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Clinical decision-making

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https://www.readbyqxmd.com/read/28645202/effects-of-mobility-and-multimorbidity-on-inpatient-and-post-acute-health-care-utilization
#1
Kristine E Ensrud, Li-Yung Lui, Lisa Langsetmo, Tien N Vo, Brent C Taylor, Peggy M Cawthon, Meredith L Kilgore, Charles E McCulloch, Jane A Cauley, Marcia L Stefanick, Kristine Yaffe, Eric S Orwoll, John T Schousboe
Background: This study examines effects of mobility and multimorbidity on hospitalization and inpatient and post-acute care (PAC) facility days among older men. Methods: Prospective study of 1701 men (mean age 79.3 years) participating in MrOS Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high...
June 22, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28644835/physician-assessments-of-drug-seeking-behavior-a-mixed-methods-study
#2
Michael A Fischer, John B McKinlay, Jeffrey N Katz, Eric Gerstenberger, Felicia Trachtenberg, Lisa D Marceau, Lisa C Welch
BACKGROUND: Pain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as "drug-seeking," or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions. METHODS AND FINDINGS: Mixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain...
2017: PloS One
https://www.readbyqxmd.com/read/28644738/national-survey-and-analysis-of-barriers-to-the-utilisation-of-the-2005-mental-capacity-act-by-people-with-bipolar-disorder-in-england-and-wales
#3
Richard Morriss, Mohan Mudigonda, Peter Bartlett, Arun Chopra, Steven Jones
BACKGROUND: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression. AIMS: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. METHODS: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA...
June 23, 2017: Journal of Mental Health
https://www.readbyqxmd.com/read/28644081/effects-of-added-lipids-on-digestibility-and-nitrogen-balance-in-oiled-common-murres-uria-aalge-and-western-grebes-aechmophorus-occidentalis-fed-four-formulations-of-a-critical-care-diet
#4
Rebecca S Duerr, Kirk C Klasing
Nutritional support is a primary therapy administered to oiled animals during responses to oil spills, but data informing nutritional decision-making during events are limited. In this study, 44 common murres ( Uria aalge ) and 6 Western grebes ( Aechmophorus occidentalis ), naturally oiled by oceanic seeps off the coast of Ventura and Santa Barbara Counties, CA, USA, were assigned to 1 of 4 groups fed diets with varying levels (6.8% [no added oil], 11%, and 20%) and types (salmon, corn) of oil added to a partially purified basal diet...
June 2017: Journal of Avian Medicine and Surgery
https://www.readbyqxmd.com/read/28643416/influence-of-academic-training-in-endodontics-and-implantology-on-decision-making-in-undergraduate-students
#5
Kenneth Pineda, Rufino Bueno, Carlos Alvarado, Francesc Abella, Miguel Roig, Fernando Duran-Sindreu
PURPOSE: To evaluate the effect of academic training on decision-making in a group of undergraduates who have undergone training in endodontics and implantology. BASIC PROCEDURES: A single group of undergraduate dentistry students (n = 65) was given a survey consisting of 15 endodontic cases. Each case included periapical radiographs and clinical photographs. Students were asked to select one of the eight proposed treatments. In their 4th year, the students first responded to the survey after completing endodontics...
June 23, 2017: Australian Endodontic Journal: the Journal of the Australian Society of Endodontology Inc
https://www.readbyqxmd.com/read/28643018/heterogeneity-of-gata2-related-myeloid-neoplasms
#6
REVIEW
Shinsuke Hirabayashi, Marcin W Wlodarski, Emilia Kozyra, Charlotte M Niemeyer
The GATA2 gene codes for a master hematopoietic transcription factor that is essential for the proliferation and maintenance of hematopoietic stem and progenitor cells. Heterozygous germline mutations in GATA2 have been initially associated with several clinical entities that are now collectively defined as GATA2 deficiency. Despite pleiotropic clinical manifestations, the high propensity for the development of myelodysplastic syndromes (MDS) constitutes the most common clinical denominator of this major MDS predisposition syndrome...
June 22, 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/28642960/comment-on-teaching-metacognition-in-clinical-decision-making-using-a-novel-mnemonic-checklist-an-exploratory-study
#7
William Kelly
No abstract text is available yet for this article.
June 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28642353/when-sanctity-of-life-and-self-determination-clash-briggs-versus-briggs-2016-ewcop-53-implications-for-policy-and-practice
#8
Jenny Kitzinger, Celia Kitzinger, Jakki Cowley
In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices...
June 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28641753/cardiac-dysfunction-in-congenital-diaphragmatic-hernia-pathophysiology-clinical-assessment-and-management
#9
Neil Patel, Florian Kipfmueller
Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery...
June 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28641576/euthanasia-for-people-with-psychiatric-disorders-or-dementia-in-belgium-analysis-of-officially-reported-cases
#10
Sigrid Dierickx, Luc Deliens, Joachim Cohen, Kenneth Chambaere
BACKGROUND: Euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases...
June 23, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28641094/emerging-concepts-in-cytomegalovirus-infection-following-hematopoietic-stem-cell-transplantation
#11
REVIEW
Jose F Camargo, Krishna V Komanduri
Despite the refinements in molecular methods for the detection of cytomegalovirus (CMV) and the advent of highly effective preemptive strategies, CMV remains a leading cause of morbidity and mortality in hematopoietic cell transplant (HCT) recipients. CMV can cause tissue-invasive disease including pneumonia, hepatitis, colitis, retinitis, and encephalitis. Mortality in HCT recipients with CMV disease can be as high as 60%. CMV infection has been associated with increased risk of secondary bacterial and fungal infections, increased risk of graft-versus-host disease, and high rates of nonrelapse mortality following HCT...
June 14, 2017: Hematology/oncology and Stem Cell Therapy
https://www.readbyqxmd.com/read/28640869/development-of-an-automated-size-based-filtration-system-for-isolation-of-circulating-tumor-cells-in-lung-cancer-patients
#12
Satomi Yagi, Yasuhiro Koh, Hiroaki Akamatsu, Kuninobu Kanai, Atsushi Hayata, Nahomi Tokudome, Keiichiro Akamatsu, Katsuya Endo, Seita Nakamura, Masayuki Higuchi, Hisashige Kanbara, Masanori Nakanishi, Hiroki Ueda, Nobuyuki Yamamoto
Circulating tumor cells (CTCs), defined as tumor cells circulating in the peripheral blood of patients with solid tumors, are relatively rare. Diagnosis using CTCs is expected to help in the decision-making for precision cancer medicine. We have developed an automated microcavity array (MCA) system to detect CTCs based on the differences in size and deformability between tumor cells and normal blood cells. Herein, we evaluated the system using blood samples from non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) patients...
2017: PloS One
https://www.readbyqxmd.com/read/28640720/fungating-wounds-management-and-treatment-options
#13
Suzanne Tandler, Jackie Stephen-Haynes
This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised...
June 22, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28640510/paediatric-intensive-care-nurses-decision-making-around-gastric-residual-volume-measurement
#14
Lyvonne N Tume, Lynne Latten, Lindsay Kenworthy
BACKGROUND: Measuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children. AIMS: We aimed to explore paediatric intensive care nurses' decision-making surrounding this practice. METHODS: This is a cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK...
June 22, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/28640142/the-derivation-and-validation-of-a-simple-model-for-predicting-in-hospital-mortality-of-acutely-admitted-patients-to-internal-medicine-wards
#15
Ali Sakhnini, Walid Saliba, Naama Schwartz, Naiel Bisharat
Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28639707/dressings-and-topical-agents-for-treating-pressure-ulcers
#16
REVIEW
Maggie J Westby, Jo C Dumville, Marta O Soares, Nikki Stubbs, Gill Norman
BACKGROUND: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers...
June 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28639478/relation-between-capacity-and-performance-in-paediatric-upper-limb-prosthesis-users
#17
Helen Lindner, Ayako Hiyoshi, Liselotte Hermansson
BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment...
June 1, 2017: Prosthetics and Orthotics International
https://www.readbyqxmd.com/read/28639296/pathways-to-professionalism-quality-improvement-care-pathways-and-the-interplay-of-standardisation-and-clinical-autonomy
#18
Graham P Martin, David Kocman, Timothy Stephens, Carol J Peden, Rupert M Pearse
Care pathways are a prominent feature of efforts to improve healthcare quality, outcomes and accountability, but sociological studies of pathways often find professional resistance to standardisation. This qualitative study examined the adoption and adaptation of a novel pathway as part of a randomised controlled trial in an unusually complex, non-linear field - emergency general surgery - by teams of surgeons and physicians in six theoretically sampled sites in the UK. We find near-universal receptivity to the concept of a pathway as a means of improving peri-operative processes and outcomes, but concern about the impact on appropriate professional judgement...
June 21, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28639060/surgical-options-in-benign-parotid-tumors-a-proposal-for-classification
#19
REVIEW
Miquel Quer, Vincent Vander Poorten, Robert P Takes, Carl E Silver, Carsten C Boedeker, Remco de Bree, Alessandra Rinaldo, Alvaro Sanabria, Ashok R Shaha, Albert Pujol, Peter Zbären, Alfio Ferlito
Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options...
June 21, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28638988/same-day-genomic-and-epigenomic-diagnosis-of-brain-tumors-using-real-time-nanopore-sequencing
#20
Philipp Euskirchen, Franck Bielle, Karim Labreche, Wigard P Kloosterman, Shai Rosenberg, Mailys Daniau, Charlotte Schmitt, Julien Masliah-Planchon, Franck Bourdeaut, Caroline Dehais, Yannick Marie, Jean-Yves Delattre, Ahmed Idbaih
Molecular classification of cancer has entered clinical routine to inform diagnosis, prognosis, and treatment decisions. At the same time, new tumor entities have been identified that cannot be defined histologically. For central nervous system tumors, the current World Health Organization classification explicitly demands molecular testing, e.g., for 1p/19q-codeletion or IDH mutations, to make an integrated histomolecular diagnosis. However, a plethora of sophisticated technologies is currently needed to assess different genomic and epigenomic alterations and turnaround times are in the range of weeks, which makes standardized and widespread implementation difficult and hinders timely decision making...
June 21, 2017: Acta Neuropathologica
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