter 1, other potential contributing issues must be considered and dealt with if a satisfactory outcome is to be achieved. These may include the following ... 

Mrs. A accompanied Mr. A to the next few therapy sessions, and she appeared equally depressed. In fact. Dr. P noticed that she felt sad and exhausted herself after each session with the A s. Dr. P felt that her own responses to the A s indicated that the depression was not improving. After careful assessment and attentive empathy to the A s pain. Dr. P felt that they needed additional resources. She brought up the idea of a medication evaluation. Initially, the A s were reluctant. But after discussing the idea of medication for an entire therapy session, they consented to be seen by Dr. P s colleague. Dr. R. 

Dr. P begins to offer many possible options for each problem they are looking to address and asks them what problems they would like to address first. As part of this discussion. Dr. P mentions the possibility of a referral for a medication evaluation even though she is not convinced medication is essential. In addition to other treatment choices, Mrs. B immediately accepts the medication referral. 

The cost beneflt ratio associated with more aggressive management of metabolic disorders (e.g., hyperphosphatemia and hypercalcemia) and sHPT has not been formally evaluated. If the associated complications such as vascular and soft tissue calcifications that may increase morbidity and hospitalizations can be significantly reduced, the additional medication costs may ultimately be of minimal consequence. 

This male infant had normal physical and intellectual development until 2 yrs of age vdien abnormalities of speech were noted. Medical evaluation was delayed until the onset of seizures at 3 yrs. Diagnostic assessment at that time revealed microcephaly, mental retardation, and the presence of protein in the urine. Over the next 3 yrs he was followed for his kidney disease and signs of a progressive deterioration of neurological function. Our initial evaluation at that time revealed a retarded child with multiple signs of neurological dysfunction — microcephaly, decreased muscle tone and reflexes, optic atrophy with decreased visual acuity, a speech deficit, and a complex seizure disorder. In addition, he had growth failure and renal disease. Electron micro-... 

Additionally, please know that OSHA does not consider time spent traveling to and from medical evaluations as either days away from work or restricted work activity. Instead, the focus is on whether the injured or ill employee needs days away from work or restricted work activity to recuperate from the work-related injury or illness. Classification of the day off as a bonus holiday is not relevant to this determination. 

Following the medical evaluation, the healthcare professional will provide a written opinion to our company. The information in the opinion is limited to whether the employee requires the hepatitis vaccine, and if the vaccine was administered. The opinion letter further acknowledges that the employee has been informed of the medical evaluation results relating to the exposure and whether additional treatment is recommended. We give the employee a copy of the written opinion within 15 days after the evaluation. 

Dyspnea Dyspnea is shortness of breath or difficulty in breathing. The victim is usually quite aware of the unusual breathing pattern. Shortness of breath can be an indicator of many physical ailments including simple exertion, a panic attack, a blow to the chest, asthma, cardiac disease, as well as exposure to toxic chemicals. If a person is suffering from shortness of breath, evaluate them for additional symptoms and possible exposures. Keep the victim in a sitting position. Remove the victim to fresh air, if possible, and seek medical attention. 

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