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Physician judgment

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https://www.readbyqxmd.com/read/28430567/how-should-clinicians-respond-to-medical-requests-from-clinician-family-members-of-patients
#1
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
#2
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
https://www.readbyqxmd.com/read/28398365/-digitalis-a-drug-to-be-scrapped
#3
Franco Cosmi, Barbara Tarquini, Beatrice Mariottoni, Deborah Cosmi
We performed a comprehensive review of the scientific literature on the use of digoxin in heart failure and atrial fibrillation. In congestive heart failure (CHF) there is only one randomized trial with a statistical sample sufficiently large. In this trial (DIG trial), which enrolled patients with systolic left ventricular dysfunction in sinus rhythm, digoxin had a neutral action on mortality and modestly reduced the overall need of hospitalization. The study was conducted in the pre-beta-blocker era and, therefore, it has a doubtful application to the current clinical context...
February 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28394626/decision-making-on-the-labor-and-delivery-unit-an-investigation-of-influencing-factors
#4
Megan E Gregory, Shirley C Sonesh, Jennifer Feitosa, Lauren E Benishek, Ashley M Hughes, Eduardo Salas
Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1)...
April 1, 2017: Human Factors
https://www.readbyqxmd.com/read/28375501/seven-ethical-issues-affecting-neurosurgeons-in-the-context-of-health-care-reform
#5
T Forcht Dagi
Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28358584/assessing-the-utility-and-validity-of-frailty-markers-in-critically-ill-adults
#6
Aluko A Hope, S J Hsieh, Alex Petti, Mariana Hurtado-Sbordoni, Joe Verghese, Michelle Ng Gong
RATIONALE: Identifying frailty by the presence of a critical number of frailty markers has been difficult to operationalize in the Intensive Care Unit (ICU) where patients often cannot complete performance measures or answer complex questions. OBJECTIVES: To assess the construct and predictive validity of a questionnaire-based approach to identifying frailty in adult ICU patients. METHODS: We conducted an observational cohort study of adults admitted to a medical or surgical ICU at one of two hospitals in New York...
March 30, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28346280/conjunctivochalasis-and-related-factors-in-an-adult-population-of-iran
#7
Hassan Hashemi, Hadith Rastad, Mohammad Hassan Emamian, Akbar Fotouhi
OBJECTIVES: To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population. METHODS: This population-based study was conducted in the context of the second phase of Shahroud Eye Cohort Study in 2014. Of 4,737 participants aged 45 to 69 years who participated in the second phase, the data of 4,702 participants were available for this report. A diagnosis of conjunctivochalasis was made based on the physician's judgment on ophthalmic examinations...
March 24, 2017: Eye & Contact Lens
https://www.readbyqxmd.com/read/28345187/novel-biomarkers-for-prostate-cancer-an-evidence-based-review-for-use-in-clinical-practice
#8
REVIEW
Vikram M Narayan, Badrinath R Konety, Christopher Warlick
Prostate cancer is a heterogeneous disease with disparate outcomes. Traditional clinical parameters are limited in their ability to differentiate between these cases, and there is uncertainty regarding management strategies. A number of novel biomarkers have emerged, but how best to use them at the point of care remains confusing. In the present review, we describe the most common novel biomarkers, their key supporting literature, and propose a meaningful algorithm for their use in clinical practice. To identify commercially available prostate cancer diagnostic tests, we carried out a PubMed literature search (through May 2016)...
March 27, 2017: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/28344599/does-ultrasound-measurement-improve-the-accuracy-of-electronic-brachytherapy-in-the-treatment-of-superficial-non-melanomatous-skin-cancer
#9
Uma Goyal, Junhan Pan, Haiyan Cui, Baldassarre Stea
PURPOSE: Electronic brachytherapy (eBT) is a form of contact radiation therapy used for thin superficial non-melanomatous skin cancers (NMSCs). An accurate measurement of diameter and depth is important for eBT treatment planning. Therefore, we compared clinical measurements by an experienced physician to measurements obtained using ultrasound (US), an objective imaging modality, in order to determine if clinical measurements were accurate enough for adequate NMSC treatment. MATERIAL AND METHODS: Eighteen patients with 20 biopsy-proven NMSCs first had a clinical examination and then an US evaluation prior to starting eBT...
February 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28334584/delayed-workup-of-rectal-bleeding-in-adult-primary-care-examining-process-of-care-failures
#10
Saul N Weingart, Elena M Stoffel, Daniel C Chung, Thomas D Sequist, Ruth I Lederman, Stephen R Pelletier, Helen M Shields
BACKGROUND: Although delayed colorectal cancer diagnoses figure prominently in medical malpractice claims, little is known about the quality of primary care clinicians' workup of rectal bleeding. METHODS: In this study, 438 patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for rectal bleeding, hemorrhoids, and blood in the stool at 10 Boston adult primary care practices. Following nurse chart abstraction, physician reviewers assessed the overall quality of care and key care processes...
January 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28293096/clinical-correlations-of-infliximab-trough-levels-and-antibodies-to-infliximab-in-south-korean-patients-with-crohn-s-disease
#11
Eun Hye Oh, Dae-Hyun Ko, Hyungil Seo, Kiju Chang, Gwang-Un Kim, Eun Mi Song, Myeongsook Seo, Ho-Su Lee, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
AIM: To investigate the clinical implications of infliximab trough levels (IFX-TLs) and antibodies to infliximab (ATI) levels in Crohn's disease (CD) patients in Asian countries. METHODS: IFX-TL and ATI level were measured using prospectively collected samples obtained with informed consent from CD patients being treated at Asan Medical Center, South Korea. We analyzed the correlations between IFX-TLs/ATI levels and the clinical activity of CD (quiescent vs active disease) based on the CD activity index, C-reactive protein level, and physician's judgment of patients' clinical status at enrollment...
February 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28292289/at-first-glance-informal-payments-experience-on-track-why-accept-or-refuse-patients-perceive-in-cardiac-surgery-department-of-public-hospitals-northeast-of-iran-2013
#12
Ali Vafaei Najar, Hossein Ebrahimipour, Arefeh Pourtaleb, Habibollah Esmaily, Mehdi Jafari, Zohre Nejatzadegan, Yasamin Molavi Taleghani
BACKGROUND: Patient's Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013. METHODS: In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28291632/necessity-of-carbapenem-use-when-prescribed-per-infectious-diseases-specialists
#13
Kellie J Goodlet, Michael D Nailor
Preauthorization strategies, including restricting broad-spectrum antimicrobials such as carbapenems to infectious diseases physicians (ID) are commonly employed by stewardship programs. The appropriateness, or "necessity" of empiric carbapenem therapy by ID, defined as an isolated organism sensitive to the carbapenem and resistant to cefepime, was evaluated over a 6month span and included 84 patients. Additionally, 30 patients followed by ID who were not prescribed a carbapenem until final susceptibilities were included as a definitive therapy group...
May 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/28260866/adherence-in-ulcerative-colitis-an-overview
#14
REVIEW
Anna Testa, Fabiana Castiglione, Olga Maria Nardone, Giorgio L Colombo
Medication adherence is an important challenge while treating chronic illnesses, such as ulcerative colitis (UC), that require a long-term management to induce and maintain clinical remission. This review provides an overview of the role that medication adherence plays in the routine management of UC, with a focus on the results of a recent Italian study reporting the perception of patients with UC regarding adherence to treatment. A literature analysis was conducted on topics, such as measurement of adherence in real practice, causes, risk factors and consequences of non-adherence and strategies, to raise patients' adherence...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28257544/navigating-clinical-ethics-using-real-case-constellations-to-guide-learners-and-teachers-in-medicine
#15
Katherine Wasson, Mark Kuczewski, Michael P McCarthy, Kayhan Parsi, Emily E Anderson, Paul Hutchison
Case-based learning is a staple of clinical ethics education in medicine. The sources for medical educators generally are lengthy case books or single, often rare, case analyses in the literature. Busy clinicians may not have the time or inclination to sift through case books to find suitable teaching material, and the latter present unusual cases that many physicians may never encounter in their own practice. Relatively few articles present multiple cases involving ethical issues that are likely to appear in everyday practice in an accessible format for teaching...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28252466/defining-clinical-excellence-in-hospital-medicine-a-qualitative-study
#16
Susrutha Kotwal, Ivonne Peña, Eric Howell, Scott Wright
INTRODUCTION: There are now more than 50,000 hospitalists working in the United States. Limited empiric research has been performed to characterize clinical excellence in hospital medicine. We conducted a qualitative study to discover elements judged to be most pertinent to excellence in clinical care delivered by hospitalists. METHODS: The chiefs of hospital medicine at five hospitals were asked to identify their "clinically best" hospitalists. Data collection, in the form of one-on-one interviews, was directed by an interview guide...
January 2017: Journal of Continuing Education in the Health Professions
https://www.readbyqxmd.com/read/28238497/structured-clinical-decision-aids-are-seldom-compared-with-subjective-physician-judgment-and-are-seldom-superior
#17
David L Schriger, Joshua W Elder, Richelle J Cooper
STUDY OBJECTIVE: We determine how often studies that evaluate the performance of an aid for decisionmaking, be it a simple laboratory or imaging test or a complex multielement decision instrument, compare the aid's performance to independent, unaided physician judgment. METHODS: This was a cross-sectional survey of all Original Research and Brief Research Report articles in Annals of Emergency Medicine from 1998 to 2015. We included all articles that evaluated the performance of an aid for decisionmaking in assisting a physician with a decision about testing, treatment, diagnosis, or disposition...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28216720/biostatistics-series-module-7-the-statistics-of-diagnostic-tests
#18
Avijit Hazra, Nithya Gogtay
Crucial therapeutic decisions are based on diagnostic tests. Therefore, it is important to evaluate such tests before adopting them for routine use. Although things such as blood tests, cultures, biopsies, and radiological imaging are obvious diagnostic tests, it is not to be forgotten that specific clinical examination procedures, scoring systems based on physiological or psychological evaluation, and ratings based on questionnaires are also diagnostic tests and therefore merit similar evaluation. In the simplest scenario, a diagnostic test will give either a positive (disease likely) or negative (disease unlikely) result...
January 2017: Indian Journal of Dermatology
https://www.readbyqxmd.com/read/28206671/surgery-for-cataracts-in-people-with-age-related-macular-degeneration
#19
REVIEW
Heather Casparis, Kristina Lindsley, Irene C Kuo, Shameema Sikder, Neil M Bressler
BACKGROUND: Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. OBJECTIVES: The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD...
February 16, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28199179/experienced-probabilities-increase-understanding-of-diagnostic-test-results-in-younger-and-older-adults
#20
Bonnie Armstrong, Julia Spaniol
BACKGROUND: With advancing age, the frequency of medical screening increases. Interpreting the results of medical tests involves estimation of posterior probabilities such as positive predictive values (PPVs) and negative predictive values (NPVs). Both laypeople and experts are typically poor at estimating posterior probabilities when the relevant statistics are communicated descriptively. The current study examined whether an experience format would improve posterior probability judgments in younger and older adults, relative to a description format...
February 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
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