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First do no harm

Hardeep Singh, Mark L Graber, Timothy P Hofer
Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient...
October 20, 2016: Journal of Patient Safety
Adélaïde Doussau, Christine Grady
Ethical concerns about randomising persons to a no-treatment arm in the context of Ebola epidemic led to consideration of alternative designs. The stepped wedge (SW) design, in which participants or clusters are randomised to receive an intervention at different time points, gained popularity. Common arguments in favour of using this design are (1) when an intervention is likely to do more good than harm, (2) all participants should receive the experimental intervention at some time point during the study and (3) the design might be preferable for practical reasons...
October 17, 2016: Journal of Medical Ethics
Elisabeth M Hodson, Sophia C Wong, Narelle S Willis, Jonathan C Craig
BACKGROUND: The majority of children who present with their first episode of nephrotic syndrome achieve remission with corticosteroid therapy. Children who fail to respond may be treated with immunosuppressive agents including calcineurin inhibitors (cyclosporin or tacrolimus) and with non-immunosuppressive agents such as angiotensin-converting enzyme inhibitors (ACEi). Optimal combinations of these agents with the least toxicity remain to be determined. This is an update of a review first published in 2004 and updated in 2006 and 2010...
October 11, 2016: Cochrane Database of Systematic Reviews
Mary Bond, Louise Crathorne, Jaime Peters, Helen Coelho, Marcela Haasova, Chris Cooper, Quentin Milner, Vicki Shawyer, Christopher Hyde, Roy Powell
BACKGROUND: Peripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation...
October 1, 2016: BMC Anesthesiology
Steven Kwasi Korang, Joshua Feinberg, Jørn Wetterslev, Janus C Jakobsen
BACKGROUND: Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention has been considered weak and clinical guidelines do not recommend the intervention. NPPV might be an effective intervention for acute asthma, but no systematic review has been conducted to assess the effects of NPPV as an add-on therapy to usual care in children with acute asthma...
September 30, 2016: Cochrane Database of Systematic Reviews
Katarzyna Kolasa, Marta Kowalczyk
BACKGROUND: There are positive and negative consequences of the implementation of out of pocket (OOP) payments as a source of the healthcare financing. On the one hand, OOP burden increases awareness of treatment costs and limits unnecessary use of healthcare services. On the other hand, it may prevent the sick from accessing needed care. Consequently there are several aspects that ought to be taken into consideration while defining the optimal structure of OOP payments. The objective of this study was twofold...
2016: BMC Public Health
Stavroula A Paschou, Andromachi Vryonidou, Dimitrios G Goulis
Adrenal incidentalomas are clinically unsuspected lesions that are detected in adrenal glands during imaging procedures for other causes. With widespread use of imaging - both computed tomography (CT) and magnetic resonance imaging (MRI) - adrenal incidentalomas are now a common clinical problem. The two main clinical issues to be determined in this setting are the risk of malignancy and the hormonal activity of these lesions. The answers to these two questions, along with the clinical characteristics of each individual patient and co-morbidities, will guide the treatment strategy, which can vary from simple follow-up to surgical resection...
October 2016: Maturitas
Szilvia Fiatal, Réka Tóth, Ágota Moravcsik-Kornyicki, Zsigmond Kósa, János Sándor, Martin McKee, Róza Ádány
INTRODUCTION: The prevalence of smoking in Romani of both genders is significantly higher than in the general population. Our aim was to determine whether a genetic susceptibility contributes to the high prevalence of smoking among Roma in a study based on data collected from cross-sectional surveys. METHODS: Twenty single nucleotide polymorphisms known to be closely related to smoking behavior were investigated in DNA samples of Hungarian Roma (N = 1273) and general (N = 2388) populations...
June 27, 2016: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
Jina Huh, Rebecca Marmor, Xiaoqian Jiang
BACKGROUND: Online health community (OHC) moderators help facilitate conversations and provide information to members. However, the necessity of the moderator in helping members achieve goals by providing the support they need remains unclear, with some prior research suggesting that moderation is unnecessary or even harmful for close-knit OHCs. Similarly, members' perceptions of moderator roles are underexplored. Starting January of 2013, WebMD moderators stopped working for WebMD communities...
2016: Journal of Medical Internet Research
Jack M Bert
It is not uncommon to damage the articular surface when performing routine arthroscopic surgical procedures of the knee. The article reviews the background, literature, and technique of performing a partial medial collateral ligament release in a tight knee when attempting to access the posterior medial compartment.
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Maha Hussain, Mario Eisenberger
No abstract text is available yet for this article.
August 25, 2016: JAMA Oncology
Marck Htm Haerkens, Wouter van Leeuwen, J Bryan Sexton, Peter Pickkers, Johannes G van der Hoeven
BACKGROUND: As the first objective of caring for patients is to do no harm, patient safety is a priority in delivering clinical care. An essential component of safe care in a clinical department is its safety climate. Safety climate correlates with safety-specific behaviour, injury rates, and accidents. Safety climate in healthcare can be assessed by the Safety Attitudes Questionnaire (SAQ), which provides insight by scoring six dimensions: Teamwork Climate, Job Satisfaction, Safety Climate, Stress Recognition, Working Conditions and Perceptions of Management...
2016: BMC Health Services Research
Bridgette D Semple
No abstract text is available yet for this article.
October 2016: European Journal of Neuroscience
Salman Zarka
Modern medicine deals with the combined quality of the profession and the medical service. The first rule of medicine is Primum non nocere" (first, do no harm). However, the essence of this unique profession cannot be confined by this basic message phrased by negation, but should be based on the principle of doing one's best to save the patient's life and to cure him. In this academic and dynamic profession, the physician keeps asking himself frequently whether the provided treatment is the best one possible...
April 2016: Harefuah
William D Sumrall, Elizabeth Mahanna, Vivek Sabharwal, Thomas Marshall
BACKGROUND: Advance directives guide healthcare providers to listen to and respect patients' wishes regarding their right to die in circumstances when cardiopulmonary resuscitation is required, and hospitals accredited by The Joint Commission are required to have a do-not-resuscitate (DNR) policy in place. However, when surgery and anesthesia are necessary for the care of the patient with a DNR order, this advance directive can create ethical dilemmas specifically involving patient autonomy and the physician's responsibility to do no harm...
2016: Ochsner Journal
Rene F Najera, Dorit R Reiss
No abstract text is available yet for this article.
2016: Health Matrix
Geoffrey C Nguyen
No abstract text is available yet for this article.
July 2016: Gastroenterology
H W Bauer, W G Bessler
The aim of all medical treatment is "primum nihil nocere" ("First, do no harm").Restoring the integrity of intestinal microbiota and optimising the immune response in recurrent infections, especially in the urinary tract, are treatment alternatives which are closer to this target than the usual focus on antibiotic prevention of recurrence.In the future, antibiotics will continue to be recommended for the prevention of urinary tract infections on a case-by-case basis. However, the problems of an excessive use of antibiotics, e...
May 2016: Aktuelle Urologie
Dominique Maiter
Prolactinoma is a common cause of infertility in young women and treatment with dopamine agonists (DA) allows restoration of fertility in over 90% of the cases. Both bromocriptine and cabergoline have shown a good safety profile when administered during early pregnancy. In particular, data on exposure of the fetus or embryo to cabergoline during the first weeks of pregnancy have now been reported in more than 900 cases, and do indicate that cabergoline is safe in this context. There is no increase in the frequency of spontaneous miscarriage, premature delivery, multiple births or neonatal malformations, and follow-up studies of the children for up to 12years after fetal exposure to cabergoline did not show any physical or developmental abnormalities...
June 2016: Annales D'endocrinologie
Helen E Farrell, Clara Lawler, Cindy S E Tan, Kate MacDonald, Kimberley Bruce, Michael Mach, Nick Davis-Poynter, Philip G Stevenson
UNLABELLED: Viruses transmit via the environmental and social interactions of their hosts. Herpesviruses have colonized mammals since their earliest origins, suggesting that they exploit ancient, common pathways. Cytomegaloviruses (CMVs) are assumed to enter new hosts orally, but no site has been identified. We show by live imaging that murine CMV (MCMV) infects nasally rather than orally, both after experimental virus uptake and during natural transmission. Replication-deficient virions revealed the primary target as olfactory neurons...
2016: MBio
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