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Clinical decision making

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https://www.readbyqxmd.com/read/28437620/american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-guidelines-for-management-of-dyslipidemia-and-prevention-of-cardiovascular-disease
#1
Paul S Jellinger, Yehuda Handelsman, Paul D Rosenblit, Zachary T Bloomgarden, Vivian A Fonseca, Alan J Garber, George Grunberger, Chris K Guerin, David S H Bell, Jeffrey I Mechanick, Rachel Pessah-Pollack, Kathleen Wyne, Donald Smith, Eliot A Brinton, Sergio Fazio, Michael Davidson
OBJECTIVE: The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols...
April 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28437573/using-internal-and-external-reviewers-can-help-to-optimise-neonatal-mortality-and-morbidity-conferences
#2
Michael-Andrew Assaad, Annie Janvier, Anie Lapointe
AIM: This study determined if there was a difference in the conclusions reached by paediatricians in morbidity and mortality conferences based on their level of involvement in a case. METHODS: All neonatal deaths occurring between August 2014 and September 2015 at Sainte-Justine Hospital, Montreal, Quebec, Canada, were reviewed by internal physicians involved in the case and external physicians who were not. The reviewers were asked to identify positive and negative clinical practice items and provide written recommendations...
April 24, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28437547/concordance-of-patient-and-physician-perceptions-of-care-in-an-orthopedic-clinic
#3
Kelly Zhang, Charles Day, Matthew L Iorio
It is essential to study whether physicians' perceptions align with their patients' views, as understanding patient perception leads to superior satisfaction and health outcomes. Previous studies have established differences in physician-patient perceptions, but no studies have been conducted in orthopedic clinics. The authors' primary goal was to evaluate differences in physician and patient perceptions of an orthopedic clinic visit. Their secondary objective was to determine the influence of visit length, demographics, and depression risk-level on patient satisfaction...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437002/dentists-restorative-decision-making-and-implications-for-an-amalgamless-profession-part-4-clinical-factors
#4
G Alexander, Hopcraft, M J Tyas, R H K Wong
BACKGROUND: The Minamata Convention embodies a world-wide reduction in the production and use of mercury and mercury-containing products and processes, including a phase-down of dental amalgam. This will change the approach to the use of direct restorative materials in the near future. There is little research as to the influence of clinical factors on dentists' decision-making which may be of use when determining the impact of any change. METHODS: An online survey relating to aspects of and attitudes to the use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association and/or Members or Fellows of the Royal Australasian College of Dental Surgeons...
April 24, 2017: Australian Dental Journal
https://www.readbyqxmd.com/read/28436686/sparking-thinking-studying-modern-precision-medicine-will-accelerate-the-progression-of-traditional-chinese-medicine-patterns
#5
Bao-Cheng Liu, Guang Ji
Incorporating "-omics" studies with environmental interactions could help elucidate the biological mechanisms responsible for Traditional Chinese Medicine (TCM) patterns. Based on the authors' own experiences, this review outlines a model of an ideal combination of "-omics" biomarkers, environmental factors, and TCM pattern classifications; provides a narrative review of the relevant genetic and TCM studies; and lists several successful integrative examples. Two integration tools are briefly introduced. The first is the integration of modern devices into objective diagnostic methods of TCM patterning, which would improve current clinical decision-making and practice...
April 24, 2017: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
https://www.readbyqxmd.com/read/28436547/are-type-d-personality-and-depression-predictors-of-anxiety-and-posttraumatic-stress-symptoms-among-icd-patients
#6
EDITORIAL
Jessica Ford
The literature surrounding posttraumatic stress symptoms (PSS) and anxiety among patients living with implantable cardioverter defibrillators (ICD) is becoming increasingly sophisticated with evidence linking traumatic stress and anxiety to cardiovascular outcomes, examinations of psychosocial treatment of PSS and anxiety, and predictive modeling all contributing to a more nuanced understanding of the predictors, course, and treatment of PSS and anxiety among ICD patients. In this issue of PACE, Habibovic, Denollet, and Pedersen report secondary analyses from the WEBCARE trial data in which the author employed Latent Class Analysis (LCA) to identify trajectories of trauma and anxiety symptoms among patients implanted with ICDs across the 12-month post-implant period and examined associations between the identified trajectories and demographic, clinical, and psychological characteristics of the participants...
April 24, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28436158/collaborating-on-medication-errors-in-nursing
#7
Marketa Marvanova, Paul J Henkel
BACKGROUND: Nurse educators are faced with changing roles and expanding responsibilities for medication administration and monitoring in pursuit of improved patient safety. The aims of this study were to develop, implement and evaluate clinical simulation experiences that included, along with nursing faculty members, a pharmacist educator for the teaching of preventable medication errors in undergraduate nursing education. METHODS: Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems in nursing practice...
April 24, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28435488/clinician-performed-bedside-ultrasound-in-improving-diagnostic-accuracy-in-patients-presenting-to-the-ed-with-acute-dyspnea
#8
Dimitrios Papanagnou, Michael Secko, John Gullett, Michael Stone, Shahriar Zehtabchi
INTRODUCTION: Diagnosing acute dyspnea is a critical action performed by emergency physicians (EP). It has been shown that ultrasound (US) can be incorporated into the work-up of the dyspneic patient; but there is little data demonstrating its effect on decision-making. We sought to examine the impact of a bedside, clinician-performed cardiopulmonary US protocol on the clinical impression of EPs evaluating dyspneic patients, and to measure the change in physician confidence with the leading diagnosis before and after US...
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
#9
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/28435313/evidence-and-consensus-recommendations-for-the-pharmacological-management-of-pain-in-india
#10
REVIEW
Gur Prasad Dureja, Rajagopalan N Iyer, Gautam Das, Jaishid Ahdal, Prashant Narang
Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28435311/application-of-bayesian-decision-making-to-laboratory-testing-for-lyme-disease-and-comparison-with-testing-for-hiv
#11
Michael J Cook, Basant K Puri
In this study, Bayes' theorem was used to determine the probability of a patient having Lyme disease (LD), given a positive test result obtained using commercial test kits in clinically diagnosed patients. In addition, an algorithm was developed to extend the theorem to the two-tier test methodology. Using a disease prevalence of 5%-75% in samples sent for testing by clinicians, evaluated with a C6 peptide enzyme-linked immunosorbent assay (ELISA), the probability of infection given a positive test ranged from 26...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28434926/scoping-review-to-develop-common-data-elements-for-lumbar-spinal-stenosis
#12
Allen Heinemann, Jason Raad, Venu Akuthota, Neil Segal, Kristian P Nitsch, Monica Rho, Leighton Chan, Ellen Casey, Joel Press, Gwendolyn Sowa, Jennifer Moore
BACKGROUND CONTEXT: Common Data Elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. While CDE's have been developed for a number of disorders, to date CDEs for Lumbar Spinal Stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages The International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS...
April 18, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28434884/neurotoxicity-outcomes-in-a-population-based-cohort-of-elderly-patients-treated-with-adjuvant-oxaliplatin-for-colorectal-cancer
#13
Michael J Raphael, Hadas D Fischer, Kinwah Fung, Peter C Austin, Geoffrey M Anderson, Christopher M Booth, Simron Singh
BACKGROUND: The addition of oxaliplatin to adjuvant treatment regimens for colorectal cancer has been shown to improve overall survival at the expense of increased toxicity. The incidence and severity of toxicity might be greater among older patients who might also derive less benefit from oxaliplatin. We evaluated the association between adjuvant oxaliplatin-based chemotherapy and neurotoxicity outcomes in an elderly cohort of patients. PATIENTS AND METHODS: A population-based cohort of patients aged > 65 years with stage II and III colorectal cancer treated with adjuvant therapy in Ontario, Canada was identified using the Ontario Cancer Registry...
March 24, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/28434416/introduction-of-health-technology-assessment-for-medicines-in-slovakia
#14
Tomas Tesar, Adam Hloska, Martin Wawruch, Lubica Lehocka, Miroslava Snopkova, Lucia Masarykova
OBJECTIVES: The aim of our study was to describe approaches to health technology assessment (HTA) for medicines in the Slovak healthcare system and the related decision-making processes concerning reimbursement for medicines. METHODS: Analysis of the Slovak legislative framework related to HTA and the reimbursement process for medicines was performed. Additionally, current practices of the Working Group for Pharmacoeconomics, Clinical Outcomes and Health Technology Assessment of the Slovak Ministry of Health were evaluated...
April 24, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28434283/considering-tapentadol-as-a-first-line-analgesic-14-questions
#15
Joseph V Pergolizzi, Frank Breve, Robert Taylor, Robert B Raffa, Stephani E Strasburger, Jo Ann LeQuang
Tapentadol is the newest centrally acting analgesic to be approved by the US FDA and regulatory bodies in other countries. It has been called the first-in-class of a novel-acting analgesic mechanism of action that combines µ-opioid receptor agonist activity with neuronal norepinephrine-reuptake inhibition in a single molecule. This duality of action should combine inhibition of ascending (afferent) pain-transmitting signals with activation of descending (efferent) pain-attenuating systems (e.g., diffuse noxious inhibitory controls)...
April 24, 2017: Pain Management
https://www.readbyqxmd.com/read/28434279/extended-use-of-electronic-health-records-by-primary-care-physicians-does-the-electronic-health-record-artefact-matter
#16
Louis Raymond, Guy Paré, Marie Marchand
The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes...
April 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/28434017/recurrent-epistaxis-predicting-risk-of-30-day-readmission-derivation-and-validation-of-rhino-ooze-score
#17
A Addison, C Paul, R Kuo, A Lamyman, P Martinez-Devesa, R Hettige
BACKGROUND: To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. METHODS: Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score)...
April 23, 2017: Rhinology
https://www.readbyqxmd.com/read/28433678/montreal-accord-on-patient-reported-outcomes-use-series-paper-4-patient-reported-outcomes-pro-can-inform-clinical-decision-making-in-chronic-care
#18
Clifton O Bingham, Vanessa Noonan, Claudine Auger, Debbie Feldman, Sara Ahmed, Susan J Bartlett
BACKGROUND: Providing patient-centered healthcare requires that patient needs, preferences, and valued outcomes are more fully integrated into all decisions. Patient reported outcome measures (PROs) provide unique information from the patient perspective on overall health, symptoms, burden, and treatment response. OBJECTIVE: We sought to describe applications of PROs in clinical settings and considerations for implementation from the perspectives of PRO researchers, clinicians, administrators, policy makers, and patients attending a multidisciplinary meeting...
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
#19
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/28433485/in-hospital-mortality-in-cirrhotic-patients-at-a-tertiary-care-center
#20
R Zubieta-Rodríguez, J Gómez-Correa, R Rodríguez-Amaya, K A Ariza-Mejia, N A Toloza-Cuta
INTRODUCTION: Cirrhosis of the liver is known for its high risk of mortality associated with episodes of acute decompensation. There is an even greater risk in patients that present with acute-on-chronic liver failure. The identification of patients at higher risk for adverse outcomes can aid in making the clinical decisions that will improve the prognosis for these patients. AIMS: To determine in-hospital mortality and evaluate the epidemiologic and clinical characteristics of patients with cirrhosis of the liver seen at a tertiary referral hospital...
April 19, 2017: Revista de Gastroenterología de México
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