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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/28425002/beyond-study-participants-a-framework-for-engaging-patients-in-the-selection-or-development-of-clinical-outcome-assessments-for-evaluating-the-benefits-of-treatment-in-medical-product-development
#1
Hilary Wilson, Ebony Dashiell-Aje, Milena Anatchkova, Karin Coyne, Asha Hareendran, Nancy Kline Leidy, Colleen A McHorney, Kathy Wyrwich
BACKGROUND: Patients are participating more actively in health care decision-making with regard to their health, as well as in the broader realm of assessing the value of medical products and influencing decisions about their registration and reimbursement. There is an increasing trend to include patients' perspectives throughout the stages of medical product development by broadening the traditional study-participant role to that of an active partner throughout the process. Including patients in the selection and development of clinical outcome assessments (COAs) to evaluate the benefit of treatment is particularly important...
April 19, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28424839/reirradiation-of-recurrent-node-positive-non-small-cell-lung-cancer-after-previous-stereotactic-radiotherapy-for-stage%C3%A2-i-disease-a%C3%A2-multi-institutional-treatment-recommendation
#2
Carsten Nieder, Dirk De Ruysscher, Laurie E Gaspar, Matthias Guckenberger, Minesh P Mehta, Patrick Cheung, Arjun Sahgal
BACKGROUND: Practice guidelines have been developed for early-stage and locally advanced non-small cell lung cancer (NSCLC). However, many common clinical scenarios still require individualized decision making. This is true for locoregional relapse after initial stereotactic radiotherapy (stereotactic body radiation therapy or stereotactic ablative radiotherapy; SBRT or SABR), an increasingly utilized curative treatment option for stage I NSCLC. METHODS: A consortium of expert radiation oncologists was established with the aim of providing treatment recommendations...
April 19, 2017: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
https://www.readbyqxmd.com/read/28421461/the-role-of-tumor-board-conferences-in-neuro-oncology-a-nationwide-provider-survey
#3
REVIEW
James Snyder, Lonni Schultz, Tobias Walbert
The tumor board or multidisciplinary cancer meeting (MCM) is the foundation of high value multidisciplinary oncology care, coordinating teams of specialists. Little is known on how these meetings are implemented in Neuro-oncology. Benefits of MCMs include coordination, direction for complicated cases, education, and a forum for communication, emerging technology, and clinical trials. This study identifies participation and utilization of neuro-oncology MCMs. A cross-sectional descriptive survey was dispersed through an internet questionnaire...
April 18, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28417662/clinician-views-of-patient-decisional-conflict-when-deciding-between-dialysis-and-conservative-management-qualitative-findings-from-the-palliative-care-in-chronic-kidney-disease-packs-study
#4
Helen Noble, Kevin Brazil, Aine Burns, Sarah Hallahan, Charles Normand, Paul Roderick, Colin Thompson, Peter Maxwell, Magdi Yaqoob
BACKGROUND: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). AIM: To explore clinician views on decisional conflict in patients with end-stage kidney disease. DESIGN: Interpretive, qualitative study. SETTING AND PARTICIPANTS: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28408620/oncofertility-fertile-ground-for-conflict-between-patient-autonomy-and-medical-values
#5
Sarah K Walsh, Elizabeth S Ginsburg, Lisa Soleymani Lehmann, Ann H Partridge
Oncofertility is a unique, multidisciplinary field that serves to bridge the gap between available fertility resources and the special reproductive needs of cancer patients. Oncofertility is a growing field due to the increasing number of survivors, development of new oncologic therapies, extension of duration of therapies, and development and refinement of reproductive therapies. While the technologies and demand for services expand, clinicians need to be appropriately prepared for dealing with various clinical scenarios that may require ethical deliberation...
April 13, 2017: Oncologist
https://www.readbyqxmd.com/read/28394963/-informed-consent-in-clinical-practice-persistent-doubts
#6
Miguel Kottow
Informed consent is the core aspect of the patient-physician relationship. Since its beginnings, clinical bioethics was opposed to the authoritarian paternalism characteristic of medicine since the 19th century. The informed consent was developed to provide patients with sufficient information to allow autonomous decisions when faced with medical diagnostic and therapeutic alternatives. In spite of bioethics’ effort to perfect informed consent, the discipline has been unable to avoid informed consent from becoming an impersonal and administrative procedure...
November 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/28390288/automatic-classification-of-human-sperm-head-morphology
#7
Violeta Chang, Laurent Heutte, Caroline Petitjean, Steffen Härtel, Nancy Hitschfeld
BACKGROUND AND OBJECTIVE: Infertility is a problem that affects up to 15% of couples worldwide with emotional and physiological implications and semen analysis is the first step in the evaluation of an infertile couple. Indeed the morphology of human sperm cells is considered to be a clinical tool dedicated to the fertility prognosis and serves, mainly, for making decisions regarding the options of assisted reproduction technologies. Therefore, a complete analysis of not only normal sperm but also abnormal sperm turns out to be critical in this context...
April 2, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28389865/what-is-the-long-term-economic-societal-effect-of-periprosthetic-infections-after-tha-a-markov-analysis
#8
Thomas J Parisi, Joseph F Konopka, Hany S Bedair
BACKGROUND: Current estimates for the direct costs of a single episode of care for periprosthetic joint infection (PJI) after THA are approximately USD 100,000. These estimates do not account for the costs of failed treatments and do not include indirect costs such as lost wages. QUESTIONS/PURPOSES: The goal of this study was to estimate the long-term economic effect to society (direct and indirect costs) of a PJI after THA treated with contemporary standards of care in a hypothetical patient of working age (three scenarios, age 55, 60, and 65 years)...
April 7, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28387537/using-phase-ii-data-for-the-analysis-of-phase-iii-studies-an-application-in-rare-diseases
#9
Simon Wandel, Beat Neuenschwander, Christian Röver, Tim Friede
BACKGROUND: Clinical research and drug development in orphan diseases are challenging, since large-scale randomized studies are difficult to conduct. Formally synthesizing the evidence is therefore of great value, yet this is rarely done in the drug-approval process. Phase III designs that make better use of phase II data can facilitate drug development in orphan diseases. METHODS: A Bayesian meta-analytic approach is used to inform the phase III study with phase II data...
March 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28376695/added-value-and-limitations-of-amyloid-pet-imaging-review-and-analysis-of-selected-cases-of-mild-cognitive-impairment-and-dementia
#10
David A Weidman, Edward Zamrini, Marwan N Sabbagh, Sandra Jacobson, Anna Burke, Christine Belden, Jessica Powell, Nidhi Bhalla, Auttawut Roontiva, Xiaoying Kuang, Ji Luo, Kewei Chen, Garrett Riggs, William Burke
Amyloid-positron emission tomography (PET) imaging of the brain detects elevated amyloid-beta (amyloid-β) neuritic plaques in vivo, which can be helpful in appropriately selected cases of mild cognitive impairment (MCI) and dementia, when Alzheimer's disease remains a possible etiology, after a comprehensive clinical evaluation. We reviewed cases of cognitively impaired patients who underwent amyloid-PET imaging because of diagnostic uncertainty. Pre- and post-PET elements of diagnosis and management were first compared, to assess impact of scan results on clinical decision-making, and then an analysis of those decisions was undertaken in appropriate clinical situations, to delineate the added value and limitations of amyloid-PET imaging...
February 2017: Neurocase
https://www.readbyqxmd.com/read/28368789/design-and-implementation-of-a-physician-coaching-pilot-to-promote-value-based-referrals-to-specialty-care
#11
Leah Tuzzio, Evette J Ludman, Eva Chang, Lorella Palazzo, Travis Abbott, Edward H Wagner, Robert J Reid
INTRODUCTION: Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. OBJECTIVES: To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. METHODS: The team designed the program using physician input and a synthesis of the literature on the determinants of referral...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28344697/learning-by-concordance-lbc-introducing-undergraduate-students-to-the-complexity-and-uncertainty-of-clinical-practice
#12
Nicolas Fernandez, Amélie Foucault, Serge Dubé, Diane Robert, Chantal Lafond, Anne-Marie Vincent, Jeannine Kassis, Driss Kazitani, Bernard Charlin
BACKGROUND: A current challenge in medical education is the steep exposure to the complexity and uncertainty of clinical practice in early clerkship. The gap between pre-clinical courses and the reality of clinical decision-making can be overwhelming for undergraduate students. The Learning-by-Concordance (LbC) approach aims to bridge this gap by embedding complexity and uncertainty by relying on real-life situations and exposure to expert reasoning processes to support learning. LbC provides three forms of support: 1) expert responses that students compare with their own, 2) expert explanations and 3) recognized scholars' key-messages...
October 2016: Canadian Medical Education Journal
https://www.readbyqxmd.com/read/28336485/low-dose-computed-tomography-for-lung-cancer-screening-clinical-and-coding-considerations
#13
REVIEW
Yiwey Shieh, Martin Bohnenkamp
Lung cancer screening with low-dose computed tomography (LDCT) was shown to reduce lung cancer mortality in the National Lung Screening Trial, a large randomized-controlled trial of high-risk current and former smokers. Despite ongoing uncertainty over the effectiveness of LDCT in the real-world setting, the Centers for Medicare and Medicaid Services (CMS) decided to cover LDCT as a preventive service. As part of its national coverage determination, CMS set forth a series of requirements for reimbursement of LDCT, including a counseling and shared decision-making visit prior to a LDCT being ordered...
March 21, 2017: Chest
https://www.readbyqxmd.com/read/28331972/safe-sleeping-positions-practice-and-policy-for-babies-with-cleft-palate
#14
Karen Davies, Iain A Bruce, Patricia Bannister, Peter Callery
Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate...
March 22, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28315547/how-can-i-change-my-patients-treatment-decision-making-by-becoming-a-nurse-scientist-%C3%A2
#15
Tamryn F Gray
"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28315120/prognostic-biomarkers-in-acute-coronary-syndromes-risk-stratification-beyond-cardiac-troponins
#16
REVIEW
K M Eggers, B Lindahl
PURPOSE OF REVIEW: Cardiac troponin (cTn) plays an essential role for assessment of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn is not absolute. In this mini-review, we summarize the evidence on the utility of established biomarkers of left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction for risk prediction beyond cTn in ACS. RECENT FINDINGS: Only few biomarkers consistently demonstrate additive prognostic value to cTn levels...
April 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28302584/uncertainty-of-physicians-and-patients-in-medical-decision-making
#17
EDITORIAL
Tejaswini Dhawale, Lotte M Steuten, H Joachim Deeg
Modern medicine has developed an apparently unlimited array of diagnostic and therapeutic tools. Treatment options, for example for patients with hematologic malignancies, are expanding rapidly. These developments, offering a spectrum of modalities, provide a new outlook on successful treatment for many patients. However, for any individual patient, decisions as to the optimum treatment strategy remain challenging as all prognostic projections are based on statistics. The challenge lies in the identification of parameters that characterize individual patients as prospective responders or non-responders and, hence, determine the prognosis...
March 13, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28298899/decision-making-in-multiple-sclerosis-the-role-of-aversion-to-ambiguity-for-therapeutic-inertia-among-neurologists-discutir-ms
#18
Gustavo Saposnik, Angel P Sempere, Daniel Prefasi, Daniel Selchen, Christian C Ruff, Jorge Maurino, Philippe N Tobler
OBJECTIVES: Limited information is available on physician-related factors influencing therapeutic inertia (TI) in multiple sclerosis (MS). Our aim was to evaluate whether physicians' risk preferences are associated with TI in MS care, by applying concepts from behavioral economics. DESIGN: In this cross-sectional study, participants answered questions regarding the management of 20 MS case scenarios, completed 3 surveys, and 4 experimental paradigms based on behavioral economics...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28292476/health-technology-assessment-hta-case-studies-factors-influencing-divergent-hta-reimbursement-recommendations-in-australia-canada-england-and-scotland
#19
Nicola Allen, Stuart R Walker, Lawrence Liberti, Sam Salek
OBJECTIVES: To evaluate the national regulatory, health technology assessment (HTA), and reimbursement pathways for public health care in Australia, Canada, England, and Scotland, to compare initial Canadian national HTA recommendations with the initial decisions of the other HTA agencies, and to identify factors for differing national HTA recommendations between the four HTA agencies. METHODS: Information from the public domain was used to develop a regulatory process map for each jurisdiction and to compare the HTA agencies' reimbursement recommendations...
March 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28290067/expert-system-classifier-for-adaptive-radiation-therapy-in-prostate-cancer
#20
Gabriele Guidi, Nicola Maffei, Claudio Vecchi, Giovanni Gottardi, Alberto Ciarmatori, Grazia Maria Mistretta, Ercole Mazzeo, Patrizia Giacobazzi, Frank Lohr, Tiziana Costi
A classifier-based expert system was developed to compare delivered and planned radiation therapy in prostate cancer patients. Its aim is to automatically identify patients that can benefit from an adaptive treatment strategy. The study predominantly addresses dosimetric uncertainties and critical issues caused by motion of hollow organs. 1200 MVCT images of 38 prostate adenocarcinoma cases were analyzed. An automatic daily re-contouring of structures (i.e. rectum, bladder and femoral heads), rigid/deformable registration and dose warping was carried out to simulate dose and volume variations during therapy...
March 13, 2017: Australasian Physical & Engineering Sciences in Medicine
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