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clinical reasoning medicine

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https://www.readbyqxmd.com/read/29045276/impact-of-required-versus-self-directed-use-of-virtual-patient-cases-on-clerkship-performance-a-mixed-methods-study
#1
Sarang Kim, Laura R Willett, Wilbur J Pan, Joyce Afran, John A Walker, Judy A Shea
PURPOSE: To explore how students use and benefit from virtual patient cases (VPCs). METHOD: In academic years 2013-2014 and 2014-2015, cohorts of students in pediatrics (Peds), family medicine (FM), and internal medicine (IM) clerkships were allocated to either core required use (CRU) or self-directed use (SU) of MedU VPCs. Outcomes included number and time of case review, student perception of learning from VPCs, National Board of Medical Examiners (NBME) subject examination scores, and summative clinical ratings for medical knowledge and differential diagnoses/problem solving...
October 17, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29034793/patient-s-utilization-of-primary-care-a-profile-of-clinical-and-administrative-reasons-for-visits-in-israel
#2
Tamar Adar, Inbar Levkovich, Orit Cohen Castel, Khaled Karkabi
BACKGROUND: Data on patients' utilization of health services in primary care is relevant to planning healthcare. Data may be collected by numerous methods, but obtaining a true picture of content of care has practical difficulties. OBJECTIVES: To describe patient's reasons for visits to primary care physicians (PCPs) as presented by the patient; and to examine the effect of patient-, doctor- and clinic-related variables on the reasons for the visit. METHODS: Visits to PCPs were observed by peer doctors during 2014, at primary care clinics in Israel...
October 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/29031620/targeting-non-small-cell-lung-cancer-with-small-molecule-egfr-tyrosine-kinase-inhibitors
#3
REVIEW
Mahaveer Singh, Hemant R Jadhav
Epidermal growth factor (EGFR) tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib, show excellent clinical efficacy for patients with non-small cell lung cancer (NSCLC) with EGFR mutations, including Exon 19 deletion and single-point substitution, and L858R of exon 21. The reason for the reduction in effectiveness of these EGFR TKIs is the T790M gatekeeper mutation in the ATP-binding pocket of Exon 20, which increases the affinity of EGFR for ATP. Newer EGFR TKIs, such as afatinib, osimertinib, rociletinib, EGF816 and ASP8273, selectively target T790M mutants, sparing wild-type EGFR...
October 12, 2017: Drug Discovery Today
https://www.readbyqxmd.com/read/29029694/prescriber-response-to-computerized-drug-alerts-for-electronic-prescriptions-among-hospitalized-patients
#4
Yael Zenziper Straichman, Daniel Kurnik, Ilan Matok, Hillel Halkin, Noa Markovits, Amitai Ziv, Ari Shamiss, Ronen Loebstein
BACKGROUND: Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, "alert fatigue", and indiscriminate rejection. OBJECTIVES: To compare acceptance rates of alerts generated by the SafeRx(®) prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified. METHODS: In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel's largest tertiary care center...
November 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29027409/-developing-traditional-chinese-medicine-injection-is-the-need-for-curing-sickness-to-save-patients
#5
Ping He, Feng-Jie Li, Lian-da Li, Yi-Kui Li
Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine...
March 2017: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
https://www.readbyqxmd.com/read/29026965/cutting-the-holy-dome-the-evolution-of-vertical-alar-resection
#6
Süreyya Şeneldir, Aytuğ Altundağ, Denizhan Dizdar
INTRODUCTION: Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique...
October 12, 2017: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/29021637/physical-frailty-and-fitness-of-older-driver
#7
Maria Helena Lenardt, Clovis Cechinel, Maria Angelica Binotto, Nathalia Hammerschmidt Kolb Carneiro, Tânia Maria Lourenço
AIM: to analyze the association between physical frailty and the results of fitness capacity exams for driving vehicles among elder Brazilians. METHODS: this is a cross sectional study, performed in traffic medicine clinics of the city of Curitiba (Brazil). The data was collected through the physical frailty tests, the use of a structured questionnaire, and searches on the records of the Brazilian National Register of Qualified Drivers.To analyze the information, the authors used descriptive statistics and non-parametrical tests...
June 30, 2017: Colombia Médica: CM
https://www.readbyqxmd.com/read/29017820/possible-utility-of-the-basophil-activation-test-for-the-analysis-of-mechanisms-involved-in-allergic-transfusion-reactions
#8
REVIEW
Fumiya Hirayama, Kazuta Yasui, Nobuki Matsuyama, Ikue Okamura-Shiki
Allergic transfusion reactions (ATRs) are the most common adverse reactions occurring during transfusion of blood components. Although most reactions are mild and involve cutaneous manifestations, severe ATRs including life-threatening anaphylaxis may also occur. The mechanisms of ATRs are largely unknown because they have not been well studied. One of the reasons for this may be the absence of a standard assay system for investigating these processes. Basophils and/or mast cells are key effector cells in immediate-type allergic reactions...
September 19, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/29017409/acute-clinical-predictors-of-symptom-recovery-in-emergency-department-patients-with-uncomplicated-mild-traumatic-brain-injury-mtbi-or-non-tbi-injuries
#9
Lindsay D Nelson, Robyn E Furger, Jana Ranson, Sergey Tarima, Thomas A Hammeke, Christopher Randolph, William B Barr, Kevin K Guskiewicz, Christopher M Olsen, E Brooke Lerner, Michael McCrea
There is a subset of patients with mild traumatic brain injury (mTBI) that report persistent symptoms that impair their functioning and quality of life. Being able to predict which patients will experience prolonged symptom recovery would help clinicians target resources for clinical follow-up to those most in need and would facilitate research to develop precision medicine treatments for mTBI. The purpose of this study was to investigate the predictors of symptom recovery in a prospective sample of emergency department trauma patients with either mTBI or non-mTBI injuries...
October 10, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28992980/adherence-to-recommendations-of-the-therapeutic-positioning-report-about-treatment-with-oral-anticoagulants-in-elderly-patients-with-atrial-fibrillation-the-esparta-study
#10
Carmen Suárez Fernández, Jose María Mostaza, Luis Castilla Guerra, Jesus Cantero Hinojosa, Josep Maria Suriñach, Fernando Acosta de Bilbao, Juan José Tamarit, José Luis Diaz Diaz, Jose Luis Hernandez, Daniel Cazorla, Carles Ràfols
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included...
October 6, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28990648/-patients-organizations-and-new-drug-approval-in-the-us-eteplirsen-and-duchenne-muscular-dystrophy-case
#11
REVIEW
(no author information available yet)
INTRODUCTION: In 2016 the US Food and Drug Administration (FDA) granted the marketing authorization for eteplirsen for Duchenne muscular dystrophy. This has been a very controversial decision since it happened after a negative assessment from both the Advisory Committee and the technical FDA evaluation team. The FDA's Center for Drug Evaluation and Research (CDER) director was who ultimately approved the product, while the FDA Commissioner did not overrule that decision. AIM: To report about the most relevant events regarding the approval of eteplirsen by the US FDA...
October 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28989242/developing-new-antimicrobial-therapies-are-synergistic-combinations-of-plant-extracts-compounds-with-conventional-antibiotics-the-solution
#12
REVIEW
Matthew J Cheesman, Aishwarya Ilanko, Baxter Blonk, Ian E Cock
The discovery of penicillin nearly 90 years ago revolutionized the treatment of bacterial disease. Since that time, numerous other antibiotics have been discovered from bacteria and fungi, or developed by chemical synthesis and have become effective chemotherapeutic options. However, the misuse of antibiotics has lessened the efficacy of many commonly used antibiotics. The emergence of resistant strains of bacteria has seriously limited our ability to treat bacterial illness, and new antibiotics are desperately needed...
July 2017: Pharmacognosy Reviews
https://www.readbyqxmd.com/read/28985348/elbow-room-for-best-practice-montgomery-patients-values-and-balanced-decision-making-in-person-centred-clinical-care
#13
Jonathan Herring, K M W Fulford, Michael Dunn, Ashok I Handa
The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor...
July 19, 2017: Medical Law Review
https://www.readbyqxmd.com/read/28982030/identifying-the-factors-influencing-practice-variation-in-thrombosis-medicine-a-qualitative-content-analysis-of-published-practice-pattern-surveys
#14
Leslie Skeith, Carol Gonsalves
Practice variation, the differences in clinical management between physicians, is one reason why patient outcomes may differ. Identifying factors that contribute to practice variation in areas of clinical uncertainty or equipoise may have implications for understanding and improving patient care. To discern what factors may influence practice variation, we completed a qualitative content analysis of all practice-pattern surveys in thrombosis medicine in the last 10years. Out of 2117 articles screened using a systematic search strategy, 33 practice-pattern surveys met eligibility criteria...
September 27, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28980842/construct-validation-of-the-english-version-of-readiness-for-interprofessional-learning-scale-ripls-are-chinese-undergraduate-students-ready-for-shared-learning
#15
Fraide A Ganotice, Lap Ki Chan
Interprofessional education has been receiving attention as a result of research suggesting the benefits of interpersonal collaboration in healthcare. In Hong Kong, the implementation of the Interprofessional Team-based Learning programme provides implicit call to study the psychometric properties of Readiness for Interprofessional Learning Scale (RIPLS) to clarify if this is a valid measure when used in the Chinese undergraduate healthcare context. This study examines the psychometric properties of RIPLS involving predominantly Chinese undergraduate healthcare students in Hong Kong...
October 5, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28979912/models-of-clinical-reasoning-with-a-focus-on-general-practice-a-critical-review
#16
Shahram Yazdani, Mohammad Hosseinzadeh, Fakhrolsadat Hosseini
INTRODUCTION: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings...
October 2017: Journal of Advances in Medical Education & Professionalism
https://www.readbyqxmd.com/read/28979313/synthesis-quality-control-and-stability-studies-of-2-18-f-fluoro-2-deoxy-d-glucose-18-f-fdg-at-different-conditions-of-temperature-by-physicochemical-and-microbiological-assays
#17
Siyavash Rahmani, Soraya Shahhoseini, Reza Mohamadi, Mostafa Vojdani
The introduction of 2-[(18)F] fluor-2-deoxy-D-glucose ((18)FDG) has provided a valuable tool for the study of glucose metabolism in both normal and diseased tissue in conjunction with positron emission tomography (PET). (18)FDG is the most important radiopharmaceutical to be used in Nuclear Medicine for studying the brain, heart and tumor. The advancement in synthesis and quality control of (18)FDG and its approval by US FDA are main reasons for increasing clinical application of (18)FDG over the last 20 years...
2017: Iranian Journal of Pharmaceutical Research: IJPR
https://www.readbyqxmd.com/read/28978556/genomic-heterogeneity-as-a-barrier-to-precision-medicine-in-gastroesophageal-adenocarcinoma
#18
Eirini Pectasides, Matthew D Stachler, Sarah Derks, Yang Liu, Steven Maron, Mirazul Islam, Lindsay Alpert, Heewon Kwak, Hedy Kindler, Blase Polite, Manish R Sharma, Kenisha Allen, Emily O'Day, Samantha Lomnicki, Melissa Maranto, Rajani Kanteti, Carrie Fitzpatrick, Christopher Weber, Namrata Setia, Shu-Yuan Xiao, John Hart, Rebecca Nagy, Kyoung-Mee Kim, Min-Gew Choi, Byung Hoon Min, Katie S Nason, Lea O'Keefe, Masayuki Watanabe, Hideo Baba, Rick Lanman, Agoston T Agoston, David J Oh, Andrew Dunford, Aaron R Thorner, Matthew D Ducar, Bruce M Wollison, Haley A Coleman, Yuan Ji, Mitchell C Posner, Kevin K Roggin, Kiran Turaga, Paul Chang, Kyle Hogarth, Uzma Siddiqui, Andres Gelrud, Gavin Ha, Samuel S Freeman, Justin Rhoades, Sarah Reed, Greg Gydush, Denisse Rotem, Jon Davison, Yu Imamura, Viktor Adalsteinsson, Jeeyun Lee, Adam J Bass, Daniel V Catenacci
Gastroesophageal adenocarcinoma (GEA) is a lethal disease where targeted therapies, even when guided by genomic biomarkers, have had limited efficacy. A potential reason for the failure of such therapies is that genomic profiling results could commonly differ between the primary and metastatic tumor. To evaluate genomic heterogeneity, we sequenced paired primary GEA and synchronous metastatic lesions across multiple cohorts, finding extensive differences in genomic alterations, including discrepancies in potentially clinically relevant alterations...
October 4, 2017: Cancer Discovery
https://www.readbyqxmd.com/read/28978257/morphological-analysis-of-live-undifferentiated-cells-derived-from-induced-pluripotent-stem-cells
#19
Yukihiko Osawa, Tomoyuki Miyamoto, Setsuyo Ohno, Eiji Ohno
Induced pluripotent stem (iPS) cells possess pluripotency and self-renewal ability. Therefore, iPS cells are expected to be useful in regenerative medicine. However, iPS cells form malignant immature teratomas after transplantation into animals, even after differentiation induction. It has been suggested that undifferentiated cells expressing Nanog that remain after differentiation induction are responsible for teratoma formation. Various methods of removing these undifferentiated cells have therefore been investigated, but few methods involve morphological approaches, which may induce less cell damage...
October 5, 2017: Stem Cells and Development
https://www.readbyqxmd.com/read/28976818/can-harmonized-regulation-overcome-intra-european-differences-insights-from-a-european-phase-iii-stem-cell-trial
#20
Christine Hauskeller
Harmonized regulation of research with human stem cells in Europe has shaped innovation in regenerative medicine. Findings from a Phase III academic clinical trial of an autologous cell procedure illustrate the obstacles that a multinational trial faces. A typology of the obstacles encountered, may help other teams embarking upon trials. The findings throw light on the situation of clinician-scientists in clinical innovation, as the expertise to run scientific trials is very complex. The innovation route of clinical translation takes insufficient account of the interdependencies between multiple social and cultural factors from outside the laboratory and the clinic...
September 2017: Regenerative Medicine
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