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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/28639707/dressings-and-topical-agents-for-treating-pressure-ulcers
#1
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
#2
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
#3
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/patient-decision-aids-for-patients-considering-total-joint-replacement-a-cost-effectiveness-analysis-alongside-a-randomised-controlled-trial
#4
Logan Trenaman, Dawn Stacey, Stirling Bryan, Monica Taljaard, Gillian Hawker, Geoff Dervin, Peter Tugwell, Nick 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 with 2-year follow-up. 343 patients were recruited from two orthopedic screening clinics in Ottawa, Canada...
June 14, 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
#5
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
#6
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
#7
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
#8
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...
June 12, 2017: Journal of Nursing Scholarship
https://www.readbyqxmd.com/read/28596804/bringing-a-humanistic-approach-to-cancer-clinical-trials
#9
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
#10
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
https://www.readbyqxmd.com/read/28578757/decision-making-under-pressure-medical-errors-in-uncertain-and-dynamic-environments
#11
Alicia M Zavala, Gary E Day, David Plummer, Anita Bamford-Wade
Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations.Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review...
June 5, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28577349/emerging-issues-in-disorders-differences-of-sex-development-dsd
#12
Margaret P Adam, Eric Vilain
Disorders/Differences of Sex Development (DSD), as defined by the 2006 Consensus Statement, are "congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical." They represent a spectrum of chronic medical conditions collectively affecting about 1% of the population and are associated with increased risk of infertility, cancer, and psychosocial distress. Clinical management in DSD is subject to multiple controversies about gender assignment, the timing and appropriateness of genital surgery and the approach to disclosure...
June 3, 2017: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/28572867/prolaris-cell-cycle-progression-test-for-localized-prostate-cancer-a-health-technology-assessment
#13
(no author information available yet)
BACKGROUND: Prostate cancer is very common and many localized tumours are non-aggressive. Determining which cancers are aggressive is important for choosing the most appropriate treatment (e.g., surgery, radiation, active surveillance). Current clinical risk stratification is reliable in forecasting the prognosis of groups of men with similar clinical and pathologic characteristics, but there is residual uncertainty at the individual level. The Prolaris cell cycle progression (CCP) test, a genomic test that estimates how fast tumour cells are proliferating, could potentially be used to improve the accuracy of individual risk assessment...
2017: Ontario Health Technology Assessment Series
https://www.readbyqxmd.com/read/28561651/precision-oncology-who-how-what-when-and-when-not
#14
Lee Schwartzberg, Edward S Kim, David Liu, Deborah Schrag
Precision oncology, defined as molecular profiling of tumors to identify targetable alterations, is rapidly developing and has entered the mainstream of clinical practice. Genomic testing involves many stakeholders working in a coordinated fashion to deliver high-quality tissue samples to high-quality laboratories, where appropriate next-generation sequencing (NGS) molecular analysis leads to actionable results. Clinicians should be familiar with the types of genomic variants reported by the laboratory and the technology used to determine the results, including limitations of current testing methodologies and reports...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28557933/transforming-medical-assessment-integrating-uncertainty-into-the-evaluation-of-clinical-reasoning-in-medical-education
#15
Suzette Cooke, Jean-Francois Lemay
In an age where practicing physicians have access to an overwhelming volume of clinical information and are faced with increasingly complex medical decisions, the ability to execute sound clinical reasoning is essential to optimal patient care. The authors propose two concepts that are philosophically paramount to the future assessment of clinical reasoning in medicine: assessment in the context of "uncertainty" (when, despite all of the information that is available, there is still significant doubt as to the best diagnosis, investigation, or treatment), and acknowledging that it is entirely possible (and reasonable) to have more than "one correct answer...
June 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28532470/health-care-professionals-attitudes-towards-evidence-based-medicine-in-the-workers-compensation-setting-a-cohort-study
#16
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
#17
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
#18
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
#19
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
#20
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
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