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Uncertainty in clinical decision making

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https://www.readbyqxmd.com/read/29135285/factors-associated-with-confidence-in-decision-making-and-satisfaction-with-risk-communication-among-patients-with-atrial-fibrillation
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/29110651/variability-in-market-uptake-of-psychotropic-medications-in-europe-reflects-cultural-diversity
#4
J M Hoebert, A K Mantel-Teeuwisse, H G M Leufkens, L van Dijk
BACKGROUND: In the last 20-30 years, many international studies have found substantial differences in the use of (older) psychotropic medication between European countries. The majority mentioned an important role for attitudes and beliefs towards psychotropic medication. So far, no studies have looked into the effects of cultural diversity on the use of new medications entering the market. As national cultures relate deeply to held values regarding, for example, what is seen as effective versus ineffective or safe versus dangerous, (cultural) diversity in decision making around the role of new medications in clinical practice may already be expected from the first day after market authorization...
November 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29108986/-i-just-don-t-know-an-exploration-of-women-s-ambivalence-about-a-new-pregnancy
#5
Abigail Cutler, Blair McNamara, Neena Qasba, Holly Powell Kennedy, Lisbet Lundsberg, Aileen Gariepy
PURPOSE: We sought to examine how ambivalence manifests in women's lives after confirmation of a new pregnancy by exploring women's feelings, attitudes, and experiences regarding pregnancy intentions, the news itself, and related pregnancy decision making. STUDY DESIGN: We recruited women aged 15 to 44 and at less than 24 completed weeks of gestational age from urban, walk-in pregnancy testing clinics in New Haven, Connecticut, from June 2014 to June 2015. We obtained quantitative and qualitative data via an enrollment survey and face-to-face, semistructured interviews, respectively...
November 3, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29103208/model-selection-and-averaging-of-nonlinear-mixed-effect-models-for-robust-phase-iii-dose-selection
#6
Yasunori Aoki, Daniel Röshammar, Bengt Hamrén, Andrew C Hooker
Population model-based (pharmacometric) approaches are widely used for the analyses of phase IIb clinical trial data to increase the accuracy of the dose selection for phase III clinical trials. On the other hand, if the analysis is based on one selected model, model selection bias can potentially spoil the accuracy of the dose selection process. In this paper, four methods that assume a number of pre-defined model structure candidates, for example a set of dose-response shape functions, and then combine or select those candidate models are introduced...
November 4, 2017: Journal of Pharmacokinetics and Pharmacodynamics
https://www.readbyqxmd.com/read/29094999/-home-parenteral-nutrition-a-consensus-document-of-experts-from-andalucia-and-extremadura
#7
Beatriz Gonzalez Aguilera, Gabriel Olveira, Pedro Pablo García Luna, José Luis Pereira Cunill, Luis Miguel Luengo, Antonio Pérez de la Cruz, Jose Antonio Irles Rocamora
Home parenteral nutrition (HPN) is a technique that has allowed the survival in the community of those patients with serious diseases resulting in an intestinal failure that made their nutrition impossible by other methods. It is indicated if there is a documented intestinal failure (understood by the reduction of the intestinal function to the minimum to the point that intravenous supplementation is required to maintain health and/or growth) with impossibility for oral or enteral exclusive nutrition, provided that there is the possibility of managing the patient at home and that there is no short-term survival expectancy...
July 28, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/29083251/the-feasibility-of-sophisticated-multicriteria-support-for-clinical-decisions
#8
James G Dolan, Peter J Veazie
BACKGROUND: Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision-making processes and outcomes of patient-level analyses done with a range of multicriteria methods that vary in ease of use and intensity of decision support, 2 factors that could affect their ease of implementation into practice. METHODS: We conducted a series of Internet surveys to compare the effects of 5 multicriteria methods that differ in user interface and required user input format on decisions regarding selection of a preferred method for lowering the risk of cardiovascular disease...
October 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29075222/meta-analytic-evidence-for-a-reversal-learning-effect-on-the-iowa-gambling-task-in-older-adults
#9
Rita Pasion, Ana R Gonçalves, Carina Fernandes, Fernando Ferreira-Santos, Fernando Barbosa, João Marques-Teixeira
Iowa Gambling Task (IGT) is one of the most widely used tools to assess economic decision-making. However, the research tradition on aging and the Iowa Gambling Task (IGT) has been mainly focused on the overall performance of older adults in relation to younger or clinical groups, remaining unclear whether older adults are capable of learning along the task. We conducted a meta-analysis to examine older adults' decision-making on the IGT, to test the effects of aging on reversal learning (45 studies) and to provide normative data on total and block net scores (55 studies)...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/29071140/a-practical-guide-and-decision-making-protocol-for-the-management-of-complex-renal-cystic-masses
#10
Peter Weibl, Milan Hora, Boris Kollarik, Kristina Kalusova, Tomas Pitra, Mesut Remzi, Wilhelm Hübner, Pascal Balzer, Tobias Klatte
OBJECTIVES: To analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM. PATIENTS AND METHODS: A comprehensive dataset of 185 patients with 188 CRCM and a minimum follow-up of 3 years were analysed for management, pathology and outcomes. RESULTS: We analysed 35 Bosniak II, 34 Bosniak IIF, 58 Bosniak III, and 61 Bosniak IV lesions...
June 2017: Arab Journal of Urology
https://www.readbyqxmd.com/read/29070577/improving-the-clinical-value-and-utility-of-cgm-systems-issues-and-recommendations-a-joint-statement-of-the-european-association-for-the-study-of-diabetes-and-the-american-diabetes-association-diabetes-technology-working-group
#11
REVIEW
John R Petrie, Anne L Peters, Richard M Bergenstal, Reinhard W Holl, G Alexander Fleming, Lutz Heinemann
The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions...
October 25, 2017: Diabetes Care
https://www.readbyqxmd.com/read/29067486/improving-the-clinical-value-and-utility-of-cgm-systems-issues-and-recommendations-a-joint-statement-of-the-european-association-for-the-study-of-diabetes-and-the-american-diabetes-association-diabetes-technology-working-group
#12
REVIEW
John R Petrie, Anne L Peters, Richard M Bergenstal, Reinhard W Holl, G Alexander Fleming, Lutz Heinemann
The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionise the use of intensive insulin therapy in diabetes; however, progress towards that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardised format for displaying results and uncertainty on how best to use CGM data to make therapeutic decisions...
December 2017: Diabetologia
https://www.readbyqxmd.com/read/29067337/clinicians-views-on-conversations-and-shared-decision-making-in-diagnostic-testing-for-alzheimer-s-disease-the-abide-project
#13
Marleen Kunneman, Ellen M A Smets, Femke H Bouwman, Niki S M Schoonenboom, Marissa D Zwan, Ruth Pel-Littel, Wiesje M van der Flier
INTRODUCTION: This study explores clinicians' views on and experiences with when, how, and by whom decisions about diagnostic testing for Alzheimer's disease are made and how test results are discussed with patients. METHODS: Following a preparatory focus group with 13 neurologists and geriatricians, we disseminated an online questionnaire among 200 memory clinic clinicians. RESULTS: Respondents were 95 neurologists and geriatricians (response rate 47...
September 2017: Alzheimer's & Dementia: Translational Research & Clinical Interventions
https://www.readbyqxmd.com/read/29065023/-you-have-to-know-the-end-of-the-story-motivations-to-follow-up-after-transitions-of-clinical-responsibility
#14
Judith L Bowen, Jonathan S Ilgen, David M Irby, Olle Ten Cate, Bridget C O'Brien
PURPOSE: Physicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians' motivations to follow up after transitioning responsibilities. METHOD: Using a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center...
November 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29065022/a-randomized-cohort-study-of-diagnostic-and-therapeutic-thresholds-in-medical-student-clinical-reasoning
#15
Jennifer N Stojan, Michelle Daniel, Helen K Morgan, Laurie Whitman, Larry D Gruppen
PURPOSE: Learning to make decisions under uncertain conditions is a critical component of diagnostic and therapeutic reasoning. This study sought to determine treatment decisions medical students make when presented with different thresholds of diagnostic uncertainty and whether they appropriately adjust diagnostic probabilities with test information. METHOD: Two classes (2015, 2016) of fourth-year students (N = 342) were presented a patient with viral pneumonia and given 10%, 20%, or 50% pretest probabilities of that patient having a superimposed bacterial infection...
November 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29058532/-will-they-be-good-enough-parents-ethical-dilemmas-views-and-decisions-among-assisted-reproductive-technology-art-providers
#16
Robert Klitzman
BACKGROUND: Many adults may make less-than-ideal parents, but important ethical questions arise concerning whether assisted reproductive technology (ART) providers should thus ever refuse treatment to certain patients, and if so, when, and how to decide. METHODS: In-depth interviews of approximately 1 hour each were conducted with 27 ART providers (17 physicians, and 10 other health providers). RESULTS: Clinicians often struggle with whether to attempt to assess and predict patients' potential future parenting abilities, and if so, how; and how to proceed if doubts arise...
October 23, 2017: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/29049852/parental-experiences-of-prenatal-whole-exome-sequencing-wes-in-cases-of-ultrasound-diagnosed-fetal-structural-anomaly
#17
Elizabeth Quinlan-Jones, Sarah C Hillman, Mark D Kilby, Sheila M Greenfield
OBJECTIVE: To explore parental experiences of WES for prenatal diagnosis, and ascertain what influenced their decision-making to undergo testing. METHOD: Twelve women comprised a purposeful sample in a series of semi-structured interviews. All had received a fetal anomaly diagnosis on ultrasound. A topic guide was used, and transcripts were thematically analysed to elicit key themes. RESULTS: Five main themes (parental experiences of prenatal WES, need for information, consent/reasons for prenatal WES, sources of support for prenatal WES, and return of WES findings to families) emerged, some with multiple sub-themes...
October 19, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29034674/-has-budget-impact-analysis-guidelines-a-new-decision-making-tool
#18
Salah Ghabri, Anne-Isabelle Poullié, Erwan Autin, Jean-Michel Josselin
INTRODUCTION: Budget impact analysis (BIA) provides short and medium-term estimates on changes in budgets and resources resulting from the adoption of new health interventions. OBJECTIVE: The objective of this article is to present the main messages of the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis : issues, recommendations and perspectives. METHODS: The HAS guidelines development process was based on data derived from a literature review on BIA (search dates : January 2000 to June 2016), an HAS retrospective investigation, a public consultation, international expert advice, and approval from the HAS Board and the Economic and Public Health Evaluation Committee...
October 2, 2017: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
https://www.readbyqxmd.com/read/29033309/ethical-considerations-in-prenatal-testing-genomic-testing-and-medical-uncertainty
#19
REVIEW
Anastasia Richardson, Kelly E Ormond
Prenatal diagnostic testing has recently progressed from karyotype to routinely available chromosomal microarray, and the potential for fetal whole exome sequencing, both through invasive diagnostic testing and, in some cases, non-invasive prenatal testing. These tests bring beneficence through providing a higher diagnostic yield, often with lower risks of miscarriage than previously available testing, but also raise the question of harms related to an increase in uncertain and unknown results. Some parents-to-be report a desire to learn as much information as possible prenatally, and there may be beneficence in providing them with this information...
October 12, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28991847/medical-humanities-the-rx-for-uncertainty
#20
Danielle Ofri
While medical students often fear the avalanche of knowledge they are required to learn during training, it is learning to translate that knowledge into wisdom that is the greatest challenge of becoming a doctor. Part of that challenge is learning to tolerate ambiguity and uncertainty, a difficult feat for doctors who are taught to question anything that is not evidence based or peer reviewed. The medical humanities specialize in this ambiguity and uncertainty, which are hallmarks of actual clinical practice but rarely addressed in medical education...
October 3, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
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