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Physician judgment

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https://www.readbyqxmd.com/read/28629581/impact-of-a-teamstepps-trauma-nurse-academy-at-a-level-1-trauma-center
#1
V Kristen Peters, Ellen M Harvey, Andi Wright, Jennifer Bath, Dan Freeman, Bryan Collier
PROBLEM: Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS: Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers...
June 16, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28622609/the-strategic-defense-of-physician-autonomy-state-public-health-agencies-as-countervailing-powers
#2
Laura Senier, Rachael Lee, Lauren Nicoll
Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy...
June 3, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28606693/etiological-diagnosis-prognostic-significance-and-role-of-electrophysiological-study-in-patients-with-brugada-ecg-and-syncope
#3
Carla Giustetto, Natascia Cerrato, Enrico Ruffino, Elena Gribaudo, Chiara Scrocco, Lorella Barbonaglia, Francesca Bianchi, Miriam Bortnik, Guido Rossetti, Paula Carvalho, Riccardo Riccardi, Davide Castagno, Matteo Anselmino, Laura Bergamasco, Fiorenzo Gaita
BACKGROUND: Syncope is considered a risk factor for life-threatening arrhythmias in Brugada patients. Distinguishing a benign syncope from one due to ventricular arrhythmias is often difficult, unless an ECG is recorded during the episode. Aim of the study was to analyze the characteristics of syncopal episodes in a large population of Brugada patients and evaluate the role of electrophysiological study (EPS) and the prognosis in the different subgroups. METHODS AND RESULTS: One hundred ninety-five Brugada patients with history of syncope were considered...
August 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28593202/feature-selection-based-on-iterative-canonical-correlation-analysis-for-automatic-diagnosis-of-parkinson-s-disease
#4
Luyan Liu, Qian Wang, Ehsan Adeli, Lichi Zhang, Han Zhang, Dinggang Shen
Parkinson's disease (PD) is a major progressive neurodegenerative disorder. Accurate diagnosis of PD is crucial to control the symptoms appropriately. However, its clinical diagnosis mostly relies on the subjective judgment of physicians and the clinical symptoms that often appear late. Recent neuroimaging techniques, along with machine learning methods, provide alternative solutions for PD screening. In this paper, we propose a novel feature selection technique, based on iterative canonical correlation analysis (ICCA), to investigate the roles of different brain regions in PD through T1-weighted MR images...
October 2016: Medical Image Computing and Computer-assisted Intervention: MICCAI ..
https://www.readbyqxmd.com/read/28586819/physician-speech-and-firearm-safety-wollschlaeger-v-governor-florida
#5
Theodore T Lee, Gregory D Curfman
To provide the highest-quality medical care, physicians must be able to communicate openly with their patients and provide advice in conformance with professional standards of care. Although states have the power to regulate many aspects of medical practice, laws that interfere with speech by preventing physicians from discussing specific subjects with patients are constitutionally suspect. In 2017, the US Court of Appeals for the Eleventh Circuit struck down key provisions of a Florida law that prohibited physicians from speaking with their patients about firearm safety as a violation of the First Amendment...
June 5, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28557953/using-in-training-evaluation-report-iter-qualitative-comments-to-assess-medical-students-and-residents-a-systematic-review
#6
Rose Hatala, Adam P Sawatsky, Nancy Dudek, Shiphra Ginsburg, David A Cook
PURPOSE: In-training evaluation reports (ITERs) constitute an integral component of medical student and postgraduate physician trainee (resident) assessment. ITER narrative comments have received less attention than the numeric scores. The authors sought both to determine what validity evidence informs the use of narrative comments from ITERs for assessing medical students and residents and to identify evidence gaps. METHOD: Reviewers searched for relevant English-language studies in MEDLINE, EMBASE, Scopus, and ERIC (last search June 5, 2015), and in reference lists and author files...
June 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28552151/supratentorial-cavernous-malformations
#7
Jason A Ellis, Daniel L Barrow
Supratentorial cavernous malformations are uncommon cerebral vascular lesions that may present many unique challenges for treating physicians. The vast majority will be discovered during workup for seizures or after symptomatic intracerebral hemorrhage. Supratentorial cavernous malformations are increasingly being discovered incidentally in patients who obtain brain imaging for unrelated reasons. Management strategies including watchful waiting, antiepileptic drug therapy, microsurgery, or an expanding array of "minimally invasive" therapies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28530771/macrophage-migration-inhibitory-factor-levels-correlate-with-an-infection-in-trauma-patients
#8
Young Duck Cho, Sung Hyuk Choi, Jung Youn Kim, Sung Jun Park, Young Hoon Yoon, Han Jin Cho, Ji Won Yeom
BACKGROUND: The role of migration inhibitory factor (MIF) is best understood in septic shock and septic disease; however, the role of MIF in a secondary infection after trauma has not yet been completely studied. This study aimed to evaluate the role of MIF in trauma patients. METHODS: The patients in the study population were divided into two groups according to the results of their MIF levels. The initial MIF levels, trauma mechanism, revised trauma score, survival rate, length of stay (LOS) in the intensive care unit (ICU), level of leukocytes, and level of C-reactive protein (CRP) were compared between the groups...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28530312/-the-second-victim-treating-the-health-care-providers
#9
REVIEW
Shimrit Shor, Orna Tal, Ron Maymon
During their professional careers, physicians and other health care providers are repeatedly exposed to emotional stress. This is usually secondary to coping with the results of a medical error or complicated medical event. Generally, in the above cases, the patient and his/her family are in the center of the medical system, being "the first victim" of such an event, while the involved caregiver, who provided the medical service, is categorized as the "second victim". "Second victims" may feel anxiety, fear, guilt or anger and experience social withdrawal, which may lead to troubling memories, depression and insomnia...
January 2017: Harefuah
https://www.readbyqxmd.com/read/28493614/accuracy-of-physical-exam-ankle-brachial-index-and-ultrasonography-in-the-diagnosis-of-arterial-injury-in-patients-with-penetrating-extremity-trauma-a-systematic-review-and-meta-analysis
#10
Ian S deSouza, Roshanak Benabbas, Sean McKee, Bardiya Zangbar, Ashika Jain, Lorenzo Paladino, Leon Boudourakis, Richard Sinert
BACKGROUND: Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Accurate and timely diagnosis is vital to enable potential intervention and prevent significant morbidity. OBJECTIVES: Using a systematic review/meta-analysis approach, we determined the utility of Physical Examination (exam), Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in ED patients who have sustained PET...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28475276/cytokine-biomarkers-of-disease-activity-and-therapeutic-response-after-initiating-methotrexate-therapy-in-patients-with-juvenile-idiopathic-arthritis
#11
Ryan S Funk, Marcia A Chan, Mara L Becker
STUDY OBJECTIVE: To evaluate the relationship between plasma cytokine levels with disease activity and therapeutic response in patients with juvenile idiopathic arthritis after initiating methotrexate (MTX) therapy. DESIGN: Single-center, observational, prospective cohort study. SETTING: Outpatient pediatric rheumatology clinic at a tertiary care academic pediatric hospital. PATIENTS: Sixty-one patients diagnosed with juvenile idiopathic arthritis who started therapy with standard-dose methotrexate (MTX) 15 mg/m(2) /week; at 3 months, treating physicians were given the option of maintaining the MTX dose, increasing the MTX dose, or adding etanercept, based on their clinical judgment...
May 5, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28473004/the-attitudes-of-family-physicians-toward-a-child-with-delayed-growth-and-development
#12
Servet Aker, Mustafa Kürşat Şahin, Ömer Kınalı, Elif Şimşek Karadağ, Tuğba Korkmaz
Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development. BACKGROUND: Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning. METHODS: This descriptive study was performed in Samsun, Turkey, in May and June 2015...
May 5, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28469985/are-these-results-trustworthy-a-guide-for-reading-the-medical-literature
#13
REVIEW
Fares Alahdab, Allison Morrow, Mouaz Alsawas, M Hassan Murad
Physicians practicing evidence-based medicine need to be able to appraise a new study and determine whether the results warrant sufficient certainty to the level that they can be applied to patient care. Without such appraisal, misleading results can be incorporated into patient care, which can lead to inefficient, costly, and possibly harmful care. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach offers a modern framework that can be applied to evaluate the trustworthiness of evidence...
April 2017: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/28461285/physician-rating-websites-what-aspects-are-important-to-identify-a-good-doctor-and-are-patients-capable-of-assessing-them-a-mixed-methods-approach-including-physicians-and-health-care-consumers-perspectives
#14
Fabia Rothenfluh, Peter J Schulz
BACKGROUND: Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. OBJECTIVE: To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects...
May 1, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28459929/behavioral-approach-to-appropriate-antimicrobial-prescribing-in-hospitals-the-dutch-unique-method-for-antimicrobial-stewardship-dumas-participatory-intervention-study
#15
Jonne J Sikkens, Michiel A van Agtmael, Edgar J G Peters, Kamilla D Lettinga, Martijn van der Kuip, Christina M J E Vandenbroucke-Grauls, Cordula Wagner, Mark H H Kramer
Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals...
May 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28453637/automated-identification-of-implausible-values-in-growth-data-from-pediatric-electronic-health-records
#16
Carrie Daymont, Michelle E Ross, A Russell Localio, Alexander G Fiks, Richard C Wasserman, Robert W Grundmeier
Objective: Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead to biased results. We developed and tested an automated method for identifying implausible values in pediatric EHR growth data. Materials and Methods: Using deidentified data from 46 primary care sites, we developed an algorithm to identify weight and height values that should be excluded from analysis, including implausible values and values that were recorded repeatedly without remeasurement...
April 26, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28447213/discordance-between-physician-and-patient-reported-disease-severity-in-adults-with-atopic-dermatitis-a-us-cross-sectional-survey
#17
Wenhui Wei, Peter Anderson, Abhijit Gadkari, Stuart Blackburn, Rachel Moon, James Piercy, Shashank Shinde, Jorge Gomez, Eric Ghorayeb
BACKGROUND: There is limited understanding of severity rating of atopic dermatitis in clinical practice. OBJECTIVES: To evaluate the agreement between physician- and patient-rated severity of atopic dermatitis. METHODS: Data were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire...
April 26, 2017: American Journal of Clinical Dermatology
https://www.readbyqxmd.com/read/28444087/civil-liability-of-the-ophthalmologist-in-the-s%C3%A3-o-paulo-court-of-appeals
#18
Isabel de Fátima Alvim Braga, Kelly de Oliveira Vieira, Thiago Gonçalves Dos Santos Martins
Objective: To conduct a data survey on the subject of medical claims involving civil liability in ophthalmology at the São Paulo Court of Appeals. Methods: A case law research was carried out on the São Paulo Court of Appeals website searching for the keyword "ophthalmologist" for all years until 2016. Results: Of the 65 cases found, 29 were selected. There has been an increase in the number of claims in ophthalmology, especially in surgical procedures on the anterior chamber of the eye...
2017: Einstein
https://www.readbyqxmd.com/read/28430567/how-should-clinicians-respond-to-medical-requests-from-clinician-family-members-of-patients
#19
Andrew Thurston
In the medical profession, receiving a request for medical management from a colleague is a routine experience. However, when the colleague is a family member of a patient and the desired or requested medical intervention is not medically indicated in the attending physician's view, the situation becomes more complicated. Ethical issues include respect for patient autonomy and social justice as well as nonmaleficence. Furthermore, interpersonal and professional relationships may be tested in this situation...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28406921/is-the-risk-of-progressive-multifocal-leukoencephalopathy-the-real-reason-for-natalizumab-discontinuation-in-patients-with-multiple-sclerosis
#20
MULTICENTER STUDY
Julia Krämer, Jan-Gerd Tenberge, Ingo Kleiter, Wolfgang Gaissmaier, Tobias Ruck, Christoph Heesen, Sven G Meuth
BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is one of the major risks of natalizumab therapy. Despite introduction of the currently employed PML risk stratification algorithm, the incidence of natalizumab-associated PML cases is not decreasing. OBJECTIVES: We addressed the following questions: How do natalizumab-treated multiple sclerosis patients and their treating physicians assess and deal with PML risk? Is PML risk the real reason for natalizumab discontinuation? METHODS: 699 natalizumab-treated multiple sclerosis patients and 99 physicians were included in this prospective observational study...
2017: PloS One
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