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Journal of the American Academy of... Feb 2019Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management... (Review)
Review
Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management decisions. Dermoscopic findings or images provided to pathologists offer important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form provide little value to pathologists. Most dermoscopic structures have direct histopathologic correlates, and therefore dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article in this continuing medical education series, we review dermoscopic features and their histopathologic correlates.
Topics: Adult; Aged; Biopsy, Needle; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermoscopy; Diagnosis, Differential; Education, Medical, Continuing; Female; Humans; Immunohistochemistry; Male; Middle Aged; Sensitivity and Specificity; Skin Neoplasms
PubMed: 30321581
DOI: 10.1016/j.jaad.2018.07.073 -
Clinics in Plastic Surgery Jul 2017Although pain management is a major challenge for clinicians, appropriate pain control is the foundation of efficacious burn care from initial injury to long-term... (Review)
Review
Although pain management is a major challenge for clinicians, appropriate pain control is the foundation of efficacious burn care from initial injury to long-term recovery. The very treatments designed to treat burn wounds may inflict more pain than the initial injury itself, making it the clinician's duty to embrace a multimodal treatment approach to burn pain. Vigilant pain assessment, meaningful understanding of the pathophysiology and pharmacologic considerations across different phases of burn injury, and compassionate attention to anxiety and other psychosocial contributors to pain will enhance the clinician's ability to provide excellent pain management.
Topics: Anesthesia; Burns; Humans; Pain Management; Pain Measurement
PubMed: 28576242
DOI: 10.1016/j.cps.2017.02.026 -
American Family Physician Dec 2015Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of...
Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn.
Topics: Continuous Positive Airway Pressure; Education, Medical, Continuing; Female; Humans; Infant, Newborn; Intubation; Male; Practice Guidelines as Topic; Respiratory Distress Syndrome, Newborn; Surface-Active Agents; Treatment Outcome
PubMed: 26760414
DOI: No ID Found -
Australian Dental Journal Mar 2017Maintaining teeth in their corrected positions following orthodontic treatment can be extremely challenging. Teeth have a tendency to move back towards the original... (Review)
Review
Maintaining teeth in their corrected positions following orthodontic treatment can be extremely challenging. Teeth have a tendency to move back towards the original malocclusion as a result of periodontal, gingival, occlusal and growth related factors. However, tooth movement can also occur as a result of normal age changes. Because orthodontics is unable to predict which patients are at risk of relapse, those which will remain stable and the extent of relapse that will occur in the long-term, clinicians need to treat all patients as if they have a high potential to relapse. To reduce this risk, long term retention is advocated. This can be a significant commitment for patients, and so retention and the potential for relapse must form a key part of the informed consent process prior to orthodontic treatment. It is vital that patients are made fully aware of their responsibilities in committing to wear retainers as prescribed in order to reduce the chance of relapse. If patients are unable or unwilling to comply as prescribed, they must be prepared to accept that there will be tooth positional changes following treatment. There is currently insufficient high quality evidence regarding the best type of retention or retention regimen, and so each clinician's approach will be affected by their personal, clinical experience and expertise, and guided by their patients' expectations and circumstances.
Topics: Humans; Malocclusion; Orthodontic Retainers; Orthodontics, Corrective; Recurrence
PubMed: 28297088
DOI: 10.1111/adj.12475 -
Journal of the American Medical... Sep 2021Telemedicine and telehealth are increasingly used in nursing homes (NHs). Their use was accelerated further by the COVID-19 pandemic, but their impact on patients and... (Review)
Review
OBJECTIVES
Telemedicine and telehealth are increasingly used in nursing homes (NHs). Their use was accelerated further by the COVID-19 pandemic, but their impact on patients and outcomes has not been adequately investigated. These technologies offer promising avenues to detect clinical deterioration early, increasing clinician's ability to treat patients in place. A review of literature was executed to further explore the modalities' ability to maximize access to specialty care, modernize care models, and improve patient outcomes.
DESIGN
Whittemore and Knafl's integrative review methodology was used to analyze quantitative and qualitative studies.
SETTING AND PARTICIPANTS
Primary research conducted in NH settings or focused on NH residents was included. Participants included clinicians, NH residents, subacute patients, and families.
METHODS
PubMed, Web of Science, CINAHL, Embase, PsycNET, and JSTOR were searched, yielding 16 studies exploring telemedicine and telehealth in NH settings between 2014 and 2020.
RESULTS
Measurable impacts such as reduced emergency and hospital admissions, financial savings, reduced physical restraints, and improved vital signs were found along with process improvements, such as expedient access to specialists. Clinician, resident, and family perspectives were also discovered to be roundly positive. Studies showed wide methodologic heterogeneity and low generalizability owing to small sample sizes and incomplete study designs.
CONCLUSIONS AND IMPLICATIONS
Preliminary evidence was found to support geriatrician, psychiatric, and palliative care consults through telemedicine. Financial and clinical incentives such as Medicare savings and reduced admissions to hospitals were also supported. NHs are met with increased challenges as a result of the COVID-19 pandemic, which telemedicine and telehealth may help to mitigate. Additional research is needed to explore resident and family opinions of telemedicine and telehealth use in nursing homes, as well as remote monitoring costs and workflow changes incurred with its use.
Topics: Aged; Humans; Medicare; Nursing Homes; Telemedicine; United States
PubMed: 33819450
DOI: 10.1016/j.jamda.2021.02.037 -
Journal of Conservative Dentistry : JCD 2017Polymerization shrinkage is one of the dental clinician's main entanglements when placing resin-based composite restorations. None of the method can assure a perfectly... (Review)
Review
Polymerization shrinkage is one of the dental clinician's main entanglements when placing resin-based composite restorations. None of the method can assure a perfectly sealed restoration for adhesive restorative materials; clinicians must abode problems of polymerization shrinkage and its possible ill effects. The objective of this article is to review different incremental techniques that can ruin the polymerization shrinkage stress of direct composite restoration.
PubMed: 29430088
DOI: 10.4103/JCD.JCD_157_16 -
Nature Medicine Nov 2018Sepsis is the third leading cause of death worldwide and the main cause of mortality in hospitals, but the best treatment strategy remains uncertain. In particular,...
Sepsis is the third leading cause of death worldwide and the main cause of mortality in hospitals, but the best treatment strategy remains uncertain. In particular, evidence suggests that current practices in the administration of intravenous fluids and vasopressors are suboptimal and likely induce harm in a proportion of patients. To tackle this sequential decision-making problem, we developed a reinforcement learning agent, the Artificial Intelligence (AI) Clinician, which extracted implicit knowledge from an amount of patient data that exceeds by many-fold the life-time experience of human clinicians and learned optimal treatment by analyzing a myriad of (mostly suboptimal) treatment decisions. We demonstrate that the value of the AI Clinician's selected treatment is on average reliably higher than human clinicians. In a large validation cohort independent of the training data, mortality was lowest in patients for whom clinicians' actual doses matched the AI decisions. Our model provides individualized and clinically interpretable treatment decisions for sepsis that could improve patient outcomes.
Topics: Administration, Intravenous; Artificial Intelligence; Clinical Decision-Making; Cohort Studies; Critical Care; Female; Humans; Learning; Male; Sepsis; Software; Vasoconstrictor Agents
PubMed: 30349085
DOI: 10.1038/s41591-018-0213-5 -
Reumatismo Oct 2018The range of pathologies that are related to primitive vasculitis is broad, complex and not as typical as we would expect. Clinicians should be aware that several forms... (Review)
Review
The range of pathologies that are related to primitive vasculitis is broad, complex and not as typical as we would expect. Clinicians should be aware that several forms of primitive and systemic vasculitis, regardless of the size of the affected vessel, may exhibit identical histological alterations. This observation has important clinical implications as it means that cases of vasculitis do not correspond clinically and histologically. Thus, while histology remains the diagnostic gold standard, it can be used only as part of the most complete clinical assessment possible. Another point worth of the clinician's attention is that vasculitis histology changes over time, as do disease evolution and activity, even without considering the masking effects of treatment and the possibility of sampling error due to the patchy occurrence of vasculitis. The purpose of this review is to identify the most common forms of vasculitis in clinical practice, and to provide guidance to the clinician on the pathology of the vessels.
Topics: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Blood Vessels; Erythema Nodosum; Giant Cell Arteritis; Humans; Organ Size; Organ Specificity; Retroperitoneal Fibrosis; Takayasu Arteritis; Vasculitis
PubMed: 30282441
DOI: 10.4081/reumatismo.2018.1096 -
Digital Biomarkers 2021Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician's reach, a new set of examination tools will redefine... (Review)
Review
Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician's reach, a new set of examination tools will redefine neurologic and neurosurgical care, serving as the basis for the . We describe its components and review specific technologies, which move beyond traditional video-based telemedicine encounters and include separate digital tools. A future suite of these clinical assessment technologies will blur the lines between history taking, examination, and remote monitoring. Prior to full-scale implementation, however, much more investigation is needed. Because of the nascent state of the technologies, researchers, clinicians, and developers should establish digital neurologic examination requirements in order to maximize its impact.
PubMed: 34056521
DOI: 10.1159/000515577 -
Current Cardiology Reports Aug 2022Wearable technology is rapidly evolving and the data that it can provide regarding an individual's health is becoming increasingly important for clinicians to consider.... (Review)
Review
PURPOSE OF REVIEW
Wearable technology is rapidly evolving and the data that it can provide regarding an individual's health is becoming increasingly important for clinicians to consider. The purpose of this review is to help inform health care providers of the benefits of smartwatch interrogation, with a focus on reviewing the various parameters and how to apply the data in a meaningful way.
RECENT FINDINGS
This review details interpretation of various parameters found commonly in newer smartwatches such as heart rate, step count, ECG, heart rate recovery (HRR), and heart rate variability (HRV), while also discussing potential pitfalls that a clinician should be aware of. Smartwatch interrogation is becoming increasingly relevant as the continuous data it provides helps health care providers make more informed decisions regarding diagnosis and treatment. For this reason, we recommend health care providers familiarize themselves with the technology and integrate it into clinical practice.
Topics: Electrocardiography; Exercise Test; Heart Rate; Humans; Wearable Electronic Devices
PubMed: 35635678
DOI: 10.1007/s11886-022-01718-0