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Crisis decision making

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https://www.readbyqxmd.com/read/28100114/borderline-personality-disorder-and-the-ethics-of-risk-management
#1
Dan Warrender
Patients with borderline personality disorder are frequent users of inpatient mental health units, with inpatient crisis intervention often used based on the risk of suicide. However, this can present an ethical dilemma for nursing and medical staff, with these clinician responses shifting between the moral principles of beneficence and non-maleficence, dependent on the outcomes of the actions of containing or tolerating risk. This article examines the use of crisis intervention through moral duties, intentions and consequences, culminating in an action/consequence model of risk management, used to explore potential outcomes...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28029695/sense-of-control-in-end-of-life-decision-making
#2
Rafael D Romo, Theresa A Allison, Alexander K Smith, Margaret I Wallhagen
OBJECTIVES: To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis. DESIGN: Grounded theory. SETTING: Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center. PARTICIPANTS: Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20)...
December 28, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28028288/a-cost-effectiveness-analysis-of-self-debriefing-versus-instructor-debriefing-for-simulated-crises-in-perioperative-medicine-in-canada
#3
Wanrudee Isaranuwatchai, Fahad Alam, Jeffrey Hoch, Sylvain Boet
PURPOSE: High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS: This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada...
2017: Journal of Educational Evaluation for Health Professions
https://www.readbyqxmd.com/read/27997293/gerontological-social-workers-are-key-to-a-sustainable-long-term-services-and-supports-system
#4
Carrie Henning-Smith
Of the myriad challenges that the new administration and 115th Congress will face, one of the most pressing will be establishing a sustainable long-term services and supports (LTSS) system responsive to the aging US population. Currently, the majority of LTSS is paid for with Medicaid and other public programs; an additional and sizeable burden falls on unpaid caregivers. Individuals generally have unrealistic expectations about their likelihood of needing LTSS and a minority of adults have made any concrete plans for their own care...
December 20, 2016: Journal of Gerontological Social Work
https://www.readbyqxmd.com/read/27997004/-reliability-of-biomedical-research
#5
Mattia Andreoletti
In the last century, use of statistics became widespread in biomedical research, making medicine more scientific. However, the misuse of statistical methods may have a negative impact on the reproducibility of experiments, which instead should be at the core of scientific method. The consequence is the so called "replicability crisis", which can affect the reliability of scientific results: if one cannot replicate a published finding, she would hardly trust it. In this paper, firstly, we will provide a short review of the replicability crisis...
December 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27984159/spectroscopy-markers-of-suicidal-risk-and-mental-pain-in-depressed-patients
#6
Fabrice Jollant, Jamie Near, Gustavo Turecki, Stéphane Richard-Devantoy
OBJECTIVE: Suicidal behavior has been associated with structural and functional impairments in neuroimaging studies, mainly localized in the prefrontal cortex. However, little is known of the in vivo biochemical alterations that could be markers of suicidal risk. METHODS: Proton magnetic resonance spectroscopy was used to measure at-rest levels of 9 metabolites (glutamate, glutamine, glutathione, GABA, N-acetylaspartate (NAA), N-acetylaspartylglutamate, myo-inositol, aspartate, total choline), in the right dorsal prefrontal cortex of 25 unmedicated depressed patients, including 15 with a history of suicidal behavior, and 33 healthy controls...
October 27, 2016: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/27965233/research-in-review-advancing-critical-care-practice
#7
Elizabeth Bridges, Margaret M McNeill, Nancy Munro
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27924753/referral-criteria-for-outpatient-specialty-palliative-cancer-care-an-international-consensus
#8
REVIEW
David Hui, Masanori Mori, Sharon M Watanabe, Augusto Caraceni, Florian Strasser, Tiina Saarto, Nathan Cherny, Paul Glare, Stein Kaasa, Eduardo Bruera
Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds...
December 2016: Lancet Oncology
https://www.readbyqxmd.com/read/27918336/resident-physicians-improve-nontechnical-skills-when-on-operating-room-management-and-leadership-rotation
#9
Devon C Cole, Christopher R Giordano, Terrie Vasilopoulos, Brenda G Fahy
BACKGROUND: Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making. METHODS: The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27878940/people-processes-and-systems-an-observational-study-of-the-role-of-technology-in-rural-youth-mental-health-services
#10
Simone Orlowski, Sharon Lawn, Ben Matthews, Anthony Venning, Gabrielle Jones, Megan Winsall, Gaston Antezana, Niranjan Bidargaddi, Peter Musiat
The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions...
November 23, 2016: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/27878123/two-validated-ways-of-improving-the-ability-of-decision-making-in-emergencies-results-from-a-literature-review
#11
REVIEW
Amir Khorram-Manesh, Johan Berlin, Eric Carlström
The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, simulation, validated, real-time, command and control, communication, collaboration, and multi-disciplinary in combination or as an isolated word. Two validated training systems developed in Sweden, 3 level collaboration (3LC) and MacSim, were identified and studied in light of the literature review in order to identify how decision-making can be trained...
October 2016: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/27831476/the-antimicrobial-resistance-crisis-management-through-gene-monitoring
#12
Carolyn A Michael, Ashley E Franks, Maurizio Labbate
Antimicrobial resistance (AMR) is an acknowledged crisis for humanity. Its genetic origins and dire potential outcomes are increasingly well understood. However, diagnostic techniques for monitoring the crisis are currently largely limited to enumerating the increasing incidence of resistant pathogens. Being the end-stage of the evolutionary process that produces antimicrobial resistant pathogens, these measurements, while diagnostic, are not prognostic, and so are not optimal in managing this crisis. A better test is required...
November 2016: Open Biology
https://www.readbyqxmd.com/read/27807085/-i-ll-be-in-a-safe-place-a-qualitative-study-of-the-decisions-taken-by-people-with-advanced-cancer-to-seek-emergency-department-care
#13
Lesley A Henson, Irene J Higginson, Barbara A Daveson, Clare Ellis-Smith, Jonathan Koffman, Myfanwy Morgan, Wei Gao
OBJECTIVE: To explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process. DESIGN: Cross-sectional qualitative study incorporating semistructured patient and caregiver interviews. METHODS: Between December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers...
November 2, 2016: BMJ Open
https://www.readbyqxmd.com/read/27775408/symptoms-circumstances-and-service-systems-pathways-to-psychiatric-crisis-service-use-among-uninsured-young-adults
#14
Sarah Carter Narendorf, Michelle R Munson, Micki Washburn, Nicole Fedoravicius, Richard Wagner, Sara K Flores
Young adults have low rates of outpatient service utilization and higher rates of emergency service use compared to older adults. This study explored pathways to crisis service use for uninsured young adults who accessed emergency psychiatric treatment. Participants were 55 young adults (ages 18-25) who were on an inpatient short-term stabilization unit and had qualifying diagnoses for outpatient services (bipolar, major depression, or schizophrenia). Semistructured qualitative interviews were conducted to understand decision-making and the events that led to service use...
October 24, 2016: American Journal of Orthopsychiatry
https://www.readbyqxmd.com/read/27754160/pl-03-1-hypertension-management-in-the-era-of-digital-information-and-communication-technologies
#15
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27729051/from-personal-crisis-care-to-convenience-shopping-an-interpretive-description-of-the-experiences-of-people-with-mental-illness-and-addictions-in-community-pharmacies
#16
Andrea L Murphy, Ruth Martin-Misener, Stan P Kutcher, Claire L O'Reilly, Timothy F Chen, David M Gardner
BACKGROUND: The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists' interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements...
October 12, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27695739/enabling-science-support-for-better-decision-making-when-responding-to-chemical-spills
#17
Jennifer L Weidhaas, Andrea M Dietrich, Nathan J DeYonker, R Ryan Dupont, William T Foreman, Daniel Gallagher, Jennifer E G Gallagher, Andrew J Whelton, William A Alexander
Chemical spills and accidents contaminate the environment and disrupt societies and economies around the globe. In the United States there were approximately 172,000 chemical spills that affected US waterbodies from 2004 to 2014. More than 8000 of these spills involved non-petroleum-related chemicals. Traditional emergency responses or incident command structures (ICSs) that respond to chemical spills require coordinated efforts by predominantly government personnel from multiple disciplines, including disaster management, public health, and environmental protection...
September 2016: Journal of Environmental Quality
https://www.readbyqxmd.com/read/27687761/development-of-a-fuzzy-stochastic-programming-with-green-z-score-criterion-method-for-planning-water-resources-systems-with-a-trading-mechanism
#18
X T Zeng, G H Huang, Y P Li, J L Zhang, Y P Cai, Z P Liu, L R Liu
This study developed a fuzzy-stochastic programming with Green Z-score criterion (FSGZ) method for water resources allocation and water quality management with a trading-mechanism (WAQT) under uncertainties. FSGZ can handle uncertainties expressed as probability distributions, and it can also quantify objective/subjective fuzziness in the decision-making process. Risk-averse attitudes and robustness coefficient are joined to express the relationship between the expected target and outcome under various risk preferences of decision makers and systemic robustness...
September 29, 2016: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/27687013/becoming-therapeutic-agents-a-grounded-theory-of-mothers-process-when-implementing-cognitive-behavioural-therapy-at-home-with-an-anxious-child
#19
Rana Pishva
: The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home...
September 29, 2016: Clinical Psychology & Psychotherapy
https://www.readbyqxmd.com/read/27667653/the-spanish-long-term-care-system-in-transition-ten-years-since-the-2006-dependency-act
#20
Luz María Peña-Longobardo, Juan Oliva-Moreno, Sandra García-Armesto, Cristina Hernández-Quevedo
At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened...
September 9, 2016: Health Policy
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