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Physician Performance reviews

Eimer Maloney, Ronan N McGinty, Daniel J Costello
PURPOSE: Reporting of 'real-world' data on efficacy and tolerability of antiepileptic medications helps to inform physicians on how newer medications perform in the clinical setting, outside of the strict regimens of clinical trials. We report our experience of prescribing lacosamide monotherapy to a diverse range of patients at our epilepsy centre. METHODS: We performed a single-centre, retrospective review of all patients who had been prescribed lacosamide monotherapy over the last 8 years...
March 8, 2018: Epilepsy Research
Shuangshuang Lu, Jiayi Wu, Yan Fang, Wei Wang, Yu Zong, Xiaosong Chen, Ou Huang, Jian-Rong He, Weiguo Chen, Yafen Li, Kunwei Shen, Li Zhu
Introduction: Approximately 5% of primary breast cancer patients present de novo stage IV breast cancer, for whom systematic therapy is the mainstream treatment. The role of surgical excision of the primary tumor has been controversial due to inconsistent results of relevant studies. Recently, with the reports of some relevant preclinical data, retrospective studies and randomized clinical trials, we've got more evidence to reexamine the issue. Based on those above, a literature review and meta-analysis was performed to determine whether surgery of the primary tumor could improve overall survival in the setting of stage IV breast cancer...
February 20, 2018: Oncotarget
Christopher J L Stone, Haris M Vaid, Rajajee Selvam, Allison Ashworth, Andrew Robinson, Geneviève C Digby
Multidisciplinary cancer clinics (MDCCs) are recognized in cancer care as an alternate model of care for lung cancer patients. However, the precise MDCC characteristics that could potentially improve the quality of care in lung cancer care have not been clearly defined. We performed a systematic review of the data regarding MDCCs in the treatment of patients with lung cancer to summarize and evaluate the available evidence and to determine valuable clinic characteristics and projected outcomes. We searched Embase, Cochrane, Medline, PubMed, and Web of Science through April 2017 for studies that included ≥ 2 physician specialties in a MDCC for lung cancer...
February 21, 2018: Clinical Lung Cancer
Giuliano Tosello, Maria Regina Torloni, Bruna S Mota, Teresa Neeman, Rachel Riera
BACKGROUND: Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Surgery to remove the primary tumour is associated with an increased survival in other types of metastatic cancer. Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase the women's survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomised controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question...
March 15, 2018: Cochrane Database of Systematic Reviews
Marc-Etienne Parent, François Vézina, Nathalie Carrier, Ariel Masetto
OBJECTIVE: To analyze the indications for and clinical procedures resulting from knee magnetic resonance imaging (MRI) in older patients. DESIGN: We retrospectively analyzed 215 medical records of patients 50 years of age and older who had undergone a unilateral knee MRI in 2009. SETTING: Centre hospitalier universitaire de Sherbrooke in Quebec. PARTICIPANTS: Patients 50 years of age and older who underwent a knee MRI in 2009...
March 2018: Canadian Family Physician Médecin de Famille Canadien
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Rohan Parikh, Samantha K Kurosky, Margarita Udall, Jane Chang, Joseph C Cappelleri, Jim P Doherty, James A Kaye
OBJECTIVE: The objective of this article is to describe real-world treatment patterns and outcomes in patients with platinum-refractory/resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer (PRROC) in the United States, United Kingdom, and Canada. METHODS/MATERIALS: Physicians retrospectively reviewed medical records of women aged 18 years or older who were diagnosed with PRROC between January 2010 and June 2014. Patient characteristics, initial PRROC therapy, and health care utilization were assessed; progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier and Cox proportional hazards methods...
March 14, 2018: International Journal of Gynecological Cancer
Katharina Feil, Regina Feuerecker, Nicolina Goldschagg, Ralf Strobl, Thomas Brandt, Albrecht von Müller, Eva Grill, Michael Strupp
Background: Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. Objective: In this study we examined the performance of the iPad based program me d x in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. Patients and methods: The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders...
2018: Frontiers in Neurology
Joseph M Bumgarner, Cameron T Lambert, Ayman A Hussein, Daniel J Cantillon, Bryan Baranowski, Kathy Wolski, Bruce D Lindsay, Oussama M Wazni, Khaldoun G Tarakji
BACKGROUND: The Kardia Band (KB) is a novel technology that enables patients to record a rhythm strip using an Apple smartwatch. The band is paired with an app providing automated detection of atrial fibrillation (AF). OBJECTIVES: To examine whether the KB could accurately differentiate sinus rhythm (SR) from AF compared to physician-interpreted 12-lead ECGs and KB recordings. METHODS: Consecutive patients with AF presenting for cardioversion (CV) were enrolled...
March 7, 2018: Journal of the American College of Cardiology
John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
Pierre Antoine Brown, Swapnil Hiremath, Edward G Clark, Edmund S H Kwok, Christopher McCudden, Ayub Akbari
BACKGROUND: Morbidity and Mortality Conferences (M&MCs) have for generations been part of the education of physicians, yet their effectiveness remains questionable. The Ottawa M&M Model (OM3) was developed to provide a structured approach to M&MCs in order to maximize the quality improvement impact of such rounds. STUDY DESIGN: We conducted a retrospective assessment of the impact of implementing nephrology-specific M&MCs using the OM3. SETTING AND PARTICIPANTS: All physicians, residents and fellows from the division of nephrology at a large academic medical center were invited to participate...
March 12, 2018: International Urology and Nephrology
Henya Sandhaus, Philip G Chen
Introduction: Functional endoscopic sinus surgery is a complex procedure used by otorhinolaryngologists to treat a host of nasal sinus pathologies. Due to the involved nasal anatomy and the nature of the procedure, teaching residents to use an endoscope is challenging. Simulation labs have been helpful but intraoperative instruction can still present difficulty in communication between resident and attending physicians during the teaching process. The purpose of this is to hypothesize a method of teaching intraoperatively that can be used supplemental to or independently of virtual reality teaching...
2018: Clinical Medicine Insights. Ear, Nose and Throat
Tigran Khachatryan, Marina Khachatryan, Ruben Fanarjyan, Mikayel Grigoryan, Arthur Grigorian
Background: Currently, transsphenoidal surgery (TSS) is the preferred method for surgical treatment of intrasellar pituitary adenomas. However, it carries some risk of intraoperative arterial injuries, which is mainly attributed to direct iatrogenic rupture of the internal carotid artery (ICA). There is anecdotal evidence suggesting that intracranial aneurysms are coincidentally found significantly more frequently in the setting of pituitary adenomas than when the incidence is compared to other intracranial neoplasms...
2018: Surgical Neurology International
Mariyam Suzana, Helen Walls, Richard Smith, Johanna Hanefeld
Background: Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. Methods: Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003-2013, together with in-depth review of medical travel schemes for the two highest importing SIDS-the Maldives and Tuvalu...
2018: BMJ Global Health
Andrew J Maiorana, Andrew D Williams, Christopher D Askew, Itamar Levinger, Jeff Coombes, Bill Vicenzino, Kade Davison, Neil A Smart, Steve E Selig
Regular exercise improves health but can also induce adverse responses. Although such episodes are rare, many guidelines for pre-participation exercise screening have historically had a low threshold for recommending medical clearance prior to the commencement of exercise, placing the responsibility for decision making about exercise participation on physicians. The 'clearance to exercise' model still occurs widely in practice, but creates cost burdens and barriers to the uptake of exercise. Moreover, many physicians are not provided the training, nor time in a standard consultation, to be able to effectively perform this role...
March 9, 2018: Sports Medicine
Valerie Charbonneau, Edmund Kwok, Loree Boyle, Ian G Stiell
BACKGROUND: The goal of this study was to determine if ED surge and end-of-shift assessment of patients affect the extent of diagnostic tests, therapeutic interventions and accuracy of diagnosis prior to referral to internal medicine. METHODS: This study was a health records review of consecutive patients referred to the internal medicine service with an ED diagnosis of heart failure, chronic obstructive pulmonary disease (COPD) or sepsis starting 1 December 2013 until 100 cases for each condition had been obtained...
March 9, 2018: Emergency Medicine Journal: EMJ
Ryan Tewell, Lisa Edgerton, Elizabeth Kyle
PURPOSE: A program at a family medicine clinic to provide naloxone prescriptions in conjunction with education on naloxone use and opioid hazards to patients at risk for opioid overdose is described. SUMMARY: Consistent with a 2016 Centers for Disease Control and Prevention (CDC) guideline on opioid prescribing for chronic pain, a family medicine clinic implemented updated controlled substance agreements and medical record templates for documentation of pain management visits and established a pharmacist-led naloxone clinic...
March 15, 2018: American Journal of Health-system Pharmacy: AJHP
Shernaz S Dossabhoy, Jessica P Simons, Kyle R Diamond, Julie M Flahive, Francesco A Aiello, Edward J Arous, Louis M Messina, Andres Schanzer
OBJECTIVE: Reinterventions after fenestrated or branched endovascular aneurysm repair (F/B-EVAR) are sometimes necessary to maintain aneurysm exclusion or endograft and target artery patency. These reinterventions are nontrivial, potentially associated with morbidity, mortality, and resource utilization. Whereas rates, types, and outcomes of reintervention after infrarenal EVAR have been well described, they have not been well described for F/B-EVAR. We sought to characterize the morbidity, mortality, and resource utilization due to reinterventions after F/B-EVAR...
March 6, 2018: Journal of Vascular Surgery
Sergey Motov, Reuben Strayer, Bryan Hayes, Mark Reiter, Steven Rosenbaum, Melanie Richman, Zachary Repanshek, Scott Taylor, Benjamin Friedman, Gary Vilke, Daniel Lasoff
BACKGROUND: Pain is one of the most common reasons patients present to the emergency department (ED). Emergency physicians should be aware of the numerous opioid and nonopioid alternatives available for the treatment of pain. OBJECTIVES: To provide expert consensus guidelines for the safe and effective treatment of acute pain in the ED. METHODS: Multiple independent literature searches using PubMed were performed regarding treatment of acute pain...
March 6, 2018: Journal of Emergency Medicine
Raed Alroughani, Alexey Boyko
BACKGROUND: Pediatric-onset multiple sclerosis (POMS) prevalence and incidence rates are increasing globally. No disease-modifying therapy are approved for MS pediatric population. Hence, we aim to review the literature on POMS to guide treating physicians on the current understanding of diagnosis and management of pediatric MS. METHODS: The authors performed a literature search and reviewed the current understanding on risk factors and disease parameters in order to discuss the challenges in assessing and implementing diagnosis and therapy in clinical practice...
March 9, 2018: BMC Neurology
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