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Clinical decision-making

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https://www.readbyqxmd.com/read/29778017/the-preconception-care-experiences-of-women-with-epilepsy-on-sodium-valproate
#1
Lorna Lawther, Helen Dolk, Marlene Sinclair, Jim Morrow
PURPOSE: To understand the preconception experiences of women with epilepsy who have been taking the teratogenic drug valproate. METHODS: Seven women were recruited, three from a preconception clinic and four from an antenatal clinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinic encounters were observed and audio-recorded. Interviews with all women were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: Women experienced a "trajectory of balance"...
May 16, 2018: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29777966/determinants-of-choice-of-delivery-place-testing-rational-choice-theory-and-habitus-theory
#2
Anja Broda, Juliane Krüger, Stephanie Schinke, Andreas Weber
OBJECTIVE: The current study uses two antipodal social science theories, the rational choice theory and the habitus theory, and applies these to describe how women choose between intraclinical (i.e., hospital-run birth clinics) and extraclinical (i.e., midwife-led birth centres or home births) delivery places. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: Data were collected in a cross-sectional questionnaire-based survey among 189 women. A list of 22 determinants, conceptualized to capture the two theoretical concepts, were rated on a 7-point Likert scale with 1 = unimportant to 7 = very important...
May 7, 2018: Midwifery
https://www.readbyqxmd.com/read/29777648/reasons-for-discontinuation-of-implanon-among-users-in-buffalo-city-metropolitan-municipality-south-africa-a-cross-sectional-study
#3
Khungelwa Patricia Mrwebi, Daniel Ter Goon, Eyitayo Omolara Owolabi, Oladele Vincent Adeniyi, Eunice Seekoe, Anthony Idowu Ajayi
Early discontinuation of implanon, a long-acting, reversible contraceptive among reproductive age women in South Africa is a serious public health concern. The aim of this study was to examine the reasons for discontinuation of implanon among its previous users. This descriptive cross-sectional study involved 188 consecutively selected participants in two large family planning clinics in Buffalo Metropolitan Municipality, East London, South Africa. Descriptive statistics was conducted using SPSS version 22...
March 2018: African Journal of Reproductive Health
https://www.readbyqxmd.com/read/29777566/care-provider-allocation-on-admissions-to-acute-mental-health-wards-the-development-and-validation-of-the-admission-team-score-list
#4
Sjobha R N van den Berg, Barbara Stringer, Roland van de Sande, Stasja Draisma
Currently, support tools are lacking to prioritize steps in the care coordination process to enable safe practice and effective clinical pathways in the first phase of acute psychiatric admissions. This study describes the development, validity, and reliability of an acute care coordination support tool, the Admission Team Score List (ATSL). The ATSL assists in care provider allocation during admissions. Face validity and feasibility of the ATSL were tested in 77 acute admissions. Endscores of filled out ATSL's were translated to recommended team compositions...
May 18, 2018: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/29777464/the-key-features-approach-to-assess-clinical-decisions-validity-evidence-to-date
#5
REVIEW
G Bordage, G Page
The key-features (KFs) approach to assessment was initially proposed during the First Cambridge Conference on Medical Education in 1984 as a more efficient and effective means of assessing clinical decision-making skills. Over three decades later, we conducted a comprehensive, systematic review of the validity evidence gathered since then. The evidence was compiled according to the Standards for Educational and Psychological Testing's five sources of validity evidence, namely, Content, Response process, Internal structure, Relations to other variables, and Consequences, to which we added two other types related to Cost-feasibility and Acceptability...
May 17, 2018: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/29777418/earliest-radiological-progression-in-glioblastoma-by-multidisciplinary-consensus-review
#6
Roelant S Eijgelaar, Anna M E Bruynzeel, Frank J Lagerwaard, Domenique M J Müller, Freek R Teunissen, Frederik Barkhof, Marcel van Herk, Philip C De Witt Hamer, Marnix G Witte
BACKGROUND: Detection of glioblastoma progression is important for clinical decision-making on cessation or initiation of therapy, for enrollment in clinical trials, and for response measurement in time and location. The RANO-criteria are considered standard for the timing of progression. To evaluate local treatment, we aim to find the most accurate progression location. We determined the differences in progression free survival (PFS) and in tumor volumes at progression (Vprog) by three definitions of progression...
May 18, 2018: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29777334/patient-engagement-in-community-health-center-leadership-how-does-it-happen
#7
Anjana E Sharma, Beatrice Huang, Margae Knox, Rachel Willard-Grace, Michael B Potter
Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs...
May 18, 2018: Journal of Community Health
https://www.readbyqxmd.com/read/29777306/respiratory-manifestations-in-lps-responsive-beige-like-anchor-lrba-protein-deficient-patients
#8
Oded Shamriz, Bella Shadur, Adeeb NaserEddin, Irina Zaidman, Natalia Simanovsky, Orly Elpeleg, Eitan Kerem, Joel Reiter, Polina Stepensky
Lipopolysaccharide (LPS)-responsive beige-like anchor (LRBA) protein deficiency is a rare syndrome of primary immune deficiency and immune dysregulation. In this study, we sought to summarize our experience with respiratory manifestations in LRBA-deficient patients. We conducted a retrospective analysis of the medical records of LRBA-deficient patients treated at Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Data retrieved included pulmonary workup, disease course, treatment, and outcome. Ten patients were included...
May 18, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29777291/growth-of-asymptomatic-intracranial-fusiform-aneurysms-incidence-and-risk-factors
#9
Jusun Moon, Young Dae Cho, Dong Hyun Yoo, Jeongjun Lee, Hyun-Seung Kang, Won-Sang Cho, Jeong Eun Kim, Li Zhang, Moon Hee Han
PURPOSE: Growth of intracranial fusiform aneurysms (IFA) may become clinically problematic through a mass effect or rupture. We investigated the growth rate and factors contributing to growth in asymptomatic untreated IFA. METHOD: As a retrospective review, we assessed patients diagnosed with asymptomatic IFA between August 2000 and September 2014, all untreated. No acute or symptomatic dissecting lesions were considered. Clinical and serial angiographic follow-up data were analyzed, defining growth as expansion > 2 mm in one or more dimensions...
May 18, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29777106/clinical-prediction-models-to-support-the-diagnosis-of-asthma-in-primary-care-a-systematic-review-protocol
#10
L Daines, S McLean, A Buelo, S Lewis, A Sheikh, H Pinnock
Substantial over-diagnosis and under-diagnosis of asthma in adults and children has recently been reported. As asthma is mostly diagnosed in non-specialist settings, a clinical prediction model (CPM) to aid the diagnosis of asthma in primary care may help improve diagnostic accuracy. We aim to systematically identify, describe, compare, and synthesise existing CPMs designed to support the diagnosis of asthma in children and adults presenting with symptoms suggestive of the disease, in primary care settings or equivalent populations...
May 18, 2018: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/29776847/a-comparative-evaluation-of-spectrophotometric-intracutaneous-analysis-and-laser-doppler-imaging-in-the-assessment-of-adult-and-paediatric-burn-injuries
#11
Somy Charuvila, Masha Singh, Declan Collins, Isabel Jones
INTRODUCTION: Clinical assessment of mid-dermal burns can be challenging. Currently, laser Doppler imaging (LDI) is the gold standard adjunct in the assessment of burn injuries. Although LDI has demonstrated reliable accuracy, it poses various limitations in routine use including cost and ease of use. In comparison, spectrophotometric intracutaneous analysis (SIA) is a relatively cheaper technique, which can be carried out using a modified digital camera that enables easy image acquisition...
March 29, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29776669/-the-role-of-end-of-life-palliative-sedation-medical-and-ethical-aspects-review
#12
REVIEW
Miriam S Menezes, Maria das Graças Mota da Cruz de Assis Figueiredo
BACKGROUND AND OBJECTIVE: Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the issue regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas...
May 15, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29776007/development-and-psychometric-evaluation-of-the-swedish-propensity-to-achieve-healthy-lifestyle-scale-in-patients-with-hypertension
#13
Anders Broström, A H Pakpour, Martin Ulander, Per Nilsen
PURPOSE: To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension. DESIGN: Cross-sectional design. METHODS: A total of 270 consecutive patients with hypertension diagnosed at 4 primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29776002/the-chaos-of-hospitalisation-for-patients-with-critical-limb-ischaemia-approaching-major-amputation
#14
Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29775994/a-broader-understanding-of-care-managers-attitudes-of-advance-care-planning-a-concurrent-nested-design
#15
Julie Aultman, Kristin R Baughman, Ruth Ludwick
AIMS AND OBJECTIVES: To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP, and to identify nuances between quantitative and qualitative data. BACKGROUND: Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility, and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29775993/postnatal-psychosocial-assessment-and-clinical-decision-making-a-descriptive-study
#16
Deborah Sims, Cathrine Fowler
AIM: The aim of this study is to describe experienced child and family health nurses' clinical decision-making during a postnatal psychosocial assessment. BACKGROUND: Maternal emotional wellbeing in the postnatal year optimises parenting and promotes infant development. Psychosocial assessment potentially enables early intervention and reduces the risk of a mental disorder occurring during this time of change. Assessment accuracy, and the interventions used are determined by the standard of nursing decision-making...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29775736/surgical-consent-practice-in-the-uk-following-the-montgomery-ruling-a-national-cross-sectional-questionnaire-study
#17
Chris McKinnon, Dafydd Loughran, Roísín Finn, Madeline Coxwell-Matthewman, Deva Sanjeeva Jeyaretna, Adam P Williams
BACKGROUND: The Supreme Court case of Montgomery vs Lanarkshire Health Board in 2015 was a landmark case for consent practice in the UK which shifted focus from a traditional paternalistic model of consent towards a more patient-centered approach. Widely recognised as the most significant legal judgment on informed consent in the last 30 years, the case was predicted to have a major impact on the everyday practice of surgeons working in the UK National Health Service (NHS). Two years after the legal definition of informed consent was redefined, we carried out an audit of surgical consent practice across the UK to establish the impact of the Montgomery ruling on clinical practice...
May 15, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29775227/choosing-to-decline-finding-common-ground-through-the-perspective-of-shared-decision-making
#18
Michele Megregian, Marianne Nieuwenhuijze
Respectful communication is a key component of any clinical relationship. Shared decision making is the process of collaboration that occurs between a health care provider and patient in order to make health care decisions based upon the best available evidence and the individual's preferences. A midwife and woman (and her support persons) engage together to make health care decisions, using respectful communication that is based upon the best available evidence and the woman's preferences, values, and goals...
May 18, 2018: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29775203/optimal-two-stage-dynamic-treatment-regimes-from-a-classification-perspective-with-censored-survival-data
#19
Rebecca Hager, Anastasios A Tsiatis, Marie Davidian
Clinicians often make multiple treatment decisions at key points over the course of a patient's disease. A dynamic treatment regime is a sequence of decision rules, each mapping a patient's observed history to the set of available, feasible treatment options at each decision point, and thus formalizes this process. An optimal regime is one leading to the most beneficial outcome on average if used to select treatment for the patient population. We propose a method for estimation of an optimal regime involving two decision points when the outcome of interest is a censored survival time, which is based on maximizing a locally efficient, doubly robust, augmented inverse probability weighted estimator for average outcome over a class of regimes...
May 18, 2018: Biometrics
https://www.readbyqxmd.com/read/29774538/oral-propranolol-in-the-treatment-of-proliferating-infantile-haemangiomas-the-british-society-for-paediatric-dermatology-consensus-guidelines
#20
L Solman, M Glover, P E Beattie, H Buckley, S Clark, J E Gach, A Giardini, I Helbling, R J Hewitt, B Laguda, S M Langan, A E Martinez, R Murphy, L Proudfoot, J Ravenscroft, H Shahidullah, L Shaw, S B Syed, L Wells, C Flohr
BACKGROUND: Infantile haemangiomas (IH) are the most common vascular tumours of infancy. Despite their frequency and potential complications, there are currently no unified UK guidelines for the treatment of IH with propranolol. There are still uncertainties and diverse opinions regarding indications, pre-treatment investigations, its use in PHACES syndrome, and cessation of treatment. METHODS: This study used a modified Delphi technique, which involved an international treatment survey, a systematic evidence review of the literature, a face-to-face multidisciplinary panel meeting and anonymous voting...
May 17, 2018: British Journal of Dermatology
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