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Clinical judgement

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https://www.readbyqxmd.com/read/28934799/factors-influencing-the-application-of-a-biopsychosocial-perspective-in-clinical-judgement-of-chronic-pain-interactive-management-with-medical-students
#1
Christopher P Dwyer, Phoebe E McKenna-Plumley, Hannah Durand, Emer M Gormley, Brian W Slattery, Owen M Harney, Padraig MacNeela, Brian E McGuire
BACKGROUND: Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients...
September 2017: Pain Physician
https://www.readbyqxmd.com/read/28925046/in-vivo-pharmacodynamic-and-pharmacokinetic-interactions-of-hibiscus-sabdariffa-calyces-extracts-with-simvastatin
#2
S J Showande, O M Adegbolagun, S I Igbinoba, T O Fakeye
WHAT IS KNOWN AND OBJECTIVES: Increasing number of patients use herbs with their medications. Such practice may result in beneficial or harmful herb-drug interactions. A recent survey reported that some participants co-administered Hibiscus sabdariffa, a widely used beverage, or tea, with their antihyperlipidaemic medications. This study therefore evaluated the effect of concomitant administration of Hibiscus sabdariffa calyces' extracts with simvastatin on hyperlipidaemia and pharmacokinetics of the drug in vivo...
September 18, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28918410/-just-like-a-normal-pain-what-do-people-with-diabetes-mellitus-experience-when-having-a-myocardial-infarction-a-qualitative-study-recruited-from-uk-hospitals
#3
Nikita Berman, Melvyn Mark Jones, Daan A De Coster
OBJECTIVE: The objective of the study was to investigate the symptoms people with diabetes experience when having a myocardial infarction (MI), their illness narrative and how they present their symptoms to the health service. SETTING: Three London (UK) hospitals (coronary care units and medical wards). PARTICIPANTS: Patients were recruited with diabetes mellitus (DM) (types 1 and 2) with a clinical presentation of MI (ST elevated MI (STEMI), non-ST elevated MI (NSTEMI), acute MI unspecified and cardiac arrest)...
September 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28906154/moving-toward-consensus-on-diagnosis-and-management-of-severe-asthma-in-adults
#4
Daniel Colodenco, Oscar Palomares, Carlos Celis, Alan Kaplan, Christian Domingo
Asthma is a considerable health problem with an increasing global prevalence. The burden of severe asthma is expected to notably increase in the following years. Some misleading concepts that sometimes appear in the literature can drive the physician responsible for the patient's management to make incorrect decisions. Furthermore, some of the concepts that appear in the literature and in the guidelines may be not be clear to understand, to follow or to adapt to the regional and local realities. This could again drive the physicians responsible of the patient's management to make incorrect clinical judgements...
September 14, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28903993/mitral-regurgitation-in-patients-with-severe-aortic-stenosis-diagnosis-and-management
#5
REVIEW
Anna Sannino, Paul A Grayburn
Severe aortic stenosis (AS) and mitral regurgitation (MR) frequently coexist. Although some observational studies have reported that moderate or severe MR is associated with higher mortality, the optimal management of such patients is still unclear. Simultaneous replacement of both aortic and mitral valves is linked to significantly higher morbidity and mortality. Recent advances in minimally invasive surgical or transcatheter therapies for MR allow for staged procedures in which surgical or transcatheter aortic valve replacement (SAVR/TAVR) is done first and MR severity re-evaluated afterwards...
September 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28895808/shared-decision-making-after-severe-stroke-how-can-we-improve-patient-and-family-involvement-in-treatment-decisions
#6
Akila Visvanathan, Martin Dennis, Gillian Mead, William N Whiteley, Julia Lawton, Fergus Neil Doubal
People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28893215/translation-and-cultural-adaptation-of-the-integrated-palliative-care-outcome-scale-including-cognitive-interviewing-with-patients-and-staff
#7
Ingela Beck, Ulrika Olsson Möller, Marlene Malmström, Anna Klarare, Henrik Samuelsson, Carina Lundh Hagelin, Birgit Rasmussen, Carl Johan Fürst
BACKGROUND: To expand our clinical and scientific knowledge about holistic outcomes within palliative care, there is a need for agreed-upon patient-reported outcome measures. These patient-reported outcome measures then require translation and cultural adaptation, either from country-specific languages to English, or the other way around. The aim of this study was to translate and cross-culturally adapt the Integrated Palliative care Outcome Scale (IPOS) to the Swedish care context. METHODS: Swedish versions of IPOS Patient and IPOS Staff were developed and culturally adapted using recommended guidelines including cognitive interviews with patients (n = 13) and staff (n = 15) from different care contexts including general and specialised palliative care...
September 11, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28891177/cognitive-challenges-to-minimising-low-value-care
#8
Ian A Scott
Clinical decisions often rely on pattern recognition, simple rules of thumb, tacit knowledge and habit. In many instances, such intuitive decisions are fast and accurate, but they can be subject to cognitive biases leading to delivery of care of low value at odds with scientific evidence of best practice. If programmes, such as EVOLVE (Evaluating Evidence, Enhancing Efficiencies) and Choosing Wisely are to have maximal impact in minimising low value care, such biases, and the factors that hide and accentuate them, need to be exposed and addressed in a collegiate and non-judgemental manner...
September 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28876662/the-role-of-laparoscopy-in-blunt-abdominal-trauma-diagnostic-therapeutic-or-both
#9
M Z Koto, F Mosai, O Y Matsevych
BACKGROUND: The use of laparoscopy in blunt abdominal trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. But the feasibility of using laparoscopy for therapeutic intervention in these patients has been debated. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted. METHOD: A retrospective analysis of a prospectively collected data was done...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876603/the-role-of-laparoscopy-in-blunt-abdominal-trauma-diagnostic-therapeutic-or-both
#10
F Mosai
BACKGROUND: The use of laparoscopy in blunt abdominal trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. But the feasibility of using laparoscopy for therapeutic intervention in these patients has been debated. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted. METHOD: A retrospective analysis of a prospectively collected data was done...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28866703/clinical-judgement-perplexed-by-initially-undisclosed-use-of-herbal-medicine-and-unexpected-cross-reactivity-of-immunoassay
#11
K T Liu, C W Lee
We report a case of symptomatic bradycardia caused by consumption of a Chinese herbal medicine which was initially undisclosed to the attending emergency physician. The scientific name of the herb is Panax japonicus. Electrocardiogram revealed sinus bradycardia. Laboratory tests were normal except for the detection of a high serum digoxin level. Further interrogation of the patient eventually disclosed ingestion of the herb which, however, did not contain any digoxin. Other active ingredients in the herb include various types of ginsenoside...
August 2017: Malaysian Journal of Pathology
https://www.readbyqxmd.com/read/28865442/midwives-experiences-of-performing-maternal-observations-and-escalating-concerns-a-focus-group-study
#12
Justine Jeffery, Alistair Hewison, Laura Goodwin, Sara Kenyon
BACKGROUND: For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations...
September 2, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28859326/similar-efficacy-and-safety-of-initial-cobra-light-and-cobra-therapy-in-rheumatoid-arthritis-4-year-results-from-the-cobra-light-trial
#13
Nicole P C Konijn, Lilian H D van Tuyl, Maarten Boers, Debby den Uyl, Marieke M Ter Wee, Lindsey K M van der Wijden, Irene E M Bultink, Pit J S M Kerstens, Alexandre E Voskuyl, Dirkjan van Schaardenburg, Michael T Nurmohamed, Willem F Lems
Objective: To assess the efficacy and safety of initial COBRA-light vs COBRA therapy in RA patients after a 4-year follow-up period. Methods: In the COBRA-light trial, 162 consecutive patients with recent-onset RA were randomized to either COBRA-light (prednisolone and MTX) or COBRA therapy (prednisolone, MTX and SSZ) for 1 year. After 1 year, treatment was continued without protocol, and adjusted by the treating physician according to clinical judgement, preferably with a treat-to-target strategy...
September 1, 2017: Rheumatology
https://www.readbyqxmd.com/read/28851331/-i-would-rather-be-told-than-not-know-a-qualitative-study-exploring-parental-views-on-identifying-the-future-risk-of-childhood-overweight-and-obesity-during-infancy
#14
Faye Bentley, Judy Anne Swift, Rachel Cook, Sarah A Redsell
BACKGROUND: Risk assessment tools provide an opportunity to prevent childhood overweight and obesity through early identification and intervention to influence infant feeding practices. Engaging parents of infants is paramount for success however; the literature suggests there is uncertainty surrounding the use of such tools with concerns about stigmatisation, labelling and expressions of parental guilt. This study explores parents' views on identifying future risk of childhood overweight and obesity during infancy and communicating risk to parents...
August 29, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28846125/intuitive-judgement-in-the-context-of-osteopathic-clinical-reasoning
#15
Torsten Liem
Previous research into osteopathic clinical and diagnostic decision making suggests that reasoning is commonly based on highly analytical as well as intuitive processes. According to the dual-process theory, the intuitive and analytical processing that leads to decision making is equally important in diagnostic reasoning. This article aims to explore the underlying and influencing factors that may lead to the development and reliability of intuition in clinical decision making generally and in osteopathic clinical reasoning specifically...
September 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28844033/state-of-the-art-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-and-coronary-stent-implantation-past-present-and-future-perspectives
#16
Giuseppe Gargiulo, Marco Valgimigli, Davide Capodanno, John A Bittl
Evidence from studies published more than 10 years ago suggested that patients receiving first-generation drug-eluting stents (DES) needed dual antiplatelet therapy (DAPT) for at least 12 months. Current evidence from randomised controlled trials (RCT) reported within the past five years suggests that patients with stable ischaemic heart disease who receive newer-generation DES need DAPT for a minimum of three to six months. Patients who undergo stenting for an acute coronary syndrome benefit from DAPT for at least 12 months, but a Bayesian network meta-analysis confirms that extending DAPT beyond 12 months confers a trade-off between reduced ischaemic events and increased bleeding...
August 25, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28835284/maintaining-immobilisation-devices-on-trauma-patients-during-ct-a-feasibility-study
#17
Pål Johan Stokkeland, Erlend Andersen, Maria Myhre Bjørndal, Arne Morten Mikalsen, Sindre Aslaksen, Per Kristian Hyldmo
BACKGROUND: To reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) scanning. A previous study found that metallic components within the inflation valve of the vacuum mattresses caused CT artefacts. The aim of our study was to investigate the effect of vacuum mattresses with plastic valves on CT artefacts, the radiation dose, and noise compared to a trauma transfer board and the spine boards currently used in our trauma system...
August 23, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28833507/usefulness-of-shear-wave-elastography-as-a-quantitative-diagnosis-of-chronic-pancreatitis
#18
Takamichi Kuwahara, Yoshiki Hirooka, Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Takeshi Yamamura, Kazuhiro Furukawa, Kohei Funasaka, Masanao Nakamura, Ryoji Miyahara, Osamu Watanabe, Masatoshi Ishigami, Senju Hashimoto, Hidemi Goto
BACKGROUND AND AIM: Chronic pancreatitis (CP) is sometimes diagnosed at the progressed stage. For the early diagnosis of CP, Endoscopic ultrasonography (EUS) may be a useful method, but its diagnostic criteria are based on subjective judgement. Shear wave elastography (SW-EG) using transabdominal ultrasonography, which quantifies tissue elasticity as an absolute value, may be an objective and non-invasive method for the diagnosis of CP. METHODS: Eighty-five patients with known or suspected CP who underwent both EUS and SW-EG from October 2012 to July 2016 were included in this study...
August 17, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28832897/reliability-of-an-online-geriatric-assessment-procedure-using-the-interrai-acute-care-assessment-system
#19
Melinda G Martin-Khan, Helen Edwards, Richard Wootton, Steven R Counsell, Paul Varghese, Wen Kwang Lim, Peteris Darzins, Lucy Dakin, Kerenaftali Klein, Leonard C Gray
OBJECTIVES: To determine whether geriatric triage decisions made using a comprehensive geriatric assessment (CGA) performed online are less reliable than face-to-face (FTF) decisions. DESIGN: Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment (FTF or online (OL)), creating two groups-two FTF (FTF-FTF, n = 81) or online and FTF (OL-FTF, n = 85)...
August 21, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28832575/using-judgement-analysis-to-identify-dietitians-referral-prioritisation-for-assessment-in-adult-acute-services
#20
M Hickson, M Davies, H Gokalp, P Harries
BACKGROUND/OBJECTIVES: Dietitians need to prioritise referrals in order to manage their work load. Novice dietitians may not receive training on prioritisation and could be helped with an evidence-based, effective decision-making training tool. To develop such a tool, it is necessary to understand how experts make prioritisation decisions. This study aimed to model expert decision-making policy for prioritising dietetic referrals in adult acute-care services. METHODS/SUBJECTS: Social judgement theory was used to model expert decision-making policy...
August 23, 2017: European Journal of Clinical Nutrition
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