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Medical decision making

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https://www.readbyqxmd.com/read/29916830/medical-decision-making-for-medically-complex-children-in-foster-care-who-knows-the-child-s-best-interests
#1
Rebecca R Seltzer, Rachel A B Dodge, Renee D Boss
Approximately one in 10 children in foster care are medically complex and require intensive medical supervision, frequent hospitalization, and difficult medical decision making. Some of these children are in foster care because their parents cannot care for their medical needs; other parents are responsible for their child's medical needs due to abuse or neglect. In either case, there can be uncertainty about the role that a child's biological parents should play in making serious medical decisions. Here we highlight some of the ethical challenges inherent in making these decisions for children in foster care, as seen through the lenses of a child welfare provider, an inpatient care physician, and a primary care pediatrician...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29915183/differences-in-attitudes-toward-genetic-testing-among-the-public-patients-and-health-care-professionals-in-korea
#2
Heesang Eum, Mangyeong Lee, Junghee Yoon, Juhee Cho, Eun Sook Lee, Kui Son Choi, Sangwon Lee, So-Youn Jung, Myong Cheol Lim, Sun-Young Kong, Yoon Jung Chang
With further advances in medical genetics, genetic tests to determine predisposition to disease are becoming viable for a growing number of diseases. Accordingly, it has also become important to identify various viewpoints on genetic testing. The aims of this study were to examine awareness of and attitudes toward genetic testing among the general public (public), cancer patients (patients), and health-care professionals (clinicians and researchers) in Korea. The present survey was conducted from November 2016 to February 2017...
June 18, 2018: European Journal of Human Genetics: EJHG
https://www.readbyqxmd.com/read/29914879/processing-of-discharge-summaries-in-general-practice-a-retrospective-record-review
#3
Rachel Ann Spencer, Simon Edward Frank Spencer, Sarah Rodgers, Stephen M Campbell, Anthony John Avery
BACKGROUND: There is a need for greater understanding of the epidemiology of primary care patient safety in order to generate solutions to prevent future harm. AIM: To estimate the rate of failures in processing actions requested in hospital discharge summaries, and to determine factors associated with these failures. DESIGN AND SETTING: The authors undertook a retrospective records review. The study population was emergency admissions for patients aged ≥75 years, drawn from 10 practices in three areas of England...
June 18, 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/29914395/factors-promoting-or-inhibiting-normal-birth
#4
Samantha J Prosser, Adrian G Barnett, Yvette D Miller
BACKGROUND: In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). However, there is limited evidence for how best to achieve increased rates of normal birth. In this study we examined the role of modifiable and non-modifiable factors in experiencing a normal birth using retrospective, self-reported data...
June 18, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29913434/factors-influencing-child-protection-professionals-decision-making-and-multidisciplinary-collaboration-in-suspected-abusive-head-trauma-cases-a-qualitative-study
#5
Laura E Cowley, Sabine Maguire, Daniel M Farewell, Harriet D Quinn-Scoggins, Matthew O Flynn, Alison M Kemp
Clinicians face unique challenges when assessing suspected child abuse cases. The majority of the literature exploring diagnostic decision-making in this field is anecdotal or survey-based and there is a lack of studies exploring decision-making around suspected abusive head trauma (AHT). We aimed to determine factors influencing decision-making and multidisciplinary collaboration in suspected AHT cases, amongst 56 child protection professionals. Semi-structured interviews were conducted with clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom...
June 15, 2018: Child Abuse & Neglect
https://www.readbyqxmd.com/read/29912774/depressive-symptoms-are-associated-with-low-treatment-adherence-in-african-american-individuals-with-systemic-lupus-erythematosus
#6
Erica Heiman, S Sam Lim, Gaobin Bao, Cristina Drenkard
OBJECTIVE: African American (AA) people with systemic lupus erythematosus (SLE) are at high morbidity and mortality risk, and they often require multiple medications. Low medication adherence is a highly prevalent, multidimensional problem associated with poor outcomes in people with SLE. Depression, a predictor of low adherence in people with chronic conditions, has been described in over 35% of AAs with SLE. We hypothesized that depressive symptoms would be increasingly associated with low adherence in this population...
June 15, 2018: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/29911758/force-feeding-and-resuscitation-of-patients-with-advanced-dementia-a-public-opinion-study
#7
Tamar Shalom, Avichai Shuv-Ami
BACKGROUND: The treatment of advanced dementia patients is very complex and presents a difficult dilemma for physicians, and especially for the patient's family. In many cases, when the advanced dementia patient has no decisional capacity, the family needs to decide about force-feeding and resuscitation for their relative. OBJECTIVES: To examine public opinion regarding force-feeding and resuscitation of patients with advanced dementia. METHODS: Data from 1002 people who accompanied a patient to a hospital emergency department in Israel were collected and analyzed...
June 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29911752/immediate-breast-reconstruction-comparative-outcome-study-of-one-stage-direct-to-implant-and-two-stage-tissue-expander-techniques
#8
Sagit Meshulam-Derazon, Tamir Shay, Sivan Lewis, Neta Adler
BACKGROUND: One-stage direct-to-implant post-mastectomy breast reconstruction has been gaining popularity over the traditional two-stage/tissue-expander approach. OBJECTIVES: To evaluate the outcome of the two post-mastectomy breast reconstruction procedures in terms of patient satisfaction. METHODS: Clinical data were collected by file review for patients who underwent mastectomy with immediate breast reconstruction at two tertiary medical centers in 2010-2013...
June 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29911318/generalized-information-theory-meets-human-cognition-introducing-a-unified-framework-to-model-uncertainty-and-information-search
#9
Vincenzo Crupi, Jonathan D Nelson, Björn Meder, Gustavo Cevolani, Katya Tentori
Searching for information is critical in many situations. In medicine, for instance, careful choice of a diagnostic test can help narrow down the range of plausible diseases that the patient might have. In a probabilistic framework, test selection is often modeled by assuming that people's goal is to reduce uncertainty about possible states of the world. In cognitive science, psychology, and medical decision making, Shannon entropy is the most prominent and most widely used model to formalize probabilistic uncertainty and the reduction thereof...
June 17, 2018: Cognitive Science
https://www.readbyqxmd.com/read/29910709/a-complex-relationship-between-suicide-dementia-and-amyloid-a-narrative-review
#10
Ismael Conejero, Sophie Navucet, Jacques Keller, Emilie Olié, Philippe Courtet, Audrey Gabelle
Background: Suicide rates are high among older adults and many conditions have been related to suicide in this population: chronic illnesses, physical disabilities, cancer, social isolation, mental disorders and neurocognitive disorders. Objectives: Among neurocognitive disorders, analysis of the relationships between dementia and suicidal behaviors led to conflicting results and some questions are still without answer. Particularly, it is not known whether (i) Alzheimer's disease (AD) increases the risk of suicidal ideation and suicide attempts (SA) or the frequency of death by suicide; (ii) the presence of suicidal ideation or SA in people older than 65 years of age is an early dementia sign; and (iii) amyloid load in frontal areas facilitates SA by modifying the decision-making pathway...
2018: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29910659/value-assessment-in-oncology-drugs-funding-of-drugs-for-metastatic-breast-cancer-in-canada
#11
J Lemieux, S Audet
Background: Life expectancy for women with metastatic breast cancer has improved since the early 2000s, in part because of the introduction of novel therapies, including chemotherapy, hormonal therapy, and targeted agents. However, those treatments can come at a cost for the patient (short- and long-term toxicities from treatment) and at a financial cost for the health care system. Given the increase in the number of costly anticancer agents being introduced into the clinical setting, the American Society of Clinical Oncology (asco) and the European Society for Medical Oncology (esmo) have developed a system to quantify the value of new cancer treatments in terms of benefit, toxicities, and costs...
June 2018: Current Oncology
https://www.readbyqxmd.com/read/29910640/gaming-science-innovations-to-integrate-health-systems-science-into-medical-education-and-practice
#12
REVIEW
Earla J White, Joy H Lewis, Lise McCoy
Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers' abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29909867/selection-of-and-evidentiary-considerations-for-wearable-devices-and-their-measurements-for-use-in-regulatory-decision-making-recommendations-from-the-epro-consortium
#13
Bill Byrom, Chris Watson, Helen Doll, Stephen Joel Coons, Sonya Eremenco, Rachel Ballinger, Marie Mc Carthy, Mabel Crescioni, Paul O'Donohoe, Cindy Howry
BACKGROUND: Wearable devices offer huge potential to collect rich sources of data to provide insights into the effects of treatment interventions. Despite this, at the time of writing this report, limited regulatory guidance on the use of wearables in clinical trial programs has been published. OBJECTIVES: To present recommendations from the Critical Path Institute's Electronic Patient-Reported Outcome Consortium regarding the selection and evaluation of wearable devices and their measurements for use in regulatory trials and to support labeling claims...
June 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/29908764/development-of-the-ripe-model-reflective-interprofessional-education-model-to-enhance-interprofessional-collaboration
#14
C Lucas, T Power, C Hayes, C Ferguson
This paper describes a novel model to providing interprofessional education (IPE) and interprofessional collaboration (IPC) within a simulated healthcare environment, in the higher education setting. The RIPE Model (Reflective Interprofessional Education Model) was developed for the purpose of enhancing IPE and IPC, clinical judgement, and decision-making between health professional students (pharmacy and nursing students) at the patient's simulated hospital bedside. A foundation 'unfolding' case utilizing the RIPE model was piloted with first year Master of pharmacy students and postgraduate nursing students at an Australian university and included a pharmacy practitioner acting as a resident medical officer (RMO) for the purpose of the teaching module...
June 2, 2018: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29908523/radiographic-study-of-haematogenous-septic-arthritis-in-dairy-calves
#15
Caroline Constant, Isabelle Masseau, Marie Babkine, Sylvain Nichols, David Francoz, Gilles Fecteau, Emma Marchionatti, Helene Larde, Andre Desrochers
OBJECTIVES:  (1) To develop an evaluation grid to provide a systematic interpretation of calves' articular radiographs, (2) to describe radiographic lesions of septic arthritis in dairy calves less than 6 months of age, (3) to investigate potential associations between demographic data or synovial bacteriological culture results and radiographic lesions (4) to determine whether an association is present between radiographic lesions, their severity and the long-term outcome. METHODS:  Medical records of 54 calves less than 180 days old treated for septic arthritis between 2009 and 2014 with radiographic images performed in the first 2 days after admission were reviewed...
June 16, 2018: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
https://www.readbyqxmd.com/read/29905841/posterior-fossa-craniotomy-for-adherent-fourth-ventricle-neurocysticercosis
#16
Lynze R Franko, Balaji Pandian, Avneesh Gupta, Luis E Savastano, Kevin S Chen, James Riddell, Daniel A Orringer
BACKGROUND AND IMPORTANCE: Neurocysticercosis (NCC) is an infectious helminthic disease often presenting in patients who have immigration or travel history from areas where NCC is endemic. Fourth ventricle cysts from NCC pose a unique treatment challenge, as there is little consensus on the best treatment. This case study describes the treatment of a patient with fourth ventricle neurocysticercosis (FVNCC), examines the therapeutic decision-making, and provides a video of a posterior fossa craniotomy (PFC) resection of a degenerative cyst...
June 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29905632/an-ethical-claim-for-providing-medical-recommendations-in-pediatric-intensive-care
#17
Katie M Moynihan, Melanie A Jansen, Shih-Ning Liaw, Peta M A Alexander, Robert D Truog
The Declaration of Geneva was recently revised to emphasize patient autonomy and the importance of clinicians sharing medical knowledge. This reflects the welcome evolution of the doctor-patient relationship from one of paternalism to more informed, shared decision-making. Unfortunately, there is an increasing trend for clinicians to avoid making recommendations, instead providing a "menu" of care options from which patients and families must choose. This seems to be underpinned by the belief that it is unacceptably paternalistic to give guidance as to which course of action may be best to take...
June 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29905139/the-four-quadrant-approach-to-ethical-issues-in-burn-care
#18
Chad M Teven, Lawrence J Gottlieb
Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905130/is-it-ethical-to-treat-pain-differently-in-children-and-adults-with-burns
#19
Sharmila Dissanaike
This commentary discusses ethical implications of the common practice of treating children's and adults' burn pain differently. Physicians have obligations to ensure that (1) their own discomfort with children's pain doesn't lead them to make pain management decisions that could place a patient at greater risk and (2) to engage in thoughtful, individualized pain management strategies. Long-term consequences of overzealous pain medication administration, for example, could include delayed recovery and integration or opioid dependence...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29903795/hepatitis-c-virus-infection-and-hospital-related-outcomes-a-systematic-review-protocol
#20
Lianping Ti, Michelle Ng, Lindila Awendila, Patrizia Maria Carrieri
INTRODUCTION: People living with hepatitis C virus (HCV) infection are disproportionately over-represented in the healthcare system due to various individual and contextual circumstances, including comorbidities and socioeconomic marginalisation. With growing trends in morbidity and mortality related to HCV infection, HCV is becoming a significant health and financial burden on the healthcare system, particularly in acute hospital settings. It is noteworthy that with the advent of direct-acting antiviral therapy the increasing number of patients who are cured of HCV could potentially result in different patterns of hospital-related outcomes over time...
June 14, 2018: BMJ Open
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