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Physician fatigue

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https://www.readbyqxmd.com/read/29133321/can-physical-assessment-techniques-aid-diagnosis-in-people-with-chronic-fatigue-syndrome-myalgic-encephalomyelitis-a-diagnostic-accuracy-study
#1
Lucy Hives, Alice Bradley, Jim Richards, Chris Sutton, James Selfe, Bhaskar Basu, Kerry Maguire, Gail Sumner, Tarek Gaber, Annice Mukherjee, Raymond N Perrin
OBJECTIVE: To assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment. METHODS: This was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order...
November 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/29132064/patients-and-caregivers-contributions-for-differentiating-epileptic-from-psychogenic-nonepileptic-seizures-value-and-limitations-of-self-reporting-questionnaires-a-pilot-study
#2
Giuseppe Erba, Elisa Bianchi, Giorgia Giussani, John Langfitt, Adam Juersivich, Ettore Beghi
PURPOSE: Questionnaires investigating semiology and comorbidities of psychogenic non-epileptic seizures (PNES) have been used mainly to help physicians expedite referrals to epilepsy centres for confirmation of diagnosis rather than as alternative diagnostic tool when video-EEG monitoring (VEM), the current gold standard, is not available or is inconclusive. METHODS: We developed one structured questionnaire for patients, exploring subjective experiences and vulnerabilities and one for eyewitnesses, focused on features observable during typical events to study prospectively 50 consecutive adult patients with PNES or epileptic seizures (ES) admitted for VEM...
November 8, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29129740/survey-on-neonatal-end-of-life-comfort-care-guidelines-across-america
#3
Shelly Haug, Sara Farooqi, Christopher G Wilson, Andrew Hopper, Grace Oei, Brian Carter
CONTEXT: Infants of age < 1 year have the highest mortality rate in pediatrics. The American Academy of Pediatrics (AAP) published guidelines for palliative care in 2013, however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL). OBJECTIVES: The purpose of this study was to evaluate current neonatal EOL comfort care practices and clinician satisfaction across America METHODS: After Institutional Review Board approval (516005), an anonymous, electronic survey was sent to members of the AAP Section on Neonatal-Perinatal Medicine...
November 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29128151/is-the-choosing-wisely-%C3%A2-campaign-model-applicable-to-the-management-of-multiple-sclerosis-in-france-a-gresep-pilot-study
#4
B Trumbic, H Zéphir, J-C Ouallet, E Le Page, D Laplaud, C Bensa, J de Sèze
BACKGROUND: Launched in the US in 2012, Choosing Wisely(®) is a campaign promoted by the American Board of Internal Medicine (ABIM) Foundation with the goal of improving healthcare effectiveness by avoiding wasteful or unnecessary medical tests, treatments and procedures. It uses concise recommendations produced by national medical societies to start discussions between physicians and patients on the relevance of these services as part of a shared decision-making process. The Multiple Sclerosis Focus Group (Groupe de Reflexion Autour de la Sclérose en Plaques; GRESEP) undertook a pilot study to assess the relevance and feasibility of this approach in the management of multiple sclerosis (MS) in France...
November 8, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29128080/-crossed-perceptions-about-malnutrition-in-patients-and-their-doctors-in-oncology
#5
Bruno Raynard, Xavier Hébuterne, François Goldwasser, Ali Ait Hssain, Pascale Dubray Longeras, Philippe Barthélémy, Edoardo Rosso, Valérie Phoutthasang, Camille Bories, Laurence Digue, David Laharie, Jean-Claude Desport, Sabrina Falkowski, Jean Lacau Saint Guily, Emmanuel Gyan
Malnutrition is common in oncology. However, it is often detected too late and nutritional support is sub-optimal. The patient's opinion, although often sought in therapeutic decisions in oncology, does not appear to be frequently taken into account in dietetic management. In NutriCancer2012 study, we interviewed patients, relatives and doctors about their perceptions of the impact of malnutrition and its quality of care. Of the 2209 patients questioned, majority said they were concerned about nutrition with 75% considering it essential to take appropriate nutritional care but only 19% self-reported link between malnutrition and fatigue...
November 8, 2017: Bulletin du Cancer
https://www.readbyqxmd.com/read/29119008/discordant-patient-physician-assessments-of-disease-activity-and-its-persistence-adversely-impact-quality-of-life-and-work-productivity-in-us-hispanics-with-rheumatoid-arthritis
#6
George A Karpouzas, Sera N Ramadan, Chelsie E Cost, Taylor L Draper, Elizabeth Hernandez, Vibeke Strand, Sarah R Ormseth
Objective: This study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit. Methods: We studied 536 Hispanics with established RA from a single centre...
2017: RMD Open
https://www.readbyqxmd.com/read/29111887/use-of-short-message-service-and-smartphone-applications-in-the-management-of-surgical-patients-a-systematic-review
#7
Keyin Lu, Nikolas E Marino, David Russell, Aashray Singareddy, Donald Zhang, Angela Hardi, Scott Kaar, Varun Puri
BACKGROUND: Mobile health and telemedicine are rapidly evolving fields used to provide healthcare remotely to patients. For surgical patients, telemedicine can improve patient education and remote monitoring of postoperative symptoms. We performed a systematic review of studies involving the use of short message service (SMS) and mobile application-based interventions in surgical patients to evaluate the advantages and disadvantages of each system, as well as of mobile interventions as a whole...
November 7, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29098917/sleep-pattern-and-decision-making-in-physicians-from-mobile-emergency-care-service-with-12-hour-work-schedules
#8
Eleni de Araújo Sales Castro, Katie Moraes de Almondes
INTRODUCTION: Shift work schedules are biological standpoint worse because compel the body to anticipate periods of wakefulness and sleep and thus eventually cause a disruption of biological rhythms. OBJECTIVE: To evaluate the sleep pattern and decision making in physicians working in mobile units of emergency attention undergoing Day Shift and Rotating Shift. METHODS: The study included 26 physicians. The instruments utilized were a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire of Horne-Ostberg, the Iowa Gambling Task (IGT) and hypothetical scenarios of decision-making created according to the Policy-Capturing Technique...
November 3, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/29094914/testosterone-therapy-review-of-clinical-applications
#9
Ryan C Petering, Nathan A Brooks
Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone. Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia. Depressed mood, fatigue, decreased strength, and a decreased sense of vitality are less specific to male hypogonadism...
October 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/29089061/violence-against-physicians-and-nurses-in-a-hospital-how-does-it-happen-a-mixed-methods-study
#10
Sigal Shafran-Tikva, David Chinitz, Zvi Stern, Paula Feder-Bubis
BACKGROUND: Violence against medical personnel is unexpected in hospitals which are devoted to healing, and yet, it is frequent and of concern in the health system. Little is known about the factors that lead to hospital violence, and even less is known about the interactions among these factors. The aim of the study was to identify and describe the perceptions of staff and patients regarding the factors that lead to violence on the part of patients and those accompanying them. METHODS: A mixed-methods study in a large, general, university tertiary hospital...
October 31, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29070999/treatment-of-leptomeningeal-metastases-in-a-patient-with-non-small-cell-lung-cancer-harboring-egfr-t790m-mutation
#11
Hardy Niu, Junle Zhou, Harvinder Maan, Maurie Markman, Jiaxin Niu
BACKGROUND: Leptomeningeal metastasis (LM) is an uncommon complication in patients with solid tumors, associated with poor survival. However, LM appears to be more frequent in lung cancer patients with EGFR mutations, posing a unique clinical challenge to treating physicians. CASE PRESENTATION: We report the case of a 68-year-old Asian man with metastatic lung adenocarcinoma harboring an EGFR L858R mutation, which was initially treated with gefitinib. He developed disease progression 1 year later...
September 2017: Case Reports in Oncology
https://www.readbyqxmd.com/read/29070277/an-ergonomic-assessment-of-operating-table-and-surgical-stool-heights-for-seated-otolaryngology-procedures
#12
Anam F Azimuddin, Erik K Weitzel, Kevin C McMains, Philip G Chen
BACKGROUND: Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated otolaryngologic procedures. Key elements of an ergonomic operating environment include the height of operating tables and surgical chairs. Surgeons benefit from proper support and positioning to prevent musculoskeletal injuries and reduce occupational risk. OBJECTIVE: The purpose of this study was to evaluate operating table and surgical seat heights, and determine whether adjustments can be made for various surgeon physiques...
October 1, 2017: Allergy & Rhinology
https://www.readbyqxmd.com/read/29066187/a-case-of-primary-adrenal-failure-in-the-emergency-department
#13
Al Giwa
BACKGROUND: Primary adrenal failure is considered to be an extremely rare disease presenting in the ED, with an incidence reported to be as low as 50 cases per 1,000,000 persons (Klauer, 2017). I would like to present a case of a young man who presented to the ED, with what I suspected to be this rare entity. CASE REPORT: A 26year old otherwise healthy male presented to our ED with complaints of weakness, nausea, vomiting, and hiccups of 1.5-day duration. He also complained of lightheadedness, describing it as if he was going to pass out...
October 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29055898/night-time-communication-at-stanford-university-hospital-perceptions-reality-and-solutions
#14
Andrew Jordan Sun, Libo Wang, Minjoung Go, Zac Eggers, Raymond Deng, Paul Maggio, Lisa Shieh
BACKGROUND: Resident work hour restrictions have led to the creation of the 'night float' to care for the patients of multiple primary teams after hours. These residents are often inundated with acute issues in the numerous patients they cover and are less able to address non-urgent issues that arise at night. Further, non-urgent pages may contribute to physician alarm fatigue and negatively impact patient outcomes. OBJECTIVE: To delineate the burden of non-urgent paging at night and propose solutions...
October 21, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29049076/fatigue-risk-management-the-impact-of-anesthesiology-residents-work-schedules-on-job-performance-and-a-review-of-potential-countermeasures
#15
Lily R Wong, Erin Flynn-Evans, Keith J Ruskin
Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29029694/prescriber-response-to-computerized-drug-alerts-for-electronic-prescriptions-among-hospitalized-patients
#16
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/29026330/parecoxib-relieves-pain-and-has-an-opioid-sparing-effect-following-major-gastrointestinal-surgery
#17
Margaret Noyes Essex, Hao Xu, Bruce Parsons, Li Xie, Chunming Li
PURPOSE: Parecoxib provides analgesia following a variety of surgeries, including minor gastrointestinal procedures. To our knowledge, there is no data on parecoxib following major gastrointestinal surgery. This study assessed the efficacy and opioid-sparing effects of parecoxib following major gastrointestinal surgeries. PATIENTS AND METHODS: Patients in this analysis were a subset from a large, randomized, double-blind, placebo-controlled trial of parecoxib following noncardiac surgeries and consisted of those undergoing a variety of major gastrointestinal surgeries via laparotomy...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/29021947/health-symptoms-in-residents-living-near-shale-gas-activity-a-retrospective-record-review-from-the-environmental-health-project
#18
Beth Weinberger, Lydia H Greiner, Leslie Walleigh, David Brown
Increasing evidence demonstrates an association between health symptoms and exposure to unconventional natural gas development (UNGD). The purpose of this study is to describe the health of adults in communities with intense UNGD who presented for evaluation of symptoms. Records of 135 structured health assessments conducted between February 2012 and October 2015 were reviewed retrospectively. Publicly available data were used to determine proximity to gas wells. Analysis was restricted to records of adults who lived within 1 km of a well in Pennsylvania and denied employment in the gas industry (n = 51)...
December 2017: Preventive Medicine Reports
https://www.readbyqxmd.com/read/29021568/the-brain-and-immune-system-prompt-energy-shortage-in-chronic-inflammation-and-ageing
#19
REVIEW
Rainer H Straub
Sequelae frequently seen in patients with chronic inflammatory diseases, such as fatigue, depressed mood, sleep alterations, loss of appetite, muscle wasting, cachectic obesity, bone loss and hypertension, can be the result of energy shortages caused by an overactive immune system. These sequelae can also be found in patients with chronic inflammatory diseases that are in remission and in ageing individuals, despite the immune system being less active in these situations. This Perspectives article proposes a new way of understanding situations of chronic inflammation (such as rheumatic diseases) and ageing based on the principles of evolutionary medicine, energy regulation and neuroendocrine-immune crosstalk...
October 12, 2017: Nature Reviews. Rheumatology
https://www.readbyqxmd.com/read/29021431/a-case-of-tocilizumab-resistant-tafro-syndrome-complicated-by-type-ii-respiratory-failure
#20
Tatsuya Aoki, Mikio Wada, Atsushi Kawashima, Kouichi Hirakawa, Akihiro Nagata, Keizo Kagawa
A 66-year-old man with a several year history of thrombocytopenia, pleural effusion and ascites, anasarca, and organomegaly presented with general fatigue, appetite loss, dyspnea with type II respiratory failure. The precise history of the patient and the re-evaluation of lymph node and bone marrow biopsies conducted by the previous physician indicated TAFRO syndrome. The patient's laboratory data improved for a year with tocilizumab, but then worsened to the point that the patient required artificial ventilation due to the deterioration of type II respiratory failure...
October 11, 2017: Internal Medicine
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