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Physician gestalt

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https://www.readbyqxmd.com/read/29177926/can-physician-gestalt-predict-survival-in-patients-with-resectable-pancreatic-adenocarcinoma
#1
Linda M Pak, Mithat Gonen, Kenneth Seier, Vinod P Balachandran, Michael I D'Angelica, William R Jarnagin, T Peter Kingham, Peter J Allen, Richard K G Do, Amber L Simpson
PURPOSE: Clinician gestalt may hold unexplored information that can be capitalized upon to improve existing nomograms. The study objective was to evaluate physician ability to predict 2-year overall survival (OS) in resected pancreatic ductal adenocarcinoma (PDAC) patients based on pre-operative clinical characteristics and routine CT imaging. METHODS: Ten surgeons and two radiologists were provided with a clinical vignette (including age, gender, presenting symptoms, and pre-operative CA19-9 when available) and pre-operative CT scan for 20 resected PDAC patients and asked to predict the probability of each patient reaching 2-year OS...
November 24, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29117900/gestalt-for-shock-and-mortality-in-the-emergency-department-a-prospective-study
#2
Yan-Ling Li, Jun-Rong Mo, Nga-Man Cheng, Stewart S W Chan, Pei-Yi Lin, Xiao-Hui Chen, Colin A Graham, Timothy H Rainer
OBJECTIVE: The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard. METHOD: In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18years or older admitted to the resuscitation room or high dependency unit were recruited...
November 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29055608/qualitative-study-to-understand-ordering-of-ct-angiography-to-diagnose-pulmonary-embolism-in-the-emergency-room-setting
#3
Soterios Gyftopoulos, Silas W Smith, Emma Simon, Masha Kuznetsova, Leora I Horwitz, Danil V Makarov
PURPOSE: To better understand the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. METHODS: We conducted semistructured interviews with our institution's emergency medicine (EM) providers and radiologists who read CTPAs performed in the emergency department. We employed the Theoretical Domains Framework-a formal, structured approach used to better understand the motivations and beliefs of physicians surrounding a complex medical decision making-to categorize the themes that arose from our interviews...
October 18, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29018000/waveform-capnography-an-alternative-to-physician-gestalt-in-determining-optimal-intubating-conditions-after-administration-of-paralytic-agents
#4
Anthony Scoccimarro, Jason R West, Marc Kanter, Nicholas D Caputo
PURPOSE: We sought to evaluate the utility of waveform capnography (WC) in detecting paralysis, by using apnoea as a surrogate determinant, as compared with clinical gestalt during rapid sequence intubation. Additionally, we sought to determine if this improves the time to intubation and first pass success rates through more consistent and expedient means of detecting optimal intubating conditions (ie, paralysis). METHODS: A prospective observational cohort study of consecutively enrolled patients was conducted from April to June 2016 at an academic, urban, level 1 trauma centre in New York City...
October 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28921731/interobserver-agreement-in-pediatric-cervical-spine-injury-assessment-between-prehospital-and-emergency-department-providers
#5
Lorin R Browne, Hamilton Schwartz, Fahd A Ahmad, Michael Wallendorf, Nathan Kuppermann, E Brooke Lerner, Julie C Leonard
BACKGROUND: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions. OBJECTIVES: The objective was to determine the interobserver agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma...
September 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28666562/emergency-medicine-myths-computed-tomography-of-the-head-prior%C3%A2-to-lumbar-puncture-in-adults-with-suspected-bacterial-meningitis-due-diligence-or-antiquated-practice
#6
Michael D April, Brit Long, Alex Koyfman
BACKGROUND: Various sources purport an association between lumbar puncture and brainstem herniation in patients with intracranial mass effect lesions. Several organizations and texts recommend head computed tomography (CT) prior to lumbar puncture in selected patients. OBJECTIVE: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis. DISCUSSION: Observational studies report a risk of post-lumbar puncture brainstem herniation in the presence of intracranial mass effect (1...
September 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28611898/utility-of-the-history-and-physical-examination-in-the-detection-of-acute-coronary-syndromes-in-emergency-department-patients
#7
REVIEW
Zachary Dw Dezman, Amal Mattu, Richard Body
Chest pain accounts for approximately 6% of all emergency department (ED) visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS). This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28554588/pathologic-c-spine-fracture-with-low-risk-mechanism-and-normal-physical-exam
#8
Andrew Hunter, Jolion McGreevy, Judith Linden
Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings...
September 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28363616/an-end-user-s-guide-to-the-heart-score-and-pathway
#9
REVIEW
Brit Long, Joshua Oliver, Matthew Streitz, Alex Koyfman
BACKGROUND: Chest pain accounts for a significant percentage of emergency department (ED) presentations. The HEART score and pathway have demonstrated an ability to appropriately risk stratify and discharge from the ED a significant proportion of patients. OBJECTIVE: This review evaluates vital components of the HEART score and pathway, while discussing important considerations for current and future use. DISCUSSION: Chest pain is a common ED presentation, and several conditions associated with chest pain result in patient morbidity and mortality...
September 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28285867/a-modified-lung-and-cardiac-ultrasound-protocol-saves-time-and-rules-in-the-diagnosis-of-acute-heart-failure
#10
Frances M Russell, Robert R Ehrman
BACKGROUND: Multiorgan ultrasound (US), which includes evaluation of the lungs and heart, is an accurate method that outperforms clinical gestalt for diagnosing acutely decompensated heart failure (ADHF). A known barrier to ultrasound use is the time needed to perform these examinations. OBJECTIVE: The primary goal of this study was to determine the test characteristics of a modified lung and cardiac US (LuCUS) protocol for the accurate diagnosis of ADHF. METHODS: This was a secondary analysis of a prospective observational study that enrolled adult patients presenting to the emergency department with undifferentiated dyspnea...
June 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28262317/individual-gestalt-is-unreliable-for-the-evaluation-of-quality-in-medical-education-blogs-a%C3%A2-metriq-study
#11
Brent Thoma, Stefanie S Sebok-Syer, Keeth Krishnan, Marshall Siemens, N Seth Trueger, Isabelle Colmers-Gray, Rob Woods, Emil Petrusa, Teresa Chan
STUDY OBJECTIVE: Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. METHODS: We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016...
September 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28243948/gestalt-assessment-of-online-educational-resources-may-not-be-sufficiently-reliable-and-consistent
#12
Keeth Krishnan, Brent Thoma, N Seth Trueger, Michelle Lin, Teresa M Chan
PURPOSE: Online open educational resources are increasingly used in medical education, particularly blogs and podcasts. However, it is unclear whether these resources can be adequately appraised by end-users. Our goal was to determine whether gestalt-based recommendations are sufficient for emergency medicine trainees and attending physicians to reliably recommend online educational resources to others. METHODS: Raters (33 trainees and 21 attendings in emergency medicine from North America) were asked to rate 40 blog posts according to whether, based on their gestalt, they would recommend the resource to (1) a trainee or (2) an attending physician...
April 2017: Perspectives on Medical Education
https://www.readbyqxmd.com/read/27677085/predicting-fluid-responsiveness-using-bedside-ultrasound-measurements-of-the-inferior-vena-cava-and-physician-gestalt-in-the-emergency-department-of-an-urban-public-hospital-in-sub-saharan-africa
#13
Hendry Robert Sawe, Cathryn Haeffele, Juma A Mfinanga, Victor G Mwafongo, Teri A Reynolds
BACKGROUND: Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. METHODS: This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension...
2016: PloS One
https://www.readbyqxmd.com/read/27639424/best-clinical-practice-blood-culture-utility-in-the-emergency-department
#14
REVIEW
Brit Long, Alex Koyfman
BACKGROUND: Bacteremia affects 200,000 patients per year, with the potential for significant morbidity and mortality. Blood cultures are considered the most sensitive method for detecting bacteremia and are commonly obtained in patients with fever, chills, leukocytosis, focal infections, and sepsis. OBJECTIVE: We sought to provide emergency physicians with a review of the literature concerning blood cultures in the emergency department. DISCUSSION: The utility of blood cultures has been a focus of controversy, prompting research evaluating effects on patient management...
November 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27485261/role-of-physician-perception-of-patient-smile-on-pretest-probability-assessment-for-acute-pulmonary-embolism
#15
MULTICENTER STUDY
Jeffrey A Kline, Dawn Neumann, Cassandra L Hall, Jacob Capito
BACKGROUND: Many clinicians use a global visual interpretation of patient appearance to decide if a patient looks sick or not. For patients with suspected acute pulmonary embolism (PE), we tested the relationship between visual appearance of a happy patient facial affect and probability of PE+ on CT pulmonary angiography (CTPA). METHODS: Eligible patients were selected by usual care to undergo CTPA, the criterion standard for PE+ or PE-. Prior to CTPA result, trained study personnel obtained physician pretest probability using the gestalt method (visual analogue scale, 0%-100%), the Wells score (0-12) and physicians' impression of whether the patient smiled during the initial examination (smile+)...
February 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27437048/guiding-principles-for-a-pediatric-neurology-icu-neuropicu-bedside-multimodal-monitor-findings-from-an-international-working-group
#16
Zachary M Grinspan, Yonina C Eldar, Daniel Gopher, Amihai Gottlieb, Rotem Lammfromm, Halinder S Mangat, Nimrod Peleg, Steven Pon, Igal Rozenberg, Nicholas D Schiff, David E Stark, Peter Yan, Hillel Pratt, Barry E Kosofsky
BACKGROUND: Physicians caring for children with serious acute neurologic disease must process overwhelming amounts of physiological and medical information. Strategies to optimize real time display of this information are understudied. OBJECTIVES: Our goal was to engage clinical and engineering experts to develop guiding principles for creating a pediatric neurology intensive care unit (neuroPICU) monitor that integrates and displays data from multiple sources in an intuitive and informative manner...
2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27294087/the-clinics-of-acute-coronary-syndrome
#17
REVIEW
Gianfranco Cervellin, Gianni Rastelli
Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt...
May 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27184993/ruling-out-pulmonary-embolism-in-primary-care-comparison-of-the-diagnostic-performance-of-gestalt-and-the-wells-rule
#18
COMPARATIVE STUDY
Janneke M T Hendriksen, Wim A M Lucassen, Petra M G Erkens, Henri E J H Stoffers, Henk C P M van Weert, Harry R Büller, Arno W Hoes, Karel G M Moons, Geert-Jan Geersing
PURPOSE: Diagnostic prediction models such as the Wells rule can be used for safely ruling out pulmonary embolism (PE) when it is suspected. A physician's own probability estimate ("gestalt"), however, is commonly used instead. We evaluated the diagnostic performance of both approaches in primary care. METHODS: Family physicians estimated the probability of PE on a scale of 0% to 100% (gestalt) and calculated the Wells rule score in 598 patients with suspected PE who were thereafter referred to secondary care for definitive testing...
May 2016: Annals of Family Medicine
https://www.readbyqxmd.com/read/27150104/pilot-study-of-the-importance-of-factors-affecting-emergency-department-opioid-analgesic-prescribing-decisions
#19
Adam C Pomerleau, Justin D Schrager, Brent W Morgan
INTRODUCTION: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers. METHODS: This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale...
September 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/26935714/prospective-evaluation-of-the-ability-of-clinical-scoring-systems-and-physician-determined-likelihood-of-appendicitis-to-obviate-the-need-for-ct
#20
Sean K Golden, John B Harringa, Perry J Pickhardt, Alexander Ebinger, James E Svenson, Ying-Qi Zhao, Zhanhai Li, Ryan P Westergaard, William J Ehlenbach, Michael D Repplinger
OBJECTIVE: To determine whether clinical scoring systems or physician gestalt can obviate the need for computed tomography (CT) in patients with possible appendicitis. METHODS: Prospective, observational study of patients with abdominal pain at an academic emergency department (ED) from February 2012 to February 2014. Patients over 11 years old who had a CT ordered for possible appendicitis were eligible. All parameters needed to calculate the scores were recorded on standardised forms prior to CT...
July 2016: Emergency Medicine Journal: EMJ
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