Salazarforbes3404
The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy.
The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error.
The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies.
The 33 studies included in this review represent four categories of debiasing strategies increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklisstand their response to these initiatives.
Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.
Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.
This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.
Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a "Lunch and Learn" educational session at a Federally Qualified Health Care Center located in the Northern California.
The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.
Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.
Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.Hypomimia/reduced facial mobility in individuals living with Parkinson's disease can lead to negative impressions and judgments by nurse practitioners and other health care practitioners. CM272 chemical structure Negative impressions and judgments can affect the quality of an episode of care. To attenuate automatic judgments, nurse practitioners must self-monitor and correct, recognizing that hypomimia is due to an underlying neurological condition and does not provide information on the personality or character of the person living with Parkinson's. Nurse practitioners can integrate inquiries that go beyond a problem focused approach to include questions about pleasurable, positive events in the life of a person living with Parkinson's disease.Colorectal cancer (CRC) is the second most common cause of cancer deaths for men and women, combined, even though it is the most preventable, treatable, and beatable cancer. Polyp removal during colonoscopy is one major way to help prevent CRC, but it can also be prevented by modifiable risk factor reduction. The National Colorectal Cancer Roundtable's campaign "80% in Every Community" is an effort to address disparities in the less-screened populations and communities. The nurse practitioner (NP) can assist health care organizations to develop policies for high-quality screening programs and create system changes to promote CRC prevention and screening. Professional organizations provide an easy way to become involved in policy change at the health system, local, state, and federal levels. State and federal policies affect patient access to care and adherence to the CRC prevention and screening recommendations. Fourteen states have not yet elected to expand Medicaid. Every NP has the knowledge, skills, and ability to advocate for the expansion of Medicaid in these remaining states to reduce this access to care barrier for underserved patients and communities.
The Neonatal Eating Assessment Tool-Mixed Breastfeeding and Bottle-feeding (NeoEAT-Mixed Feeding) is a parent-report assessment of symptoms of problematic feeding in infants who are feeding by both breast and bottle.
To establish reference values for the NeoEAT-Mixed Feeding and evaluate factors that contribute to symptoms of problematic feeding in healthy, full-term infants.
Parents of 409 infants less than 7 months old completed an online survey. Median and percentile scores are presented for infants aged 0-2, 2-4, 4-6, and 6-7 months old.
Neonatal Eating Assessment Tool-Mixed Feeding total score and scores for the Gastrointestinal Tract Function and Energy & Physiologic Stability subscales decreased with increasing infant age. Infant Regulation and Feeding Flexibility subscale scores remained stable over time, whereas Sensory Responsiveness subscale scores increased with increasing infant age. Infants with more gastrointestinal symptoms had higher NeoEAT-Mixed Feeding total scores.
The reported reference values may be used to identify infants in need of further assessment, referral, and intervention. In healthy, full-term infants with concurrent gastrointestinal symptoms and problematic feeding, interventions targeted at gastrointestinal symptoms may help to improve symptoms of problematic feeding as well.
The reported reference values may be used to identify infants in need of further assessment, referral, and intervention. In healthy, full-term infants with concurrent gastrointestinal symptoms and problematic feeding, interventions targeted at gastrointestinal symptoms may help to improve symptoms of problematic feeding as well.Believed to be zoonotic in origin, COVID-19 is a novel coronavirus subtype, which spreads from person to person through droplet transmission. As of late April, 2020, 895,766 cases of COVID-19 infections were recorded in the United States. This infection was responsible for 50,439 deaths. Because of close, person-to-person proximity, coupled with possible contact with body fluids, transmission of COVID-19 during sexual activity is possible. However, some activities carry higher risks of transmission than others. This article explores the risks of COVID-19 transmission associated with kissing, oral sex (fellatio and annilingus), and anal receptive and anal insertive intercourse among men who have sex with men (MSM). Recommendations for counseling MSM on safer sexual decision-making, many of which are applicable in the general prevention of sexually transmitted infections, are also provided. Nurse practitioners can serve as advocates in preventing sexually associated COVID-19 communication in MSM and contribute to the advancement of this continuously evolving area of public health science.Giant cell tumor of bone is a locally aggressive, rarely metastasizing neoplasm. Evidence suggests that the neoplastic cells may be osteoblastic in differentiation. Standard treatment is surgical removal, but medical therapy with denosumab, an inhibitor of receptor activator of nuclear factor-κβ ligand, has become a component of patient management in select cases. Denosumab-treated giant cell tumor of bone (DT-GCTB) shows drastic morphologic changes including the presence of abundant bone. To further determine the relationship of the neoplastic cells to osteoblast phenotype, we performed a morphologic and immunohistochemical study on a series of DT-GCTB. Cases of DT-GCTB were retrieved from surgical pathology files, available slides were reviewed, and immunohistochemistry for H3.3 G34W, SATB2, and p63 was performed. The cohort included 31 tumors from 30 patients (23 malefemale), ages 15 to 73 years (median=36 y). The morphology of post-denosumab-treated tumors ranged from tumors composed of an abundant bone matrix with few spindle cells to spindle cell-predominant tumors. Five had focal residual classic CGTB, and 2 manifested mild nuclear atypia. The majority expressed all markers 86.2% for H3.3 G34W, 96.7% for SATB2, and 100% for p63. All markers stained the various tumor components including spindle cells and the cells on the surface of and within the treated tumor bone matrix. Most markers were also positive in reactive-appearing woven bone adjacent to tumor 84.6% for H3.3 G34W, 100% for SATB2, and 68% for p63. These findings suggest that denosumab treatment of giant cell tumor of bone results in osteoblastic differentiation with bone production.High-grade neuroendocrine carcinomas (NEC) of the endometrium are rare and account for less then 1% of all endometrial carcinomas. Both small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) morphologies have been reported. Little is known regarding the molecular features of endometrial NEC including how they compare to pulmonary NEC (the most common site for these neoplasms) and the more common endometrial carcinoma histotypes. In this study, we investigated the molecular alterations in a series of endometrial NEC using a targeted next generation sequencing panel (Oncopanel). Fourteen NEC were sequenced; pure NEC (n=4) and mixed (n=10) with endometrioid adenocarcinoma (n=9) or carcinosarcoma (n=1). The NEC components of mixed tumors comprised LCNEC (n=6) and SCNEC (n=4). The 4 pure NEC comprised LCNEC (n=2) and SCNEC (n=2). Molecular analysis classified tumors into the 4 The Cancer Genome Atlas groups (1) POLE-mutated/ultramutated (1/14; 7%), (2) microsatellite instabiliin immunohistochemistry.Primary pulmonary myxoid sarcoma (PPMS) is a recently reported, exceedingly rare low-grade lung neoplasm characterized by reticular/lace-like growth of spindle to epithelioid cells embedded in an abundant myxoid matrix. Morphologically, it overlaps with a myxoid variant of angiomatoid fibrous histiocytoma (AFH) of the soft tissue. Genetically, they were both reported to harbor EWSR1-CREB1 fusion, while EWSR1-ATF1 has only been reported in AFH thus far. We report a case of primary pulmonary low-grade myxoid spindle cell tumor with morphologic and immunohistochemical features of PPMS but with an EWSR1-ATF1 fusion gene. In addition, we also encountered a case of endobronchial AFH with EWSR1-CREB1 translocation but also focal morphologic features of PPMS. These findings provide new evidence supporting the concept that PPMS and a myxoid variant of AFH represent a continuum with overlapping histologic, immunohistochemical, and genetic features.
