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https://www.readbyqxmd.com/read/27895250/clinical-reasoning-a-70-year-old-woman-with-acute-onset-weakness-and-progressive-hemiataxia
#1
Karisa C Schreck, Jennifer L Orthmann-Murphy, Scott D Newsome
No abstract text is available yet for this article.
November 29, 2016: Neurology
https://www.readbyqxmd.com/read/27889951/performance-of-the-high-dimensional-propensity-score-in-a-nordic-health-care-model
#2
Jesper Hallas, Anton Pottegård
The high-dimensional propensity score (hdPS) is increasingly used as a tool to adjust for confounding in observational studies of drug effects. It was developed within very rich data sources, e.g., the American claims databases. Thus, it is unknown whether it can be applied in settings that provide little more than prescriptions and diagnoses from hospital contacts, as in the Nordic data sources. Our objective was to evaluate the performance of hdPS under such circumstances. As our model, we chose the association between use of selective cyclooxygenase-2 inhibitors (coxibs) and traditional NSAIDs (tNSAIDs) and the risk of upper GI bleeding...
November 27, 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27884254/troponin-testing-for-clinicians
#3
REVIEW
John E Brush, Sanjay Kaul, Harlan M Krumholz
The analytical performance of troponin assays has improved markedly in the last 2 decades. The variety of assays, their evolution over time, and their critical importance in influencing care, mandates the need for skills in their use. There are 3 critical elements necessary for optimal use of troponin testing in clinical care, as follows: 1) the analytical performance of the assay; 2) the clinical sensitivity and specificity of the test result; and 3) the clinical reasoning for ordering and the proper clinical context for interpreting the test result...
November 29, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27881121/knowledge-is-not-enough-to-solve-the-problems-the-role-of-diagnostic-knowledge-in-clinical-reasoning-activities
#4
Jan Kiesewetter, Rene Ebersbach, Nike Tsalas, Matthias Holzer, Ralf Schmidmaier, Martin R Fischer
BACKGROUND: Clinical reasoning is a key competence in medicine. There is a lack of knowledge, how non-experts like medical students solve clinical problems. It is known that they have difficulties applying conceptual knowledge to clinical cases, that they lack metacognitive awareness and that higher level cognitive actions correlate with diagnostic accuracy. However, the role of conceptual, strategic, conditional, and metacognitive knowledge for clinical reasoning is unknown. METHODS: Medical students (n = 21) were exposed to three different clinical cases and instructed to use the think-aloud method...
November 24, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27874843/high-fidelity-simulation-experience-in-emergency-settings-doctors-and-nurses-satisfaction-levels
#5
Diletta Calamassi, Tiziana Nannelli, Andrea Guazzini, Laura Rasero, Stefano Bambi
BACKGROUND AND AIM OF THE WORK: Lots of studies describe High Fidelity Simulation (HFS) as an experience well-accepted by the learners. This study has explored doctors and nurses satisfaction levels during HFS sessions, searching the associations with the setting of simulation events (simulation center or on the field simulation). Moreover, we studied the correlation between HFS experience satisfaction levels and the socio-demographic features of the participants. METHODS: Mixed method study, using the Satisfaction of High-Fidelity Simulation Experience (SESAF) questionnaire through an online survey...
November 22, 2016: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/27873406/watch-scrubs-a-video-observational-study-of-workplace-based-learning-at-sacred-heart-hospital
#6
Eliot L Rees, Yashashwi Sinha, Benjamin Davies, Patrick J Quinn
CONTEXT: Workplace-based learning remains the cornerstone of clinical training. Teaching in the clinical environment promotes active engagement as trainees are required to combine their competencies (e.g. skills in history taking, examination and clinical reasoning) to determine an appropriate course of action. High-quality clinical teaching supports and scaffolds trainees' learning in clinical workplaces. OBJECTIVES: This study aimed to explore the quality of clinical teaching at a large teaching hospital...
December 2016: Medical Education
https://www.readbyqxmd.com/read/27872506/harmonising-adult-reference-intervals-in-australia-and-new-zealand-the-continuing-story
#7
REVIEW
Gus Koerbin, Jillian R Tate
Reference intervals (RIs) are used to help clinicians determine if a patient can be classified as being in a diseased or healthy state and there are often sound scientific and clinical reasons for differences in RIs. One of the current strategic priorities for the Australasian Association of Clinical Biochemists is to encourage and assist laboratories to achieve harmonisation of RIs for common clinical chemistry analytes where sound calibration and traceability are in place. This need is based on good laboratory practice, providing the clinician with results that allow appropriate and reliable clinical interpretation and progression further toward the national e-health framework and a single electronic health record...
August 2016: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/27872229/clinical-reasoning-a-64-year-old-man-with-visual-distortions
#8
Emer R McGrath, Ayush Batra, Alice D Lam, Joseph F Rizzo, Andrew J Cole
No abstract text is available yet for this article.
November 22, 2016: Neurology
https://www.readbyqxmd.com/read/27867288/visual-functional-mismatch-between-coronary-angiography-fractional-flow-reserve-and-quantitative-coronary-angiography
#9
Morteza Safi, Vahid Eslami, Mohammad Hasan Namazi, Hossain Vakili, Habib Saadat, Saeid Alipourparsa, Ali Adibi, Mohammad Reza Movahed
Anatomical and functional mismatches are not uncommon in the assessment of coronary lesions. The aim of this study was to identify clinical and lesion-specific factors affecting angiographic, anatomical, and functional mismatch in intermediate coronary lesions. In patients who underwent coronary angiography for clinical reasons, fractional flow reserve (FFR), and quantitative coronary angiography (QCA) analyses for intermediate stenotic lesions were performed simultaneously. Mismatches between the measured values were analyzed...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27860416/the-adequacy-of-the-q-methodology-for-clinical-validation-of-nursing-diagnoses-related-to-subjective-foci
#10
Susana Miguel, Sílvia Caldeira, Margarida Vieira
OBJECTIVE: This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. METHODS: Discussion paper about the characteristics of the Q methodology. FINDINGS: This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. CONCLUSIONS: The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses...
November 17, 2016: International Journal of Nursing Knowledge
https://www.readbyqxmd.com/read/27860194/description-and-student-self-evaluation-of-a-pilot-small-group-learning-and-integrated-simulation-program-for-medical-students-in-the-first-clinical-year
#11
M R Levinson, D Kelly, K Zahariou, M Johnson, C Jackman, Sara Mackenzie
INTRODUCTION: Contemporary education for medical students should be student centered, integrated and contextualized. Small group learning promotes clinical reasoning and skills for lifelong learning. Simulation can provide experiential learning in a safe and controlled environment. We developed a weekly integrated problem based learning and simulation program (IPS) over two semesters in the first clinical year to augment clinical placement experience and contextualize theory into work relevant practice...
November 17, 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27859988/challenges-to-the-validity-of-using-medicine-labels-to-categorize-clinical-behavior-an-empirical-and-normative-critique-of-off-label-prescribing
#12
Narcyz Ghinea, Ian Kerridge, Miles Little, Wendy Lipworth
This study aimed to determine whether the label status of a medicine penetrates into the clinical reasoning of Australian medical practitioners and to explore the possible reasons for our findings using semistructured interviews with 14 Australian physicians. The interviews revealed 3 broad catalysts for off-label prescribing. The first of these was lack of awareness or understanding of the regulatory process in general and labels more specifically. The second was the perception that labels are not meaningful guides for clinical practice...
November 14, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27856379/templates-as-a-method-for-implementing-data-provenance-in-decision-support-systems
#13
Vasa Curcin, Elliot Fairweather, Roxana Danger, Derek Corrigan
Decision support systems are used as a method of promoting consistent guideline-based diagnosis supporting clinical reasoning at point of care. However, despite the availability of numerous commercial products, the wider acceptance of these systems has been hampered by concerns about diagnostic performance and a perceived lack of transparency in the process of generating clinical recommendations. This resonates with the Learning Health System paradigm that promotes data-driven medicine relying on routine data capture and transformation, which also stresses the need for trust in an evidence-based system...
November 14, 2016: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/27846882/the-quality-of-feedback-during-formative-osces-depends-on-the-tutors-profile
#14
Noelle Junod Perron, Martine Louis-Simonet, Bernard Cerutti, Eva Pfarrwaller, Johanna Sommer, Mathieu Nendaz
BACKGROUND: During their pre-clinical years, medical students are given the opportunity to practice clinical skills with simulated patients. During these formative objective structured clinical encounters (OSCEs), tutors from various backgrounds give feedback on students' history taking, physical exam, and communication skills. The aim of the study was to evaluate whether the content and process of feedback varied according to the tutors' profile. METHODS: During 2013, all 2(nd) and 3(rd) year medical students and tutors involved in three formative OSCEs were asked to fill in questionnaires, and their feedback sessions were audiotaped...
November 15, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27837309/prescribing-trends-of-atrial-fibrillation-patients-who-switched-from-warfarin-to-a-direct-oral-anticoagulant
#15
Zachary D Hale, Xiowen Kong, Brian Haymart, Xiaokui Gu, Eva Kline-Rogers, Steve Almany, Jay Kozlowski, Gregory D Krol, Scott Kaatz, James B Froehlich, Geoffrey D Barnes
Direct oral anticoagulant (DOAC) agents offer several lifestyle and therapeutic advantages for patients relative to warfarin in the treatment of atrial fibrillation (AF). These alternative agents are increasingly used in the treatment of AF, however the adoption practices, patient profiles, and reasons for switching to a DOAC from warfarin have not been well studied. Through the Michigan Anticoagulation Quality Improvement Initiative, abstracted data from 3873 AF patients, enrolled between 2010 and 2015, were collected on demographics and comorbid conditions, stroke and bleeding risk scores, and reasons for anticoagulant switching...
November 11, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27834170/feedback-in-formative-osces-comparison-between-direct-observation-and-video-based-formats
#16
Noëlle Junod Perron, Martine Louis-Simonet, Bernard Cerutti, Eva Pfarrwaller, Johanna Sommer, Mathieu Nendaz
INTRODUCTION: Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1) direct observation of an encounter followed by verbal feedback (direct feedback) and 2) subsequent review of the videotaped encounter by both student and supervisor (video-based feedback). The aim of the study was to evaluate whether content and process of feedback differed between both formats...
2016: Medical Education Online
https://www.readbyqxmd.com/read/27833929/clinical-reasoning-of-infectious-diseases-physicians-behind-the-use-or-nonuse-of-transesophageal-echocardiography-in-staphylococcus-aureus-bacteremia
#17
Heather Young, Bryan C Knepper, Connie S Price, Susan Heard, Timothy C Jenkins
In this prospective cohort with Staphylococcus aureus bacteremia, transesophageal echocardiography (TEE) was performed in 24% of cases. Consulting Infectious Diseases physicians most frequently cited low suspicion for endocarditis due to rapid clearance of blood cultures and the presence of a secondary focus requiring an extended treatment duration as reasons for foregoing TEE.
October 2016: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/27832706/the-simulated-clinical-environment-cognitive-and-emotional-impact-among-undergraduates
#18
Marie-Laurence Tremblay, Alexandre Lafleur, Jimmie Leppink, Diana H J M Dolmans
CONTEXT: Simulated clinical immersion (SCI) is used in undergraduate healthcare programs to expose the learner to real-life situations in authentic simulated clinical environments. For novices, the environment in which the simulation occurs can be distracting and stressful, hence potentially compromising learning. OBJECTIVES: This study aims to determine whether SCI (with environment) imposes greater extraneous cognitive load and stress on undergraduate pharmacy students than simulated patients (SP) (without environment)...
November 10, 2016: Medical Teacher
https://www.readbyqxmd.com/read/27830518/influence-of-splanchnic-artery-stenosis-on-the-in-hospital-clinical-course-of-elderly-patients
#19
Fabrizio Cardin, Stefania Fratta, Egle Perissinotto, Carmelo Militello, Bruno Martella
BACKGROUND: Chronic mesenteric ischaemia (CMI) has a long asymptomatic period, but little is known about the clinical implications of this phase of the disease, particularly in the elderly, who are most exposed to the condition. AIMS: The aim of the present observational study was to survey the in-hospital clinical course of elderly patients during the non-specific phase of the disease due to occlusion of at least one splanchnic artery. METHODS: For a median of 29 months, we followed up 85 patients aged 65 and over who, for various clinical reasons, had undergone computed tomographic and magnetic resonance angiography during 2010 at Padua Teaching Hospital, assessing economic impact and reasons for admission...
November 9, 2016: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/27821571/clinical-reasoning-a-59-year-old-man-with-multifocal-strokes-then-subsequent-painful-eye-movements-and-diplopia
#20
Jessica L Weinstein, Ahmara G Ross, Nicole M Fuerst, Daniel Lubin, Grant T Liu
No abstract text is available yet for this article.
November 8, 2016: Neurology
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