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Clinical ethics

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https://www.readbyqxmd.com/read/28087554/how-prepared-are-uk-medical-graduates-for-practice-a-rapid-review-of-the-literature-2009-2014
#1
Lynn V Monrouxe, Lisa Grundy, Mala Mann, Zoe John, Eleni Panagoulas, Alison Bullock, Karen Mattick
OBJECTIVE: To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. DESIGN: A rapid review of the literature (registration #CRD42013005305). DATA SOURCES: Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge...
January 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28086784/health-related-quality-of-life-assessment-in-acute-coronary-syndrome-patients-the-effectiveness-of-early-phase-i-cardiac-rehabilitation
#2
Lawrence Anchah, Mohamed Azmi Hassali, Melissa Siaw Han Lim, Mohamed Izham Mohamed Ibrahim, Kui Hian Sim, Tiong Kiam Ong
BACKGROUND: Acute Coronary Syndrome (ACS) is one of the most burdensome cardiovascular diseases in terms of the cost of interventions. The Cardiac Rehabilitation Programme (CRP) is well-established in improving clinical outcomes but the assessment of actual clinical improvement is challenging, especially when considering pharmaceutical care (PC) values in phase I CRP during admission and upon discharge from hospital and phase II outpatient interventions. This study explores the impact of pharmacists' interventions in the early stages of CRP on humanistic outcomes and follow-up at a referral hospital in Malaysia...
January 13, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28079801/acute-necrotizing-retinal-vasculitis-as-onset-of-systemic-lupus-erythematosus-a-case-report
#3
Simeon Monov, Ruska Hristova, Rositza Dacheva, Reni Toncheva, Russka Shumnalieva, Viara Shoumnalieva-Ivanova, Daniela Monova
RATIONALE: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by autoantibody production, complement activation, and deposition of immune complexes in tissues and organs. SLE can involve any region of the visual system. Although ocular manifestations are not part of the classification criteria for SLE, they can be observed in up to one-third of the patients with SLE. They are rarely reported at the time of disease onset. Retinal vasculitis is usually associated with active generalized disease...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28078909/apparent-treatment-resistant-hypertension-patient-physician-relationship-and-ethical-issues
#4
Julian E Mariampillai, Per Anders Eskås, Sondre Heimark, Anne Cecilie K Larstorp, Fadl Elmula M Fadl Elmula, Aud Høieggen, Per Nortvedt
BACKGROUND: Poor drug adherence is a major cause of apparent treatment-resistant hypertension. As a consequence, several methods have been developed and attempted implemented in clinical practice to reveal non-adherence and to monitor drug adherence. There are, however, several hitherto unresolved ethical aspects regarding potential methods for drug monitoring in these patients. RESULTS: The most striking challenge is the balance between patient autonomy and the physician's desire for the patient to adhere to the prescribed therapy...
January 12, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28078512/the-role-of-apparent-diffusion-coefficient-values-in-characterization-of-solid-focal-liver-lesions-a-prospective-and-comparative-clinical-study
#5
Dawei Yang, Jie Zhang, Dan Han, Erhu Jin, Zhenghan Yang
We evaluated and compared the diagnostic accuracy (DA) of apparent diffusion coefficient (ADC) values with that of lesion-to-liver ADC ratios in the characterization of solid focal liver lesions (FLLs). This prospective study was approved by the Institutional Human Ethics Board, after waiving written informed consent. Diffusion-weighted imaging and other routine magnetic resonance imaging were performed on 142 consecutive patients with suspected liver disease. The mean ADC values and lesion-to-liver ADC ratios were compared between benign and malignant solid FLLs...
January 4, 2017: Science China. Life Sciences
https://www.readbyqxmd.com/read/28078482/irreversible-electroporation-as-treatment-of-locally-advanced-and-as-margin-accentuation-in-borderline-resectable-pancreatic-adenocarcinoma
#6
P Marsanic, A Mellano, A Sottile, M De Simone
In recent years, many local ablation technologies based on thermal damage have been used in the treatment of locally advanced pancreatic carcinoma (LAPC) and borderline resectable pancreatic carcinoma (BLRPC). However, they are associated with major complications because of possible vascular and ductal damage. Irreversible electroporation (IRE) is a nonthermal ablation technology that seems safe near vital vascular and ductal structures. IRE could be used as exclusive treatment of LAPC (en situ to IRE) after induction chemotherapy In BLRPC, surgery is not really radical in 6% of patients (microscopic residual) and local recurrences occur in 11-42% of apparent radical resections...
January 11, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/28077415/international-multiphase-mixed-methods-study-protocol-to-develop-a-cross-cultural-patient-reported-outcome-instrument-for-children-and-young-adults-with-cleft-lip-and-or-palate-cleft-q
#7
Karen W Y Wong Riff, Elena Tsangaris, Tim Goodacre, Christopher R Forrest, Andrea L Pusic, Stefan J Cano, Anne F Klassen
INTRODUCTION: Patient-reported outcome (PRO) instruments should be developed according to rigorous guidelines in order to provide clinically meaningful, scientifically sound measurement. Understanding the methodology behind instrument development informs the selection of the most appropriate tool. This mixed methods protocol describes the development of an internationally applicable PRO instrument, the CLEFT-Q, for evaluating outcomes of treatment for cleft lip and/or palate (CL/P). METHODS AND ANALYSIS: The study includes three main phases that occur iteratively and interactively...
January 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28077127/navigating-social-and-ethical-challenges-of-biobanking-for-human-microbiome-research
#8
Kim H Chuong, David M Hwang, D Elizabeth Tullis, Valerie J Waters, Yvonne C W Yau, David S Guttman, Kieran C O'Doherty
BACKGROUND: Biobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications (ELSI). While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate. DISCUSSION: We draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs of pediatric and adult patients...
January 11, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28076534/absorption-and-metabolization-of-sex-hormones-and-their-transformation-into-contraceptive-technologies-the-paths-taken-by-medical-thought-in-brazil
#9
Claudia Bonan, Luiz Antonio Teixeira, Andreza Rodrigues Nakano
The article analyses knowledge assimilation and the development of clinical and research practices relating to sex hormones among Brazilian gynaecologists. It discusses the paths taken by medical thought from the reception of the hormones to their transformation into contraceptives. Our objective is to comprehend styles of introducing and disseminating medical technologies in the area of reproductive health in Brazil. It uses methods of historical analysis and takes as its source the Anais Brasileiros de Ginecologia, a journal published between 1936 and 1970...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28074588/care-under-the-influence
#10
Joseph J Fins, Samantha F Knowlton
A forty-year-old man is brought to the emergency room by his wife at five in the morning, two hours after he fell down the stairs at home, hitting his head and injuring his arm. He tells the ER physician that he got up to get a drink of water and tripped in the dark. His speech is slurred, and he smells strongly of alcohol. Lab results reveal elevated liver enzymes, and his blood alcohol level is 0.1. His medical history is unremarkable. When asked about his alcohol consumption, he says he usually has one or two drinks a night with dinner but that he drinks more on holidays and special occasions...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28073796/comparative-efficacy-and-tolerability-of-pharmacological-interventions-for-attention-deficit-hyperactivity-disorder-in-children-adolescents-and-adults-protocol-for-a-systematic-review-and-network-meta-analysis
#11
Samuele Cortese, Nicoletta Adamo, Christina Mohr-Jensen, Adrian J Hayes, Sahar Bhatti, Sara Carucci, Cinzia Del Giovane, Lauren Z Atkinson, Tobias Banaschewski, Emily Simonoff, Alessandro Zuddas, Corrado Barbui, Marianna Purgato, Hans-Christoph Steinhausen, Farhad Shokraneh, Jun Xia, Andrea Cipriani, David Coghill
INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28073791/rapid-deployment-aortic-replacement-radar-registry-in-spain-a-protocol
#12
Victor Bautista-Hernandez, Natalia Cal-Purriños, Jose M Arribas-Leal, Manuel Carnero-Alcazar, Jose F Gutierrez-Diez, Jose J Cuenca-Castillo
INTRODUCTION: Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28072907/symptomatic-treatments-for-amyotrophic-lateral-sclerosis-motor-neuron-disease
#13
REVIEW
Louisa Ng, Fary Khan, Carolyn A Young, Mary Galea
BACKGROUND: Motor neuron disease (MND), which is also known as amyotrophic lateral sclerosis (ALS), causes a wide range of symptoms but the evidence base for the effectiveness of the symptomatic treatment therapies is limited. OBJECTIVES: To summarise the evidence from Cochrane Systematic Reviews of all symptomatic treatments for MND. METHODS: We searched the Cochrane Database of Systematic Reviews (CDSR) on 15 November 2016 for systematic reviews of symptomatic treatments for MND...
January 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28072645/psychotherapy-parity-and-ethical-utilization-management
#14
Eric M Plakun
Managed care has long functioned with the assumption of a split in clinical and ethical responsibility for treatment. The insurance company clinician has been seen as owing a primary obligation to the insurance company and its utilization management standards, while the treating clinician is seen as holding primary clinical and ethical responsibility for the patient and the treatment. This article explores the potential impact of mental health parity mandates and recent clarifications of the American Psychiatric Association's ethical code on this split for psychiatrists and other clinicians who develop utilization management standards or serve as utilization reviewers...
January 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28070839/-1-h-and-31-p-myocardial-magnetic-resonance-spectroscopy-in-non-obstructive-hypertrophic-cardiomyopathy-patients-and-competitive-athletes
#15
Francesco Secchi, Giovanni Di Leo, Marcello Petrini, Riccardo Spairani, Marco Alì, Marco Guazzi, Francesco Sardanelli
PURPOSE: The clinical differentiation between athlete's heart and mild forms of non-obstructive hypertrophic cardiomyopathy (HCM) is crucial. We hypothesized that differences do exist between the myocardial metabolism of patients with non-obstructive HCM and competitive athletes (CAs). Our aim was to evaluate myocardial metabolism with (31)P-MRS and (1)H-MRS in HCM patients and CAs. MATERIALS AND METHODS: After Ethics Committee approval, 15 CAs and 7 HCM patients were prospectively enrolled...
January 9, 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/28070833/assessing-the-accuracy-of-algorithm-derived-cardiorespiratory-fitness-in-surgical-patients-a-prospective-cohort-study
#16
Fadi Hammal, Tanis Quaife, Kieran Purich, Robert Haennel, Ferrante S Gragasin, Daniella San Martin-Feeney, Barry A Finegan
PURPOSE: To determine if a non-exercise algorithm-derived assessment of cardiorespiratory fitness (CRFA) accurately predicted estimated values obtained using a six-minute walk test (CRF6MWD) and the Duke Activity Status Index (CRFDASI). METHODS: Following research ethics board approval, an observational cohort study was conducted in selected, consenting patients undergoing elective surgery. Participants completed questionnaires assessing their self-reported exercise capacity...
January 9, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28070792/wearable-cameras-are-useful-tools-to-investigate-and-remediate-autobiographical-memory-impairment-a-systematic-prisma-review
#17
REVIEW
Mélissa C Allé, Liliann Manning, Jevita Potheegadoo, Romain Coutelle, Jean-Marie Danion, Fabrice Berna
Autobiographical memory, central in human cognition and every day functioning, enables past experienced events to be remembered. A variety of disorders affecting autobiographical memory are characterized by the difficulty of retrieving specific detailed memories of past personal events. Owing to the impact of autobiographical memory impairment on patients' daily life, it is necessary to better understand these deficits and develop relevant methods to improve autobiographical memory. The primary objective of the present systematic PRISMA review was to give an overview of the first empirical evidence of the potential of wearable cameras in autobiographical memory investigation in remediating autobiographical memory impairments...
January 9, 2017: Neuropsychology Review
https://www.readbyqxmd.com/read/28070115/proposal-for-a-prospective-registry-for-moyamoya-disease-in-japan
#18
Ken Kazumata, Masaki Ito, Haruto Uchino, Hiroshi Nishihara, Kiyohiro Houkin
The number of clinical research papers published worldwide on moyamoya disease (MMD) has increased recently. However, the majority of the literature comprises retrospective single-center studies collecting data on small numbers of patients. Several multi-center studies are ongoing in Japan; however, the current data are insufficient for comprehensively outlining the various characteristics of MMD. To enhance our knowledge on epidemiologic, vascular, and genetic aspects of MMD, a prospective multicenter registry will be established in Japan that will help to streamline clinical research as well as improve clinical treatments and long-term outcomes...
January 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28069021/preoperative-optimization-of-patient-expectations-improves-long-term-outcome-in-heart-surgery-patients-results-of-the-randomized-controlled-psy-heart-trial
#19
Winfried Rief, Meike C Shedden-Mora, Johannes A C Laferton, Charlotte Auer, Keith J Petrie, Stefan Salzmann, Manfred Schedlowski, Rainer Moosdorf
BACKGROUND: Placebo effects contribute substantially to outcome in most fields of medicine. While clinical trials typically try to control or minimize these effects, the potential of placebo mechanisms to improve outcome is rarely used. Patient expectations about treatment efficacy and outcome are major mechanisms that contribute to these placebo effects. We aimed to optimize these expectations to improve outcome in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: In a prospective three-arm randomized clinical trial with a 6 month follow-up, 124 patients scheduled for CABG surgery were randomized to either a brief psychological pre-surgery intervention to optimize outcome expectations (EXPECT); or a psychological control intervention focusing on emotional support and general advice, but not on expectations (SUPPORT); or to standard medical care (SMC)...
January 10, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28069017/dose-escalation-of-stereotactic-body-radiotherapy-sbrt-for-locally-advanced-unresectable-pancreatic-cancer-patients-with-cyberknife-protocol-of-a-phase-i-study
#20
Shui-Wang Qing, Xiao-Ping Ju, Yang-Sen Cao, Huo-Jun Zhang
BACKGROUND: Dose escalation of SBRT for locally advanced pancreatic cancer patients had been reported in several studies in one or three fractions, and phase I protocol was developed to investigate the maximum tolerated dose with CyberKnife for locally advanced unresectable pancreatic cancer patients in five fractions. METHODS: The study is designed as a mono-center phase I study. The primary endpoint is to determine the maximum tolerated dose by frequency of III/IV GI (gastrointestinal) toxicity...
January 9, 2017: Radiation Oncology
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