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Defensive Medicine

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1. Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients

Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients LABORATORY MEDICINE PRACTICE GUIDELINES EDITED BY LORALIE J. LANGMAN AND PAUL J. JANNETTO Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients Co-Sponsored byLABORATORY MEDICINE PRACTICE GUIDELINES Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients Loralie J. Langman Committee Chair Department of Laboratory Medicine and Pathology Mayo Clinic (...) References 101 Table of ContentsLABORATORY MEDICINE PRACTICE GUIDELINES Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients 5 Executive Summary Introduction The American Association for Clinical Chemistry (AACC) Acad- emy, formerly the National Academy of Clinical Biochemistry (NACB), has developed a laboratory medicine practice guidelines (LMPG) for using laboratory tests to monitor drug therapy in pain management patients. The scope and purpose of this guideline

2018 American Academy of Pain Medicine

2. How defensive medicine is defined and understood in European medical literature: A systematic review

How defensive medicine is defined and understood in European medical literature: A systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files (...) . No metastases/ only primary tumor 4. No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data

2020 PROSPERO

3. Myth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of Antibiotics. (Abstract)

Myth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of Antibiotics. Given the global crisis of antimicrobial resistance, the continued misuse of antibiotics is perplexing, particularly despite persistent attempts to curb usage. This issue extends beyond traditional "wastage" areas, of livestock and community medicine, to hospitals, raising questions regarding the current principles of hospital practice. Drawing on five focus group discussions, we explore why doctors act (...) in the ways they do regarding antibiotics, revealing how practices are done, justified, and perpetuated. We posit that antibiotic misuse is better understood in terms of social relations of fear, survival and a desire for autonomy; everyday rituals, performances, and forms of professional etiquette; and the mixed obligations evident in the health sector. Moreover, that antibiotic misuse presents as a case study of the broader problematic of defensive medicine. We argue that the impending global antibiotic

2017 Qualitative Health Research

4. Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands. Full Text available with Trip Pro

relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.Physicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive (...) Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands. This study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.Cross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used

2019 BMJ open

5. Evidence Brief - Barriers and Facilitators to Use of Medications for Opioid Use Disorder

from the Veterans Affairs/Department of Defense (DoD), Centers for Disease Control & Prevention (CDC), and the American Society of Addiction Medicine recommending their use, these medications are underutilized within VHA populations and the general community. 4,16,17 Within VHA, the percentage of Veterans with diagnosed OUD on medication was approximately 39% at the end of the second quarter of 2019. 6 While improved compared to treatment rates of approximately 34% in 2016, this rate of OUD (...) Administration’s (VHA) overall response to the crisis of opioid-related morbidity and mortality, VHA provides treatment for those with opioid use disorder (OUD), a diagnosis made based on symptoms, such as drug cravings, and behaviors, such as compulsive drug seeking and drug use despite negative consequences. Methadone, buprenorphine, and extended-release naltrexone are approved by the Federal Drug Administration (FDA) for treatment of OUD. However, these medications are underutilized within VHA

2019 Veterans Affairs Evidence-based Synthesis Program Reports

6. Policy on Medically-Necessary Care

and pro-vision of individual and community-based health care programs to achieve comprehensive health care. 2. Establishment of a dental home for all children by 12 months of age in order to institute an individualized preventive oral health program based upon each patient’s unique caries risk assessment. 3. Healthcare providers who diagnose oral disease to either provide therapy or refer the patient to a primary care dentist or dental/medical specialist as dictated by the nature and complexity (...) 2000;22(1):27-32. 67. Prabhu NT, Nunn JH, Evans DJ. A comparison of costs in providing dental care for special needs patients under sedation or general anesthesia in the North East of England. Prim Dent Care 2006;13(4):125-8. 68. Institute of Medicine Committee on Medicare Coverage Extensions. Medically necessary dental services. In; Field MJ, Lawrence RL, Zwanziger L, eds. Extending Medicare Coverage for Preventive and Other Services. Washington (DC): National Academies Press (US); 2000. Available

2019 American Academy of Pediatric Dentistry

7. ‘From Defensive Paranoia to …Openness to Outside Scrutiny’: Prison Medical Officers in England and Wales, 1979–86 Full Text available with Trip Pro

‘From Defensive Paranoia to …Openness to Outside Scrutiny’: Prison Medical Officers in England and Wales, 1979–86 This article examines how a branch of medicine based within the criminal justice system responded to a society which by the 1970s and 1980s was increasingly critical of the prison system and medical authority. The Prison Medical Service, responsible for the health care of prisoners in England and Wales, was criticised by prison campaigners and doctors alike for being (...) unethical, isolated, secretive, and beholden to the interests of the Home Office rather than those of their patients. While prison doctors responded defensively to criticisms in the 1970s and 1980s, comparing their own standards of practice favourably with those found in the NHS, and arguing that doctors from outside would struggle to cope in the prison environment, by 1985 their attitudes had changed. Giving evidence to a House of Commons committee, prison doctors displayed a much greater willingness

2018 Medical history

8. Exploring clusters of defense styles, psychiatric symptoms and academic achievements among medical students: a cross-sectional study in Pakistan Full Text available with Trip Pro

Exploring clusters of defense styles, psychiatric symptoms and academic achievements among medical students: a cross-sectional study in Pakistan The clusters of participants with a homogeneous psychological make-up can be identified using sophisticated machine learning techniques such as the two-step clustering algorithm. It can also help us to identify the synergistic and additive effects of a range of psychometric variables. The identification of synergistic effect of this clustering (...) of defense mechanism has significant practical implications as they share a certain variance. This study aims to identify the clusters of ego defenses and their relationship with academic performance and mental health outcome in medical students.The high achievers scored higher on mature and neurotic defense styles and lower on immature than their counter parts. A higher proportion of medical students in high achievers group had normal scores on depressive symptoms than low achievers. While a majority

2018 BMC research notes

9. Integrating Antimicrobial Therapy with Host Immunity to Fight Drug-Resistant Infections: Classical vs. Adaptive Treatment Full Text available with Trip Pro

Integrating Antimicrobial Therapy with Host Immunity to Fight Drug-Resistant Infections: Classical vs. Adaptive Treatment Antimicrobial resistance of infectious agents is a growing problem worldwide. To prevent the continuing selection and spread of drug resistance, rational design of antibiotic treatment is needed, and the question of aggressive vs. moderate therapies is currently heatedly debated. Host immunity is an important, but often-overlooked factor in the clearance of drug-resistant (...) of resistant bacteria. Our analysis and simulations uncover effective treatment strategies that promote synergy between the host immune system and the antimicrobial drug in clearing infection. Both in classical and adaptive treatment, we quantify how treatment timing and the strength of the immune response determine the success of moderate therapies. We explain key parameters and dimensions, where an adaptive regime differs from classical treatment, bringing new insight into the ongoing debate

2016 PLoS computational biology

10. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care

the standardization of concentrations in compounded medications; developing, spreading, and advocating for pediatric-specific health care information technology for drug delivery; educating providers on methods to reduce medication errors, including medication reconciliation; ensuring that providers maintain access to and proficiency in the use of a comprehensive and current pharmaceutical knowledge base; and creating policies that advocate for safe medication delivery to children in all health care settings (...) . Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care Brigitta U. Mueller , Daniel Robert Neuspiel , Erin R. Stucky Fisher , COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY, COMMITTEE ON HOSPITAL CARE Abstract Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its

2019 American Academy of Pediatrics

11. In Defense of Pharmaceutically Enhancing Human Morality Full Text available with Trip Pro

In Defense of Pharmaceutically Enhancing Human Morality I will discuss the prospect of pharmaceutically enhancing human morality and decision making in such a way as to eliminate morally unjustifiable choices and promote desirable ones.Our species in the relatively short period since it has emerged has enormously advanced in knowledge, science, and technical progress. When it comes to moral development, the distance it has covered is almost negligible. What if we could medically accelerate our (...) moral development? What if we could once and for all render our species totally immune to certain vices?I will examine whether pharmaceutically intervening in human morality would compromise the autonomy of moral agents. I will argue that the argument from the autonomy of the moral agent is neither stable nor convincing.In the light of Kantian ethics we might consider moral enhancement by pharmaceutical means to be a perfect duty for moral agents.

2017 Current therapeutic research, clinical and experimental

12. Medical nihilism: The limits of a decontextualised critique of medicine. Full Text available with Trip Pro

Medical nihilism: The limits of a decontextualised critique of medicine. In a new and interesting book entitled Medical Nihilism (2018), Jacob Stegenga attempts to convince us that modern medical therapies are less effective than we think. Given the heterogeneity of hypotheses in medicine and the evidence for or against them, I argue that such a decontextualised critique cannot be made unless substantially weakened. Instead, I put forward an alternative, more nuanced and defensible epistemic (...) view of medicine. According to this view, evaluating medical evidence requires analysis of both the methods of research e.g. randomised controlled trial (RCT), and context-specific information. This is because the way a trial (even an RCT) is conducted e.g. the population recruited and how it is intervened on, will vary and will have significant effects on the likelihood of a positive outcome. Moreover, the relationship between the positive outcome of a trial and the actual effectiveness

2019 Studies in history and philosophy of biological and biomedical sciences Controlled trial quality: uncertain

13. Soldiers as subjects of medical research: Comments on Hassidim et al. on ethical standards of the Israel Defense Force Full Text available with Trip Pro

Soldiers as subjects of medical research: Comments on Hassidim et al. on ethical standards of the Israel Defense Force In 2008 a group of former soldiers of the Israel Defense Force (IDF) sued the Ministry of Defense and others, claiming they had suffered from medical problems that resulted from an IDF medical experiment in which they had participated in the 1970s. There was no compelling medical evidence with respect to causal relationships between their participation in the experiment (...) and their later medical problems. The President of the District Court, Justice Hila Gerstl, appointed me, with the consent of the parties, to write a deposition with respect to the ethical aspects of the case. My comments in the sequel rest on my deposition, applying not only to the case that had been under discussion but also to each and every case of experimentation. My arguments, strictly confined to the ethical aspects of the case, as opposed to the legal aspects and the debated facts, were not in favor

2017 Israel journal of health policy research

14. Violence toward health workers in Bahrain Defense Force Royal Medical Services’ emergency department Full Text available with Trip Pro

Violence toward health workers in Bahrain Defense Force Royal Medical Services’ emergency department Employees working in emergency departments (EDs) in hospital settings are disproportionately affected by workplace violence as compared to those working in other departments. Such violence results in minor or major injury to these workers. In other cases, it leads to physical disability, reduced job performance, and eventually a nonconducive working environment for these workers.A cross (...) -sectional exploratory questionnaire was used to collect data used for the examination of the incidents of violence in the workplace. This study was carried out at the ED of the Bahrain Defense Force (BDF) Hospital. Participants for the study were drawn from nurses, support staff, and emergency physicians. Both male and female workers were surveyed.The study included responses from 100 staff in the ED of the BDF Hospital in Bahrain (doctors, nurses, and support personnel). The most experienced type

2017 Open access emergency medicine : OAEM

15. A Multi-defense Strategy: Enhancing Bactericidal Activity of a Medical Grade Polymer with a Nitric Oxide Donor and Surface-immobilized Quaternary Ammonium Compound Full Text available with Trip Pro

A Multi-defense Strategy: Enhancing Bactericidal Activity of a Medical Grade Polymer with a Nitric Oxide Donor and Surface-immobilized Quaternary Ammonium Compound Although the use of biomedical devices in hospital-based care is inevitable, unfortunately, it is also one of the leading causes of the nosocomial infections, and thus demands development of novel antimicrobial materials for medical device fabrication. In the current study, a multi-defense mechanism against Gram-positive and Gram (...) -defense mechanism were fabricated to kill bacteria via both active and passive mode. This was done by incorporating a nitric oxide (NO) donor S-nitroso-N-acetypenicillamine (SNAP) in a medical grade polymer (CarboSil®) and a benzophenone based quaternary ammonium antimicrobial small molecule (BPAM) was surface immobilized as the top layer. The developed biomaterial was tested with Gram-positive and Gram-negative strains and was found to be effective against both the strains resulting in up to 99.98

2017 Acta biomaterialia

16. The ‘Compleat Physician’ and Experimentation in Medicines: Everard Maynwaring (c.1629–1713) and the Restoration Debate on Medical Practice in London Full Text available with Trip Pro

The ‘Compleat Physician’ and Experimentation in Medicines: Everard Maynwaring (c.1629–1713) and the Restoration Debate on Medical Practice in London Restoration London saw a wave of publications by physicians advocating that the 'compleat physician' should be one who experimented and produced his own medicines. Only thus, they argued, could the medical hierarchy be restored and medical authority re-established on a defensible basis. This article seeks to explain the context (...) for this unusual approach, and why it failed to attract mainstream physicians by the end of the century, by considering the sixty-year career of one of its leading advocates, Everard Maynwaring (c.1629-1713), a prolific medical author, and what his own failure to enter the medical establishment may show about the problems inherent in this model for the physician. A university-trained gentleman physician who converted to chymical medicine c.1660, Maynwaring published learned and relatively unpolemical texts

2018 Medical history

17. American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

addresses the perioperative use of antirheumatic drug therapy including traditional disease- modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to with- hold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based (...) . This guideline does not address indications for THA or TKA, medical decisions unrelated to antirheumatic drug therapy, choice of implant, surgical approach, or perioper- ative evaluation and management of concurrent disease, such as that affecting the cervical spine of patients with RA. Although patients with RA, SpA, JIA, or SLE should be assessed for risk of venous thromboembolism and major acute coronary event (8,25), this guideline does not address cardiac risk assessment or perioperative venous

2017 American College of Rheumatology

18. National Research Agenda on the Health Impacts of Non-Medical Cannabis Use

Institute on Drug Abuse — International Program. (A list of participants is at the end of this summary.) The meeting brought together close to 50 experts and stakeholders representing a wide range of perspectives, including public health, law enforcement, prevention, academia and non-governmental organizations, and federal and provincial representatives: ? To identify current knowledge and research gaps related to the health effects of non-medical cannabis use; ? To identify existing data sources (...) Research Agenda on the Health Impacts of Non-Medical Cannabis Use Canadian Centre on Substance Abuse •Centre canadien de lutte contre les toxicomanies Page 4 ? When it is used in combination with other substances (e.g., pharmaceutical, recreational or nutraceutical5 substances); and ? When substituted for other substances (e.g., what are the opioid-sparing and substitution effects of cannabis and cannabinoids)? • Validation of existing research: What research needs to be redone and which data need

2017 Canadian Centre on Substance Abuse

19. Real time medical learning using the WhatsApp cellular network: a cross sectional study following the experience of a division’s medical officers in the Israel Defense Forces Full Text available with Trip Pro

Real time medical learning using the WhatsApp cellular network: a cross sectional study following the experience of a division’s medical officers in the Israel Defense Forces Primary care medical officers (MOs) are expected to maintain self-education while serving in their units in order to maintain professional standards. With the rise of smartphone use in the Israel Defense Forces (IDF), the WhatsApp application can facilitate medical learning. To date, there has been no description

2016 Disaster and Military Medicine

20. Why medical school is like playing defense

your only option is to learn from what went wrong. Appreciate the way the offensive player scored on you and do not let her do it again like that. You adapt. You know where I’m going with this. Medical school is like playing defense. There is no glory in studying. Your friends from home don’t appreciate the fact that you spent 12 hours in the library on a Sunday memorizing drug names and mechanisms of action. But, just like defense, you can have pride in yourself. You can appreciate the fact (...) Why medical school is like playing defense Why medical school is like playing defense Why medical school is like playing defense | | March 11, 2018 5 Shares There is no glory in defense. Fans don’t notice it. The most perfectly-executed defensive play results in a non-event; that is, the other team doesn’t score. Then everyone forgets about it, and the game moves on. But there is an art to defense. It is reactionary in nature: You must read the offense and anticipate what’s coming. You have

2018 KevinMD blog

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