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Physician judgment

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https://www.readbyqxmd.com/read/28931621/minimal-clinically-important-difference-for-safe-and-simple-novel-acute-ischemic-stroke-therapies
#1
Jessica S Cranston, Brett D Kaplan, Jeffrey L Saver
BACKGROUND AND PURPOSE: Determining the minimal clinically important difference (MCID) is essential for evaluating novel therapies. For acute ischemic stroke, expert surveys have yielded MCIDs that are substantially higher than the MCIDs observed in actual expert behavior in guideline writing and clinical practice, potentially because of anchoring bias. METHODS: We administered a structured, internet-based survey to a cross-section of academic stroke neurologists in the United States...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28904153/imaging-and-diagnosis-of-physical-child-abuse
#2
Marlene M Johnson
Child abuse involves grave and disturbing acts of violence that can have lasting physical and emotional consequences for children and their families. The diagnosis of child abuse is emotionally difficult for those involved, and an error in judgment either way can have a detrimental effect on the health and safety of the child. Physicians rely on the skills of the imaging team to produce high-quality images that assist in differentiating inflicted injuries from accidental trauma. This article explores the significance of imaging in child abuse by discussing the types of injuries that occur and the imaging studies that aid in diagnosing physical child abuse...
September 2017: Radiologic Technology
https://www.readbyqxmd.com/read/28891842/the-american-society-of-colon-and-rectal-surgeons-clinical-practice-guidelines-for-the-treatment-of-colon-cancer
#3
Jon D Vogel, Cagla Eskicioglu, Martin R Weiser, Daniel L Feingold, Scott R Steele
The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus...
October 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28888853/monitoring-guidance-for-patients-with-hypophosphatasia-treated-with-asfotase-alfa
#4
REVIEW
Priya S Kishnani, Eric T Rush, Paul Arundel, Nick Bishop, Kathryn Dahir, William Fraser, Paul Harmatz, Agnès Linglart, Craig F Munns, Mark E Nunes, Howard M Saal, Lothar Seefried, Keiichi Ozono
Hypophosphatasia (HPP) is a rare, inherited, systemic, metabolic disorder caused by autosomal recessive mutations or a single dominant-negative mutation in the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). The disease is associated with a broad range of signs, symptoms, and complications, including impaired skeletal mineralization, altered calcium and phosphate metabolism, recurrent fractures, pain, respiratory problems, impaired growth and mobility, premature tooth loss, developmental delay, and seizures...
July 25, 2017: Molecular Genetics and Metabolism
https://www.readbyqxmd.com/read/28879791/incorporation-of-pcsk9-inhibitors-into-prevention-of-atherosclerotic-cardiovascular-disease
#5
Cezary Wójcik
Primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has become recently more complex than ever, leaving the clinicians perplexed with outdated guidelines and emerging evidence about new LDL-C lowering therapies. 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have focused on high intensity statin therapy for specific groups of patients, while abandoning long established LDL-C goals, a strategy which no longer seems valid. PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors have emerged as the add-on therapy on top of statins and/or ezetimibe for the treatment of hypercholesterolemia and ASCVD prevention...
September 7, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28879545/real-life-use-of-onabotulinumtoxina-for-symptom-relief-in-patients-with-chronic-migraine-repose-study-methodology-and-baseline-data
#6
Brendan Davies, Charly Gaul, Paolo Martelletti, Juan Carlos García-Moncó, Stephanie Brown
BACKGROUND: Migraine is a debilitating neurological disorder that affects 14.1% of the US and 14.7% of the European populations. Chronic migraine (CM) is broadly defined as headache occurring on ≥15 days per month for ≥3 months, and has an estimated worldwide prevalence of 1.4% to 2.2%. OnabotulinumtoxinA is currently approved for the treatment of CM in most European countries, and is the only preventative treatment approved for adults with CM, based on results from the PREEMPT clinical trial programme...
September 6, 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28873121/truth-telling-in-the-setting-of-cultural-differences-and-incurable-pediatric-illness-a-review
#7
Abby R Rosenberg, Helene Starks, Yoram Unguru, Chris Feudtner, Douglas Diekema
Importance: Navigating requests from parents or family caregivers not to disclose poor prognosis to seriously ill children can be challenging, especially when the requests seem culturally mediated. Pediatric clinicians must balance obligations to respect individual patient autonomy, professional truth telling, and tolerance of multicultural values. Observations: To provide suggestions for respectful and ethically appropriate responses to nondisclosure requests, we used a hypothetical case example of a Middle Eastern adolescent patient with incurable cancer and conducted an ethical analysis incorporating (1) evidence from both Western and Middle Eastern medical literature and (2) theories of cultural relativism and justice...
September 5, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28866900/patient-preference-for-stereotactic-radiosurgery-plus-or-minus-whole-brain-radiotherapy-for-the-treatment-of-brain-metastases
#8
K Liang Zeng, Srinivas Raman, Arjun Sahgal, Hany Soliman, May Tsao, Carole Wendzicki, Edward Chow, Simon S Lo
BACKGROUND: Optimal management for limited, non-resectable brain metastases is an evolving area in radiation oncology. Previous data show no difference in survival between stereotactic radiosurgery (SRS) and SRS plus whole-brain radiotherapy (WBRT). Neurocognitive toxicities, treatment duration and tumor recurrence differ and therefore patient values play an important role in decision making. We aim to elicit patient preferences and understand factors important in deciding which treatment to pursue...
August 8, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28858696/social-support-flexible-resources-and-health-care-navigation
#9
Elizabeth A Gage-Bouchard
Recent research has focused attention on the role of patients' and clinicians' cultural skills and values in generating inequalities in health care experiences. Yet, examination of how social structural factors shape people's abilities to build, refine, and leverage strategies for navigating the health care system have received less attention. In this paper I place focus on one such social structural factor, social support, and examine how social support operates as a flexible resource that helps people navigate the health care system...
August 18, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28857614/attitudes-about-when-and-how-to-treat-patients-with-al-amyloidosis-an-international-survey
#10
Paolo Milani, Morie A Gertz, Giampaolo Merlini, Angela Dispenzieri
The aim of this survey was to describe the treatment decision making of expert physicians in when and how to treat patients with AL amyloidosis. Fifty amyloid expert physicians completed the survey. Autologous stem cell transplant (ASCT) was considered the first line therapy, if medically feasible, by 73% of the physicians. Excluding ASCT, cyclophosphamide-bortezomib-dexamethasone regimen was the preferred strategy by 72%. Depending on organ involvement, the goal for treatment was CR for 27-35% and very good partial response (VGPR) for 65-72%...
August 31, 2017: Amyloid: the International Journal of Experimental and Clinical Investigation
https://www.readbyqxmd.com/read/28818632/the-views-of-clergy-regarding-ethical-controversies-in-care-at-the-end-of-life
#11
Michael J Balboni, Adam Sullivan, Patrick T Smith, Danish Zaidi, Christine Mitchell, James A Tulsky, Daniel Sulmasy, Tyler J VanderWeele, Tracy A Balboni
CONTEXT: While religion often informs ethical judgments, little is known about the views of American clergy regarding controversial end-of-life ethical issues including allowing to die and physician-aid in dying or physician-assisted suicide (PAD/PAS). OBJECTIVE: To describe the views of U.S. clergy concerning allowing to die and PAD/PAS. METHODS: A survey was mailed to 1665 nationally representative clergy between 8/2014 to 3/2015 (60% response rate)...
August 14, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28802925/objective-measurement-and-monitoring-of-nonmotor-symptoms-in-parkinson-s-disease
#12
Lisa Klingelhoefer, Onanong Jitkritsadakul, Roongroj Bhidayasiri
The comprehensive evaluation of nonmotor symptoms (NMS) in Parkinson's disease (PD) starts with the awareness of physicians, patients, and caregivers on their nature, clinical presentation, and effect on patient's daily activities and quality of life. This awareness can be better achieved if the symptoms can be visualized, measured, and monitored. As NMS are largely subjective in nature, a majority of them cannot be visualized (unlike tremor, which is easily seen), making their identification and quantification difficult...
2017: International Review of Neurobiology
https://www.readbyqxmd.com/read/28802364/the-reliability-of-flexible-nasolaryngoscopy-in-the-identification-of-vocal-fold-movement-impairment-in-young-infants
#13
Yi-Chun Carol Liu, Tyler McElwee, Mary Musso, Tara L Rosenberg, Julina Ongkasuwan
OBJECTIVE: Flexible nasolaryngoscopy (FNL) is considered the gold standard for evaluation of vocal fold mobility but there has been no data on the reliability of interpretation in the infant population. Visualization may be limited by excessive movement, secretions, or floppy supraglottic structures that prevent accurate diagnosis of vocal fold movement impairment (VFMI). We sought to evaluate the inter- and intra-rater reliability of FNL for the evaluation of VFMI in young infants. STUDY TYPE: Case-control...
September 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28782058/consistency-of-brca1-and-brca2-variant-classifications-among-clinical-diagnostic-laboratories
#14
Stephen E Lincoln, Shan Yang, Melissa S Cline, Yuya Kobayashi, Can Zhang, Scott Topper, David Haussler, Benedict Paten, Robert L Nussbaum
BACKGROUND: Genetic tests of the cancer predisposition genes BRCA1 and BRCA2 inform significant clinical decisions for both physicians and patients. Most uncovered variants are benign, and determining which few are pathogenic (disease-causing) is sometimes challenging and can potentially be inconsistent among laboratories. The ClinVar database makes de-identified clinical variant classifications from multiple laboratories publicly available for comparison and review, per recommendations of the American Medical Association (AMA), the American College of Medical Genetics (ACMG), the National Society for Genetic Counselors (NSGC), and other organizations...
July 2017: JCO Precis Oncol
https://www.readbyqxmd.com/read/28756147/defining-and-measuring-decision-making-for-the-management-of-trauma-patients
#15
Amin Madani, Amanda Gips, Tarek Razek, Dan L Deckelbaum, David S Mulder, Jeremy R Grushka
BACKGROUND: Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. METHODS: Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance...
July 26, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28745210/variability-in-threshold-for-medication-error-reporting-between-physicians-nurses-pharmacists-and-families
#16
Patricia Keefer, Kelley Kidwell, Candace Lengyel, Kavita Warrier, Deborah Wagner
BACKGROUND: Voluntary medication error reporting is an imperfect resource used to improve the quality of medication administration. It requires judgment by front-line staff to determine how to report enough to identify opportunities to improve patient safety but not jeopardize that safety by creating a culture of "report fatigue." OBJECTIVE: This study aims to provide information on interpretability of medication error and the variability between subgroups of caregivers in the hospital setting...
July 24, 2017: Current Drug Safety
https://www.readbyqxmd.com/read/28744847/factors-considered-by-clinicians-when-prognosticating-intracerebral-hemorrhage-outcomes
#17
David Y Hwang, Stacy Y Chu, Cameron A Dell, Mary J Sparks, Tiffany D Watson, Carl D Langefeld, Mary E Comeau, Jonathan Rosand, Thomas W K Battey, Sebastian Koch, Mario L Perez, Michael L James, Jessica McFarlin, Jennifer L Osborne, Daniel Woo, Steven J Kittner, Kevin N Sheth
BACKGROUND: The early subjective clinical judgment of clinicians outperforms formal prognostic scales for accurate determination of outcome after intracerebral hemorrhage (ICH), with the judgment of physicians and nurses having equivalent accuracy. This study assessed specific decisional factors that physicians and nurses incorporate into early predictions of functional outcome. METHODS: This prospective observational study enrolled 121 ICH patients at five US centers...
July 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28743987/empathy-for-others-suffering-and-its-mediators-in-mental-health-professionals
#18
Hernando Santamaría-García, Sandra Baez, Adolfo M García, Daniel Flichtentrei, María Prats, Ricardo Mastandueno, Mariano Sigman, Diana Matallana, Marcelo Cetkovich, Agustín Ibáñez
Empathy is a complex cognitive and affective process that allows humans to experience concern for others, comprehend their emotions, and eventually help them. In addition to studies with healthy subjects and various neuropsychiatric populations, a few reports have examined this domain focusing on mental health workers, whose daily work requires the development of a saliently empathic character. Building on this research line, the present population-based study aimed to (a) assess different dimensions of empathy for pain in mental health workers relative to general-physicians and non-medical workers; and (b) evaluate their relationship with relevant factors, such as moral profile, age, gender, years of experience, and workplace type...
July 25, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28740667/discordance-of-physician-clinical-judgment-vs-pneumonia-severity-index-psi-score-to-admit-patients-with-low-risk-community-acquired-pneumonia-a-prospective-multicenter-study
#19
Pedro J Marcos, Marcos I Restrepo, Francisco J González-Barcala, Nilam J Soni, Iria Vidal, Pilar Sanjuàn, Diego Llinares, Lucía Ferreira-Gonzalez, Carlos Rábade, Isabel Otero-González, Pedro Marcos, Héctor Verea-Hernando
BACKGROUND: The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. METHODS: An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28718756/stereotypes-influence-destination-memory-in-normal-aging
#20
Mohamad El Haj
Background/Study Context: A substantial body of literature suggests that stereotypes can play a determining role in making judgments about the source of information. This study investigated this issue for destination memory or remembering to whom information has been previously told. METHODS: Younger adults and older adults told six medical and six mechanical facts to a picture depicting a physician, and also told six different medical and six different mechanical facts to a picture depicting a mechanic...
July 2017: Experimental Aging Research
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