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Physician judgment

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https://www.readbyqxmd.com/read/28493614/accuracy-of-physical-exam-ankle-brachial-index-and-ultrasonography-in-the-diagnosis-of-arterial-injury-in-patients-with-penetrating-extremity-trauma-a-systematic-review-and-meta-analysis
#1
Ian S deSouza, Roshanak Benabbas, Sean McKee, Bardiya Zangbar, Ashika Jain, Lorenzo Paladino, Leon Boudourakis, Richard Sinert
BACKGROUND: Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Accurate and timely diagnosis is vital to enable potential intervention and prevent significant morbidity. OBJECTIVES: Using a systematic review/meta-analysis approach, we determined the utility of Physical Examination (exam), Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in ED patients who have sustained PET...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28475276/cytokine-biomarkers-of-disease-activity-and-therapeutic-response-after-initiating-methotrexate-therapy-in-patients-with-juvenile-idiopathic-arthritis
#2
Ryan S Funk, Marcia A Chan, Mara L Becker
STUDY OBJECTIVE: To evaluate the relationship between plasma cytokine levels with disease activity and therapeutic response in patients with juvenile idiopathic arthritis after initiating methotrexate (MTX) therapy. DESIGN: Single-center, observational, prospective cohort study. SETTING: Outpatient pediatric rheumatology clinic at a tertiary care academic pediatric hospital. PATIENTS: Sixty-one patients diagnosed with juvenile idiopathic arthritis who started therapy with standard-dose methotrexate (MTX) 15 mg/m(2) /week; at 3 months, treating physicians were given the option of maintaining the MTX dose, increasing the MTX dose, or adding etanercept, based on their clinical judgment...
May 5, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28473004/the-attitudes-of-family-physicians-toward-a-child-with-delayed-growth-and-development
#3
Servet Aker, Mustafa Kürşat Şahin, Ömer Kınalı, Elif Şimşek Karadağ, Tuğba Korkmaz
Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development. BACKGROUND: Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning. METHODS: This descriptive study was performed in Samsun, Turkey, in May and June 2015...
May 5, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28469985/are-these-results-trustworthy-a-guide-for-reading-the-medical-literature
#4
REVIEW
Fares Alahdab, Allison Morrow, Mouaz Alsawas, M Hassan Murad
Physicians practicing evidence-based medicine need to be able to appraise a new study and determine whether the results warrant sufficient certainty to the level that they can be applied to patient care. Without such appraisal, misleading results can be incorporated into patient care, which can lead to inefficient, costly, and possibly harmful care. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach offers a modern framework that can be applied to evaluate the trustworthiness of evidence...
April 2017: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/28461285/physician-rating-websites-what-aspects-are-important-to-identify-a-good-doctor-and-are-patients-capable-of-assessing-them-a-mixed-methods-approach-including-physicians-and-health-care-consumers-perspectives
#5
Fabia Rothenfluh, Peter J Schulz
BACKGROUND: Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. OBJECTIVE: To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects...
May 1, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28459929/behavioral-approach-to-appropriate-antimicrobial-prescribing-in-hospitals-the-dutch-unique-method-for-antimicrobial-stewardship-dumas-participatory-intervention-study
#6
Jonne J Sikkens, Michiel A van Agtmael, Edgar J G Peters, Kamilla D Lettinga, Martijn van der Kuip, Christina M J E Vandenbroucke-Grauls, Cordula Wagner, Mark H H Kramer
Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals...
May 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28453637/automated-identification-of-implausible-values-in-growth-data-from-pediatric-electronic-health-records
#7
Carrie Daymont, Michelle E Ross, A Russell Localio, Alexander G Fiks, Richard C Wasserman, Robert W Grundmeier
Objective: Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead to biased results. We developed and tested an automated method for identifying implausible values in pediatric EHR growth data. Materials and Methods: Using deidentified data from 46 primary care sites, we developed an algorithm to identify weight and height values that should be excluded from analysis, including implausible values and values that were recorded repeatedly without remeasurement...
April 26, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28447213/discordance-between-physician-and-patient-reported-disease-severity-in-adults-with-atopic-dermatitis-a-us-cross-sectional-survey
#8
Wenhui Wei, Peter Anderson, Abhijit Gadkari, Stuart Blackburn, Rachel Moon, James Piercy, Shashank Shinde, Jorge Gomez, Eric Ghorayeb
BACKGROUND: There is limited understanding of severity rating of atopic dermatitis in clinical practice. OBJECTIVES: To evaluate the agreement between physician- and patient-rated severity of atopic dermatitis. METHODS: Data were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire...
April 26, 2017: American Journal of Clinical Dermatology
https://www.readbyqxmd.com/read/28444087/civil-liability-of-the-ophthalmologist-in-the-s%C3%A3-o-paulo-court-of-appeals
#9
Isabel de Fátima Alvim Braga, Kelly de Oliveira Vieira, Thiago Gonçalves Dos Santos Martins
Objective: To conduct a data survey on the subject of medical claims involving civil liability in ophthalmology at the São Paulo Court of Appeals. Methods: A case law research was carried out on the São Paulo Court of Appeals website searching for the keyword "ophthalmologist" for all years until 2016. Results: Of the 65 cases found, 29 were selected. There has been an increase in the number of claims in ophthalmology, especially in surgical procedures on the anterior chamber of the eye...
2017: Einstein
https://www.readbyqxmd.com/read/28430567/how-should-clinicians-respond-to-medical-requests-from-clinician-family-members-of-patients
#10
Andrew Thurston
In the medical profession, receiving a request for medical management from a colleague is a routine experience. However, when the colleague is a family member of a patient and the desired or requested medical intervention is not medically indicated in the attending physician's view, the situation becomes more complicated. Ethical issues include respect for patient autonomy and social justice as well as nonmaleficence. Furthermore, interpersonal and professional relationships may be tested in this situation...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28406921/is-the-risk-of-progressive-multifocal-leukoencephalopathy-the-real-reason-for-natalizumab-discontinuation-in-patients-with-multiple-sclerosis
#11
MULTICENTER STUDY
Julia Krämer, Jan-Gerd Tenberge, Ingo Kleiter, Wolfgang Gaissmaier, Tobias Ruck, Christoph Heesen, Sven G Meuth
BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is one of the major risks of natalizumab therapy. Despite introduction of the currently employed PML risk stratification algorithm, the incidence of natalizumab-associated PML cases is not decreasing. OBJECTIVES: We addressed the following questions: How do natalizumab-treated multiple sclerosis patients and their treating physicians assess and deal with PML risk? Is PML risk the real reason for natalizumab discontinuation? METHODS: 699 natalizumab-treated multiple sclerosis patients and 99 physicians were included in this prospective observational study...
2017: PloS One
https://www.readbyqxmd.com/read/28398365/-digitalis-a-drug-to-be-scrapped
#12
Franco Cosmi, Barbara Tarquini, Beatrice Mariottoni, Deborah Cosmi
We performed a comprehensive review of the scientific literature on the use of digoxin in heart failure and atrial fibrillation. In congestive heart failure (CHF) there is only one randomized trial with a statistical sample sufficiently large. In this trial (DIG trial), which enrolled patients with systolic left ventricular dysfunction in sinus rhythm, digoxin had a neutral action on mortality and modestly reduced the overall need of hospitalization. The study was conducted in the pre-beta-blocker era and, therefore, it has a doubtful application to the current clinical context...
February 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28394626/decision-making-on-the-labor-and-delivery-unit-an-investigation-of-influencing-factors
#13
Megan E Gregory, Shirley C Sonesh, Jennifer Feitosa, Lauren E Benishek, Ashley M Hughes, Eduardo Salas
Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1)...
April 1, 2017: Human Factors
https://www.readbyqxmd.com/read/28375501/seven-ethical-issues-affecting-neurosurgeons-in-the-context-of-health-care-reform
#14
T Forcht Dagi
Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28358584/assessing-the-utility-and-validity-of-frailty-markers-in-critically-ill-adults
#15
Aluko A Hope, S J Hsieh, Alex Petti, Mariana Hurtado-Sbordoni, Joe Verghese, Michelle Ng Gong
RATIONALE: Identifying frailty by the presence of a critical number of frailty markers has been difficult to operationalize in the Intensive Care Unit (ICU) where patients often cannot complete performance measures or answer complex questions. OBJECTIVES: To assess the construct and predictive validity of a questionnaire-based approach to identifying frailty in adult ICU patients. METHODS: We conducted an observational cohort study of adults admitted to a medical or surgical ICU at one of two hospitals in New York...
March 30, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28346280/conjunctivochalasis-and-related-factors-in-an-adult-population-of-iran
#16
Hassan Hashemi, Hadith Rastad, Mohammad Hassan Emamian, Akbar Fotouhi
OBJECTIVES: To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population. METHODS: This population-based study was conducted in the context of the second phase of Shahroud Eye Cohort Study in 2014. Of 4,737 participants aged 45 to 69 years who participated in the second phase, the data of 4,702 participants were available for this report. A diagnosis of conjunctivochalasis was made based on the physician's judgment on ophthalmic examinations...
March 24, 2017: Eye & Contact Lens
https://www.readbyqxmd.com/read/28345187/novel-biomarkers-for-prostate-cancer-an-evidence-based-review-for-use-in-clinical-practice
#17
REVIEW
Vikram M Narayan, Badrinath R Konety, Christopher Warlick
Prostate cancer is a heterogeneous disease with disparate outcomes. Traditional clinical parameters are limited in their ability to differentiate between these cases, and there is uncertainty regarding management strategies. A number of novel biomarkers have emerged, but how best to use them at the point of care remains confusing. In the present review, we describe the most common novel biomarkers, their key supporting literature, and propose a meaningful algorithm for their use in clinical practice. To identify commercially available prostate cancer diagnostic tests, we carried out a PubMed literature search (through May 2016)...
March 27, 2017: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/28344599/does-ultrasound-measurement-improve-the-accuracy-of-electronic-brachytherapy-in-the-treatment-of-superficial-non-melanomatous-skin-cancer
#18
Uma Goyal, Junhan Pan, Haiyan Cui, Baldassarre Stea
PURPOSE: Electronic brachytherapy (eBT) is a form of contact radiation therapy used for thin superficial non-melanomatous skin cancers (NMSCs). An accurate measurement of diameter and depth is important for eBT treatment planning. Therefore, we compared clinical measurements by an experienced physician to measurements obtained using ultrasound (US), an objective imaging modality, in order to determine if clinical measurements were accurate enough for adequate NMSC treatment. MATERIAL AND METHODS: Eighteen patients with 20 biopsy-proven NMSCs first had a clinical examination and then an US evaluation prior to starting eBT...
February 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28334584/delayed-workup-of-rectal-bleeding-in-adult-primary-care-examining-process-of-care-failures
#19
Saul N Weingart, Elena M Stoffel, Daniel C Chung, Thomas D Sequist, Ruth I Lederman, Stephen R Pelletier, Helen M Shields
BACKGROUND: Although delayed colorectal cancer diagnoses figure prominently in medical malpractice claims, little is known about the quality of primary care clinicians' workup of rectal bleeding. METHODS: In this study, 438 patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for rectal bleeding, hemorrhoids, and blood in the stool at 10 Boston adult primary care practices. Following nurse chart abstraction, physician reviewers assessed the overall quality of care and key care processes...
January 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28293096/clinical-correlations-of-infliximab-trough-levels-and-antibodies-to-infliximab-in-south-korean-patients-with-crohn-s-disease
#20
Eun Hye Oh, Dae-Hyun Ko, Hyungil Seo, Kiju Chang, Gwang-Un Kim, Eun Mi Song, Myeongsook Seo, Ho-Su Lee, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
AIM: To investigate the clinical implications of infliximab trough levels (IFX-TLs) and antibodies to infliximab (ATI) levels in Crohn's disease (CD) patients in Asian countries. METHODS: IFX-TL and ATI level were measured using prospectively collected samples obtained with informed consent from CD patients being treated at Asan Medical Center, South Korea. We analyzed the correlations between IFX-TLs/ATI levels and the clinical activity of CD (quiescent vs active disease) based on the CD activity index, C-reactive protein level, and physician's judgment of patients' clinical status at enrollment...
February 28, 2017: World Journal of Gastroenterology: WJG
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