scholarly journals Practice Current

2019 ◽  
Vol 9 (3) ◽  
pp. 263-270
Author(s):  
Ajal Dave ◽  
Aravind Ganesh ◽  
Malik Muhammad Adil ◽  
Jack W. Tsao
Keyword(s):  
Expert Opinion ◽  
Online Survey ◽  
Preventative Treatment ◽  
Ongoing Debate ◽  
Link Type ◽  
Common Complaint ◽  
Expectation Management ◽  
Work Up

A common complaint after concussion is the development of new or worsening headaches which can make it difficult or even impossible for patients to work or function in their day-to-day lives. Uncertainties associated with the complaints and a wide variety of approaches exist regarding the appropriate work-up and management of these patients. Areas of ongoing debate include the need for neuroimaging; optimal, acute, and preventative treatment; and proper counseling and expectation management. Given the wide variety of potential approaches and the lack of consensus, we sought expert opinion from around the globe on how to evaluate and manage patients with headache following concussion. Similar questions were posed to the rest of our readership in an online survey (links.lww.com/CPJ/A96), the results of which are also presented.

scholarly journals Diagnosis and management of bile acid diarrhoea: a survey of UK expert opinion and practice

2019 ◽  
Vol 11 (5) ◽  
pp. 358-363 ◽  
Author(s):  
Julian R F Walters ◽  
Ramesh Arasaradnam ◽  
H Jervoise N Andreyev ◽  
Keyword(s):  
Bile Acid ◽  
Expert Opinion ◽  
Best Practice ◽  
Online Survey ◽  
Design Method ◽  
Diagnosis And Management ◽  
Bile Acid Malabsorption ◽  
Presenting Symptoms ◽  
Wide Range ◽  
The Uk

ObjectiveBile acid diarrhoea (BAD), which includes bile acid malabsorption, causes a variety of digestive symptoms. Diagnostic rates and management vary considerably. We conducted a survey of current practice to review expert opinion and provide guidance on diagnosis and management.Design/methodAn online survey was conducted of clinical members of the UK Bile Acid Related Diarrhoea Network, who had all published research on BAD (n=21). Most were National Health Service consultants who had diagnosed over 50 patients with the condition.ResultsThe preferred terminology was to use BAD, with primary and secondary to classify causes. A wide range of presenting symptoms and associated conditions were recognised. SeHCAT (tauroselcholic acid) was the preferred diagnostic test, and 50% of respondents thought general practitioners should have access to this. Patients who met the Rome IV diagnostic criteria for functional diarrhoea, irritable bowel syndrome (IBS) with predominant diarrhoea or postcholecystectomy diarrhoea were usually investigated by SeHCAT, which was used sometimes in other types of IBS. Treatment with a bile acid sequestrant was offered to patients with low SeHCAT values, with expected response rates >70% in the most severe. Colestyramine was the usual sequestrant, starting between 2 g and 8 g daily; colesevelam was an alternative. In patients who had an incomplete response, increasing the dose, changing to an alternative sequestrant, use of loperamide and a low fat diet were suggested. Recommendations for follow-up and to improve the overall patient experience were made.ConclusionThis expert survey indicates current best practice in the diagnosis and management of BAD.

scholarly journals ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries – the Israeli experience

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Dror Dicker ◽  
Batya Kornboim ◽  
Rakefet Bachrach ◽  
Naim Shehadeh ◽  
Shani Potesman-Yona ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Online Survey ◽  
International Study ◽  
Direct Patient Care ◽  
Link Type ◽  
Full Responsibility ◽  
Medical Need ◽  
Treatment Of Obesity ◽  
Israeli Experience

Abstract Background Obesity is a highly prevalent, complex, and chronic relapsing disease with a considerable unmet medical need. We aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity treatment among people with obesity (PwO) and physicians in Israel. Methods The ACTION-IO study was an online survey conducted in 11 countries, including Israel. Findings from the Israeli cohort are reported here. Israeli respondents were PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and physicians primarily in direct patient care. Results In total, 750 PwO and 169 physicians completed the survey in Israel. Although most PwO (70%) and physicians (95%) perceived obesity as a chronic disease, the majority of PwO assumed full responsibility for their own weight loss (88%) compared with only 19% of physicians who placed the responsibility for weight loss on their patients with obesity. Many PwO (62%) and physicians (73%) agreed that a complete change in lifestyle would be required for PwO to lose weight and felt that treatment of obesity should be a team effort between different healthcare professionals (HCPs; 80 and 90%, respectively). Dietitians were considered by 82% of physicians to be the most effective professionals in helping PwO achieve their weight loss goals. Many PwO (69%) liked that their HCP initiated weight management discussions and 68% of those who had not previously discussed their weight would like their HCP to initiate the conversation. However, among PwO who had discussed their weight with an HCP, 59% considered the discussions to be a little helpful or not at all helpful. The beliefs that patients have little interest in or motivation for losing weight were identified by physicians as the main reasons (71 and 70%, respectively) for not initiating weight management discussions. Conclusions In line with the ACTION-IO international study, our Israeli dataset reveals a need to improve awareness, primarily among physicians, on the physiologic basis and clinical management of obesity, including how to approach weight and weight management discussions during patient consultations. Trial registration Registered at ClinicalTrials.gov, NCT03584191. Data first posted on ClinicalTrials.gov: 12 July 2018 - ‘Retrospectively registered’.

scholarly journals Data from a survey on the impact of the pandemic on early-stage academics

2021 ◽  
Vol 1 ◽  
pp. 138
Author(s):  
Edyta Swider-Cios ◽  
Katalin Solymosi ◽  
Mangala Srinivas
Keyword(s):  
Young Children ◽  
Online Survey ◽  
Early Stage ◽  
Family Members ◽  
Early Career ◽  
Group Leaders ◽  
Early Career Researchers ◽  
Link Type ◽  
Share Data ◽  
The Impact

We would like to share data from a survey run by the Young Academy of Europe (YAE) from June to October 2020, with questions aiming to unravel the situation of early-career researchers (including early stage group leaders) working in Europe, during the COVID-19 pandemic. We were particularly interested in the impact of care activities (related to young children or other family members), and the impact of gender. We include the online survey and collected data, without identifying information. The survey is published in Nature Career Column (July, 2021) (https://www.nature.com/articles/d41586-021-01952-6).

Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences

Diagnosis ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 115-121
Author(s):  
Norbert Donner-Banzhoff ◽  
Beate Müller ◽  
Martin Beyer ◽  
Jörg Haasenritter ◽  
Carola Seifart
Keyword(s):  
Primary Care Physicians ◽  
Online Survey ◽  
Original Diagnosis ◽  
Defensive Strategies ◽  
Analytical Reasoning ◽  
Gut Feelings ◽  
Extensive Collection ◽  
Diagnostic Work ◽  
Cognitive Mode ◽  
Work Up

AbstractBackgroundHealth professionals are encouraged to learn from their errors. Determining how primary care physicians (PCPs) react to a case, in which their original diagnosis differed from the final outcome, could provide new insights on how they learn from experiences. We explored how PCPs altered their diagnostic evaluation of future patients after cases where the originally assumed diagnosis turned out to be wrong.MethodsWe asked German PCPs to complete an online survey where they described how the patient concerned originally presented, the subsequent course of events and whether they would change their diagnostic work-up of future patients. Qualitative methods were used to analyze narrative text obtained by this survey.ResultsA total of 29 PCPs submitted cases, most of which were ultimately found to be more severe than originally assumed. PCPs (n = 27) reflected on changes to their subsequent clinical decisions in the form of general maxims (n = 20) or more specific rules (n = 11). Most changes would have resulted in a lower threshold for investigations, referral and/or a more extensive collection of diagnostic information. PCPs decided not only to listen more often to their intuition (gut feelings), but to also practice more analytical reasoning. Participants felt the need for change of practice even if no clinical standards had been violated in the diagnosis of that case. Some decided to resort to defensive strategies in the future.ConclusionsWe describe mechanisms by which physicians calibrate their decision thresholds, as well as their cognitive mode (intuitive vs. analytical). PCPs reported the need for change in clinical practice despite the absence of error in some cases.

Abstract 179: International Survey of Clinical Case Vignettes in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marie Luby ◽  
Steven J Warach ◽  
Gregory W Albers ◽  
Christophe Cognard ◽  
Geoffrey A Donnan ◽  
...  
Keyword(s):  
Perfusion Imaging ◽  
Online Survey ◽  
Clinical Case ◽  
Imaging Findings ◽  
Time Intervals ◽  
Stroke Imaging ◽  
Case Vignettes ◽  
Appropriate Therapy ◽  
Imaging Strategy ◽  
Work Up

Background and Purpose: To quantify consistency across stroke centers worldwide in the typical imaging and treatment decisions made when presented with independent clinical case vignettes including various imaging findings across specific time from onset intervals. Methods: Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging circulated an online survey of clinical case vignettes through its website, through the websites of national professional societies from multiple countries as well as through email distribution lists from STIR and participating societies. Vignettes varied in terms of patient’s age, time from onset, neurological symptoms and NIHSS. The survey displayed the imaging findings offered by the imaging strategy selected, and the responders selected the appropriate therapy considering time from onset, clinical presentation and imaging findings. Results: We received responses from 30 countries including 260 centers. The specific onset interval presented: 0-3 hours, 6 hours, 10 hours or wake-up, influenced the type of imaging work-up selected rather than the clinical scenario. CT was used more often than MRI across all time intervals. For cases with M1 occlusion and large penumbra, vascular imaging was most common (36%) in 0-3 hours and perfusion imaging more frequently used in 6 hours (62%) and wake-up stroke (65%). For large penumbra cases with M1 or ICA occlusion, combination, IV tPA thrombolysis followed by endovascular\IA, treatment (81%) was most common in 0-3 hours. Endovascular treatment was selected the most at 6 hours (43%) for M1 occlusion and large penumbra cases but still selected in 27% of patients up to 10 hours for ICA occlusion and large penumbra cases. For M1 occlusion and large penumbra cases imaged with MRI only, treatment of wake-up stroke increased to 89% from 58% cases imaged with CT alone. Sites that obtained more imaging tended to be more aggressive in terms of revascularization treatment, particularly endovascular therapy. Conclusions: Adding vascular and\or perfusion imaging increased the likelihood of thrombolysis across all time intervals. Usage of MRI perfusion imaging was associated with an increased likelihood of enrollment into a randomized trial up to 83%.

scholarly journals Women’s acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross-sectional online survey results

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052084
Author(s):  
Laurie W Smith ◽  
C Sarai Racey ◽  
Lovedeep Gondara ◽  
Mel Krajden ◽  
Marette Lee ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Online Survey ◽  
Screening Program ◽  
Hpv Testing ◽  
Cross Sectional ◽  
Positive Screen ◽  
Link Type

ObjectiveTo study participant’s acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening.DesignCross-sectional online survey of clinical trial participants.SettingPrimary care, population-based Cervix Screening Program, British Columbia, Canada.ParticipantsA total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit.Outcome measuresAcceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary).ResultsMost respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4–5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable.ConclusionsIn this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening.Trial registration numbersISRCTN79347302 and NCT00461760.

scholarly journals Predicting public take-up of digital contact tracing during the COVID-19 crisis: Results of a national survey

2020 ◽  
Author(s):  
Young Ern Saw ◽  
Edina YQ Tan ◽  
Jessica S Liu ◽  
Jean CJ Liu
Keyword(s):  
Online Survey ◽  
Critical Mass ◽  
National Level ◽  
Sociodemographic Factors ◽  
Primary Outcome Measure ◽  
Contact Tracing ◽  
Network Analyses ◽  
Link Type ◽  
Situational Characteristics ◽  
Pandemic Severity

AbstractBackgroundIn the global outbreak of coronavirus disease 2019 (COVID-19), new digital solutions have been developed for infection control. In particular, contact tracing mobile applications provide a means for governments to manage both health and economic concerns. However, public reception of these applications is paramount to success, and global take-up rates have been low.ObjectiveIn this study, we sought to identify sociodemographic factors predicting voluntary downloads of a contact tracing mobile application.MethodsA sample of 505 adults from the general community completed an online survey. As the primary outcome measure, participants indicated whether they had downloaded a contact tracing application introduced at the national level (“TraceTogether”). As predictor variables, we assessed: (1) participant demographics; (2) behavioral changes on account of the pandemic; and (3) pandemic severity (the number of cases and lockdown status).ResultsWithin our dataset, the strongest predictor of digital contact tracing take-up was the extent to which individuals had already adjusted their lifestyles because of the pandemic (Z = 13.97, p < .001). Network analyses revealed that take-up was most related to: using hand sanitizers, avoiding public transport, and preferring outdoor over indoor venues during the pandemic. However, demographic and situational characteristics did not significantly predict application downloads.ConclusionsEfforts to introduce contact tracing applications could capitalize on pandemic-related behavioral adjustments that individuals have made. Given that critical mass is needed for contact tracing to be effective, we urge further research to understand how citizens respond to contact tracing applications.Trial RegistrationClinicalTrials.govNCT04468581

The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice

2018 ◽  
Vol 55 (5) ◽  
pp. 535-542 ◽  
Author(s):  
Annemarie Schop ◽  
Michelle MA Kip ◽  
Karlijn Stouten ◽  
Soraya Dekker ◽  
Jurgen Riedl ◽  
...  
Keyword(s):  
General Practitioners ◽  
Online Survey ◽  
Correct Diagnosis ◽  
Laboratory Work ◽  
Test Results ◽  
Anaemia Of Chronic Disease ◽  
Routine Work ◽  
Laboratory Test Results ◽  
Underlying Causes ◽  
Work Up

Background We investigated the percentage of patients diagnosed with the correct underlying cause of anaemia by general practitioners when using an extensive versus a routine laboratory work-up. Methods An online survey was distributed among 836 general practitioners. The survey consisted of six cases, selected from an existing cohort of anaemia patients ( n = 3325). In three cases, general practitioners were asked to select the laboratory tests for further diagnostic examination from a list of 14 parameters (i.e. routine work-up). In the other three cases, general practitioners were presented with all 14 laboratory test results available (i.e. extensive work-up). General practitioners were asked to determine the underlying cause of anaemia in all six cases based on the test results, and these answers were compared with the answers of an expert panel. Results A total of 139 general practitioners (partly) responded to the survey (17%). The general practitioners were able to determine the underlying cause of anaemia in 53% of cases based on the routine work-up, whereas 62% of cases could be diagnosed using an extensive work-up ( P = 0.007). In addition, the probability of a correct diagnosis decreased with the patient’s age and was also affected by the underlying cause itself, with anaemia of chronic disease being hardest to diagnose ( P = 0.003). Conclusion The use of an extensive laboratory work-up in patients with newly diagnosed anaemia is expected to increase the percentage of correct underlying causes established by general practitioners. Since the underlying cause can still not be established in 31.3% of anaemia patients, further research is necessary.

scholarly journals Bartonella quintana as a cause for prosthetic valve endocarditis and post-sternotomy mediastinitis

2021 ◽  
Author(s):  
Nienke L. Plantinga ◽  
Roemer J. Vos ◽  
Lyuba Georgieva ◽  
Nienke Roescher
Keyword(s):  
Type Species ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Content Type ◽  
Bartonella Quintana ◽  
Link Type ◽  
Severe Infections ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

An otherwise healthy patient, with minimal clinical, biochemical and peroperative signs of infection, was diagnosed with Bartonella quintana prosthetic valve endocarditis by 16S PCR. The patient subsequently developed a post-sternotomy mediastinitis and Bartonella quintana was the only detected pathogen. Bartonella quintana can cause severe infections in individuals not classically at risk, and may be missed in the routine diagnostic work-up of endocarditis.

Cardiomyopathies

2020 ◽  
pp. 120-244
Author(s):  
Perry Elliott ◽  
Pier D. Lambiase ◽  
Dhavendra Kumar
Keyword(s):  
Risk Stratification ◽  
Heart Muscle ◽  
Takotsubo Syndrome ◽  
Arrhythmogenic Cardiomyopathy ◽  
Ongoing Debate ◽  
Family Screening ◽  
Adults And Children ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The chapter covers heart muscle diseases, starting from the classification and the importance of a cardiomyopathy-focused mindset for diagnostic work up. It goes on to examine genetics, diagnosis, common challenging differentials, and family screening in a number of specific cardiomyopathies in both adults and children. Management of specific cardiomyopathies is discussed in detail, including symptomatic and prognostic treatment with drugs, devices, and surgery, with focus on areas of ongoing debate, such as arrhythmic risk stratification and overlap between dilated and arrhythmogenic cardiomyopathy. In the final section it discusses the pathophysiology, diagnosis, and management of a distinct condition (and arguably not a cardiomyopathy), Takotsubo syndrome.

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