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Physician judgment

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https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#1
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29123339/hospital-workers-confidence-for-end-of-life-decisions-in-their-family-a-multicenter-study
#2
Monica Leon, Luis Omar Chavez, Sharon Einav, Joseph Varon
Aims: To study whether health-care workers feel capable of making resuscitation decisions for their own families, the confidence in their family to represent their own preferences, and if some health-care workers feel greater confidence in their ability to undertake such decisions for their family than others. Methods: An anonymous survey conducted among health-care workers of nine institutions in North and Central America. The self-administered questionnaire included demographic and professional characteristics, attitudes, personal preferences, and value judgments on the topic of resuscitation...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29111936/empowerment-failure-how-shortcomings-in-physician-communication-unwittingly-undermine-patient-autonomy
#3
Peter A Ubel, Karen A Scherr, Angela Fagerlin
Many health care decisions depend not only upon medical facts, but also on value judgments-patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of medical decision making effectively promotes patients' health care goals...
November 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/29107948/assessment-of-pleural-air-leakage-using-digital-chest-drainage-system-after-surgical-pulmonary-resection-comparison-of-visible-alveolar-air-leakage-with-the-digital-value-measured-by-a-digital-chest-drainage-system
#4
Ryo Mori, Koji Yamazaki, Fumihiro Shoji, Hidenori Kouso, Chie Ushijima, Naoko Miura, Tomoyoshi Takenaka, Sadanori Takeo
BACKGROUND: The sensitivity of postoperative pleural air leakage (PAL) after pulmonary resection is evaluated by a simple subjective grading method in clinical practice. A new electronic digital chest drainage evaluation system (DCS) recently became clinically available. This study was designed to evaluate the clinical application of the DCS in monitoring the airflow volume and managing postoperative PAL. METHODS: We prospectively enrolled 25 patients who underwent pulmonary resection...
2017: PloS One
https://www.readbyqxmd.com/read/29099239/physician-approaches-to-conflict-with-families-surrounding-end-of-life-decision-making-in-the-icu-a-qualitative-study
#5
Hashim M Mehter, Jessica B McCannon, Jack A Clark, Renda Soylemez Wiener
RATIONALE: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. OBJECTIVES: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making...
November 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29091230/2017-hiv-medicine-association-of-infectious-diseases-society-of-america-clinical-practice-guideline-for-the-management-of-chronic-pain-in-patients-living-with-human-immunodeficiency-virus
#6
R Douglas Bruce, Jessica Merlin, Paula J Lum, Ebtesam Ahmed, Carla Alexander, Amanda H Corbett, Kathleen Foley, Kate Leonard, Glenn Jordan Treisman, Peter Selwyn
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population...
October 30, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29084070/utility-of-soft-tissue-lateral-neck-radiographs-in-the-emergency-department-the-5-year-experience-of-a-large-tertiary-care-pediatric-hospital
#7
Tais Sao Pedro, Dennis Scolnik, Jeffrey Traubici, Derek Stephens
INTRODUCTION: Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. OBJECTIVE: The aim of this study was to review the experience of a large tertiary care pediatric emergency department (ED) in using lateral soft tissue neck radiographs in the diagnosis of suspected RPI...
October 27, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29080001/the-relevance-of-the-hippocratic-oath-to-the-ethical-and-moral-values-of-contemporary-medicine-part-i-the-hippocratic-oath-from-antiquity-to-modern-times
#8
REVIEW
Helen Askitopoulou, Antoniοs N Vgontzas
The present paper discusses the relevance and significance of the Hippocratic Oath to contemporary medical ethical and moral values. It attempts to answer the questions about some controversial issues related to the Oath. The text is divided in two parts. Part I discusses the general attributes and ethical values of the Oath, while Part II presents a detailed analysis of each passage of the Oath with regard to perennial ethical principles and moral values. Part I starts with the contribution of Hippocrates and his School of Cos to medicine...
October 27, 2017: European Spine Journal
https://www.readbyqxmd.com/read/29075996/comparison-between-performance-of-single-fiber-reflectance-spectroscopy-sfrs-system-and-colposcopy-a-phase-iii-trial
#9
Sanaz Hariri Tabrizi, Farah Farzaneh, Seyed Mahmoud Reza Aghamiri, Maliheh Arab, Maryamsadat Hosseini, Tahereh Ashrafganjoei, Mohammad Chehrazi
Herein, the performance of single-fiber reflectance spectroscopy (SFRS) in detection of cervical pre-cancerous squamous intraepithelial lesions (SIL) was compared with colposcopy. Based on the previous results obtained from 167 samples and finding the contributing parameters in differentiating SILs from non-SILs, a user-friendly interface was developed to detect the SILs using SFRS system. Detection of SILs in 301 patients was performed by both SFRS system and routine colposcopy. In addition to physician-determined sites, four quarters of the cervix were measured by SFRS system and suspicious lesions detected by either method were biopsied...
December 2017: Lasers in Medical Science
https://www.readbyqxmd.com/read/29049239/clinical-features-and-diagnosis-of-chronic-pulmonary-aspergillosis-in-chinese-patients
#10
Xiaomeng Hou, Hong Zhang, Lei Kou, Wei Lv, Jingjing Lu, Ji Li
Chronic pulmonary aspergillosis (CPA) has recently been recognized as a significant global health burden. In China, the diagnosis of CPA is still unfamiliar to most doctors. The aim of this study was to demonstrate the clinical manifestations and diagnoses of CPA in China.A multidisciplinary team of doctors retrospectively screened 690 records of patients diagnosed with pulmonary aspergillosis from January 2000 to December 2016 at Peking Union Medical College Hospital, Beijing, China. Of these, 69 patients were diagnosed with CPA...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29049120/a-contemporary-medicolegal-analysis-of-outpatient-medication-management-in-chronic-pain
#11
Christopher R Abrecht, Ethan Y Brovman, Penny Greenberg, Ellen Song, James P Rathmell, Richard D Urman
BACKGROUND: Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO)...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29040244/a-prospective-study-of-the-causes-of-bruises-in-premobile-infants
#12
Kenneth W Feldman, Tricia M Tayama, Leslie E Strickler, Lee A Johnson, Gauri Kolhatkar, Catherine A DeRidder, Dana C Matthews, Robert Sidbury, James A Taylor
OBJECTIVE: This study had 2 objectives. First, to determine the behavior of physicians evaluating premobile infants with bruises. Second, and most importantly, to learn whether infants with unexplained bruising who had been initially evaluated by primary care and emergency department (ED) physicians are as likely to have their bruises attributed to child abuse as those children evaluated by child abuse physicians. METHODS: Primary care, ED, and child abuse pediatricians (CAPs) in King County, Washington, San Mateo, Calif, Albuquerque, NM, La Crosse, Wis, and Torrance, Calif prospectively identified and studied infants younger than 6 months with less than 6 bruises, which were judged by the evaluating clinician to be explained or unexplained after their initial clinical examination...
October 16, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29028465/cultivating-humility-and-diagnostic-openness-in-clinical-judgment
#13
John R Stone
In this case, a physician rejects a patient's concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician's judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient's suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29026507/face-and-content-validity-of-the-macarthur-competence-assessment-tool-for-the-treatment-of-iranian-patients
#14
Ali Saber, Seyed Mahmoud Tabatabaei, Godarz Akasheh, Mojtaba Sehat, Zahra Zanjani, Bagher Larijani
BACKGROUND: There is not a valid Persian tool for measuring the decision-making competency of patients. The aim of this study is to evaluate the face and content validity of the MacArthur Competence Assessment Tool for the treatment of Iranian Persian-speaking patients. METHODS: To assess the validity of the Persian version of the tool, a self-administrated questionnaire was designed. The Lawshe method was also used for assessing each item. Content validity ratio (CVR) and content validity index (CVI) were used to assess the content validity quantitatively...
2017: International Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29020263/2017-hivma-of-idsa-clinical-practice-guideline-for-the-management-of-chronic-pain-in-patients-living-with-hiv
#15
R Douglas Bruce, Jessica Merlin, Paula J Lum, Ebtesam Ahmed, Carla Alexander, Amanda H Corbett, Kathleen Foley, Kate Leonard, Glenn Jordan Treisman, Peter Selwyn
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population...
September 14, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29019063/statin-prescribing-in-the-elderly-special-considerations
#16
REVIEW
M Leya, N J Stone
PURPOSE OF REVIEW: Our aim was to examine the current evidence behind prescribing statins to individuals over 65 years of age with emphasis on those older than 75. Individuals over 75 years of age may often have multiple comorbidities and take many medications. Additionally, they are often underrepresented in randomized controlled trials (RCTs) of statins in older populations. While results of RCTs demonstrate the benefit of statin therapy in both primary and secondary prevention patients, clinicians must more carefully consider adverse effects and drug-drug interactions before prescribing statin therapy as well as determining the intensity in older individuals...
October 11, 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28975242/ethics-and-the-legalization-of-physician-assisted-suicide-an-american-college-of-physicians-position-paper
#17
Lois Snyder Sulmasy, Paul S Mueller
Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end...
October 17, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28968901/general-practitioners-perspective-on-poverty-a-qualitative-study-in-montreal-canada
#18
Christine Loignon, Thomas Gottin, Sophie Dupéré, Christophe Bedos
Background: Social inequalities in healthcare systems persist worldwide. Physicians' prejudices and negative attitudes towards people living in poverty are one of the determinants of healthcare inequalities. We know very little about general practitioners' (GPs) perceptions of poverty, which shape their attitudes. Objective: To identify the perceptions of poverty of GPs who deal with it in everyday practice. Methods: A qualitative study based on interviews with GPs working in deprived urban neighbourhoods...
August 24, 2017: Family Practice
https://www.readbyqxmd.com/read/28967729/how-to-define-the-relative-contraindications-to-oral-anticoagulant-therapy
#19
Roberto F E Pedretti
There is currently a lack of consensus on which anticoagulant therapy contraindications should be considered "absolute" and which should be considered "relative". Guidelines do not clearly identify absolute and relative contraindications to anticoagulant therapy. Recent guidelines on AF of the European Society of Cardiology underline the relevance of several factors and their use in scores, leaving anyway space to the clinical judgment of the physician. A high bleeding risk score should generally not result per se in a contraindication to anticoagulant therapy...
August 28, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28960240/elder-friendly-emergency-department-development-and-validation-of-a-quality-assessment-tool
#20
Jane McCusker, T T Minh Vu, Nathalie Veillette, Sylvie Cossette, Alain Vadeboncoeur, Antonio Ciampi, Deniz Cetin-Sahin, Eric Belzile
OBJECTIVES: To develop and validate a comprehensive quality assessment tool for emergency department (ED) geriatric care. DESIGN: Four-step study: (1) Content development of tool by a multidisciplinary panel, (2) survey of ED lead physicians and nurses, (3) development of subscales using principal component analysis and clinical judgment, (4) reliability and validity assessment. SETTING: Province of Quebec, Canada. PARTICIPANTS: Lead ED nurses and physicians at 76 Quebec EDs who participated in a 2013/14 survey (66% of 116 adult nonpsychiatric EDs in the province)...
September 27, 2017: Journal of the American Geriatrics Society
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