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Physician judgement

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https://www.readbyqxmd.com/read/27920229/octreotide-use-in-post-cardiac-surgery-chylothorax-a-12-year-perspective
#1
Abdulrazaq Sheikh Aljazairi, Tauhid Ahmed Bhuiyan, Abdullah Hasan Alwadai, Rayd Abdulaziz Almehizia
BACKGROUND: Chylothorax following cardiothoracic surgery is a rare condition in pediatric patients with significant morbidity and mortality. Pharmacological management with octreotide suggests possible efficacy; however, current evidence is inadequate. The objective of this study was to assess the safety and efficacy of octreotide as a therapeutic option in this clinical setting. METHODS: This was a 12-year single-center retrospective cohort study of all patients (birth to 18-years old) who received octreotide for management of post-cardiac surgery chylothorax between January 2003 to August 2015...
December 5, 2016: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27878797/choosing-wisely-at-the-end-of-life-the-crucial-role-of-medical-indication
#2
Gian Domenico Borasio, Ralf J Jox
At the end of life, several treatments are administered routinely that lack medical indication and may cause significant harm to patients. Examples include artificial hydration and oxygen therapy in the dying phase, as well as enteral nutrition in advanced dementia. Medical indication is defined as the appropriateness of a therapeutic or diagnostic measure in the patient's concrete clinical situation, in light of the best available evidence. The decision about the absence or presence of a medical indication is a core competence of physicians...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27789117/acute-ataxia-in-children-a-review-of-the-differential-diagnosis-and-evaluation-in-the-emergency-department
#3
REVIEW
Mauro Caffarelli, Amir A Kimia, Alcy R Torres
Acute ataxia in a pediatric patient poses a diagnostic dilemma for any physician. While the most common etiologies are benign, occasional individuals require urgent intervention. Children with stroke, toxic ingestion, infection, and neuro-inflammatory disorders frequently exhibit ataxia as an essential-if not the only-presenting feature. The available retrospective research utilize inconsistent definitions of acute ataxia, precluding the ability to pool data from these studies. No prospective data exist that report on patients presenting to the emergency department with ataxia...
December 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/27780804/how-i-treat-anticoagulation-in-atrial-fibrillation
#4
Benjamin A Steinberg
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and conveys a significant risk of morbidity and mortality due to related stroke and systemic embolism. Oral anticoagulation (OAC) is the mainstay of thromboembolism prevention and management of anticoagulation can be challenging. For patients without significant valvular disease, decisions around anticoagulation therapy are first based on the presence of additional stroke risk factors, as measured by the CHA2DS2-VASc score. Patients with increased CHA2DS2-VASc scores (by regional guidelines) should next be evaluated to determine if they are candidates for non-vitamin K antagonist oral anticoagulant (NOAC) therapy...
October 25, 2016: Blood
https://www.readbyqxmd.com/read/27762022/game-theory-and-strategy-in-medical-training
#5
Amy Blake, Bryan T Carroll
OBJECTIVE: This paper analyses how game theory can provide a framework for understanding the strategic decision-making that occurs in everyday scenarios in medical training and practice, and ultimately serves as a tool for improving the work environment and patient care. Game theory has been applied to a variety of fields outside of its native economics, but has not been thoroughly studied in the context of health care provision. METHODS: The paper discusses four of the most common 'games' and applies each to a scenario in medicine to provide new insight on the incentives and drivers for certain types of behaviour and a deeper understanding of why certain results are valued more strongly than others...
November 2016: Medical Education
https://www.readbyqxmd.com/read/27749215/burden-of-illness-associated-with-non-radiographic-axial-spondyloarthritis-a-multiperspective-european-cross-sectional-observational-study
#6
Joachim Sieper, Tim Holbrook, Christopher M Black, Robert Wood, Xiaohan Hu, Sumesh Kachroo
OBJECTIVES: To assess the impact of non-radiographic axial spondyloarthritis (nr-axSpA) on patients and society based on real-world evidence from the Adelphi nr-axSpA Disease Specific Programme, a cross-sectional survey of rheumatologists and their patients in Germany, France, Spain, Italy and the UK. METHODS: Physicians completed patient record forms for the next two patients consulting with nr-axSpA (diagnosis at the physician's judgement); patients were invited to complete a patient self-completion form...
August 31, 2016: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/27692838/pulmonary-contusion-and-traumatic-pneumatoceles-in-a-platform-diver-with-hemoptysis
#7
Joanna Shi-En Chan, Jeremy C Wee, R Ponampalam, Evelyn Wong
BACKGROUND: Injuries in divers resulting purely from impact with the water are uncommon in the published literature. We present a case report of pulmonary contusion in a young diver. CASE REPORT: A young, healthy competitive platform diver landed flat on his back in the water from a dive of 10 meters. He complained of upper back pain and had an episode of hemoptysis after the dive. He was initially observed for 15 hours postinjury, and was discharged when three chest radiographs (CXRs) taken at 1, 7, and 11 hours postinjury did not show significant abnormalities...
September 28, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27687503/candida-vulvovaginitis-a-store-with-a-buttery-and-a-show-window
#8
Gilbert G G Donders, Jack D Sobel
Although being an utterly frequent, non-mortal, yet distressing disease, and despite good knowledge of the pathogenesis and the availability of specific and safe treatment, vulvovaginal Candida (VVC) infection remains one of the most enigmatic problems for both physicians and patients. Good treatment requires a proper diagnosis. Too many caregivers (and patients treating themselves) react too simple-minded on the symptoms of VVC and treat VVC where they see it on the vulva. In this opinion paper, we plea for a thorough examination of women with VVC, especially in those women who suffer from recurrent disease since a long time, sometimes decades, which necessitates intensive examination of the vaginal flora, as this is invariably the reservoir for relapses and recurrent vulvitis...
September 30, 2016: Mycoses
https://www.readbyqxmd.com/read/27633637/establishing-cross-discipline-consensus-on-contraception-pregnancy-and-breast-feeding-related-educational-messages-and-clinical-practices-to-support-women-with-rheumatoid-arthritis-an-australian-delphi-study
#9
Andrew M Briggs, Joanne E Jordan, Ilana N Ackerman, Sharon Van Doornum
OBJECTIVE: Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas. DESIGN: 3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas...
September 15, 2016: BMJ Open
https://www.readbyqxmd.com/read/27623758/ankle-brachial-index-for-the-diagnosis-of-lower-limb-peripheral-arterial-disease
#10
Fay Crawford, Karen Welch, Alina Andras, Francesca M Chappell
BACKGROUND: Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD...
September 14, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27613167/the-wide-experience-of-the-sequential-therapy-for-patients-with-metastatic-renal-cell-carcinoma
#11
REVIEW
Julio Lambea, Urbano Anido, Olatz Etxániz, Luis Flores, Álvaro Montesa, Juan Manuel Sepúlveda, Emilio Esteban
Sequential targeted therapies are the standard of care for patients with metastatic renal cell carcinoma (mRCC). Several drugs are available for patients whose disease progresses while they receive initial tyrosine kinase inhibitor (TKI) therapy; these include nivolumab (an inhibitor of PD-1 receptor), everolimus (an inhibitor of the mechanistic target of rapamycin) or additional TKIs. Until now, there has been no clinical evidence to support the use of one strategy versus another, so investigators and physicians rely on experience, judgement and findings from molecular analyses to select the appropriate treatment...
November 2016: Current Oncology Reports
https://www.readbyqxmd.com/read/27607606/in-vivo-assessment-by-parents-and-a-physician-using-the-amsterdam-infant-stool-scale-provided-better-inter-rater-agreement-than-photographic-evaluation
#12
Katarzyna Wojtyniak, Andrea Horvath, Piotr Dziechciarz
AIM: This study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs. METHODS: The stools of children aged two to 18 months, who were not toilet-trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone...
September 8, 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/27589938/quality-assurance-manual-of-endoscopic-screening-for-gastric-cancer-in-japanese-communities
#13
Chisato Hamashima, Akira Fukao
The Japanese government introduced endoscopic screening for gastric cancer in 2015 as a public policy based on the Japanese guidelines on gastric cancer screening. To provide appropriate endoscopic screening for gastric cancer in Japanese communities, we developed a quality assurance manual of endoscopic screening and recommend 10 strategies with their brief descriptions as follows: (i) Formulation of a committee responsible for implementing and managing endoscopic screening, and for deciding the suitable implementation methods in consideration of the local context; (ii) Development of an interpretation system that leads to a final judgement to standardize endoscopic examination and improve its accuracy; (iii) Preparation of management and reporting systems for adverse effects by the committee for safety management; (iv) Obtaining informed consent before operation following adequate explanations regarding the benefits and harms of endoscopic screening; (v) Avoidance of frequent screenings to reduce false-positive results and overdiagnosis...
September 2, 2016: Japanese Journal of Clinical Oncology
https://www.readbyqxmd.com/read/27566637/validation-of-an-algorithm-to-determine-the-primary-care-treatability-of-emergency-department-visits
#14
Molly Moore Jeffery, M Fernanda Bellolio, Julian Wolfson, Jean M Abraham, Bryan E Dowd, Robert L Kane
OBJECTIVES: We propose a new claims-computable measure of the primary care treatability of emergency department (ED) visits and validate it using a nationally representative sample of Medicare data. STUDY DESIGN AND SETTING: This is a validation study using 2011-2012 Medicare claims data for a nationally representative 5% sample of fee-for-service beneficiaries to compare the new measure's performance to the Ballard variant of the Billings algorithm in predicting hospitalisation and death following an ED visit...
August 26, 2016: BMJ Open
https://www.readbyqxmd.com/read/27499409/south-african-healthcare-provider-perspectives-on-transitioning-adolescents-into-adult-hiv-care
#15
Tiffany H Kung, Melissa L Wallace, Kathryn L Snyder, Victoria K Robson, Tarub S Mabud, Cathy D Kalombo, Linda-Gail Bekker
BACKGROUND: The first generation of South African (SA) children perinatally infected with HIV is entering adulthood, and there is now a pressing need for systematised transfer of these patients from paediatric to adult care. OBJECTIVES: Previous research has investigated the HIV healthcare transition in North America and Europe, yet none has been conducted in SA. Our study is the first to describe the perspectives of healthcare providers overseeing the transition in resource-limited settings...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27405976/variability-of-panretinal-photocoagulation-lesions-across-physicians-and-patients-quantification-of-diameter-and-intensity-variation
#16
Mark Saeger, Jan Heckmann, Konstantine Purtskhvanidze, Amke Caliebe, Johann Roider, Stefan Koinzer
BACKGROUND: Photocoagulation lesion intensity relies on the judgement of retinal blanching. Lesions turn out variable due to observer-dependent judgement and time dependency of blanching. We investigated lesion variability per patient and per physician in clinical routine treatments. METHODS: In this observational clinical trial, different physicians performed panretinal photocoagulation for diabetic retinopathy. Study eyes received 20-30 study lesions at 20 ms (three physicians, nine eyes) and 200 ms (four physicians, 12 eyes) irradiation time (532 nm continuous wave photocoagulator, 300 μm spot size)...
July 12, 2016: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/27388348/bacteraemia-predictive-factors-among-general-medical-inpatients-a-retrospective-cross-sectional-survey-in-a-japanese-university-hospital
#17
Sayato Fukui, Yuki Uehara, Kazutoshi Fujibayashi, Osamu Takahashi, Teruhiko Hisaoka, Toshio Naito
OBJECTIVES: The precise criteria for obtaining blood cultures have not been established; they depend on the physician's judgement. We examined clinical parameters to determine predictive factors of bacteraemia and the need for blood cultures among general medical inpatients. DESIGN: A retrospective cross-sectional survey. SETTING: A Japanese university hospital. PARTICIPANTS: All general inpatients who had blood cultures taken from 1 January 2011 to 31 December 2012...
2016: BMJ Open
https://www.readbyqxmd.com/read/27377077/a-snapshot-survey-of-perceptions-of-healthcare-professionals-on-ageing-surgeons
#18
Vaikunthan Rajaratnam, Chandra M Kumar, Anupama Roy Chowdhury, Chang Su
OBJECTIVE: The aim of this research was to understand healthcare professionals' perception of the continued practice of ageing surgeons in Singapore. METHODOLOGY: A quantitative method was chosen for this research to determine healthcare professionals' perception of the practice of ageing surgeons. Ethical approval was obtained from the local ethical review board. A cross-sectional method using a population survey was performed among healthcare professionals in two tertiary institutions and the study was confined to stakeholders in practices of ageing surgeons...
July 4, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27334875/the-end-of-medical-confidentiality-patients-physicians-and-the-state-in-history
#19
Philip Rieder, Micheline Louis-Courvoisier, Philippe Huber
Medical confidentiality has come under attack in the public sphere. In recent disasters both journalists and politicians have questioned medical confidentiality and claimed that in specific contexts physicians should be compelled to communicate data on their patients' health. The murders of innocent individuals by a suicidal pilot and a Swiss convicted criminal have generated polemical debates on the topic. In this article, historical data on medical confidentiality is used to show that medical practices of secrecy were regularly attacked in the past, and that the nature of medical confidentiality evolved through time depending on physicians' values and judgements...
September 2016: Medical Humanities
https://www.readbyqxmd.com/read/27226516/understanding-and-utilizing-patient-preferences-in-cancer-treatment-decisions
#20
Peter A Ubel
Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments...
May 2016: Journal of the National Comprehensive Cancer Network: JNCCN
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