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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/28331972/safe-sleeping-positions-practice-and-policy-for-babies-with-cleft-palate
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
https://www.readbyqxmd.com/read/28289961/the-time-has-come-for-new-models-in-febrile-neutropenia-a-practical-demonstration-of-the-inadequacy-of-the-mascc-score
#8
A Carmona-Bayonas, P Jiménez-Fonseca, J Virizuela Echaburu, M Sánchez Cánovas, F Ayala de la Peña
Since its publication more than 15 years ago, the MASCC score has been internationally validated any number of times and recommended by most clinical practice guidelines for the management of febrile neutropenia (FN) around the world. We have used an empirical data-supported simulated scenario to demonstrate that, despite everything, the MASCC score is impractical as a basis for decision-making. A detailed analysis of reasons supporting the clinical irrelevance of this model is performed. First, seven of its eight variables are "innocent bystanders" that contribute little to selecting low-risk candidates for ambulatory management...
March 13, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28264822/understanding-clinician-influences-and-patient-perspectives-on-outpatient-discharge-decisions-a-qualitative-study
#9
N A Harun, A Y Finlay, V Piguet, S Salek
OBJECTIVE: To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision. DESIGN: Qualitative study involving observations of consultations and semistructured interviews with outpatients. SETTING: National Health Service outpatient clinics at a university hospital secondary referral centre...
March 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28261901/discussing-prognosis-and-treatment-goals-with-patients-with-advanced-cancer-a-qualitative-analysis-of-oncologists-language
#10
Wen-Ying Sylvia Chou, Lauren M Hamel, Chan L Thai, David Debono, Robert A Chapman, Terrance L Albrecht, Louis A Penner, Susan Eggly
BACKGROUND: The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information. OBJECTIVE: This qualitative study describes oncologists' language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer. DESIGN: We analysed transcripts from video recordings of clinical interactions between patients with Stage III or IV cancer (n=26) and their oncologists (n=9)...
March 5, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28255279/diagnosing-dementia-ethnography-interactional-ethics-and-everyday-moral-reasoning
#11
Alexandra Hillman
This article highlights the contribution of ethnography and qualitative sociology to the ethical challenges that frame the diagnosis of dementia. To illustrate this contribution, the paper draws on an ethnographic study of UK memory clinics carried out between 2012 and 2014. The ethnographic data, set alongside other studies and sociological theory, contest the promotion of a traditional view of autonomy; the limiting of the point of ethical interest to a distinct moment of diagnosis disclosure; and the failure to recognise risk and uncertainty in the building of clinical 'facts' and their communication...
February 2017: Social Theory & Health: STH
https://www.readbyqxmd.com/read/28243988/fotrocan-delphi-consensus-statement-regarding-the-prevention-and-treatment-of-cancer-associated-thrombosis-in-areas-of-uncertainty-and-low-quality-of-evidence
#12
P Jimenez-Fonseca, A Carmona-Bayonas, C Calderon, J Fontcuberta Boj, C Font, R Lecumberri, M Monreal, A J Muñoz Martín, R Otero, A Rubio, P Ruiz-Artacho, C Suarez Fernández, E Colome, P Pérez Segura
INTRODUCTION: Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines. MATERIALS AND METHODS: Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method...
February 27, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28239490/current-management-of-traumatic-macular-holes
#13
REVIEW
Wu Liu, Andrzej Grzybowski
Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further.
2017: Journal of Ophthalmology
https://www.readbyqxmd.com/read/28237193/evaluating-frameworks-that-provide-value-measures-for-health-care-interventions
#14
Jeanne S Mandelblatt, Scott D Ramsey, Tracy A Lieu, Charles E Phelps
The recent acceleration of scientific discovery has led to greater choices in health care. New technologies, diagnostic tests, and pharmaceuticals have widely varying impact on patients and populations in terms of benefits, toxicities, and costs, stimulating a resurgence of interest in the creation of frameworks intended to measure value in health. Many of these are offered by providers and/or advocacy organizations with expertise and interest in specific diseases (e.g., cancer and heart disease). To help assess the utility of and the potential biases embedded in these frameworks, we created an evaluation taxonomy with seven basic components: 1) define the purpose; 2) detail the conceptual approach, including perspectives, methods for obtaining preferences of decision makers (e...
February 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28230894/diagnosing-crime-and-diagnosing-disease-bias-reduction-strategies-in-the-forensic-and-clinical-sciences
#15
Joseph J Lockhart, Saty Satya-Murti
Cognitive effort is an essential part of both forensic and clinical decision-making. Errors occur in both fields because the cognitive process is complex and prone to bias. We performed a selective review of full-text English language literature on cognitive bias leading to diagnostic and forensic errors. Earlier work (1970-2000) concentrated on classifying and raising bias awareness. Recently (2000-2016), the emphasis has shifted toward strategies for "debiasing." While the forensic sciences have focused on the control of misleading contextual cues, clinical debiasing efforts have relied on checklists and hypothetical scenarios...
February 23, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28225816/bayesian-prediction-of-placebo-analgesia-in-an-instrumental-learning-model
#16
Won-Mo Jung, Ye-Seul Lee, Christian Wallraven, Younbyoung Chae
Placebo analgesia can be primarily explained by the Pavlovian conditioning paradigm in which a passively applied cue becomes associated with less pain. In contrast, instrumental conditioning employs an active paradigm that might be more similar to clinical settings. In the present study, an instrumental conditioning paradigm involving a modified trust game in a simulated clinical situation was used to induce placebo analgesia. Additionally, Bayesian modeling was applied to predict the placebo responses of individuals based on their choices...
2017: PloS One
https://www.readbyqxmd.com/read/28223290/nephrologists-perspectives-on-defining-and-applying-patient-centered-outcomes-in-hemodialysis
#17
Allison Tong, Wolfgang C Winkelmayer, David C Wheeler, Wim van Biesen, Peter Tugwell, Braden Manns, Brenda Hemmelgarn, Tess Harris, Sally Crowe, Angela Ju, Emma O'Lone, Nicole Evangelidis, Jonathan C Craig
BACKGROUND AND OBJECTIVES: Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists' perspectives on defining and implementing patient-centered outcomes in hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand...
March 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28210100/the-cost-effectiveness-of-a-nsclc-patient-assistance-program-for-pemetrexed-maintenance-therapy-in-people-s-republic-of-china
#18
Qiang Shi, Shanlian Hu, Wesley E Furnback, Gregory F Guzauskas, Jiejing Shen, Bruce Cm Wang
BACKGROUND: Eli Lilly and the China Primary Health Care Foundation are currently implementing a patient assistance program (PAP) in China, which allows first-line nonsquamous non-small-cell lung cancer (NSCLC) patients who complete four cycles of pemetrexed induction therapy to receive free, continuous pemetrexed maintenance therapy. OBJECTIVE: To estimate the cost-effectiveness of pemetrexed maintenance therapy vs basic standard care (BSC) and the economic impacts of providing a PAP for pemetrexed maintenance therapy to NSCLC patients who have completed pemetrexed induction therapy in a Chinese health care setting...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28194191/prediction-of-clinical-peanut-allergy-status-among-children-in-hamilton-ontario-using-chart-review-data-collected-during-2012-2015
#19
Elizabeth Simms, Gary Foster, Katherine Arias, Mark Larché, Tosha Freitag, Tina Walker, Susanna Goncharova, Andrea Marrin, Andreas Freitag, Manel Jordana, Susan Waserman
BACKGROUND: Peanut sensitization does not necessarily indicate clinical peanut allergy, and uncertainty as to whether or not there is true peanut allergy can lead to increased anxiety and decreased quality of life for patients and their families. The gold standard for diagnosing clinical peanut allergy is the oral food challenge, but this method is time-consuming and can cause severe allergic reactions. It would therefore be beneficial to develop a tool for predicting clinical peanut allergy in peanut-sensitized individuals whose peanut allergy status is unknown so as to better determine who requires an oral food challenge for diagnosis...
2017: Allergy, Asthma, and Clinical Immunology
https://www.readbyqxmd.com/read/28184315/mental-capacity-and-borderline-personality-disorder
#20
Karyn Ayre, Gareth S Owen, Paul Moran
The use of the Mental Capacity Act 2005 in assessing decision-making capacity in patients with borderline personality disorder (BPD) is inconsistent. We believe this may stem from persisting confusion regarding the nosological status of personality disorder and also a failure to recognise the fact that emotional dysregulation and characteristic psychodynamic abnormalities may cause substantial difficulties in using and weighing information. Clearer consensus on these issues is required in order to provide consistent patient care and reduce uncertainty for clinicians in what are often emergency and high-stakes clinical scenarios...
February 2017: BJPsych Bulletin
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