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Intuition in medical practice

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https://www.readbyqxmd.com/read/28987479/nurses-early-recognition-of-neonatal-sepsis
#1
Michele Boettiger, Lynda Tyer-Viola, Joseph Hagan
OBJECTIVE: To determine nurses' perceptions of the most common physiologic and behavioral indicators of neonatal sepsis. DESIGN: Descriptive correlational study. SETTING: A women's and children's hospital in an academic medical center in the southwestern United States. PARTICIPANTS: Nurses (N = 181) who cared for neonates in the mother-infant and NICU settings. METHODS: Participants completed an e-mail survey developed from the literature to ascertain their perceptions of which physiologic and behavioral indicators were most often associated with neonatal sepsis...
October 4, 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/28943333/finding-discriminative-and-interpretable-patterns-in-sequences-of-surgical-activities
#2
Germain Forestier, François Petitjean, Pavel Senin, Laurent Riffaud, Pierre-Louis Henaux, Pierre Jannin
OBJECTIVE: Surgery is one of the riskiest and most important medical acts that is performed today. Understanding the ways in which surgeries are similar or different from each other is of major interest to understand and analyze surgical behaviors. This article addresses the issue of identifying discriminative patterns of surgical practice from recordings of surgeries. These recordings are sequences of low-level surgical activities representing the actions performed by surgeons during surgeries...
September 21, 2017: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/28916030/fellowship-candidate-selection-at-the-best-medical-center-a-novel-process
#3
Philip R Cohen
Dr. Ida Lystic completed her MD degree at the prestigious Harvey Medical School (which has since been renamed the Harvey Provider School) and her residency in internal medicine and gastroenterology fellowship at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. She was subsequently hired as an assistant professor at the BEST (Byron Edwards and Samuel Thompson) Medical Center in 2015. After eventually completing an extensive list of employment requirements, she was able to begin seeing patients...
September 2017: Clinics in Dermatology
https://www.readbyqxmd.com/read/28864694/labtracker-a-medical-smartphone-app-for-the-interpretation-of-consecutive-laboratory-results-an-external-validation-study
#4
Judith M Hilderink, Roger J M W Rennenberg, Floris H M Vanmolkot, Otto Bekers, Richard P Koopmans, Steven J R Meex
OBJECTIVES: When monitoring patients over time, clinicians may struggle to distinguish 'real changes' in consecutive blood parameters from so-called natural fluctuations. In practice, they have to do so by relying on their clinical experience and intuition. We developed Labtracker+, a medical app that calculates the probability that an increase or decrease over time in a specific blood parameter is real, given the time between measurements. DESIGN: We presented patient cases to 135 participants to examine whether there is a difference between medical students, residents and experienced clinicians when it comes to interpreting changes between consecutive laboratory results...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28852361/the-scarcity-of-orthopaedic-physician-scientists
#5
Joseph A Buckwalter, Jacob M Elkins
Breakthrough advances in medicine almost uniformly result from the translation of new basic scientific knowledge into clinical practice, rather than from assessment, modification or refinement of current methods of diagnosis and treatment. However, as is intuitively understood, those most responsible for scientific conception and creation-scientists - are generally not the ones applying these advances at the patient's bedside or the operating room, and vice versa. Recognition of the scarcity of clinicians with a background that prepares them to develop new basic knowledge, and to critically evaluate the underlying scientific basis of methods of diagnosis and treatment, has led to initiatives including federally funded Physician-Scientist programs, whereby young, motivated scholars begin a rigorous training, which encompasses education and mentorship within both medical and scientific fields, culminating in the conferment of both MD and PhD degrees...
2017: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/28831858/intuition-in-clinical-decision-making-differences-among-practicing-nurses
#6
Elizabeth M Miller, Pamela D Hill
PURPOSE: To examine the relationships and differences in the use of intuition among three categories of practicing nurses from various clinical units at a medical center in the Midwest. DESIGN: Descriptive, correlational, cross-sectional, prospective design. METHOD: Three categories of nurses were based on the clinical unit: medical/surgical nurses ( n = 42), step-down/progressive care nurses ( n = 32), and critical care nurses ( n = 24). Participants were e-mailed the Rew Intuitive Judgment Scale (RIJS) via their employee e-mail to measure intuition in clinical practice...
August 1, 2017: Journal of Holistic Nursing: Official Journal of the American Holistic Nurses' Association
https://www.readbyqxmd.com/read/28796637/the-use-of-error-and-uncertainty-methods-in-the-medical-laboratory
#7
Wytze P Oosterhuis, Hassan Bayat, David Armbruster, Abdurrahman Coskun, Kathleen P Freeman, Anders Kallner, David Koch, Finlay Mackenzie, Gabriel Migliarino, Matthias Orth, Sverre Sandberg, Marit S Sylte, Sten Westgard, Elvar Theodorsson
Error methods - compared with uncertainty methods - offer simpler, more intuitive and practical procedures for calculating measurement uncertainty and conducting quality assurance in laboratory medicine. However, uncertainty methods are preferred in other fields of science as reflected by the guide to the expression of uncertainty in measurement. When laboratory results are used for supporting medical diagnoses, the total uncertainty consists only partially of analytical variation. Biological variation, pre- and postanalytical variation all need to be included...
August 10, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28730671/many-faces-of-rationality-implications-of-the-great-rationality-debate-for-clinical-decision-making
#8
Benjamin Djulbegovic, Shira Elqayam
Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models...
July 20, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28726015/community-perceptions-of-hospitals-and-shared-physical-space-a-qualitative-study
#9
Daniel Skinner, Berkeley Franz, Kelly Kelleher, Robert Penfold
In addition to providing critical medical services to communities, hospitals are also forces of broader change when seen from the perspective of neighborhood development. Over the past few decades the obligation on the part of U.S. nonprofit hospitals to positively impact the communities in which they are located has become entrenched in both U.S. tax law and the practices of many hospitals. This article presents findings from a grounded theory qualitative study of the relationship between a non-profit children's hospital in Columbus, Ohio, and the neighborhood in which it is located...
July 19, 2017: Culture, Medicine and Psychiatry
https://www.readbyqxmd.com/read/28591902/-the-need-for-psychosocial-support-of-parents-of-children-in-neonatal-care
#10
Nicole Schäfer, Harald Karutz, Olaf Schenk
Background Advances in neonatal care have reduced mortality but increased morbidity in babies born pre-maturely or after high-risk pregnancies. However, this often increases the burden on the family and the parents in particular. A systematic review of the literature was conducted that demonstrated the importance of psychosocial support for parents of children in neonatal care. Methods A systematic search of Pubmed, Psyndex, CINAHI and medpilot was conducted. Reference lists of the included articles were also searched for relevant publications...
June 7, 2017: Zeitschrift Für Geburtshilfe und Neonatologie
https://www.readbyqxmd.com/read/28526721/health-care-resource-utilization-and-associated-costs-among-metastatic-cutaneous-melanoma-patients-treated-with-ipilimumab-intuition-study
#11
Grant A McArthur, Peter Mohr, Paolo Antonio Ascierto, Ana Arance, Ana Banos Hernaez, Peter Kaskel, Michael Weichenthal, Reshma Shinde, Kendall Stevinson
BACKGROUND: There are limited real-world data on health care resource utilization (HCRU) among advanced melanoma patients. The objective of this study was to describe HCRU and health care costs associated with the management of advanced melanoma patients receiving ipilimumab. METHODS: This retrospective multinational, observational study included advanced melanoma patients from Australia, Germany, Italy, and Spain who had received at least 1 dose of ipilimumab. Data extracted from medical charts included inpatient admissions, outpatient visits, surgical procedures, laboratory investigations, radiation therapy, imaging studies, and concomitant medications...
August 2017: Oncologist
https://www.readbyqxmd.com/read/28471111/intelligent-diagnosis-of-jaundice-with-dynamic-uncertain-causality-graph-model
#12
Shao-Rui Hao, Shi-Chao Geng, Lin-Xiao Fan, Jia-Jia Chen, Qin Zhang, Lan-Juan Li
Jaundice is a common and complex clinical symptom potentially occurring in hepatology, general surgery, pediatrics, infectious diseases, gynecology, and obstetrics, and it is fairly difficult to distinguish the cause of jaundice in clinical practice, especially for general practitioners in less developed regions. With collaboration between physicians and artificial intelligence engineers, a comprehensive knowledge base relevant to jaundice was created based on demographic information, symptoms, physical signs, laboratory tests, imaging diagnosis, medical histories, and risk factors...
May 2017: Journal of Zhejiang University. Science. B
https://www.readbyqxmd.com/read/28464865/empathy-in-psychoanalysis-and-medical-education-what-can-we-learn-from-each-other
#13
Henriette Löffler-Stastka, Felicitas Datz, Karoline Parth, Ingrid Preusche, Xenia Bukowski, Charles Seidman
BACKGROUND: Several research areas, including medical education (ME), focus on empathy as an important topic in interpersonal relationships. This focus is central to the use of communication skills related to empathy and even more crucial to provide information in a way that makes patients feel more involved in the treatment process. Psychoanalysis (PA) provides its initial concept of empathy based on affective aspects including findings from neuroscience and brain research. Enhancing cooperation between ME and PA can help to integrate both aspects of empathy into a longitudinal training program...
May 2, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28460709/assessment-of-knowledge-in-palliative-care-of-physical-therapists-students-at-a-university-hospital-in-brazil
#14
Livia R Zalaf, Mayara S Bianchim, Daniel A Alveno
BACKGROUND: In Brazil there are several challenges to reach a humanized health care. Among them is the well-known lack in academic education and training in palliative care field. This lack is mostly due to the modern medical care culture that prioritize curative medicine ahead of palliative care. As the goal of saving lives is rooted in medical training, death is still confronted as the main enemy of the health professionals. OBJECTIVE: To analyze the knowledge of palliative care among the physical therapists of a University Hospital...
March 2017: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/28454581/changing-the-culture-of-assessment-the-dominance-of-the-summative-assessment-paradigm
#15
Christopher J Harrison, Karen D Könings, Lambert W T Schuwirth, Valerie Wass, Cees P M van der Vleuten
BACKGROUND: Despite growing evidence of the benefits of including assessment for learning strategies within programmes of assessment, practical implementation of these approaches is often problematical. Organisational culture change is often hindered by personal and collective beliefs which encourage adherence to the existing organisational paradigm. We aimed to explore how these beliefs influenced proposals to redesign a summative assessment culture in order to improve students' use of assessment-related feedback...
April 28, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28344696/systems-1-and-2-thinking-processes-and-cognitive-reflection-testing-in-medical-students
#16
Shu Wen Tay, Paul Ryan, C Anthony Ryan
BACKGROUND: Diagnostic decision-making is made through a combination of Systems 1 (intuition or pattern-recognition) and Systems 2 (analytic) thinking. The purpose of this study was to use the Cognitive Reflection Test (CRT) to evaluate and compare the level of Systems 1 and 2 thinking among medical students in pre-clinical and clinical programs. METHODS: The CRT is a three-question test designed to measure the ability of respondents to activate metacognitive processes and switch to System 2 (analytic) thinking where System 1 (intuitive) thinking would lead them astray...
October 2016: Canadian Medical Education Journal
https://www.readbyqxmd.com/read/28341982/pocket-sized-point-of-care-cardiac-ultrasound-devices-role-in-the-emergency-department
#17
A Colclough, P Nihoyannopoulos
BACKGROUND: Acute breathlessness accounts for 8% of accident and emergency attendances. Point-of-care cardiac ultrasound (US) effectively reduces time to diagnosis. Fast and practical information via pocket-sized cardiac US devices may better the diagnosis in this complex patient group. METHODS: We prospectively enrolled 40 consecutive patients presenting with shortness of breath at the emergency department (ED). Divided into two groups were all adult patients over 18 with acute breathing difficulties (triage category 1-3): 21 patients received a short focused cardiac US scan using a pocket-sized Vscan and 19 patients received no scan...
May 2017: Herz
https://www.readbyqxmd.com/read/28296165/nice-to-watch-students-evaluate-online-lectures
#18
Nancy Sturman, Benjamin Mitchell, Amy Mitchell
BACKGROUND: Many clinical teachers who previously gave face-to-face lectures now record presentations for students to view asynchronously online. These teachers need to understand student expectations of online lectures (OLLs), and their place in the overall 'ecology' of student learning resources, in order to ensure that students watch, and learn from, their lectures. METHODS: We conducted focus groups with a convenience sample of medical students undertaking their general practice placements, exploring student uses, evaluations and expectations of OLLs...
March 14, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28157389/critical-thinking-in-critical-care-five-strategies-to-improve-teaching-and-learning-in-the-intensive-care-unit
#19
Margaret M Hayes, Souvik Chatterjee, Richard M Schwartzstein
Critical thinking, the capacity to be deliberate about thinking, is increasingly the focus of undergraduate medical education, but is not commonly addressed in graduate medical education. Without critical thinking, physicians, and particularly residents, are prone to cognitive errors, which can lead to diagnostic errors, especially in a high-stakes environment such as the intensive care unit. Although challenging, critical thinking skills can be taught. At this time, there is a paucity of data to support an educational gold standard for teaching critical thinking, but we believe that five strategies, routed in cognitive theory and our personal teaching experiences, provide an effective framework to teach critical thinking in the intensive care unit...
April 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28129956/-medically-unexplained-symptoms-care-in-internal-medicine-a-paradigm-of-doctor-patient-relationship-in-situation-of-uncertainty
#20
B Ranque, O Nardon
Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered...
July 2017: La Revue de Médecine Interne
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