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Physician judgment

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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
#1
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
#2
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
https://www.readbyqxmd.com/read/27904437/empirical-and-philosophical-analysis-of-physicians-judgments-of-medical-indications
#3
Joar Björk, Niels Lynöe, Niklas Juth
BACKGROUND: The aim of this study was to investigate whether physicians who felt strongly for or against a treatment, in this case a moderately life prolonging non-curative cancer treatment, differed in their estimation of medical indication for this treatment as compared to physicians who had no such sentiment. A further aim was to investigate how the notion of medical indication was conceptualised. METHODS: A random sample of GPs, oncologists and pulmonologists (n = 646) comprised the study group...
December 2016: Clinical Ethics
https://www.readbyqxmd.com/read/27894438/how-doctors-think-common-diagnostic-errors-in-clinical-judgment-lessons-from-an-undiagnosed-and-rare-disease-program
#4
REVIEW
Robert M Kliegman, Brett J Bordini, Donald Basel, James J Nocton
The scientific process of analysis and deduction is frequently, often subconsciously, used by physicians to develop a differential diagnosis based on patients' symptoms. Common disorders are most frequently diagnosed in general practice. Rare diseases are uncommon and frequently remain undiagnosed for many years. Cognitive errors in clinical judgment delay definitive diagnosis. Whole-exome sequencing has helped identify the cause of undiagnosed or rare diseases in up to 40% of children. This article provides experiences with an undiagnosed or rare disease program, where detailed data accumulation and a multifaceted analytical approach assisted in diagnosing atypical presentations of common disorders...
February 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/27892670/impact-of-adjuvant-chemotherapy-in-elderly-breast-patients-in-taiwan-a-hospital-based-study
#5
Hsiu-Chuan Lee, Wei-Yu Chen, Wen- Tsung Huang, Kuo- Chen Cheng, Yu-Feng Tian, Chung-Han Ho, Chao- Jung Tsao, Yin- Hsun Feng
Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty. To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months...
January 10, 2016: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/27890107/an-analysis-of-causative-factors-in-closed-criminal-medical-malpractice-cases-of-the-taiwan-supreme-court-2000-2014
#6
Kuan-Han Wu, Shih-Yu Cheng, Yung-Lin Yen, Chien-Hung Wu, Ming-Ta Tsai, Fu-Jen Cheng
Most medical malpractice in Taiwan leads to criminal prosecution. This study examined the epidemiologic factors and clinical errors that led to medical malpractice convictions in Taiwanese criminal prosecutions. A retrospective, 15-year population-based review of criminal Supreme Court judgments pertaining to medical malpractice against physicians and nurses was conducted. Eighty-four cases were reviewed, yielding data that included the number and specialty involved, accused hospitals, the diagnosis, the time interval between incidents to closure, result of adjudication, the origin of cases (private vs...
November 2016: Legal Medicine
https://www.readbyqxmd.com/read/27878349/operation-start-times-and-postoperative-morbidity-from-liver-resection-a-propensity-score-matching-analysis
#7
Qiang Lu, Yuan Shen, Jing Zhang, Yi-Fan Ren, Jian Dong, Zhao-Qing Du, Xue-Min Liu, Zheng Wu, Yi Lv, Xu-Feng Zhang
BACKGROUND: Surgeons are likely to get progressively fatigued and work less effectively during the course of a normal workday. We sought to examine the effects of surgery start times (morning vs. afternoon) and workload of the surgeons on morbidity of patients after partial liver resection (LR). METHODS: A total of 155 pairs of the patients from 383 patients undergoing LR were generated by propensity score analysis (PSM) according to the start times of surgery: group M (morning surgery, 8 a...
November 22, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27874878/presenting-treatment-safety-data-subjective-interpretations-of-objective-information
#8
Sara W Faulks, Steven R Feldman
Educating patients about the risks of treatment is obligatory. An inherent problem with risk education is that patients can become terrified of rare risks associated with the treatment, resulting in possible treatment refusal, poor adherence, and continued disease symptoms. Such fears are a common obstacle observed with the use of biologic medications to treat psoriasis. In this article, we use graphical presentation of psoriasis safety data to illustrate how patients subjectively interpret objective information...
October 2016: Cutis; Cutaneous Medicine for the Practitioner
https://www.readbyqxmd.com/read/27870089/lessons-for-the-nfl-from-workers-compensation
#9
Richard Diana
In the article "A Proposal to Address NFL Club Doctors' Conflicts of Interest and to Promote Player Trust," Glenn Cohen et al. write, "The [NFL's] current structure forces club doctors to have obligations to two parties-the club and the player-and to make difficult judgments about when one party's interests must yield to another's." I can understand why some might be suspicious about bias in the current NFL medical system, in which the club doctors have a professional duty to put their player-patients' best interests first yet are employed by clubs, which have a primary goal of winning football games...
November 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27860022/shared-decision-making-with-vulnerable-populations-in-the-emergency-department
#10
Ana Castaneda-Guarderas, Jeffrey Glassberg, Corita R Grudzen, Ka Ming Ngai, Margaret E Samuels-Kalow, Erica Shelton, Stephen P Wall, Lynne D Richardson
The emergency department occupies a unique position within the health care system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes and lack of cultural competence; as well as patient mistrust, and the consequences of their social and economic disenfranchisement...
November 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27853850/clinical-and-imaging-predictors-of-management-in-retained-products-of-conception
#11
Aya Kamaya, Priya Menon Krishnarao, Nita Nayak, R Brooke Jeffrey, Katherine E Maturen
OBJECTIVES: To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC). METHODS: 334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians...
November 17, 2016: Abdominal Radiology
https://www.readbyqxmd.com/read/27848171/the-influence-of-first-impressions-on-subsequent-ratings-within-an-osce-station
#12
Timothy J Wood, James Chan, Susan Humphrey-Murto, Debra Pugh, Claire Touchie
Competency-based assessment is placing increasing emphasis on the direct observation of learners. For this process to produce valid results, it is important that raters provide quality judgments that are accurate. Unfortunately, the quality of these judgments is variable and the roles of factors that influence the accuracy of those judgments are not clearly understood. One such factor is first impressions: that is, judgments about people we do not know, made quickly and based on very little information. This study explores the influence of first impressions in an OSCE...
November 15, 2016: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/27846187/classification-and-treatment-of-chronic-neck-pain-a-longitudinal-cohort-study
#13
Richard Liu, Connie Kurihara, Hue-Ting Tsai, Peter J Silvestri, Michael I Bennett, Paul F Pasquina, Steven P Cohen
BACKGROUND AND OBJECTIVES: Neck pain exerts a steep personal and socioeconomic toll, ranking as the fourth leading cause of disability. The principal determinant in treatment decisions is whether pain is neuropathic or nonneuropathic, as this affects treatment at all levels. Yet, no study has sought to classify neck pain in this manner. METHODS: One hundred participants referred to an urban, academic military treatment facility with a primary diagnosis of neck pain were enrolled and followed up for 6 months...
November 14, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27823694/design-and-rationale-for-the-acute-congestive-heart-failure-urgent-care-evaluation-the-acute-study
#14
Douglas S Lee, Jacques S Lee, Michael J Schull, Jeremy M Grimshaw, Peter C Austin, Jack V Tu
BACKGROUND: Heart failure (HF) is one of the leading reasons for emergency department (ED) visits and hospitalization. However, externally validated risk algorithms for acute prognostication of heart failure patients are not available. Thus, many low-risk patients are hospitalized and some high-risk patients are discharged home, which, in some cases, may lead to death. OBJECTIVES: The first objective of the ACUTE study is to perform a prospective validation of the Emergency Heart failure Mortality Risk Grade (EHMRG), which is a risk score derived to predict 7-day mortality in the ED setting...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27823686/how-well-does-physician-risk-assessment-predict-stroke-and-bleeding-in-atrial-fibrillation-results-from-the-outcomes-registry-for-better-informed-treatment-of-atrial-fibrillation-orbit-af
#15
Benjamin A Steinberg, Peter Shrader, Sunghee Kim, Laine Thomas, Gregg C Fonarow, Jack Ansell, Peter R Kowey, Daniel E Singer, Bernard J Gersh, Kenneth W Mahaffey, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Assessments of stroke and bleeding risks are essential to selecting oral anticoagulation in patients with atrial fibrillation (AF). We aimed to assess outcomes according to physician assessed risk, with comparison to empirical risk scores. METHODS: This was a prospective, observational study of 9,715 outpatients with AF enrolled in ORBIT-AF, a US national registry. Stroke and bleeding risks were quantified by physician assignment, CHADS2 and CHA2DS2-VASc stroke scores, and ATRIA and HAS-BLED bleeding scores...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27822928/factors-contributing-to-discordance-between-the-2011-acr-eular-criteria-and-physician-clinical-judgment-for-the-identification-of-remission-in-patients-with-rheumatoid-arthritis
#16
Yoon Kyoung Sung, Soo Kyung Cho, Dam Kim, Bo Young Yoon, Chan Bum Choi, Hoon Suk Cha, Jung Yoon Choe, Won Tae Chung, Seung Jae Hong, Jae Bum Jun, Young Mo Kang, Jinseok Kim, Tae Hwan Kim, Tae Jong Kim, Eunmi Koh, Choong Ki Lee, Jisoo Lee, Shin Seok Lee, Sung Won Lee, Hye Soon Lee, Yeon Ah Lee, Sung Hoon Park, Dae Hyun Yoo, Wan Hee Yoo, Sang Cheol Bae
Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database...
December 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27822087/the-danish-database-for-acute-and-emergency-hospital-contacts
#17
REVIEW
Annmarie T Lassen, Henrik Jørgensen, Hanne Blæhr Jørsboe, Annette Odby, Mikkel Brabrand, Jacob Steinmetz, Julie Mackenhauer, Hans Kirkegaard, Christian Fynbo Christiansen
AIM FOR DATABASE: Aim of the Danish database for acute and emergency hospital contacts (DDAEHC) is to monitor the quality of care for all unplanned hospital contacts in Denmark (acute and emergency contacts). STUDY POPULATION: The DDAEHC is a nationwide registry that completely covers all acute and emergency somatic hospital visits at individual level regardless of presentation site, presenting complaint, and department designation since January 1, 2013. MAIN VARIABLES: The DDAEHC includes ten quality indicators - of which two are outcome indicators and eight are process indicators...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27815703/development-of-an-activity-disease-score-in-patients-with-uveitis-uvedai
#18
Esperanza Pato, Mª Auxiliadora Martin-Martinez, Adela Castelló, Rosalía Méndez-Fernandez, Santiago Muñoz-Fernández, Miguel Cordero-Coma, Lucia Martinez-Costa, Elia Valls, Miguel Reyes, Félix Francisco, Mar Esteban, Alex Fonollosa, Fernando Sanchez-Alonso, Cruz Fernández-Espartero, Teresa Diaz-Valle, José Miguel Carrasco, Emma Beltran-Catalán, Marisa Hernández-Garfella, María Victoria Hernández, Laura Pelegrin, Ricardo Blanco, David Diaz-Valle
To develop a disease activity index for patients with uveitis (UVEDAI) encompassing the relevant domains of disease activity considered important among experts in this field. The steps for designing UVEDAI were: (a) Defining the construct and establishing the domains through a formal judgment of experts, (b) A two-round Delphi study with a panel of 15 experts to determine the relevant items, (c) Selection of items: A logistic regression model was developed that set ocular inflammatory activity as the dependent variable...
November 4, 2016: Rheumatology International
https://www.readbyqxmd.com/read/27804088/first-real-world-insights-into-belimumab-use-and-outcomes-in-routine-clinical-care-of-systemic-lupus-erythematosus-in-germany-results-from-the-observe-germany-study
#19
Andreas Schwarting, Johann O Schroeder, Tobias Alexander, Marc Schmalzing, Christoph Fiehn, Christof Specker, Alessandra Perna, Constanze Cholmakow-Bodechtel, Volker B Koscielny, Heike Carnarius
OBSErve Germany was the first observational study of belimumab as add-on treatment for systemic lupus erythematosus (SLE) in routine clinical care in Germany, retrospectively collecting data from 102 SLE patients, 6 months before and after belimumab initiation. Most patients had moderate or severe SLE and several SLE manifestations. After 6 months of belimumab treatment, 78% of patients showed an improvement in overall disease activity of at least 20% in their physician's judgment and for 42% of patients the improvement was at least 50%...
December 2016: Rheumatology and Therapy
https://www.readbyqxmd.com/read/27802505/diagnosis-of-gout-a-systematic-review-in-support-of-an-american-college-of-physicians-clinical-practice-guideline
#20
Sydne J Newberry, John D FitzGerald, Aneesa Motala, Marika Booth, Margaret A Maglione, Dan Han, Abdul Tariq, Claire E O'Hanlon, Roberta Shanman, Whitney Dudley, Paul G Shekelle
Background: Alternative strategies exist for diagnosing gout that do not rely solely on the documentation of monosodium urate (MSU) crystals. Purpose: To summarize evidence regarding the accuracy of clinical tests and classification algorithms compared with that of a reference standard of MSU crystals in joint aspirate for diagnosing gout. Data Sources: Several electronic databases from inception to 29 February 2016. Study Selection: 21 prospective cohort, cross-sectional, and case-control studies including participants with joint inflammation and no previous definitive gout diagnosis who had MSU analysis of joint aspirate...
November 1, 2016: Annals of Internal Medicine
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