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Clinical judgement

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https://www.readbyqxmd.com/read/28053702/outcomes-of-an-inpatient-refeeding-protocol-in-youth-with-anorexia-nervosa-rady-children-s-hospital-san-diego-university-of-california-san-diego
#1
Tamara R Maginot, Maya M Kumar, Jacqueline Shiels, Walter Kaye, Kyung E Rhee
BACKGROUND: Current guidelines for nutritional rehabilitation in hospitalized restrictive eating disorder patients recommend a cautious approach to refeeding. Several studies suggest that higher calorie diets may be safe and effective, but have traditionally excluded severely malnourished patients. The goal of this study was to evaluate the safety of a higher calorie nutritional rehabilitation protocol (NRP) in a broad sample of inpatients with restrictive eating disorders, including those who were severely malnourished...
2017: Journal of Eating Disorders
https://www.readbyqxmd.com/read/28029673/histopathologic-analysis-of-pancreaticoduodenectomy-specimen
#2
R Dhakhwa, N Kafle
INTRODUCTION: Whipple's Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors. Our aim was to study the distribution and histopathologic features of these tumors and to examine local trends of periampullary neoplasms resected with a PD. METHODS: A descriptive study was conducted in the department of Pathology, Kathmandu Medical College Teaching Hospital from July 2013 to June 2016...
October 2016: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/28025842/a-review-of-safe-staffing-models-and-their-applicability-to-care-homes
#3
Gary Mitchell, Carol Cousins, Ruth Burrows, Gary Cousins
Presently, there are a range of evidence-based staffing tools that have been used to inform nursing, midwifery and health care capacity. These tools are designed to be used with professional judgement and include frameworks such as Rhys Hearn, the National Services Scotland Care Home Staffing Project, a variety of Royal College of Nursing Tool Kits including the Older People in Hospital's tool and the only National Institute of Clinical Excellence approved safe-staffing tool, Shelford's Safer Nursing Tool. These safe-staffing tools are used to score a patient's or resident's level of dependency across a number of domains, for example a patient/resident's ability to wash, dress, mobilise or fulfil their own elimination needs...
December 26, 2016: Journal of Nursing Management
https://www.readbyqxmd.com/read/28012349/is-the-prevalence-of-major-depression-increasing-in-the-canadian-adolescent-population-assessing-trends-from-2000-to-2014
#4
Kathryn Wiens, Jeanne V A Williams, Dina H Lavorato, Anne Duffy, Tamara M Pringsheim, Tolulope T Sajobi, Scott B Patten
BACKGROUND: Major depressive disorder is a relatively common diagnosis with onset across the lifespan. There is a recent belief that major depressive episodes (MDE) are increasing in adolescence; however, it is not clear if this is truly an increase in prevalence or reflective of other causes such as change in diagnostic patterns. This study aimed to determine whether evidence supports an epidemic of MDE in Canadian adolescents. METHODS: Past year MDE prevalence estimates were derived from a series of nationally representative surveys...
November 23, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28007808/dangerous-liaisons-psychiatry-and-law-in-the-court-of-protection-expert-discourses-of-insight-and-compliance
#5
Paula Case
A finding that 'P' (as the person who is subject to Court of Protection proceedings is known) lacks mental capacity is the trigger for exposing them to decision-making by others and the powers of the Court of Protection (CoP) which, in the words of Justice Hedley, can be 'invasive and draconian' (Hedley J in PC v City of York Council cited in [2013] EWCA Civ 478 [13]). Whilst the law asserts the upper hand in the assessment of mental capacity for persons who come before the CoP, it is the discipline of psychiatry, which dominates expert witness testimony in these proceedings...
2016: Medical Law Review
https://www.readbyqxmd.com/read/28003693/all-india-difficult-airway-association-2016-guidelines-for-the-management-of-anticipated-difficult-extubation
#6
Pankaj Kundra, Rakesh Garg, Apeksh Patwa, Syed Moied Ahmed, Venkateswaran Ramkumar, Amit Shah, Jigeeshu Vasishtha Divatia, Sumalatha Radhakrishna Shetty, Ubaradka S Raveendra, Jeson R Doctor, Dilip K Pawar, Ramesh Singaravelu, Sabyasachi Das, Sheila Nainan Myatra
Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity...
December 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28000339/people-with-epilepsy-receive-more-statins-than-the-general-population-but-have-no-higher-cardiovascular-risk-results-from-a-cross-sectional-study
#7
R M Vivanco-Hidalgo, R Elosua, A Gómez González, A Moreira, L Díez, M Grau, I R Degano, J Roquer
BACKGROUND AND PURPOSE: Epilepsy has been associated with cardiovascular comorbidity. Risk prediction equations are the standard tools in primary prevention of cardiovascular disease. Our aim was to compare the prevalence of cardiovascular risk factors (CVRFs), cardiovascular risk and statin use in people with epilepsy (PWE) and the general population. METHODS: The CVRFs and cardiovascular risk score were compared between 815 PWE from an outpatient register and 5336 participants from a general population cohort...
December 21, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/27998665/a-study-to-evaluate-the-reliability-of-using-two-dimensional-photographs-three-dimensional-images-and-stereoscopic-projected-three-dimensional-images-for-patient-assessment
#8
S Zhu, Y Yang, B Khambay
Clinicians are accustomed to viewing conventional two-dimensional (2D) photographs and assume that viewing three-dimensional (3D) images is similar. Facial images captured in 3D are not viewed in true 3D; this may alter clinical judgement. The aim of this study was to evaluate the reliability of using conventional photographs, 3D images, and stereoscopic projected 3D images to rate the severity of the deformity in pre-surgical class III patients. Forty adult patients were recruited. Eight raters assessed facial height, symmetry, and profile using the three different viewing media and a 100-mm visual analogue scale (VAS), and appraised the most informative viewing medium...
December 17, 2016: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27995660/a-new-paradigm-for-clinical-communication-critical-review-of-literature-in-cancer-care
#9
REVIEW
Peter Salmon, Bridget Young
OBJECTIVES: To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS: A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements...
December 20, 2016: Medical Education
https://www.readbyqxmd.com/read/27987492/-significance-and-diagnostic-value-of-synovial-fluid-anti-cyclic-citrullinated-peptide-antibody-and-anti-mutated-citrullinated-vimentin-antibodies-in-patients-with-serum-negative-rheumatoid-arthritis
#10
S J Qu, H Ye, R L Jia, Z G Li
OBJECTIVE: To explore the significance of synovial fluid (SF) anti-cyclic citrullinated peptide (CCP) antibodies and anti-mutated citrullinated vimentin (MCV) antibodies in the diagnosis of serum negative rheumatoid arthritis (SNRA). METHODS: Enzyme linked immunosorbent assay (ELISA) method was apllied in the detection of two groups of patients with knee joint fluid resistance against CCP antibody and antibody of MCV, the experimental group to SNRA patients, a total of 29 cases, and the control for patients with osteoarthritis (OA), a total of 28 cases, and clinical manifestations and laboratory parameters of the two groups were collected...
December 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/27986697/does-increased-duration-of-consultant-presence-affect-length-of-hospital-stay-for-unplanned-admissions-in-acute-paediatrics-an-observational-before-and-after-analysis-using-administrative-healthcare-data
#11
Daniel Cromb, Chris Carter, Claire Lemer, C Ronny Cheung
OBJECTIVES: This study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital. METHOD DESIGN/SETTING/PARTICIPANTS/INTERVENTIONS/OUTCOME MEASURES: An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission...
December 16, 2016: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27979791/stigma-and-its-impact-on-glucose-control-among-youth-with-diabetes-protocol-for-a-canada-wide-study
#12
Anne-Sophie Brazeau, Meranda Nakhla, Michael Wright, Constadina Panagiotopoulos, Daniele Pacaud, Mélanie Henderson, Elham Rahme, Deborah Da Costa, Kaberi Dasgupta
BACKGROUND: Stigma in chronic disease involves unwarranted rejection, judgement, or exclusion by others based on the chronic disease itself. OBJECTIVE: We aim to determine the prevalence of stigma among youth and young adults with type 1 diabetes in Canada, to assess associations between stigma and glycemic control, and to explore ways to address stigma related to type 1 diabetes. METHODS: The study includes 3 distinct phases: (1) refinement of survey questions, (2) assessment of test-retest reliability, and (3) a data collection and analysis phase (online survey and mailed-in capillary blood sample to assess hemoglobin A1c)...
December 15, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27976369/clomiphene-and-other-antioestrogens-for-ovulation-induction-in-polycystic-ovarian-syndrome
#13
REVIEW
Julie Brown, Cindy Farquhar
BACKGROUND: Subfertility due to anovulation is a common problem in women. First-line oral treatment is with antioestrogens such as clomiphene citrate, but resistance may be apparent with clomiphene. Alternative and adjunctive treatments have been used including tamoxifen, dexamethasone, and bromocriptine. The effectiveness of these is to be determined. OBJECTIVES: To determine the relative effectiveness of antioestrogen agents including clomiphene alone or in combination with other medical therapies in women with subfertility associated with anovulation, possibly caused by polycystic ovarian syndrome...
December 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27967828/homozygous-familial-hypercholesterolaemia-update-on-management
#14
Michael France
Homozygous familial hypercholesterolaemia (HoFH) is an inherited disease causing an approximately fourfold increase in blood low-density lipoprotein cholesterol (LDLC) from birth compared with the age-matched normal population owing to reduced low-density lipoprotein receptor (LDLR) activity. Such elevated cholesterol is associated with accelerated atheromatous disease, particularly of the aortic root and coronary arteries. However, HoFH is clinically heterogeneous, reflecting residual low-density lipoprotein receptor (LDLR) activity...
November 2016: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/27966437/physician-consensus-on-preventability-and-predictability-of-readmissions-based-on-standard-case-scenarios
#15
L S van Galen, T Cooksley, H Merten, M Brabrand, C B Terwee, C H Nickel, C P Subbe, R Kidney, J Soong, L Vaughan, I Weichert, M H H Kramer, P W B Nanayakkara
BACKGROUND: Policy makers struggle with unplanned readmissions as a quality indicator since integrating preventability in such indicators is difficult. Most studies on the preventability of readmissions questioned physicians whether they consider a given readmission to be preventable, from which conclusions on factors predicting preventable readmissions were derived. There is no literature on the interobserver agreement of physician judgement. AIM: To assess the degree of agreement among physicians regarding predictability and preventability of medical readmissions...
December 2016: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/27960121/the-attitudes-of-pregnant-women-and-midwives-towards-raised-bmi-in-a-maternity-setting-a-discussion-of-two-repertory-grid-studies
#16
Emma L Hodgkinson, Debbie M Smith, Dougal J Hare, Anja Wittkowski
OBJECTIVES: Weight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18-30kg/m(2). This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs. PARTICIPANTS: Ten pregnant women with a BMI≥30kg/m(2) and 11 midwives and from an inner city maternity service were recruited...
December 6, 2016: Midwifery
https://www.readbyqxmd.com/read/27943366/putting-the-puzzle-together-the-role-of-problem-definition-in-complex-clinical-judgement
#17
Sayra Cristancho, Lorelei Lingard, Thomas Forbes, Michael Ott, Richard Novick
CONTEXT: We teach judgement in pieces; that is, we talk about each aspect separately (patient, plan, resources, technique, etc.). We also let trainees figure out how to put the pieces together. In complex situations, this might be problematic. Using data from a drawing-based study on surgeons' experiences with complex situations, we explore the notion of 'problem definition' in real-world clinical judgement using the theoretical lens of systems engineering. METHODS: 'Emergence', the sensitising concept for analysis, is rooted in two key systems premises: that person and context are inseparable and that what emerges is an act of choice...
December 12, 2016: Medical Education
https://www.readbyqxmd.com/read/27941006/constructing-diagnostic-likelihood-clinical-decisions-using-subjective-versus-statistical-probability
#18
John Kinnear, Ruth Jackson
BACKGROUND: Although physicians are highly trained in the application of evidence-based medicine, and are assumed to make rational decisions, there is evidence that their decision making is prone to biases. One of the biases that has been shown to affect accuracy of judgements is that of representativeness and base-rate neglect, where the saliency of a person's features leads to overestimation of their likelihood of belonging to a group. This results in the substitution of 'subjective' probability for statistical probability...
December 9, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27925577/the-role-of-ultrasound-compared-to-biopsy-of-temporal-arteries-in-the-diagnosis-and-treatment-of-giant-cell-arteritis-tabul-a-diagnostic-accuracy-and-cost-effectiveness-study
#19
Raashid Luqmani, Ellen Lee, Surjeet Singh, Mike Gillett, Wolfgang A Schmidt, Mike Bradburn, Bhaskar Dasgupta, Andreas P Diamantopoulos, Wulf Forrester-Barker, William Hamilton, Shauna Masters, Brendan McDonald, Eugene McNally, Colin Pease, Jennifer Piper, John Salmon, Allan Wailoo, Konrad Wolfe, Andrew Hutchings
BACKGROUND: Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9-61% of true cases. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. DESIGN: Prospective multicentre cohort study...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27925274/supplementation-of-a-clinical-trial-by-historical-control-data-is-the-prospect-of-dynamic-borrowing-an-illusion
#20
N W Galwey
There are strong arguments, ethical, logistical and financial, for supplementing the evidence from a new clinical trial using data from previous trials with similar control treatments. There is a consensus that historical information should be down-weighted or discounted relative to information from the new trial, but the determination of the appropriate degree of discounting is a major difficulty. The degree of discounting can be represented by a bias parameter with specified variance, but a comparison between the historical and new data gives only a poor estimate of this variance...
December 7, 2016: Statistics in Medicine
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