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Astute Medical

Olivia Weisser
This article looks at cases of venereal disease from the early 1700s and how healers presented themselves as shrewd interpreters of patients' bodies and souls. Because the disease was so stigmatizing, patients were said to be unreliable narrators of their own symptoms and health histories. Practitioners, in turn, exhibited diagnostic expertise by sagely navigating such constraints. They characterized themselves as medical detectives who gathered clues and made diagnoses in spite of patients' alleged lies and omissions...
2017: Bulletin of the History of Medicine
Deborah P Waldrop, Jacqueline M McGinley, Brian Clemency
The convergence of medical treatment that can extend life with written medical orders that make it possible to refuse such treatment brings the differential dynamics of contemporary end-of-life decision making into sharp focus. Communication between families and clinicians can be confusing, uncertain, and pressured when death is imminent. These situations create distress that ultimately influences the end-of-life experience for people who are dying and those who care for them. This article presents the analysis of the decisional dynamics that emerge from the intersection of the patient-family-provider awareness that death is near with the presence or absence of documentation of expressed wishes for end-of-life care...
February 2018: Journal of Pain and Symptom Management
Scott S De Rossi, Katharine Ciarrocca
The oral cavity is frequently involved in conditions that affect the skin or other multi-organ diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. Anatomically, the mouth is easily accessible. An astute dental provider has the opportunity to observe physical and oral conditions that might include undiagnosed or poorly managed systemic disease. This article reviews four less common oral disease of medical significance.
September 2016: Journal of the California Dental Association
Claudio Ronco, Lilia Rizo-Topete, Mara Serrano-Soto, Kianoush Kashani
Acute kidney injury (AKI) is a common condition in critically ill patients. Multiple studies have identified AKI as a strong independent risk factor for higher morbidity and mortality. AKI is often multifactorial, asymptomatic and difficult to predict. In recent years, the discovery of several AKI biomarkers, including the recent validation and approval of cell cycle arrest biomarkers (NephroCheck, Astute Medical, San Diego, CA, USA), has provided additional tools to detect patients at high risk of AKI and improve their outcomes...
March 1, 2017: Nephrology, Dialysis, Transplantation
Akhilesh K Sista
There has been a resurgence of interest in defining the optimal treatment for severe pulmonary embolism (PE), fueled by pivotal and provocative trials, new catheter-based medical devices, and growing evidence of deleterious short- and long-term outcomes. In this environment, and especially given the multidisciplinary nature of PE care, the interventional radiologist (IR) needs to become an astute, disease-specific expert. This review article describes the following "steps" an IR can take to reach this level: (1) understand PE stratification and epidemiology; (2) recognize the treatment goals for massive PE; (3) recognize the wide range of attitudes toward therapeutic escalation for submassive PE; (4) recognize what we do not know about the treatment of submassive PE and the limitations of current studies; (5) know the literature surrounding inferior vena cava filter insertion for severe PE; (6) integrate into the longitudinal care of the patient; and (7) be at the leading edge of new trials and technologies...
March 2017: Seminars in Interventional Radiology
Aniket Sonsale, Reshma Bharamgoudar
Throughout their careers, doctors are likely to come across complex management and leadership scenarios that many would not have had prior training in. Expectations of doctors are rising and it is becoming increasingly necessary to be able to astutely handle a variety of situations. Medical curricula must reflect this change and adapt to include the teaching of key management and leadership skills. Despite budgeting pressures, the National Health Service continues to spend vast sums of money on external management consultants...
April 2017: Perspectives on Medical Education
Mark C Hutten
As the baby boom generation ages, it is projected that by 2050 the number of Americans older than 65 years of age will increase to a staggering 88 million. Those Americans 85 years and older will soon represent the fastest growing segment of the population, predicted to surge to 20 million by 2060. Management of chronic disease processes affecting older Americans will consume 86% of the nation's healthcare expenditures. Dentists and specialists alike must understand these disease processes and become active members of the healthcare team...
November 2016: General Dentistry
Nachiket Patel, Elizabeth Ngo, Timothy E Paterick, Krishnaswamy Chandrasekaran, Jamil Tajik
The physical examination skills of young physicians in training need careful examination as advancing technology seems to have replaced those skills compared to prior generations of physicians. A question to ponder is how should medical education address the convincing evidence that physician trainees of today are less astute at the physical examination than those that came before them? This inquiry must address whether the decline in physical examination skills hinders accurate, cost effective, and timely diagnoses...
October 15, 2016: International Journal of Cardiology
Kathleen D Liu, Anitha Vijayan, Mitchell H Rosner, Jing Shi, Lakhmir S Chawla, John A Kellum
BACKGROUND: The NEPROCHECK test (Astute Medical, San Diego, CA, USA) combines urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) to identify patients at high risk for acute kidney injury (AKI). In a US Food and Drug Administration registration trial (NCT01573962), AKI was determined by a three-member clinical adjudication committee. The objectives were to examine agreement among adjudicators as well as between adjudicators and consensus criteria for AKI and to determine the relationship of biomarker concentrations and adjudicator agreement...
October 2016: Nephrology, Dialysis, Transplantation
Aubri M Waters, Jason B Caboot, Madeleine M Verhovsek, David P Harper, Melissa A Forouhar
An asymptomatic toddler and his mother consistently demonstrated low transcutaneous pulse oximetry (SpO2) measurements, discordant with normal arterial blood gas analyses while breathing room air. Previous evaluations by medical teams were unable to identify an etiology of their perceived hypoxia. Further investigation revealed that the boy carried an abnormal variant, Hb Grifton or α87(F8)His→Pro; HBA1: c.263A > C (or HBA2), discovered on newborn screening, which was not suspected as the underlying cause of his abnormal pulse oximetry readings until an inpatient admission to our hospital for asymptomatic "hypoxia," where he was found to share these same characteristics with his mother...
August 2016: Hemoglobin
Reinhard Merkel
There is as yet no widely agreed-upon solution to the standard textbook problem whether actively shutting off a life-sustaining medical device, e.g. a respirator, and thus bringing about a patient's death amounts to active killing or just to an omission of further treatment. Apart from a range of astutely contrived case examples and respective particular solutions proposed in the literature, there seems to be no consensus on the normative principles such solutions should be grounded in, not even on the need for such principles beyond sheer intuition...
June 2016: Journal of Medical Ethics
J Michelle Kahlenberg
PURPOSE OF REVIEW: Blockade of interleukin (IL)-1 signaling is one of the oldest biologic therapies, yet the use of these agents is on the rise as the role of IL-1 activation is being recognized in a wide spectrum of inflammatory disorders. This review will cover established and emerging uses of IL-1 antagonism in rheumatic diseases. RECENT FINDINGS: Expanding off-label indications for IL-1 blockade include neutrophil-dominant skin diseases, including pyoderma gangrenosum, hidradenitis supperativa, and pustular psoriasis...
May 2016: Current Opinion in Rheumatology
Kyle J Gunnerson, Andrew D Shaw, Lakhmir S Chawla, Azra Bihorac, Ali Al-Khafaji, Kianoush Kashani, Matthew Lissauer, Jing Shi, Michael G Walker, John A Kellum
BACKGROUND: Acute kidney injury (AKI) is an important complication in surgical patients. Existing biomarkers and clinical prediction models underestimate the risk for developing AKI. We recently reported data from two trials of 728 and 408 critically ill adult patients in whom urinary TIMP2•IGFBP7 (NephroCheck, Astute Medical) was used to identify patients at risk of developing AKI. Here we report a preplanned analysis of surgical patients from both trials to assess whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) accurately identify surgical patients at risk of developing AKI...
February 2016: Journal of Trauma and Acute Care Surgery
S Nilima, Anuj Sharma
Timely and accurate diagnosis of a medical/dental condition is the first critical step to ensure appropriate treatment. Lack of astuteness in diagnosis may assume many forms. Each medical/dental practitioner is morally and legally bound to perform his or her duties to a specified standard of care. The cause of misdiagnosis may be hurriedness, lack of testing, or a simple mistake; failure to diagnose can constitute a breach of that duty, making the medical/dental provider liable for any resulting damages. The following case report highlights one such misdiagnosed case...
September 2015: Contemporary Clinical Dentistry
Nandkishor S Chindarkar, Lakhmir S Chawla, Joely A Straseski, Saeed A Jortani, Denise Uettwiller-Geiger, Robert R Orr, John A Kellum, Robert L Fitzgerald
BACKGROUND: Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) have demonstrated significantly improved diagnostic performance in assessing risk for acute kidney injury (AKI) compared with existing biomarkers. We present the findings of a multi-site trial to determine the reference intervals for these biomarkers in apparently healthy adults and those with stable chronic morbid conditions without AKI. METHODS: A urine specimen was collected from apparently healthy subjects (N=378) and subjects with at least one stable chronic morbidity (N=372)...
January 15, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
Igor Sorokin, Adam Schatz, Charles Welliver
Placebo medications and sham surgeries have long been thought to be inert treatments. These groups served as a threshold to which an active treatment should be compared in a randomized trial to determine the true efficacy of the active treatment. However, surprising changes in subjective symptom scores and objective measures of voiding have been demonstrated in numerous placebo medication or sham surgery arms of trials. The exact mechanisms by which these inactive treatments augment patient outcomes are not clearly defined and multiple theories have been proposed to explain the often pronounced response...
October 2015: Current Urology Reports
Tobias Else
The last decades have elucidated the genetic basis of pheochromocytoma (PC) and paraganglioma (PGL) (PCPGL)-associated hereditary syndromes. However, the history of these syndromes dates back at least another 150 years. Detailed descriptions by clinicians and pathologists in the 19th and 20th centuries led to the recognition of the PCPGL-associated syndromes von Hippel-Lindau disease, neurofibromatosis type 1, and multiple endocrine neoplasia type 2. In the beginning of the current millennium the molecular basis of the hereditary PGL syndrome was elucidated by the discovery of mutations in genes encoding enzymes of the Krebs cycle, such as succinate dehydrogenase genes (SDHx) and other mutations, causing 'pseudo-hypoxia' signaling...
August 2015: Endocrine-related Cancer
Sharon K Byrne, Shonta D Collins
Using available evidence and astute assessment skills, nurses and advanced practice nurses, as members of an inter-professional team, were able to assess, diagnose, and initiate treatment for a child with lymphatic filariasis within a global health practice setting. The lessons learned during health outreach trips to an underserved commune of Port-au-Prince, Haiti can promote an understanding of appropriate nursing practice related to this parasitic infection. They can also assist nursing students, nurse practitioner students, and faculties as members of a medical outreach team to promote sustainability which is a benchmark of nursing leadership in global health...
July 2015: MCN. the American Journal of Maternal Child Nursing
Sandy Macleod
OBJECTIVE: Australasians contributed to the medical literature on shell shock during and after World War I. CONCLUSIONS: AW Campbell, Elliot Smith, Carmalt Jones and AG Butler made significant contributions, and several 'frontline doctors' recorded astute observations.
August 2015: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Marcela Mautone, Parm Naidoo
Charcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic neuropathy. Patients with diabetes complicated by CN have especially high morbidity, frequency of hospitalisation, and therefore, significant utilisation of expensive medical resources. The diagnosis of early CN can be challenging and is based on clinical presentation supported by various imaging modalities. Imaging is important for the detection of early CN and is useful in monitoring progression and complications of the disease...
August 2015: Journal of Medical Imaging and Radiation Oncology
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