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https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#1
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28438830/implementing-shared-decision-making-in-the-nhs-lessons-from-the-magic-programme
#2
(no author information available yet)
No abstract text is available yet for this article.
April 24, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28437869/risk-modeling-of-interdependent-complex-systems-of-systems-theory-and-practice
#3
Yacov Y Haimes
The emergence of the complexity characterizing our systems of systems (SoS) requires a reevaluation of the way we model, assess, manage, communicate, and analyze the risk thereto. Current models for risk analysis of emergent complex SoS are insufficient because too often they rely on the same risk functions and models used for single systems. These models commonly fail to incorporate the complexity derived from the networks of interdependencies and interconnectedness (I-I) characterizing SoS. There is a need to reevaluate currently practiced risk analysis to respond to this reality by examining, and thus comprehending, what makes emergent SoS complex...
April 24, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/28436342/comparison-of-neural-substrates-of-temporal-discounting-between-youth-with-autism-spectrum-disorder-and-with-obsessive-compulsive-disorder
#4
C O Carlisi, L Norman, C M Murphy, A Christakou, K Chantiluke, V Giampietro, A Simmons, M Brammer, D G Murphy, D Mataix-Cols, K Rubia
BACKGROUND: Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) share abnormalities in hot executive functions such as reward-based decision-making, as measured in the temporal discounting task (TD). No studies, however, have directly compared these disorders to investigate common/distinct neural profiles underlying such abnormalities. We wanted to test whether reward-based decision-making is a shared transdiagnostic feature of both disorders with similar neurofunctional substrates or whether it is a shared phenotype with disorder-differential neurofunctional underpinnings...
April 24, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/28435499/the-fast-and-the-furious-low-risk-chest-pain-and-the-rapid-rule-out-protocol
#5
REVIEW
Maite Anna Huis In 't Veld, Louise Cullen, Simon A Mahler, Barbra E Backus, Zachary D W Dezman, Amal Mattu
Accelerated diagnostic pathways (ADP) have been designed to identify low-risk chest pain patients in the emergency department. This review article discusses the Asia-Pacific Evaluation of Chest Pain Trial (ASPECT) score, the Accelerated Diagnostic Protocol for Chest Pain Trial (ADAPT) score, the Emergency Department Assessment of Chest Pain Score (EDACS), the HEARTScore and the HEART pathway. These ADPs have been validated in various studies and aid the emergency provider with identifying the low-risk chest pain patient who is appropriate for discharge home, while at the same time highlighting those patients who would benefit from further in-patient work up...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435417/the-evolution-of-an-interprofessional-shared-decision-making-research-program-reflective-case-study-of-an-emerging-paradigm
#6
Maman Joyce Dogba, Matthew Menear, Dawn Stacey, Nathalie Brière, France Légaré
INTRODUCTION: Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn's theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. METHODS: In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings...
July 19, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28433677/montreal-accord-on-patient-reported-outcomes-use-series-paper-9-anonymization-and-ethics-considerations-for-capturing-and-sharing-patient-reported-outcomes-pro
#7
L Arbuckle, E Moher, S J Bartlett, S Ahmed, K El Emam
BACKGROUND: Patient reported outcomes (PRO) are collected with consent for care, however using the data for any other purpose requires consent for that additional purpose, or the anonymization of the data. Collecting explicit consent to use this data for secondary purposes, before the patient completes a PRO, can also bias the responses. OBJECTIVE: We consider the ethical and security issues related to the collection of data at the point of care or in the population, and the aggregation and integration of PRO data with administrative databases to facilitate decision-making and comparative effectiveness research...
April 19, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28433671/montreal-accord-on-patient-reported-outcomes-use-series-paper-3-patient-reported-outcomes-pro-can-facilitate-shared-decision-making-and-guide-self-management
#8
V K Noonan, A Lyddiatt, P Ware, S B Jaglal, R J Riopelle, C O Bingham, S Figueiredo, R Sawatzky, M Santana, S J Bartlett, S Ahmed
BACKGROUND: There is a shift towards making health care patient-centred whereby patients are part of medical decision-making and take responsibility for managing their health. Patient-reported outcomes (PROs) capture the patient voice and can be used to engage patients in medical decision-making. OBJECTIVE: The objective of this paper is to present important factors from patients', clinicians', researchers', and decision-makers' perspectives that influence successful adoption of PROs in clinical practice...
April 19, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28431632/combined-evaluation-of-personality-risk-and-coping-in-ms-patients-a-step-towards-individualized-treatment-choice-the-pericoms-study-i
#9
G Bsteh, E Monz, L Zamarian, S Hagspiel, H Hegen, M Auer, S Wurth, F Di Pauli, F Deisenhammer, T Berger
BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory neurological disease requiring disease-modifying treatment (DMT). To provide patients with the optimal individual therapeutic option, treatment recommendations should be based not only on individual disease course and DMT specific benefit-risk estimates, but also on patient's individual characteristics such as personality, risk attitude and coping strategies. However, these characteristics are difficult to objectify in clinical routine practice without the support of appropriate evaluation instruments...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28431609/benefit-risk-perception-of-natalizumab-therapy-in-neurologists-and-a-large-cohort-of-multiple-sclerosis-patients
#10
Christoph Heesen, Ingo Kleiter, Sven G Meuth, Julia Krämer, Jürgen Kasper, Sascha Köpke, Wolfgang Gaissmaier
BACKGROUND: Natalizumab (NAT) is associated with the risk of progressive multifocal leukoencephalopathy (PML). Risk stratification algorithms have been developed, however, without detectable reduction of PML incidence. OBJECTIVE: To evaluate to which extent patients and physicians understand and accept risks associated with NAT treatment. METHODS: Prospective observational cohort study in German MS centers (n=73) among NAT-treated MS patients (n=801) and their neurologists (n=99)...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28431587/psychometric-properties-of-the-sdm-q-9-questionnaire-for-shared-decision-making-in-multiple-sclerosis-item-response-theory-modelling-and-confirmatory-factor-analysis
#11
Javier Ballesteros, Ester Moral, Luis Brieva, Elena Ruiz-Beato, Daniel Prefasi, Jorge Maurino
BACKGROUND: Shared decision-making is a cornerstone of patient-centred care. The 9-item Shared Decision-Making Questionnaire (SDM-Q-9) is a brief self-assessment tool for measuring patients' perceived level of involvement in decision-making related to their own treatment and care. Information related to the psychometric properties of the SDM-Q-9 for multiple sclerosis (MS) patients is limited. The objective of this study was to assess the performance of the items composing the SDM-Q-9 and its dimensional structure in patients with relapsing-remitting MS...
April 22, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28430791/the-medically-managed-patient-with-severe-symptomatic-aortic-stenosis-in-the-tavr-era-patient-characteristics-reasons-for-medical-management-and-quality-of-shared-decision-making-at-heart-valve-treatment-centers
#12
Kumar Dharmarajan, Jill Foster, Megan Coylewright, Philip Green, John P Vavalle, Osman Faheem, Pei-Hsiu Huang, Amar Krishnaswamy, Vinod H Thourani, Lisa A McCoy, Tracy Y Wang
BACKGROUND: Little is known about patients with severe symptomatic aortic stenosis (AS) who receive medical management despite evaluation at a heart valve treatment center. OBJECTIVE: We identified patient characteristics associated with medical management, physician-reported reasons for selecting medical management, and patients' perceptions of their involvement and satisfaction with treatment selection. METHODS AND RESULTS: Of 454 patients evaluated for AS at 9 established heart valve treatment centers from December 12, 2013 to August 19, 2014, we included 407 with severe symptomatic AS...
2017: PloS One
https://www.readbyqxmd.com/read/28429620/physician-perspectives-on-decision-making-for-treatment-of-pediatric-sleep-disordered-breathing
#13
Emily F Boss, Anne R Links, Ron Saxton, Tina L Cheng, Mary Catherine Beach
Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis...
April 1, 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28428160/simulated-conversations-with-virtual-humans-to-improve-patient-provider-communication-and-reduce-unnecessary-prescriptions-for-antibiotics-a-repeated-measure-pilot-study
#14
Antoinette Schoenthaler, Glenn Albright, Judith Hibbard, Ron Goldman
BACKGROUND: Despite clear evidence that antibiotics do not cure viral infections, the problem of unnecessary prescribing of antibiotics in ambulatory care persists, and in some cases, prescribing patterns have increased. The overuse of antibiotics for treating viral infections has created numerous economic and clinical consequences including increased medical costs due to unnecessary hospitalizations, antibiotic resistance, disruption of gut bacteria, and obesity. Recent research has underscored the importance of collaborative patient-provider communication as a means to reduce the high rates of unnecessary prescriptions for antibiotics...
April 19, 2017: JMIR Medical Education
https://www.readbyqxmd.com/read/28427915/-multimorbidity-in-general-practice-and-the-ariadne-principles-a-person-centred-approach
#15
Alexandra Prados-Torres, Isabel Del Cura-González, Juan Daniel Prados-Torres, Francisca Leiva-Fernández, Juan Antonio López-Rodríguez, Amaia Calderón-Larrañaga, Christiane Muth
Multimorbidity, defined as the coexistence of two or more chronic conditions in one same individual, has negative consequences for people suffering from it and it poses a real challenge for health systems. In primary care, where most of these patients are attended, the clinical management of multimorbidity can be a complex task due, among others, to the high volume of clinical information that needs to be handled, the scarce scientific evidence available to approach multimorbidity, and the need for coordination among multiple health providers to guarantee continuity of care...
April 17, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28426540/family-functioning-predicts-end-of-life-care-quality-in-patients-with-cancer-multicenter-prospective-cohort-study
#16
Myung Kyung Lee, Young Ho Yun
BACKGROUND: Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC). OBJECTIVE: The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer. METHODS: Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea...
April 20, 2017: Cancer Nursing
https://www.readbyqxmd.com/read/28426465/neoadjuvant-treatment-a-novel-standard
#17
Sandro Pasquali, Elena Palassini, Silvia Stacchiotti, Paolo G Casali, Alessandro Gronchi
PURPOSE OF REVIEW: The aim of this study was to summarize developments in the adjuvant/neoadjuvant chemotherapy of high-risk adult-type soft tissue sarcomas (STS). RECENT FINDINGS: The role of adjuvant/neaodjuvant chemotherapy in these patients is controversial, with a meta-analysis suggesting a 10% survival benefit. Recently, a randomized controlled trial in high-risk STS of extremities and trunk wall showed a 20% improvement in progression-free and overall survival after three preoperative cycles of epirubicin along with ifosfamide compared with a histology-tailored chemotherapy...
April 19, 2017: Current Opinion in Oncology
https://www.readbyqxmd.com/read/28424546/perspectives-of-older-people-living-in-long-term-care-facilities-and-of-their-family-members-toward-advance-care-planning-discussions-a-systematic-review-and-thematic-synthesis
#18
REVIEW
Veronica Mignani, Francesca Ingravallo, Elena Mariani, Rabih Chattat
OBJECTIVE: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. METHODS: The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28423756/shared-decision-making-via-personal-health-record-technology-for-routine-use-of-diabetic-youth-a-study-protocol
#19
Selena Davis, Abdul Roudsari, Karen L Courtney
Engaging patients in the self-management decision-making provides opportunities for positive health outcomes. The process of shared decision making (SDM) is touted as the pinnacle of patient-centred care, yet it has been difficult to implement in practice. Access to tools resulting from the integration of all health data and clinical evidence, and an ease of communications with care providers are needed to engage patients in decision making. Personal health record (PHR) technology is a promising approach for overcoming such barriers...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28421812/the-frequency-of-incidental-findings-and-subsequent-evaluation-in-low-dose-ct-scans-for-lung-cancer-screening
#20
Lillie Morgan, Humberto Choi, Michal Reid, Ali Khawaja, Peter J Mazzone
RATIONALE: The USPSTF recommends lung cancer screening with low-dose chest CT scans (LDCT) for a well-defined high-risk population. Data on the frequency and impact of incidental findings on LDCT scans performed within a centralized lung cancer screening program has not been reported. OBJECTIVES: Previous studies have reported IFs in the setting of clinical trials. We present our findings in a real clinical setting where the decision to manage these findings may depend on factors that are not captured in a research trial such as disclosing IFs, patient preferences, severity of comorbidities, and physician expertise...
April 19, 2017: Annals of the American Thoracic Society
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