keyword
MENU ▼
Read by QxMD icon Read
search

Uncertainty in clinical decision making

keyword
https://www.readbyqxmd.com/read/28923833/nephrology-provider-prognostic-perceptions-and-care-delivered-to-older-adults-with-advanced-kidney-disease
#1
Huzaifah Salat, Andrei Javier, Edward D Siew, Rocio Figueroa, Loren Lipworth, Edmond Kabagambe, Aihua Bian, Thomas G Stewart, Maie H El-Sourady, Mohana Karlekar, Cesar Y Cardona, T Alp Ikizler, Khaled Abdel-Kader
BACKGROUND AND OBJECTIVES: Prognostic uncertainty is one barrier that impedes providers in engaging patients with CKD in shared decision making and advance care planning. The surprise question has been shown to identify patients at increased risk of dying. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In our prospective observational study, 488 patients ≥60 years of age with CKD stage 4 or 5 were enrolled. Binary surprise question (i.e., "Would you be surprised if this patient died in the next 12 months?") responses were recorded, and dialysis planning preferences, presence of advance care planning documentation, and care preceding death were abstracted...
September 18, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28923759/extending-the-reach-of-evidence-based-medicine-a-proposed-categorization-of-lower-level-evidence
#2
REVIEW
Frank C Detterbeck, Michael K Gould, Sandra Z Lewis, Sheena Patel
Clinical practice involves making many management decisions for which only limited formal evidence exists. While the methodology of evidence-based medicine has evolved tremendously, there is a need to better characterize lower-level evidence. This should enhance the ability to appropriately weigh the evidence against other considerations, and counter the temptation to think it is more robust than it actually is. A framework to categorize lower-level evidence is proposed, consisting of non-randomized comparisons, extrapolation using indirect evidence, rationale and clinical experience (i...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28923030/the-eef1a2-gene-expression-as-risk-predictor-in-localized-prostate-cancer
#3
Thomas Stefan Worst, Frank Waldbillig, Abdallah Abdelhadi, Cleo-Aron Weis, Maria Gottschalt, Annette Steidler, Jost von Hardenberg, Maurice Stephan Michel, Philipp Erben
BACKGROUND: Besides clinical stage and Gleason score, risk-stratification of prostate cancer in the pretherapeutic setting mainly relies on the serum PSA level. Yet, this is associated with many uncertainties. With regard to therapy decision-making, additional markers are needed to allow an exact risk prediction. Eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) was previously suggested as driver of tumor progression and potential biomarker. In the present study its functional and prognostic relevance in prostate cancer was investigated...
September 18, 2017: BMC Urology
https://www.readbyqxmd.com/read/28901535/a-benefit-risk-analysis-approach-to-capture-regulatory-decision-making-multiple-myeloma
#4
G K Raju, Karthik Gurumurthi, Reuben Domike, Dickran Kazandjian, Ola Landgren, Gideon M Blumenthal, Ann Farrell, Richard Pazdur, Janet Woodcock
Drug regulators around the world make decisions about drug approvability based on qualitative benefit-risk analysis. In this work, a quantitative benefit-risk analysis approach captures regulatory decision-making about new drugs to treat multiple myeloma (MM). MM assessments have been based on endpoints such as time to progression (TTP), progression-free survival (PFS), and objective response rate (ORR) which are different than benefit-risk analysis based on overall survival (OS) due to an increased focus on quality of life instead of quantity of life...
September 13, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28895808/shared-decision-making-after-severe-stroke-how-can-we-improve-patient-and-family-involvement-in-treatment-decisions
#5
Akila Visvanathan, Martin Dennis, Gillian Mead, William N Whiteley, Julia Lawton, Fergus Neil Doubal
People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28882750/grey-areas-new-zealand-ambulance-personnel-s-experiences-of-challenging-resuscitation-decision-making
#6
Natalie Elizabeth Anderson, Merryn Gott, Julia Slark
INTRODUCTION: When faced with a patient in cardiac arrest, ambulance personnel must rapidly make complex decisions with limited information. Much of the research examining decisions to commence, continue, withhold or terminate resuscitation has used retrospective audits of registry data and clinical documentation. This study offers a provider-perspective which characterises uncertainty and highlights clinical, cognitive, emotional and physical demands associated with decision-making in the cardiac arrest context...
September 4, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28876150/collaborating-across-the-threshold-the-development-of-interprofessional-expertise-in-child-safeguarding
#7
Rick Hood, Jayne Price, Daniele Sartori, Daryl Maisey, Jessica Johnson, Zoe Clark
This article reports on an empirical study of the expertise that different professionals develop in working together to safeguard children. The research involved three key professional groups who work with children: nursing, teaching, and social work. The methodology used a clinical scenario and critical incident to explore professional perspectives and experiences of collaboration. Data collection was via semi-structured interviews with a sample of 18 practitioners, composed of pre- and post-qualifying practitioners from each professional group...
September 6, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28864119/value-based-decision-making-under-uncertainty-in-hoarding-and-obsessive-compulsive-disorders
#8
Helen Pushkarskaya, David Tolin, Lital Ruderman, Daniel Henick, J MacLaren Kelly, Christopher Pittenger, Ifat Levy
Difficulties in decision making are a core impairment in a range of disease states. For instance, both obsessive- compulsive disorder (OCD) and hoarding disorder (HD) are associated with indecisiveness, inefficient planning, and enhanced uncertainty intolerance, even in contexts unrelated to their core symptomology. We examined decision-making patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid OCD and HD, and 57 individuals from the general population, using a well-validated choice task grounded in behavioral economic theory...
August 24, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28838468/computational-dysfunctions-in-anxiety-failure%C3%A2-to%C3%A2-differentiate-signal-from-noise
#9
He Huang, Wesley Thompson, Martin P Paulus
BACKGROUND: Differentiating whether an action leads to an outcome by chance or by an underlying statistical regularity that signals environmental change profoundly affects adaptive behavior. Previous studies have shown that anxious individuals may not appropriately differentiate between these situations. This investigation aims to precisely quantify the process deficit in anxious individuals and determine the degree to which these process dysfunctions are specific to anxiety. METHODS: One hundred twenty-two subjects recruited as part of an ongoing large clinical population study completed a change point detection task...
September 15, 2017: Biological Psychiatry
https://www.readbyqxmd.com/read/28837373/informed-consent-and-decision-making-among-participants-in-novel-design-phase-i-oncology-trials
#10
Katherine E Reeder-Hayes, Megan C Roberts, Gail E Henderson, Elizabeth C Dees
BACKGROUND: Although phase I clinical trials are the gateway to progress in cancer therapies, this setting poses ethical challenges to ensure that patients provide consent free from misunderstandings of therapeutic intent or unrealistic expectations of benefit. The design of phase I oncology trials has evolved rapidly over time and today includes more targeted agents and combinations of experimental drugs with standard drugs, which may further complicate how patients understand phase I research participation...
August 24, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28830493/unsatisfactory-colposcopy-clinical-decision-making-in-conditions-of-uncertainty
#11
Kristyn M Manley, Rebecca A Simms, Sarah Platt, Amit Patel, Rachna Bahl
BACKGROUND: Unsatisfactory colposcopy, where the cells of interest are not visible in women with a positive cervical screening test, is a common area of clinical uncertainty due to the lack of clear evidence and guidance. Colposcopists' opinions and experiences are likely to have a significant influence on service provision and the development of national policy. The aim of this study was to analyse decision-making when applied to women with unsatisfactory colposcopy. METHODS: A multi-centre qualitative study utilizing a series of focus groups in an English healthcare region...
August 22, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28820870/controversies-in-the-identification-and-management-of-acute-pulmonary-hypertension-in-preterm-neonates
#12
REVIEW
Regan E Giesinger, Kiran More, Jodie Odame, Amish Jain, Robert P Jankov, Patrick J McNamara
It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute HRF in the preterm neonate, outline the pathophysiological conditions that may present as acute PH and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system...
August 18, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28820515/the-role-of-oncology-nurses-in-discussing-clinical-trials
#13
Susan A Flocke, Elizabeth Antognoli, Barbara J Daly, Brigid Jackson, Sarah E Fulton, Tasnuva M Liu, Jessica Surdam, Sharon Manne, Neal J Meropol
PURPOSE/OBJECTIVES: To describe oncology nurses' experiences discussing clinical trials with their patients, and to assess barriers to these discussions.
. RESEARCH APPROACH: A qualitative study designed to elicit narratives from oncology nurses. 
. SETTING: Community- and academic-based oncology clinics throughout the United States.
. PARTICIPANTS: 33 oncology nurses involved in direct patient care in community-based and large hospital-based settings...
September 1, 2017: Oncology Nursing Forum
https://www.readbyqxmd.com/read/28815014/the-relationship-between-intolerance-of-uncertainty-in-chiropractic-students-and-their-treatment-intervention-choices
#14
Stanley I Innes, Charlotte Leboeuf-Yde, Bruce F Walker
BACKGROUND: Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students' intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief...
2017: Chiropractic & Manual Therapies
https://www.readbyqxmd.com/read/28814131/what-factors-influence-women-s-perceptions-of-their-systemic-recurrence-risk-after-breast-cancer-treatment
#15
Kamaria L Lee, Nancy K Janz, Brian J Zikmund-Fisher, Reshma Jagsi, Lauren P Wallner, Allison W Kurian, Steven J Katz, Paul Abrahamse, Sarah T Hawley
BACKGROUND: Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS: Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754)...
August 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28806999/trading-certainty-for-speed-how-much-uncertainty-are-decisionmakers-and-guideline-developers-willing-to-accept-when-using-rapid-reviews-an-international-survey
#16
Gernot Wagner, Barbara Nussbaumer-Streit, Judith Greimel, Agustín Ciapponi, Gerald Gartlehner
BACKGROUND: Decisionmakers and guideline developers demand rapid syntheses of the evidence when time sensitive evidence-informed decisions are required. A potential trade-off of such rapid reviews is that their results can have less reliability than results of systematic reviews that can lead to an increased risk of making incorrect decisions or recommendations. We sought to determine how much incremental uncertainty about the correctness of an answer guideline developers and health policy decisionmakers are willing to accept in exchange for a rapid evidence-synthesis...
August 14, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28796436/the-impact-of-personalized-probabilistic-wall-thickness-models-on-peak-wall-stress-in-abdominal-aortic-aneurysms
#17
J Biehler, W A Wall
If computational models are ever to be used in high stakes decision making in clinical practice, the use of personalized models and predictive simulation techniques is a must. This entails rigorous quantification of uncertainties as well as harnessing available patient-specific data to the greatest extent possible. Although researcher are beginning to realize that taking uncertainty in model input parameters into account is a necessity, the predominantly used probabilistic description for these uncertain parameters are based on elementary random variable models...
August 10, 2017: International Journal for Numerical Methods in Biomedical Engineering
https://www.readbyqxmd.com/read/28765854/psa-testing-for-men-at-average-risk-of-prostate-cancer
#18
Bruce K Armstrong, Michael J Barry, Mark Frydenberg, Robert A Gardiner, Ian Haines, Stacy M Carter
Prostate-specific antigen (PSA) testing of men at normal risk of prostate cancer is one of the most contested issues in cancer screening. There is no formal screening program, but testing is common - arguably a practice that ran ahead of the evidence. Public and professional communication about PSA screening has been highly varied and potentially confusing for practitioners and patients alike. There has been much research and policy activity relating to PSA testing in recent years. Landmark randomised controlled trials have been reported; authorities - including the 2013 Prostate Cancer World Congress, the Prostate Cancer Foundation of Australia, Cancer Council Australia, and the National Health and Medical Research Council - have made or endorsed public statements and/or issued clinical practice guidelines; and the US Preventive Services Task Force is revising its recommendations...
July 26, 2017: Public Health Research & Practice
https://www.readbyqxmd.com/read/28753792/interrogating-metastatic-prostate-cancer-treatment-switch-decisions-a-multi-institutional-survey
#19
David Lorente, Praful Ravi, Niven Mehra, Carmel Pezaro, Aurelius Omlin, Alexa Gilman, Miguel Miranda, Pasquale Rescigno, Michael Kolinsky, Nuria Porta, Diletta Bianchini, Nina Tunariu, Raquel Perez, Joaquin Mateo, Heather Payne, Leon Terstappen, Maarten IJzerman, Emma Hall, Johann de Bono
BACKGROUND: Evaluation of responses to treatment for metastatic castration-resistant prostate cancer (mCRPC) remains challenging. Consensus criteria based on prostate-specific antigen (PSA) and clinical and radiologic biomarkers are inconsistently utilized. Circulating tumor cell (CTC) counts can inform prognosis and response, but are not routinely used. OBJECTIVE: To evaluate the use of biomarkers and trends in clinical decision-making in current mCRPC treatment...
October 10, 2016: European Urology Focus
https://www.readbyqxmd.com/read/28747103/a-deliberative-framework-to-identify-the-need-for-real-life-evidence-building-of-new-cancer-drugs-after-interim-funding-decision
#20
Leanne Leung, Mário L de Lemos, Laurel Kovacic
Background With the rising cost of new oncology treatments, it is no longer sustainable to base initial drug funding decisions primarily on prospective clinical trials as their performance in real-life populations are often difficult to determine. In British Columbia, an approach in evidence building is to retrospectively analyse patient outcomes using observational research on an ad hoc basis. Methods The deliberative framework was constructed in three stages: framework design, framework validation and treatment programme characterization, and key informant interview...
January 1, 2017: Journal of Oncology Pharmacy Practice
keyword
keyword
106681
1
2
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"