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Clinical judgement

Manavi Tyagi, Theodora Fteropoulli, Catherine S Hurt, Shashivadan P Hirani, Lorna Rixon, Anna Davies, Nathalie Picaut, Fiona Kennedy, John Deanfield, Shay Cullen, Stanton P Newman
OBJECTIVE: We carried out a cross-sectional study to assess cognitive function in a sample of adult CHD patients, within the Functioning in Adult Congenital Heart Disease study London. The association between cognitive functioning and disease complexity was examined. METHODS: A total of 310 patients participated in this study. Patients were classified into four structural complexity groups - tetralogy of Fallot, transposition of the great arteries, single ventricle, and simple conditions...
October 18, 2016: Cardiology in the Young
Joachim Sieper, Tim Holbrook, Christopher M Black, Robert Wood, Xiaohan Hu, Sumesh Kachroo
OBJECTIVES: To assess the impact of non-radiographic axial spondyloarthritis (nr-axSpA) on patients and society based on real-world evidence from the Adelphi nr-axSpA Disease Specific Programme, a cross-sectional survey of rheumatologists and their patients in Germany, France, Spain, Italy and the UK. METHODS: Physicians completed patient record forms for the next two patients consulting with nr-axSpA (diagnosis at the physician's judgement); patients were invited to complete a patient self-completion form...
August 31, 2016: Clinical and Experimental Rheumatology
J A Van Heerden, J R Burger, J J Gerber
BACKGROUND: Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients. OBJECTIVE: To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients. METHODS: A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period...
September 9, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Anne Moessner, James F Malec, Scott Beveridge, Cara Camiolo Reddy, Tracy Huffman, Julia Marton, Audrey J Schmerzler
PRIMARY OBJECTIVE: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation. RESEARCH DESIGN: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity. METHODS AND PROCEDURES: One hundred and thirty-four individuals with moderate-severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System...
August 11, 2016: Brain Injury: [BI]
R K MacKenzie, J Dowell, D Ayansina, J A Cleland
Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, "non-cognitive" tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: ). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools...
October 4, 2016: Advances in Health Sciences Education: Theory and Practice
Shailender Mehta, Anjali Joshi, Barbara Bajuk, Nadia Badawi, Sarah McIntyre, Kei Lui
AIM: Whole body therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy was introduced into clinical practice in New South Wales (NSW) and Australian Capital Territory in 2007. State-wide policy adopting the eligibility criteria and practice based on trial-designs was published in 2009. METHODS: The study was conducted by retrospectively reviewing medical records of all TH infants born between 2007 and 2011 in NSW and Australian Capital Territory to examine if eligibility criteria (assessed against evidence-based policy directives) were met...
October 4, 2016: Journal of Paediatrics and Child Health
Theresa Tawiah, Kristian Schultz Hansen, Frank Baiden, Jane Bruce, Mathilda Tivura, Rupert Delimini, Seeba Amengo-Etego, Daniel Chandramohan, Seth Owusu-Agyei, Jayne Webster
BACKGROUND: The presumptive approach of confirming malaria in health facilities leads to over-diagnosis of malaria, over use of anti-malaria drugs and the risk of drug resistance development. WHO recommends parasitological confirmation before treatment with artemisinin-based combination therapy (ACT) in all suspected malaria patients. The use of malaria rapid diagnostic tests (mRDTs) would make it possible for prescribers to diagnose malaria at point-of-care and better target the use of antimalarials...
2016: PloS One
Joanna Shi-En Chan, Jeremy C Wee, R Ponampalam, Evelyn Wong
BACKGROUND: Injuries in divers resulting purely from impact with the water are uncommon in the published literature. We present a case report of pulmonary contusion in a young diver. CASE REPORT: A young, healthy competitive platform diver landed flat on his back in the water from a dive of 10 meters. He complained of upper back pain and had an episode of hemoptysis after the dive. He was initially observed for 15 hours postinjury, and was discharged when three chest radiographs (CXRs) taken at 1, 7, and 11 hours postinjury did not show significant abnormalities...
September 28, 2016: Journal of Emergency Medicine
Gilbert G G Donders, Jack D Sobel
Although being an utterly frequent, non-mortal, yet distressing disease, and despite good knowledge of the pathogenesis and the availability of specific and safe treatment, vulvovaginal Candida (VVC) infection remains one of the most enigmatic problems for both physicians and patients. Good treatment requires a proper diagnosis. Too many caregivers (and patients treating themselves) react too simple-minded on the symptoms of VVC and treat VVC where they see it on the vulva. In this opinion paper, we plea for a thorough examination of women with VVC, especially in those women who suffer from recurrent disease since a long time, sometimes decades, which necessitates intensive examination of the vaginal flora, as this is invariably the reservoir for relapses and recurrent vulvitis...
September 30, 2016: Mycoses
Andrew J Knighton, Tom Belnap, Kim Brunisholz, Kelly Huynh, Jay T Bishoff
INTRODUCTION: The introduction of the protein-specific antigen (PSA) test in care means that prostate cancer (PCa) is being detected earlier and more frequently. The result of increased screening using PSA, digital rectal examination and awareness of prostate was an increase in the number of men with low risk cancers. Active surveillance has become a viable alternative to immediate treatment with surgery, radiation and other forms of localized treatment. Evidence suggests that there is no significant difference in mortality rates between AS and surgery...
2016: EGEMS
Rahul Mhaskar, Branko Miladinovic, Thomas M Guterbock, Benjamin Djulbegovic
OBJECTIVE: The ethicists believe that the goal of clinical research is to benefit future and not current (trial) patients. Many clinicians believe that the clinical trial enrolment offers best management for their patients. The objective of our study was to identify the situations when a clinical trial is beneficial for the patients enrolled in the trial and future patients. DESIGN: Factorial vignette-based cross-sectional survey via the internet. PARTICIPANTS: Institutional review board (IRB) members of the US Medical Schools...
2016: BMJ Open
P Lambe, E Kay, D Bristow
AIM: In 2013 the UKCAT included a non-cognitive situational judgement test in addition to the four cognitive subtests commonly used by UK dental schools to select students. However, little is known about the situational judgement test's psychometric properties and relationship to other selection tools. This study's aim was explore these issues to inform decisions about the inclusion of the UKCAT SJT in the dental student selection process. METHOD: The sample comprised a cohort of applicants to a Bachelor of Dental Surgery programme, at a UK dental school, which does not use achievement in the UKCAT SJT in its selection process...
September 26, 2016: European Journal of Dental Education: Official Journal of the Association for Dental Education in Europe
Timothy J Morris, Andrew Picken, Duncan M C Sharp, Nigel K H Slater, Christopher J Hewitt, Karen Coopman
With the cell therapy industry continuing to grow, the ability to preserve clinical grade cells, including mesenchymal stem cells (MSCs), whilst retaining cell viability and function remains critical for the generation of off-the-shelf therapies. Cryopreservation of MSCs, using slow freezing, is an established process at lab scale. However, the cytotoxicity of cryoprotectants, like Me2SO, raises questions about the impact of prolonged cell exposure to cryoprotectant at temperatures >0 °C during processing of large cell batches for allogenic therapies prior to rapid cooling in a controlled rate freezer or in the clinic prior to administration...
September 20, 2016: Cryobiology
N O A Palmer, J A Kirton, D Speechley
Objective To investigate the clinical experiences of foundation dentists (FDs) in the North West of England.Methods Three research methods were used: a questionnaire completed by FDs at the end of their training; an analysis of the clinical logs of experience recorded in the educational portfolios; and analysis of NHS Business Services Authority (NHSBSA) activity data for the 12 month period of training of FDs.Results A response rate of 100% (N = 50) was achieved for the questionnaire and complete data for 49 of the 50 FDs was available from the NHSBSA and clinical logs in the educational portfolios...
September 23, 2016: British Dental Journal
Gerald R Elsworth, Alison Beauchamp, Richard H Osborne
BACKGROUND: The development of the Health Literacy Questionnaire (HLQ), reported in 2013, attracted widespread international interest. While the original study samples were drawn from clinical and home-based aged-care settings, the HLQ was designed for the full range of healthcare contexts including community-based health promotion and support services. We report a follow-up study of the psychometric properties of the HLQ with respondents from a diverse range of community-based organisations with the principal goal of contributing to the development of a soundly validated evidence base for its use in community health settings...
2016: BMC Health Services Research
Xi Vivien Wu, Karin Enskär, Lay Hoon Pua, Doreen Gek Noi Heng, Wenru Wang
BACKGROUND: A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated. Difficulties in the development of valid and reliable assessment measures in nursing competency have resulted in the development of assessment instruments with an increase in face and content validity, but few studies have tested these instruments psychometrically...
2016: BMC Medical Education
Yutaka Imai
It has been confirmed that clinical significance of home blood pressure measurements (HBPM) is higher than clinic BP measurements and ambulatory BP monitoring. However, several drawbacks of HBPM have also been mentioned, e.g. selection and reporting biases, difficulties of calculation of multiple measurements, difficulties of onsite judgement of numerous recordings, etc. Recent devices for HBPM incorporate memory function. This function can overcome such drawbacks of HBPM. These memorized data can transmit, storage, retrieve, be arithmetic and control, be judged based on algorithm and be got feedback...
September 2016: Journal of Hypertension
Dionysios Dellaportas, James A Gossage, Andrew R Davies
Introduction. With the improving survival of cancer patients, the development of a secondary primary cancer is an increasingly common phenomenon. Extensive surgery during initial treatment may pose significant challenges to surgeons managing the second primary cancer. Case Presentation. A 69-year-old male, who had a pancreaticoduodenectomy three years ago for pancreatic head adenocarcinoma, underwent an uneventful extended total gastrectomy for gastroesophageal junctional adenocarcinoma. The reconstruction controversies and considerations are highlighted...
2016: Case Reports in Surgery
Andrew M Briggs, Joanne E Jordan, Ilana N Ackerman, Sharon Van Doornum
OBJECTIVE: Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas. DESIGN: 3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas...
September 15, 2016: BMJ Open
Merav Kliner, Alex Keenan, David Sinclair, Sam Ghebrehewet, Paul Garner
BACKGROUND: The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the recommendation. OBJECTIVES: To clarify the rationale, and evidence base, for influenza vaccination of healthcare workers from the occupational health, employer and patient safety perspectives. DESIGN: Systematic appraisal of published systematic reviews...
September 13, 2016: BMJ Open
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