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Crisis decision making

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https://www.readbyqxmd.com/read/28300527/the-development-of-an-evacuation-protocol-for-patients-with-ventricular-assist-devices-during-a-disaster
#1
Katherine J Davis, Joseph Suyama, Jennifer Lingler, Michael Beach
Introduction Health care providers are on the forefront of delivering care and allocating resources during a disaster; however, very few are adequately trained to respond in these situations. Furthermore, there is a void in the literature regarding the specific care needs of patients with ventricular assist devices (VADs) in a disaster setting. This project aimed to develop an evidenced-based protocol to aid health care providers during the evacuation of patients with VADs during a disaster. METHODS: This is a qualitative study that used expert review, tabletop discussion, and a survey of health care professionals to develop and evaluate an evacuation protocol...
March 16, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28295461/what-do-uk-medical-students-value-most-in-their-careers-a-discrete-choice-experiment
#2
Jennifer A Cleland, Peter Johnston, Verity Watson, Nicolas Krucien, Diane Skåtun
CONTEXT: Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors...
March 14, 2017: Medical Education
https://www.readbyqxmd.com/read/28289516/biochemical-changes-in-the-injured-brain
#3
EDITORIAL
Seelora Sahu, Deb Sanjay Nag, Amlan Swain, Devi Prasad Samaddar
Brain metabolism is an energy intensive phenomenon involving a wide spectrum of chemical intermediaries. Various injury states have a detrimental effect on the biochemical processes involved in the homeostatic and electrophysiological properties of the brain. The biochemical markers of brain injury are a recent addition in the armamentarium of neuro-clinicians and are being increasingly used in the routine management of neuro-pathological entities such as traumatic brain injury, stroke, subarachnoid haemorrhage and intracranial space occupying lesions...
February 26, 2017: World Journal of Biological Chemistry
https://www.readbyqxmd.com/read/28286699/rural-women-s-experience-of-living-and-giving-birth-in-relief-camps-in-pakistan
#4
Humaira Maheen, Elizabeth Hoban
BACKGROUND: Women are more vulnerable than men in the same natural disaster setting. Preexisting gender inequality, socio-cultural community dynamics and poverty puts women at significant risk of mortality. Pregnant women are particularly vulnerable because of their limited or no access to prenatal and obstetric care during any disaster or humanitarian emergency setting. METHODS: In-depth interviews were conducted with 15 women who gave birth during the 2011 floods in Sindh Province, Pakistan...
January 31, 2017: PLoS Currents
https://www.readbyqxmd.com/read/28285860/a-discussion-about-public-health-lead-and-legionella-pneumophila-in-drinking-water-supplies-in-the-united-states
#5
Michael B Rosen, Lok R Pokhrel, Mark H Weir
Lead (Pb) in public drinking water supplies has garnered much attention since the outset of the Flint water crisis. Pb is a known hazard in multiple environmental matrices, exposure from which results in long-term deleterious health effects in humans. This discussion paper aims to provide a succinct account of environmental Pb exposures with a focus on water Pb levels (WLLs) in the United States. It is understood that there is a strong correlation between WLLs and blood Pb levels (BLLs), and the associated health effects...
March 9, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#6
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28238300/penetrating-abdominal-injuries-during-the-syrian-war-patterns-and-factors-affecting-mortality-rates
#7
Shawqi Arafat, Mhd Belal Alsabek, Mousa Ahmad, Iman Hamo, Eskander Munder
BACKGROUND: A large number of innocent Syrians were injured or killed during the years of war. This retrospective study investigates the differences in patterns of injury and factors affecting the mortality rate in 324 patients coming to Damascus Hospital with penetrating abdominal trauma, and illustrates the difficulties of diagnosis and decision making in crisis situations. METHODS: A retrospective study was registered from patient's records between October 2012 and June 2013 in Damascus Hospital...
February 14, 2017: Injury
https://www.readbyqxmd.com/read/28230438/the-influence-of-placements-on-adult-nursing-graduates-choice-of-first-post
#8
Mark Wareing, Renate Taylor, Aileen Wilson, Adrienne Sharples
BACKGROUND: This article presents findings from a study that sought to explore the extent to which clinical placements have an impact on nursing students' decisions regarding their first staff nurse post. Within the UK, nursing is facing a recruitment crisis with particular difficulty recruiting to areas such as primary care and care of older people. Transitioning into a new role is challenging in any occupation, but it is a particular problem in nursing where the realities of professional practice often differ from students' perception of the staff nurse role as shaped by their clinical placements...
February 23, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28221338/pathways-towards-instability-in-financial-networks
#9
Marco Bardoscia, Stefano Battiston, Fabio Caccioli, Guido Caldarelli
Following the financial crisis of 2007-2008, a deep analogy between the origins of instability in financial systems and complex ecosystems has been pointed out: in both cases, topological features of network structures influence how easily distress can spread within the system. However, in financial network models, the details of how financial institutions interact typically play a decisive role, and a general understanding of precisely how network topology creates instability remains lacking. Here we show how processes that are widely believed to stabilize the financial system, that is, market integration and diversification, can actually drive it towards instability, as they contribute to create cyclical structures which tend to amplify financial distress, thereby undermining systemic stability and making large crises more likely...
February 21, 2017: Nature Communications
https://www.readbyqxmd.com/read/28184260/perioperative-management-of-left-ventricular-diastolic-dysfunction-and-heart-failure-an-anesthesiologist-s-perspective
#10
REVIEW
Taeha Ryu, Seok-Young Song
Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28156679/decision-support-needs-assessment-in-newly-diagnosed-malignant-glioma
#11
Camilo E Fadul, Heather Wishart
33 Background: Diagnosis of malignant glioma is catastrophic and standard treatment options remain non-curative. Patients are not guaranteed a good outcome, have significantly decreased QOL and exposure to risk. Shared decision making, is believed to diffuse decisional distress accompanying complex situations. METHODS: Semi-structured interviews explored patient, caregiver and physician perceptions of standard of care treatment recommendations following diagnosis. Cognitive, neurological and functional ability was evaluated with neurological examination, Karnofsky Performance Scale (KPS), Trail-Making Test and The Hopkins Verbal Learning Test (HVLT)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28153937/beliefs-and-attitudes-to-bowel-cancer-screening-in-patients-with-ckd-a-semistructured-interview-study
#12
Laura J James, Germaine Wong, Jonathan C Craig, Angela Ju, Narelle Williams, Wai H Lim, Nicholas Cross, Allison Tong
BACKGROUND AND OBJECTIVES: Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand...
February 2, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28153060/how-to-choose-using-the-delphi-method-to-develop-consensus-triggers-and-indicators-for-disaster-response
#13
Rebecca Lis, Vicki Sakata, Onora Lien
OBJECTIVE: To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. METHODS: A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators...
February 3, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28114092/-utilization-of-technological-resources-within-the-framework-of-operation-of-a-mobile-mental-health-unit
#14
D Garoni, D Sarantidis, K Katsadoros
Telepsychiatry was introduced in the early 1950's for the provision of mental health services from a distance. In 1990 the progress made in telecommunications technologies caused a significant expansion in telepsychiatry services. It can refer to store and forward technologies, interactive technologies, remote monitoring technologies and it is applied to contribute to the lift of restrictions placed on providing mental health services. Restrictions may exist due to geographic isolation, lack of specialized services, high cost of moving patients etc...
October 2016: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/28100114/borderline-personality-disorder-and-the-ethics-of-risk-management
#15
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
#16
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)...
March 2017: 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
#17
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
#18
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
#19
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
#20
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
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