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Clinical judgement

Latifah Alazmi, Grace E Gadsby, Nicola R Heneghan, T David Punt
BACKGROUND: Left/right judgment tasks (LRJTs) are used in the management of chronic pain. This use is predicated on their ability to elicit the simulation of movements (i.e. motor imagery), including those where the execution of the same movements induces pain. While established for limb-based LRJTs, the ability of trunk-based LRJTs to elicit motor imagery of trunk movements has not been demonstrated. OBJECTIVE: To establish whether data from a trunk-based LRJT are indicative of motor imagery being elicited for the specific lateralised trunk postures presented...
March 7, 2018: Musculoskeletal Science & Practice
Stephan Petersenn
Secondary adrenal insufficiency may pose specific challenges during pregnancy. The interpretation of diagnostic tests is hindered by physiological adaptations of the HPA axis. Due the relevant increases in CBG, measurement of salivary cortisol may be preferable, but lacks sufficiently established cut-offs both for early-morning evaluation and during dynamic testing. Hydrocortisone should be used for replacement to avoid overexposure of the fetus, with dose adjustments according to clinical judgement. To account for increased free cortisol levels during the course of pregnancy, hydrocortisone may be increased by 5-7...
March 15, 2018: Minerva Endocrinologica
Shatha A Al Shanqeeti, Yasser N Alkhudairy, Alwaleed A Alabdulwahed, Anwar E Ahmed, Maysoon S Al-Adham, Naveed M Mahmood
To estimate the prevalence of subclinical hypothyroidism (SCH) in Saudi Arabia and assess the need for an SCH screening program. Methods: This cross-sectional study was conducted at King Abdulaziz Medical City and the Khashmulaan Clinic at the National Guard Health Affairs, Riyadh, Saudi Arabia in August 2016. All women attending the antenatal clinics were  invited to participate in the study. In addition, data were retrieved from the files of pregnant women who had been screened for hypothyroidism from January 2016 to August 2016...
March 2018: Saudi Medical Journal
J Liu, Y Li, Y Cai, Z C Jin
Objective: To investigate the predictive value of elevated serum S100B level in patients with multiple traumas combined delirium for the clinical prognosis prior to intensive care unit (ICU) discharge. Methods: One hundred seventy-nine patients with multiple traumas diagnosed as delirium after admission over 48 hours to the Department of Critical Care Medicine, People's Hospital Affiliated to Jiangsu University from January 2013 to December 2016 were divided into two groups according to the level of serum S100B measured prior to the ICU discharge: high S100B group (≥0...
March 6, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Karin Michèle Schmid, Remo Kugler, Prasad Nalabothu, Carles Bosch, Carlalberta Verna
BACKGROUND: Non-nutritive sucking habits may adversely affect the orofacial complex. This systematic literature review aimed to find scientific evidence on the effect of pacifier sucking on orofacial structures. METHODS: A search on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to find all pertinent articles published from inception until February 2018, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
March 13, 2018: Progress in Orthodontics
Jessica Stevenson, Allison Tong, Katrina L Campbell, Jonathan C Craig, Vincent W Lee
OBJECTIVE: To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. DESIGN: Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. SETTING: 21 haemodialysis centres across Australia. PARTICIPANTS: 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences...
March 8, 2018: BMJ Open
Chunzhen Tan, Edimansyah Abdin, Wilfred Liang, Lye Yin Poon, Ngar Yee Poon, Swapna Verma
AIM: Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non-adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non-adherent behaviour. METHODS: The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore...
March 9, 2018: Early Intervention in Psychiatry
Saumya S Gurbani, Eduard Schreibmann, Andrew A Maudsley, James Scott Cordova, Brian J Soher, Harish Poptani, Gaurav Verma, Peter B Barker, Hyunsuk Shim, Lee A D Cooper
PURPOSE: Proton MRSI is a noninvasive modality capable of generating volumetric maps of in vivo tissue metabolism without the need for ionizing radiation or injected contrast agent. Magnetic resonance spectroscopic imaging has been shown to be a viable imaging modality for studying several neuropathologies. However, a key hurdle in the routine clinical adoption of MRSI is the presence of spectral artifacts that can arise from a number of sources, possibly leading to false information...
March 9, 2018: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Wissam Shalish, Samantha Latremouille, Jesse Papenburg, Guilherme Mendes Sant'Anna
CONTEXT: A variety of extubation readiness tests have already been incorporated into clinical practice in preterm infants. OBJECTIVE: To identify predictor tests of successful extubation and determine their accuracy compared with clinical judgement alone. METHODS: MEDLINE, Embase, PubMed, Cochrane Library and Web of Science were searched between 1984 and June 2016. Studies evaluating predictors of extubation success during a period free of mechanical inflations in infants less than 37 weeks' gestation were included...
March 8, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Stewart Forsyth, Philip C Calder, Francis Zotor, Paul Amuna, Barbara Meyer, Bruce Holub
BACKGROUND: A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries...
March 8, 2018: Annals of Nutrition & Metabolism
Bruno Sangro, Carlo Ludovico Maini, Giuseppe Maria Ettorre, Roberto Cianni, Rita Golfieri, Daniele Gasparini, Samer Ezziddin, Philipp M Paprottka, Francesco Fiore, Mark Van Buskirk, Jose Ignacio Bilbao, Rita Salvatori, Emanuela Giampalma, Onelio Geatti, Kai Wilhelm, Ralf Thorsten Hoffmann, Francesco Izzo, Mercedes Iñarrairaegui, Carlo Urigo, Alberta Cappelli, Alessandro Vit, Hojjat Ahmadzadehfar, Tobias Franz Jakobs, Rosa Sciuto, Giuseppe Pizzi, Secondo Lastoria
PURPOSE: Radioembolisation is part of the multimodal treatment of hepatocellular carcinoma (HCC) at specialist liver centres. This study analysed the impact of prior treatment on tolerability and survival following radioembolisation. METHODS: This was a retrospective analysis of 325 consecutive patients with a confirmed diagnosis of HCC, who received radioembolisation with yttrium-90 resin microspheres at eight European centres between September 2003 and December 2009...
March 7, 2018: European Journal of Nuclear Medicine and Molecular Imaging
Mihaela-Roxana Mănoiu, Jade Amine Amri, Alexandra Țicle, Cristina Stan
Optic nerve head drusen is an incidental finding in current ophthalmological practice. Although patients rarely display symptoms, structural, and functional defects, there are exceptional cases when clinical appearance can make it difficult to diagnose underlying or coexisting conditions, such as glaucoma. The following case report demonstrates how overlapping optic nerve pathologies can interfere in clinical judgement and therapeutic decision making in a young male patient, with relevant family history for both glaucoma and bilateral optic nerve head drusen...
October 2017: Romanian Journal of Ophthalmology
May-Lill Johansen, Bente Ervik
BACKGROUND: Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. METHODS: A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals...
March 7, 2018: BMC Health Services Research
Jennie Abbott, Megan Middlemiss, Vicki Bruce, David Smailes, Robert Dudley
BACKGROUND AND OBJECTIVES: When asked to evaluate faces of strangers, people with paranoia show a tendency to rate others as less trustworthy. The present study investigated the impact of arousal on this interpersonal bias, and whether this bias was specific to evaluations of trust or additionally affected other trait judgements. The study also examined the impact of eye gaze direction, as direct eye gaze has been shown to heighten arousal. METHODS: In two experiments, non-clinical participants completed face rating tasks before and after either an arousal manipulation or control manipulation...
February 26, 2018: Journal of Behavior Therapy and Experimental Psychiatry
M Uccello, M Moschetta, G Mak, T Alam, C Murias Henriquez, H-T Arkenau
Chemotherapy remains the mainstay of treatment for advanced pancreatic ductal adenocarcinoma (pda). Two randomized trials have demonstrated superiority of the combination regimens folfirinox (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) and gemcitabine plus nab-paclitaxel over gemcitabine monotherapy as a first-line treatment in adequately fit subjects. Selected pda patients progressing to first-line therapy can receive secondline treatment with moderate clinical benefit. Nevertheless, the optimal algorithm and the role of combination therapy in second-line are still unclear...
February 2018: Current Oncology
Bhornsawan Thanathornwong
Objectives: In this study, a clinical decision support system was developed to help general practitioners assess the need for orthodontic treatment in patients with permanent dentition. Methods: We chose a Bayesian network (BN) as the underlying model for assessing the need for orthodontic treatment. One thousand permanent dentition patient data sets chosen from a hospital record system were prepared in which one data element represented one participant with information for all variables and their stated need for orthodontic treatment...
January 2018: Healthcare Informatics Research
Louise E van Eekeren, Sophia G de Vries, Jiri F P Wagenaar, René Spijker, Martin P Grobusch, Abraham Goorhuis
BACKGROUND: Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars. METHODS: We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever...
February 24, 2018: Travel Medicine and Infectious Disease
W O Tatum, G Rubboli, P W Kaplan, S M Mirsatari, K Radhakrishnan, D Gloss, L O Caboclo, F W Drislane, M Koutroumanidis, D L Schomer, D Kastelijn-Nolst Trenite, Mark Cook, S Beniczky
Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline...
February 1, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Richard J Pugh, Amy Ellison, Kate Pye, Christian P Subbe, Chris M Thorpe, Nazir I Lone, Andrew Clegg
BACKGROUND: For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. METHODS: Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017)...
February 26, 2018: Critical Care: the Official Journal of the Critical Care Forum
Jean-Louis Vincent, Sharon Einav, Rupert Pearse, Samir Jaber, Peter Kranke, Frank J Overdyk, David K Whitaker, Federico Gordo, Albert Dahan, Andreas Hoeft
: Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring...
February 22, 2018: European Journal of Anaesthesiology
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