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https://www.readbyqxmd.com/read/28238497/structured-clinical-decision-aids-are-seldom-compared-with-subjective-physician-judgment-and-are-seldom-superior
#1
David L Schriger, Joshua W Elder, Richelle J Cooper
STUDY OBJECTIVE: We determine how often studies that evaluate the performance of an aid for decisionmaking, be it a simple laboratory or imaging test or a complex multielement decision instrument, compare the aid's performance to independent, unaided physician judgment. METHODS: This was a cross-sectional survey of all Original Research and Brief Research Report articles in Annals of Emergency Medicine from 1998 to 2015. We included all articles that evaluated the performance of an aid for decisionmaking in assisting a physician with a decision about testing, treatment, diagnosis, or disposition...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28216720/biostatistics-series-module-7-the-statistics-of-diagnostic-tests
#2
Avijit Hazra, Nithya Gogtay
Crucial therapeutic decisions are based on diagnostic tests. Therefore, it is important to evaluate such tests before adopting them for routine use. Although things such as blood tests, cultures, biopsies, and radiological imaging are obvious diagnostic tests, it is not to be forgotten that specific clinical examination procedures, scoring systems based on physiological or psychological evaluation, and ratings based on questionnaires are also diagnostic tests and therefore merit similar evaluation. In the simplest scenario, a diagnostic test will give either a positive (disease likely) or negative (disease unlikely) result...
January 2017: Indian Journal of Dermatology
https://www.readbyqxmd.com/read/28206671/surgery-for-cataracts-in-people-with-age-related-macular-degeneration
#3
REVIEW
Heather Casparis, Kristina Lindsley, Irene C Kuo, Shameema Sikder, Neil M Bressler
BACKGROUND: Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision. OBJECTIVES: The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD...
February 16, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28199179/experienced-probabilities-increase-understanding-of-diagnostic-test-results-in-younger-and-older-adults
#4
Bonnie Armstrong, Julia Spaniol
BACKGROUND: With advancing age, the frequency of medical screening increases. Interpreting the results of medical tests involves estimation of posterior probabilities such as positive predictive values (PPVs) and negative predictive values (NPVs). Both laypeople and experts are typically poor at estimating posterior probabilities when the relevant statistics are communicated descriptively. The current study examined whether an experience format would improve posterior probability judgments in younger and older adults, relative to a description format...
February 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28195378/to-cut-or-not-to-cut-that-is-the-question-a-review-of-the-anatomy-the-technique-risks-and-benefits-of-an-episiotomy
#5
REVIEW
Mitchel Alan Muhleman, Islam Aly, Andrew Walters, Nitsa Topale, R Shane Tubbs, Marios Loukas
Childbirth can be a traumatic experience on the female body. Some techniques may be implemented to make the process smoother and decrease the potential lacerations that can occur. Episiotomies have been used by obstetricians and midwives to help make the fetal decent down the vaginal canal less turbulent. A physician must use his best judgment on when it is necessary to make this incision and what form of incision to make. Before making an incision one must understand the female external and internal anatomy and thoroughly comprehend the stages of birth to understand how and what complications can occur...
February 13, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/28188004/introducing-a-morbidity-and-mortality-conference-in-rwanda
#6
Egide Abahuje, Innocent Nzeyimana, Jennifer L Rickard
OBJECTIVES: To assess the structure, format, and educational features of a morbidity and mortality (M&M) conference in Rwanda. To determine factors associated with adverse events and to define opportunities for improvement. DESIGN: Retrospective, descriptive study of all cases presented at a surgical M&M conference over a 1-year period. Cases were reviewed for factors associated with adverse events and opportunities for improvement. Factors were characterized as delays in presentation, delays in diagnosis, delays in the operating room, errors in judgment, technical errors, advanced disease, and missing resources or malnutrition...
February 7, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28156525/feasibility-of-a-physician-extender-approach-to-increase-advance-care-planning-uptake
#7
Cynthia Fanning
: 8 Background: Advanced care planning (ACP) for people with life-limiting cancer has been associated with improved patient quality of life and care more consistent with patient wishes. Nevertheless, even though approximately 70% of patients with a life-limiting illness will require the substituted judgment of a proxy, fewer than 25% of patients have documented goals of care. This poor uptake has been attributed to limits in physician time and ACP training. The current study evaluated the feasibility of utilizing a physician-extender trained in ACP best practices to overcome these barriers and improve ACP uptake...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28146079/recurrent-pneumonia-in-children-a-reasoned-diagnostic-approach-and-a-single-centre-experience
#8
REVIEW
Silvia Montella, Adele Corcione, Francesca Santamaria
Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed...
January 29, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28128775/clinical-judgment-research-on-economic-topics-role-of-congruence-of-tasks-in-clinical-practice
#9
Christine C Huttin
This paper discusses what can ensure the performance of judgment studies with an information design that integrates economics of medical systems, in the context of digitalization of healthcare. It is part of a series of 5 methodological papers on statistical procedures and problems to implement judgment research designs and decision models, especially to address cost of care, and ways to measure conversation on cost of care between physicians and patients, with unstructured data such as economic narratives to complement billing and financial information (e...
January 20, 2017: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/28119771/usefulness-of-four-commonly-used-neuropathic-pain-screening-questionnaires-in-patients-with-chronic-low-back-pain-a-cross-sectional-study
#10
Kapil Gudala, Babita Ghai, Dipika Bansal
BACKGROUND: Recently symptoms-based screening questionnaires have gained attention for screening for a neuropathic pain component (NePC) in various chronic pain conditions. The present study assessed the usefulness of four commonly used NePC screening questionnaires including the Self-completed douleur neuropathique 4 (S-DN4), the ID Pain, the painDETECT questionnaire (PDQ), and the Self-completed Leeds Assessment of neuropathic Symptoms and Signs (S-LANSS) questionnaire in patients with chronic low back pain (CLBP) to assess the presence of NePC...
January 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/28097934/automatic-and-quantitative-measurement-of-laryngeal-video-stroboscopic-images
#11
Chung-Feng Jeffrey Kuo, Joseph Kuo, Shang-Wun Hsiao, Chi-Lung Lee, Jih-Chin Lee, Bo-Han Ke
The laryngeal video stroboscope is an important instrument for physicians to analyze abnormalities and diseases in the glottal area. Stroboscope has been widely used around the world. However, without quantized indices, physicians can only make subjective judgment on glottal images. We designed a new laser projection marking module and applied it onto the laryngeal video stroboscope to provide scale conversion reference parameters for glottal imaging and to convert the physiological parameters of glottis. Image processing technology was used to segment the important image regions of interest...
January 2017: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
https://www.readbyqxmd.com/read/28093627/-validation-of-the-german-version-of-the-6%C3%A2-item-screener-brief-cognitive-test-with-broad-application-possibilities
#12
S Krupp, A Seebens, J Kasper, M Willkomm, F Balck
BACKGROUND: Especially during admission the detection of cognitive deficits relevant to everyday life should burden patient and examiner as little as possible. The 6‑item screener (SIS) takes approximately 1 min, is easy to learn, does not require any material and is independent of the patient's visual and fine motor skills. The test was first published in 2002 by Callahan who approved the present German translation. OBJECTIVE: We checked the convergent and discriminant validity, reliability and sensitivity to change of the German translation among geriatric patients...
January 16, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28089214/prevalence-of-chronic-pancreatitis-results-of-a-primary-care-physician-based-population-study
#13
Gabriele Capurso, Livia Archibugi, Piera Pasquali, Alessandro Aceti, Paolo Balducci, Patrizia Bianchi, Francesco Buono, Stefano Camerucci, Rosanna Cantarini, Sergio Centofanti, Patrizia Colantonio, Riccarda Cremaschi, Sergio Crescenzi, Caterina Di Mauro, Davide Di Renzi, Andrea Filabozzi, Alfonso Fiorillo, Giuseppe Giancaspro, Paola Giovannetti, Giuseppe Lanna, Claudio Medori, Emilio Merletti, Enzo Nunnari, Francesca Paris, Marco Pavone, Angela Piacenti, Almerindo Rossi, Maria Cristina Scamuffa, Giovanni Spinelli, Marco Taborchi, Biagio Valente, Antonella Villanova, Alberto Chiriatti, Gianfranco Delle Fave
BACKGROUND: Data on chronic pancreatitis prevalence are scanty and usually limited to hospital-based studies. AIM: Investigating chronic pancreatitis prevalence in primary care. METHODS: Participating primary care physicians reported the prevalence of chronic pancreatitis among their registered patients, environmental factors and disease characteristics. The data were centrally reviewed and chronic pancreatitis cases defined according to M-ANNHEIM criteria for diagnosis and severity and TIGAR-O classification for etiology...
December 27, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28087362/clinical-phenotypes-and-outcomes-of-heritable-and-sporadic-pulmonary-veno-occlusive-disease-a-population-based-study
#14
David Montani, Barbara Girerd, Xavier Jaïs, Marilyne Levy, David Amar, Laurent Savale, Peter Dorfmüller, Andrei Seferian, Edmund M Lau, Mélanie Eyries, Jérôme Le Pavec, Florence Parent, Damien Bonnet, Florent Soubrier, Elie Fadel, Olivier Sitbon, Gérald Simonneau, Marc Humbert
BACKGROUND: Bi-allelic mutations of the EIF2AK4 gene cause heritable pulmonary veno-occlusive disease and/or pulmonary capillary haemangiomatosis (PVOD/PCH). We aimed to assess the effect of EIF2AK4 mutations on the clinical phenotypes and outcomes of PVOD/PCH. METHODS: We did a population-based study using clinical, functional, and haemodynamic data from the registry of the French Pulmonary Hypertension Network. We reviewed the clinical data and outcomes from all patients referred to the French Referral Centre (Pulmonary Department, Hospital Kremlin-Bicêtre, University Paris-Sud) with either confirmed or highly probable PVOD/PCH with DNA available for mutation screening (excluding patients with other risk factors of pulmonary hypertension, such as chronic respiratory diseases)...
February 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28074576/decisions-and-authority
#15
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28027265/the-importance-of-patient-satisfaction-a-blessing-a-curse-or-simply-irrelevant
#16
Justin B Cohen, Terence M Myckatyn, Keith Brandt
New regulations require that physician performance must be evaluated and graded in both objective and subjective ways. This represents a novel factor in American health care delivery driven by the reality that the United States spends more than any other nation on health care yet still lags behind in key outcome measures. Patient satisfaction has been established as a core component of physician rankings and reimbursement. In fact, it already has acted as both a powerful motivator and stressor. Patient feedback has driven hospital administrators' agendas to improve facilities and provide relative luxuries to inpatients, and individual providers have been tempted to ignore sound medical judgment by relenting to patient requests to increase their satisfaction scores...
January 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28024438/to-participate-or-not-participate-in-unprofessional-behavior-is-that-the-question
#17
Renato Soleiman Franco, Camila Ament Giuliani Dos Santos Franco, Solena Ziemer Kusma, Milton Severo, Maria Amélia Ferreira
INTRODUCTION: Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior. METHODS: The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal...
December 26, 2016: Medical Teacher
https://www.readbyqxmd.com/read/28007118/rapidly-progressive-cataract-formation-associated-with-non-small-cell-lung-cancer-therapy
#18
Erica Liu, Kamden Kopani
: We report 6 patients who developed rapidly progressive hypermature cataracts after starting treatment with rociletinib, a non-small-cell lung cancer therapy with known side effects of hyperglycemia, fatigue, and prolonged QT. Early cataract detection and surgery may prevent complications during future cataract removal. Although rociletinib development has been suspended, there are patients who have been treated and will continue to be treated with this medication based on their physician's judgment...
December 2016: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/27999255/accelerometry-based-activity-recognition-and-assessment-in-rheumatic-and-musculoskeletal-diseases
#19
Lieven Billiet, Thijs Willem Swinnen, Rene Westhovens, Kurt de Vlam, Sabine Van Huffel
One of the important aspects to be considered in rheumatic and musculoskeletal diseases is the patient's activity capacity (or performance), defined as the ability to perform a task. Currently, it is assessed by physicians or health professionals mainly by means of a patient-reported questionnaire, sometimes combined with the therapist's judgment on performance-based tasks. This work introduces an approach to assess the activity capacity at home in a more objective, yet interpretable way. It offers a pilot study on 28 patients suffering from axial spondyloarthritis (axSpA) to demonstrate its efficacy...
December 16, 2016: Sensors
https://www.readbyqxmd.com/read/27993410/consensus-document-for-the-use-of-the-polypill-in-the-secondary-prevention-of-cardiovascular-disease
#20
José Ramón González-Juanatey, José María Mostaza, José María Lobos, Benjamín Abarca, José Luis Llisterri, Gonzalo Baron-Esquivias, Enrique Galve, Rosa María Lidón, Francisco Xavier Garcia-Moll, Pedro Luis Sánchez, Carmen Suárez, Jesús Millán, Vicente Pallares, José Juan Alemán, Isabel Egocheaga
Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain...
February 9, 2017: Medicina Clínica
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