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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/29334910/treatment-selection-of-early-stage-non-small-cell-lung-cancer-the-role-of-the-patient-in-clinical-decision-making
#1
S Mokhles, J J M E Nuyttens, M de Mol, J G J V Aerts, A P W M Maat, Ö Birim, A J J C Bogers, J J M Takkenberg
BACKGROUND: The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. METHODS: Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician...
January 15, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29320522/do-systematic-reviews-address-community-healthcare-professionals-wound-care-uncertainties-results-from-evidence-mapping-in-wound-care
#2
Janice Christie, Trish A Gray, Jo C Dumville, Nicky A Cullum
BACKGROUND: Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals...
2018: PloS One
https://www.readbyqxmd.com/read/29306097/cue-acquisition-a-feature-of-malawian-midwives-decision-making-process-to-support-normality-during-the-first-stage-of-labour
#3
Elizabeth Chodzaza, Elaine Haycock-Stuart, Aisha Holloway, Rosemary Mander
OBJECTIVE: to explore Malawian midwives decision making when caring for women during the first stage of labour in the hospital setting. DESIGN AND METHODS: this focused ethnographic study examined the decision making process of 9 nurse-midwives with varying years of clinical experience in the real world setting of an urban and semi urban hospital from October 2013 to May 2014.This was done using 27 participant observations and 27 post-observation in-depth interviews over a period of six months...
December 6, 2017: Midwifery
https://www.readbyqxmd.com/read/29286944/update-of-a-systematic-review-of-autoresuscitation-after-cardiac-arrest
#4
Laura Hornby, Sonny Dhanani, Sam D Shemie
OBJECTIVES: There has been a growth in publications focusing on the phenomena of autoresuscitation in recent years. In 2010, we systematically reviewed the medical literature with the primary objective of summarizing the evidence on the timing of autoresuscitation. Healthcare professionals have continued to voice concerns regarding the potential for autoresuscitation. With this in mind, the objective of this brief report is to update the results of our original review of autoresuscitation...
December 26, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29275896/bayesian-averaging-over-decision-tree-models-for-trauma-severity-scoring
#5
V Schetinin, L Jakaite, W Krzanowski
Health care practitioners analyse possible risks of misleading decisions and need to estimate and quantify uncertainty in predictions. We have examined the "gold" standard of screening a patient's conditions for predicting survival probability, based on logistic regression modelling, which is used in trauma care for clinical purposes and quality audit. This methodology is based on theoretical assumptions about data and uncertainties. Models induced within such an approach have exposed a number of problems, providing unexplained fluctuation of predicted survival and low accuracy of estimating uncertainty intervals within which predictions are made...
December 21, 2017: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/29273843/estimating-the-reference-incremental-cost-effectiveness-ratio-for-the-australian-health-system
#6
Laura Catherine Edney, Hossein Haji Ali Afzali, Terence Chai Cheng, Jonathan Karnon
BACKGROUND: Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs-the benefits of the best alternative use of the additional resources required to fund a new technology. OBJECTIVE: The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies...
December 22, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/29273079/united-kingdom-frozen-shoulder-trial-uk-frost-multi-centre-randomised-12-month-parallel-group-superiority-study-to-compare-the-clinical-and-cost-effectiveness-of-early-structured-physiotherapy-versus-manipulation-under-anaesthesia-versus-arthroscopic-capsular
#7
Stephen Brealey, Alison L Armstrong, Andrew Brooksbank, Andrew Jonathan Carr, Charalambos P Charalambous, Cushla Cooper, Belen Corbacho, Joseph Dias, Iona Donnelly, Lorna Goodchild, Catherine Hewitt, Ada Keding, Lucksy Kottam, Sarah E Lamb, Catriona McDaid, Matthew Northgraves, Gerry Richardson, Sara Rodgers, Sarwat Shah, Emma Sharp, Sally Spencer, David Torgerson, Francine Toye, Amar Rangan
BACKGROUND: Frozen shoulder (also known as adhesive capsulitis) occurs when the capsule, or the soft tissue envelope around the ball and socket shoulder joint, becomes scarred and contracted, making the shoulder tight, painful and stiff. It affects around 1 in 12 men and 1 in 10 women of working age. Although this condition can settle with time (typically taking 1 to 3 years), for some people it causes severe symptoms and needs referral to hospital. Our aim is to evaluate the clinical and cost-effectiveness of two invasive and costly surgical interventions that are commonly used in secondary care in the National Health Service (NHS) compared with a non-surgical comparator of Early Structured Physiotherapy...
December 22, 2017: Trials
https://www.readbyqxmd.com/read/29273068/exploring-patient-and-family-involvement-in-the-lifecycle-of-an-orphan-drug-a-scoping-review
#8
REVIEW
Andrea Young, Devidas Menon, Jackie Street, Walla Al-Hertani, Tania Stafinski
BACKGROUND: Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i...
December 22, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/29244075/the-athlete-s-heart-is-a-proarrhythmic-heart-and-what-that-means-for-clinical-decision-making
#9
Hein Heidbuchel
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. The athlete's heart, a heart that adapts so magically to cope with the demands of exercise, harbours many structural and functional changes that by themselves predispose to arrhythmia development, at the atrial, nodal and ventricular levels...
December 13, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29239595/explaining-the-absence-of-surgical-procedure-regulation
#10
Jonathan J Darrow
Each year in the United States, surgeons perform approximately 64 million surgical procedures, ranging from tooth extraction to open heart surgery. Yet, notwithstanding the frequency of surgical procedures and their often critical importance to patient health, no state or federal agency either approves the use of new surgical procedures or directly regulates existing procedures. The absence of surgical procedure regulation differs from the regulation of new pharmaceutical products, which can be introduced into interstate commerce only after the Food and Drug Administration (FDA) has reviewed "adequate and well-controlled [clinical] investigations" and concluded the data from those studies sufficiently establish the drug's safety and efficacy...
2017: Cornell Journal of Law and Public Policy
https://www.readbyqxmd.com/read/29233397/assessment-of-student-pharmacists-ethical-decision-making
#11
Jaclyn R Myers, Mary E Kiersma, Kimberly S Plake
INTRODUCTION: In previous research, investigators have expressed concern about the ethical ambivalence of pharmacists in decision-making. The objectives of this study were to examine student pharmacists': 1) attitudes and responses regarding specific common ethical situations and 2) perceived level of difficulty in making ethical decisions. METHODS: A self-administered 38-item survey was given to second and third year student pharmacists at Purdue University. The survey comprised five sections, including: 1) attitudes towards common ethical situations, 2) responses to specific ethical scenarios, 3) emergency lending, 4) perceived level of difficulty in resolving ethical dilemmas, and 5) demographics...
November 2017: Currents in Pharmacy Teaching & Learning
https://www.readbyqxmd.com/read/29214577/patient-empowerment-and-involvement-in-research
#12
Lilisbeth Perestelo-Pérez, Amado Rivero-Santana, Analia Abt-Sacks, Ana Toledo-Chavarri, Noe Brito, Yolanda Álvarez-Pérez, Nerea González-Hernández, Pedro Serrano-Aguilar
Patients with rare diseases often face difficulties in clinical care due to the low prevalence of their diseases and the resulting healthcare professionals' lack of expertise. Valid and standardized guidelines for clinical management are also lacking due to the scarcity of research and the variability of the clinical expressivity within each disease. In addition, in cases of rare diseases, the patient and health professional relationship may not fit with the traditional assumptions of medical care. Although the communication process between patients and healthcare professionals shares most of the general features of the standard patient-health professional interaction, rare diseases may be burdened with additional issues...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29212628/mobile-health-intervention-to-increase-oral-cancer-therapy-adherence-in-patients-with-chronic-myeloid-leukemia-the-remind-system-clinical-feasibility-and-acceptability-assessment
#13
Amanda Pereira-Salgado, Jennifer A Westwood, Lahiru Russell, Anna Ugalde, Bronwen Ortlepp, John F Seymour, Phyllis Butow, Lawrence Cavedon, Kevin Ong, Sanchia Aranda, Sibilah Breen, Suzanne Kirsa, Andrew Dunlevie, Penelope Schofield
BACKGROUND: Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. OBJECTIVE: The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase)...
December 6, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29208052/collaborative-modeling-of-an-implementation-strategy-a-case-study-to-integrate-health-promotion-in-primary-and-community-care
#14
Gonzalo Grandes, Alvaro Sanchez, Josep M Cortada, Haizea Pombo, Catalina Martinez, Laura Balagué, Mary Helen Corrales, Enrique de la Peña, Justo Mugica, Esther Gorostiza
BACKGROUND: Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. RESULTS: Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations...
December 6, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29206942/understanding-decision-making-in-cardiac-imaging-determinants-of-appropriate-use
#15
Ricardo Fonseca, Kim Jose, Thomas H Marwick
Aims: Appropriate Use Criteria (AUC) for echocardiography were developed in 2007 to facilitate decision-making, reduce variability in test utilization, and encourage rational use of imaging. However, there is little evidence that the AUC have favourably influenced ordering behaviour. This study explores the factors that contribute to clinicians requesting echocardiograms with a focus on appropriate use. Methods and results: Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital...
November 30, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29203506/effectiveness-of-preoperative-medical-consultations-by-internal-medicine-physicians-a-systematic-review
#16
Clarabelle T Pham, Catherine L Gibb, Robert A Fitridge, Jonathan D Karnon
OBJECTIVE: Clinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29172767/contesting-and-differentially-constructing-uncertainty-negotiations-of-contraceptive-use-in-the-clinical-encounter
#17
Krystale E Littlejohn, Katrina Kimport
Most women of reproductive age have access to highly effective contraception, and all available methods are associated with side effects. Whether a woman will experience side effects is uncertain, however, which can pose challenges for clinicians who discuss the methods with patients. In this study, we analyze 102 contraceptive counseling visits to understand how clinicians discursively construct knowledge in the context of uncertainty. We find that while some present the uncertainty of side effects in a straightforward, patient-accessible way, others negotiate their predictions by (1) differentially constructing uncertainty, suggesting that positive side effects are likely and negative side effects are unlikely, and (2) contesting uncertainty, presenting the risk of serious side effects as controllable...
December 2017: Journal of Health and Social Behavior
https://www.readbyqxmd.com/read/29135285/factors-associated-with-confidence-in-decision-making-and-satisfaction-with-risk-communication-among-patients-with-atrial-fibrillation
#18
Berith Hedberg, Dan Malm, Jan-Erik Karlsson, Kristofer Årestedt, Anders Broström
BACKGROUND: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. AIM: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms...
November 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29133377/information-provided-by-diagnostic-and-screening-tests-improving-probabilities
#19
REVIEW
Mark Weatherall
Uncertainty in clinical encounters is inevitable and despite this uncertainty clinicians must still work with patients to make diagnostic and treatment decisions. Explicit diagnostic reasoning based on probabilities will optimise information in relation to uncertainty. In clinical diagnostic encounters, there is often pre-existing information that reflects the probability any particular patient has a disease. Diagnostic testing provides extra information that refines diagnostic probabilities. However, in general diagnostic tests will be positive in most, but not all cases of disease (sensitivity) and may not be negative in all cases of disease absence (specificity)...
November 13, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29126124/predicting-drug-safety-and-communicating-risk-benefits-of-a-bayesian-approach
#20
Stanley E Lazic, Nicholas Edmunds, Christopher E Pollard
Drug toxicity is a major source of attrition in drug discovery and development. Pharmaceutical companies routinely use preclinical data to predict clinical outcomes and continue to invest in new assays to improve predictions. However, there are many open questions about how to make the best use of available data, combine diverse data, quantify risk, and communicate risk and uncertainty to enable good decisions. The costs of suboptimal decisions are clear: resources are wasted and patients may be put at risk...
November 6, 2017: Toxicological Sciences: An Official Journal of the Society of Toxicology
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