Clinical practice guidelines (CPGs) are an important source of justification for clinical decisions in modern evidence-based practice. Yet, we have given little attention to how they argue their evidence. In particular, how do CPGs argue for treatment with long-term medications that are increasingly prescribed to older patients? APPROACH AND RATIONALE: ...

The Sound Judgment Series consists of invited articles highlighting the clinical value of using ultrasound first in specific clinical diagnoses where ultrasound has shown comparative or superior value. The series is meant to serve as an educational tool for medical and sonography students and clinical practitioners and may help integrate ...

Adherence to antihypertensive medications represents a crucial success factor for optimal blood pressure (BP) control in clinical practice. This study evaluated whether an additional pharmacist-led medication counseling could achieve better optimal BP control and enhance compliance. In a designated family clinic in a region with similar resident characteristics to Hong ...

ISSUES.: Methamphetamine- or amphetamine-type stimulants are the second most frequently used illicit drug worldwide, second only to cannabis. Behavioural treatments are efficacious, but their impact is limited underscoring the need for other treatment options, notably, pharmacotherapy. APPROACH.: A review of randomised controlled trials of pharmacotherapies for methamphetamine- or amphetamine-type stimulants ...

Abstract Over the past decade, the scientific community has begun to recognize the importance of biological sex differences in disease pathology, diagnosis, prevention, and treatment; however, the practice of sex-specific analysis and reporting is not integrated as standard practice by either our federal health agencies or by major medical journals. ...

Aims. For people with schizophrenia, non-adherence to antipsychotic medications may result in high use of health and other services. The objective of our research was to examine the economic consequences of non-adherence in patients with schizophrenia taking antipsychotic medication. Methods. Data were taken from QUATRO, a randomized controlled trial that ...

OBJECTIVE: There are few data regarding the effect of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial results on the management of intracranial atherosclerotic disease (ICAD). We sought to understand the impact of the SAMMPRIS trial on current ICAD clinical practices and future ...

RATIONALEAIMS AND OBJECTIVES: Like health technology assessment (HTA) agencies, hospitals are faced with requests for innovative and costly medical devices. However, local decision makers are frequently confronted with a lack of high-quality clinical data when assessing the effectiveness of innovative medical devices. The aim of this study was to quantify ...

BACKGROUND:: Rapid scale-up of Voluntary Medical Male Circumcision (VMMC) is needed to realize potential reductions in HIV incidence in sub-Saharan Africa. New disposable VMMC devices such as the Shang Ring may offer several advantages over standard surgery, including lower costs. Methods: We compared direct costs of the Shang Ring and ...

Beginning with a rumination on the AIDS-inspired poetry of Thom Gunn, this article by the guest editors introduces the special issue of the Journal of Medical Humanities titled "Queer in the Clinic." After providing an overview of the historical legacy and contemporary dilemmas of LGBTQ persons in biomedical practice, the ...

OBJECTIVE: The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. RESEARCH DESIGN AND METHODS: In a 2×2 ...

Background Abortion services are legally available in Ukraine although there are issues in quality and access. Two studies were conducted in Ukraine to expand options for women, and to determine the efficacy and acceptability of medical abortion. Study design Two open-label clinical trials were conducted at six clinics in Ukraine. ...

Since the 1940s, various attempts have been made to treat peripheral tinnitus by way of intratympanic injection. This administration procedure requires only low concentrations of medication, thanks to the highly targeted delivery to the site of action and comes with minimal systemic exposure. While different compounds have been tested for ...

Compliance with antipsychotic medication is clinically important but challenging for schizophrenia patients. Clinical trials and epidemiological studies strongly suggest that improved compliance results in reduced hospitalizations and other adverse outcomes. Examination of Medicaid and commercial claim data suggests that a significant portion of schizophrenia patients have a regular pattern of ...

Regulatory convergence in safety reporting requirements for medical device clinical trials has not yet been achieved. The Global Harmonization Task Force (GHTF) issued new guidance, GHTF/SG5/N5, on this topic in August 2012. First, we compared current reporting requirements for drug and medical devices in Japan with the international guidelines International ...

Atrial fibrillation is a major risk factor for first and recurrent ischaemic stroke, and anticoagulation, mainly by use of coumarin medications, is an effective strategy for reducing ischaemic stroke occurrence in these patients. However, the coumarin medications have disadvantages. Over the past decade, important strides have been made towards developing ...

OBJECTIVES: Although observational studies provide useful descriptive and correlative information, their role in the evaluation of medical interventions remains contentious. There has been no systematic evaluation of authors' attitudes toward their own nonrandomized studies and how often they recommend specific medical practices. STUDY DESIGN AND SETTING: We reviewed all original ...

Understanding how proposed medical devices will interface with humans is a major challenge that impacts both the design of innovative new devices and approval and regulation of existing devices. Today, designing and manufacturing medical devices requires extensive and expensive product cycles. Bench tests and other preliminary analyses are used to ...

ABSTRACT: BACKGROUND: Long acting injections (LAI) have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications. METHOD: Randomized controlled trial with (50) participants with a diagnosis of schizophrenia randomized to risperidone LAI ...

To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services. Randomized clinical trial of three clinical decision support delivery modalities: email messages to care managers (email), printed reports to clinic administrators (report) and letters to patients (letter) conducted among 20,180 Medicaid ...

Safe behavior of modern medical systems is the most important issue in this industry. Software has to follow safety instructions to keep the system away from any error situation. This paper proposes a new approach for safety management which can be used in different phases of software development before implementation ...

Priapism due to sickle cell disease is a common but less well characterized complication of the disorder. It represents a "medical emergency" with the key determinant of outcome being the duration of penile ischaemia and time to detumescence of <4 h associated with a successful treatment outcome. Management can be outpatient-based ...

In 1802, the director of the Berlin Royal Deaf-Mute Asylum, Ernst Adolph Eschke, performed an experiment to investigate the possibility of curing deafness by means of galvanism. This article explores the hope for a cure for deafness that was connected to the voltaic pile, and concludes that the treatment was ...

To determine the long term clinical effectiveness of laparoscopic fundoplication as an alternative to drug treatment for chronic gastro-oesophageal reflux disease (GORD). Five year follow-up of multicentre, pragmatic randomised trial (with parallel non-randomised preference groups). Initial recruitment in 21 UK hospitals. Responders to annual questionnaires among 810 original participants. At ...

Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally accepted definition of medication ...

While randomized, well-controlled, clinical trials have been viewed as the gold standard in the evaluation of medical products, including drugs, biological products, and medical devices, it is not uncommon for safety assessment to be performed using observational studies, for ethical or practical reasons. In observational studies, various biases could be ...

Although qualitative studies are becoming more appreciated in healthcare, the number of publications of quality studies remains low. Little is known about the frequency and characteristics of citation in qualitative studies. TO COMPARE THE ACADEMIC IMPACT OF QUALITATIVE STUDIES TO THAT OF TWO QUANTITATIVE STUDIES: systematic reviews and randomized controlled ...

In a previous issue of The Journal, I anticipated the decision of the Ninth Circuit in United States v. Loughner. The Ninth Circuit's opinion upheld the involuntary medication of Mr. Loughner under a Harper order, with awareness that he could thereby gain trial competence, and it allowed Mr. Loughner's extended ...

Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials ...

A retrospective analysis of 130 patients was conducted in a Phase I oncology clinic to assess the effect of QTc formula selection on clinical trial eligibility. QTc values were calculated from screening electrocardiograms using 7 formulae (Bazett, Fridericia, Framingham, Hodges, Mayeda, Van de Water and Wohlfart). QTc values > 470 ms for females ...

Background: Clinical reasoning is the cornerstone of medical practice. To date, there is no established framework regarding clinical reasoning difficulties, how to identify them, and how to remediate them. Aim: To identify the most common clinical reasoning difficulties as they present in residents' patient encounters, case summaries, or medical notes. ...

In an ironic twist, the absence of clinical notes sufficient to properly rule on manslaughter and forgery charges brought in the United Arab Emirates (UAE) against 77-year-old veteran Cape Town oncologist Professor Cyril Karabus may have led to his acquittal. On 6 December the prosecution failed for the second time ...

Medical Education 2012: 46: 1174-1178 Context  Clinical reasoning lies at the heart of medical practice and has been the subject of scholarly inquiry and research for some decades. However, despite this, it is still poorly understood. This is largely because current theoretical models are limited in their explanatory power because ...

ABSTRACT. The beneficial effects of pharmacotherapy on children with attention-deficit hyperactivity disorder (ADHD) are well documented. We use near-infrared spectroscopy (NIRS) methodology to determine reorganization of brain neurovascular properties following the medication treatment. Twenty-six children with ADHD (ages six through 12) participated in a modified laboratory school protocol to monitor ...

ObjectiveAttention control (AC) conditions are used to balance nonspecific attention in randomized trials of behavioral interventions. Very little guidance about which behavioral interventions and outcomes merit AC is available in the literature. The primary aim of the present study is to demonstrate a scenario in which use of AC in ...

Predictive characteristics of subjects agreeing to be randomized into clinical trials for the treatment of schizophrenia and schizoaffective disorder have been little studied. In this study, we used data from the recruitment phase of a randomized trial that compared long acting injectable (LAI) risperidone to oral antipsychotic medications. Basic socio-demographic ...

PURPOSE OF REVIEW: Although current asthma guidelines stress the importance of assessing and enhancing adherence to asthma treatment, medication adherence rates in asthma patients are consistently low in practice. In this review, we summarize current literature on method of measurement, prevalence, outcome and intervention of medication adherence in asthma patients. ...

The Great East Japan Earthquake on 11 March 2011 caused major damage in northeastern Japan. The Kanto region experienced a massive electrical power shortage in the summer of 2011. A questionnaire was submitted to 354 hemodialysis clinics in Kanagawa prefecture and the Tokyo metropolitan area, excluding isolated islands, and 176 ...

ABSTRACT Background: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological ...

The efficacy of HIV pre-exposure prophylaxis (PrEP) has been demonstrated in four clinical trials to date; however, the success of PrEP is largely dependent on high levels of medication adherence. Due to their extensive experience and expertise in medication adherence counseling, as well as their ability to monitor and manage ...

The aim of this article is to demonstrate that the ruling commonly cited as the original precedent(1) for the doctrine that, at common law, medical practitioners' duty of confidentiality to their patients does not apply to court testimony,(2) did not, in fact, establish any such theory. The ruling by Lord ...

The evaluation of a defendant's ability to stand trial is a core task in the field of legal medicine as a supportive instrument of jurisprudence. Before the trial, the court-appointed expert informs him-/herself regarding existing somatic and psychological illness(-es) within the context of preparing an expert evaluation, then composing the ...

Clinical medical examinations are difficult. Courses that attempt to instil such clinical examination skills are expensive, and this is even more so for Maltese graduates who must perforce travel by air from the island of Malta to such venues. This year (2012) was a landmark year with a record seven ...

Multiregional clinical trials provide the potential to make safe and effective medical products simultaneously available to patients globally. As regulatory decisions are always made in a local context, this poses huge regulatory challenges. In this article we propose two conditional decision rules that can be used for medical product approval ...

We sought to evaluate medical student need for HIV postexposure prophylaxis (PEP) prior to their elective and introduce a 'Pilot PEP Clinic'. We undertook a survey of 388 medical students to assess their elective plans. All were offered an appointment in a clinic, assessed via a protocol and provided a ...

Low quality clinical trials have a possibility to have errors in the process of deriving the results and therefore distort the study. Quality assessment of clinical trial is necessary in order to prevent any clinical application erroneous results is important. Randomized controlled trial (RCT) is a design for evaluate the ...

Atrial fibrillation (AF) is a prevalent condition particularly amongst the elderly, which contributes to both morbidity and mortality. The burden of disease has lead to significant increases in health care utilization and cost in recent years. Treatment of atrial fibrillation consists of either a rate or rhythm control strategy. Rhythm ...

The current study examines participants' attributions of change in a double-blind, randomized controlled trial of problem drinkers wanting to moderate their alcohol consumption. Participants were assigned to 12 weeks of naltrexone or placebo, which was paired with either combined motivational interviewing and cognitive behavioral therapy (MBSCT) along with an enhanced ...

Cannabis-based medications have been a topic of intense study since the endogenous cannabinoid system was discovered two decades ago. In 2011, for the first time, a cannabis extract was approved for clinical use in Germany. Selective literature review. Cannabis-based medications exert their effects mainly through the activation of cannabinoid receptors ...

Adolescent smoking remains a public health problem. Despite concerns regarding adolescent nicotine dependence, few well-designed smoking cessation studies have been conducted with teen smokers. This is particularly true regarding pharmacologic treatments for nicotine dependence. Currently, pharmacologic aids are not recommended for treating adolescent nicotine dependence, as efficacy has not been ...