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Physician judgment

James M West
Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Anita H Clayton, Sheryl A Kingsberg, Irwin Goldstein
INTRODUCTION: Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients. AIM: To review the diagnosis and evidence-based treatment of low sexual desire in women with a focus on strategies that can be used efficiently and effectively in the clinic...
March 6, 2018: Sexual Medicine
Thomas R Radomski, Felicia R Bixler, Susan L Zickmund, KatieLynn M Roman, Carolyn T Thorpe, Jennifer A Hale, Florentina E Sileanu, Leslie R M Hausmann, Joshua M Thorpe, Katie J Suda, Kevin T Stroupe, Adam J Gordon, Chester B Good, Michael J Fine, Walid F Gellad
BACKGROUND: The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. OBJECTIVE: To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers...
March 8, 2018: Journal of General Internal Medicine
Ji Yun Jung, So Yoon Kim, Dong Gyu Kim, Choong Bai Kim, Kyong-Choun Chi, Won Kyung Kang, Won Lee
Purpose: The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. Methods: A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion...
March 2018: Annals of Surgical Treatment and Research
Francesca Trentin, Mariele Gatto, Margherita Zen, Larosa Maddalena, Linda Nalotto, Francesca Saccon, Elisabetta Zanatta, Luca Iaccarino, Andrea Doria
To date, belimumab is the only biological drug approved for the treatment of patients with active refractory SLE. We compared and critically analyzed the results of 11 observational clinical-practice-based studies, conducted in SLE referral centers. Despite the differences in endpoints and follow-up duration, all studies remarked that belimumab provides additional benefits when used as an add-on to existing treatment, allowing a higher rate of patients to reach remission and to taper or discontinue corticosteroids...
March 6, 2018: Clinical Reviews in Allergy & Immunology
Amitha Kalaichandran, Nick Barrowman, Jason Chan, Karine Toupin-April, Sunita Vohra, Roger Zemek
Background and Objectives: Up to one-half of children may use complementary health approaches (CHA). However, current prevalence in North America, variables associated with CHA use and caregiver perceptions of effectiveness are unclear. We aimed to determine the self-reported use of CHA during the previous 12 months in paediatric patients, demographic variables associated with CHA use and perceptions around effectiveness of CHA. Methods: A cross-sectional survey study of patients aged between 28 days and 18 years who presented to a large paediatric emergency department was conducted between December 2014 and July 2015...
February 2018: Paediatrics & Child Health
Jiong Qin, Yi Wang, Xin-Fang Huang, Yu-Qin Zhang, Fang Fang, Yin-Bo Chen, Zhong-Dong Lin, Yan-Chun Deng, Fei Yin, Li Jiang, Ye Wu, Xiang-Shu Hu
BACKGROUND: This study aimed to assess efficacy and safety of oxcarbazepine (OXC) oral suspension in pediatric patients aged 2-5 years with partial seizures (PS) and/or generalized tonic-clonic seizures (GTCS) in real-world clinical practice in China. METHODS: This 26-week, prospective, single-arm, multicenter, observational study recruited pediatric patients aged 2-5 years with PS or GTCS suitable for OXC oral suspension treatment based on physicians' judgments from 11 medical centers in China...
February 20, 2018: World Journal of Pediatrics: WJP
SuHwan Shin, Seung Gyeong Jang, KyeongTae Min, Won Lee, So Yoon Kim
BACKGROUND: Complex regional pain syndrome (CRPS) involves severe pain and it is difficult to identify the exact cause or pathogenesis. Therefore, there are controversies regarding legal issues related to the establishment of damage in medical malpractice lawsuits involving CRPS. This study aimed to analyze malpractice lawsuits involving CRPS, which occurred after the disputed medical treatment, to provide information on the courts' opinion and characteristics of the cases. METHODS: This study analyzed 23 lawsuit judgments involving CRPS that were sentenced from 2005 to 2015...
February 26, 2018: Journal of Korean Medical Science
Ying Shen, Kaiqi Yuan, Daoyuan Chen, Joël Colloc, Min Yang, Yaliang Li, Kai Lei
BACKGROUND: The available antibiotic decision-making systems were developed from a physician's perspective. However, because infectious diseases are common, many patients desire access to knowledge via a search engine. Although the use of antibiotics should, in principle, be subject to a doctor's advice, many patients take them without authorization, and some people cannot easily or rapidly consult a doctor. In such cases, a reliable antibiotic prescription support system is needed. METHODS AND RESULTS: This study describes the construction and optimization of the sensitivity and specificity of a decision support system named IDDAP, which is based on ontologies for infectious disease diagnosis and antibiotic therapy...
February 9, 2018: Artificial Intelligence in Medicine
Alastair J Moore, Rachel M Mercer, Ali I Musani
Much has changed since the last review of interventional pulmonology (IP) published in this Clinics series. The rate of development of new techniques and their complexities require IP physicians to be constantly maintaining and updating their skill set. International agreed training pathways help ensure that the interventionalists of the present and future have the required knowledge of anatomy, manual dexterity, and clinical judgment to keep up with the continuing advances that are constantly expanding IP's diagnostic and therapeutic boundaries...
March 2018: Clinics in Chest Medicine
Joseph P Ornato, Tammy Nguyen, Peter Moffett, Stephen Miller, Michael J Vitto, David Evans, Alan Payne, Kathy Baker, Mary Schaeffer
BACKGROUND: Little is known about hemodynamics in adult, out-of-hospital (OHCA) patients following return of spontaneous circulation (ROSC). A 1994 study when "high-dose epinephrine" use was common showed consistently elevated systemic vascular resistance (SVR) lasting ≥6 hours in 49 adult patients after return of spontaneous circulation (ROSC). STUDY AIM: To characterize hemodynamic abnormalities in adult OHCA patients soon after ROSC. Our hypothesis was that, unlike the consistently high SVR values reported when "high-dose" epinephrine was in common use, there would be a more heterogenous distribution of SVR values using current adrenergic therapy...
February 6, 2018: Resuscitation
Yuan Li, Dong Gao, Weibo Liang, Lirong Qiu, Xin Liu, Lin Zhang, Zhenhua Deng
OBJECTIVE: An analysis of malpractice lawsuits judged in court compared with those mediated in court may help explain perceptions of malpractice risk. METHODS: We conducted a retrospective study of malpractice lawsuits mediated and judged in court using data from district courts in Beijing from 2010 through 2014. We evaluated the number of cases, the payment amount, and the time to resolution, by resolution type. Patient age, sex, the severity of injury, and adverse event type were measured...
January 30, 2018: Journal of Forensic and Legal Medicine
Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R Warix
BACKGROUND: Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia. OBJECTIVE: This review evaluates recent literature and addresses ED considerations in the management of AF. DISCUSSION: Emergency physicians should first assess patient clinical stability and evaluate and treat reversible causes...
January 30, 2018: American Journal of Emergency Medicine
Jason L Vassy, J Kelly Davis, Christine Kirby, Ian J Richardson, Robert C Green, Amy L McGuire, Peter A Ubel
BACKGROUND: Genomics will play an increasingly prominent role in clinical medicine. OBJECTIVE: To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. DESIGN: Qualitative analysis. PARTICIPANTS: PCPs and their generally healthy patients undergoing genome sequencing. APPROACH: Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits...
January 26, 2018: Journal of General Internal Medicine
John T Chibnall, Raymond C Tait, Julie K Gammack
Objective: In a moderated mediation model, this study examined the interaction effect of pain severity and medical evidence on physician judgments of chronic pain. The effects of higher pain severity on physician judgments were expected to be mediated through anticipated clinical burden, but only when medical evidence was low. Design: Participants were randomly assigned to one of six case descriptions of a chronic pain patient in a 3 × 2 design that varied by reported pain severity (4, 6, 8/10) and medical evidence (low vs high)...
January 19, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Michelle Bowdler, Hannah Kent
Physicians must remain vigilant about their ethical duties to patients, especially in high-stakes situations. The question raised by this case-whether a physician should comply with a parent's demand for treatment against her underage child's wishes-is not one of life or death in which a guardian might more credibly argue her judgment should stand. Given that forcing a rape kit exam on a patient who refuses to give assent could be further traumatizing, we argue that the physician should not comply. Deciding upon a course of action in this situation will involve considering what is in the patient's best interest and what constitutes a physician's appropriate role in gathering evidence for criminal investigations...
January 1, 2018: AMA Journal of Ethics
Amy Barnhorst, Garen Wintemute, Marian E Betz
Mandatory reporting of persons believed to be at imminent risk for committing violence or attempting suicide can pose an ethical dilemma for physicians, who might find themselves struggling to balance various conflicting interests. Legal statutes dictate general scenarios that require mandatory reporting to supersede confidentiality requirements, but physicians must use clinical judgment to determine whether and when a particular case meets the requirement. In situations in which it is not clear whether reporting is legally required, the situation should be analyzed for its benefit to the patient and to public safety...
January 1, 2018: AMA Journal of Ethics
Nazzareno Fagoni, Simone Piva, Elena Peli, Fabio Turla, Elisabetta Pecci, Livio Gualdoni, Bertilla Fiorese, Frank Rasulo, Nicola Latronico
BACKGROUND: Weaning protocols expedite extubation in mechanically ventilated patients, yet the literature investigating the application in tracheostomized patients remains scarce. The primary objective of this parallel randomized controlled pilot trial (RCT) was to assess the feasibility and safety of a nurse-led weaning protocol (protocol) compared to weaning based on physician's clinical judgment (control) in tracheostomized critically ill patients. RESULTS: We enrolled 65 patients, 27 were in the protocol group and 38 in the control group...
January 22, 2018: Annals of Intensive Care
Michele L McCarroll, Rami A Ahmed, Alan Schwartz, Michael David Gothard, Steven Scott Atkinson, Patrick Hughes, Jose Cepeda Brito, Lori Assad, Jerry Myers, Richard L George
Background: The National Aeronautics and Space Administration (NASA) developed plans for potential emergency conditions from the Exploration Medical Conditions List. In an effort to mitigate conditions on the Exploration Medical Conditions List, NASA implemented a crew medical officer (CMO) designation for eligible astronauts. This pilot study aims to add knowledge that could be used in the Integrated Medical Model. Methods: An analogue population was recruited for two categories: administrative physicians (AP) representing the physician CMOs and technical professionals (TP) representing the non-physician CMOs...
October 2017: BMJ Simul Technol Enhanc Learn
James Granfortuna, Kaye Shoffner, Stephen E DePasquale, Sejal Badre, Chet Bohac, Cisio De Oliveira Brandao
PURPOSE: The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient's cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA. METHODS: Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10...
January 19, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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