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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/28532470/health-care-professionals-attitudes-towards-evidence-based-medicine-in-the-workers-compensation-setting-a-cohort-study
#1
Nieke A Elbers, Robin Chase, Ashley Craig, Lyn Guy, Ian A Harris, James W Middleton, Michael K Nicholas, Trudy Rebbeck, John Walsh, Simon Willcock, Keri Lockwood, Ian D Cameron
BACKGROUND: Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers' compensation system could provide a partial solution, by reducing uncertainty about effective treatment...
May 22, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28529122/shared-decision-making-a-buzz-word-in-the-netherlands-the-pace-quickens-towards-nationwide-implementation%C3%A2
#2
Trudy van der Weijden, Heleen Post, Paul L P Brand, Haske van Veenendaal, Ton Drenthen, Linda Aj van Mierlo, Peep Stalmeier, Olga C Damman, Anne Stiggelbout
Currently, shared decision making (SDM) is on the agenda among target patient representative groups, policy makers and professional bodies. Although the International Conference for Shared Decision Making (ISDM) 2011 generated a positive boost, hesitation was also felt among Dutch clinicians, who are challenged by many new tasks. No hesitation is seen among the majority of patients, opting mostly for the SDM model. We haven't reached these patients' needs fully yet, given disappointing research data on patients' experiences and professional behaviour...
May 18, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28521742/the-linguistic-validation-of-the-gut-feelings-questionnaire-in-three-european-languages
#3
Marie Barais, Johannes Hauswaldt, Daniel Hausmann, Slawomir Czachowski, Agnieszka Sowinska, Paul Van Royen, Erik Stolper
BACKGROUND: Physicians' clinical decision-making may be influenced by non-analytical thinking, especially when perceiving uncertainty. Incidental gut feelings in general practice have been described, namely, as "a sense of alarm" and "a sense of reassurance". A Dutch Gut Feelings Questionnaire (GFQ) was developed, validated and afterwards translated into English following a linguistic validation procedure. The aims were to translate the GFQ from English into French, German and Polish; to describe uniform elements as well as differences and difficulties in the linguistic validation processes; to propose a procedural scheme for future GFQ translations into other languages...
April 20, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28521070/drug-therapy-for-symptoms-associated-with-anxiety-in-adult-palliative-care-patients
#4
REVIEW
Susan Salt, Caroline A Mulvaney, Nancy J Preston
BACKGROUND: This is an update of a Cochrane Review first published in 2004 (Issue 1) and previously updated in 2012 (Issue 10). Anxiety is common in palliative care patients. It can be a natural response to the complex uncertainty of having a life-limiting illness or impending death, but it may represent a clinically significant issue in its own right. OBJECTIVES: To assess the effectiveness of drug therapy for treating symptoms of anxiety in adults with a progressive life-limiting illness who are thought to be in their last year of life...
May 18, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28500765/developing-bayesian-networks-from-a-dependency-layered-ontology-a-proof-of-concept-in-radiation-oncology
#5
Alan M Kalet, Jason N Doctor, John H Gennari, Mark H Phillips
PURPOSE: Bayesian networks (BNs) are graphical representations of probabilistic knowledge that offer normative reasoning under uncertainty and are well suited for use in medical domains. Traditional knowledge-based network development of BN topology requires that modeling experts establish relevant dependency links between domain concepts by searching and translating published literature, querying domain experts, or applying machine learning algorithms on data. For initial development these methods are time-intensive and this cost hinders the growth of BN applications in medical decision making...
May 13, 2017: Medical Physics
https://www.readbyqxmd.com/read/28499120/characterising-bias-in-regulatory-risk-and-decision-analysis-an-analysis-of-heuristics-applied-in-health-technology-appraisal-chemicals-regulation-and-climate-change-governance
#6
Brian H MacGillivray
In many environmental and public health domains, heuristic methods of risk and decision analysis must be relied upon, either because problem structures are ambiguous, reliable data is lacking, or decisions are urgent. This introduces an additional source of uncertainty beyond model and measurement error - uncertainty stemming from relying on inexact inference rules. Here we identify and analyse heuristics used to prioritise risk objects, to discriminate between signal and noise, to weight evidence, to construct models, to extrapolate beyond datasets, and to make policy...
May 9, 2017: Environment International
https://www.readbyqxmd.com/read/28480472/added-value-from-secondary-use-of-person-generated-health-data-in-consumer-health-informatics-contribution-of-the-consumer-health-informatics-imia-working-group
#7
P-Y Hsueh, Y-K Cheung, S Dey, K K Kim, F J Martin-Sanchez, S K Petersen, T Wetter
INTRODUCTION: Various health-related data, subsequently called Person Generated Health Data (PGHD), is being collected by patients or presumably healthy individuals as well as about them as much as they become available as measurable properties in their work, home, and other environments. Despite that such data was originally just collected and used for dedicated predefined purposes, more recently it is regarded as untapped resources that call for secondary use. METHOD: Since the secondary use of PGHD is still at its early evolving stage, we have chosen, in this paper, to produce an outline of best practices, as opposed to a systematic review...
May 8, 2017: Yearbook of Medical Informatics
https://www.readbyqxmd.com/read/28476211/-patient-centred-prescription-model-to-improve-adequate-prescription-and-therapeutic-adherence-in-patients-with-multiple-disorders
#8
Joan Espaulella-Panicot, Núria Molist-Brunet, Daniel Sevilla-Sánchez, Javier González-Bueno, Jordi Amblàs-Novellas, Núria Solà-Bonada, Carles Codina-Jané
Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role...
May 2, 2017: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/28465777/use-of-the-prostate-core-mitomic-test-in-repeated-biopsy-decision-making-real-world-assessment-of-clinical-utility-in-a-multicenter-patient-population
#9
Lorena Legisi, Elise DeSa, M Nasar Qureshi
BACKGROUND: Prostate cancer is the most common cancer diagnosed in men in developed countries. Using molecular testing may help to improve outcomes in this clinically challenging group. Since 2011, the Prostate Core Mitomic Test (PCMT), which quantifies a 3.4-kb mitochondrial DNA deletion strongly associated with prostate cancer, has been used by more than 50 urology practices accessing pathology services through our laboratory in New Jersey. However, the use of a molecular test can only be beneficial if it affects patient management and improves outcomes...
December 2016: American Health & Drug Benefits
https://www.readbyqxmd.com/read/28445256/cost-effectiveness-analysis-of-ultrasonography-screening-for-nonalcoholic-fatty-liver-disease-in-metabolic-syndrome-patients
#10
Pochamana Phisalprapa, Siripen Supakankunti, Phunchai Charatcharoenwitthaya, Piyaporn Apisarnthanarak, Aphinya Charoensak, Chaiwat Washirasaksiri, Weerachai Srivanichakorn, Nathorn Chaiyakunapruk
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) can be diagnosed early by noninvasive ultrasonography; however, the cost-effectiveness of ultrasonography screening with intensive weight reduction program in metabolic syndrome patients is not clear. This study aims to estimate economic and clinical outcomes of ultrasonography in Thailand. METHODS: Cost-effectiveness analysis used decision tree and Markov models to estimate lifetime costs and health benefits from societal perspective, based on a cohort of 509 metabolic syndrome patients in Thailand...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28441617/the-magic-survey-in-hormone-receptor-positive-hr-her2-negative-her2-breast-cancer-when-might-multigene-assays-be-of-value
#11
Matti Aapro, Michelino De Laurentiis, Dan Rea, Juan Enrique Bargallo Rocha, Roberto Elizalde, László Landherr, Barbro Linderholm, Eleftherios Mamounas, Christos Markopoulos, Patrick Neven, Alexander Petrovsky, Roman Rouzier, Vincent Smit, Christer Svedman, Daniel Schneider, Christoph Thomssen, Miguel Martin
BACKGROUND: A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions...
June 2017: Breast: Official Journal of the European Society of Mastology
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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