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Medical 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/28449291/consumer-and-carer-perspectives-in-the-development-of-a-mental-health-research-treatment-and-teaching-facility-a-thematic-analysis
#2
M Katsikitis, B R Lane, I Ozols, D Statham
INTRODUCTION: Recovery-oriented mental health policies recognise consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. AIM: This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment, and teaching facility in their region. METHODS: Two 2 hr focus groups were conducted, with separate groups held for mental health consumers (n = 9) and carers (n = 9) respectively...
April 27, 2017: Journal of Psychiatric and Mental Health Nursing
https://www.readbyqxmd.com/read/28448488/the-potential-economic-burden-of-zika-in-the-continental-united-states
#3
Bruce Y Lee, Jorge A Alfaro-Murillo, Alyssa S Parpia, Lindsey Asti, Patrick T Wedlock, Peter J Hotez, Alison P Galvani
BACKGROUND: As the Zika virus epidemic continues to spread internationally, countries such as the United States must determine how much to invest in prevention, control, and response. Fundamental to these decisions is quantifying the potential economic burden of Zika under different scenarios. METHODOLOGY/PRINCIPLE FINDINGS: To inform such decision making, our team developed a computational model to forecast the potential economic burden of Zika across six states in the US (Alabama, Florida, Georgia, Louisiana, Mississippi, and Texas) which are at greatest risk of Zika emergence, under a wide range of attack rates, scenarios and circumstances...
April 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28447933/acute-decompensated-heart-failure-new-strategies-for-improving-outcomes
#4
Emily Singer Fisher, Boyd Burns
Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients...
May 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28447421/clinical-decision-support-for-hematology-laboratory-test-utilization
#5
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/28446422/web-based-medical-appointment-systems-a-systematic-review
#6
Peng Zhao, Illhoi Yoo, Jaie Lavoie, Beau James Lavoie, Eduardo Simoes
BACKGROUND: Health care is changing with a new emphasis on patient-centeredness. Fundamental to this transformation is the increasing recognition of patients' role in health care delivery and design. Medical appointment scheduling, as the starting point of most non-urgent health care services, is undergoing major developments to support active involvement of patients. By using the Internet as a medium, patients are given more freedom in decision making about their preferences for the appointments and have improved access...
April 26, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28445219/canadian-national-guidelines-and-recommendations-for-integrating-career-advising-into-medical-school-curricula
#7
Kelly Howse, June Harris, Nancy Dalgarno
Career planning, decision making about specialty choice, and preparation for residency matching are significant sources of stress for medical students. Attempts have been made to structure and formalize career advising by including it in accreditation standards. There is an expressed need for national guidelines on career advising for medical students. The Future of Medical Education in Canada Postgraduate (FMEC PG) Implementation Project was created to ensure Canadian medical trainees receive the best education possible...
April 25, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28445100/remap-a-framework-for-goals-of-care-conversations
#8
Julie W Childers, Anthony L Back, James A Tulsky, Robert M Arnold
Conversations regarding goals of care with patients who have advanced cancer still occur too late, and oncologists say they lack the training to have these conversations effectively. Experts recommend a number of strategies when having these discussions, including discussing prognosis, responding to patient emotion, exploring values, and often making a recommendation for medical treatments that fit those values. To help learners, from residents to attending oncologists, learn these complex conversational skills, we have developed a framework with a mnemonic, REMAP: Reframe, Expect emotion, Map out patient goals, Align with goals, and Propose a plan...
April 26, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28444218/current-dilemmas-in-defining-the-boundaries-of-disease
#9
Jenny Doust, Mary Jean Walker, Wendy A Rogers
Boorse's biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, and is out of step with medical processes for identifying disease boundaries...
April 21, 2017: Journal of Medicine and Philosophy
https://www.readbyqxmd.com/read/28444071/reducing-pressure-ulcers-in-patients-with-prolonged-acute-mechanical-ventilation-a-quasi-experimental-study
#10
Cecilia Inés Loudet, María Cecilia Marchena, María Roxana Maradeo, Silvia Laura Fernández, María Victoria Romero, Graciela Esther Valenzuela, Isabel Eustaquia Herrera, Martha Teresa Ramírez, Silvia Rojas Palomino, Mariana Virginia Teberobsky, Leandro Ismael Tumino, Ana Laura González, Rosa Reina, Elisa Estenssoro
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle"...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28443139/maximal-testosterone-suppression-in-the-management-of-recurrent-and-metastatic-prostate-cancer
#11
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/28442189/exploring-how-residents-who-partially-participate-in-family-planning-training-determine-their-level-of-participation
#12
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
https://www.readbyqxmd.com/read/28441667/significance-of-user-participation-in-a-hospital-information-system-success-insights-from-a-case-study
#13
Naveed Saleem, Douglas Steel, Gokhan Gercek, Ashish Chandra
User participation in the development of a system is universally prescribed as an effective strategy to ensure the success of the resultant system. However, the existing literature on the merits of user participation only provides equivocal evidence. Various analyses of this literature point out that this equivocal evidence may be due to inconsistent operational measures of the user participation and system success constructs. Planned organizational change and participative decision making, the underlying paradigms of user participation construct, suggest that the development of some information systems may require blending of users' system-related functional expertise and developers' technical expertise to ensure system success...
April 2017: Health Care Manager
https://www.readbyqxmd.com/read/28441096/judicial-decision-making-and-juvenile-offenders-effects-of-medical-evidence-and-victim-age
#14
John Michael Falligant, Rebecca L Fix, Apryl A Alexander
A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse...
April 25, 2017: Journal of Child Sexual Abuse
https://www.readbyqxmd.com/read/28440718/problematizing-the-concept-of-the-borderline-group-in-performance-assessments
#15
Matt Homer, Godfrey Pell, Richard Fuller
INTRODUCTION: Many standard setting procedures focus on the performance of the "borderline" group, defined through expert judgments by assessors. In performance assessments such as Objective Structured Clinical Examinations (OSCEs), these judgments usually apply at the station level. METHODS AND RESULTS: Using largely descriptive approaches, we analyze the assessment profile of OSCE candidates at the end of a five year undergraduate medical degree program to investigate the consistency of the borderline group across stations...
May 2017: Medical Teacher
https://www.readbyqxmd.com/read/28439664/women-at-familial-risk-of-breast-cancer-electing-for-prophylactic-mastectomy-frequencies-procedures-and-decision-making-characteristics
#16
Sarah Schott, Lisa Vetter, Monika Keller, Thomas Bruckner, Michael Golatta, Sabine Eismann, Nicola Dikow, Christina Evers, Christof Sohn, Joerg Heil
BACKGROUND: Some women of families at high risk of breast cancer (BC) choose prophylactic mastectomy (PM) in spite of ambiguous evidence for survival benefits. The aim of this study was to investigate counselees' characteristics, decisions on PM, and frequencies of different procedures to better understand how to tailor interventions. PATIENTS AND METHODS: Eight hundred and forty-nine counselees who attended interdisciplinary consultation for genetic risk adjustment at the University Hospital Heidelberg between July 2009 and July 2011 received a tripartite questionnaire addressing sociodemographic characteristics, psychological parameters, behavioural questions, and medical data...
April 24, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28439398/a-practical-approach-to-the-pharmacological-management-of-hypertension-in-older-people
#17
REVIEW
Nikesh Parekh, Amy Page, Khalid Ali, Kevin Davies, Chakravarthi Rajkumar
Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing...
April 2017: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/28439359/education-in-neurology-resident-documentation-using-payroll-simulation
#18
John W Liang, Vicki L Shanker
BACKGROUND: Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. OBJECTIVE: To improve the quality of neurology resident documentation through payroll simulation. METHODS: A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28439218/pediatric-reference-intervals-for-biochemical-markers-gaps-and-challenges-recent-national-initiatives-and-future-perspectives
#19
Houman Tahmasebi, Victoria Higgins, Angela W S Fung, Dorothy Truong, Nicole M A White-Al Habeeb, Khosrow Adeli
Reference intervals provide valuable information to medical practitioners in their interpretation of quantitative laboratory test results, and are critical in the assessment of patient health and in clinical decision-making. The reference interval serves as a health-associated benchmark with which to compare an individual test result. While the concept of reference intervals and their utility appear straightforward, the process of establishing accurate and reliable reference intervals is considerably complex and involved...
March 2017: EJIFCC
https://www.readbyqxmd.com/read/28437620/american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-guidelines-for-management-of-dyslipidemia-and-prevention-of-cardiovascular-disease
#20
Paul S Jellinger, Yehuda Handelsman, Paul D Rosenblit, Zachary T Bloomgarden, Vivian A Fonseca, Alan J Garber, George Grunberger, Chris K Guerin, David S H Bell, Jeffrey I Mechanick, Rachel Pessah-Pollack, Kathleen Wyne, Donald Smith, Eliot A Brinton, Sergio Fazio, Michael Davidson
OBJECTIVE: The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols...
April 2017: Endocrine Practice
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