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The Impact of Deployment and Combat Exposure on Physical Health Among Military Personnel: A Systematic Review of Incidence, Prevalence, and Risks.

Mil Med 2021 Jul 23. Epub 2021 Jul 23.

Expertcentre Force Health Protection, Military Healthcare Organisation, Ministry of Defence, Doorn 3941 PW, The Netherlands.

Objectives: The impact of deployment and combat on mental health of military personnel is well described. Less evidence is available to demonstrate and summarize the incidence, prevalence, and risks of these exposures on physical health. This study aims to (1) systematically review the available literature to determine the incidence and prevalence of physical health conditions among military personnel during and after deployment and (2) investigate the risks of deployment and combat exposure on physical health. Read More

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EXPRESS: Factors influencing the use of different methods of consent in a randomised acute stroke trial, the Third International Stroke Trial (IST-3).

Int J Stroke 2021 Jul 22:17474930211037123. Epub 2021 Jul 22.

University of Edinburgh, DCN, Western General Hospital, Edinburgh, United Kingdom of Great Britain and Northern Ireland.

Background Obtaining informed consent in people with acute stroke is complex since many, as a direct result of their stroke, lose capacity to make important decisions. Furthermore reperfusion interventions are time dependent necessitating rapid consent. We developed 4 different consent approaches to facilitate recruitment of a broad range of patients in the Third International Stroke Trial (IST-3). Read More

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Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample.

BMJ Open 2021 Jul 21;11(7):e045465. Epub 2021 Jul 21.

Applied Linguistics, University of Warwick, Coventry, UK.

Objectives: To develop a programme theory for the intervention of patients receiving discharge letters.

Design: We used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. Read More

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Management of sport-related concussion in emergency departments in England: a multi-center study.

Brain Inj 2021 Jul 21:1-8. Epub 2021 Jul 21.

Department of Health Professions, Manchester Metropolitan University, Manchester, UK.

Objective: To establish the current knowledge of sport-related concussion (SRC) management of clinicians in emergency departments in the North West of England.

Methods: A cross-sectional, multi-center study design was used and included emergency department clinicians (EDCs) across 15 centers in the North West of England. A 22-question survey was issued with questions focused on the 5th International Conference on Concussion Consensus Statement. Read More

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Use of suggestive seizure manipulation methods in the investigation of patients with possible psychogenic nonepileptic seizures - an international ILAE survey.

Epilepsia Open 2021 Jul 21. Epub 2021 Jul 21.

The University of Sheffield, Academic Neurology Unit, Royal Hallamshire Hospital, Sheffield, UK, S10 2JF.

Video-encephalographic (vEEG) seizure recordings make essential contributions to the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES). The yield of vEEG examinations can be increased through suggestive seizure manipulation (SSM) (i.e. Read More

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Reflecting on Palliative Care Integration in Canada: A Qualitative Report.

Curr Oncol 2021 Jul 19;28(4):2753-2762. Epub 2021 Jul 19.

Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada.

Studies have identified integrated interdisciplinary care as a hallmark of effective palliative care. Although models attempt to show how integration may function, there is little literature available that practically explores how integration is fostered and maintained. In this study we asked palliative care clinicians across Canada to comment on how services are integrated across the healthcare system. Read More

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Initiating technology dependence to sustain a child's life: a systematic review of reasons.

J Med Ethics 2021 Jul 19. Epub 2021 Jul 19.

School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland

Background: Decision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. Read More

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Length and Redundancy of Outpatient Progress Notes Across a Decade at an Academic Medical Center.

JAMA Netw Open 2021 Jul 1;4(7):e2115334. Epub 2021 Jul 1.

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.

Importance: There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy.

Objective: To measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry. Read More

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Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Oncology, Dementia, Frailty, and Pulmonary Diseases.

J Palliat Med 2021 Jul 14. Epub 2021 Jul 14.

Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.

Prognostication has been described as "Medicine's Lost Art." Taken with diagnosis and treatment, prognostication is the third leg on which medical care rests. As research leads to additional beneficial treatments for vexing conditions like cancer, dementia, and lung disease, prognostication becomes even more difficult. Read More

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Personal Formularies of Primary Care Physicians Across 4 Health Care Systems.

JAMA Netw Open 2021 Jul 1;4(7):e2117038. Epub 2021 Jul 1.

Mass General Brigham, Boston, Massachusetts.

Importance: More conservative prescribing has the potential to reduce adverse drug events and patient harm and cost; however, no method exists defining the extent to which individual clinicians prescribe conservatively. One potential domain is prescribing a more limited number of drugs. Personal formularies-defined as the number and mix of unique, newly initiated drugs prescribed by a physician-may enable comparisons among clinicians, practices, and institutions. Read More

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Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: a systematic review protocol.

JBI Evid Synth 2021 Jul 13. Epub 2021 Jul 13.

Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA Rural Health Corporation of Northeastern Pennsylvania, Freeland, PA, USA Department of Family Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers School of Nursing, Newark, NJ, USA Department of Health Policy, School of Public Health, Texas A&M, College Station, TX, USA Montefiore Einstein Starfish Program, Montefiore Medical Center, Bronx, NY, USA College of Education & Human Development, Georgia State University, Atlanta, GA, USA.

Objective: This systematic review will assess the biological sex disparity in survival outcomes following treatment for renal cell carcinoma and analyze the estimates of biological sex disparity outcomes following supposed or proposed curative treatment.

Introduction: Renal cell carcinoma is a type of kidney cancer. There is a lack of conformity in the literature on the biological sex disparity in survival outcomes after treatment. Read More

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Physician Use of Stigmatizing Language in Patient Medical Records.

JAMA Netw Open 2021 Jul 1;4(7):e2117052. Epub 2021 Jul 1.

Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.

Importance: Negative attitudes toward patients can adversely impact health care quality and contribute to health disparities. Stigmatizing language written in a patient's medical record can perpetuate negative attitudes and influence decision-making of clinicians subsequently caring for that patient.

Objective: To identify and describe physician language in patient health records that may reflect, or engender in others, negative and positive attitudes toward the patient. Read More

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"Unheard minds, again and again": autistic insider perspectives and theory of mind.

Disabil Rehabil 2021 Jul 13:1-11. Epub 2021 Jul 13.

Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.

Purpose: The Theory of Mind (ToM) deficit hypothesis is a dominant construct used to explain the social and communication difficulties observed in autistic individuals. This hypothesis was based on an interpretation of autistic individuals' observable behavior, not based on insider accounts. Insider perspectives still remain mostly absent in research on ToM. Read More

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'Life-changing surgery': English-language news media representation of selective dorsal rhizotomy.

Child Care Health Dev 2021 Jul 12. Epub 2021 Jul 12.

Royal Children's Hospital, Melbourne, Victoria, Australia.

Background: Selective dorsal rhizotomy (SDR) is a neurosurgical intervention to reduce spasticity in children with cerebral palsy. Parents researching SDR for their child may be influenced by framing of SDR in news media articles they read. This study examined framing of SDR in English-language news media. Read More

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Exploring a combined biomarker for tuberculosis treatment response: protocol for a prospective observational cohort study.

BMJ Open 2021 Jul 8;11(7):e052885. Epub 2021 Jul 8.

Respiratory medicine, Royal Free London NHS Foundation Trust, London, UK.

Introduction: An improved understanding of factors explaining tuberculosis (TB) treatment response is urgently needed to help clinicians optimise and personalise treatment and assist scientists undertaking novel treatment regimen trials. Promising outcome proxy measures, including sputum bacillary load and host immune response, are widely reported with variable results. However, they have not been studied together in combination with antibiotic exposure. Read More

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Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update.

Liver Cancer 2021 Jun 19;10(3):181-223. Epub 2021 May 19.

Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.

The Clinical Practice Manual for Hepatocellular Carcinoma was published based on evidence confirmed by the Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma along with consensus opinion among a Japan Society of Hepatology (JSH) expert panel on hepatocellular carcinoma (HCC). Since the JSH Clinical Practice Guidelines are based on original articles with extremely high levels of evidence, expert opinions on HCC management in clinical practice or consensus on newly developed treatments are not included. However, the practice manual incorporates the literature based on clinical data, expert opinion, and real-world clinical practice currently conducted in Japan to facilitate its use by clinicians. Read More

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Baseline Knowledge Attitudes Satisfaction and Aspirations With Advance Care Planning: A Cross-Sectional Study.

Am J Hosp Palliat Care 2021 Jul 6:10499091211030447. Epub 2021 Jul 6.

Department of Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, TN, USA.

Background: Studies have consistently demonstrated low rates of adoption of Advance Care Planning in the community.

Methods: We studied Medicare enrollees age 65 and over and non-Medicare patients using a cross-sectional survey undertaken in February and March 2019 using questionnaires completed by out-patients attending a teaching hospital clinic in East Tennessee USA. We evaluated patient knowledge, attitudes, satisfaction and aspirations towards Advance Care Planning. Read More

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How Do Patients with Life-Limiting Illness and Caregivers Want End-Of-Life Prognostic Information Delivered? A Pilot Study.

Healthcare (Basel) 2021 Jun 22;9(7). Epub 2021 Jun 22.

Institute for Evidence Based Healthcare, Bond University, Robina 4226, Australia.

We aimed to identify the level of prognostic disclosure, type of prognostic information and delivery format of prognostic communication that older adults diagnosed with a life-limiting illness or caregivers prefer to receive. We developed and pilot tested an open-ended survey to 15 older patients and caregivers who had experience in health services for life-limiting illness either for a relative, friend or themselves. Five hypothetical clinical scenarios of prognostic options were presented to ascertain preferences. Read More

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Similarities and Differences in the Learning Profiles of Adolescents with SLD and SLI in Mathematics-A Preliminary Analysis.

Brain Sci 2021 Jun 25;11(7). Epub 2021 Jun 25.

First Psychiatric Clinic, "Papageorgiou" General Hospital, Ring Road Thessaloniki, N. Efkarpia, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54603 Thessaloniki, Greece.

SLI and SLD constitute two independent neurodevelopmental disorders, which frequently cause challenges in the diagnosis process, especially due to their nature. This has caused disagreement among clinicians regarding their recognition as separate or overlapping disorders. The objective of the study was to enlighten the path of valid diagnosis and intervention during adolescence when the two disorders change their manifestation and overlap. Read More

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Telemedicine Training in the COVID Era: Revamping a Routine OSCE to Prepare Medicine Residents for Virtual Care.

J Med Educ Curric Dev 2021 Jan-Dec;8:23821205211024076. Epub 2021 Jun 16.

Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA.

Background: During the rapid onset of the pandemic, clinicians transitioned from traditional outpatient practice to virtual modalities for providing routine care to patient panels. Like training programs nationwide, telemedicine training and assessment had not been systematically incorporated into our residency. In response, a scheduled Internal Medicine (IM) Objective Structured Clinical Examination (OSCE) was adapted to a remote modality to become virtual care-focused learning experience for trainees and to provide valuable feedback to educators. Read More

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TEXT4myBACK - The Development Process of a Self-Management Intervention Delivered Via Text Message for Low Back Pain.

Arch Rehabil Res Clin Transl 2021 Jun 27;3(2):100128. Epub 2021 Apr 27.

Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia.

Objective: To develop a bank of text messages for a lifestyle-based self-management intervention for people with low back pain (LBP).

Design: Iterative development process.

Setting: Community and primary care. Read More

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A Pediatric Hospital Physical Therapy and Occupational Therapy Department's Response to COVID-19: An Administrative Case Report.

Phys Ther 2021 Jun 25. Epub 2021 Jun 25.

Boston Children's Hospital, Department of Physical Therapy and Occupational Therapy Services, 300 Longwood Avenue, MA 02115.

Objective: The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges.

Methods (case Description): The case report setting is a physical therapy and occupational therapy department (department) of an academic pediatric medical center that provides a range of health care services for children and youth. Challenges that COVID-19 presented to the Department included: (1) managing safety concerns for patients, their families, and staff; (2) continuing to provide high-quality therapy services within state mandated restrictions; (3) triaging patients; and (4) keeping clinicians employed and working productively. Read More

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Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants.

BMJ Open 2021 06 23;11(6):e045897. Epub 2021 Jun 23.

Monash Newborn, Monash Newborn at Monash Children's Hospital, Clayton, Victoria, Australia.

Introduction: Respiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks' gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. Read More

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Participant injury in clinical trials conducted in New Zealand for the benefit of manufacturers: an unfair system?

Mark J Bolland

N Z Med J 2021 06 4;134(1536):124-131. Epub 2021 Jun 4.

Associate Professor of Medicine, Department of Medicine, University of Auckland; Department of Endocrinology, Auckland District Health Board.

A patient with a long-standing medical condition was enrolled in a clinical trial, deemed as conducted for the benefit of the manufacturer. The patient entered the trial and, shortly afterward, developed a severe illness that left him with a significant permanent disability. Clinical investigators and clinicians not involved in the trial believed the illness was related to trial participation. Read More

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"The stakes could not be higher": A mixed methods study of parental social media use in pediatric oncology.

Pediatr Blood Cancer 2021 Jun 16:e29176. Epub 2021 Jun 16.

Department of Pediatrics, Division of Pediatric Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York, USA.

Background: To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists' advice and information found on SM.

Procedure: Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child's health were recruited through SM sites and nonprofit organizations across the United States and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. Read More

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The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report.

Sex Med 2021 Jun 11;9(4):100372. Epub 2021 Jun 11.

Universidad Veracruzana, Centro de Investidaciones Cerebrales, Veracruz, MX.

Introduction: Persistent Genital Arousal Disorder (PGAD) is defined as "spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing, pulsating) in the absence of sexual interest and desire" and traditionally causes marked distress, embarrassment and shame. PGAD may be caused by starting, discontinuing, or making adjustments in certain antidepressants or other medications.

Aim: To report the case of a 36- year- old woman with PGAD, likely due to changes in her psychiatric medications, who was treated with pramipexole and experienced improvement in her PGAD symptoms. Read More

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Labels improve emergency medicine physician comfort and ability to use a slit lamp.

AEM Educ Train 2021 Jul 8;5(3):e10570. Epub 2021 Feb 8.

Emergency Medicine Department Regions Hospital St. Paul MI USA.

Slit-lamp (SL) biomicroscopy is an important skill for emergency medicine (EM) clinicians. However, residents and faculty have varying levels of comfort and skill with this procedure. While some of the discomfort may be from a knowledge gap, we hypothesized that at least some difficulty came from infrequent use and forgetting which of the many knobs, levers, buttons, and switches of the SL create the desired effects. Read More

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Integrating primary care and public health to enhance response to a pandemic.

Prim Health Care Res Dev 2021 06 10;22:e27. Epub 2021 Jun 10.

Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand.

Primary health care (PHC) includes both primary care (PC) and essential public health (PH) functions. While much is written about the need to coordinate these two aspects, successful integration remains elusive in many countries. Furthermore, the current global pandemic has highlighted many gaps in a well-integrated PHC approach. Read More

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The practicalities of providing expert evidence for the court.

Paediatr Respir Rev 2021 Apr 22. Epub 2021 Apr 22.

Senior Counsel, Greenway Chambers in Sydney, NSW, Australia.

The role of the expert witness is clear in the eyes of the court but that understanding is less consistent for the medical professionals who may be called on in this capacity. The fundamental key is the clinician's purpose in using their experience, knowledge and training as they provide the court with an unbiased assessment of the clinical issues that have arisen in the case. Using the Australian context, this article provides guidance for clinicians who are asked to provide the court with their expertise through written and spoken representations, drawing upon experience and the use of the "Expert Witness Code of Conduct". Read More

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COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust.

JMIR Ment Health 2021 Jun 21;8(6):e29314. Epub 2021 Jun 21.

Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.

From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic. Read More

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