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Decision aids

Barbara J Howard, Raymond Sturner
Purpose of review: To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Recent findings: Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening...
December 2017: Current Developmental Disorders Reports
Tyler P Robin, Timothy S Sannes, Feng-Ming Spring Kong, Francoise Mornex, Fred R Hirsch, Chad G Rusthoven, Laurie E Gaspar
INTRODUCTION: Guidelines have recommended prophylactic cranial irradiation (PCI) for patients with limited-stage small-cell lung cancer with at least a partial response after thoracic chemoradiation. However, the survival advantage has been small and was observed in an era before magnetic resonance imaging and surveillance. Neurotoxicity also remains a concern, especially in older adults. Thus, patients have a complex value-laden decision to make. We sought to better understand the role physicians play in patient decision making and introduce a patient decision aid (PDA) to potentially facilitate these discussions...
February 17, 2018: Clinical Lung Cancer
Kimberley Lau, Joseph Wilkinson, Ram Moorthy
OBJECTIVE: Following the announcement of the NHS Cancer Plan in 2000, anyone suspected of having cancer has to be seen by a specialist within two weeks of referral. Since this introduction, studies have shown that only 6.3-14.6% of 2-week referrals were diagnosed with a head and neck cancer and that majority of the cancer diagnoses were via other referral routes. These studies suggest that the referral scheme is not currently cost effective. Our aim is to develop a scoring system that determines the risk of head and neck cancer in a patient, which can then be used to aid GP referrals...
March 15, 2018: Clinical Otolaryngology
Robert A Bailey, Alicia C Shillington, Qing Harshaw, Martha M Funnell, Jeffrey VanWingen, Nananda Col
INTRODUCTION: Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. METHODS: Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options...
March 13, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Jasper Littmann, Alena Buyx
Antibiotics resistance presents one of the major challenges for health care in the twenty-first century. This paper examines the ethical problems that arise as a result of antibiotic resistance. Two main categories of ethical problems in infectious disease control are distinguished: those that are exacerbated by antibiotics resistance, and those that are a direct result of antibiotics resistance. The second category, which is considered in greater detail in this paper, includes, among others, issues of fair distribution of effective antibiotics, if they are considered a scarce resource...
March 13, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Vanessa Chenel, W Ben Mortenson, Manon Guay, Jeffrey William Jutai, Claudine Auger
In order to promote self-determination, patients have to be actively involved with their care providers in health-care decision making, especially when such decisions involve personal preferences. Decision aids (DAs) are tools that can contribute to patient-centered decision-making processes. To benefit from previous fieldwork and avoid duplicating developmental efforts and producing many similar DAs, the adaptation of existing DAs to new cultural contexts is a resource-saving option. However, there are no guidelines on how to culturally adapt and validate DAs...
2018: Patient Preference and Adherence
M Palova, T Szotkowski, A Hlusi, K Indrak, J Navratilova, M Divoka, T Papajik
Primary myelofibrosis (PMF) is a chronic clonal myeloid disorder. Together with essential thrombocythemia (ET) and polycythemia vera (PV), it belongs to a group of Philadelphia chromosome-negative myeloproliferative neoplasms. An integral part of laboratory tests carried out in this disease group is detecting the presence of mutations in the Janus kinase 2 gene at position 617 (JAK2 V617F) and in the gene encoding for the receptor for thrombopoietin (myeloproliferative leukemia virus oncogene, MPL) found in approximately 60% of PMF patients...
2018: Neoplasma
(no author information available yet)
Tetanus is an acute specific infection caused by obligate anaerobes, which is still a serious public health problem. Tetanus bacterium is an obligate anaerobic bacterium, widely distributed in nature, which can exist in dust, soil, human or animal excrement. The bacteria invade the body primarily through the skin or mucosal wounds, and most commonly in trauma and burn patients, unclean newborns, and unsafe surgical instruments. Exotoxin produced by tetanus bacteria can cause temporary changes in the central nervous system, manifested as systemic skeletal muscle persistence and paroxysmal spasm, severe cases of laryngospasm, asphyxia, lung infections and organ failure, which is a very serious and potentially fatal disease...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
David P Miller, Nancy Denizard-Thompson, Kathryn E Weaver, L Doug Case, Jennifer L Troyer, John G Spangler, Donna Lawler, Michael P Pignone
Background: Screening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened. Objective: To examine the effect of a digital health intervention, Mobile Patient Technology for Health-CRC (mPATH-CRC), on rates of CRC screening. Design: Randomized clinical trial. ( NCT02088333). Setting: 6 community-based primary care practices. Participants: 450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening...
March 13, 2018: Annals of Internal Medicine
Rita Azevedo, Janine Soares, Andreia Peixoto, Sofia Cotton, Luís Lima, Lúcio Lara Santos, José Alexandre Ferreira
CONTEXT: Circulating tumor cells (CTC) in peripheral blood of cancer patients provide an opportunity for real-time liquid biopsies capable of aiding early intervention, therapeutic decision, response to therapy, and prognostication. Nevertheless, the rare and potentially heterogeneous molecular nature of CTC has delayed the standardization of robust high-throughput capture/enrichment and characterization technologies. OBJECTIVE: This review aims to systematize emerging solutions for CTC analysis in bladder cancer (BC), their opportunities and limitations, while providing key insights on specific technologic aspects that may ultimately guide molecular studies and clinical implementation...
March 9, 2018: Urologic Oncology
Elaine J Lin, Shivani Reddy, Vidhi V Shah, Jashin J Wu
The use of biologic medications has represented a great advancement in the treatment of moderate to severe plaque psoriasis and has improved patients' quality of life. Despite the increasing popularity of biologics, their neurological side effects have been a constant concern. Reports of demyelinating diseases associated with tumor necrosis factor α (TNF-α) inhibitors continue to accumulate. Additionally, efalizumab was withdrawn from the market in 2009 for causing progressive multifocal leukoencephalopathy (PML)...
January 2018: Cutis; Cutaneous Medicine for the Practitioner
A-G E Ausseil, J R Dymond, L Newstrom
Honey bees require nectar and pollen from flowers: nectar for energy and pollen for growth. The demand for nectar and pollen varies during the year, with more pollen needed in spring for colony population growth, and more nectar needed in summer to sustain the maximum colony size and collect surplus nectar stores for winter. Sufficient bee forage is therefore necessary to ensure a healthy bee colony. Land-use changes can reduce the availability of floral resources suitable for bees, thereby increasing the susceptibility of bees to other stressors such as disease and pesticides...
March 12, 2018: Ecological Applications: a Publication of the Ecological Society of America
Mary E Cooley, Hermine Poghosyan, Kim Sprunck-Harrild, Jonathan P Winickoff, Stephen B Edge, Karen M Emmons
Cancer survivors are a rapidly growing population and an important target for tobacco treatment interventions. Continued smoking after the diagnosis of cancer is associated with a higher risk of cancer recurrence and mortality. Systematic tobacco cessation programs are effective. This study surveyed American College of Surgeons Commission on Cancer (CoC) programs in the Northeast region of the USA regarding their tobacco control programs. Seventy percent of cancer survivors are treated within CoC programs. The purpose of this study was to describe the extent of implementation of tobacco treatment and determine the organizational delivery of tobacco treatment as measured by the presence of goals to address smoking, leadership support, and integration of tobacco treatment guidelines into care delivery...
March 8, 2018: Translational Behavioral Medicine
Takashi Kuragaichi, Yuma Kurozumi, Shogo Ohishi, Yasuo Sugano, Akihiro Sakashita, Norihiko Kotooka, Makoto Suzuki, Taiki Higo, Dai Yumino, Yasuko Takada, Seiko Maeda, Saori Yamabe, Koichi Washida, Tomonori Takahashi, Tomohito Ohtani, Yasushi Sakata, Yukihito Sato
BACKGROUND: Palliative care for heart failure (HF) patients is recommended in Western guidelines, so this study aimed to clarify the current status of palliative care for HF patients in Japan.Methods and Results:A survey was sent to all Japanese Circulation Society-authorized cardiology training hospitals (n=1,004) in August 2016. A total of 544 institutions (54%) returned the questionnaire. Of them, 527 (98%) answered that palliative care is necessary for patients with HF. A total of 227 (42%) institutions held a palliative care conference for patients with HF, and 79% of the institutions had <10 cases per year...
March 10, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Mary M Mitchell, Eric D Hansen, Tuo-Yen Tseng, Meng Shen, Cynda Rushton, Tom Smith, Nancy Hutton, Jennifer Wolfe, Lee Bone, Jeanne Keruly, Lawrence Wissow, Amy R Knowlton
CONTEXT & OBJECTIVE: Advance care planning (ACP) rates remain low, especially among people who are HIV positive, disadvantaged, and African American. While ACP can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. METHODS: Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, MD, who had histories of illicit drug use...
March 8, 2018: Journal of Pain and Symptom Management
Swetha Narayanan, Bruce Blumberg, Marla L Clayman, Vivian Pan, Catherine Wicklund
Exome sequencing is a clinical diagnostic test offered primarily for children and adults with suspected genetic conditions. The purpose of this study was to explore issues related to exome sequencing in a reproductive clinical setting. This was a qualitative study using semi-structured interviews. Participants were professionals drawn from four key stakeholder groups-healthcare providers, laboratory/industry, ethics, and government. Transcribed interviews were analyzed for emergent themes. Most participants saw potential clinical utility in offering prenatal exome sequencing for diagnostic purposes as opposed to screening...
March 10, 2018: Journal of Genetic Counseling
Keamogetswe Molokoane-Mokgoro, Lara Nicole Goldstein, Mike Wells
INTRODUCTION: Ultrasound assessment of the inferior vena cava (IVC) has gained favour in aiding fluid management decisions for controlled, mechanically ventilated patients as well as in non-mechanically ventilated, spontaneously breathing patients. Its utility in spontaneously breathing patients during positive pressure non-invasive ventilation has not yet been determined. The use of the axillary vein, as an alternative option to the IVC due to its ease of accessibility and independence from intra-abdominal pressure, has also not been evaluated...
March 9, 2018: Emergency Medicine Journal: EMJ
Martijn H Hulsmans, Mark van Heijl, Roderick M Houwert, Bart J Burger, Egbert Jan M Verleisdonk, Dirk Jan Veeger, Olivier A van der Meijden
PURPOSE: Surgical treatment of displaced midshaft clavicle fractures requires a decision between plate fixation and intramedullary (IM) fixation. Numerous studies report on the biomechanical properties of various repair constructs. The goal of this systematic review was to provide an overview of studies describing the biomechanical properties of the most commonly used surgical fixations of midshaft clavicle fractures. Additionally, we aimed to translate these biomechanical results into clinically relevant conclusions...
February 21, 2018: Injury
Isabelle Scholl, Allison LaRussa, Pola Hahlweg, Sarah Kobrin, Glyn Elwyn
BACKGROUND: Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature...
March 9, 2018: Implementation Science: IS
Edmund R Hunt, Christopher Kendall, Emma Stanbury, Ana B Sendova-Franks, Nigel R Franks
Visual landmarks are important navigational aids to many animals, and when more than one is available their juxtaposition can convey valuable new information to a navigator about progress toward a goal, depending on the landmarks' comparative distinctiveness. We investigated the effect of presenting rock ant colonies (Temnothorax albipennis) with identical horizontal landmarks either side of their route, versus one horizontal landmark paired with a sloping landmark, as they navigated to a new nest site. Our findings suggest that ants can obtain more navigational information from a combination of dissimilar landmarks: the average tortuosity of the route taken between old and new nests was significantly lower when a horizontal landmark was paired with a monotonically downward sloping landmark (the paths were more direct)...
March 6, 2018: Behavioural Processes
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