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Medical decision

Camilla Hardeland, Kjetil Sunde, Helge Ramsdal, Susan R Hebbert, Linda Soilammi, Fredrik Westmark, Fredrik Nordum, Andreas E Hansen, Jon E Steen-Hansen, Theresa M Olasveengen
AIM: Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. METHODS: Mixed-methods: design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files...
October 18, 2016: Resuscitation
Joseph K Maddry, Alejandra G Mora, Shelia Savell, Lauren K Reeves, Crystal A Perez, Vikhyat S Bebarta
BACKGROUND: Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes...
November 2016: Journal of Trauma and Acute Care Surgery
Kathryn L Kreicher, Jeremy S Bordeaux
Importance: Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. Objective: To present the newest and best evidence to close common practice gaps in cutaneous surgery. Evidence Review: We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others...
October 20, 2016: JAMA Facial Plastic Surgery
Olga Tursunov, Nathan I Cherny, Freda DeKeyser Ganz
PURPOSE/OBJECTIVES: To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. DESIGN: Descriptive comparative study.
. SETTING: Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. SAMPLE: A convenience sample of 34 family members of dying patients receiving palliative sedation...
November 1, 2016: Oncology Nursing Forum
Heidi Preis, Yael Benyamini
INTRODUCTION: Basic beliefs about birth as a natural and safe or a medical and risky process are central in the decisions on where and how to birth. Despite their importance, they have not been studied separately from other childbirth-related constructs. Our aim was to develop a measure to assess these beliefs. METHOD: Pregnant Israeli women (N = 850, gestational week ≥14) were recruited in women's health centers, in online natural birth forums, and through home midwives...
October 21, 2016: Journal of Psychosomatic Obstetrics and Gynaecology
Alistair E W Johnson, Mohammad M Ghassemi, Shamim Nemati, Katherine E Niehaus, David A Clifton, Gari D Clifford
Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms...
February 2016: Proceedings of the IEEE
Jason W Beckstead
BACKGROUND: Brunswik's Lens Model and lens model equation (LME) have been applied extensively in medical decision making. Clinicians often face the dual challenge of formulating a judgment of patient risk for some adverse outcome and making a yes or no decision regarding a particular risk-reducing treatment option. OBJECTIVE: In this article, I examine the correlation between clinical risk judgments and treatment-related decisions, referring to this linkage as "cohesion"...
October 20, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
A A Dos Reis, L Bertelli, W O Sousa
Radiological or nuclear emergency situations could lead to incorporation of radionuclides by the population. Intakes of radionuclides can be evaluated through measurements of radionuclides present in organs and tissues, or in urinary and/or fecal excretion. In an emergency situation involving a large number of people, the decision to provide medical treatment to an individual will likely be based on a single measurement. For that purpose, the National Council on Radiation Protection and Measurements (NCRP) has presented the Clinical Decision Guide (CDG) quantity, which corresponds to an intake amount of a radionuclide by an individual for which treatment is recommended...
October 7, 2016: Radiation Protection Dosimetry
Irosh Fernando, Frans Henskens, Masoud Talebian
OBJECTIVE: Complex treatment decisions can be suboptimal due to lack of a reliable decision-making model, a need this paper aims to meet. METHOD: A model for making complex treatment decisions is introduced. RESULTS: The utility of the proposed method is demonstrated by making a complex treatment decision involving evaluation of clozapine treatment in a treatment-resistant patient. CONCLUSION: The proposed method implemented as a software tool can provide a framework for shared decision-making involving the patient...
October 10, 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Thomas Martini, Christian Gilfrich, Roman Mayr, Maximilian Burger, Armin Pycha, Atiqullah Aziz, Michael Gierth, Christian G Stief, Stefan C Müller, Florian Wagenlehner, Jan Roigas, Oliver W Hakenberg, Florian Roghmann, Philipp Nuhn, Manfred Wirth, Vladimir Novotny, Boris Hadaschik, Marc-Oliver Grimm, Paul Schramek, Axel Haferkamp, Daniela Colleselli, Birgit Kloss, Edwin Herrmann, Margit Fisch, Matthias May, Christian Bolenz
INTRODUCTION: Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort. MATERIALS AND METHODS: We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer RadIcal Cystectomy Series 2011) database...
September 19, 2016: Clinical Genitourinary Cancer
Amy Y Tsou, Jonathan R Treadwell
BACKGROUND: Systematic review (SR) abstracts are important for disseminating evidence syntheses to inform medical decision making. We assess reporting quality in SR abstracts using PRISMA for Abstracts (PRISMA-A), Cochrane Handbook, and Agency for Healthcare Research & Quality guidance. METHODS: We evaluated a random sample of 200 SR abstracts (from 2014) comparing interventions in the general medical literature. We assessed adherence to PRISMA-A criteria, problematic wording in conclusions, and whether "positive" studies described clinical significance...
October 20, 2016: Research Synthesis Methods
Natasa M Milic, Srdjan Masic, Jelena Milin-Lazovic, Goran Trajkovic, Zoran Bukumiric, Marko Savic, Nikola V Milic, Andja Cirkovic, Milan Gajic, Mirjana Kostic, Aleksandra Ilic, Dejana Stanisavljevic
BACKGROUND: The scientific community increasingly is recognizing the need to bolster standards of data analysis given the widespread concern that basic mistakes in data analysis are contributing to the irreproducibility of many published research findings. The aim of this study was to investigate students' attitudes towards statistics within a multi-site medical educational context, monitor their changes and impact on student achievement. In addition, we performed a systematic review to better support our future pedagogical decisions in teaching applied statistics to medical students...
2016: PloS One
David A Siegel, Reda Wilson, Edward J Wilkinson, Julia W Gargano, Meg Watson, Brenda Y Hernandez, Marc T Goodman, Charles F Lynch, Elizabeth R Unger, Mona Saraiya
CONTEXT: -Knowing the subtype of vulvar cancer histology is important for estimating human papillomavirus-related cancer etiology. Surveillance of human papillomavirus-related vulvar cancers informs public health decisions related to vaccination against human papillomavirus. OBJECTIVE: -To assess the accuracy of registry classifications of vulvar cancer and determine the histologic classification of cases reported as not otherwise specified. DESIGN: -Pathology specimens were collected from Florida, Iowa, and Hawaii cancer registries...
October 20, 2016: Archives of Pathology & Laboratory Medicine
Joshua J Fenton, Kevin Fiscella, Anthony F Jerant, Francis Sousa, Mark Henderson, Tonya Fancher, Peter Franks
A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants' academic metrics for socioeconomic disadvantage...
2016: Journal of Health Care for the Poor and Underserved
Eric Klingelhoefer, Hendrik Bergert, Stephan Kersting, Stefan Ludwig, Norbert Weiss, Frank Schönleben, Robert Grützmann, Gabor Gäbel
BACKGROUND: Peripheral arterial disease (PAD) is one of the most underestimated diseases because of its high prevalence and unfavorable prognosis. Many PAD patients without suitable autologous veins or options for endovascular treatment receive prosthetic above-knee femoropopliteal bypass (PAKB). Until now predictors of prosthetic bypass failure and of increased amputation risk remain indistinct. This study aimed to identify predictive factors associated with better bypass patency and limb salvage to achieve a more favorable outcome after PAKB reconstruction...
August 2016: Journal of Vascular Surgery
J de Gelder, J A Lucke, B de Groot, A J Fogteloo, S Anten, K Mesri, E W Steyerberg, C Heringhaus, G J Blauw, S P Mooijaart
BACKGROUND: Older patients experience high rates of adverse outcomes after an emergency department (ED) visit. Early identification of those at high risk could guide preventive interventions and tailored treatment decisions, but available models perform poorly in discriminating those at highest risk. The present study aims to develop and validate a prediction model for functional decline and mortality in older patients presenting to the ED. METHODS: A prospective follow-up study in patients aged ≥ 70, attending the EDs of the LUMC, the Netherlands (derivation) and Alrijne Hospital, the Netherlands (validation) was conducted...
October 2016: Netherlands Journal of Medicine
Amy Blake, Bryan T Carroll
OBJECTIVE: This paper analyses how game theory can provide a framework for understanding the strategic decision-making that occurs in everyday scenarios in medical training and practice, and ultimately serves as a tool for improving the work environment and patient care. Game theory has been applied to a variety of fields outside of its native economics, but has not been thoroughly studied in the context of health care provision. METHODS: The paper discusses four of the most common 'games' and applies each to a scenario in medicine to provide new insight on the incentives and drivers for certain types of behaviour and a deeper understanding of why certain results are valued more strongly than others...
November 2016: Medical Education
Geerte C Den Hollander, Joyce L Browne, Daniel Arhinful, Rieke van der Graaf, Kerstin Klipstein-Grobusch
To address the burden of maternal morbidity and mortality in low- and middle-income countries (LMICs), research with pregnant women in these settings is increasingly common. Pregnant women in LMIC-context may experience vulnerability related to giving consent to participate in a clinical trial. To recognize possible layers of vulnerability this study aims to identify factors that influence the decision process towards clinical trial participation of pregnant women in an urban middle-income setting. This qualitative research used participant observation, in-depth interviews, and focus group discussion with medical staff and pregnant women eligible for trial participation, at a regional hospital in Accra, Ghana...
October 20, 2016: Developing World Bioethics
Sonya Charles, Allison B Wolf
In this article, we discuss decision making during labor and delivery, specifically focusing on decision making around offering women a trial of labor after cesarean section (TOLAC). Many have discussed how humans are notoriously bad at assessing risks and how we often distort the nature of various risks surrounding childbirth. We will build on this discussion by showing that physicians make decisions around TOLAC not only based on distortions of risk, but also based on personal values (i.e. what level of risk are you comfortable with or what types of risks are you willing to take) rather than medical data (or at least medical data alone)...
October 20, 2016: Journal of Medical Humanities
Jessica B McGillen, Sarah-Jane Anderson, Timothy B Hallett
INTRODUCTION: The new WHO guidelines recommend offering pre-exposure prophylaxis (PrEP) to people who are at substantial risk of HIV infection. However, where PrEP should be prioritised, and for which population groups, remains an open question. The HIV landscape in sub-Saharan Africa features limited prevention resources, multiple options for achieving cost saving, and epidemic heterogeneity. This paper examines what role PrEP should play in optimal prevention in this complex and dynamic landscape...
2016: Journal of the International AIDS Society
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