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Clinical decision-making

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https://www.readbyqxmd.com/read/28449293/a-novel-approach-to-study-medical-decision-making-in-the-clinical-setting-the-own-point-of-view-perspective
#1
Thierry Pelaccia, Jacques Tardif, Emmanuel Triby, Bernard Charlin
BACKGROUND: Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision-making in an authentic setting are increasing significantly. They are based on the use of qualitative methods which are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording...
April 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28449244/indications-and-extent-of-central-neck-dissection-for-papillary-thyroid-cancer-an-american-head-and-neck-society-consensus-statement
#2
Nishant Agrawal, Maria R Evasovich, Emad Kandil, Salem I Noureldine, Erin A Felger, Ralph P Tufano, Dennis H Kraus, Lisa A Orloff, Raymon Grogan, Peter Angelos, Brendan C Stack, Bryan McIver, Gregory W Randolph
BACKGROUND: The primary purposes of this interdisciplinary consensus statement were to review the relevant indications for central neck dissection (CND) in patients with papillary thyroid cancer (PTC) and to outline the appropriate extent and relevant techniques required to accomplish a safe and effective CND. METHODS: A writing group convened by the American Head and Neck Society (AHNS) Endocrine Committee was tasked with identifying the important clinical elements to consider when managing the central neck compartment in patients with PTC based on available evidence in the literature, and the group's collective experience...
April 27, 2017: Head & Neck
https://www.readbyqxmd.com/read/28449093/opinions-of-lung-cancer-clinicians-on-shared-decision-making-in-early-stage-non-small-cell-lung-cancer%C3%A2
#3
Sahar Mokhles, Alex P W M Maat, Joachim G J V Aerts, Joost J M E Nuyttens, Ad J J C Bogers, Johanna J M Takkenberg
OBJECTIVES: To investigate the opinions of lung cancer clinicians concerning shared decision making (SDM) in early-stage non-small-cell lung cancer patients. METHODS: A survey was conducted among Dutch cardiothoracic surgeons and lung surgeons, pulmonologists and radiation oncologists. The opinions of clinicians on the involvement of patients in treatment decision making was assessed using a 1-5 Likert-type scale. Through open questions, we queried barriers to and drivers of SDM in clinical practice...
April 25, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28448482/diabetes-self-management-education-programs-in-nonmetropolitan-counties-united-states-2016
#4
Stephanie A Rutledge, Svetlana Masalovich, Rachel J Blacher, Magon M Saunders
PROBLEM/CONDITION: Diabetes self-management education (DSME) is a clinical practice intended to improve preventive practices and behaviors with a focus on decision-making, problem-solving, and self-care. The distribution and correlates of established DSME programs in nonmetropolitan counties across the United States have not been previously described, nor have the characteristics of the nonmetropolitan counties with DSME programs. REPORTING PERIOD: July 2016. DESCRIPTION OF SYSTEMS: DSME programs recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators (i...
April 28, 2017: MMWR. Surveillance Summaries: Morbidity and Mortality Weekly Report. Surveillance Summaries
https://www.readbyqxmd.com/read/28448428/therapeutic-ultrasound-in-navicular-stress-injuries-in-elite-track-and-field-athletes
#5
Nikolaos Malliaropoulos, Dimosthenis Alaseirlis, George Konstantinidis, Agapi Papalada, Ioannis Tsifountoudis, Kosmas Petras, Nicola Maffulli
OBJECTIVE: To ascertain whether therapeutic ultrasound (TUS) can be used to assess the progression of conservative management in navicular stress injuries. DESIGN: This is a prospective, clinical case series. Level of evidence IV. SETTING: All participants were examined and followed up in a private Sports Injury Clinic. PARTICIPANTS: Ten elite track and field athletes with severe dorsal midfoot pain over the navicular bone participated in this study...
May 2017: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
https://www.readbyqxmd.com/read/28448386/barriers-to-goal-concordant-care-for-older-patients-with-acute-surgical-illness-communication-patterns-extrinsic-to-decision-aids
#6
Lauren J Taylor, Sara K Johnson, Michael J Nabozny, Jennifer L Tucholka, Nicole M Steffens, Kristine L Kwekkeboom, Karen J Brasel, Toby C Campbell, Margaret L Schwarze
OBJECTIVE: We sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care. BACKGROUND: Decision aids are designed to facilitate difficult clinical decisions by providing better treatment information. However, these interventions may not be sufficient to effectively reveal patient values and promote preference-aligned decisions for seriously ill, older adults. METHODS: We conducted a secondary analysis of 31 decision-making conversations between surgeons and frail, older inpatients with acute surgical problems at a single tertiary care hospital...
April 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28447539/feasibility-of-preference-driven-radiotherapy-dose-treatment-planning-to-support-shared-decision-making-in-anal-cancer
#7
Heidi S Rønde, Leonard Wee, John Pløen, Ane L Appelt
PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multiple dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy...
April 27, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28447421/clinical-decision-support-for-hematology-laboratory-test-utilization
#8
REVIEW
R Jackups, J J Szymanski, S P Persaud
Clinical decision support (CDS) is the use of information and communication technologies to improve clinical decision making and patient care. CDS applications have been used in many aspects of health care, including medication ordering and diagnostic prediction algorithms. As economic and regulatory pressures place a strain on laboratory resources, the potential of CDS to improve utilization of laboratory testing has also begun to be realized. Hematology and coagulation laboratories stand to gain tremendously from the implementation of CDS interventions, given their mixture of high-volume, low-cost tests (eg CBC, PT, aPTT) and tests that carry a high potential of being misused or misinterpreted (eg lupus anticoagulant, erythrocyte sedimentation rate, heparin-induced thrombocytopenia testing)...
May 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28447000/8th-edition-ajcc-uicc-staging-of-cancers-of-the-esophagus-and-esophagogastric-junction-application-to-clinical-practice
#9
Thomas W Rice, Deepa T Patil, Eugene H Blackstone
The 8th edition of the American Joint Committee on Cancer (AJCC) staging of epithelial cancers of the esophagus and esophagogastric junction (EGJ) presents separate classifications for clinical (cTNM), pathologic (pTNM), and postneoadjuvant (ypTNM) stage groups. Histopathologic cell type markedly affects survival of clinically and pathologically staged patients, requiring separate groupings for each cell type, but ypTNM groupings are identical for both cell types. Clinical categories, typically obtained by imaging with minimal histologic information, are limited by resolution of each method...
March 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28446852/clinical-performance-of-emergency-surgical-officers-in-southern-ethiopia
#10
Abera A Gobeze, Zelalem Kebede, Yifru Berhan, Biku Ghosh
BACKGROUND: Serious shortage of gynecologists and surgeons for several decades leading to a three-year masters level training was initiated in 2009. However, systematic analysis was not done to assess the graduates' performance. The purpose of this study was to assess improvement in access to emergency surgical and obstetrical care services. METHODS: Both quantitative and qualitative methods were employed to assess the competence of emergency surgical officers (ESOs) in their decision making and surgical skills in eight hospitals between 2012 and 2014...
September 2016: Ethiopian Journal of Health Sciences
https://www.readbyqxmd.com/read/28446364/clinical-and-laboratory-diagnosis-of-heparin-induced-thrombocytopenia-an-update
#11
REVIEW
Emmanuel J Favaloro, Georgia McCaughan, Leonardo Pasalic
Heparin remains a commonly used anticoagulant in prophylaxis and treatment of venous and arterial thrombosis, in addition to ensuring patency of artificial blood circuits such as cardiopulmonary bypass (CPB). Heparin induced thrombocytopenia (HIT) is a rare but potentially fatal complication of heparin therapy that results from production of polyclonal antibodies to heparin in complex, usually with platelet factor 4 (PF4). In a proportion of patients, this causes platelet activation and thrombin generation, which may result in thrombosis...
April 23, 2017: Pathology
https://www.readbyqxmd.com/read/28446164/core-information-sets-for-informed-consent-to-surgical-interventions-baseline-information-of-importance-to-patients-and-clinicians
#12
Barry G Main, Angus G K McNair, Richard Huxtable, Jenny L Donovan, Steven J Thomas, Paul Kinnersley, Jane M Blazeby
BACKGROUND: Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient's values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient...
April 26, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28445256/cost-effectiveness-analysis-of-ultrasonography-screening-for-nonalcoholic-fatty-liver-disease-in-metabolic-syndrome-patients
#13
Pochamana Phisalprapa, Siripen Supakankunti, Phunchai Charatcharoenwitthaya, Piyaporn Apisarnthanarak, Aphinya Charoensak, Chaiwat Washirasaksiri, Weerachai Srivanichakorn, Nathorn Chaiyakunapruk
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) can be diagnosed early by noninvasive ultrasonography; however, the cost-effectiveness of ultrasonography screening with intensive weight reduction program in metabolic syndrome patients is not clear. This study aims to estimate economic and clinical outcomes of ultrasonography in Thailand. METHODS: Cost-effectiveness analysis used decision tree and Markov models to estimate lifetime costs and health benefits from societal perspective, based on a cohort of 509 metabolic syndrome patients in Thailand...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28445126/clinical-features-and-surgical-treatment-of-sacral-schwannomas
#14
Weibo Pan, Zhan Wang, Nong Lin, Xin Huang, Meng Liu, Xiaobo Yan, Zhaoming Ye
BACKGROUND: Sacral schwannoma is relatively rare and both the early diagnosis and appropriate treatment of sacral schwannomas are equally very challenging. METHODS: 11 sacral schwannoma cases operated at the Second Affiliated Hospital, School of Medicine, Zhejiang University, from 2012 to 2016, were investigated retrospectively and 10 were followed up. All patients were assessed with X-ray, CT and MRI, and underwent an intralesional excision. RESULTS: One patient was male, nine were female and the average age was 48 (ranging between 31 and 63)...
April 8, 2017: Oncotarget
https://www.readbyqxmd.com/read/28444715/can-a-patient-reported-outcome-be-adequate-without-assessing-quality-of-life-in-lower-urinary-tract-dysfunction
#15
REVIEW
Nikki Cotterill, Andrea Tubaro
AIMS AND METHODS: A think tank was convened at the sixth ICI-RS meeting held in the United Kingdom on September 2015, to consider the adequacy of patient reported outcome (PRO) measurement if quality of life (QoL) evaluation were excluded. Rigorous methodology is proposed for the development of PROs and much is written about this process but the necessity for QoL inclusion is rarely discussed. The decision was therefore taken to consider what QoL evaluation provides and what these data provide...
April 2017: Neurourology and Urodynamics
https://www.readbyqxmd.com/read/28443173/qualitative-grading-as-a-tool-in-the-management-of-multilevel-lumbar-spine-stenosis
#16
Shardul Madhav Soman, Jimmy Chokshi, Naitik Chhatrala, Gulam Haider Tharadara, Mukund Prabhakar
STUDY DESIGN: This is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS). PURPOSE: The aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS. OVERVIEW OF LITERATURE: LSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features...
April 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/28443139/maximal-testosterone-suppression-in-the-management-of-recurrent-and-metastatic-prostate-cancer
#17
REVIEW
Laurence Klotz, Rodney H Breau, Loretta L Collins, Martin E Gleave, Tom Pickles, Frederic Pouliot, Fred Saad
INTRODUCTION: Testosterone suppression, or androgen-deprivation therapy (ADT), is an established treatment for recurrent and metastatic prostate cancer (PCa). Based on the accuracy and sensitivity of early assays (c. 1960-1970), the castrate testosterone level was set at ≤1.7 nmol/l. Improved sensitivity of testosterone assays shows that both surgical and medical castration can achieve levels <0.7 nmol/l. However, the clinical implications and importance of maximum testosterone suppression remains a subject of controversy...
January 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28443058/predicting-outcome-12-months-after-mild-traumatic-brain-injury-in-patients-admitted-to-a-neurosurgery-service
#18
Torgeir Hellstrøm, Tobias Kaufmann, Nada Andelic, Helene L Soberg, Solrun Sigurdardottir, Eirik Helseth, Ole A Andreassen, Lars T Westlye
OBJECTIVE: Accurate outcome prediction models for patients with mild traumatic brain injury (MTBI) are key for prognostic assessment and clinical decision-making. Using multivariate machine learning, we tested the unique and added predictive value of (1) magnetic resonance imaging (MRI)-based brain morphometric and volumetric characterization at 4-week postinjury and (2) demographic, preinjury, injury-related, and postinjury variables on 12-month outcomes, including global functioning level, postconcussion symptoms, and mental health in patients with MTBI...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28442207/tibio-talo-calcaneal-fusion-after-limb-salvage-procedures-a-retrospective-study
#19
Lukas Zak, Gerald E Wozasek
BACKGROUND: The treatment of limb threatening trauma on the distal tibia or hindfoot often results in posttraumatic osteoarthritis requiring tibiotalocalcaneal (TTC) arthrodesis. The purpose of this study was to present a case series of patients undergoing various techniques of joint fusion after bone reconstruction and deformity correction as a salvage procedure. The study should help trauma surgeons making decisions in limb salvage and deformity correction in complex lower leg and foot injuries by presenting options and treatment strategies...
April 15, 2017: Injury
https://www.readbyqxmd.com/read/28442189/exploring-how-residents-who-partially-participate-in-family-planning-training-determine-their-level-of-participation
#20
Jema K Turk, Felisa Preskill, Alecia Fields, Uta Landy, Jody E Steinauer
OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) requires that obstetrics and gynecology residency programs provide access to abortion training, though residents may elect to opt out of participating due to religious or moral objections. While clinical benefits of partial participation have previously been explored, our study aimed to explore how residents navigate partial participation in abortion training and determine their limits. STUDY DESIGN: This study was qualitative in nature...
April 22, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
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