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decision training

Duy Dao, S M A Salehizadeh, Yeon Noj, Jo Woon Chong, Chae Cho, Dave Mcmanus, Chad E Darling, Yitzhak Mendelson, Ki H Chon
Motion and noise artifacts (MNAs) impose limits on the usability of the photoplethysmogram (PPG), particularly in the context of ambulatory monitoring. MNAs can distort PPG, causing erroneous estimation of physiological parameters such as heart rate (HR) and arterial oxygen saturation (SpO2). In this study we present a novel approach, "TifMA," based on using the Time-frequency spectrum of PPG to first detect the MNA-corrupted data and next discard the non-usable part of the corrupted data. The term "non-usable" refers to segments of PPG data from which the HR signal cannot be recovered accurately...
October 21, 2016: IEEE Journal of Biomedical and Health Informatics
Noam Segev, Maayan Harel, Shie Mannor, Koby Crammer, Ran El-Yaniv
We propose novel model transfer-learning methods that refine a decision forest model M learned within a "source" domain using a training set sampled from a "target" domain, assumed to be a variation of the source. We present two random forest transfer algorithms. The first algorithm searches greedily for locally optimal modifications of each tree structure by trying to locally expand or reduce the tree around individual nodes. The second algorithm does not modify structure, but only the parameter (thresholds) associated with decision nodes...
October 18, 2016: IEEE Transactions on Pattern Analysis and Machine Intelligence
Jairo N Fuertes, Arielle Toporovsky, Mariela Reyes, Jennifer Bennett Osborne
OBJECTIVE: This article discusses the physician-patient working alliance and reviews the empirical research that has been generated on the working alliance to date. METHODS: The paper presents a brief history of the study of the physician-patient relationship, and discusses constructs that have examined aspects of the relationship, such as empathy, trust, and shared decision-making. Lastly, a meta-analysis was conducted based on the seven empirical studies (a total N of 1023 patients) that have examined the physician-patient working alliance...
October 19, 2016: Patient Education and Counseling
Michael J Ellis, Lesley J Ritchie, Patrick J McDonald, Dean Cordingley, Karen Reimer, Satnam Nijjar, Mark Koltek, Shahid Hosain, Janine Johnston, Behzad Mansouri, Scott Sawyer, Norm Silver, Richard Girardin, Shannon Larkins, Sara Vis, Erin Selci, Michael Davidson, Scott Gregoire, Angela Sam, Brian Black, Martin Bunge, Marco Essig, Peter MacDonald, Jeff Leiter, Kelly Russell
OBJECTIVES: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. METHODS: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015...
October 24, 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Ranmalee Eramudugolla, Jasmine Price, Sidhant Chopra, Xiaolan Li, Kaarin J Anstey
OBJECTIVES: To design a low-cost simulator-based driving assessment for older adults and to compare its validity with that of an on-road driving assessment and other measures of older driver risk. DESIGN: Cross-sectional observational study. SETTING: Canberra, Australia. PARTICIPANTS: Older adult drivers (N = 47; aged 65-88, mean age 75.2). MEASUREMENTS: Error rate on a simulated drive with environment and scoring procedure matched to those of an on-road test...
October 22, 2016: Journal of the American Geriatrics Society
Parker Magin, Rebecca Stewart, Allison Turnock, Amanda Tapley, Elizabeth Holliday, Nick Cooling
Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation...
October 21, 2016: Advances in Health Sciences Education: Theory and Practice
Erin Traister, Kim L Larson, Dell Hagwood
PURPOSE: We sought to understand decision making, family involvement, and cultural factors that influence palliative care for Guatemalans. DESIGN: A qualitative descriptive study was conducted in Guatemala to explore palliative care experiences among seven participants. FINDINGS: The overarching theme was Relief from Suffering, reinforced by three support systems: the family, community rezadora, and priest. The family made decisions and provided physical care...
October 21, 2016: Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society
Charles Kaboré, Valéry Ridde, Séni Kouanda, Ludovic Queuille, Paul-André Somé, Isabelle Agier, Alexandre Dumont
BACKGROUND: Since 2006, Burkina Faso has subsidized the cost of caesarean sections to increase their accessibility. Caesareans are performed by obstetricians, general practitioners, and nurses trained in emergency surgery. While the national caesarean rate is still too low (only 2 % in 2010), 12 to 24 % of caesareans performed in hospital are, in fact, not medically indicated. The objective of this study is to evaluate the effectiveness and analyze the implementation of a multi-faceted intervention to lower the rate of non-medically indicated caesareans in Burkina Faso...
October 21, 2016: BMC Pregnancy and Childbirth
Joseph K Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
November 2016: Journal of Trauma and Acute Care Surgery
Donald J Viglione, Gregory J Meyer, Ana Cristina Resende, Claudia Pignolo
Learning to code the imagery, communication, and behavior associated with Rorschach responding is challenging. Although there is some survey research on graduate students' impressions of their Rorschach training, research has not identified which coding decisions students find to be the most problematic and time-consuming. We surveyed students to identify what they struggled with most when learning coding and to quantify how difficult it is to learn how to code. Participants (n = 191) from the United States, Brazil, Denmark, Israel, and Italy rated 57 aspects of coding using a 4-point scale that encompassed both the time required to code and the subjective difficulty of doing so...
October 21, 2016: Journal of Personality Assessment
Benjamin B Massenburg, Hillary E Jenny, Saurabh Saluja, John G Meara, Mark G Shrime, Nivaldo Alonso
BACKGROUND: Cleft lip and/or palate (CLP) is estimated to occur in 1 out of every 700 births, but for many people residing in low- and middle-income countries this deformity may be repaired late in life or not at all. This study aims to analyze worldwide provider-perceived barriers to the surgical repair of CLP in low- and middle-income countries. METHODS: From 2011 to 2014, Smile Train distributed a multiple-choice, voluntary survey to healthcare providers to identify areas of need in CLP care worldwide...
October 2016: Journal of Craniofacial Surgery
Catherine de Blacam, Sean Tierney, Odhran Shelley
BACKGROUND: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity...
October 20, 2016: Journal of Plastic Surgery and Hand Surgery
Amy Blake, Bryan T Carroll
OBJECTIVE: This paper analyses how game theory can provide a framework for understanding the strategic decision-making that occurs in everyday scenarios in medical training and practice, and ultimately serves as a tool for improving the work environment and patient care. Game theory has been applied to a variety of fields outside of its native economics, but has not been thoroughly studied in the context of health care provision. METHODS: The paper discusses four of the most common 'games' and applies each to a scenario in medicine to provide new insight on the incentives and drivers for certain types of behaviour and a deeper understanding of why certain results are valued more strongly than others...
November 2016: Medical Education
(no author information available yet)
Purpose: Radiology represents a highly relevant part of undergraduate medical education from preclinical studies to subinternship training. It is therefore important to establish a content base for teaching radiology in German Medical Faculties. Materials and Methods: The German Society of Radiology (DRG) developed a model curriculum for radiological teaching at German medical universities, which is presented in this article. There is also a European model curriculum for undergraduate teaching (U-level curriculum of the European Society of Radiology)...
November 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Lu Chen, Courtney A Kurtyka, Eric A Welsh, Jason I Rivera, Brienne E Engel, Teresita Muñoz-Antonia, Sean J Yoder, Steven A Eschrich, Ben C Creelan, Alberto A Chiappori, Jhanelle E Gray, Jose Luis Ramirez, Rafael Rosell, Matthew B Schabath, Eric B Haura, Dung-Tsa Chen, W Douglas Cress
Clinicians routinely prescribe adjuvant chemotherapy (ACT) for resected non-small cell lung cancer patients. However, ACT only improves five-year disease-free survival in stage I-III non-small cell lung cancer by 5-15%, with most patients deriving no benefit. Herein, deregulation of the E2F pathway was explored as a biomarker in lung adenocarcinoma patients. An E2F pathway scoring system, based on 74 E2F-regulated genes, was trained for RNA from two platforms: fresh-frozen (FF) or formalin-fixed paraffin-embedded (FFPE) tissues...
October 14, 2016: Oncotarget
Ghasem-Sam Toloo, Peter Aitken, Julia Crilly, Gerry FitzGerald
BACKGROUND: Patients attending hospital emergency departments (ED) commonly cite the urgency and severity of their condition as the main reason for choosing the ED. However, the patients' perception of urgency and severity may be different to the nurses' perception of their urgency and severity, which is underpinned by their professional experience, knowledge, training and skills. This discordance may be a cause of patient dissatisfaction. The purpose of this study is to understand the extent of agreement/disagreement between the patient's perceived priority and actual triage category and associated factors...
October 18, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Erin L Abner, Pamela B Teaster, Marta S Mendiondo, Holly Ramsey-Klawsnik, Jennifer L Marcum, Tim N Crawford, Tenzin Wangmo
The purpose of this study was to identify characteristics of investigations of sexual abuse concerning vulnerable adults residing in facility settings that were associated with case substantiation. Data on 410 reports of sexual abuse were collected prospectively from Adult Protective Services (APS) and state licensure agency staff in New Hampshire, Oregon, Tennessee, Texas, and Wisconsin over a six-month period. Specifically, we examined differences between reports that were substantiated and those that were not by comparing characteristics of alleged victims, alleged perpetrators, and aspects of investigation using logistic regression...
October 17, 2016: Journal of Interpersonal Violence
Karin Pukk Härenstam, Drew Gaffney
Most safety-critical enterprises have programs for teaching and training non-technical skills to their employees. These skills must complement pure technical skills. Programs for teaching and introducing these skills (communication, leadership, teamwork, decision-making, handling of conflicts and feed-back) are developing also in health-care. It is important that non-technical skills in combination with technical skills are seen as the foundation when developing new and safer ways to do the daily work with patients...
October 17, 2016: Läkartidningen
Peter Szasz, Esther M Bonrath, Marisa Louridas, Andras B Fecso, Brett Howe, Adam Fehr, Michael Ott, Lloyd A Mack, Kenneth A Harris, Teodor P Grantcharov
OBJECTIVES: The objectives of this study were to (1) create a technical and nontechnical performance standard for the laparoscopic cholecystectomy, (2) assess the classification accuracy and (3) credibility of these standards, (4) determine a trainees' ability to meet both standards concurrently, and (5) delineate factors that predict standard acquisition. BACKGROUND: Scores on performance assessments are difficult to interpret in the absence of established standards...
July 28, 2016: Annals of Surgery
Todd P Chang, Sheree M Schrager, Alyssa J Rake, Michael W Chan, Phung K Pham, Grant Christman
Multimedia in assessing clinical decision-making skills (CDMS) has been poorly studied, particularly in comparison to traditional text-based assessments. The literature suggests multimedia is more difficult for trainees. We hypothesize that pediatric residents score lower in diagnostic skill when clinical vignettes use multimedia rather than text for patient findings. A standardized method was developed to write text-based questions from 60 high-resolution, quality multimedia; a series of expert panels selected 40 questions with both a multimedia and text-based counterpart, and two online tests were developed...
October 17, 2016: Advances in Health Sciences Education: Theory and Practice
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