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"clinical reasoning"

Steve Karas, Megan J Olson Hunt, Bill Temes, Martin Thiel, Trenton Swoverland, Brett Windsor
Objectives: To determine the difference on neck outcomes with directional manipulation to the thoracic spine. There is evidence that thoracic spine manipulation is effective in treating patients with neck pain. However, there is no research that determines if the assessment of directional hypomobility and the selection of thrust direction offer improved outcomes. Methods: A total of 69 patients with cervical spine pain were randomly assigned to receive either a manipulation that was consistent with their thoracic spine motion loss (matched) or opposite their motion loss (unmatched)...
February 2018: Journal of Manual & Manipulative Therapy
Matthew L Maciejewski, Bradley G Hammill, Corrine I Voils, Laura Ding, Elizabeth A Bayliss, Lesley H Curtis, Virginia Wang
Background: Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications. Objective: We examined whether the number of prescribers of these medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia. Methods: A retrospective cohort of 383,145 older adults with diabetes, hypertension or dyslipidemia in the US Medicare program living in 10 states...
2018: SAGE Open Medicine
Joseph R Maccio, Lindsay Carlton, Sarah Fink, Chanel Ninan, Chandree Van Vranken, Garret Biese, Colin McGowan, Joseph G Maccio, Julia Tranquillo
Background: Directional preference is a phenomenon that occurs in musculoskeletal disorders. It is associated with improved symptomatic and functional outcomes. Research has shown a 90% increase in the identification of directional preference in the peripheral joints between 2006 and 2012. There is currently no research analyzing if predictive variables exist for establishing directional preference. Case Description: This report presents 19 consecutive patients with wrist pain...
December 2017: Journal of Manual & Manipulative Therapy
Kallol K Set, Amanda R B Weber, Fatema J Serajee, Ahm M Huq
No abstract text is available yet for this article.
February 13, 2018: Neurology
Meera R Basu, Alberto J Espay, Emily G Wakefield, Steve W Wu
No abstract text is available yet for this article.
February 6, 2018: Neurology
Yvette Keemink, Eugene J F M Custers, Savannah van Dijk, Olle Ten Cate
Objectives: To assess illness script richness and maturity in preclinical students after they attended a specifically structured instructional format, i.e., a case based clinical reasoning (CBCR) course. Methods: In a within-subject experimental design, medical students who had finished the CBCR course participated in an illness script experiment. In the first session, richness and maturity of students' illness scripts for diseases discussed during the CBCR course were compared to illness script richness and maturity for similar diseases not included in the course...
February 9, 2018: International Journal of Medical Education
Hahnsung Kim, Suhyung Park, Eung Yeop Kim, Jaeseok Park
PURPOSE: To develop a novel, retrospective multi-phase non-contrast-enhanced MRA (ROMANCE MRA) in a single acquisition for robust angiogram separation even in the presence of cardiac arrhythmia. METHODS: In the proposed ROMANCE MRA, data were continuously acquired over all cardiac phases using retrospective, multi-phase flow-sensitive single-slab 3D fast spin echo (FSE) with variable refocusing flip angles, while an external pulse oximeter was in sync with pulse repetitions in FSE to record real-time information on cardiac cycles...
February 9, 2018: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Michael Pearce, Siew Wan Hee, Jason Madan, Martin Posch, Simon Day, Frank Miller, Sarah Zohar, Nigel Stallard
BACKGROUND: Most confirmatory randomised controlled clinical trials (RCTs) are designed with specified power, usually 80% or 90%, for a hypothesis test conducted at a given significance level, usually 2.5% for a one-sided test. Approval of the experimental treatment by regulatory agencies is then based on the result of such a significance test with other information to balance the risk of adverse events against the benefit of the treatment to future patients. In the setting of a rare disease, recruiting sufficient patients to achieve conventional error rates for clinically reasonable effect sizes may be infeasible, suggesting that the decision-making process should reflect the size of the target population...
February 8, 2018: BMC Medical Research Methodology
Jean-Marie Castillo, Yoon Soo Park, Ilene Harris, Jeffrey J H Cheung, Lonika Sood, Maureen D Clark, Kulamakan Kulasegaram, Ryan Brydges, Geoffrey Norman, Nicole Woods
CONTEXT: 'Transfer' is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies...
February 8, 2018: Medical Education
Francois Maissan, Jan Pool, Edwin de Raaij, Jürgen Mollema, Raymond Ostelo, Harriet Wittink
OBJECTIVE: Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. DATA SOURCES: Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. STUDY SELECTION: RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included...
February 2, 2018: Musculoskeletal Science & Practice
Evan J Petersen, Stephanie M Thurmond
Study Design Resident's case problem. Background Patients presenting with multiple symptomatic areas pose a diagnostic challenge for the physical therapist. Though musculoskeletal and nonmusculoskeletal symptoms typically present separately, they can occur simultaneously and mimic each other. Consequently, the ability to differentiate between musculoskeletal and nonmusculoskeletal symptoms is an important skill for physical therapists. The purpose of this resident's case problem was to describe the clinical-reasoning process leading to medical and physical therapy management of a patient presenting with upper and lower back pain, bilateral radiating arm and leg pain, and abdominal pain...
February 6, 2018: Journal of Orthopaedic and Sports Physical Therapy
Maria Elvén, Jacek Hochwälder, Elizabeth Dean, Anne Söderlund
BACKGROUND AND AIM: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. METHODS: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance...
February 6, 2018: Physiotherapy Theory and Practice
Penni Blazak, Craig Hacking, Jeffrey Presneill, Michael Reade
INTRODUCTION: Computed tomographic (CT) imaging is widely available in Australian rural and remote hospitals and is often performed prior to patient transfer to definitive tertiary hospital care. We hypothesised that critically ill trauma and neurosurgical patients might have CT scans repeated after interhospital transfer and that the utility of this practice might be low in relation to the additional financial cost and radiation exposure. METHODS: We conducted a retrospective review of clinical records to determine the proportion of trauma and neurosurgical patients transferred to our tertiary ICU from other hospitals between 1 June 2013 and 30 June 2014 who underwent a repeat CT scan...
February 5, 2018: Journal of Medical Imaging and Radiation Oncology
Regina Royan, Christine Wu, Nik Theyyunni, Sacha Montas, James A Cranford, Joseph B House, Michael P Lukela, Sally A Santen
Introduction: Transitioning from the pre-clinical environment to clerkships poses a challenge to students and educators alike. Students along with faculty developed the Clinical Reasoning Elective (CRE) to provide pre-clinical students exposure to patients in the emergency department and the opportunity to build illness scripts and practice clinical skills with longitudinal mentorship in a low-stakes environment before entering clerkships. It is a voluntary program. Each year, the CRE has received overwhelming positive feedback from students...
January 2018: Western Journal of Emergency Medicine
Benjamin Smallheer, Jennifer Hunt, Judson Smith
The purpose of this innovative learning strategy was to decrease students' fear and anxiety within the critical care environment before the initiation of a critical care capstone clinical experience by enhancing their familiarity of the critical care environment through deliberate practice and experiential learning. This will in turn increase student knowledge and competence in the critical care setting.Critical care units are often used during a capstone clinical experience to enhance critical thinking and clinical reasoning...
March 2018: Dimensions of Critical Care Nursing: DCCN
Mary Ann Jessee
BACKGROUND: The link between clinical education and development of clinical reasoning is not well supported by one theoretical perspective. Learning to reason during clinical education may be best achieved in a supportive sociocultural context of nursing practice that maximizes reasoning opportunities and facilitates discourse and meaningful feedback. Prelicensure clinical education seldom incorporates these critical components and thus may fail to directly promote clinical reasoning skill...
January 1, 2018: Journal of Nursing Education
Béatrice Deschênes St-Pierre, Anne-Marie Trudelle, Robert Laforce
No abstract text is available yet for this article.
January 30, 2018: Neurology
Rachel Nave, Tatiana Umansky, Rosalie Ber, Zaher Azzam, Amir Karban
INTRODUCTION: There is no current medical licensing examination in Israel (2016). The only objective indicators which reflect students' medical knowledge and basic clinical reasoning skills are the national medical examination scores. The aim of the present study was to investigate the nature of the relationship between students' demography, gender and academic achievements during their pre-clinical studies and their final national internal medicine examination scores. METHODS: The study was based on data collected by the Technion information system...
January 2018: Harefuah
Meredith Young, Aliki Thomas, Stuart Lubarsky, Tiffany Ballard, David Gordon, Larry D Gruppen, Eric Holmboe, Temple Ratcliffe, Joe Rencic, Lambert Schuwirth, Steven J Durning
Clinical reasoning is an essential component of a health professional's practice. Yet clinical reasoning research has produced a notably fragmented body of literature. In this article, the authors describe the pause-and-reflect exercise they undertook during the execution of a synthesis of the literature on clinical reasoning in the health professions. Confronted with the challenge of establishing a shared understanding of the nature and relevant components of clinical reasoning, members of the review team paused to independently generate their own personal definitions and conceptualizations of the construct...
January 23, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
M Di Carlofelice, A Everitt, D Muir, A Winston
OBJECTIVES: Despite adequate suppression of plasma HIV RNA, viral escape in cerebrospinal fluid (CSF) is widely reported. Rates of CSF HIV RNA escape vary in the literature. In persons living with HIV (PLWH) undergoing lumbar puncture examination for clinical reasons, we assessed rates of CSF HIV RNA escape. METHODS: Persons living with HIV attending a designated HIV neurology service undergoing CSF assessment for clinical reasons between January 2015 and April 2017 were included in the study...
January 25, 2018: HIV Medicine
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