Responses are measured on a scale of 1 to 5, with 5 being the best score. MR MOHAMED AHMED - Complex Spine "No staff member is going to be forced to relocate or lose their job with Queensland Health," he said. Independent practitioners are not Inova employees, agents or representatives of Inova and are solely responsible for their provision of medical care to you. When Shaun Podbury suffered severe ruptures to his spine in a paragliding accident, he was airlifted directly to Princess Alexandra Hospital (PAH). Ankle Problems/Surgery and Treatments, Elbow Problems/Surgery and Treatments, Hip Problems/Surgery and Treatments, University of Illinois College of Medicine at Chicago, Inova Medical Group - Orthopaedics and Sports Medicine. Orthopaedics - Princess Alexandra Hospital - NHS The spinal unit is the community of experts that surrounds us," he said. Mohamed Ahmed, Consultant Orthopaedic Spinal Surgeon provides a quick insight into the best steps for a good recovery from back pain. ", Browse for your location and find more local ABC News and information. Brisbane Private Hospital, Public Hospital Appointment: . Cape Town Area, South Africa. Phone: 07 3163 8111 Spinal injury patient left in 'limbo' at Princess Alexandra Hospital amid understaffing, bed shortages, Follow our live blog for the latest from the Met Gala, Keep up with the latest ASX and business news. "You have no idea when you're going to get a bed, you've just had a traumatic injury that's life-changing, so you're trying to deal with that mentally as well. "Whether it happens at the PA or Herston all the support services whether it's actually in the surgical area, whether it's plastics, whether it's in therapies, will still be provided to patients. Pediatric Specialists of Virginia. Patients are de-identified for confidentiality and patient privacy. healthdirect's information and advice are developed and managed within a rigorous .css-9pahks{transition-property:var(--chakra-transition-property-common);transition-duration:var(--chakra-transition-duration-fast);transition-timing-function:var(--chakra-transition-easing-ease-out);cursor:pointer;-webkit-text-decoration:underline;text-decoration:underline;outline:2px solid transparent;outline-offset:2px;color:var(--chakra-colors-white);}.css-9pahks:hover,.css-9pahks[data-hover]{-webkit-text-decoration:underline;text-decoration:underline;}.css-9pahks:focus-visible,.css-9pahks[data-focus-visible]{box-shadow:var(--chakra-shadows-outline);}.css-9pahks:focus,.css-9pahks[data-focus]{outline-color:var(--chakra-colors-formControlFocus);outline-offset:1px;outline-width:2px;box-shadow:var(--chakra-shadows-none);border-radius:var(--chakra-radii-small);}clinical governance framework. Personalised Hormone Health and Menopause Care at One Ashford Hospital. PAH: Hospital trauma and orthopaedics department recognised for Princess Alexandra Hospital. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. He really made me feel comfortable. Queensland Health's Shaun Drummond said he would be meeting with patients and stakeholders face-to-face in two separate consultations next month. Alternatively you can view a full list of our specialists. I cannot thank Mr Ahmed enough. NHS constitutional rights | He has been a consultant at the Princess Alexandra Hospital since 2006 and has developed a large foot and ankle practice as well as managing tauma. Call 855-694-6682, Nemours Alfred I duPont Hospital for Children. Mater Medical Centre The Patient Rating score is an average of all responses to physician related questions on our nationally-recognized Press Ganey Patient Satisfaction Survey. There is no charge or fee to you or for the participating provider for our service. The successful candidate will report directly to a Consultant Orthopaedic Surgeon. Dr. Holzman is an orthopedic surgeon with a subspecialty designation in orthopedic trauma. Additionally, Mr Satish Kutty (pictured), consultant trauma and orthopaedic surgeon, received the Regional Trainer of the Year accolade. In this video, Mr Mohamed Ahmed answers the most common questions relating to spinal decompression. Princess Alexandra Hospital is a tertiary health care centre, providing care in most major adult specialties. Princess Alexandra Hospital NHS Trust Oct 2018 - Present4 years 7 months Harlow Education The University of Edinburgh Bachelor's DegreeMedicineMBChB 2002 - 2007 Chartered Management Institute. Orthopaedics; Orthopaedics. Help us to keep Service Finder up to date. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. We are one of Australia's leading academic and research health centres. Dr. Holzman is an orthopedic surgeon with a subspecialty designation in orthopedic trauma. Please provide specific details about what is incorrect (e.g. Mr Paul Allen - Consultant Orthopaedic Surgeon, Rivers Hospital Freedom of information | He also offers treatment for hip and knee disorders. We pay our respects to the Traditional Owners and to Elders both past and present. Timing of first review appointments at orthopaedic outpatients/fracture clinic, NB No matter the chronicity all should be referred to ED or local orthopaedic registrar on call. "I had been around the unit, and I absolutely acknowledge that the unit needs replacement," he said. MBBS FRACS FAOrthA CIME, Phone: +61 7 3834 6592 Responses are measured on a scale of 1 to 5, with 5 being the best score. He studied medicine in Sudan and underwent higher surgical training in Orthopaedics and Trauma in Norway. He has a broad experience in adult spinal surgery, using the very latest techniques and treatments. Hand and Upper Limb Surgeon including microsurgery Dr Ahmed had previously carried out a Medial Branch Block procedure. Mater Online - Dr Matthew J Hope Australian Orthopaedic Association (Past QLD Branch Committee Member) Privacy notice | Email: mroffice@upperlimb.com, Qualifications: Sitemap, Health and Wellness - Private allied health, Mater Intellectual Disability and Autism Service, Mater Memory and Cognitive Disorders Clinic, Outpatient Clinics for patients aged 16+, Rehabilitation Unit - Private Hospital Brisbane, Rehabilitation Unit - Private Hospital Redland, Mater at Home - community and in home care, HealthandWellness-Privatealliedhealth, MaterIntellectualDisabilityandAutismService, MaterMemoryandCognitiveDisordersClinic, OutpatientClinicsforpatientsaged16+, RehabilitationUnit-PrivateHospitalBrisbane, RehabilitationUnit-PrivateHospitalRedland, MateratHome-communityandinhomecare. A native of Chicago, IL, Dr. Holzman currently resides in Fairfax with his fiance. There is no charge or fee to you or for the participating provider for our service. We are extremely proud of the programme. This is a prestigious award from the British Orthopaedic Association (BOA) which selects one surgeon every two years for this fellowship. (http://www.health.qld.gov.au/pahospital/), Princess Alexandra Hospital, 199 Ipswich Road WOOLLOONGABBA QLD 4102. Neil. He has a specific interest in the management of pelvic and acetabular fractures. Dr Philip Rowell is an Orthopaedic surgeon and an Oncologist and has published research in the areas of sports medicine, paediatric orthopaedics, arthroplasty and orthopaedic oncology. Dr Hope is the Director of Orthopaedics at the Princess Alexandra Hospital and additionally completes public work at the Queensland Children's Hospital, specialising in complex paediatric foot conditions and trauma. Fax: +61 7 3834 6593 It may contain important information that you should check with your preferred translation tool. If you have not had an outpatient appointment in the last 12 months, your GP will need to provide a new medical referral. Orthopaedic Surgery - Hand, Orthopaedic Surgery . Patients are de-identified for confidentiality and patient privacy. reports of patients being left naked in front of others and lying in their own faeces. A spinal injury patient has waited sixweeks to receive a bed at Queensland's only dedicated spinal unit, compromising his recovery and leaving himin mental and physical "limbo". Princess Alexandra Hospital | Metro South Health Repair of tendon in the knee and lower leg. Your email address will not be published. It is nationally recognised for its expertise in trauma management and is a major transplantation centre for livers, kidneys, bone, cartilage, and corneas. Australian Medical Association A spinal injury patient says a proposal to relocate the Princess Alexandra Hospital's spinal unit is a "kneejerk reaction" that will create more problems than it solves. 8095 Innovation Park Drive, Fairfax, VA 22031 Questions? 8095 Innovation Park Drive, Fairfax, VA 22031 Questions? suspected septic arthritis, Evidence of acute inflammation e.g: haemarthrosis, tense effusion, Uncontrolled sepsis including hand infections, Upper limb radiculopathy in the presence of suspected cervical spine infection, Acute development of peripheral nerve compression symptoms following trauma or acute event, Evidence of acute inflammation for example, Suspected infection or sudden pain in arthroplasty. Mr Podbury said a relocation would make it more difficult for spinal injury patients to access necessary therapy services, and said the relocation would not resolve existing understaffing issues. "And every piece of research regarding rehab from spinal injuries says the earlier you start, the more likelihood there is of getting significant gains.". Well done to the award winners and all those who support the surgeons in the background. This provides a single point of entry for all referrals to Princess Alexandra Hospital, including the Spinal Injuries Unit. Jun 2016 - Aug 20163 months. The Trust has an excellent success rate in this. Outpatient Services | Queensland Health He received immediate surgery upon arrival at the hospital's orthopaedic unit. View Orthopaedics at Herts and Essex Community Hospital Haymeads Lane, Bishop's Stortford, Hertfordshire, CM23 5JH View Orthopaedics data about Herts and Essex Community Hospital; View Orthopaedics at Princess Alexandra Hospital Hamstel Road, Harlow, Essex, CM20 1QX View Orthopaedics data about Princess Alexandra Hospital Terms and conditions, Electronic consent for treatment or a procedure, How to give a compliment, raise a concern, or make a complaint, Upper limb disorders, both arthroscopy and open surgery, Lower limb disorders including complex and revision joint replacements and arthroscopy of the hip, knee and foot ankle. Mr Podbury told ABC Radio Brisbane it felt like he was in a system that was not fit for purpose. Fellow of the Australian Orthopaedic Association You may be referred to our hip arthroscopy services by a neighbouring trust. Getting here Viewing your appointment letters online Make movement count Electronic consent for treatment or a procedure Appointments Get involved Outpatients Visiting our hospitals He completed his medical training with honours at Bart's in 1995 and ultimately undertook his orthopaedic surgical training at The Royal London Hospital. Dr Fay Gilder, medical director at The Princess Alexandra Hospital NHS Trust, added: I am delighted to see the trauma and orthopaedics department acknowledged for the amazing training they offer. He is also a visiting Consultant Orthopaedic Surgeon at the Princess Alexandra Hospital. Driving Walking. He operates privately at the Brisbane Private Hospital. integrated electronic medical records. American Association of Orthopedic Surgeons (International Member), Private Hospital Appointment: Visiting fellow to Tygerberg orthopaedic trauma unit. "You spend that six weeks in limbo, and it's not just physical limbo, it's the mental limbo," he said. Meryl Ludwig, MD | Inova Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Mr Kosuge is an orthopaedic surgeon serving West Essex and East Hertfordshire, with sub-specialist interests in hip and knee surgery as well as musculoskeletal trauma. "The staff here are amazing, [but] they work under terrible conditions; they're understaffed, underfunded," he said. "That advice will be absolutely informed by patients, by the staff, by stakeholders.". Urgent referrals Arranging urgent review To arrange a VERY URGENT outpatient appointment, please phone the relevant hospital's switchboard and ask to speak to the Orthopaedic Registrar on-call. This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced. Independent practitioners are not Inova employees, agents or representatives of Inova and are solely responsible for their provision of medical care to you. Dr Philip Rowell | The Wesley Hospital It includes Inova employed providers (indicated by A Member of Inova Medical Group) and independent practitioners who have obtained the appropriate medical staff privileges at an Inova facility or care site. Email this page Mr Mohamed Ahmed is an Orthopaedic Surgeon practicing at Princess Alexandra Hospital (Harlow) and some major private hospitals around the London area. He is currently in private practice at the Brisbane Private Hospital as part of the Brisbane Hand & Upper Limb Clinic. To make appointments to see him privately, please contact his rooms on (07) 3834 6592. High Wych Road Sawbridgeworth, Hertfordshire CM21 0HH. Mercy, Dignity, Care, Commitment & Quality, Emergencies & Enquiries The Patient Rating score is an average of all responses to physician related questions on our nationally-recognized Press Ganey Patient Satisfaction Survey. Here at One Hatfield Hospital, we are always pleased to hear what our patients think of the service they have received. Dennis Kosuge - Consultant Orthopaedic Hip and Knee Surgeon, Essex and To make appointments to see him privately, please . I am also humbled to have received the Trainer of the Year Award for the region and the ASG Fellowship. Performance. Hospitals and Department contacts 8095 Innovation Park Drive, Fairfax, VA 22031. Orthopaedics is an area of surgery caring for injuries and conditions that affect bones, joints, muscles, tendons and nerves. But Mr Drummond said he could not guarantee that current patients would be able to complete their rehabilitation in their existing ward at the PAH. PAH: Hospital trauma and orthopaedics department recognised for training excellence. About Michael Holzman, MD. His sports trauma work also sees him regularly treating state and national sports men and women along side many young state representative athletes. "I can guarantee their therapy will be completed," he said. Since 2019 he has held a position as an Orthopaedic Specialist at The Princess Alexandra Hospital, where he specialises in Orthopaedic Oncology and . Our services range from: Upper limb disorders, both arthroscopy and open surgery; . . Orthopaedics. "Number one is that all of the current patients that are here need to be guaranteed that we can finish our rehab with the current staffing the nurses and all of the allied health," he said. Dr Hope is Chair of the Queensland RACS Trauma Committee and sits on the National RACS Trauma Committee. Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally. Dr Adam Parr - Queensland Combined Orthopaedic Specialists QCOS Spine To arrange a VERY URGENT outpatient appointment, please phone the relevant hospitals switchboard and ask to speak to the Orthopaedic Registrar on-call. offering top-notch medical expertise, full access to Inova facilities, and the convenience of Higher than average. Waiting time. Orthopaedics is an area of surgery caring for injuries and conditions that affect bones, joints, muscles, tendons and nerves. Copyright 2023 One Healthcare. He joinedInova Medical Group with more than 6 years of clinical experience. Queensland Hand Surgery Society (Past President, Past Secretary / Treasurer) For information about this service, or to book an appointment, please call. Mr Mohamed Ahmed - One Healthcare Cricket: Harlow impress in first cup game of the season, East of England firms record jump in business confidence, Local democracy threat in Levelling Up bill, say councillors, Brilliant musicians visit St Jamess school for workshop, Nurses across England strike in biggest walkout so far, Harlow Athletics Club is back on the comeback trail as number increase, Time for common sense says Harlow Alliance Partys candidate in Staple Tye. This Find a Doctor referral service is sponsored by Inova. Find assessment and management information on Orthopaedics conditions at: If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region. My wife and I as a patients have received excellent service from this team at PAH including after care from joint replacement. The department was awarded second place in the East of England Trauma and Orthopaedic Training Programmes Trainee Led Training Hospital of the Year Awards for the third year running. Visitor restrictions at our facilities due to COVID-19. In 2006 he completed a fellowship in Foot and Ankle Surgery in Brisbane. Board-certified specialties granted by an ABMS Member Board. Mr Satish Kutty said: It is absolutely fantastic that the department has been given this prestigious recognition. Originally Dr Hope completed his medical degree, training at the University of Edinburgh, before completing his specialist Orthopaedic training and being awarded his FRSCEd (Trauma and Orthopaedics). His vision is to provide a trusted and modern approach to managing spinal Hide; . Australian Society of Orthopaedic Surgeons Check before visiting. 22505 Landmark Ct 225 Ashburn, VA 20148. He joined Inova Medical Group with more than 6 years of clinical experience. opening hours are incorrect, phone number disconnected, etc) and the required changes to be made, if you know them. Specialists Results - North West Private Hospital This follows the achievement of being awarded the Austrian-Swiss-German (ASG) Fellowship for 2020. A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible. Rheumatology: How to Approach Medically Unexplained Symptoms (CPD). I had Radiofrequency Ablation performed by Mohammed Ahmed who explained what was going to happen prior to the procedure. We are nationally recognised for our expertise in trauma management and organ transplants. Who's who at The Princess Alexandra Hospital NHS Trust (October 2019) Non-executive directors Executive management team Cancer, cardiology and clinical support Family and Medicine women's services and critical care Estates and facilitiesSurgery Patient PanelPS&Q facilitators Steve Clarke chairman Non Andrew Holden vice chairman Pam Court Non- Our services | Princess Alexandra Hospital 1st February 2023 (Preferred Method)Electronic referrals integrated into existing GP practice software, Medical Objects: MQ4113000HCHealthLink EDI: qldmshrh, Fact sheet: Referring to MSH with secure messaging, Is your patient eligible for the nurse navigator service? The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation. Professor Ross graduated from The University of Queensland with MBBS in 1987. Tel: FOLLOW US. But itwas six weeks before he gained access to a bed in the Spinal Injuries Unit to begin his rehabilitation and recovery. Comments are gathered from our Press Ganey Patient Satisfaction Survey and displayed in their entirety. Sitemap | "And you're in a system that seems to not care, that leaves you to the side, and says we're getting to you when we can.". Print this page Departments and services - Princess Alexandra Hospital - NHS Hamstel Road Harlow Essex CM20 1QX. Completed advanced fellowship in Spinal Surgery at Cardiff University Hospital. The latest successes for the department follow Mr Jehangir Mahaluxmivala, a consultant orthopaedic surgeon, being named the Trainer of the Year 2020 by the Royal London Rotation for Trauma and Orthopaedics. Throughout both procedures Dr Ahmed has put me at ease in a professional manner and shown immense compassion in regards to the back pain which I have been suffering over the last couple of years. 24th May 2023 Free Australian health advice you can count on. Service Finder: Princess Alexandra Hospital - Orthopaedics. We are all dedicated to supporting and developing the orthopaedic surgeons of the future.. Mr Podbury said he had received "nothing but support" from spinal unit staff once becoming a patient there, but said bed shortages and worsening conditions for staff were "not acceptable". Queensland Health director-general Shaun Drummond said the department would be reviewing options to refurbish and upsize the PAH spinal unit. Professor Mark Ross is an Orthopaedic Surgeon who specialises in surgery of the hand, wrist, elbow and shoulder including microsurgery, arthroscopy and joint replacement. Required fields are marked *. Congratulations Satish on recieving the ASG award, as a patient of yours I have recieved the best service I could have asked for. He has a broad experience in adult spinal surgery, using the very latest techniques and treatments. Please make note of the following information. Congratulations to Satish and to all of the department.. In his spare time he likes to golf, run, and spend time with friends and family. "For someone to suggest that that can be moved is just ridiculous.". Average waiting time from GP referral to treatment for this department. He is based at The Princess Alexandra Hospital NHS Trust in Harlow (NHS) and The Rivers Hospital in Sawbridgeworth (Private). He completed his FRACS in Orthopaedic Surgery in 1996 and undertook a fellowship in Hand and Upper Limb Surgery at the Princess Alexandra Hospital in 1997, before travelling to the USA to undertake a 12-month Fellowship at the Kleinert Institute for Hand and Microsurgery in Louisville, Kentucky. There have been a range of recent plaudits for the team, following a longstanding tradition of outstanding achievement. Back to top of page Mr Mohamed Ahmed, Consultant OrthopaedicSpinal Surgeon,specialises in minimally invasivespinal surgery (keyhole surgery) using the latest advanced techniquesto help his patientsrecover quickly and with good outcomes. Dr Mark Ross - Brisbane Hand & Upper Limb - Clinic Paw-some airport trip for guide dog puppies, Henry Moore Studios and Gardens collaborates with University Centre Colchester, Rugby: Harlow are on their way to Twickenham after semi-final triumph in cup, Harlow Fields bring colour and joy to Celebrate Harlow. The following are not routinely provided in a public Orthopaedics service. Back to search results Search again. Official information from NHS about Princess Alexandra Hospital including contact details, directions, opening hours and service/treatment details He has been the lead clinician for many years and has been involved in the expansion of the department and the provision of a specialist joint replacement unit and a hip fracture unit. Spinal injury patient left in 'limbo' at Princess Alexandra Hospital Your email address will not be published. Dr Matthew Hope is a dual qualified orthopaedic specialist, with a special interest in foot and ankle surgery. Tygerberg Hospital. 14th April 2023 Dr Hope is the Director of Orthopaedics at the Princess Alexandra Hospital and additionally completes public work at the Queensland Childrens Hospital, specialising in complex paediatric foot conditions and trauma. Orthopaedics | Referrals | Metro South Health Actual or threatened cauda equina syndrome, bilateral nerve pain (leg pain below knees), unexplained or unexpected loss of bladder or bowel function, Spinal tumour with significant pain and/or neurological deficit, Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms, Spinal trauma with significant pain and/or neurological deficit, High risk of irreversible deficit if not assessed urgently, Acute back or neck pain secondary to neoplastic disease or infection, Fracture requiring manipulation or operation, Acute high energy fracture with/without neurological abnormality, Injury associated with vascular compromise, Osteoporotic / pathological fracture new abnormal neurology, Open injuries with possible tendon or joint involved, Nail bed injuries or retained foreign body, if there is documentation indicating adequate alignment and satisfactory initial treatment of fracture to be seen within 14 days of referral, all other fracture cases, delayed presentation of tendon and nerve injuries - to be seen within 7 days of referral, Being unwell, flushed, lethargic, fever, flat, anorexic and/or, Systemically unwell, febrile or suspicion of septic arthritis, Suspicion or concern of non-accidental injury, All suspected or confirmed SUFE should be referred to the ED or local ortho no matter the chronicity, All orthopaedic oncology referrals should be directed to Princess Alexandra Hospital. Princess Alexandra Hospital | Queensland Health Search the Princess Alexandra Hospital website. Website by Jump 2 IT Media Ltd. Mr Mohamed Ahmed is an Orthopaedic Surgeon practicing at Princess Alexandra Hospital (Harlow) and some major private hospitals around the London area. He is also a member of the Queensland Health Surgical Advisory Committee. Consultant Spinal Orthopaedic Surgeon Mr Ahmed is a Consultant Spinal Orthopaedic Surgeon at Princess Alexandra Hospital/Harlow. Queensland Shoulder Society (Past President, Past Secretary / Treasurer) Suite 41, Level 7 Learn about bulk billing. Mr Podbury said the proposal to relocate the spinal unit to Herston was a "kneejerk reaction" that was not in the best interests of patients. Home; Patients and visitors. The Princess Alexandra Hospital NHS Trust Hamstel Road Harlow Essex CM20 1QX Contact telephone numbers Main switchboard: 01279 444 455 To change an outpatients appointment, please call: 01279 827 391 To contact the maternity team if you are in labour, please call: 01279 444 455 and enter extension x 2144 Other information Very happy about the procedure he performed. "Yes, the building needs to be replaced, but that's not the spinal unit. "And the second part, which is really, really terrible, is that the staff here haven't even been guaranteed their jobs at the PA until this thing is put to bed, and that needs to happen.". Use tab and cursor keys to move around the page (more information), Corrupt conduct and public interest disclosures, Centre for Functioning and Health Research, Residential aged care end of life care pathway, ACP resources for Culturally and linguistically diverse people, ACP resources for Aboriginal and Torres Strait Islander people, Older Persons Advocacy and Legal Service (OPALS), Princess Alexandra Hospital Digital Library Refurbishment, Princess Alexandra Hospital Spinal Injury Unit upgrade, Consumer, carer and community engagement strategy, Primary Health Network Partnership Protocol, Allied Health research capability and development strategy, Measles resources for health professionals, Aboriginal and Torres Strait Islander people, Aboriginal and Torres Strait Islander resources, People with culturally and linguistically diverse backgrounds, People who are from refugee or asylum seeker backgrounds, Communication kit for patients who are Deaf or Hard of Hearing, Be Heard communication kit for patients who are Deaf or Hard of Hearing, Australian Charter of Healthcare Rights Community Languages, Princess Alexandra Hospital intern recruitment, Australian Translational Genomics Centre (ATGC), Research facilitation and capability services, Indemnity, insurance and commercialisation, Back and/or neck pain (Spinal Surgical Service), Bone and Soft Tissue Tumour (Sarcoma) Service, Peripheral Entrapment Neuropathies including CTS (Orthopaedics), Clinically indicated e.g.
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