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physician impairment

Thomas Morville, Tine Dohlmann, Anja B Kuhlman, Tine Monberg, Mimmi Torp, Bolette Hartmann, Jens J Holst, Steen Larsen, Jørn W Helge, Flemming Dela
Background Statins are widely used to lower cholesterol concentrations in both primary and secondary prevention of cardiovascular disease. The treatment increases the risk of muscle pain (myalgia) and of type 2 diabetes. However, the underlying mechanisms remain disputed. Methods We investigated whether statin induced myalgia is coupled to impaired glucose homeostasis using oral glucose tolerance test (OGTT), intravenous glucose tolerance test (IVGTT) and the hyperinsulinemic euglycemic clamp. We performed a cross-sectional study of statin users without CVD (primary prevention) stratified into a statin myalgic (M; n=25) and a non-myalgic (NM; n=39) group as well as a control group (C; n=20) consisting of non-statin users...
December 5, 2018: Diabetes/metabolism Research and Reviews
Jan Löhler, Martin Lehmann, Veronika Segler, Stefan Volkenstein, Rolf-Dieter Battmer, Arneborg Ernst, Frederike Gräbner, Peter Schlattmann, Rainer Schönweiler, Barbara Wollenberg, Stefan Dazert
BACKGROUND: In Germany, about 15 million people are suffering from hearing loss (HL), whereas only 16 % are using hearing aids. Untreated hearing loss may lead to severe complications (e. g. social isolation, depression, progress of dementia). An early and widespread screening, beginning at the age of 50, is meant to improve this shortage in medical care. By this study, the Mini-Audio-Test (MAT), a six-question and three-step answers containing questionnaire on subjective HL, should be verified on a normal collective of subjects (sensitivity (Se), specificity (Sp), positive predictive value (Ppv))...
December 5, 2018: Laryngo- Rhino- Otologie
Oana A Tatucu-Babet, Emma J Ridley
Outpatients who receive hyperbaric oxygen treatment (HBOT) may represent a group at significant risk of malnutrition owing to the underlying conditions that are often treated with HBOT (e.g., non-healing diabetic wounds and radiation-induced skin injury). In this issue, See and colleagues provide new, preliminary evidence of the prevalence of malnutrition in a small group of HBOT outpatients treated in an Australian hospital, reporting that approximately one-third of patients receiving HBOT were at risk of malnutrition...
December 24, 2018: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Michiko Toizumi, Hien Minh Vo, Duc Anh Dang, Hiroyuki Moriuchi, Lay-Myint Yoshida
Rubella vaccination programs have dramatically reduced the incidence of rubella and congenital rubella syndrome (CRS) in developed countries. However, CRS prevalence is still rising in developing countries where rubella-containing vaccines (RCV) are not included in the immunization program and even in some countries where a part of the population lacks immunity to rubella despite the presence of RCV in the regular immunization program. This review aimed to summarize the clinical features of CRS using data from our studies conducted between 2011 and 2015 in Vietnam, wherein we examined clinical manifestations in Vietnamese children with CRS who were born after the large rubella outbreak of 2011; a series of studies dealing with CRS in North America and Europe after the 1960s epidemic; and those from countries before introduction of RCVs...
November 29, 2018: Vaccine
Heather Cuevas, Catherine Ward
RATIONALE, AIMS, AND OBJECTIVES: The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population...
November 29, 2018: Journal of Evaluation in Clinical Practice
Jonathan R G Etnel, Willem A Helbing, Jolien W Roos-Hesselink, Regina The, Ad J J C Bogers, Johanna J M Takkenberg
Background: To assess the current state of patient information and decision-making in congenital aortic and pulmonary valve disease, we conducted a survey among patients, parents and physicians. Methods: A questionnaire was sent by ground mail to 157 adults and 32 parents of children who previously underwent surgery for congenital aortic or pulmonary valve disease at 0-40 years of age between January 2005 and February 2014 at the Erasmus University Medical Center and to all paediatric and adult congenital cardiologists and congenital cardiac surgeons in the Netherlands (n=88)...
2018: Open Heart
Tomohiko Ono, Nobuhiro Ikemura, Takehiro Kimura, Ikuko Ueda, Hiroaki Tanaka, Hanako Tokuda, Noriyuki Yajima, Keisuke Matsumura, Masahiro Suzuki, Keiichi Fukuda, Shun Kohsaka, Seiji Takatsuki
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been widely used to prevent stroke in non-valvular atrial fibrillation (NVAF) patients. Stringent monitoring is not required for NOACs, albeit dose adjustments are needed based on specific patient factors, such as renal function, body weight and age, or concomitant medications. We investigated the NOAC dosing patterns and evaluated the predictors of the non-standardized dose reduction (NSDR). METHODS: A total of 2452 newly diagnosed NVAF patients were consecutively recruited from secondary- and tertiary-care hospitals between 2012 and 2017...
January 2019: Journal of Cardiology
David Latz, Anja Bergermann, Jeannie Jungnitsch, Jan Peter Grassmann, Erik Schiffner, Britta Gahr, Anne Tank, Joachim Windolf, Stefanie Ritz-Timme, Lilly Graß, Pascal Jungbluth
BACKGROUND: People who have become victims of domestic or public violence often suffer long-term physical, psychological and social impairment. Due to physical injury, the first contact with the health care system is frequently an A & E Department. Thus, physicians and especially surgeons play a key role in detecting victims of domestic or public violence. The specific needs of victims are adequate medical treatment of injuries, forensic documentation, as well as interdisciplinary medical support to prevent further morbidity and violence...
November 27, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
M Bauer, C Wickenhauser, A Haak, N Pazaitis, U Siebolts, C Mawrin, C Strauss, V Rickerts, D Stoevesandt, O A Cornely, J F Meis, F Hagen
Introduction: Cryptococcosis in immunocompetent adults is a rare disease in Europe, mostly induced by members of the Cryptococcus gattii species complex. The diagnosis can be challenging due to its rarity, unspecific symptoms and long symptomless latency. Case presentation: A 49-year-old woman with a three weeks history of headache was admitted to the hospital due to discrete ataxia and impaired vision. Cranial magnetic resonance imaging (MRI) showed a contrast-enhancing mass in the cerebellum...
October 2018: JMM Case Reports
Xavier Charest-Morin, Stephen Betschel, Rozita Borici-Mazi, Amin Kanani, Gina Lacuesta, Georges-Étienne Rivard, Eric Wagner, Susan Wasserman, Bill Yang, Christian Drouet
Background: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is an autosomal dominant disease resulting in random and unpredictable attacks of swelling. The swelling in C1-INH-HAE is a result of impaired regulation of bradykinin production. The fact that the array of tests needed to diagnose HAE is not always available to the treating physicians is challenging for them and their patients. Methods: The data for this article were extracted from two distinct surveys...
2018: Allergy, Asthma, and Clinical Immunology
H Jacobs, J Callhoff, F Hoffmann, A Zink, K Albrecht
BACKGROUND: Only small amounts of data are available on the prescription frequency of physical therapies (PT) for patients with rheumatoid arthritis (RA). OBJECTIVE: The aim of the study was to evaluate prescription frequencies of PT considering functional status and sociodemographic factors. MATERIAL AND METHODS: A total of 98,963 adults diagnosed with RA in 2013 were identified in claims data from the BARMER health insurance. A questionnaire was sent to a representative sample of 6193 people requesting information on the disease status...
November 26, 2018: Zeitschrift Für Rheumatologie
Maryam S Hamidi, Bryan Bohman, Christy Sandborg, Rebecca Smith-Coggins, Patty de Vries, Marisa S Albert, Mary Lou Murphy, Dana Welle, Mickey T Trockel
BACKGROUND: Awareness of the economic cost of physician attrition due to burnout in academic medical centers may help motivate organizational level efforts to improve physician wellbeing and reduce turnover. Our objectives are: 1) to use a recent longitudinal data as a case example to examine the associations between physician self-reported burnout, intent to leave (ITL) and actual turnover within two years, and 2) to estimate the cost of physician turnover attributable to burnout. METHODS: We used de-identified data from 472 physicians who completed a quality improvement survey conducted in 2013 at two Stanford University affiliated hospitals to assess physician wellness...
November 27, 2018: BMC Health Services Research
Marina L Rodocanachi Roidi, Ioannis U Isaias, Francesca Cozzi, Francesca Grange, Fabrizia M Scotti, Valentina F Gestra, Alessandra Gandini, Enrico Ripamonti
AIM: To describe a new clinical tool, the Rett Syndrome Motor Evaluation Scale (RESMES) and to assess (loco-)motor function in people with Rett syndrome (RTT). METHOD: Formal assessment provided by physicians was followed by parents' direct observation at home using the RESMES. Sixty females (mean [SD] age 12y 5mo [8y 9mo], range 3-40y) with a clinical diagnosis and genetically determined RTT participated in the study. Spearman's/Pearson's coefficients assessed the correlation between the clinicians' and caregivers' evaluations, as well as the correlation of RESMES scores with other scales, namely the Pain Assessment in Advanced Dementia, the Rett Assessment Rating Scale, the Modified Ashworth Scale, and hand function (assessed with a scale of evaluation of purposeful hand function)...
November 26, 2018: Developmental Medicine and Child Neurology
Jie Liu, Xuehua Zhang, Xiaojun Ding, Min Song, Kexu Sui
OBJECTIVE: To explore the relationship between the clinical onset locations and the electrophysiological characteristics of different spinal segments in amyotrophic lateral sclerosis (ALS) patients. To develop a rapid examination method using electromyographs (EMGs) for the diagnosis of ALS. METHODS: The clinical symptoms and electrodiagnostic examination results of 150 patients with definite or probable ALS were retrospectively analyzed. The patients were divided into four groups according to the primary onset locations (arms and legs onset, arms onset, legs onset, and bulbar onset groups)...
November 23, 2018: Neurological Sciences
Thanompong Sathienluckana, Weerapon Unaharassamee, Chuthamanee Suthisisang, Orabhorn Suanchang, Thanarat Suansanae
Introduction: Cognitive impairment is a core feature and shows the highest impact on functional outcome in patients with schizophrenia. There have been no previous studies investigating the role of the pharmacist in a multidisciplinary team on cognitive outcomes in patients with schizophrenia. Purpose: We evaluated the impact of pharmacist intervention on cognitive outcomes in patients with schizophrenia by focusing on anticholinergic discontinuation. Patients and methods: A prospective, open-label, randomized, controlled study was conducted...
2018: Integrated Pharmacy Research and Practice
Steven T Bird, Richard S Swain, Fang Tian, Olanrewaju O Okusanya, Peter Waldron, Mona Khurana, Elizabeth L Durmowicz, Yong Ma, Jacqueline M Major, Kate Gelperin
BACKGROUND: Serious and fatal deferasirox-induced kidney injury has been reported in paediatric patients. This study aimed to investigate the effects of deferasirox dose and serum ferritin concentrations on kidney function and the effect of impaired kidney function on dose-normalised deferasirox minimum plasma concentration (Cmin ). METHODS: We did a case-control analysis using pooled data from ten clinical studies. We identified transfusion-dependent patients with thalassaemia, aged 2-15 years, who were receiving deferasirox and had available baseline and follow-up serum creatinine and ferritin measurements...
November 16, 2018: Lancet Child & Adolescent Health
Maya Balakrishnan, Stephen Chris Pappas
In the intersection of alcohol ingestion with the law, medical ethics, and public safety, physicians are often unsure about how to proceed. Physicians' primary focus should be on patient education with an ethical and legal duty to warn the patient of the adverse effects of alcohol. Warning third parties of potential harm related to alcohol-related impairment may involve a breach of patient confidentiality; therefore it should only be undertaken after careful analysis suggests that the risk for significant harm exceeds the burden that results to the patient from warning others...
February 2019: Clinics in Liver Disease
Astrid Lhermite, Maria Teresa Munoz Sastre, Paul C Sorum, Etienne Mullet
The views of laypeople and professionals (nurses, occupational therapists, psychologists, and physicians) on the capacity to make informed decisions of elderly people with depression or dementia were examined. Participants were presented with vignettes created by varying the levels of three factors: (a) the type of decision (e.g., agreeing to surgery), (b) the health problem (e.g., slight depression), and (c) the availability of social support. Through cluster analysis, four different positions were found. Seventeen percent of the participants considered that even persons suffering from slight depression were already quite incapacitated...
November 18, 2018: International Journal of Aging & Human Development
Fur-Hsing Wen, Jen-Shi Chen, Wen-Chi Chou, Wen-Cheng Chang, Chia-Hsun Hsieh, Siew Tzuh Tang
BACKGROUND: High-quality EOL care depends on thoroughly assessing terminally ill patients' preferences for end-of-life (EOL) care and tailoring care to individual needs. Studies on predictors of EOL-care preferences were primarily cross-sectional and assessed preferences for multiple life-sustaining treatments (LSTs), making clinical applications difficult. OBJECTIVE: /Methods: We examined factors predisposing cancer patients (N=303) to specific LST-preference states (life-sustaining preferring, comfort preferring, uncertain, and nutrition preferring) derived from six LSTs (cardio-pulmonary resuscitation, intensive care unit care, chest compression, intubation with mechanical ventilation, intravenous nutrition, and tube feeding) in patients' last 6 months by multilevel multinomial logistic regression...
November 14, 2018: Journal of Pain and Symptom Management
Gary C Brown, Melissa M Brown
Perceptions of the quality-of-life (QOL) associated with vision loss vary widely. Herein, we consider the perceptions of patients with vision loss as the criterion for QOL quantification associated with vision loss. With the QOL instrument, time tradeoff utility analysis, the upper anchor of 1.00 is associated with permanent normal vision, while the lower anchor of 0.00 is associated with death. A time tradeoff utility of 0.26 is associated with no light perception bilaterally. Patients with legal blindness in the U...
November 14, 2018: Survey of Ophthalmology
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