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Decision support

Alexandra Page, Natalie M V Morrison
Gender, a personal history of trauma and attitudes towards continuous vs recovered memories of abuse significantly impact the believability of Child Sexual Abuse (CSA) disclosures in community samples. Yet, whether these variables influence the believability of CSA disclosure and subsequent clinical decisions made by practicing psychologists is underexplored. A vignette of trauma disclosure from a hypothetical adult client was presented via an online survey to 292 registered psychologists. Participants rated the believability of the disclosure, answered an open-ended item regarding treatment planning, and completed the Brief Betrayal Trauma Survey to measure personal trauma history...
March 17, 2018: Child Abuse & Neglect
Kunal N Karmali, Donald M Lloyd-Jones, Joep van der Leeuw, David C Goff, Salim Yusuf, Alberto Zanchetti, Paul Glasziou, Rodney Jackson, Mark Woodward, Anthony Rodgers, Bruce C Neal, Eivind Berge, Koon Teo, Barry R Davis, John Chalmers, Carl Pepine, Kazem Rahimi, Johan Sundström
BACKGROUND: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level. METHODS AND FINDINGS: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013...
March 2018: PLoS Medicine
Cláudia Melo, Ana Fonseca, Mariana Moura-Ramos, Teresa Almeida-Santos, Maria Cristina Canavarro
PURPOSE: To assess female cancer patients' perceptions of the fertility preservation decision-making process and to examine the effect of clinicians' support on the decision quality. METHODS: A total of 71 patients participated in this longitudinal study with two assessment time points (before cancer therapy, after cancer therapy). Self-report measures assessed the decision-making process, the decision quality and the clinicians' support. RESULTS: A less positive experience in the decision-making process was associated with higher decisional regret and lower decisional satisfaction...
March 20, 2018: Journal of Psychosocial Oncology
Sandy Oelschlegel, Kelsey Leonard Grabeel, Emily Tester, Robert E Heidel, Jennifer Russomanno
Patient engagement in health care decisions largely depends on a patient's health literacy and the health literacy attributes of the health care organization. Librarians have an established role in connecting patients with health information in the context of their care. However, librarians can play a larger role in helping to make changes in their organization's health literacy attributes. This article discusses one medical library's process of leading systematic assessment of their organization's health literacy attributes...
April 2018: Medical Reference Services Quarterly
Mariana V Meireles, Ana Roberta P Pascom, Elisabeth C Duarte
OBJECTIVE: To identify clinical, sociodemographic and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014-2015. METHODS: Data from four information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving virological suppression (VLS), defined as having either a viral load count (VL) >200 copies/mL or an aids-related death recorded within 180±90 days after treatment initiation...
March 19, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Fauzia Knight, Renata Kokanović, Damien Ridge, Lisa Brophy, Nicholas Hill, Kate Johnston-Ataata, Helen Herrman
Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners...
March 1, 2018: Qualitative Health Research
Gaëlle Encrenaz, Sonia Laberon, Christine Lagabrielle, Gautier Debruyne, Jacques Pouyaud, Nicole Rascle
PURPOSE: The relationship between enterprise size and psychosocial working conditions has received little attention so far but some findings suggest that they are more favorable in small enterprises. This could have a positive impact on workers' mental health. The objective of this study was to test the mediating effect of perceived working conditions in the relationship between enterprise size and anxious or depressive episodes. METHODS: Data from the 2010 SUMER French periodical cross-sectional survey was analyzed (N=31 420 for the present study)...
March 20, 2018: International Journal of Occupational Safety and Ergonomics: JOSE
Joo Myung Lee, Joon Hyung Doh, Chang Wook Nam, Eun Seok Shin, Bon Kwon Koo
The presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease, and ischemia-directed revascularization has been a standard of care. Fractional flow reserve (FFR) is an invasive method used to detect the functionally significant epicardial coronary stenosis, and FFR-guided revascularization strategy has been proven to be superior to angiography-guided strategy. Recently, a hyperemia-free index, instantaneous wave free ratio (iFR), was developed and showed its non-inferiority for clinical outcomes compared with FFR-guided strategy...
March 2018: Korean Circulation Journal
Venessa Chin, Adnan Nagrial, Katrin Sjoquist, Chelsie A O'Connor, Lorraine Chantrill, Andrew V Biankin, Rob Jpm Scholten, Desmond Yip
BACKGROUND: Pancreatic cancer (PC) is a highly lethal disease with few effective treatment options. Over the past few decades, many anti-cancer therapies have been tested in the locally advanced and metastatic setting, with mixed results. This review attempts to synthesise all the randomised data available to help better inform patient and clinician decision-making when dealing with this difficult disease. OBJECTIVES: To assess the effect of chemotherapy, radiotherapy or both for first-line treatment of advanced pancreatic cancer...
March 20, 2018: Cochrane Database of Systematic Reviews
F Willeboordse, F G Schellevis, M C Meulendijk, J G Hugtenburg, P J M Elders
Background Implementation of clinical medication reviews in daily practice is scarcely evaluated. The Opti-Med intervention applied a structured approach with external expert teams (pharmacist and physician) to conduct medication reviews. The intervention was effective with respect to resolving drug related problems, but did not improve quality of life. Objective The objective of this process evaluation was to gain more insight into the implementation fidelity of the intervention. Setting Process evaluation alongside a cluster randomized trial in 22 general practices and 518 patients of 65 years and over...
March 20, 2018: International Journal of Clinical Pharmacy
Ioannis N Mammas, Demetrios A Spandidos
According to Professor Basil T. Darras, Professor of Neurology (Pediatrics) at Harvard Medical School and Director of the Spinal Muscular Atrophy (SMA) Program at Boston Children's Hospital in Boston (MA, USA), the diagnosis of SMA type I is clinical and is based on detailed general physical and neurological examinations. SMA type I remains the most common genetic disease resulting in death in infancy and is really devastating for the child, the parents, as well as the medical professionals with the privilege of caring for patients with SMA and their parents...
April 2018: Experimental and Therapeutic Medicine
Sarina R Isenberg, Norah L Crossnohere, Manali I Patel, Alison Conca-Cheng, John F P Bridges, Sandy M Swoboda, Thomas J Smith, Timothy M Pawlik, Matthew Weiss, Angelo E Volandes, Anne Schuster, Judith A Miller, Carolyn Pastorini, Debra L Roter, Rebecca A Aslakson
OBJECTIVE: Video-based advanc care planning (ACP) tools have been studied in varied medical contexts; however, none have been developed for patients undergoing major surgery. Using a patient- and family-centredness approach, our objective was to implement human-centred design (HCD) to develop an ACP decision support video for patients and their family members when preparing for major surgery. DESIGN AND METHODS: The study investigators partnered with surgical patients and their family members, surgeons and other health professionals to design an ACP decision support video using key HCD principles...
March 18, 2018: BMJ Supportive & Palliative Care
Elizabeth A Lakota, Voon Ong, Shawn Flanagan, Christopher M Rubino
Rezafungin (CD101) is a novel echinocandin antifungal agent currently in clinical development for the treatment of candidemia and invasive candidiasis. Rezafungin has potent in vitro activity against Candida albicans and Candida glabrata , including azole- and echinocandin-resistant isolates. The objective of this analysis was to develop a population pharmacokinetic (PK) model to characterize the disposition of rezafungin in plasma following intravenous (IV) administration. Data from two Phase 1 studies, a single-ascending-dose study and a multiple-ascending-dose study, were available...
March 19, 2018: Antimicrobial Agents and Chemotherapy
Jemma L Walker, Nick J Andrews, Gayatri Amirthalingam, Harriet Forbes, Sinead M Langan, Sara L Thomas
BACKGROUND: Vaccination against herpes zoster was introduced in the United Kingdom in 2013 for individuals aged 70 years, with a phased catch-up campaign for 71-79 year olds. Vaccine introduction has resulted in a marked fall in incident herpes zoster and in post-herpetic neuralgia (PHN), but formal evaluation of vaccine effectiveness is needed. METHODS: In a population-based cohort study of older individuals born between 1933 and 1946, we used linked UK anonymised primary care health records for the first three years of the vaccination programme (01/09/2013-31/08/2016) and multivariable Poisson regression to obtain incidence rates and vaccine effectiveness (VE) against zoster and PHN...
March 16, 2018: Vaccine
Vivian Isaac, Sabrina Winona Pit, Craig S McLachlan
BACKGROUND: Social isolation in medical students is a subjective experience that may influence medical career decision making. Rural self-efficacy has been shown to influence rural career intentions following a rural clinical placement, however its impact on social isolation during a rural clinical placement has not been previously modeled. The objective of this study is to explore whether self-perception of social isolation is associated with rural career intent in rural medical students...
March 20, 2018: BMC Medical Education
Julie A Lynch, Brygida Berse, Merry Rabb, Paul Mosquin, Rob Chew, Suzanne L West, Nicole Coomer, Daniel Becker, John Kautter
BACKGROUND: Tumor testing for mutations in the epidermal growth factor receptor (EGFR) gene is indicated for all newly diagnosed, metastatic lung cancer patients, who may be candidates for first-line treatment with an EGFR tyrosine kinase inhibitor. Few studies have analyzed population-level testing. METHODS: We identified clinical, demographic, and regional predictors of EGFR & KRAS testing among Medicare beneficiaries with a new diagnosis of lung cancer in 2011-2013 claims...
March 20, 2018: BMC Cancer
Andrew J Vonasch, Roy F Baumeister, Alfred R Mele
Four experiments supported the hypothesis that ordinary people understand free will as meaning unconstrained choice, not having a soul. People consistently rated free will as being high unless reduced by internal constraints (i.e., things that impaired people's mental abilities to make choices) or external constraints (i.e., situations that hampered people's abilities to choose and act as they desired). Scientific paradigms that have been argued to disprove free will were seen as reducing, but usually not eliminating free will, and the reductions were because of constrained conscious choice...
March 16, 2018: Consciousness and Cognition
João Castelhano, Paula Tavares, Susana Mouga, Guiomar Oliveira, Miguel Castelo-Branco
OBJECTIVE: Electroencephalographic biomarkers have been widely investigated in autism, in the search for diagnostic, prognostic and therapeutic outcome measures. Here we took advantage of the information available in temporal oscillatory patterns evoked by simple perceptual decisions to investigate whether stimulus dependent oscillatory signatures can be used as potential biomarkers in autism spectrum disorder (ASD). METHODS: We studied an extensive set of stimuli (9 categories of faces) and performed data driven classification (Support vector machine, SVM) of ASD vs...
February 20, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Rainey Banick Wood
During prenatal care and postpartum hospitalization, nurses have an important role in assisting new mothers to make informed decisions about feeding their newborn infants. There is overwhelming evidence that breastfeeding is beneficial for most new mothers and babies; therefore, perinatal nurses encourage breastfeeding. Newborn infant feeding conversations with women who have chosen to formula feed may be complicated and may cause tension in the nurse-patient relationship. Despite this po tential difficulty, these conversations are essential to establish a feeding plan for the newborn infant and to promote healthy outcomes for mothers and babies...
March 16, 2018: MCN. the American Journal of Maternal Child Nursing
Modupe Akinola, Elizabeth Page-Gould, Pranjal H Mehta, Zaijia Liu
Prior research has found inconsistent effects of diversity on group performance. The present research identifies hormonal factors as a critical moderator of the diversity-performance connection. Integrating the diversity, status, and hormone literatures, we predicted that groups collectively low in testosterone, which orients individuals less toward status competitions and more toward cooperation, would excel with greater group diversity. In contrast, groups collectively high in testosterone, which is associated with a heightened status drive, would be derailed by diversity...
March 1, 2018: Psychological Science
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