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Physician judgment

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https://www.readbyqxmd.com/read/28087362/clinical-phenotypes-and-outcomes-of-heritable-and-sporadic-pulmonary-veno-occlusive-disease-a-population-based-study
#1
David Montani, Barbara Girerd, Xavier Jaïs, Marilyne Levy, David Amar, Laurent Savale, Peter Dorfmüller, Andrei Seferian, Edmund M Lau, Mélanie Eyries, Jérôme Le Pavec, Florence Parent, Damien Bonnet, Florent Soubrier, Elie Fadel, Olivier Sitbon, Gérald Simonneau, Marc Humbert
BACKGROUND: Bi-allelic mutations of the EIF2AK4 gene cause heritable pulmonary veno-occlusive disease and/or pulmonary capillary haemangiomatosis (PVOD/PCH). We aimed to assess the effect of EIF2AK4 mutations on the clinical phenotypes and outcomes of PVOD/PCH. METHODS: We did a population-based study using clinical, functional, and haemodynamic data from the registry of the French Pulmonary Hypertension Network. We reviewed the clinical data and outcomes from all patients referred to the French Referral Centre (Pulmonary Department, Hospital Kremlin-Bicêtre, University Paris-Sud) with either confirmed or highly probable PVOD/PCH with DNA available for mutation screening (excluding patients with other risk factors of pulmonary hypertension, such as chronic respiratory diseases)...
January 10, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28074576/decisions-and-authority
#2
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28027265/the-importance-of-patient-satisfaction-a-blessing-a-curse-or-simply-irrelevant
#3
Justin B Cohen, Terence M Myckatyn, Keith Brandt
New regulations require that physician performance must be evaluated and graded in both objective and subjective ways. This represents a novel factor in American health care delivery driven by the reality that the United States spends more than any other nation on health care yet still lags behind in key outcome measures. Patient satisfaction has been established as a core component of physician rankings and reimbursement. In fact, it already has acted as both a powerful motivator and stressor. Patient feedback has driven hospital administrators' agendas to improve facilities and provide relative luxuries to inpatients, and individual providers have been tempted to ignore sound medical judgment by relenting to patient requests to increase their satisfaction scores...
January 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28024438/to-participate-or-not-participate-in-unprofessional-behavior-is-that-the-question
#4
Renato Soleiman Franco, Camila Ament Giuliani Dos Santos Franco, Solena Ziemer Kusma, Milton Severo, Maria Amélia Ferreira
INTRODUCTION: Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior. METHODS: The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal...
December 26, 2016: Medical Teacher
https://www.readbyqxmd.com/read/28007118/rapidly-progressive-cataract-formation-associated-with-non-small-cell-lung-cancer-therapy
#5
Erica Liu, Kamden Kopani
: We report 6 patients who developed rapidly progressive hypermature cataracts after starting treatment with rociletinib, a non-small-cell lung cancer therapy with known side effects of hyperglycemia, fatigue, and prolonged QT. Early cataract detection and surgery may prevent complications during future cataract removal. Although rociletinib development has been suspended, there are patients who have been treated and will continue to be treated with this medication based on their physician's judgment...
December 2016: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/27999255/accelerometry-based-activity-recognition-and-assessment-in-rheumatic-and-musculoskeletal-diseases
#6
Lieven Billiet, Thijs Willem Swinnen, Rene Westhovens, Kurt de Vlam, Sabine Van Huffel
One of the important aspects to be considered in rheumatic and musculoskeletal diseases is the patient's activity capacity (or performance), defined as the ability to perform a task. Currently, it is assessed by physicians or health professionals mainly by means of a patient-reported questionnaire, sometimes combined with the therapist's judgment on performance-based tasks. This work introduces an approach to assess the activity capacity at home in a more objective, yet interpretable way. It offers a pilot study on 28 patients suffering from axial spondyloarthritis (axSpA) to demonstrate its efficacy...
December 16, 2016: Sensors
https://www.readbyqxmd.com/read/27993410/consensus-document-for-the-use-of-the-polypill-in-the-secondary-prevention-of-cardiovascular-disease
#7
José Ramón González-Juanatey, José María Mostaza, José María Lobos, Benjamín Abarca, José Luis Llisterri, Gonzalo Baron-Esquivias, Enrique Galve, Rosa María Lidón, Francisco Xavier Garcia-Moll, Pedro Luis Sánchez, Carmen Suárez, Jesús Millán, Vicente Pallares, José Juan Alemán, Isabel Egocheaga
Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain...
December 16, 2016: Medicina Clínica
https://www.readbyqxmd.com/read/27990470/medical-students-development-of-ethical-judgment-exploring-the-learners-perspectives-using-a-mixed-methods-approach
#8
Thorsten Langer, Danny Jazmati, Ole Jung, Christian Schulz, Martin W Schnell
Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students' perspectives on their development in ethical judgment has received less attention. Better insights in the learners' experiences can help to improve educational interventions in medical ethics...
2016: GMS Journal for Medical Education
https://www.readbyqxmd.com/read/27941151/diagnosis-and-treatment-of-leishmaniasis-clinical-practice-guidelines-by-the-infectious-diseases-society-of-america-idsa-and-the-american-society-of-tropical-medicine-and-hygiene-astmh
#9
Naomi Aronson, Barbara L Herwaldt, Michael Libman, Richard Pearson, Rogelio Lopez-Velez, Peter Weina, Edgar M Carvalho, Moshe Ephros, Selma Jeronimo, Alan Magill
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
December 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27941143/diagnosis-and-treatment-of-leishmaniasis-clinical-practice-guidelines-by-the-infectious-diseases-society-of-america-idsa-and-the-american-society-of-tropical-medicine-and-hygiene-astmh
#10
Naomi Aronson, Barbara L Herwaldt, Michael Libman, Richard Pearson, Rogelio Lopez-Velez, Peter Weina, Edgar M Carvalho, Moshe Ephros, Selma Jeronimo, Alan Magill
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
December 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27938806/pressure-and-disenchantment-in-physicians-part-ii-lessons-for-physicians-from-the-tao-te-ching
#11
Clay J Cockerell
Physicians are faced with many stressors today that place them at risk of disenchantment, depression, and "burnout." Although this is costly to the individual physician, it is equally costly to society because physician stress can lead to exercise of poor judgment and medical errors. It also threatens to exacerbate physician shortages, as more physicians opt to retire or, in some cases, change careers altogether. In this essay, suggestions are made as to how to deal with these stressors that, if used, can ameliorate them at least to some degree...
January 2017: Clinics in Dermatology
https://www.readbyqxmd.com/read/27934567/tolerance-professional-judgment-and-the-discretionary-space-of-the-physician
#12
Daniel P Sulmasy
Arguments against physicians' claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection...
January 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/27934565/conscientious-objection-and-effective-referral
#13
Roger Trigg
Complicity in an immoral, and even criminal, activity, such as robbery or murder, is itself regarded as involving responsibility for those acts. What should the position be of health professionals who are expected to participate in actions that they believe are morally wrong? Professional responsibilities may clash with private conscience. Even referring a patient to someone else, when what is in question may be assisted suicide, or euthanasia, seems to involve some complicity. This is a live issue in Canada, but similar dilemmas occur elsewhere...
January 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/27929734/assessment-of-the-validity-and-reliability-of-a-questionnaire-on-knowledge-and-attitude-of-general-practitioners-about-andropause
#14
Maliheh Abootalebi, Marzieh Kargar, Alireza Aminsharifi
BACKGROUND AND OBJECTIVE: Andropause is one of the clinical and biochemical syndromes in aging men associated with the decrease in serum testosterone levels. With the increase in aging male population, life span in Iran, and focus on quality of life, andropause will become a major health issue that needs to be addressed in order to prevent disability. General practitioners, as the first level of health care providers, are in the best position to assess their knowledge and attitude about andropause period, so a structured instrument is necessary to assess them...
December 8, 2016: Aging Male: the Official Journal of the International Society for the Study of the Aging Male
https://www.readbyqxmd.com/read/27929229/the-mental-status-examination
#15
David Norris, Molly S Clark, Sonya Shipley
The mental status examination includes general observations made during the clinical encounter, as well as specific testing based on the needs of the patient and physician. Multiple cognitive functions may be tested, including attention, executive functioning, gnosia, language, memory, orientation, praxis, prosody, thought content, thought processes, and visuospatial proficiency. Proprietary and open-source clinical examination tools are available, such as the Mini-Mental State Examination and the Mini-Cog...
October 15, 2016: American Family Physician
https://www.readbyqxmd.com/read/27927523/adult-spinal-deformity-surgeons-are-unable-to-accurately-predict-postoperative-spinal-alignment-using-clinical-judgment-alone
#16
Tamir Ailon, Justin K Scheer, Virginie Lafage, Frank J Schwab, Eric Klineberg, Daniel M Sciubba, Themistocles S Protopsaltis, Lukas Zebala, Richard Hostin, Ibrahim Obeid, Tyler Koski, Michael P Kelly, Shay Bess, Christopher I Shaffrey, Justin S Smith, Christopher P Ames
OBJECT: Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. METHODS: Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician...
July 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
#17
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/27919244/surgical-antibiotic-prophylaxis-in-children-a-mixed-method-study-on-healthcare-professionals-attitudes
#18
Angela Giusti, Stefania Spila Alegiani, Marta Luisa Ciofi Degli Atti, Sofia Colaceci, Roberto Raschetti, Pasquale Arace, Raffaele Spiazzi, Massimiliano Raponi
BACKGROUND: Qualitative and quantitative research investigating determinants of adherence to clinical guidelines (GLs) on surgical antibiotic prophylaxis (SAP) are scarce. We conducted a mixed-method study aimed at investigating barriers and at describing attitudes of healthcare professionals (HCPs) regarding SAP in three Italian children's hospitals. METHODS: The study comprised two sequential phases: 1) collection of qualitative data through focus groups; 2) conduction of a survey on HCPs attitudes towards SAP...
December 5, 2016: BMC Pediatrics
https://www.readbyqxmd.com/read/27910252/memory-performance-on-the-story-recall-test-and-prediction-of-cognitive-dysfunction-progression-in-mild-cognitive-impairment-and-alzheimer-s-dementia
#19
Jong-Hwan Park, Hyuntae Park, Sang Wuk Sohn, Sungjae Kim, Kyung Won Park
AIM: To determine the factors that influence diagnosis and differentiation of patients with mild cognitive impairment (MCI) and Alzheimer's dementia (AD) by comparing memory test results at baseline with those at 1-2-year follow up. METHODS: We consecutively recruited 23 healthy participants, 44 MCI patients and 27 patients with very mild AD according to the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorder Association criteria for probable Alzheimer's disease and Petersen's clinical diagnostic criteria...
December 1, 2016: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/27906442/the-role-of-fillers-in-aesthetic-medicine-medico-legal-aspects
#20
E Marinelli, G Montanari Vergallo, G Reale, A di Luca, I Catarinozzi, S Napoletano, S Zaami
In recent years there has been an exponential increase of fillers use in aesthetic medicine. The popularity of this anti-wrinkle product is based on their capacity to offer significant improvement in the aesthetic field, particularly to skin rejuvenating processes with non-invasive and less expensive techniques, if compared to the surgical methods (i.e. surgical lifting). The great number of fillers on the market is composed of a large heterogenic number of biomaterials. The aim of this review was to provide an overview and a classification of the filling materials that are most commonly used...
November 2016: European Review for Medical and Pharmacological Sciences
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