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https://www.readbyqxmd.com/read/27933732/hypothesis-driven-physical-examination-curriculum
#1
Sharon Allen, Andrew Olson, Jeremiah Menk, James Nixon
BACKGROUND: Medical students traditionally learn physical examination skills as a rote list of manoeuvres. Alternatives like hypothesis-driven physical examination (HDPE) may promote students' understanding of the contribution of physical examination to diagnostic reasoning. We sought to determine whether first-year medical students can effectively learn to perform a physical examination using an HDPE approach, and then tailor the examination to specific clinical scenarios. Medical students traditionally learn physical examination skills as a rote list of manoeuvres CONTEXT: First-year medical students at the University of Minnesota were taught both traditional and HDPE approaches during a required 17-week clinical skills course in their first semester...
December 9, 2016: Clinical Teacher
https://www.readbyqxmd.com/read/27932533/preoperative-proteinuria-and-reduced-glomerular-filtration-rate-predicts-renal-replacement-therapy-in-patients-supported-with-continuous-flow-left-ventricular-assist-devices
#2
Veli K Topkara, Ellie J Coromilas, Arthur Reshad Garan, Randall C Li, Francesco Castagna, Douglas L Jennings, Melana Yuzefpolskaya, Koji Takeda, Hiroo Takayama, Robert N Sladen, Donna M Mancini, Yoshifumi Naka, Jai Radhakrishnan, Paolo C Colombo
BACKGROUND: Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. METHODS AND RESULTS: Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015...
December 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/27932337/development-of-a-critical-appraisal-tool-to-assess-the-quality-of-cross-sectional-studies-axis
#3
Martin J Downes, Marnie L Brennan, Hywel C Williams, Rachel S Dean
OBJECTIVES: The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. DESIGN: An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs...
December 8, 2016: BMJ Open
https://www.readbyqxmd.com/read/27931238/elaboration-of-a-nomogram-to-predict-nonsentinel-node-status-in-breast-cancer-patients-with-positive-sentinel-node-intraoperatively-assessed-with-one-step-nucleic-amplification-retrospective-and-validation-phase
#4
Franco Di Filippo, Simona Di Filippo, Anna Maria Ferrari, Raffaele Antonetti, Alessandro Battaglia, Francesca Becherini, Laia Bernet, Renzo Boldorini, Catherine Bouteille, Simonetta Buglioni, Paolo Burelli, Rafael Cano, Vincenzo Canzonieri, Pierluigi Chiodera, Alfredo Cirilli, Luigi Coppola, Stefano Drago, Luca Di Tommaso, Privato Fenaroli, Roberto Franchini, Andrea Gianatti, Diana Giannarelli, Carmela Giardina, Florence Godey, Massimo M Grassi, Giuseppe B Grassi, Siobhan Laws, Samuele Massarut, Giuseppe Naccarato, Maria Iole Natalicchio, Sergio Orefice, Fabrizio Palmieri, Tiziana Perin, Manuela Roncella, Massimo G Roncalli, Antonio Rulli, Angelo Sidoni, Corrado Tinterri, Maria C Truglia, Isabella Sperduti
BACKGROUND: Tumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND)...
December 8, 2016: Journal of Experimental & Clinical Cancer Research: CR
https://www.readbyqxmd.com/read/27930597/how-do-readers-choose-to-undergo-treatments-based-on-medical-articles
#5
Ye-Seul Lee, Jeongjoo Kim, Seongsu Joo, Byeongho Go, Hyangsook Lee, Younbyoung Chae
The purpose of this study is to study the reader's cognitive process in reading medical articles and its influence on the decision-making process. Twenty-four participants completed a survey pertaining to 36 medical articles on new treatments with similar text structures and similar titles. Participants rated each article on its level of interest, informativeness, and reliability, and were asked whether they would choose the treatments in the news article. A cognitive decision-making model can be applied to health contexts, in which the reader's subjective ratings on interest, informativeness, and reliability were positively associated with choosing new treatments...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27930542/the-incidence-and-risk-factors-of-postoperative-neurological-deterioration-after-posterior-decompression-with-or-without-instrumented-fusion-for-thoracic-myelopathy
#6
Hui Wang, Lei Ma, Rui Xue, Dalong Yang, Tao Wang, Yanhong Wang, Sidong Yang, Wenyuan Ding
The aim of this study was to explore the incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy, and hope to provide references in decision-making and surgical planning for both spinal surgeon and thoracic stenosis patients.By retrieving the medical records from January 2001 to November 2015, 168 patients were retrospectively reviewed. According to the occurrence of postoperative neurological deterioration, patients were divided into 2 groups: neurological deterioration (ND) group and non-ND group...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27929212/top-poems-of-2015-consistent-with-the-principles-of-the-choosing-wisely-campaign
#7
Roland Grad, Mark H Ebell
The authors applied a novel method to identify recent clinical studies that showed results consistent with the principles of the Choosing Wisely campaign. The method, based on crowdsourcing studies known as POEMs (patientoriented evidence that matters), involved analyzing POEM ratings submitted by physician members of the Canadian Medical Association in the context of their continuing medical education. In the 251 unique POEMs delivered to these physicians in 2015, an average of 1,284 physician ratings were received per POEM...
October 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27928250/correlates-of-process-of-suicide-attempt-and-perception-of-its-prevention
#8
Dushad Ram, Darshan Mahegowda, Basavana Gowdappa H
Objective: Suicide attempt may follow a process right from the inception of the first information about ‎suicide until the act itself. This study was conducted to determine the relationship between ‎perception of suicide prevention with the process of suicide attempt and demographic ‎variables following a suicidal attempt.‎ Method: In this hospital based cross-sectional study, 168 consecutive admitted participants with a ‎suicide attempt were screened, and 109 who met the study criteria were recruited to ‎participate in this study before discharge...
July 2016: Iranian Journal of Psychiatry
https://www.readbyqxmd.com/read/27927728/preventability-of-hospital-readmissions-from-skilled-nursing-facilities-a-consumer-perspective
#9
J Mary Lou Jacobsen, John F Schnelle, Avantika A Saraf, Emily A Long, Eduard E Vasilevskis, Sunil Kripalani, Sandra F Simmons
PURPOSE OF THE STUDY: A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission. DESIGN AND METHODS: Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge...
December 7, 2016: Gerontologist
https://www.readbyqxmd.com/read/27927491/age-at-initiation-and-deformity-magnitude-influence-complication-rates-of-surgical-treatment-with-traditional-growing-rods-in-early-onset-scoliosis
#10
Vidyadhar V Upasani, Kevin C Parvaresh, Jeff B Pawelek, Patricia E Miller, George H Thompson, David L Skaggs, John B Emans, Michael P Glotzbecker
STUDY DESIGN: Multi-center retrospective review. OBJECTIVE: The purpose of this study was to identify preoperative variables associated with postoperative complications in early-onset scoliosis (EOS) patients treated with traditional growing rods (TGR); and to develop a model to predict the incidence of postoperative complications based on preoperative variables. SUMMARY OF BACKGROUND DATA: TGRs are commonly used to treat progressive EOS. Prior research has demonstrated a high rate of postoperative complications using this technique; however, few studies have identified preoperative factors that contribute to such complications...
September 2016: Spine Deformity
https://www.readbyqxmd.com/read/27927262/first-successful-pre-distribution-of-stable-iodine-tablets-under-japan-s-new-policy-after-the-fukushima-daiichi-nuclear-accident
#11
Mayo Ojino, Sumito Yoshida, Takashi Nagata, Masami Ishii, Makoto Akashi
Stable iodine tablets are effective in reducing internal exposure to radioactive iodine, which poses a risk for thyroid cancer and other conditions. After the Fukushima Daiichi nuclear power plant accident, the Japanese government shifted its policy on stable iodine tablet distribution from "after-the-fact" to "before-the-fact" and instructed local governments to pre-distribute stable iodine tablets to residents living within a 5-km radius of nuclear facilities. The nation's first pre-distribution of stable iodine tablets was carried out in June and July of 2014 in Kagoshima Prefecture...
December 8, 2016: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/27926681/influence-of-immediate-and-delayed-lower-limb-amputation-compared-with-lower-limb-salvage-on-functional-and-mental-health-outcomes-post-rehabilitation-in-the-u-k-military
#12
Peter Ladlow, Rhodri Phillip, Russell Coppack, John Etherington, James Bilzon, M Polly McGuigan, Alexander N Bennett
BACKGROUND: Medical practitioners face difficult decisions over whether to amputate or to salvage a lower limb that has undergone trauma. To our knowledge, there has been little evidence reporting the impact of different surgical decisions on functional and mental health outcomes following intensive rehabilitation that might inform decision-making. METHODS: This study is a retrospective, independent-group comparison of rehabilitation outcomes from a U.K. military complex trauma rehabilitation center...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926449/the-role-of-dopamine-in-the-pathophysiology-and-treatment-of-apathy
#13
T T-J Chong, M Husain
Disorders of diminished motivation, such as apathy, are common and prevalent across a wide range of medical conditions, including Parkinson's disease, Alzheimer's dementia, stroke, depression, and schizophrenia. Such disorders have a significant impact on morbidity and quality of life, yet their management lacks consensus and remains unsatisfactory. Here, we review laboratory and clinical evidence for the use of dopaminergic therapies in the treatment of apathy. Dopamine is a key neurotransmitter that regulates motivated decision making in humans and other species...
2016: Progress in Brain Research
https://www.readbyqxmd.com/read/27925381/doctors-use-of-mobile-devices-in-the-clinical-setting-a-mixed-methods-study
#14
Arany Nerminathan, Amanda Harrison, Megan Phelps, Karen M Scott
AIM: To explore how doctors use mobile devices in the clinical setting and understand drivers for use. METHODS: A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors' reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others' use. RESULTS: The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting...
December 7, 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27922750/pre-implementation-guidelines-for-infectious-disease-point-of-care-testing-in-medical-institutions
#15
Annemiek A van der Eijk, Andrei N Tintu, John P Hays
Infectious disease point-of-care test (ID-POCT) devices are becoming widely available, and in this respect, international quality standards and guidelines are available for consultation once ID-POCT has been implemented into medical institutions. However, specific guidelines for consultation during the initial pre-implementation decision-making process are currently lacking. Further, there exist pre-implementation issues specific to ID-POCT. Here we present pre-implementation guidelines for consultation when considering the implementation of ID-POCT in medical institutions...
December 6, 2016: Future Microbiology
https://www.readbyqxmd.com/read/27921276/relationship-between-physician-adjudicated-adverse-events-and-patient-reported-health-related-quality-of-life-in-a-phase-ii-clinical-trial-nct01143402-of-patients-with-metastatic-uveal-melanoma
#16
Thomas M Atkinson, Jennifer L Hay, Alexander Shoushtari, Yuelin Li, Daniel J Paucar, Sloane C Smith, Ragini R Kudchadkar, Austin Doyle, Jeffrey A Sosman, Jorge Fernando Quevedo, Mohammed M Milhem, Anthony M Joshua, Gerald P Linette, Thomas F Gajewski, Jose Lutzky, David H Lawson, Christopher D Lao, Patrick J Flynn, Mark R Albertini, Takami Sato, Karl Lewis, Brian Marr, David H Abramson, Mark Andrew Dickson, Gary K Schwartz, Richard D Carvajal
PURPOSE: Clinical trials commonly use physician-adjudicated adverse event (AE) assessment via the common terminology criteria for adverse events (CTCAE) for decision-making. Patient-reported health-related quality of life (HRQoL) data are becoming more frequent in oncology; however, the relationship between physician-adjudicated AE assessment and HRQoL is understudied. METHODS: Data from a phase II trial (clinicaltrials.gov identifier: NCT01143402) where patients with metastatic uveal melanoma were randomized to receive selumetinib, an oral MEK inhibitor, or chemotherapy were analyzed...
December 5, 2016: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/27920623/factors-influencing-decision-making-for-or-against-adjuvant-and-neoadjuvant-chemotherapy-in-postmenopausal-hormone-receptor-positive-breast-cancer-patients-in-the-evaluate-tm-study
#17
Paul Gaß, Peter A Fasching, Tanja Fehm, Johann de Waal, Mahdi Rezai, Bernd Baier, Gerold Baake, Hans-Christian Kolberg, Martin Guggenberger, Mathias Warm, Nadia Harbeck, Rachel Wuerstlein, Jörg-Uwe Deuker, Peter Dall, Barbara Richter, Grischa Wachsmann, Cosima Brucker, Jan W Siebers, Nikos Fersis, Thomas Kuhn, Christopher Wolf, Hans-Walter Vollert, Georg-Peter Breitbach, Wolfgang Janni, Robert Landthaler, Andreas Kohls, Daniela Rezek, Thomas Noesselt, Gunnar Fischer, Stephan Henschen, Thomas Praetz, Volker Heyl, Thorsten Kühn, Thomas Krauss, Christoph Thomssen, Andre Hohn, Hans Tesch, Christoph Mundhenke, Alexander Hein, Claudia Rauh, Christian M Bayer, Adib Jacob, Katja Schmidt, Erik Belleville, Peyman Hadji, Sara Y Brucker, Matthias W Beckmann, Diethelm Wallwiener, Sherko Kümmel, Christian R Löhberg
BACKGROUND: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. METHODS: Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited...
October 2016: Breast Care
https://www.readbyqxmd.com/read/27919451/gastrostomy-tube-placement-an-opportunity-for-establishing-patient-centered-goals-of-care
#18
Christopher M McGreevy, Sri Ram Pentakota, Omar Mohamed, Kevin Sigler, Anne C Mosenthal, Ana Berlin
BACKGROUND: Surgeons and other health care providers are frequently consulted for gastrostomy tube placement in seriously ill patients at risk of outcomes poorly aligned with patient goals. Palliative care assessments have been recommended to guide decision-making in this setting. We aimed to characterize patient-centered outcomes and define the extent of unmet palliative care need in patients receiving gastrostomy tubes. METHODS: This is a retrospective study of all adult, nontrauma inpatients who underwent gastrostomy tube placement over 16 months at an urban academic medical center...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27919368/clinical-reasoning-in-the-context-of-active-decision-support-during-medication-prescribing
#19
Jan Horsky, Jos Aarts, Leonie Verheul, Diane L Seger, Heleen van der Sijs, David W Bates
OBJECTIVE: Describe and analyze reasoning patterns of clinicians responding to drug-drug interaction alerts in order to understand the role of patient-specific information in the decision-making process about the risks and benefits of medication therapy. Insights could be used to inform the design of decision-support interventions. METHODS: Thirty-two clinicians working with five EHRs in two countries completed sets of six medication orders each and responded to high- and low-severity drug-drug interaction alerts while verbalizing their thoughts in a standard think-aloud protocol...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27918336/resident-physicians-improve-nontechnical-skills-when-on-operating-room-management-and-leadership-rotation
#20
Devon C Cole, Christopher R Giordano, Terrie Vasilopoulos, Brenda G Fahy
BACKGROUND: Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making. METHODS: The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015...
December 1, 2016: Anesthesia and Analgesia
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