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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/27921140/cocaine-administration-dose-dependently-increases-sexual-desire-and-decreases-condom-use-likelihood-the-role-of-delay-and-probability-discounting-in-connecting-cocaine-with-hiv
#1
Matthew W Johnson, Evan S Herrmann, Mary M Sweeney, Robert S LeComte, Patrick S Johnson
OBJECTIVES: Although cocaine use has been linked to sexual HIV risk behavior for decades, the direct effects of cocaine on sexual desire and sexual decision-making are unexamined. Research suggests delay discounting (devaluation of future outcomes) and probability discounting (devaluation of uncertain outcomes) play roles in condom use decisions. This study examined the effect of cocaine administration on sexual desire, hypothetical condom use, and discounting tasks. METHODS: This double-blind, within-subjects study compared the effects of 0, 125, and 250 mg/70 kg oral cocaine HCl in 12 cocaine users...
December 5, 2016: Psychopharmacology
https://www.readbyqxmd.com/read/27905926/understanding-clinical-and-non-clinical-decisions-under-uncertainty-a-scenario-based-survey
#2
Vlad V Simianu, Margaret A Grounds, Susan L Joslyn, Jared E LeClerc, Anne P Ehlers, Nidhi Agrawal, Rafael Alfonso-Cristancho, Abraham D Flaxman, David R Flum
BACKGROUND: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty...
December 1, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27882864/patient-participation-in-palliative-care-decisions-an-ethnographic-discourse-analysis
#3
Emmanuelle Bélanger, Charo Rodríguez, Danielle Groleau, France Légaré, Mary Ellen MacDonald, Robert Marchand
The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team...
2016: International Journal of Qualitative Studies on Health and Well-being
https://www.readbyqxmd.com/read/27872507/calculated-chemistry-parameters-do-they-need-to-be-harmonised
#4
REVIEW
David Hughes, James Cg Doery, Kay Weng Choy, Robert Flatman
In clinical chemistry, harmonisation of the testing process is a global initiative with the purpose of improving patient safety, allowing better integration of research data and enabling the use of national electronic heath records. In Australia, as in other countries, the initial focus has been on the harmonisation of the more commonly measured analytes. There are also a number of calculated parameters, derived from these measured analytes, which could also be considered for harmonisation. Calculated parameters that are reported by laboratories and used for clinical decision-making should undergo the same robust process of harmonisation as is the case for the measured analytes...
August 2016: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/27870900/to-fear-is-to-gain-the-role-of-fear-recognition-in-risky-decision-making-in-tbi-patients-and-healthy-controls
#5
Annemarie C Visser-Keizer, Herma J Westerhof-Evers, Marleen J J Gerritsen, Joukje van der Naalt, Jacoba M Spikman
Fear is an important emotional reaction that guides decision making in situations of ambiguity or uncertainty. Both recognition of facial expressions of fear and decision making ability can be impaired after traumatic brain injury (TBI), in particular when the frontal lobe is damaged. So far, it has not been investigated how recognition of fear influences risk behavior in healthy subjects and TBI patients. The ability to recognize fear is thought to be related to the ability to experience fear and to use it as a warning signal to guide decision making...
2016: PloS One
https://www.readbyqxmd.com/read/27847964/-autoantibody-associated-autoimmune-encephalitis-and-cerebellitis-clinical-presentation-diagnostic-work-up-and-treatment
#6
J Lewerenz, S Jarius, B Wildemann, K-P Wandinger, F Leypoldt
There is no other field of neurology where clinically relevant serological biomarkers have witnessed a surge in importance over the past decade resembling that in autoimmune encephalitis and cerebellitis. A multitude of newly discovered neuronal autoantibodies facilitate early diagnosis, estimation of prognosis, and therapeutic decision-making. However, this has led to growing uncertainty with regard to meaningful patient selection, the appropriate extent of testing, and management of seronegative cases. This review summarizes the essential aspects of the clinical presentation, diagnostic work-up, pathophysiology, and treatment of autoimmune encephalitis and cerebellitis...
December 2016: Der Nervenarzt
https://www.readbyqxmd.com/read/27833462/health-economic-impact-and-prospective-clinical-utility-of-oncotype-dx%C3%A2-genomic-prostate-score
#7
David Albala, Michael J Kemeter, Phillip G Febbo, Ruixiao Lu, Vincy John, Dylan Stoy, Bela Denes, Marybeth McCall, Alan W Shindel, Frank Dubeck
Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/ nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone...
2016: Reviews in Urology
https://www.readbyqxmd.com/read/27827859/precision-health-economics-and-outcomes-research-to-support-precision-medicine-big-data-meets-patient-heterogeneity-on-the-road-to-value
#8
Yixi Chen, Gregory F Guzauskas, Chengming Gu, Bruce C M Wang, Wesley E Furnback, Guotong Xie, Peng Dong, Louis P Garrison
The "big data" era represents an exciting opportunity to utilize powerful new sources of information to reduce clinical and health economic uncertainty on an individual patient level. In turn, health economic outcomes research (HEOR) practices will need to evolve to accommodate individual patient-level HEOR analyses. We propose the concept of "precision HEOR", which utilizes a combination of costs and outcomes derived from big data to inform healthcare decision-making that is tailored to highly specific patient clusters or individuals...
November 2, 2016: Journal of Personalized Medicine
https://www.readbyqxmd.com/read/27824270/clinical-characterization-and-treatment-patterns-for-the-frequent-exacerbator-phenotype-in-chronic-obstructive-pulmonary-disease-with-severe-or-very-severe-airflow-limitation
#9
Francesco Blasi, Luca Neri, Stefano Centanni, Franco Falcone, Giuseppe Di Maria
Chronic obstructive pulmonary disease (COPD) patients experiencing several episodes of acute clinical derangement suffer from increased morbidity, mortality, and accelerated decline in lung function. Nevertheless, the relationship between co-morbidity profile and exacerbation rates in the frequent exacerbator phenotype is poorly characterized, and evidence-based management guidelines are lacking. We sought to evaluate the co-morbidity profile and treatment patterns of "frequent exacerbators" with severe or very severe airflow limitation...
November 8, 2016: COPD
https://www.readbyqxmd.com/read/27815108/evaluation-and-management-of-the-nursing-home-resident-with-respiratory-symptoms-and-an-equivocal-chest-x-ray-report
#10
Mallory McClester Brown, Philip D Sloane, Christine E Kistler, David Reed, Kimberly Ward, David Weber, Sheryl Zimmerman
OBJECTIVES: Pneumonia is a leading cause of morbidity and mortality in nursing home (NH) residents. Chest x-ray evidence is considered a key diagnostic criterion for pneumonia by the Infectious Disease Society of America (IDSA) diagnostic guidelines, the modified McGeer diagnostic criteria, and the Loeb criteria for initiating antibiotics; however, x-ray interpretation is often equivocal. We conducted chart audits of patients in NHs who had chest x-rays for new respiratory symptoms to determine the degree of ambiguity in the radiology reports and their relationship to antibiotic prescription decisions...
December 1, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27809865/exploring-the-barriers-and-facilitators-to-use-of-point-of-care-tests-in-family-medicine-clinics-in-the-united-states
#11
Victoria Hardy, Matthew Thompson, William Alto, Gina A Keppel, Jaime Hornecker, Adriana Linares, Beth Robitaille, Laura-Mae Baldwin
BACKGROUND: Point-of-care tests (POCTs) are increasingly used in family medicine clinics in the United States. While the diagnostics industry predicts significant growth in the number and scope of POCTs deployed, little is known about clinic-level attitudes towards implementation of these tests. We aimed to explore attitudes of primary care providers, laboratory and clinic administrative/support staff to identify barriers and facilitators to use of POCTs in family medicine. METHODS: Seven focus groups and four semi-structured interviews were conducted with a total of 52 clinic staff from three family medicine clinics in two US states...
November 3, 2016: BMC Family Practice
https://www.readbyqxmd.com/read/27808574/predicting-injury-challenges-in-prospective-injury-risk-factor-identification
#12
Daniel R Clifton, Dustin R Grooms, Jay Hertel, James A Onate
CONTEXT: Musculoskeletal injury-prediction methods vary and may have limitations that affect the accuracy of results and clinical meaningfulness. BACKGROUND: Research examining injury risk factors is meaningful, but attempting to extrapolate injury risk from studies that do not prospectively assess injury occurrence may limit clinical applications. Injury incidence is a vital outcome measure, which allows for the appropriate interpretation of injury-prediction analyses; a lack of injury-incidence data may decrease the accuracy and increase the uncertainty of injury-risk estimates...
August 2016: Journal of Athletic Training
https://www.readbyqxmd.com/read/27803369/oxygen-exchange-and-c-reactive-protein-predict-safe-discharge-in-patients-with-h1n1-influenza
#13
B Morton, K Nweze, J O'Connor, P Turton, E Joekes, J D Blakey, I D Welters
BACKGROUND: Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. AIM: Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. DESIGN: We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-11 influenza pandemic...
October 18, 2016: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27798056/computational-modelling-for-congenital-heart-disease-how-far-are-we-from-clinical-translation
#14
REVIEW
Giovanni Biglino, Claudio Capelli, Jan Bruse, Giorgia M Bosi, Andrew M Taylor, Silvia Schievano
Computational models of congenital heart disease (CHD) have become increasingly sophisticated over the last 20 years. They can provide an insight into complex flow phenomena, allow for testing devices into patient-specific anatomies (pre-CHD or post-CHD repair) and generate predictive data. This has been applied to different CHD scenarios, including patients with single ventricle, tetralogy of Fallot, aortic coarctation and transposition of the great arteries. Patient-specific simulations have been shown to be informative for preprocedural planning in complex cases, allowing for virtual stent deployment...
October 25, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27790692/shared-decision-making-and-patient-decision-aids-in-dermatology
#15
J Tan, E Linos, M A Sendelweck, E J van Zuuren, S Ersser, R P Dellavalle, H Williams
Shared decision making combines individual patient interests and values with clinical best evidence under the guiding principle of patient autonomy. Patient decision aids can support shared decision making and facilitate decisions that have multiple options with varying outcomes for which patients may attribute different values. Given the variable psychosocial impact of skin disease on individuals and relative uncertainty regarding best treatments and their adherence in many dermatological conditions, informed shared decision making, supported by patient decision aids, should constitute a central component of dermatological care...
November 2016: British Journal of Dermatology
https://www.readbyqxmd.com/read/27783750/differentiating-clinical-care-from-disease-prevention-a-prerequisite-for-practicing-quaternary-prevention
#16
Charles Dalcanale Tesser, Armando Henrique Norman
This article contends that the distinction between clinical care (illness) and prevention of future disease is essential to the practice of quaternary prevention. The authors argue that the ongoing entanglement of clinical care and prevention transforms healthy into "sick" people through changes in disease classification criteria and/or cut-off points for defining high-risk states. This diverts health care resources away from those in need of care and increases the risk of iatrogenic harm in healthy people...
October 20, 2016: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/27782847/understanding-variations-in-patient-screening-and-recruitment-in-a-multicentre-pilot-randomised-controlled-trial-a-vignette-based-study
#17
Paul Hilton, Brian S Buckley, Elaine McColl, Denise Howel, Douglas G Tincello, Catherine Brennand
BACKGROUND: The INVESTIGATE-I study was designed to inform a future definitive randomised trial of invasive urodynamic testing, compared to basic clinical assessment with noninvasive tests prior to surgical treatment, in women with stress urinary incontinence or stress-predominant mixed urinary incontinence. In a pilot randomised controlled trial, women from seven participating sites were screened, consented and randomised. Overall, 771 patients were identified from clinic notes and correspondence as being potential recruits and were sent the Patient Information Leaflet...
October 26, 2016: Trials
https://www.readbyqxmd.com/read/27782287/graphical-presentation-of-patient-treatment-interaction-elucidated-by-continuous-biomarkers-current-practice-and-scope-for-improvement
#18
Yu-Ming Shen, Lien D Le, Rory Wilson, Ulrich Mansmann
BACKGROUND: Biomarkers providing evidence for patient-treatment interaction are key in the development and practice of personalized medicine. Knowledge that a patient with a specific feature - as demonstrated through a biomarker - would have an advantage under a given treatment vs. a competing treatment can aid immensely in medical decision-making. Statistical strategies to establish evidence of continuous biomarkers are complex and their formal results are thus not easy to communicate...
October 26, 2016: Methods of Information in Medicine
https://www.readbyqxmd.com/read/27741945/certainty-rating-in-pre-and-post-tests-of-study-modules-in-an-online-clinical-pharmacy-course-a-pilot-study-to-evaluate-teaching-and-learning
#19
Karen Luetsch, Judith Burrows
BACKGROUND: Graduate and post-graduate education for health professionals is increasingly delivered in an e-learning environment, where automated, continuous formative testing with integrated feedback can guide students' self-assessment and learning. Asking students to rate the certainty they assign to the correctness of their answers to test questions can potentially provide deeper insights into the success of teaching, with test results informing course designers whether learning outcomes have been achieved...
October 14, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27737713/fourfold-asthma-study-fast-a-study-protocol-for-a-randomised-controlled-trial-evaluating-the-clinical-cost-effectiveness-of-temporarily-quadrupling-the-dose-of-inhaled-steroid-to-prevent-asthma-exacerbations
#20
Andrew Skeggs, Tricia McKeever, Lelia Duley, Eleanor Mitchell, Lucy Bradshaw, Kevin Mortimer, Samantha Walker, Steve Parrott, Andrew Wilson, Ian Pavord, Chris Brightling, Mike Thomas, David Price, Graham Devereux, Bernard Higgins, Tim Harrison, Rebecca Haydock
BACKGROUND: Asthma is one of the commonest chronic diseases in the UK. Acute exacerbations of asthma are unpredictable, disruptive and frightening. They cause considerable morbidity and account for a large component of the health service costs of asthma. The widespread use of an asthma self-management plan, designed to encourage disease monitoring and timely intervention, can reduce exacerbations and is, therefore, recommended for all patients with asthma. Unfortunately, the majority of patients are not provided with such a plan...
October 13, 2016: Trials
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