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Intuition in medical practice

David N Bernstein, Aakash Keswani, David Ring
BACKGROUND: There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure...
November 30, 2016: Clinical Orthopaedics and related Research
Amanda Jane Elliott, Fiona Harris, Sandra G Laird
BACKGROUND: Most people with diabetes are not attaining desirable levels of HbA1c (glycated haemoglobin), or of blood pressure and cholesterol, leaving them at risk of developing complications. AIM: To identify ways of improving diabetes control by gaining insight into patients' attitudes/beliefs. DESIGN AND SETTING: Questionnaires were offered to patients attending for a diabetes review in the 24 GP practices of North East Hampshire and Farnham Clinical Commissioning Group...
December 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Hollis H King, Charles Thomas Cayce, Jeph Herrin
: Early osteopathic theory and practice, and the work of the medical intuitive Edgar Cayce suggested that the abdominal areas of individuals with epilepsy would manifest "cold spots." The etiology for this phenomenon was thought to be abdominal adhesions caused by inflammation and viscero-somatic reflexes caused by adhesions or injury to visceral or musculoskeletal system structures. Indeed, until that advent of electroencephalography in the 1930s, medical practice regarding epilepsy focused on abdominal neural and visceral structures...
October 21, 2016: Explore: the Journal of Science and Healing
Xiao C Zhang, Ana M Bermudez, Pranav M Reddy, Ravi R Sarpatwari, Darin B Chheng, Taylor J Mezoian, Victoria R Schwartz, Quinneil J Simmons, Gregory D Jay, Leo Kobayashi
STUDY OBJECTIVE: A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care...
November 14, 2016: Annals of Emergency Medicine
Izabela Z Schultz, Ada K Law, Leanna C Cruikshank
Within the fields of psychiatry, psychology, and neuropsychology, medical examiners are often tasked with providing an opinion about an injured individual's health prognosis and likelihood of returning to work. Traditionally, examiners have conducted such assessments by employing clinical intuition, expert knowledge, and judgment. More recently, however, an accumulation of research on factors predictive of disability has allowed examiners to provide prognostications using specific empirically supported evidence...
November 2016: International Journal of Law and Psychiatry
Ayşen Esen Danacı, Kuzeymen Balıkçı, Orkun Aydın, Cengiz Cengisiz, A Burak Uykur
OBJECTIVE: It has been widely acknowledged that the community and health professionals hold negative attitudes toward patients with impaired mental health. This constitutes a majör obstacle for those patients in coping with their disease, managing their care, and hence regulating their lives. Although studies carried out in Turkey document the presence of stigma, they provide limited information about the ways for solving this problem. Drawing on the litrature, the present study investigated the effect of medical education on stigmatization...
2016: Türk Psikiyatri Dergisi, Turkish Journal of Psychiatry
Gail G Salvatierra, Ruth C Bindler, Kenn B Daratha
PURPOSE: The purpose of this article is to present an overview of rapid response team (RRT) history in the United States, provide a review of prior RRT effectiveness research, and propose the reframing of four new questions of RRT measurement that are designed to better understand RRTs in the context of contemporary nursing practice as well as patient outcomes. ORGANIZING CONSTRUCT: RRTs were adopted in the United States because of their intuitive appeal, and despite a lack of evidence for their effectiveness...
September 26, 2016: Journal of Nursing Scholarship
Danil V Makarov, Erica Sedlander, R Scott Braithwaite, Scott E Sherman, Steven Zeliadt, Cary P Gross, Caitlin Curnyn, Michele Shedlin
BACKGROUND: Approximately half of veterans with low-risk prostate cancer receive guideline-discordant imaging. Our objective was to identify and describe (1) physician knowledge, attitudes, and practices related to the use of imaging to stage prostate cancer, (2) patient attitudes and behaviors related to use of imaging, and (3) to compare responses across three VA medical centers (VAMCs). METHODS: A qualitative approach was used to explore patient and provider knowledge and behaviors relating to the use of imaging...
2016: Implementation Science: IS
Miguel Valerio, Tiago Marques Godinho, Carlos Costa
The production of medical imaging studies and associated data has been growing in the last decades. Their primary use is to support medical diagnosis and treatment processes. However, the secondary use of the tremendous amount of stored data is generally more limited. Nowadays, medical imaging repositories have turned into rich databanks holding not only the images themselves, but also a wide range of metadata related to the medical practice. Exploring these repositories through data analysis and business intelligence techniques has the potential of increasing the efficiency and quality of the medical practice...
2016: Studies in Health Technology and Informatics
Patricia L Hart, LeeAnna Spiva, Lonnie Dolly, Kristen Lang-Coleman, Nadia Prince-Williams
AIM AND OBJECTIVE: To explore and understand the experiences of medical-surgical nurses as first responders during clinical deterioration events. BACKGROUND: Nurses are key players in identifying and responding to deterioration events to escalate the level of care essential to address specific needs of patients. Delays in recognising signs and symptoms of patient deterioration and activation of Rapid Response Teams have been linked to a lack of nontechnical skills (leadership, teamwork, situational awareness) resulting in increased patient morbidity and mortality...
November 2016: Journal of Clinical Nursing
Marco Esposito, Benjamin Busam, Christoph Hennersperger, Julia Rackerseder, Nassir Navab, Benjamin Frisch
PURPOSE: The staging of female breast cancer requires detailed information about the level of cancer spread through the lymphatic system. Common practice to obtain this information for patients with early-stage cancer is sentinel lymph node (SLN) biopsy, where LNs are radioactively identified for surgical removal and subsequent histological analysis. Punch needle biopsy is a less invasive approach but suffers from the lack of combined anatomical and nuclear information. We present and evaluate a system that introduces live collaborative robotic 2D gamma imaging in addition to live 2D ultrasound to identify SLNs in the surrounding anatomy...
September 2016: International Journal of Computer Assisted Radiology and Surgery
Caitriona L Cox, Zoe Fritz
In modern practice, doctors who outright lie to their patients are often condemned, yet those who employ non-lying deceptions tend to be judged less critically. Some areas of non-disclosure have recently been challenged: not telling patients about resuscitation decisions; inadequately informing patients about risks of alternative procedures and withholding information about medical errors. Despite this, there remain many areas of clinical practice where non-disclosures of information are accepted, where lies about such information would not be...
October 2016: Journal of Medical Ethics
Michael P McRae, Glennon Simmons, Jorge Wong, John T McDevitt
The combination of point-of-care (POC) medical microdevices and machine learning has the potential transform the practice of medicine. In this area, scalable lab-on-a-chip (LOC) devices have many advantages over standard laboratory methods, including faster analysis, reduced cost, lower power consumption, and higher levels of integration and automation. Despite significant advances in LOC technologies over the years, several remaining obstacles are preventing clinical implementation and market penetration of these novel medical microdevices...
July 19, 2016: Accounts of Chemical Research
An Lievrouw, Stijn Vanheule, Myriam Deveugele, Martine Vos, Piet Pattyn, Van Belle, Dominique D Benoit
PURPOSE/OBJECTIVES: To explore variations in coping with moral distress among physicians and nurses in a university hospital oncology setting.
. RESEARCH APPROACH: Qualitative interview study.
. SETTING: Internal medicine (gastroenterology and medical oncology), gastrointestinal surgery, and day clinic chemotherapy at Ghent University Hospital in Belgium.
. PARTICIPANTS: 17 doctors and 18 nurses with varying experience levels, working in three different oncology hospital settings...
July 1, 2016: Oncology Nursing Forum
Eivind Engebretsen, Kristin Heggen, Sietse Wieringa, Trisha Greenhalgh
The evidence-based practice and evidence-based medicine (EBM) movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty as integral parts of medical practice...
December 2016: Medicine, Health Care, and Philosophy
S Salminger, J A Mayer, A Sturma, O Riedl, K D Bergmeister, O C Aszmann
BACKGROUND: Prosthetic replacement after amputation or loss of function of the upper extremity has gained therapeutic value over the last years. The control of upper arm prostheses has been refined by the use of selective nerve transfers, and the indication for prosthetic replacement has been expanded. OBJECTIVES: Overview regarding surgical, therapeutic and prosthetic options in upper extremity amputations or their loss of function. METHODS: Selective literature research including the authors' own experience in everyday clinical practice, as well as a review of medical records...
May 2016: Der Unfallchirurg
Suhael R Momin, Robert R Lorenz, Eric D Lamarre
IMPORTANCE: Physicians recognize the value of accurate documentation to facilitate patient care, communication, and the distribution of professional fees. However, the association between inpatient documentation, hospital billing, and quality metrics is less clear. OBJECTIVES: To identify areas of deficiency in inpatient documentation and to instruct health care professionals on how to improve the quality and accuracy of clinical records. DESIGN, SETTING, AND PARTICIPANTS: A single-arm pre-post study was conducted from January 1, 2013, to December 31, 2014, among 17 attending and 12 resident physicians treating 1188 patients at an academic medical center...
June 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
(no author information available yet)
This conference was conceived in 1991 when a small group of individuals envisioned how virtual reality, then in its first era of widespread enthusiasm, might transform medicine by immersing physicians, students, and patients in data more completely. They predicted that interactive learning tools might better engage medical students by assessing real-time performance and customizing lessons in sync. Simulation could enhance the "see one, do one, teach one" model with the repetition that athletes and musicians used to perfect their skills...
2016: Studies in Health Technology and Informatics
Parkhide Hassani, Alireza Abdi, Rostam Jalali, Nader Salari
BACKGROUND: Intuition as a way of learning in nursing is applied to decision making and judgment in complicated clinical situations. Several studies have been conducted on intuition in clinical settings, but comprehension of this concept is unclear. Moreover, there is a lack of information about intuition in critical care nurses caring for more seriously ill patients. This study aimed to explore Iranian critical care nurses' understanding of intuition in clinical practice. METHODS: In a descriptive-phenomenological study, 12 nurses employed in critical care units of the hospitals affiliated to Kermanshah University of Medical Sciences were purposively recruited to the study...
2016: Psychology Research and Behavior Management
Matthieu Schuers, Nicolas Griffon, Gaëtan Kerdelhue, Quentin Foubert, Alain Mercier, Stéfan J Darmoni
BACKGROUND: Physicians are increasingly encouraged to practice evidence-based medicine (EBM), and their decisions require evidence based on valid research. Existing literature shows a mismatch between general practitioners' (GPs) information needs and evidence available online. The aim of this study was to explore the attitudes and behavior of residents in general medicine and GPs when seeking medical information online. METHODS: Five focus groups (FGs) involving residents in general medicine and GPs were conducted between October 2013 and January 2014...
May 2016: International Journal of Medical Informatics
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