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clinical reasoning medicine

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https://www.readbyqxmd.com/read/28432543/understanding-and-improving-decisions-in-clinical-medicine-i-reasoning-heuristics-and-error
#1
Vincenzo Crupi, Fabrizio Elia
No abstract text is available yet for this article.
April 21, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28432483/what-s-in-a-gold-standard-in-defence-of-randomised-controlled-trials
#2
Marius Backmann
The standardised randomised clinical trial (RCT) has been exceedingly popular in medical research, economics, and practical policy making. Recently, RCTs have faced criticism. First, it has been argued by John Worrall that we cannot be certain that our sample is not atypical with regard to possible confounding factors. I will argue that at least in the case of medical research, we know enough about the relevant causal mechanisms to be justified to ignore a number of factors we have good reason not to expect to be disruptive...
April 21, 2017: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/28431457/precision-medicine-and-pharmacogenetics-what-does-oncology-have-that-addiction-medicine-does-not
#3
Henry R Kranzler, Rachel V Smith, Robert Schnoll, Afaf Moustafa, Emma Greenstreet-Akman
BACKGROUND AND AIMS: Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation...
April 21, 2017: Addiction
https://www.readbyqxmd.com/read/28424542/why-do-psychiatric-patients-stop-antipsychotic-medication-a-systematic-review-of-reasons-for-nonadherence-to-medication-in-patients-with-serious-mental-illness
#4
REVIEW
Dawn I Velligan, Martha Sajatovic, Ainslie Hatch, Pavel Kramata, John P Docherty
BACKGROUND: Antipsychotic medication reduces the severity of serious mental illness (SMI) and improves patient outcomes only when medicines were taken as prescribed. Nonadherence to the treatment of SMI increases the risk of relapse and hospitalization and reduces the quality of life. It is necessary to understand the factors influencing nonadherence to medication in order to identify appropriate interventions. This systematic review assessed the published evidence on modifiable reasons for nonadherence to antipsychotic medication in patients with SMI...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28421331/two-troubling-trends-in-the-conversation-over-whether-clinical-ethics-consultants-have-ethics-expertise
#5
Abram Brummett, Christopher J Ostertag
In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical expertise on irresolvable meta-ethical debates as the reason for this move...
April 18, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28419307/truth-or-spin-disease-definition-in-cancer-screening
#6
Lynette Reid
Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds...
April 17, 2017: Journal of Medicine and Philosophy
https://www.readbyqxmd.com/read/28414396/postural-tachycardia-syndrome-diagnosis-and-management-in-adolescents-and-young-adults
#7
Geoffrey L Heyer
Postural tachycardia syndrome (POTS) represents a common form of orthostatic intolerance that disproportionately affects young women from puberty through adulthood. Patients with POTS have day-to-day orthostatic symptoms with the hallmark feature of an excessive, sustained, and symptomatic rise in heart rate during orthostatic testing. Although considerable overlap exists, three subtypes of POTS have been described: neuropathic, hyperadrenergic, and hypovolemic forms. The wide spectrum of symptoms and comorbidities can make treatment particularly challenging...
April 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28413313/additional-risk-minimisation-measures-for-medicinal-products-in-the-european-union-a-review-of-the-implementation-and-effectiveness-of-measures-in-the-united-kingdom-by-one-marketing-authorisation-holder
#8
Elaine Agyemang, Lorna Bailey, John Talbot
INTRODUCTION: Additional risk minimisation measures (aRMMs) for medicinal products are necessary to address specific important safety issues which may not be practically achieved through routine risk management measures alone. The implementation and determination of effectiveness for aRMMs can be a challenge as it involves multiple stakeholders. It is therefore important to have concise objectives to avoid undue burden on patients, healthcare professionals and the healthcare system. AIM: The aim of this study was to examine how aRMMs are implemented and how effectiveness is assessed in the European Union (EU) using practical examples from Roche Products Limited in the United Kingdom (UK) (referred to as the 'Company')...
2017: Pharmaceutical Medicine
https://www.readbyqxmd.com/read/28407198/chlorpromazine-dose-for-people-with-schizophrenia
#9
REVIEW
Katharine Dudley, Xiaomeng Liu, Saskia De Haan
BACKGROUND: The World Health Organization (WHO) Model Lists of Essential Medicines lists chlorpromazine as one of its five medicines used in psychotic disorders. OBJECTIVES: To determine chlorpromazine dose response and dose side-effect relationships for schizophrenia and schizophrenia-like psychoses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (December 2008; 2 October 2014; 19 December 2016)...
April 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28404721/family-medicine-residents-training-in-knowledge-about-and-perceptions-of-digital-rectal-examination
#10
Annick Bussières, Alexandre Bouchard, David Simonyan, Sebastien Drolet
OBJECTIVE: To evaluate family medicine residents' training in, knowledge about, and perceptions of digital rectal examination (DRE). DESIGN: Descriptive study, using an online survey that was available in French and English. SETTING: Quebec. PARTICIPANTS: A total of 217 residents enrolled in a family medicine program. MAIN OUTCOME MEASURES: Residents' demographic characteristics; the DRE teaching they received throughout their medical training; their reasons for omitting DRE; their recognition of DRE indications (strong vs weak) and application of DRE for 10 anorectal complaints; and their perceptions of the overall quality of the DRE training they received...
April 2017: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/28399922/the-elusive-ideal-of-inclusiveness-lessons-from-a-worldwide-survey-of-neurologists-on-the-ethical-issues-raised-by-whole-genome-sequencing
#11
Thierry Hurlimann, Iris Jaitovich Groisman, Béatrice Godard
The anticipation of ethical issues that may arise with the clinical use of genomic technologies is crucial to envision their future implementation in a manner sensitive to local contexts. Yet, populations in low- and middle-income countries are underrepresented in studies that aim to explore stakeholders' perspectives on the use of such technologies. Within the framework of a research project entitled "Personalized medicine in the treatment of epilepsy", we sought to increase inclusiveness by widening the reach of our survey, inviting neurologists from around the world to share their views and practices regarding the use of whole-genome sequencing in clinical neurology and its associated ethics...
April 11, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28399870/the-role-of-traditional-healers-in-the-diagnosis-and-management-of-burkitt-lymphoma-in-cameroon-understanding-the-challenges-and-moving-forward
#12
Glenn M Afungchwi, Peter B Hesseling, Elena J Ladas
BACKGROUND: Burkittlymphoma(BL) is the most common childhood cancer in Cameroon with a reported incidence of 3 per 100,000 children under 15 years in the Northwest region. Treatment at three Baptist mission hospitals has a recorded cure rate of over 50%. Traditional medicine(TM) is recognized by the national health system, but its scope is undefined and entraps children with BL. The aim of this study was to investigate the attitudes and practices of parents and traditional healers (TH) towards TM in children with BL in order to develop recommendations for an integrative approach and improved access to life-saving treatment for children with BL...
April 11, 2017: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/28399679/an-overview-of-quinoline-as-a-privileged-scaffold-in-cancer-drug-discovery
#13
Robert Musiol
The concept of privileged structures is well known and is often used in the process of drug design and development. Although its assumptions are not clear, its overall usefulness remains high. Various substructures have been identified as privileged and quinoline is a prime example of such a structure. Areas covered: Quinoline drugs that are currently approved or under clinical investigation were reviewed based on a literature search. Their modes of action and outcomes during clinical research are discussed...
April 20, 2017: Expert Opinion on Drug Discovery
https://www.readbyqxmd.com/read/28398379/-the-slow-acceptance-of-new-oral-anticoagulants-in-italy-a-critical-analysis-of-a-problem
#14
Giovanni Luca Botto, Claudio Cuccia, Edoardo Gronda, Federico Lombardi, Maurizio Lunati, Antonio Maggi, Ferdinando Maria Massari, Giuseppe Musumeci, Fabrizio Oliva, Luigi Oltrona Visconti, Cesare Proto, Enrico Pusineri, Walter Ageno
The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has revolutionized the prevention and the therapeutic approaches to thromboembolic events in patients with nonvalvular atrial fibrillation and represents with no doubts one of the most remarkable advances in the history of cardiovascular medicine over the last years. NOACs beyond a comparable efficacy with vitamin K antagonists allow to overcome the limitations of this last category of drugs owing to their less drug to drug interactions and a predictable anticoagulant effect that allows a fixed dose administration without the need for continuous monitoring...
March 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28398227/miniaturized-real-time-pcr-on-a-q3-system-for-rapid-kras-genotyping
#15
Maria Guarnaccia, Rosario Iemmolo, Salvatore Petralia, Sabrina Conoci, Sebastiano Cavallaro
Colorectal cancer (CRC) is an aggressive human malignancy with a complex genomic landscape harboring KRAS mutations. In 40%-60% of patients with CRC, constantly active KRAS proteins affect the prognosis, surgical strategy, and clinical benefit from therapy with anti-epidermal growth factor receptor (EGFR) agents. For this reason, there is a greater demand for minimally-invasive diagnostic devices to characterize the genetic pattern and prevent the acquired mechanism to drug resistance. The rapid developments in cutting-edge diagnostic techniques are expected to play a growing role in medicine and represent an attractive promise to identify potential responders to personalized medicine...
April 11, 2017: Sensors
https://www.readbyqxmd.com/read/28397057/clinical-application-analysis-of-andrographolide-total-ester-sulfonate-injection-a-traditional-chinese-medicine-licensed-in-china
#16
Ying Zhao, Pu Huang, Zhe Chen, Si-Wei Zheng, Jin-Yang Yu, Chen Shi
Andrographolide total ester sulfonate (ATES) injection is one of the products of traditional Chinese medicine (TCM) currently used against viral infection in China. ATES injection was approved for manufacturing and marketing in January 2002. It is indicated for acute respiratory infections, tonsillitis, chronic obstructive pulmonary disease, influenza, foot and mouth disease, bronchiolitis, herpangina, mumps, infectious mononucleosis and psychosis. However, its usage also carries risk. We investigated the use of ATES at the Wuhan Union Hospital from January 2014 to December 2014 and evaluated its real-world clinical application using the hospital centralized monitoring method...
April 2017: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/28396229/troponin-testing-in-patients-without-chest-pain-or-electrocardiographic-ischemic-changes
#17
Zvi Shimoni, Rossina Arbuzov, Paul Froom
BACKGROUND: Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes. OBJECTIVES: The objective of this study was to determine clinical utility, and downstream testing in patients with elevated troponin values but without chest pain or electrocardiographic changes. METHODS: We selected all patients aged 30-100 years hospitalized in cardiology and internal medicine departments from July 1, 2013 until July 31, 2016...
April 7, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28382695/discordant-non-invasive-prenatal-testing-nipt-a-systematic-review
#18
REVIEW
Tanja Schlaikjaer Hartwig, Louise Ambye, Steen Sørensen, Finn Stener Jørgensen
With a high sensitivity and specificity, NIPT is an incomparable screening test for fetal aneuploidy. However, the method is rather newly introduced and experiences with discordant results are few. We did a systematic review of literature reporting details of false positive and false negative NIPT results. Discordant sex chromosome results were not included. We identified 22 studies reporting case details. In total 206 discordant cases were included, of which 88% were false positive and 12% false negative. Details on maternal age, gestational age, platform/company, Z-score, fetal fraction, results and explanation were specified...
April 5, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/28382404/prediction-of-hepatotoxicity-for-drugs-using-human-pluripotent-stem-cell-derived-hepatocytes
#19
Jong Hyun Kim, Min Wang, Jaehun Lee, Han-Jin Park, Chungseong Han, Hee Su Hong, Jeong Seong Kim, Geun Ho An, Kijung Park, Hee-Kyung Park, Shi Feng Zhu, Xiao-Bo Sun, Jong-Hoon Kim, Dong-Hun Woo
Drug-induced liver toxicity is a main reason for withdrawals of new drugs in late clinical phases and post-launch of the drugs. Thus, hepatotoxicity screening of drug candidates in pre-clinical stage is important for reducing drug attrition rates during the clinical development process. Here, we show commercially available hepatocytes that could be used for early toxicity evaluation of drug candidates. From our hepatic differentiation technology, we obtained highly pure (≥98%) hepatocytes from human embryonic stem cells (hESCs) having mature phenotypes and similar gene expression profiles with those of primary human tissues...
April 5, 2017: Cell Biology and Toxicology
https://www.readbyqxmd.com/read/28379080/interprofessional-collaborative-reasoning-by-residents-and-nurses-in-internal-medicine-evidence-from-a-simulation-study
#20
K S Blondon, F Maître, V Muller-Juge, N Bochatay, S Cullati, P Hudelson, N V Vu, G L Savoldelli, M R Nendaz
Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session...
April 2017: Medical Teacher
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