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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/28739478/an-overview-of-clinical-guidelines-for-the-management-of-vertebral-compression-fracture-a-systematic-review
#1
REVIEW
Patrícia Parreira, Chris G Maher, Rodrigo Z Megale, Lyn March, Manuela L Ferreira
BACKGROUND CONTEXT: Vertebral compression fractures are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision-making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory. PURPOSE: The aim of this study was to appraise the recommendations and methodological quality of international clinical guidelines for the management of VCFs...
July 21, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28739455/decision-making-in-critical-limb-ischemia-a-markov-simulation
#2
Aaron J Deutsch, C Charles Jain, Kimberly G Blumenthal, Mark W Dickinson, Anne M Neilan
BACKGROUND: Critical limb ischemia (CLI) is a feared complication of peripheral vascular disease that often requires surgical management and may require amputation of the affected limb. OBJECTIVE: To use a decision model to inform clinical management for a 63-year-old woman with CLI and multiple medical comorbidities, including advanced heart failure and diabetes. METHODS: Markov decision model evaluating four strategies: amputation, surgical bypass, endovascular therapy (e...
July 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28738325/a-proposal-of-the-european-association-for-the-study-of-obesity-to-improve-the-icd-11-diagnostic-criteria-for-obesity-based-on-the-three-dimensions-etiology-degree-of-adiposity-and-health-risk
#3
Johannes Hebebrand, Jens-Christian Holm, Euan Woodward, Jennifer Lyn Baker, Ellen Blaak, Dominique Durrer Schutz, Nathalie J Farpour-Lambert, Gema Frühbeck, Jason G C Halford, Lauren Lissner, Dragan Micic, Dana Mullerova, Gabriela Roman, Karin Schindler, Hermann Toplak, Tommy L S Visscher, Volkan Yumuk
Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research...
July 22, 2017: Obesity Facts
https://www.readbyqxmd.com/read/28726048/is-ct-perfusion-helpful-in-the-treatment-allocation-of-patients-with-acute-ischemic-stroke-an-expert-opinion-analysis
#4
Laura Strada, Jonathan Y Streifler, Bruno Del Sette, Matteo Puntoni, Antonio Castaldi, Daria Bianchini, Massimo Del Sette
BACKGROUND: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT). AIMS: To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis. PATIENTS AND METHOD: One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion...
July 19, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28723476/charting-recent-progress-and-challenges-in-metastatic-castration-resistant-prostate-cancer-is-there-an-optimal-treatment-sequence
#5
REVIEW
Stéphane Oudard, Pablo Maroto, Gaston Demonty, Winald R Gerritsen
CONTEXT: Recent developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC) have led to uncertainty about the optimal sequence of agents. OBJECTIVE: To review and assess treatment options and sequence in patients with mCRPC. EVIDENCE ACQUISITION: To identify data on the optimal use of approved treatments, we searched PubMed for studies on the use of recently approved agents for men with mCRPC published before March 2015...
October 2016: European Urology Focus
https://www.readbyqxmd.com/read/28682507/taking-on-the-doctor-role-in-whole-task-simulation
#6
Maggie Bartlett, Simon P Gay, Ruth Kinston, Robert McKinley
BACKGROUND: Untimed simulated primary care consultations focusing on safe and effective clinical outcomes were first introduced into undergraduate medical education in Otago, New Zealand, in 2004. We extended this concept and included a secondary care version for final-year students. We offer students opportunities to manage entire consultations, which include making and implementing clinical decisions with simulated patients (SPs). Formative feedback is given by SPs on the achievement of pre-determined outcomes and by faculty members on clinical decision making, medical record keeping and case presentation...
July 6, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28672402/testing-for-respiratory-viruses-in-children-to-swab-or-not-to-swab
#7
Peter J Gill, Susan E Richardson, Olivia Ostrow, Jeremy N Friedman
Importance: While most viral respiratory tract infections can be diagnosed clinically, clinicians frequently order tests to identify the specific offending virus. While there has been tremendous growth in the variety, availability, and sophistication of the types of respiratory viral tests, there may have been less critical thought and discussion among frontline clinicians about the clinical utility and specific indications for testing. We summarize the rationale historically used to support respiratory virus testing in children, with a review of the supporting evidence...
July 3, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28661491/informed-decision-making-and-psychosocial-outcomes-in-pregnant-and-nonpregnant-women-offered-population-fragile-x-carrier-screening
#8
Sylvia A Metcalfe, Melissa Martyn, Alice Ames, Vicki Anderson, Alison D Archibald, Grad Dip Gen Couns, Rob Carter, Jonathan Cohen, Megan Cotter, M GenCouns, William Dang, Martin B Delatycki, Susan Donath, Samantha Edwards, PGrad Dip Educ, Grad Dip Gen Couns, Robin Forbes, Grad Dip Gen Couns, Mioara Gavrila, M MedSci, Jane Halliday, Chriselle Hickerton, Melissa Hill, Grad Dip Gen Couns, Lorilli Jacobs, PGrad Dip Ultrasound, Vicki Petrou, Grad Dip Gen Couns, Loren Plunkett, M GenCouns, Leslie Sheffield, F Racp, Alison Thornton, Grad Dip Gen Couns, Sandra Younie, PGrad Dip Hlth Econ, Jon D Emery
PurposePopulation-based carrier screening for fragile X syndrome (FXS) is still not universally endorsed by professional organizations due to concerns around genetic counseling for complex information and potential for psychosocial harms.MethodsWe determined uptake levels, decision making, and psychosocial impact in a prospective study of pregnant and nonpregnant Australian women offered FXS carrier screening in clinical settings. Women received pretest genetic counseling, and completed questionnaires when deciding and one month later...
June 29, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28659428/real-world-experience-of-treatment-decision-making-in-carotid-stenosis-in-a-neurovascular-board
#9
David Leander Rimmele, Axel Larena-Avellaneda, Anna C Alegiani, Michael Rosenkranz, Nils Ole Schmidt, Jan Regelsberger, Friedhelm C Hummel, Tim Magnus, Eike Sebastian Debus, Jens Fiehler, Christian Gerloff, Götz Thomalla
OBJECTIVE: To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option. METHODS: We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions...
June 28, 2017: Neurology
https://www.readbyqxmd.com/read/28655365/grade-evidence-to-decision-etd-framework-for-coverage-decisions
#10
Elena Parmelli, Laura Amato, Andrew D Oxman, Pablo Alonso-Coello, Massimo Brunetti, Jenny Moberg, Francesco Nonino, Silvia Pregno, Carlo Saitto, Holger J Schünemann, Marina Davoli
OBJECTIVES: Coverage decisions are decisions by third party payers about whether and how much to pay for technologies or services, and under what conditions. Given their complexity, a systematic and transparent approach is needed. The DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) Project, a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group initiative funded by the European Union, has developed GRADE Evidence to Decision (EtD) framework for different types of decisions, including coverage ones...
June 28, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28639707/dressings-and-topical-agents-for-treating-pressure-ulcers
#11
REVIEW
Maggie J Westby, Jo C Dumville, Marta O Soares, Nikki Stubbs, Gill Norman
BACKGROUND: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers...
June 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28628931/-the-probabilistic-efficiency-frontier-a-value-assessment-of-treatment-options-in-hepatitis-c
#12
Axel C Mühlbacher, Andrew Sadler
Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV)...
June 19, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28627841/clinical-decision-making-from-theory-to-practice%C3%A2-and-backward
#13
Lionel De Alencastro, Carole Clair, Isabella Locatelli, Mark H Ebell, Nicolas Senn
Being able to analyze all the successive steps of decision making from the first contact with the patient to the final diagnosis is complex because it refers sometimes to intuitive elements proper to each clinician. However, understanding how they integrate probabilities of diseases into their clinical practice and manage diagnostic uncertainties is crucial. This allows a more rational practice of medicine and identifying factors related to the patient, physician or context that may modify the clinical decision making...
May 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28624294/decision-aids-for-patients-considering-total-joint-replacement-a-cost-effectiveness-analysis-alongside-a-randomised-controlled-trial
#14
L Trenaman, D Stacey, S Bryan, M Taljaard, G Hawker, G Dervin, P Tugwell, N Bansback
BACKGROUND: Shared decision-making (SDM) is a key priority to improve patient-centred care, and can play an important role in helping patients decide whether to undergo total joint arthroplasty (TJA). Patient decision aids can support SDM; however, they may incur an upfront cost. We aimed to estimate the health and economic effects of patient decision aids for TJA. METHODS: A cost-effectiveness analysis of a randomised controlled trial (RCT) with 2-year follow-up...
June 15, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28623146/an-update-of-the-global-burden-of-pertussis-in-children-younger-than-5-years-a-modelling-study
#15
Karene Hoi Ting Yeung, Philippe Duclos, E Anthony S Nelson, Raymond Christiaan W Hutubessy
BACKGROUND: Since the publication in 2003 of a model to estimate the disease burden of pertussis, new evidence of the protective effect of incomplete pertussis vaccination against severe pertussis has been reported. We revised the model to provide new estimates of regional and global pertussis cases and deaths for children younger than 5 years. METHODS: We developed a revised model with data from 2014 to estimate pertussis cases and deaths. Pertussis cases were defined according to the WHO clinical case definition, as a coughing illness lasting at least 2 weeks with paroxysms of coughing, inspiratory whooping, or post-tussive vomiting...
June 13, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28618973/from-clinical-uncertainties-to-precision-medicine-the-emerging-role-of-the-gut-barrier-and-microbiome-in-small-bowel-functional-diseases
#16
Wojciech Marlicz, Diana Yung, Karolina Skonieczna-Żydecka, Igor Loniewski, Saskia van Hemert, Beata Loniewska, Anastasios Koulaouzidis
Over the last decade, remarkable progress has been made in the understanding of disease pathophysiology. Many new theories expound on the importance of emerging factors such as microbiome influences, genomics/omics, stem cells, innate intestinal immunity or mucosal barrier complexities. This has introduced a further dimension of uncertainty into clinical decision-making, but equally, may shed some light on less well-understood and difficult to manage conditions. Areas covered: Comprehensive review of the literature on gut barrier and microbiome relevant to small bowel pathology...
June 16, 2017: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28610580/parental-decision-making-involvement-and-decisional-conflict-a-descriptive-study
#17
Laura Boland, Jennifer Kryworuchko, Anton Saarimaki, Margaret L Lawson
BACKGROUND: Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child's health. However, little is known about parents' experience of decisional conflict. We explored parents' perceived decision making involvement and its association with parents' decisional conflict...
June 13, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28605124/developing-abilities-to-navigate-through-the-grey-zones-in-complex-environments-nurses-reasons-for-applying-to-a-clinical-ethics-residency-for-nurses
#18
Martha Jurchak, Pamela J Grace, Susan M Lee, Danny G Willis, Angelika A Zollfrank, Ellen M Robinson
BACKGROUND AND PURPOSE: Nurses face complex ethical issues in practice and have to determine appropriate actions. An inability to conceptualize or follow a preferred course of action can give rise to moral uncertainty or moral distress. Both moral uncertainty and moral distress are problematic for nurses and their patients. A program designed to increase nurse confidence in moral decision making, the clinical ethics residency for nurses (CERN), was offered selectively to nurses affiliated with two academic medical centers...
July 2017: Journal of Nursing Scholarship
https://www.readbyqxmd.com/read/28596804/bringing-a-humanistic-approach-to-cancer-clinical-trials
#19
REVIEW
Roberto Jun Arai, Elaine Santana Longo, Maria Helena Sponton, Maria Del Pilar Estevez Diz
In this article, we describe some practical aspects that promote the humanisation of clinical research. Actions are not limited to improving the communication skills of medical staff but also include maintenance of care continuity, accessible written information, and application of theoretic models such as shared decision-making and management of stress in decision-making under uncertainty. We believe that a comprehensive strategy will increase patients' motivation to participate in and adhere to clinical research...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28583183/design-and-implementation-of-a-decision-aid-for-juvenile-idiopathic-arthritis-medication-choices
#20
William B Brinkman, Ellen A Lipstein, Janalee Taylor, Pamela J Schoettker, Katherine Naylor, Karla Jones, Sheetal S Vora, Catherine C Mims, Elizabeth Roth-Wojcicki, Beth Gottlieb, Nancy Griffin, Carole Lannon, Esi Morgan
BACKGROUND: Randomized trials have demonstrated the efficacy of patient decision aids to facilitate shared decision making in clinical situations with multiple medically reasonable options for treatment. However, little is known about how best to implement these tools into routine clinical practice. In addition, reliable implementation of decision aids has been elusive and spread within pediatrics has been slow. We sought to develop and reliably implement a decision aid for treatment of children with juvenile idiopathic arthritis...
June 5, 2017: Pediatric Rheumatology Online Journal
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