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Physician judgment

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https://www.readbyqxmd.com/read/29242573/extremely-premature-birth-informed-written-consent-and-the-greek-ideal-of-sophrosyne
#1
Joseph W Kaempf, Kevin Dirksen
Most extremely premature infants die in the intensive care unit or suffer significant neurologic impairment. Many therapies result in unhealthy consequences, and the emotional and financial turmoil for families warrant reappraisal of our motives. Shared decision-making and informed consent in preference-sensitive conditions imply the family: (a) understands the medical problem, (b) grasps the risks and benefits of each therapy, (c) has the opportunity to ask questions and reflect upon options, (d) knows their values and preferences are understood, and (e) accepts or declines therapies without judgment or penalty...
December 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29223304/the-relationship-between-perceived-gender-judgment-and-well-being-among-surgical-residents
#2
Arghavan Salles, Laurel Milam, Geoffrey Cohen, Claudia Mueller
BACKGROUND: Physician well-being is a significant problem. Here we explore whether one factor, a resident's concern for being judged by one's gender, influences well-being. METHODS: Over two years at one institution, we surveyed surgical residents on validated measures of well-being as well as the extent to which they felt they were judged because of their gender (gender judgment). We used correlations and linear regression to investigate the relationships between gender judgment and well-being...
November 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29207217/-clinical-competence-in-nephrology-proposal-of-an-evaluation-pathway-and-definition-of-professional-levels
#3
Marco Formica, Sabrina Chiapello, Federico Marazzi, Daniela Falconi, Marita Marengo, Maurizio Gherzi, Fabio Tattoli, Ilaria Serra, Michela Tamagnone, Chiara Bottaro, Patrizia Garis, Grazia Maria Alberico
The need to assess clinical competencies in a medical environment is an intriguing issue due to progressive involvement of young physicians in clinical practice, as well as for connections tied to evaluation systems to define postgraduate training and career progression. To reach this goal, system must be based upon contributions that are aimed to achieve a clear and homogeneous evaluation pathway and strictly related to the continuing medical education institution (credits). All these presuppositions are instrumental for the proposal of a sheet which could allow a data retrieval useful to depict a career progression by means of: identification of reproducible parameters along with clear standards; advices for indicators; objective judgments that could drive to a score meaningful for reaching higher steps in the performance evaluation...
December 5, 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/29205262/perceptions-on-the-value-of-bodily-functions-in-multiple-sclerosis
#4
C Heesen, R Haase, S Melzig, J Poettgen, M Berghoff, P Friedemann, U Zettl, M Marziniak, K Angstwurm, R Kern, T Ziemssen, J P Stellmann
BACKGROUND: In neurological diseases presenting with a plethora of symptoms, the value of bodily functions for a given patient might be a guide for clinical management. Multiple sclerosis (MS) is paradigmatic in this respect, and little is known about the value of different bodily functions of patients and their physicians' perceptions. METHODS: In a multicenter study, 171 patients with relapsing-remitting multiple sclerosis (RRMS), 61% with a clinically active disease within the last 2 years were followed over up to 3 years and yearly patients and their study physician rated on the perceived value of 13 bodily functions via a priority list...
December 3, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/29201906/age-adjusted-d-dimer-in-the-prediction-of-pulmonary-embolism-does-a-normal-age-adjusted-d-dimer-rule-out-pe
#5
Jacob Ortiz, Rabia Saeed, Christopher Little, Saul Schaefer
Risk assessment for pulmonary embolism (PE) currently relies on physician judgment, clinical decision rules (CDR), and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA) at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0...
2017: BioMed Research International
https://www.readbyqxmd.com/read/29198543/exposure-to-gastric-acid-inhibitors-increases-the-risk-of-infection-in-preterm-very-low-birth-weight-infants-but-concomitant-administration-of-lactoferrin-counteracts-this-effect
#6
Paolo Manzoni, Ruben García Sánchez, Michael Meyer, Ilaria Stolfi, Lorenza Pugni, Hubert Messner, Silvia Cattani, Pasqua Maria Betta, Luigi Memo, Lidia Decembrino, Lina Bollani, Matteo Rinaldi, Maria Fioretti, Michele Quercia, Milena Maule, Elena Tavella, Alessandro Mussa, Chryssoula Tzialla, Nicola Laforgia, Fabio Mosca, Rosario Magaldi, Michael Mostert, Daniele Farina
OBJECTIVE: To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit. STUDY DESIGN: This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants...
November 30, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29177993/classification-of-hospital-admissions-into-emergency-and-elective-care-a-machine-learning-approach
#7
Jonas Krämer, Jonas Schreyögg, Reinhard Busse
Rising admissions from emergency departments (EDs) to hospitals are a primary concern for many healthcare systems. The issue of how to differentiate urgent admissions from non-urgent or even elective admissions is crucial. We aim to develop a model for classifying inpatient admissions based on a patient's primary diagnosis as either emergency care or elective care and predicting urgency as a numerical value. We use supervised machine learning techniques and train the model with physician-expert judgments. Our model is accurate (96%) and has a high area under the ROC curve (>...
November 25, 2017: Health Care Management Science
https://www.readbyqxmd.com/read/29162047/treatment-recommendations-within-the-leeway-of-clinical-guidelines-a-qualitative-interview-study-on-oncologists-clinical-deliberation
#8
I Otte, S Salloch, A Reinacher-Schick, J Vollmann
BACKGROUND: Recommending the optimal treatment for an individual patient requires a well-balanced consideration of various medical, social and ethical factors. The interplay of these factors, interpretation of the patient's situation and understanding of the existing clinical guidelines can lead to divergent therapy recommendations, depending on the attending physician. Gaining a better understanding of the individual process of medical decision-making and the differences occurring will support the delivery of optimal individualized care within the clinical setting...
November 21, 2017: BMC Cancer
https://www.readbyqxmd.com/read/29151544/-creation-and-evaluation-of-educational-programs-for-additional-delayed-scan-of-fdg-pet-ct
#9
Ryota Wada, Takashi Kamiya, Kouichi Fujino, Junpei Ueda, Kayako Isohashi, Mitsuaki Tatsumi, Jun Hatazawa
Generally, FDG-PET/CT image is acquired at the 60th minute after tracer administration. Depending on the clinical case, additional delayed scans may be useful. However, it is difficult to judge whether additional delayed scan is useful or not. The purposes of this study were creation and evaluation of educational programs to help radiological technologists to decide the usefulness of additional delayed scan of FDG-PET/CT. METHODS: Educational programs consisted of the instructional materials and the judgment test of clinical cases...
2017: Nihon Hoshasen Gijutsu Gakkai Zasshi
https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#10
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
#11
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
#12
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
#13
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
#14
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
#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...
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
#16
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
#17
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
#18
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
#19
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
#20
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
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