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physician impairment

Davide Martino, Tammy Hedderly
Tics and stereotypies are the most common pathological repetitive complex motor behaviors occurring during the neurodevelopmental period. Although they may appear transiently during development without acquiring a pathological status, when they become chronic they may be distressing, socially impairing, or even, in the case of malignant tics, potentially physically harmful. Despite a certain similarity in their phenomenology, physicians should be able to distinguish them for their different variability over time, topographical distribution, association with sensory manifestations, and relationship with environmental triggers...
February 4, 2019: Parkinsonism & related Disorders
Yotsapon Thewjitcharoen, Amia Jones Elizabeth, Siriwan Butadej, Soontaree Nakasatien, Phawinpon Chotwanvirat, Ekgaluck Wanothayaroj, Sirinate Krittiyawong, Tinapa Himathongkam, Thep Himathongkam
BACKGROUND: Dysglycemic status defined by prediabetes and diabetes is known to be related with future risk of diabetic complications and cardiovascular diseases. Herein, we aimed to determine the diagnostic accuracy of glycated hemoglobin (HbA1c) when compared with oral glucose tolerance test (OGTT) as a reference test in identifying dysglycemic status among high-risk Thai patients receiving care in an out-patient setting. METHODS: An 11-year retrospective cross-sectional study of high-risk Thai patients who underwent OGTT during 2007-2017 was analysed...
February 15, 2019: BMC Endocrine Disorders
K F Becher, S Madersbacher, M C Michel
Based on new evidence, we discuss the risk of central nervous side effects, mainly reduced cognition/dementia and depressive symptoms during the use of drugs for the treatment of lower urinary symptoms suggestive of benign prostatic hyperplasia. Cognitive impairments during use of muscarinic antagonists are well documented and mechanistically well understood, but their occurrence differs quantitatively between members of this drug class. The occurrence of depressive symptoms while using 5α-reductase inhibitors only became known recently but has now been observed consistently in several studies and is mechanistically plausible; it appears to occur with similar incidence when using dutasteride and finasteride...
February 14, 2019: Der Urologe. Ausg. A
L Park, C Kouhanim, S Lee, Z Mendoza, K Patrick, L Gertsik, C Aguilar, D Gullaba, S Semenova, S Jhee
BACKGROUND: The recruitment challenges for MCI and AD subjects into clinical trials are well known, and this is particularly true for early phase studies. Currently, only 10-20% of all patients who are referred for research from the community are trial eligible (Grill and Karlawish, 2011). Due to the limited and specific study objectives in early phase study designs, these rates drop to approximately one patient every two months. Barriers to research recruitment are multi-factorial, involving patient centered factors, issues related to caregiver/study partner participation, and aspects related to the involvement of their treating physicians...
2019: Journal of Prevention of Alzheimer's Disease
Edward V Loftus, Walter Reinisch, Remo Panaccione, Sofie Berg, Gabriela Alperovich, Mareike Bereswill, Jasmina Kalabic, Joel Petersson, Roopal Thakkar, Anne M Robinson, Geert D'Haens
Background: PYRAMID was an international multicenter, noninterventional, postmarketing registry assessing long-term safety and effectiveness of adalimumab (Humira), as used in routine clinical practice. Methods: Adult patients with moderately to severely active Crohn's disease with or without prior adalimumab experience were enrolled in the registry and followed for up to 6 years. Effectiveness measurements included the Physician's Global Assessment (PGA, a composite of Harvey Bradshaw Index [HBI] and rectal bleeding score), clinical remission (HBI < 5), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and Work Productivity and Activity Impairment (WPAI) questionnaire...
February 8, 2019: Inflammatory Bowel Diseases
Sebastian A Ahmadi, Hosai Sadat, Kai-Michael Scheufler, Hans-Jakob Steiger, Beate Weber, Thomas Beez
STUDY DESIGN: Retrospective analysis of anonymized malpractice claims. SUMMARY OF BACKGROUND DATA: Spine surgery is considered a high-risk specialty with regards to malpractice claims. However, limited data is available for Germany. We analyzed the rate, subject and legal outcome of malpractice claims faced by spine surgeons in one of the largest Medical Council coverage areas in Germany, representing 60,000 physicians and a population of 10 million. METHODS: Analysis of all malpractice claims regarding spinal surgeries completed by the Review Board (RB) of the North Rhine Medical Council (NRMC) from 2012-2016...
February 8, 2019: Spine Journal: Official Journal of the North American Spine Society
Natalie Plewig, Robert Ofenloch, Thomas Mettang, Elke Weisshaar
BACKGROUND: Chronic itch (CI) is a frequent symptom in hemodialysis (HD) patients. Previous studies demonstrated great impairments of general well-being and health-related quality of life (HRQOL) as well as a higher mortality in those suffering from CI. OBJECTIVE: The German Epidemiological Hemodialysis Itch Study (GEHIS) is a representative cohort of HD patients in Germany. All patients were followed-up 4 years later. The current analyses present data on the course of CI in HD patients, its associated factors including comorbidities, laboratory values and HRQOL...
February 11, 2019: Journal of the European Academy of Dermatology and Venereology: JEADV
Marisha Agana, Julia Frueh, Manmohan Kamboj, Dilip R Patel, Shibani Kanungo
Inborn errors of metabolism (IEMs) are rare genetic or inherited disorders resulting from an enzyme defect in biochemical and metabolic pathways affecting proteins, fats, carbohydrates metabolism or impaired organelle function presenting as complicated medical conditions involving several human organ systems. They involve great complexity of the underlying pathophysiology, biochemical workup, and molecular analysis, and have complicated therapeutic options for management. Age of presentation can vary from infancy to adolescence with the more severe forms appearing in early childhood accompanied by significant morbidity and mortality...
December 2018: Annals of Translational Medicine
Jasmine Turna, William Simpson, Beth Patterson, Philippe Lucas, Michael Van Ameringen
Cannabis is commonly used recreationally for its euphoric and relaxing effects, while its medical use is permitted in several jurisdictions. With only low-quality evidence suggesting anxiolytic effects of cannabis and strong public sentiment surrounding such purported effects, the purpose of this study was to examine the prevalence of cannabis for medicinal purposes (CMP) use for anxiety symptoms. An online survey was disseminated to CMP users registered with a Canadian licensed producer. Respondents completed demographic and validated self-report questionnaires (GAD-7, PHQ-9, MINI-SPIN, and panic disorder/agoraphobia DSM-5 criteria)...
January 31, 2019: Journal of Psychiatric Research
Linlin Zhang, Yang Qiu, Nan Zhang, Shuang Li
Difficult doctor‒patient relationships are a common reality in many health-care organizations. Its harmful impacts have been mainly discussed from the perspectives of patients. However, understanding of its negative effects on physicians is limited. Drawing on the job demands-resources model and the conservation of resources theory, we hypothesize that difficult relationships with patients negatively predict physicians' work engagement, mediated by physicians' personal resources (e.g. prosocial motivation and problem-solving pondering)...
February 7, 2019: Psychological Reports
Frank X Scheuermeyer, Hubert Wong, Tyler W Barrett, Jim Christenson, Eric Grafstein, Brian Grunau, Matt Wiens, Grant Innes
CLINICIAN'S CAPSULEWhat is known about the topic?The influence of renal impairment upon emergency department-based outcomes in patients with atrial fibrillation or flutter (AFF) is unknown.What did this study ask?What was the impact of renal impairment upon adverse events (AE) and rate and rhythm control (RRC) attempts in emergency department (ED) AFF patients?What did this study find?When ED AFF patients with renal impairment are administered RRC, they have more than 10% excess AE risk.Why does this study matter to clinicians?Emergency physicians should be cautious about attempting RRC in ED AFF patients with renal impairment...
February 6, 2019: CJEM
Kristin Somerville, Zachary Walston, Tye Marr, Dale Yake
STUDY DESIGN: Case Series. BACKGROUND: Shoulder pain is a prevalent problem in health care. Traditionally, treatment is based on a pathoanatomical diagnosis determined through the use of special tests. The validity of these special tests is questionable and minimal evidence exists to support these tests to guide treatment. The purpose of this case series is to apply the principles of irritability, proposed by McClure and Michener in the Staged Approach Rehabilitation Classification, to adult patients with varying anatomical diagnoses...
February 5, 2019: Physiotherapy Theory and Practice
C Lai, G Filippetti, I Schifano, P Aceto, M Tomai, S Lai, L Pierro, A Renzi, A Carnovale, M Maranghi
OBJECTIVE: The aim of the present study was to assess the association among anxiety, depression, stress, social support and emotional abilities with adherence and healthcare spending in type 2 diabetic patients. PATIENTS AND METHODS: Sixty-four patients were enrolled and completed: Interpersonal Processes of Care (IPC), 20-item Toronto Alexithymia Scale (TAS-20), Rapid Stress Assessment Scale (RSAS), Morisky Medication Adherence Scale (MMAS-4), International Physical Activity Questionnaire (IPAQ)-Short Form and a socio-anamnestic questionnaire regarding also the healthcare spending...
January 2019: European Review for Medical and Pharmacological Sciences
Rieke Alten, P G Conaghan, V Strand, E Sullivan, S Blackburn, H Tian, K Gandhi, S M Jugl, A Deodhar
OBJECTIVE: There are limited data on therapy selection and switching in psoriatic arthritis (PsA). This 18 country, real-world study assessed use and switching of immunomodulatory therapy (biologic/apremilast), the extent of treatment failure and its association with reduced physical functioning, health-related quality of life (HRQoL), and work productivity and activity impairment (WPAI). METHODS: PsA patients under routine care and their treating physicians provided demographics, current therapy, reasons for switching, duration of first therapy, HRQoL, HAQ-DI, and WPAI...
February 4, 2019: Clinical Rheumatology
Louis Jacob, Jens Bohlken, Karel Kostev
BACKGROUND: Previous research has found a positive association between the use of antiepileptic drugs (AEDs) and dementia. However, there have been some concerns about the generalizability of its findings. OBJECTIVE: The goal of this case-control study was to analyze the association between AED use and dementia risk in Germany. METHODS: This study included patients who had received a first dementia diagnosis from one of 1,203 general practitioners or 202 neuropsychiatrists between 2013 and 2017 (index date)...
January 28, 2019: Journal of Alzheimer's Disease: JAD
Claudia Lampic, Lena Wettergren
International guidelines recommend that health care providers initiate discussions about treatment impact on fertility with cancer patients of reproductive age, or with parents/legal guardians of children, as early as possible in the treatment process. Still, both physicians and patients confirm that this is not always the case. This literature review summarizes findings regarding oncologists' and pediatric oncologists' perspectives and challenges of providing fertility preservation care, and points out directions for development...
February 3, 2019: Acta Obstetricia et Gynecologica Scandinavica
Stefanie Corradini, Daniel Reitz, Montserrat Pazos, Stephan Schönecker, Michael Braun, Nadia Harbeck, Christiane Matuschek, Edwin Bölke, Ute Ganswindt, Filippo Alongi, Maximilian Niyazi, Claus Belka
Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95...
January 31, 2019: Cancers
Roser Vives, Diana Fernandez-Galinski, Francisca Gordo, Alberto Izquierdo, Joan C Oliva, Carmen Colilles, Caridad Pontes
BACKGROUND: Bupivacaine and levobupivacaine have similar pharmacokinetic and pharmacodynamic characteristics, and are used regularly in spinal anesthesia. Whether potential differences in their hemodynamic and anesthetic profiles could determine a differential risk of complications in elderly subjects, is controversial. The main objective was to compare the effects of intrathecally administered levobupivacaine (LB) versus bupivacaine (B), on regional cerebral O2 saturation during spinal anesthesia, cognitive status and neurological complications in elderly patients undergoing surgery for hip fracture...
January 31, 2019: BMC Anesthesiology
Paschalis Gavriilidis, Nicola de'Angelis, Aurelio Tobias
Background: Despite the existing evidence, many physicians are reluctant to use opioid analgesia for acute abdominal pain. Methods: We performed updated conventional and network meta-analyses. For the first time to our knowledge, direct and indirect evidence of any type of opioid analgesia was estimated and compared using network meta-analysis. Results: There was no significant difference in the intensity of pain between the two cohorts (mean difference (MD) = 0...
February 2019: Journal of Clinical Medicine Research
Ai-Lynn Wong, Elaine Meehan, Franz E Babl, Susan M Reid, Anthony Catto-Smith, Katrina Williams, Dinah S Reddihough
AIM: To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken. METHODS: The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes...
January 30, 2019: Journal of Paediatrics and Child Health
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