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Parker J Magin, Amanda Tapley, Simon Morgan, Kim Henderson, Elizabeth G Holliday, Andrew R Davey, Jean Ball, Nigel F Catzikiris, Katie J Mulquiney, Mieke L van Driel
OBJECTIVE: To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. DESIGN: Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars)...
July 17, 2017: Medical Journal of Australia
Jeffrey A Kline
BACKGROUND: Failure to test for pulmonary embolism (PE) can be a lethal mistake, but PE and produces symptoms similar to many other diseases. Overtesting for PE has negative consequences. OBJECTIVES: Use published evidence to create a rationale and safe diagnostic approach for ambulatory and emergency patients with suspected PE in 2017. FINDINGS: Pulmonary embolism need not be pursued in patients with no symptoms of PE in the present or recent history (dyspnea, chest pain, cough or syncope), and always normal vital signs...
June 7, 2017: Thrombosis Research
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
Jerome R Hoffman, Christopher R Carpenter
No abstract text is available yet for this article.
February 7, 2017: Journal of the American Geriatrics Society
Karen Arane, Ilene Claudius, Ran D Goldman
QUESTION: For many years, the term apparent life-threatening event (ALTE) was associated with sudden infant death syndrome, and parents who described an acute event in their infants were sent to the hospital for admission. I understand that for infants new terminology is recommended. What is the current approach to a near-death experience of an infant? ANSWER: A recent clinical practice guideline revised the name and definition of an ALTE to a brief resolved unexplained event (BRUE)...
January 2017: Canadian Family Physician Médecin de Famille Canadien
Rhonda B Friedman, Kelli L Sullivan, Sarah F Snider, George Luta, Kevin T Jones
Objective: An important aspect of the rehabilitation of cognitive and linguistic function subsequent to brain injury is the maintenance of learning beyond the time of initial treatment. Such maintenance is often not satisfactorily achieved. Additional practice, or overtraining, may play a key role in long-term maintenance. In particular, the literature on learning in cognitively intact persons has suggested that it is testing, and not studying, that contributes to maintenance of learning. The present study investigates the hypothesis that continuing to test relearned words in persons with anomia will lead to significantly greater maintenance compared with continuing to study relearned words...
October 10, 2016: Neuropsychology
Simon Morgan, Andy Morgan, Rohan Kerr, Amanda Tapley, Parker Magin
OBJECTIVE: To assess the effectiveness of an educational intervention on test-ordering attitudes and intended practice of GP trainees, and any associations between changes in test ordering and trainee characteristics. DESIGN: Preworkshop and postworkshop survey of attitudes to test ordering, intended test-ordering practices for 3 clinical scenarios (fatigue, screening, and shoulder pain), and tolerance for uncertainty. SETTING: Three Australian regional general practice training providers...
September 2016: Canadian Family Physician Médecin de Famille Canadien
Jeremy Samuel Faust, Andreea Nemes
Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation...
August 2016: Emergency Medicine Practice
Aparna R Parikh, Nancy L Keating, Pang-Hsiang Liu, Stacy W Gray, Carrie N Klabunde, Katherine L Kahn, David A Haggstrom, Sapna Syngal, Benjamin Kim
PURPOSE: Little is known about the roles of genetic and molecular testing and Lynch syndrome screening in the formulation of predictive and prognostic assessments for patients with stage II colorectal cancer (CRC). METHODS: From 2012 to 2013, we surveyed medical oncologists in the Cancer Care Outcomes Research and Surveillance Consortium and evaluated oncologists' selection of microsatellite instability (MSI) and/or immunohistochemistry (IHC) for mismatch repair (MMR) proteins, germline testing for MMR genes, BRAF and KRAS mutation analysis, and Oncotype DX in stage II CRC...
March 2016: Journal of Oncology Practice
Jonne J Sikkens, Djoeke G Beekman, Abel Thijs, Patrick M Bossuyt, Yvo M Smulders
Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes' theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test...
2016: PloS One
Sarah E P Munce, Sonya Allin, Leslie Carlin, Joanna Sale, Gillian Hawker, Sandra Kim, Debra A Butt, Irene Polidoulis, Karen Tu, Susan B Jaglal
Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontario's family physicians (FPs). Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing...
2016: Journal of Osteoporosis
Steven C Boyages
No abstract text is available yet for this article.
January 18, 2016: Medical Journal of Australia
Simon A Mahler, Robert F Riley, Gregory B Russell, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, John Bringolf, Stephanie B Elliott, David M Herrington, Gregory L Burke, Chadwick D Miller
OBJECTIVES: Accelerated diagnostic protocols (ADPs), such as the HEART Pathway, are gaining popularity in emergency departments (EDs) as tools used to risk stratify patients with acute chest pain. However, provider nonadherence may threaten the safety and effectiveness of ADPs. The objective of this study was to determine the frequency and impact of ADP nonadherence. METHODS: A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. This trial enrolled 282 adult ED patients with symptoms concerning for acute coronary syndrome without ST-elevation on electrocardiogram...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Rozalina G McCoy, Holly K Van Houten, Joseph S Ross, Victor M Montori, Nilay D Shah
STUDY QUESTION: What is the extent and effect of excessive testing for glycated hemoglobin (HbA1c) among adults with controlled type 2 diabetes? METHODS: A retrospective analysis of data from a national administrative claims database included commercially insured individuals in the USA, 2001-13. Study patients were aged 18 years or older, had type 2 diabetes with stable glycemic control (two consecutive tests showing HbA1c<7.0% within 24 months), did not use insulin, had no history of severe hypoglycemia or hyperglycemia, and were not pregnant...
December 8, 2015: BMJ: British Medical Journal
Vivian S Lee, Thomas Miller, Chrissy Daniels, Marilynn Paine, Brian Gresh, A Lorris Betz
Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process...
March 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Christopher R Carpenter, Ali S Raja, Michael D Brown
Overtesting, the downstream consequences of overdiagnosis, and overtreatment of some patients are topics of growing debate within emergency medicine (EM). The "Preventing Overdiagnosis" conference, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, with sponsorship from consumer organizations, medical journals, and academic institutions, is evidence of an expanding interest in this topic. However, EM represents a compellingly unique environment, with increased decision density tied to high stakes for patients and providers with missed or delayed diagnoses in a professional atmosphere that does not tolerate mistakes...
December 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Eleftherios P Diamandis, Michelle Li
High-throughput technologies such as next-generation genomics, transcriptomics and proteomics are capable of generating massive amounts of data quickly, and at relatively low costs. It is tempting to use this data for various medical applications including preclinical disease detection and for prediction of disease predisposition. Pilot projects, initiated by various research groups and Google, are currently underway, but results with not be available for a few years. We here summarize some possible difficulties with these approaches, by using examples from already tried cancer and other screening programs...
March 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Elliot B Tapper, Neil Sengupta, Michelle Lai, Gary Horowitz
No abstract text is available yet for this article.
September 2015: JAMA Internal Medicine
Ray Moynihan, Brooke Nickel, Jolyn Hersch, Jenny Doust, Alexandra Barratt, Elaine Beller, Kirsten McCaffery
OBJECTIVE: Overdiagnosis occurs when someone is diagnosed with a disease that will not harm them. Against a backdrop of growing evidence and concern about the risk of overdiagnosis associated with certain screening activities, and recognition of the need to better inform the public about it, we aimed to ask what the Australian community understood overdiagnosis to mean. DESIGN, SETTING AND PARTICIPANTS: Content analysis of verbatim responses from a randomly sampled community telephone survey of 500 Australian adults, between January and February 2014...
2015: BMJ Open
Hemal K Kanzaria, Robert H Brook, Marc A Probst, Dustin Harris, Sandra H Berry, Jerome R Hoffman
OBJECTIVES: Despite the potential benefits of shared decision-making (SDM), its integration into emergency care is challenging. Emergency physician (EP) perceptions about the frequency with which they use SDM, its potential to reduce medically unnecessary diagnostic testing, and the barriers to employing SDM in the emergency department (ED) were investigated. METHODS: As part of a larger project examining beliefs on overtesting, questions were posed to EPs about SDM...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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