Articles: patients.
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Our goals were to determine whether selection bias occurred in a prehospital study comparing an esophageal detector device (EDD) to a disposable capnometer for detecting esophageal intubation, and to determine whether such a bias would have changed the study's conclusions about EDD effectiveness. ⋯ The high "first attempt" intubation success rate seen in this study was due to selective exclusion of failed intubations. This selection bias led to a clinically important overestimation of the EDD's negative predictive value. Bias may substantially alter the estimations of test accuracy reported in scientific studies. To reduce the chance of unrecognized selection bias in studies of diagnostic tests, investigators must determine whether recruited subjects resemble patients in whom the test will ultimately be used.
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Eubios J Asian Int Bioeth · Jul 2000
Attitudes and practices of patients and physicians towards patient autonomy: a survey conducted prior to the enactment of the Patients' Rights Bill in Israel.
On the surface, it would appear that patients would welcome the opportunity to relinquish their traditional subordination to doctors in therapeutic decision making, and that doctors would be pleased to have partners with whom to share the burden involved in making such fateful decisions. We investigated the attitudes and practices of patients and physicians towards "patient autonomy" in an outpatient clinic of an internal medicine department prior to the enactment of the Patient's Rights Bill in Israel. There were 81 patients randomly chosen from those attending the study clinic and 21 physicians randomly selected from among the physicians treating them. ⋯ However, when presented with ethical dilemmas, the physicians were not consistent in their attitude in terms of respecting "patient autonomy." The findings of an Israeli survey conducted three years after the bill's passage showed that only one-third of the studied physicians had read the Israel Medical Association booklet's explaining the new law and most of them claimed that the new law had no affect on their daily encounter with patients, meaning that the law did not affect any change in these physicians' pattern of behavior. We concluded that if the Patient's Rights Bill is to achieve its goals, it will have to be accompanied by a widespread educational campaign to encourage the public to appreciate the value and the importance of the autonomy granted to them, and to guide them in exercising this autonomy to its best advantage. In parallel, the medical profession will need to be aware of the importance of achieving the therapeutic goals while upholding ethical and moral values in health care.
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Comparative Study
[Prospective study of patients who leave the emergency department before being seen by the physician].
To define epidemiological characteristics, the main reasons, and outcome of patients who leave the emergency department (ED) without being seen by a physician. ⋯ Patients who leave ED department before being seen by a doctor are usually young, literate, have not previously visited their community physician, and consulted for minor complaints. The main reason to leave is their own impression of suffering a minor disease, and less than 50% visit another physician after their leaving, being the rate of hospital admission low. We should be particularly cautious with those patients referred by a community doctor and those identified as to have a seriously affected health status at their arrival at the hospital, since they are at increased risk to be admitted.
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To assess the relative frequency of violent ideation [VI] in physical rehabilitation and community samples, and to identify associated factors. ⋯ Recent research supports the contention that there is a relationship between ideation, angry affect, aggressive behavior and delayed recovery. Thus the presence of VI in the patient should be a cause for concern, and has clear ramifications for those working in the clinical setting. Primary prevention should involve not only the identification of hostile patients at risk for VI and aggression, it should also involve identifying programs or systems where a higher incidence of VI is likely to be observed. As VI was found to be associated with a range of variables, including characterological disorders, mood and social conflict, a further evaluation of factors contributing to VI would be recommended prior to intervention.
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There is a lack of objective measurements of the spinal cord stimulator (SCS) trial results, which leads to increased number of failed permanent placements. Certain modes of sensory functions were tested as possible correlates with trial success. ⋯ PTT may possibly serve as an objective measurement of the SCS trial outcome.