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Physician judgement

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https://www.readbyqxmd.com/read/28906154/moving-toward-consensus-on-diagnosis-and-management-of-severe-asthma-in-adults
#1
Daniel Colodenco, Oscar Palomares, Carlos Celis, Alan Kaplan, Christian Domingo
Asthma is a considerable health problem with an increasing global prevalence. The burden of severe asthma is expected to notably increase in the following years. Some misleading concepts that sometimes appear in the literature can drive the physician responsible for the patient's management to make incorrect decisions. Furthermore, some of the concepts that appear in the literature and in the guidelines may be not be clear to understand, to follow or to adapt to the regional and local realities. This could again drive the physicians responsible of the patient's management to make incorrect clinical judgements...
September 14, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28905303/measuring-what-matters-to-the-patient-health-related-quality-of-life-after-aortic-valve-and-thoracic-aortic-surgery
#2
Frederiek de Heer, Arjen L Gökalp, Jolanda Kluin, Johanna J M Takkenberg
With improved outcomes following cardiac surgery, health related quality of life (HRQoL) gains increasing importance for the better judgement of choosing the preferred treatment strategy in the individual patient. The physician perception of patient preferences can differ considerably from actual patient preferences, underlining the importance of gathering evidence of actual patient preferences before and quality of life after cardiac surgery. The objective of the current review is to provide an overview of current insights into the quality of life measurements after aortic valve and thoracic aortic surgery and to provide starting points for the application of HRQoL measurements toward the future...
September 13, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28895664/the-severe-and-acute-complications-of-the-biologics-in-psoriasis
#3
Elias Oussedik, Nupur U Patel, Devin R Cash, Angela S Gupta, Steven R Feldman
Biologic therapies have revolutionized the approach to immune-mediated diseases such as psoriasis. Due to their favorable safety profiles and excellent efficacy, biologic agents are considered the gold-standard for moderate-to-severe psoriasis. The aim of this paper is to saliently review the severe and acute complications of the Food and Drug Administration (FDA) approved biologic agents for psoriasis. Reviewed agents include tumor necrosis factor alpha (TNF-alpha) inhibitors (etanercept, infliximab, and adalimumab), interleukin 12/23 inhibitors (ustekinumab), and interleukin 17 inhibitors (secukinumab and ixekizumab)...
September 12, 2017: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
https://www.readbyqxmd.com/read/28866703/clinical-judgement-perplexed-by-initially-undisclosed-use-of-herbal-medicine-and-unexpected-cross-reactivity-of-immunoassay
#4
K T Liu, C W Lee
We report a case of symptomatic bradycardia caused by consumption of a Chinese herbal medicine which was initially undisclosed to the attending emergency physician. The scientific name of the herb is Panax japonicus. Electrocardiogram revealed sinus bradycardia. Laboratory tests were normal except for the detection of a high serum digoxin level. Further interrogation of the patient eventually disclosed ingestion of the herb which, however, did not contain any digoxin. Other active ingredients in the herb include various types of ginsenoside...
August 2017: Malaysian Journal of Pathology
https://www.readbyqxmd.com/read/28859326/similar-efficacy-and-safety-of-initial-cobra-light-and-cobra-therapy-in-rheumatoid-arthritis-4-year-results-from-the-cobra-light-trial
#5
Nicole P C Konijn, Lilian H D van Tuyl, Maarten Boers, Debby den Uyl, Marieke M Ter Wee, Lindsey K M van der Wijden, Irene E M Bultink, Pit J S M Kerstens, Alexandre E Voskuyl, Dirkjan van Schaardenburg, Michael T Nurmohamed, Willem F Lems
Objective: To assess the efficacy and safety of initial COBRA-light vs COBRA therapy in RA patients after a 4-year follow-up period. Methods: In the COBRA-light trial, 162 consecutive patients with recent-onset RA were randomized to either COBRA-light (prednisolone and MTX) or COBRA therapy (prednisolone, MTX and SSZ) for 1 year. After 1 year, treatment was continued without protocol, and adjusted by the treating physician according to clinical judgement, preferably with a treat-to-target strategy...
September 1, 2017: Rheumatology
https://www.readbyqxmd.com/read/28776437/warfarin-monitoring-in-nursing-homes-assessed-by-case-histories-do-recommendations-and-electronic-alerts-affect-judgements
#6
Reyes Serrano Teruel, Geir Thue, Svein Ivar Fylkesnes, Sverre Sandberg, Ann Helen Kristoffersen
PURPOSE: Older adults treated with warfarin are prone to complications, and high-quality monitoring is essential. The aim of this case history based study was to assess the quality of warfarin monitoring in a routine situation, and in a situation with an antibiotic-warfarin interaction, before and after receiving an electronic alert. MATERIALS AND METHODS: In April 2014, a national web-based survey with two case histories was distributed among Norwegian nursing home physicians and general practitioners working part-time in nursing homes...
September 2017: Scandinavian Journal of Primary Health Care
https://www.readbyqxmd.com/read/28741976/fampridine-response-in-ms-patients-with-gait-impairment-in-a-real-world-setting-need-for-new-response-criteria
#7
Francisco Alejandro Rodriguez-Leal, Rocco Haase, Katja Thomas, Judith Christina Eisele, Undine Proschmann, Thorsten Schultheiss, Raimar Kern, Tjalf Ziemssen
OBJECTIVE: The primary objective of this real-world study was to describe the response to fampridine and changes of gait parameters in multiple sclerosis (MS) patients' walking disability (Expanded Disability Status Scale (EDSS): 4-7) after treatment with fampridine for 2 weeks as recommended by the European Medicines Agency (EMA) and compare it with the overall physician's judgement. METHODS: A total of 211 adult MS patients were analyzed using a multimodal gait assessment including the timed 25-foot walk test (T25FW), 2-minute walking test (2-MWT), 12-item Multiple Sclerosis Walking Scale (MSWS-12), the GAITRite electronic walkway system, and the patients' clinical global impression (CGI)...
July 1, 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/28740510/hematopoietic-stem-cell-transplantation-a-bioethical-lens
#8
REVIEW
Arcangelo Liso, Margherita Neri, Francesca Maglietta, Raffaele La Russa, Emanuela Turillazzi
Hematopoietic stem cell transplantation (HSCT) is one of a range of therapeutic options available to patients suffering from various diseases. HSCT procedure involves important ethical and legal aspects that can occur at every phase of the procedure: the clinical choice of whether to perform the procedure, pretransplantation preparation regimens, donor selection, stem cell harvest procedure, transplantation phase, and short-term and long-term follow-up care. In this discussion paper, we outline the ethical issue-facing physicians involved in HSCT...
2017: Stem Cells International
https://www.readbyqxmd.com/read/28723476/charting-recent-progress-and-challenges-in-metastatic-castration-resistant-prostate-cancer-is-there-an-optimal-treatment-sequence
#9
REVIEW
Stéphane Oudard, Pablo Maroto, Gaston Demonty, Winald R Gerritsen
CONTEXT: Recent developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC) have led to uncertainty about the optimal sequence of agents. OBJECTIVE: To review and assess treatment options and sequence in patients with mCRPC. EVIDENCE ACQUISITION: To identify data on the optimal use of approved treatments, we searched PubMed for studies on the use of recently approved agents for men with mCRPC published before March 2015...
October 2016: European Urology Focus
https://www.readbyqxmd.com/read/28703305/use-of-multicriteria-decision-analysis-for-assessing-the-benefit-and-risk-of-over-the-counter-analgesics
#10
Andrew Moore, Anne Crossley, Bernard Ng, Lawrence Phillips, Özgür Sancak, K D Rainsford
OBJECTIVES: To test the ability of a multicriteria decision analysis (MCDA) model to incorporate disparate data sources of varying quality along with clinical judgement in a benefit-risk assessment of six well-known pain-relief drugs. METHODS: Six over-the-counter (OTC) analgesics were evaluated against three favourable effects and eight unfavourable effects by seven experts who specialise in the relief of pain, two in a 2-day facilitated workshop whose input data and judgements were later peer-reviewed by five additional experts...
July 13, 2017: Journal of Pharmacy and Pharmacology
https://www.readbyqxmd.com/read/28639296/pathways-to-professionalism-quality-improvement-care-pathways-and-the-interplay-of-standardisation-and-clinical-autonomy
#11
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/28560817/outcomes-of-pulmonary-arterial-hypertension-therapy-in-australia-is-monotherapy-adequate
#12
Avalon Moonen, Roger Garsia, Peter Youssef, Paul Torzillo, Tamera Corte, Christiane Boehm, Rachael Cordina, David Celermajer, Edmund Lau
BACKGROUND: In Australia, government-subsidised treatment of pulmonary arterial hypertension (PAH) is limited to monotherapy. Recent international guidelines advocate that initial combination therapy be considered for all symptomatic PAH patients. We sought to characterise "real-life" outcomes in PAH patients initiated on monotherapy. METHODS: We performed a retrospective analysis of 100 consecutive PAH patients at a single centre, who were commenced on monotherapy for PAH between 2004 and 2015...
May 31, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28538648/less-is-more-antibiotic-duration-and-outcomes-in-fournier-s-gangrene
#13
Margaret Hedgecock Lauerman, Olga Kolesnik, Kinjal Sethuraman, Ronald Rabinowitz, Manjari Joshi, Emily Clark, Deborah Stein, Thomas Scalea, Sharon Henry
BACKGROUND: Antibiotic management of Fournier's gangrene (FG) is without evidence-based guidelines and is based on expert opinion. The effect of duration of antibiotic therapy on outcomes in FG is unknown. METHODS: A retrospective review was performed of FG patients from 2012 to 2015 at a single institution. Patients were managed by our institutional practice of complete primary wound closure as possible, with antibiotic duration according to physician judgment...
September 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28535332/interventions-for-treating-anxiety-after-stroke
#14
REVIEW
Peter Knapp, C Alexia Campbell Burton, John Holmes, Jenni Murray, David Gillespie, C Elizabeth Lightbody, Caroline L Watkins, Ho-Yan Y Chun, Sharon R Lewis
BACKGROUND: Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke. Physicians can treat these patients with antidepressants or other anxiety-reducing drugs, or both, or they can provide psychological therapy. This review looks at available evidence for these interventions. This is an update of the review first published in October 2011. OBJECTIVES: The primary objective was to assess the effectiveness of pharmaceutical, psychological, complementary, or alternative therapeutic interventions in treating stroke patients with anxiety disorders or symptoms...
May 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28447853/finding-balance-standardizing-practice-is-corseting-physician-judgement
#15
Peter J Pronovost, Stephen A Berry, Kathleen M Sutcliffe
No abstract text is available yet for this article.
April 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28440855/accuracy-of-current-diagnostic-criteria-for-acute-bacterial-infection-in-older-adults-in-the-emergency-department
#16
Jeffrey M Caterino, Robert Leininger, David M Kline, Lauren T Southerland, Salman Khaliqdina, Christopher W Baugh, Daniel J Pallin, Kurt B Stevenson
OBJECTIVES: To compare the accuracy of the Loeb criteria, emergency department (ED) physicians' diagnoses, and Centers for Disease Control and Prevention (CDC) guidelines for acute bacterial infection in older adults with a criterion standard expert review. DESIGN: Prospective, observational study. SETTING: Urban, tertiary-care ED. PARTICIPANTS: Individuals aged 65 and older in the ED, excluding those who were incarcerated, underwent a trauma, did not speak English, or were unable to consent...
August 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28406719/structured-expert-consensus-on-actinic-keratosis-treatment-algorithm-focusing-on-daylight-pdt
#17
Piergiacomo Calzavara-Pinton, Merete Hædersdal, Kirk Barber, Nicole Basset-Seguin, María Emilia Del Pino Flores, Peter Foley, Gaston Galimberti, Rianne Gerritsen, Yolanda Gilarbete, Sally Ibbotson, Ketty Peris, Sheetal Sapra, Eleni Sotiriou, Luis Torezan, Claas Ulrich, Jonathan Guillemot, Janek Hendrich, Rolf-Markus Szeimies
BACKGROUND: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). OBJECTIVES: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. METHODS: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options...
April 1, 2017: Journal of Cutaneous Medicine and Surgery
https://www.readbyqxmd.com/read/28338533/sepsis-patients-in-the-emergency-department-stratification-using-the-clinical-impression-score-predisposition-infection-response-and-organ-dysfunction-score-or-quick-sequential-organ-failure-assessment-score
#18
Vincent M Quinten, Matijs van Meurs, Anna E Wolffensperger, Jan C Ter Maaten, Jack J M Ligtenberg
OBJECTIVE: The aim of this study was to compare the stratification of sepsis patients in the emergency department (ED) for ICU admission and mortality using the Predisposition, Infection, Response and Organ dysfunction (PIRO) and quick Sequential Organ Failure Assessment (qSOFA) scores with clinical judgement assessed by the ED staff. PATIENTS AND METHODS: This was a prospective observational study in the ED of a tertiary care teaching hospital. Adult nontrauma patients with suspected infection and at least two Systemic Inflammatory Response Syndrome criteria were included...
May 8, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28300480/impossible-decision-an-investigation-of-risk-trade-offs-in-the-intensive-care-unit
#19
Tom W Reader, Geetha Reddy, Stephen J Brett
In the intensive care unit (ICU), clinicians must often make risk trade-offs on patient care. For example, on deciding whether to discharge a patient before they have fully recovered in order to create a bed for another, sicker, patient. When misjudged, these decisions can negatively influence patient outcomes: yet it can be difficult, if not impossible, for clinicians to evaluate with certainty the safest course of action. Using a vignette-based interview methodology, a naturalistic decision-making approach was utilised to study this phenomena...
March 16, 2017: Ergonomics
https://www.readbyqxmd.com/read/28295898/training-program-for-japanese-medical-personnel-to-combat-child-maltreatment
#20
Koji Tanoue, Masayoshi Senda, Byongmun An, Midori Tasaki, Megumi Taguchi, Kosuke Kobashi, Shinji Oana, Fumitake Mizoguchi, Yuko Shiraishi, Fujiko Yamada, Makiko Okuyama, Kotaro Ichikawa
BACKGROUND: In 2014, we created a training program for personnel in medical institutions in Japan to combat child maltreatment. The aim of the present study was to document the effectiveness of this program. METHODS: Participants completed a questionnaire before and after the training lecture. The questionnaire designed for the training program included demographic questions such years of practice and area of specialty (i.e. physician, nurse, social worker, public health nurse, technician, and others), as well as experience of suspected child maltreatment cases and training in dealing with such cases...
March 11, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
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