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Medical decision making

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https://www.readbyqxmd.com/read/29458074/subthalamic-nucleus-stimulation-dopaminergic-treatment-and-impulsivity-in-parkinson-s-disease
#1
Frédérique Fluchère, Borís Burle, Franck Vidal, Wery van den Wildenberg, Tatiana Witjas, Alexandre Eusebio, Jean-Philippe Azulay, Thierry Hasbroucq
BACKGROUND: Deep brain stimulation of the subthalamic nucleus (STN DBS) is known to increase response speed and lower response accuracy in Parkinson's disease (PD) patients. It has been proposed that this speed-accuracy tradeoff is due to enhanced sensitivity of the motor system to sensory information. An alternative possibility is that this effect is due to weakened suppressive processes. The two alternative interpretations can be tested by analyzing the electromyographic activity (EMG) of the response agonists when the patients perform conflict reaction time tasks...
February 16, 2018: Neuropsychologia
https://www.readbyqxmd.com/read/29457470/shared-decision-making-in-psychiatry-a-study-of-patient-attitudes
#2
Josie Nott, Aspen Mcintosh, Clare Taube, Mark Taylor
OBJECTIVES: Shared decision-making (SDM) is promoted as beneficial in mental healthcare, despite a dearth of supportive evidence. We aimed to obtain patients' perspective on SDM in a 'real world' hospital sample. METHODS: Structured validated questionnaires were used to examine SDM with regard to treatment choices, and whether SDM influences attitudes towards treatment. The Mini-Mental State Examination was used to assess decision-making capacity. RESULTS: A total of 109 individuals participated, with 60% reporting experiencing SDM...
February 1, 2018: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/29457273/clinical-risk-factors-for-early-seizure-recurrence-in-dogs-hospitalized-for-seizure-evaluation
#3
M Kwiatkowska, A Tipold, E Huenerfauth, A Pomianowski
BACKGROUND: Epileptic seizures are a common cause for neurological evaluations in dogs. HYPOTHESIS/OBJECTIVES: To determine the timing, frequency, and risk factors for early seizure recurrence (ESR) among dogs admitted to the hospital for seizure evaluation and to facilitate rapid decision making about whether dogs should be placed in the intensive care unit (ICU) or day ward. ANIMALS: Nine-hundred twenty-two dogs referred for seizure investigation; 214 patients were included...
February 18, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29457244/the-different-moral-bases-of-patient-and-surrogate-decision-making
#4
Daniel Brudney
My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job-the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job-the team just doesn't like how she is doing it. My analysis raises the question of whether (or perhaps when) she should be overridden...
January 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29457235/the-intimate-responsibility-of-surrogate-decision-making
#5
Hilde Lindemann
Daniel Brudney's clear-headed analysis, in this issue of the Hastings Center Report, of the difference between a patient's and a surrogate's right to make medical treatment decisions contributes to a longstanding conversation in bioethics. Brudney offers an epistemological and a moral argument for the patient's and the surrogate's right to decide. The epistemological argument is the same for both parties: the (competent) patient has a right to decide because she is presumed to know her own interests better than anyone else, and the surrogate is entitled to make decisions because she knows the patient better than anyone else...
January 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29455902/online-social-network-response-to-studies-on-antidepressant-use-in-pregnancy
#6
Simone N Vigod, Ebrahim Bagheri, Fattane Zarrinkalam, Hilary K Brown, Muhammad Mamdani, Joel G Ray
BACKGROUND: About 8% of U.S women are prescribed antidepressant medications around the time of pregnancy. Decisions about medication use in pregnancy can be swayed by the opinion of family, friends and online media, sometimes beyond the advice offered by healthcare providers. Exploration of the online social network response to research on antidepressant use in pregnancy could provide insight about how to optimize decision-making in this complex area. METHODS: For all 17 research articles published on the safety of antidepressant use in pregnancy in 2012, we sought to explore online social network activity regarding antidepressant use in pregnancy, via Twitter, in the 48h after a study was published, compared to the social network activity in the same period 1week prior to each article's publication...
March 2018: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/29454340/risk-perception-of-blood-transfusions-a-comparison-of-patients-and-allied-healthcare-professionals
#7
Jan A Graw, Katja Eymann, Felix Kork, Martin Zoremba, Rene Burchard
BACKGROUND: Due to an increasing demand in health care services plans to substitute selective physician-conducted medical activities have become attractive. Because administration of a blood transfusion is a highly standardized procedure, it might be evaluated if obtaining a patient's consent for a blood transfusion can be delegated to allied healthcare professionals. Physicians and patients perceive risks of transfusions differently. However, it is unknown how allied healthcare professionals perceive risks of transfusion-associated adverse events...
February 17, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29454337/the-second-patient-family-members-of-cancer-patients-and-their-role-in-end-of-life-decision-making
#8
Katsiaryna Laryionava, Timo A Pfeil, Mareike Dietrich, Stella Reiter-Theil, Wolfgang Hiddemann, Eva C Winkler
BACKGROUND: Family members are important companions of severely ill patients with cancer. However, studies about the desirability and difficulties of integrating relatives in the decision-making process are rare in oncology. This qualitative study explores the family role in decisions to limit treatment near the end of life from the professionals' point of view. METHODS: Qualitative in-depth interviews were conducted with oncologists (n = 12) and nurses (n = 6) working at the Department of Hematology/Oncology at the University Hospital in Munich, Germany...
February 17, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29453808/three-dimensional-printing-in-congenital-heart-disease-a-systematic-review
#9
REVIEW
Ivan Lau, Zhonghua Sun
Three-dimensional (3D) printing has shown great promise in medicine with increasing reports in congenital heart disease (CHD). This systematic review aims to analyse the main clinical applications and accuracy of 3D printing in CHD, as well as to provide an overview of the software tools, time and costs associated with the generation of 3D printed heart models. A search of different databases was conducted to identify studies investigating the application of 3D printing in CHD. Studies based on patient's medical imaging datasets were included for analysis, while reports on in vitro phantom or review articles were excluded from the analysis...
February 17, 2018: Journal of Medical Radiation Sciences
https://www.readbyqxmd.com/read/29453304/protocol-investigating-the-clinical-utility-of-an-objective-measure-of-attention-impulsivity-and-activity-qbtest-for-optimising-medication-management-in-children-and-young-people-with-adhd-qbtest-utility-for-optimising-treatment-in-adhd-quota-a-feasibility
#10
Charlotte L Hall, Marilyn James, Sue Brown, Jennifer L Martin, Nikki Brown, Kim Selby, Julie Clarke, Hena Vijayan, Boliang Guo, Kapil Sayal, Chris Hollis, Madeleine J Groom
INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement...
February 15, 2018: BMJ Open
https://www.readbyqxmd.com/read/29452562/deciphering-the-sunshine-act-transparency-regulation-and-financial-conflicts-in-health-care
#11
Richard S Saver
The Physician Payments Sunshine Act ("Sunshine Act"), enacted to address financial conflicts in health care, is the first comprehensive federal legislation mandating public reporting of payments between drug companies, device manufacturers, and medicine. This article analyzes the Sunshine Act's uneven record, exploring how the law serves as an intriguing example of the uncertain case for transparency regulation in health care. The Sunshine Act's bumpy rollout demonstrates that commanding transparency through legislation can be arduous because of considerable implementation challenges...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29452052/agency-and-fatalism-in-older-appalachian-women-s-information-seeking-about-gynecological-cancer
#12
Emma C Potter, Katherine R Allen, Karen A Roberto
Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women's agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment...
February 16, 2018: Journal of Women & Aging
https://www.readbyqxmd.com/read/29451697/optimizing-case-reports-and-case-series-guidance-on-how-to-improve-quality
#13
REVIEW
I Garcia-Doval, J Albrecht, C Flohr, J Batchelor, J R Ingram
Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It provides information on how to increase the validity of the bedside decision-making process that these studies report, using tools such as validated outcomes and split body or n-of-1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance...
February 16, 2018: British Journal of Dermatology
https://www.readbyqxmd.com/read/29451466/what-women-s-health-wants-in-your-market
#14
Zachary Hafner
Women are a key focus segment for health care organizations both because of the medical services they utilize as individuals and the influence they have on the health care of others. In one survey, 59% of women and 94% of working moms reported making or heavily influencing health care decisions for their entire families.
February 2018: Managed Care
https://www.readbyqxmd.com/read/29450795/ethics-and-confidentiality-for-psychologists-in-academic-health-centers
#15
Kathleen Ashton, Amy Sullivan
Psychologists in academic health centers (AHC) face important ethical issues including confidentiality when working with a multidisciplinary team, sharing of information through the electronic health record, obtaining informed consent in a fast-paced healthcare environment, cultural competency in the medical setting, and issues related to supervision and training. The goal of this paper is to describe ethical issues for psychologists in AHCs in the context of case examples, and to consider ethical decision-making tools to enhance clinical care...
February 15, 2018: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/29450784/-a-challenging-decision-making-process-pro-or-con-surgical-heart-valve-replacement-in-a-case-of-long-term-non-adherence-a-case-report
#16
René Florian Oswald, H Christof Müller-Busch
A young, still multimorbid woman aquires infectious endocarditis. Anamnestically severe non-adherence concerning medical advice is reported. Complete cure may only be achieved by performing surgical heart valve replacement, which implies lifelong scrupulous oral anticoagulation postoperatively. Discussion evolves within medical staff, whether surgery should be indicated or not.
February 15, 2018: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29450624/-intraoperative-optical-coherence-tomography-in-explorative-vitrectomy-in-patients-with-vitreous-haemorrhage-a-case-series
#17
D Heinrich, S Bohnacker, M A Nasseri, N Feucht, C P Lohmann, M Maier
BACKGROUND: High-resolution spectral domain optical coherence tomography (SD-OCT) is a gold standard technique for diagnosis, management and monitoring of patients with vitreoretinal diseases. Preoperative diagnostics for evaluation of intraocular and retinal status in patients with vitreous haemorrhage are limited, thus final therapeutic decisions can only be made during explorative vitrectomy. We evaluated the use of intraoperative SD-OCT (iSD-OCT) as a real-time additional diagnostic tool during explorative vitrectomy in patients with vitreous haemorrhage...
February 15, 2018: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/29450466/diagnostic-criteria-of-ulcerative-pyoderma-gangrenosum-a-delphi-consensus-of-international-experts
#18
Emanual Maverakis, Chelsea Ma, Kanade Shinkai, David Fiorentino, Jeffrey P Callen, Uwe Wollina, Angelo Valerio Marzano, Daniel Wallach, Kyoungmi Kim, Courtney Schadt, Anthony Ormerod, Maxwell A Fung, Andrea Steel, Forum Patel, Rosie Qin, Fiona Craig, Hywel C Williams, Frank Powell, Alexander Merleev, Michelle Y Cheng
Importance: Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials. Objective: To propose and validate diagnostic criteria for ulcerative pyoderma gangrenosum. Evidence Review: Diagnostic criteria were created following a Delphi consensus exercise using the RAND/UCLA Appropriateness Method...
February 14, 2018: JAMA Dermatology
https://www.readbyqxmd.com/read/29450209/creation-and-assessment-of-a-clinical-predictive-calculator-and-mortality-associated-with-candida-krusei-bloodstream-infections
#19
Ryan Kronen, Kevin Hsueh, Charlotte Lin, William G Powderly, Andrej Spec
Background: Candida krusei bloodstream infection (CK BSI) is associated with high mortality, but whether this is due to underlying comorbidities in affected patients or the organism itself is unknown. Identifying patient characteristics that are associated with CK BSI is crucial for clinical decision-making and prognosis. Methods: We conducted a retrospective analysis of hospitalized patients with Candida BSI at our institution between 2002 and 2015. Data were collected on demographics, comorbidities, medications, procedures, central lines, vital signs, and laboratory values...
February 2018: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29449298/clinical-validation-of-a-public-health-policy-making-platform-for-hearing-loss-evotion-protocol-for-a-big-data-study
#20
Giorgos Dritsakis, Dimitris Kikidis, Nina Koloutsou, Louisa Murdin, Athanasios Bibas, Katherine Ploumidou, Ariane Laplante-Lévesque, Niels Henrik Pontoppidan, Doris-Eva Bamiou
INTRODUCTION: The holistic management of hearing loss (HL) requires an understanding of factors that predict hearing aid (HA) use and benefit beyond the acoustics of listening environments. Although several predictors have been identified, no study has explored the role of audiological, cognitive, behavioural and physiological data nor has any study collected real-time HA data. This study will collect 'big data', including retrospective HA logging data, prospective clinical data and real-time data via smart HAs, a mobile application and biosensors...
February 15, 2018: BMJ Open
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