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Medical narrative

Paul L Schneider, Zhaoping Li
OBJECTIVE: To provide a thorough analysis of the range of ethical concerns that may present in relation to the care of the morbidly obese inpatient over the course of several years of care. METHODS: A narrative of the patient's complex medical care is given, with particular attention to the recommendations of three separate ethics committee consultations that were sought by his health care providers. An ethical analysis of the relevant issues is given within the Principles of Biomedical Ethics framework, highlighting the principles of autonomy, beneficence, non-maleficence, and justice...
2016: Narrative Inquiry in Bioethics
Nathan Hodson, Alice Ryrie, Rose Glennerster
No abstract text is available yet for this article.
November 2016: Medical Education
Andrew Silapaswan, Douglas Krakower, Kenneth H Mayer
Since FDA approval of HIV pre-exposure prophylaxis (PrEP) for HIV prevention, attention has been focused on PrEP implementation. The CDC estimates that 1.2 million U.S. adults might benefit from PrEP, but only a minority are using PrEP, so there is a significant unmet need to increase access for those at risk for HIV. Given the large numbers of individuals who have indications for PrEP, there are not enough practicing specialists to meet the growing need for providers trained in providing PrEP. Moreover, since PrEP is a preventive intervention for otherwise healthy individuals, primary care providers (PCPs) should be primary prescribers of PrEP...
October 19, 2016: Journal of General Internal Medicine
Gisella Orsini
This article aims to shed light on the self-perceptions of people with eating disorders in Malta and Italy through a deep understanding of their narratives. In contrast to the biomedical perception of the phenomenon and in opposition with the prevalent feminist theories on the subject, I consider eating disorders as the result of self-transformative processes. I suggest that anorexics, bulimics and binge eaters are actively and deliberately engaged in a project of moral self-transformation that is culturally defined...
October 19, 2016: Culture, Medicine and Psychiatry
Rafael Bello Corassa, Carmen Aceijas, Paula Aryane Brito Alves, Hemda Garelick
AIMS: This article aimed to provide a critical review of the evolution of Chagas' disease (ChD) in Brazil, its magnitude, historical development and management, and challenges for the future. METHODS: A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles' references. Narrative analysis was structured around five main themes identified: vector transmission, control programme, transfusion, oral and congenital transmission...
October 10, 2016: Perspectives in Public Health
Brett McCarty
In The Anticipatory Corpse, Jeffrey Bishop claims that modern medicine has lost formal and final causality as the dead body has become epistemologically normative, and that a singular focus on efficient and material causality has thoroughly distorted modern medical practice. Bishop implies that the renewal of medicine will require its housing in alternate social spaces. This essay critiques both Bishop's diagnosis and therapy by arguing, first, that alternate social imaginaries, though perhaps marginalized, are already present within the practice of medicine...
October 6, 2016: Journal of Medicine and Philosophy
Myriam Cielo Pérez, Nanor Minoyan, Valéry Ridde, Marie-Pierre Sylvestre, Mira Johri
BACKGROUND: Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions, particularly in low- and middle-income countries (LMICs). Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions...
October 19, 2016: Systematic Reviews
Peter Rijnbeek
Massive numbers of electronic health records are currently being collected globally, including structured data in the form of diagnoses, medications, laboratory test results, and unstructured data contained in clinical narratives. This opens unprecedented possibilities for research and ultimately patient care. However, actual use of these databases in a multi-center study is severely hampered by a variety of challenges, e.g., each database has a different database structure and uses different terminology systems...
September 2016: Journal of Hypertension
Jo Kidd, Sue Ziebland
Online health information is increasingly popular and may bring both benefits and potential harm to users with mental health problems. The encouragement of harmful behaviour among this population is a particular concern. The website provides the benefits of shared experience by publishing excerpts from rigorous research interviews with patients, contextualised with medical information. This article sets out evidence for the positive and negative effects of online mental health information and describes the methodology behind healthtalk...
October 2016: BJPsych Bulletin
M Raj, S W Choi, J Platt
Informed consent (IC) struggles to meet the ethical principles it strives to embody in the context of hematopoietic cell transplantation (HCT). Patients often participate in multiple clinical trials making it difficult to effectively inform the participants and fulfill complex regulations. The recent Notice of Proposed Rule Making would make major changes to federal requirements, providing a timely opportunity to evaluate existing practice. Twenty health care professionals within a Midwest Academic Medical Center involved in obtaining IC in the HCT clinic or involved in patient care during or after the IC process were interviewed to understand: (1) how they approached the IC process; (2) how they described a 'successful' IC process; and (3) opportunities for innovation...
October 17, 2016: Bone Marrow Transplantation
Lauren J Ralph, Diana Greene Foster, Katrina Kimport, David Turok, Sarah C M Roberts
OBJECTIVE: Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy...
October 10, 2016: Contraception
Deborah Azrael, Alexander Mukamal, Amy P Cohen, David Gunnell, Catherine Barber, Matthew Miller
INTRODUCTION: Identifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time. METHODS: Using suicide cases from the 16 NVDRS states that participated throughout 2005-2012, free-text and code searches were conducted for four types of variables-incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names-to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases...
November 2016: American Journal of Preventive Medicine
Cynthia Lien, Tony Rosen, Elizabeth M Bloemen, Robert C Abrams, Maria Pavlou, Mark S Lachs
OBJECTIVES: To identify patterns of personal experience or behavior in self-neglect by exploring narratives of cognitively intact older adults. DESIGN: Descriptive study involving semistructured interviews and unstructured narratives. SETTING: A parent study of self-neglect characteristics. PARTICIPANTS: Cognitively intact, self-neglecting older adults referred from 11 community-based senior services agencies (N = 69)...
October 14, 2016: Journal of the American Geriatrics Society
Maria Jenelyn M Alviar, Tom Hale, Monalisa Dungca
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 12, 2011. Phantom limb pain (PLP) is pain that arises in the missing limb after amputation and can be severe, intractable, and disabling. Various medications have been studied in the treatment of phantom pain. There is currently uncertainty in the optimal pharmacologic management of PLP. OBJECTIVES: This review aimed to summarise the evidence of effectiveness of pharmacologic interventions in treating PLP...
October 14, 2016: Cochrane Database of Systematic Reviews
William R Saltzman
This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience...
October 13, 2016: Family Process
Oleksa G Rewa, Pierre-Marc Villeneuve, Philippe Lachance, Dean T Eurich, Henry T Stelfox, R T Noel Gibney, Lisa Hartling, Robin Featherstone, Sean M Bagshaw
OBJECTIVES: Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. DESIGN: A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources...
October 11, 2016: Intensive Care Medicine
Abby Wilkerson, Joseph Fisher, Wade Fletcher
Writing is central both to the medical diagnostic codification of disability and to disabled people's efforts to interrupt, complicate, or disrupt dominant medical narratives. This Symposium, like the George Washington University conference from which it takes its name, creates space for diverse modes and genres of claiming authority regarding diagnosis and its cultural and material effects. "Queer" and "crip" interrogations of diagnosis illuminate its status as a cultural phenomenon, embracing culturally disavowed embodiments and embodied experiences as tools for diagnosing inegalitarian social relations and opportunities for cultural interventions...
October 5, 2016: Journal of Bioethical Inquiry
Karen Harkness, Harleah G Buck, Heather Arthur, Sandra Carroll, Tammy Cosman, Michael McGillion, Sharon Kaasalainen, Jennifer Kryworuchko, Sheila O'Keefe-McCarthy, Diana Sherifali, Patricia H Strachan
AIM: While caregivers (CGs) make an important contribution to the self-care of heart failure (HF) patients, there are no reliable and valid tools for measuring such contributions. Current interventions that strive to optimize patient outcomes through self-care strategies neglect to account for CG contributions, a potential confounder on outcomes. The aim of the study was to develop an instrument that measures CG contributions to HF patients' self-care. DESIGN: The study design follows an established process for instrument development...
January 2016: Nurs Open
Robin A Ducas, Christopher Labos, David Allen, Mehrdad Golian, Maya Jeyaraman, Justin Lys, Amrinder Mann, Leslie Copstein, Sherri Vokey, Rasheda Rabbani, Ryan Zarychanski, Ahmed M Abou-Setta, Alan H Menkis
BACKGROUND: Delays in reperfusion for patients with myocardial ischemia leads to increased morbidity and mortality. The objective of this review was to identify, evaluate, and critically appraise the evidence on whether pre-hospital electrocardiography (ECG) reduces patient mortality and improves post-ST-segment myocardial infarction patient-oriented outcomes. METHODS: We searched PubMed/MEDLINE, EMBASE, and Cochrane Library (1990-2015) for controlled clinical studies...
June 14, 2016: Canadian Journal of Cardiology
Antonio Trabacca, Teresa Vespino, Antonella Di Liddo, Luigi Russo
Cerebral palsy (CP) is one of the most frequent causes of child disability in developed countries. Children with CP need lifelong assistance and care. The current prevalence of CP in industrialized countries ranges from 1.5 to 2.5 per 1,000 live births, with one new case every 500 live births. Children with CP have an almost normal life expectancy and mortality is very low. Despite the low mortality rate, 5%-10% of them die during childhood, especially when the severe motor disability is comorbid with epilepsy and severe intellectual disability...
2016: Journal of Multidisciplinary Healthcare
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