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physician impairment

Eelco van Duinkerken, Juliana Farme, Jesus Landeira-Fernandez, Marcia C Dourado, Jerson Laks, Daniel C Mograbi
The capacity to make decisions is an important feature of daily living, which is closely linked to proper cognitive functioning. In conditions in which cognitive functioning becomes compromised, such as in Alzheimer's disease (AD), decision-making capacity can also get affected. Especially in AD, this has important implications, since over the course of the condition many important clinical decisions have to be made. For caregivers as well as physicians, it is sometimes difficult to determine how and when to intervene in the decision-making process...
August 3, 2018: Journal of Alzheimer's Disease: JAD
Nobumasa Ohara, Mayuko Hirokawa, Michi Kobayashi, Yohei Ikeda, Yuichiro Yoneoka, Yasuhiro Seki, Katsuhiko Akiyama, Takashi Tani, Kenshi Terajima, Tetsutaro Ozawa
A 69-year-old Japanese man with a history of suprasellar surgery and irradiation developed bradykinesia and mild fatigue without muscle weakness, myalgia, pyramidal or extrapyramidal signs, parkinsonian symptoms, or ataxia. An endocrinological work-up revealed anterior hypopituitarism associated with secondary adrenal insufficiency. Higher brain function tests indicated an impaired frontal lobe function. The patient's bradykinesia, fatigue, and frontal lobe dysfunction improved within 2 weeks after the initiation of corticosteroid replacement therapy...
August 10, 2018: Internal Medicine
Marzieh Salehi, Adrian Vella, Tracey McLaughlin, Mary-Elizabeth Patti
Context: Hypoglycemia, occurring after bariatric and other forms of upper gastrointestinal surgery, is increasingly encountered by clinical endocrinologists. The true frequency of this condition remains uncertain, due, in part, to differences in the diagnostic criteria and in the affected populations, as well as relative lack of patient and physician awareness and understanding of this condition. Postbariatric hypoglycemia can be severe and disabling for some patients, with neuroglycopenia (altered cognition, seizures, and loss of consciousness) leading to falls, motor vehicle accidents, and job and income loss...
August 1, 2018: Journal of Clinical Endocrinology and Metabolism
Jose Luis Lopez-Campos, Bernardino Alcázar Navarrete, Joan B Soriano, Juan J Soler-Cataluña, José Miguel Rodríguez González-Moro, Manuel E Fuentes Ferrer, Myriam Calle Rubio
Purpose: Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy. Methods: EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014-May 2015)...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Sinikka Tarvonen-Schröder, Anne Kaljonen, Katri Laimi
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set...
September 2018: International Journal of Rehabilitation Research. Revue Internationale de Recherches de Réadaptation
Frederick Schneider, Jan Martin, Gerhard Schneider, Christian M Schulz
BACKGROUND: Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS: NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care...
2018: PloS One
Xia-An Bi, Qian Xu, Xianhao Luo, Qi Sun, Zhigang Wang
The identification of abnormal cognitive decline at an early stage becomes an increasingly significant conundrum to physicians and is of major interest in the studies of mild cognitive impairment (MCI). Support vector machine (SVM) as a high-dimensional pattern classification technique is widely employed in neuroimaging research. However, the application of a single SVM classifier may be difficult to achieve the excellent classification performance because of the small-sample size and noise of imaging data...
2018: Frontiers in Psychiatry
Christina Wittkamp, Lisa Traeger, Ines Ellermann, Maria Eveslage, Andrea U Steinbicker
Preoperative anemia occurs in about one third of patients who undergo elective surgery and is associated with an impaired outcome. Therefore, screening of preoperative anemia was established in the context of a multidisciplinary Patient Blood Management (PBM) program at the University Hospital of Muenster, Germany. Anemic patients without contraindications were treated with intravenous (IV) iron (ferric carboxymaltose) to increase their hemoglobin (Hgb) levels and hence to treat anemia prior to surgery. Interestingly, we detected a large variability in the response of Hgb levels after IV iron administration...
2018: PloS One
Rasmus K B Richelsen, Signe B Jensen, Henrik Nielsen
To assess the incidence, predictive factors, and prognosis of acyclovir-induced nephrotoxicity. We conducted a historical prospective cohort study of patients treated with intravenous acyclovir in North Denmark Region from 2009 to 2016. Information on baseline demographics, co-morbidities, plasma creatinine, and treatment was obtained from the medical records. The primary outcome was an increase of ≥ 40 μmol/L in plasma creatinine level from baseline. We included 276 patients treated with intravenous acyclovir of which 29 (10...
August 7, 2018: European Journal of Clinical Microbiology & Infectious Diseases
Preeti Kothari, Yugal Kishor Sharma, Milind A Patvekar, Aayush Gupta
Background: The relationship between impaired quality of life (QoL) due to melasma and its clinical severity remains equivocal despite several studies. Aim: The aim was to study the correlation, if any, between the clinical severity and the impairment in QOL due to melasma. Methods: This cross-sectional, questionnaire-based study was conducted on a cohort of 141 patients of melasma attending the outpatient department of our referral hospital...
July 2018: Indian Journal of Dermatology
Veera K van Wijnen, Dik Ten Hove, Ciarán Finucane, Wouter Wieling, Arie M van Roon, Jan C Ter Maaten, Mark P M Harms
OBJECTIVES: Continuous noninvasive blood pressure (BP) measurement enables us to observe rapid changes in BP and to study underlying hemodynamic mechanisms. This study aimed to gain insight into the pathophysiological mechanisms underlying short-term orthostatic BP recovery patterns in a real-world clinical setting with (pre)syncope patients. SETTING AND PARTICIPANTS: In a prospective cohort study, the active lying-to-standing test was performed in suspected (pre)syncope patients in the emergency department with continuous noninvasive finger arterial BP measurement...
August 2, 2018: Journal of the American Medical Directors Association
Ciro Manzo, Jordi Serra-Mestres, Alberto Castagna, Marco Isetta
Background: Since the introduction of glucocorticoids (GCs) in the physician's pharmacological arsenal, it has been known that they are a cause of behavioral or psychiatric adverse events (BPAE), as well as of cognitive problems. To the best of our knowledge, the relationship between these adverse events and GCs in older persons has never been evaluated, except through case-reports or series with few cases. In this paper, a review of the literature regarding BPAEs and cognitive disorders in older people treated with CSs is undertaken...
August 1, 2018: Medicines (Basel, Switzerland)
Carlos H Lifschitz, Mohamad Miqdady, Flavia Indrio, Joseph Haddad, Eslam Tawfik, Akbari AbdelHak, Nezha Mouane, Mohamad Salah, Katayoun Khatami, Beheshteh Olang, Yvan Vandenplas
BACKGROUND: Iron deficiency (ID) with or without anemia is associated with impaired mental and psychomotor development. Given the paucity of information on physicians' knowledge and practices on iron (Fe) supplementation and impact of ID in the Middle East and North Africa (MENA), it was felt important to conduct a survey. METHOD: A group of expert physicians developed a questionnaire that was randomly distributed among MENA doctors to assess their knowledge and practices on introduction of complementary feeding, impact of ID, its prevention and their impression on prevalence of ID...
August 2, 2018: Journal of Pediatric Gastroenterology and Nutrition
Erica Nishida Hasimoto, Daniele Cristina Cataneo, Tarcísio Albertin Dos Reis, Antonio José Maria Cataneo
OBJECTIVE: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. METHODS: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis...
July 30, 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Viktoria S Wurmbach, Anette Lampert, Steffen J Schmidt, Simone Bernard, Petra A Thürmann, Hanna M Seidling, Walter E Haefeli
The difficulties of managing a complex medication regimen are often underestimated in outpatient care. A large number of drugs (polypharmacy) and complicated dosage schemes or dosage forms may overstrain patients. Indeed, wrong drug administration can impair treatment success or cause adverse drug events.Patients are often unaware of the medication administration errors. Furthermore they do not voice administration problems, often because they are not aware of the potential to optimize their drug therapy...
July 31, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Mei Lan Ko, Kai Lin Wei, Yi-Jung Ho, Pai Huei Peng, Henry Horng Shing Lu
BACKGROUND/PURPOSE: To investigate the knowledge and learning ability of glaucoma patients regarding their anti-glaucoma topical medications. METHODS: Patients on regular follow-up at the Glaucoma Clinic at Hsin-Chu General Hospital were recruited. After detailed ocular examinations, the participants were asked to recall and identify their glaucoma eye drops. The same test was repeated 3 months later. The results of both tests, the learning ability of patients regarding their glaucoma drugs, and the relationship between learning ability and demographic variables were evaluated...
July 27, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Kota Imai, Hiroki Murayama, Takahisa Hirose
INTRODUCTION: The Japanese guidelines emphasize treatment individualization and intensification with oral anti-diabetes drugs and glucagon-like peptide-1 receptor agonists (OADGs) as add-on therapy to insulin in the management of type 2 diabetes mellitus (T2DM). However, a step-wise treatment algorithm is not clearly defined in the Japanese guidelines. This study explores the treatment factors and patient characteristics for selecting the OADGs as add-on therapy to insulin from physicians' perspectives in a real-world setting in Japan...
July 30, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Anna Mirska, Wojciech Kułak, Bożena Okurowska-Zawada, Elżbieta Dmitruk
PURPOSE: The aim of this study was to assess the effectiveness of long-term therapy with multiply botulinum neurotoxin (BoNT) injections. METHODS: In 2004-2010, 60 children with spastic cerebral palsy aged 2-16 were treated multiple botulinum toxin sessions (injections in gastrocnemius muscle and soleus muscles). In each patient, we rated muscle tone by Modified Ashworth Scale, passive range of motion in ankle joint with extended, and flexed knee joint and gait using the Physician Rating Scale...
July 30, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Andrew T Gabrielson, Rita A Sartor, Wayne J G Hellstrom
BACKGROUND: Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an increased prevalence of sexual dysfunction among patients with thyroid disorders. As such, it is important for sexual medicine physicians to be primed on the presentation of patients with overlying sexual and thyroid dysfunction to allow for proper management. AIM: To review the available literature exploring the relationship between thyroid disease and sexual dysfunction in men and women...
July 26, 2018: Sexual Medicine Reviews
Mariana G Braz, Kátina M Souza, Lorena M C Lucio, Giulia C C Di Renzo, Luciana M Feliciano, João Paulo C Marcondes, C-Y Oliver Chen, José Reinaldo C Braz, Leandro G Braz
Operating room professionals are scarcely aware of their individual occupational exposure to waste anesthetic gases (WAGs). Medical residents spend several hours per day in operating rooms and consequently experience occupational exposure to WAGs. Considering that no studies have yet evaluated the potential toxicity in medical residents exposed to WAGs using the buccal micronucleus cytome (BMCyt) assay, this pioneering study aimed to compare the BMCyt assay markers, including DNA damage, cell proliferation, and cell death in the exfoliated buccal cells of surgery and anesthesiology residents occupationally exposed to WAGs...
August 2018: Mutation Research
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