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clinical reasoning medicine

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https://www.readbyqxmd.com/read/27917402/academic-institution-pilot-study-shows-far-fewer-diagnoses-of-sinusitis-than-reported-nationally
#1
Sarah R Akkina, Sarah J Novis, Nahid R Keshavarzi, Melissa A Pynnonen
OBJECTIVE: To compare the prevalence of acute sinusitis (AS) and chronic sinusitis (CS) diagnosed by primary care and emergency medicine physicians in our academic institution to national data. STUDY DESIGN: Cross-sectional pilot study of institutional census data and a population-based national sample. The setting was primary care and emergency departments at an academic healthcare institution and community healthcare practices nationally. MATERIALS AND METHODS: We determined the proportion of adults visits at our institution for AS and CS from January 1, 2005, to December 31, 2010...
October 2016: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/27914568/motivations-of-patients-seeking-supportive-care-for-cancer-from-physicians%C3%A2-prescribing-homeopathic-or-conventional-medicines-results-of-an-observational-cross-sectional-study
#2
Karine Danno, Aurélie Colas, Gilles Freyer, Jean-Paul Guastalla, Gérard Duru, Eric Musial, Vincent Libourel, Jean-Philippe Fendler, Jean-Louis Masson, Marie-France Bordet
BACKGROUND & AIMS: The motivations of patients who consult a homeopathic (GP-Ho) or conventional (GP-CM) general practitioner for supportive care during cancer treatment have not been widely studied. We investigated the reasons why cancer patients consult a GP-Ho versus a GP-CM for supportive care and the GPs' motivations for their prescriptions. METHODS: This observational survey was carried out in France between October 2008 and October 2011. GPs across France were randomly selected and asked to recruit four cancer patients each...
November 2016: Homeopathy: the Journal of the Faculty of Homeopathy
https://www.readbyqxmd.com/read/27913545/what-have-we-learned-from-large-population-studies-of-von-willebrand-disease
#3
Robert R Montgomery, Veronica H Flood
Von Willebrand factor (VWF) is a critical regulator of hemostatic processes, including collagen binding, platelet adhesion, and platelet aggregation. It also serves as a carrier protein to normalize plasma factor VIII synthesis, release, and survival. While VWF protein measurements by immunoassay are reasonably comparable between institutions, the measurement of VWF ristocetin cofactor activity (VWF:RCo) has significant variability. Other tests of VWF function, including collagen binding or platelet glycoprotein IIb-IIIa binding, are not universally available, yet these functional defects may cause major bleeding even with normal VWF antigen (VWF:Ag) and VWF:RCo assays...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27907983/north-korean-refugee-doctors-preliminary-examination-scores
#4
Sung Uk Chae, Jeong Hee Yang, Joon Seop Hyun, June Hee Kim, Seok Hoon Kang
PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test...
December 2016: Korean Journal of Medical Education
https://www.readbyqxmd.com/read/27906701/child-sexual-abuse-confirmed-by-forensic-examination-in-salvador-bahia-brazil
#5
Welington Dos Santos Silva, Ubirajara de Oliveira Barroso-Junior
Child sexual abuse is a worldwide public health issue. The objective of this study was to describe the demographic and clinical characteristics of children in cases of sexual abuse confirmed by material evidence at forensic examination. Cases of children younger than 12 years examined for suspected sexual abuse at the Institute of Forensic Medicine in Salvador, Bahia, Brazil, were reviewed retrospectively. The period evaluated was between 2005 and 2010. The inclusion criterion was the coroner's confirmation of sexual abuse based on material evidence...
November 30, 2016: American Journal of Forensic Medicine and Pathology
https://www.readbyqxmd.com/read/27905006/guidelines-on-the-management-of-atrial-fibrillation-in-the-emergency-department-a-critical-appraisal
#6
Giorgio Costantino, Gian Marco Podda, Lorenzo Falsetti, Primiano Iannone, Ana Lages, Alberto M Marra, Maristella Masala, Olaug Marie Reiakvam, Florentia Savva, Jan Schovanek, Sjoerd van Bree, Inês João da Silva Chora, Graziella Privitera, Silvio Ragozzino, Matthias von Rotz, Lycke Woittiez, Christopher Davidson, Nicola Montano
Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF...
November 30, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27902720/intervention-to-improve-appropriate-prescribing-and-reduce-polypharmacy-in-elderly-patients-admitted-to-an-internal-medicine-unit
#7
Milena Urfer, Luigia Elzi, Salome Dell-Kuster, Stefano Bassetti
BACKGROUND: Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice. OBJECTIVE: To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy. METHODS: We assessed the efficacy and safety of a 5-point checklist to be used by all physicians on the internal medicine wards of a Swiss hospital by comparing outcomes in 450 consecutive patients aged ≥65 years hospitalized after the introduction of the checklist, and in 450 consecutive patients ≥65 years hospitalized before the introduction of the checklist...
2016: PloS One
https://www.readbyqxmd.com/read/27896691/a-pilot-study-of-the-chronology-of-present-illness-restructuring-the-hpi-to-improve-physician-cognition-and-communication
#8
Laura M Mazer, Tina Storage, Sylvia Bereknyei, Jeffrey Chi, Kelley Skeff
BACKGROUND: Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction. OBJECTIVE: To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers. DESIGN: Internal medicine residents used the CPI during a 2-week night-float rotation...
November 28, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27893012/surgeons-and-trauma-care-physicians-perception-of-the-impact-of-the-globalization-of-medical-education-on-quality-of-care-in-lima-peru
#9
Lacey N LaGrone, Leah N Isquith-Dicker, Eduardo Huaman Egoavil, Manuel J A Rodriguez Castro, Alfredo Allagual, Fernando Revoredo, Charles N Mock
Importance: The globalization of medical education-the process by which trainees in any region gain access to international training (electronic or in-person)-is a growing trend. More data are needed to inform next steps in the responsible stewardship of this process, from the perspective of trainees and institutions at all income levels, and for use by national and international policymakers. Objective: To describe the impact of the globalization of medical education on surgical care in Peru from the perspective of Peruvian surgeons who received international training...
November 23, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27889810/rhodamine-bound-maghemite-as-a-long-term-dual-imaging-nanoprobe-of-adipose-tissue-derived-mesenchymal-stromal-cells
#10
Vratislav Cmiel, Josef Skopalik, Katerina Polakova, Jan Solar, Marketa Havrdova, David Milde, Ivan Justan, Massimiliano Magro, Zenon Starcuk, Ivo Provaznik
In the last few years, magnetically labeled cells have been intensively explored, and non-invasive cell tracking and magnetic manipulation methods have been tested in preclinical studies focused on cell transplantation. For clinical applications, it is desirable to know the intracellular pathway of nanoparticles, which can predict their biocompatibility with cells and the long-term imaging properties of labeled cells. Here, we quantified labeling efficiency, localization, and fluorescence properties of Rhodamine derivatized superparamagnetic maghemite nanoparticles (SAMN-R) in mesenchymal stromal cells (MSC)...
November 26, 2016: European Biophysics Journal: EBJ
https://www.readbyqxmd.com/read/27889404/adolescent-suicidal-ingestion-national-trends-over-a-decade
#11
David C Sheridan, Robert G Hendrickson, Amber L Lin, Rongwei Fu, B Zane Horowitz
PURPOSE: Suicide attempts by adolescents most commonly involve the overdose of medications. To date, there has been little information on the over-the-counter or prescription medicines that adolescents ingest for self-harm. Identification of medications chosen in suicide attempts may help guide anticipatory guidance to parents by primary care providers and Poison Centers in prevention programs. METHODS: This was a retrospective observational study using the American Association of Poison Control Center's National Poison Data System...
November 23, 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/27881121/knowledge-is-not-enough-to-solve-the-problems-the-role-of-diagnostic-knowledge-in-clinical-reasoning-activities
#12
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/27873322/non-medical-prescribing-versus-medical-prescribing-for-acute-and-chronic-disease-management-in-primary-and-secondary-care
#13
REVIEW
Greg Weeks, Johnson George, Katie Maclure, Derek Stewart
BACKGROUND: A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. OBJECTIVES: To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care)...
November 22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27871211/registry-and-health-insurance-claims-data-in-vascular-research-and-quality-improvement
#14
Christian-Alexander Behrendt, Franziska Heidemann, Henrik Christian Rieß, Konstanze Stoberock, Sebastian Eike Debus
The expansion of procedures in multidisciplinary vascular medicine has sparked a controversy regarding measures of quality improvement. In addition to primary registries, the use of health insurance claims data is becoming of increasing importance. However, due to the fact that health insurance claims data are not collected for scientific evaluation but rather for reimbursement purposes, meticulous validation is necessary before and during usage in research and quality improvement matters. This review highlights the advantages and disadvantages of such data sources...
November 22, 2016: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/27864208/payer-view-of-personalized-medicine
#15
Edmund J Pezalla
PURPOSE: The process and methods used by payers when evaluating coverage of personalized medicine testing are described. SUMMARY: Personalized medicine encompasses a number of diagnostic tools that measure drug metabolism, genetic risk for disease development, and tumor type or markers that can guide oncology treatments. However, whole genome testing, tumor marker testing, and testing for drug metabolism are additional costs to the healthcare system. In order to justify these costs, payers and health technology assessment bodies must evaluate the individual tests or groups of tests on their own merits...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
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
#16
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/27856758/tissue-scale-personalized-modeling-and-simulation-of-prostate-cancer-growth
#17
Guillermo Lorenzo, Michael A Scott, Kevin Tew, Thomas J R Hughes, Yongjie Jessica Zhang, Lei Liu, Guillermo Vilanova, Hector Gomez
Recently, mathematical modeling and simulation of diseases and their treatments have enabled the prediction of clinical outcomes and the design of optimal therapies on a personalized (i.e., patient-specific) basis. This new trend in medical research has been termed "predictive medicine." Prostate cancer (PCa) is a major health problem and an ideal candidate to explore tissue-scale, personalized modeling of cancer growth for two main reasons: First, it is a small organ, and, second, tumor growth can be estimated by measuring serum prostate-specific antigen (PSA, a PCa biomarker in blood), which may enable in vivo validation...
November 29, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27856379/templates-as-a-method-for-implementing-data-provenance-in-decision-support-systems
#18
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/27854360/recommendations-for-reporting-of-secondary-findings-in-clinical-exome-and-genome-sequencing-2016-update-acmg-sf-v2-0-a-policy-statement-of-the-american-college-of-medical-genetics-and-genomics
#19
Sarah S Kalia, Kathy Adelman, Sherri J Bale, Wendy K Chung, Christine Eng, James P Evans, Gail E Herman, Sophia B Hufnagel, Teri E Klein, Bruce R Korf, Kent D McKelvey, Kelly E Ormond, C Sue Richards, Christopher N Vlangos, Michael Watson, Christa L Martin, David T Miller
Disclaimer: These recommendations are designed primarily as an educational resource for medical geneticists and other healthcare providers to help them provide quality medical services. Adherence to these recommendations is completely voluntary and does not necessarily assure a successful medical outcome. These recommendations should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed toward obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen...
November 17, 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/27854194/prevention-and-treatment-of-constipation-in-children-from-the-perspective-of-iranian-traditional-medicine
#20
REVIEW
Monireh Sadat Motaharifard, Zahra Jafari, Maryam Sadat Paknejad, Laleh Oveidzadeh, Mehrdad Karimi
Constipation is one of the most common complaints of children and a common cause of referrals to pediatricians. Numerous reasons for this disease have been mentioned in the Iranian traditional medicine (ITM). It is believed that this disorder is mostly due to the lack of consideration of the six essential principles (Setteh-ye-Zarurieah), which are necessary to maintain health and prevent disease. In this descriptive study we collected and classified the concepts related to the topic by reviewing reliable ITM text books...
November 2016: Journal of Integrative Medicine
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