medical opinion
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2022 ◽  
Vol 12 (1) ◽  
pp. 0-0

The exponential growth of big data demands an efficient knowledge discovery. The electronic medical records of patients on medical data Clouds contain implicit medical information. Although the periodic health examination (PHE) reports describing a set of screening tests for healthy individuals performed periodically, common individuals require the assistance of an expert to interpret the results for a medical opinion. This research study proposes a metaphoric design of Electronic Medical Record (EMR) for PHE reports of patients. The outcomes of this study glimpses useful findings for the common people in the self-interpretation of their medical reports. Besides, among a variety of solutions, the study uses the metaphoric representation to convert the numerical data and medical terminology to familiar graphic representations from real life. The study identifies the detailed requirements to propose a conceptual architecture for metaphoric EMR reports. The future work will result in a prototype design, evaluation, and refinement of metaphors based on stakeholders' feedback.


2021 ◽  
Vol 26 (5-6) ◽  
pp. 561-581
Author(s):  
Aslıhan Gürbüzel

Abstract This article examines the translation, circulation, and adaptation of the medical opinion of Spanish physician Nicolas Monardes (d. 1588) on tobacco in the Ottoman Empire. In addition to medical and encyclopedist authors, the spread of new medical knowledge in learned and eventually popular registers was the result of the efforts of religious authorities. These latter authorities, namely jurists, Sufis, and preachers, took an interest in the bodily and mental effects of smoking for its moral implications. In forming their medical-moral discourse, they sought and studied contemporary medical works of both Ottoman and European provenance. Challenging the strict division between learned and popular medicine, this article argues that Ottoman religious authorities, while often excluded from the history of medicine, played significant roles in the circulation, adaptation, and localization of medical knowledge.


2021 ◽  
Author(s):  
ABBA AMSAMI ELGUJJA

This paper reviewed the extent to which Bolam provided healthcare professionals with immunity from claims based on negligence in the past, and whether Bolitho was able to resolve that issue.During the early 1950s, when the NHS was in its golden era, the medical profession was still “unregulated and paternalistic” in approach. Consequently, the medical profession had enjoyed unreserved obedience from patients and was treated with great reverence by society. John Hector Bolam was a patient who sustained fractures because the defendants applied unmodified electro-convulsive therapy on him. So, his suit for negligence provided the much-needed opportunity for grounding the principles of medical negligence which was still in its early stage of development. The issue was unprecedented, and therefore the dictum of Lord President Clyde in the Scottish case of Hunter and Hanley became handy. The ruling gave doctors the latitude to set standards of care and justify their actions by simply having their peers support them. It placed the onus of proving “Wednesbury unreasonableness” on the patients in order to succeed in medical negligence litigation against a doctor. That was very difficult to prove. This attracted criticisms against Bolam that it provided excessive immunity to doctors and difficulties to the patients. Several cases had been decided in favor of the doctors and allied healthcare professionals.A similar opportunity arose in 1984 when the Bolitho rule was propounded which empowered the courts to intervene and determine if a body of medical opinion is indeed responsible, by subjecting their evidence to the logicality and risk/benefit analysis tests.Issues for consideration include, to what extent did Bolam provide immunity to healthcare professionals and, post-Bolitho, if the issues have now been resolved. To accomplish that, the author will examine the various court decisions pre-and post- Bolitho with a view to coming up with the answer(s) to the issues raised


Author(s):  
Shyh Poh Teo

Introduction: To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate. Materials and Methods: We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013. Results:  We  studied 29 patients with a median age of 63 years. A diagnosis was provided  in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization. Conclusion: Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should  be sought  by vestibular  physiotherapists  if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.


2021 ◽  
pp. 23-24
Author(s):  
Taif Alqahtani ◽  
Faisal Konbaz

Introduction: Herniated nucleus pulposus (HNP) is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The reactive scoliosis is frequently associated with lumbar HNPs, a compensatory effort to relieve nerve compression. Moreover, reactive scoliosis secondary to lumbar HNP is typically associated with children and usually resolves with effective management of lumbar HNP. Although the surgical intervention is frequently employed among adults, only 0.5% of discectomies are carried out in children <16 years old.  The current case report is of a 15-year-old girl, with no history of spinal ailment, who presented with a large disc herniation at L4–L5 region, associated with a reactive secondary scoliosis, which was resolved following a successful surgical intervention. Case Report: A 15-year-old female with known case of scoliosis and a history of lower back pain for nine months following a fall while playing football presented at outpatient clinic. She sought medical opinion after two months of persistent pain with radiculopathy to the right side toward big toe. Similarly, there was normal plantar reflex and no clonus or Hoffman sign. There was positive straight leg raise test as well as positive contralateral straight leg raise test. Scoliosis is idiopathic in majority of young patients. However, it might also arise as a part or complication of a triggering health state. Although scoliosis has been frequently associated with lumbar HNP among adolescents, most patients with lumbar disc ailment in this age group might be underdiagnosed initially. Similarly, in our case study the patient was not diagnosed when medical opinion was sought after two months of persistent pain with radiculopathy to the right side toward big toe. The clinical characteristics of pediatric lumbar HNP are usually comparable to those seen in adults; however, one distinguishing feature is that up to 90% have a positive straight-leg raising test. The most common symptom is lumbar pain; limitation of lumbar motility and lassegue are the most common signs. The etiology, pathophysiology, and patterns of the scoliotic posture in cases secondary to HNP remain debated. It is highly recommended to do CT scan in cases of adolescent lumbar HNP to rule out apophyseal ring fracture; accurate diagnosis helps surgeon in planning the appropriate surgical intervention needed. Scoliosis secondary to lumbar disc herniation is observed occasionally, therefore, its clinical significance and pathophysiology are not well-established. However, it is well-recognized that children’s spines have superior adaptive capacity, which shields nervous tissue. An example of this could be scoliosis in patients with root compression, when they bend to the side contrary to the compression, causing an enlargement of the affected foramen and root release. It has been reported that 80% of the patients with disc herniation and scoliosis had the convexity on the side of the root compression. The MRI findings revealed that the scoliosis widened the foramen. Similarly, in our case report the X-ray depicted scoliotic deformity with convexity toward the right side. MRI is the best imaging technique to indicate disc herniation and eliminate other likelihoods in both children and adolescents. Surgical interventions, such as micro-endoscopy discectomy and percutaneous endoscopic lumbar discectomy, could achieve considerable pain relief and function improvement. Our case finding revealed that microscopic discectomy relieved the pain and improved the scoliosis. Conclusion: Lumbar disc herniation is a rare entity among both children and adolescent and may also result in scoliosis and lumbar pain with or without sciatica. Therefore, lumbar disc herniation in association with scoliosis need vigilant evaluation of signs and symptoms in addition to appropriate diagnostic imaging. Imaging has a vital role in the diagnosis of underlying disease state and helps in clinical management along with surgical planning. The appropriate treatment is discectomy.


Toxics ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 228
Author(s):  
Jiraporn Chittrakul ◽  
Ratana Sapbamrer ◽  
Wachiranun Sirikul

The incidence of respiratory disease is increasing. In relation to this, in addition to infection, factors associated with working with chemical insecticides are a cause for concern. Some of the chemicals involved have been shown to affect the respiratory system, and consequentially workers are at increased risk of conditions such as asthma. However, medical opinion around this area is still controversial; therefore, the objective of this study is to investigate the association between exposure to insecticides and asthma by means of a systematic review of the relevant literature. Relevant literature was identified, and a systematic review was conducted to investigate the association between exposure to insecticides and asthma. A total of five studies (three cross sectional and two cohort) including 45,435 subjects were identified as relevant. The summary odds ratios related to the impact of exposure to specific insecticides on asthma were organophosphates 1.31 (95%CI = 1.17–1.48, I2 = 27%, p = 0.172), carbamates 1.44 (95%CI 1.08–1.92, I2 = 56.7%, p = 0.031) and organochlorines 1.31 (95%CI 1.19–1.64, I2 = 37.3%, p = 0.131). Farmers exposed to certain insecticides may have an increased risk of asthma and asthmatic symptoms, but further research on that issue is urgently needed.


2021 ◽  
pp. 384-390
Author(s):  
D. Kh. Khaibullina ◽  
Yu. N. Maksimov ◽  
F. I. Devlikamova

As defined in the WHO Bulletin (1999), low back pain (LBP) is pain, muscle tension or stiffness localized in the back between the XII pair of ribs and the lower gluteal folds, with or without irradiation in lower limbs. The LBP syndrome is not a nosological unit, but due to its high prevalence, social and economic importance, it has a separate heading in ICD-10 – (M 54.5). Various structures can be the source of LBP: intervertebral discs, facet and sacroiliac joints, muscles, ligaments, tendons, fascia, spinal cord and its roots, peripheral nerves, etc. Depending on which structure the source of pain is, the nature of the pain can have a nociceptive, neuropathic or mixed character, which affects the tactics of patient management. The variety of clinical manifestations of LBP introduces certain difficulties in the process of making a diagnosis and may entail the appointment of treatment methods that are inadequate for the patient’s condition. In such cases, it is advisable to conduct an additional consultation in order to obtain a second medical opinion. The message is devoted to the analysis of a clinical case of LBP. During the examination of the patient, the nature of the pain, initially regarded as neuropathic, began to be interpreted as nociceptive. In accordance with this, a complex treatment was prescribed, which included pharmacological preparations and methods of non-drug therapy. In order to quickly relieve the pain syndrome, the drug dexketoprofen was used according to a stepwise scheme. Obtaining effective anesthesia within 5 days made it possible to abandon further NSAID intake and to continue follow-up treatment with a preparation of B vitamins, a muscle relaxant and SYSADOA in combination with non-drug methods of treatment. The considered clinical case illustrates both the difficulties arising in the diagnosis of LBP and the possibilities of successful conservative therapy of this disease. 


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stéphane Sanchez ◽  
Isabelle Adamowicz ◽  
Jan Chrusciel ◽  
Philippe Denormandie ◽  
Pierre Denys ◽  
...  

Abstract Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.


Author(s):  
Deirdre Philbin ◽  
Dani Hall

Febrile children presenting to the emergency department pose unique challenges. This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red flags and appropriate investigations. Emergency clinicians must be aware of the risk factors for SBI in febrile children, including young age, ill-appearing children and those with complex comorbidities or immunodeficiency. The presence of red flags in febrile children should immediately alert concern and prompt senior clinician review. This article also discusses the appropriate use of investigations and their role in complementing clinical assessment. When discharging children home after emergency department assessment, safety netting should be undertaken to ensure parents are aware when to seek further medical opinion. The presence of a prolonged fever of 5 days or longer should alert suspicion and usually requires further investigation.


Author(s):  
Rushikesh Umak

Cloud based healthcare computing have changed the face of healthcare in many ways. The main advantages of cloud computing in healthcare are scalability of the required service and the provision to upscale or downsize the data storge, collaborating Artificial Intelligence (AI) and machine learning. The current paper examined various research studies to explore the utilization of intelligent techniques in health systems and mainly focused into the security and privacy issues in the current technologies. E-Healthcare is an emerging field of medical informatics, referring to the delivery of health services and information using the Internet and related technologies. Rendering efficient storage and security for all data is very important for cloud computing. Securing and privacy preserving of data is of high priority when it comes to cloud storage. E-Healthcare is the most important source in the healthcare society. E-healthcare system is now being popularized globally. Implementing the E-healthcare system will have more advantages such as online services for teleconsultation (second medical opinion), e-prescription, e-referral, telemonitoring, telecare etc. E-healthcare system provides high level of security and cost-effective use of patients records, information and communication in support of healthcare and health related issues.


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