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1

Evolutionary construction of medical decision trees  

Microsoft Academic Search

In helping physicians, decision support systems are becoming a very important part of medical decision making. A prospective candidate for such tasks are decision trees that have already been successfully used for many medical decision making purposes. Although very effective and reliable, the traditional construction approach, which hasn't changed much since its introduction, is still not perfect in real-world decision

V. Podforelec; Peter Kokol

1998-01-01

2

The Importance of Professional Activity to Personnel Decisions for Medical Technologists in Academia.  

ERIC Educational Resources Information Center

Criteria related to merit evaluations of medical technology faculty were evaluated, based on a survey of members of the American Society for Medical Technology's scientific section on education. Questionnaire responses were obtained from 27 academic institutions. Criteria included publications, institutional committee activity, research, clinical…

Miller, Sharon; Kimball, Olive M.

3

The Importance of Mathematics in Health and Human Judgment: Numeracy, Risk Communication, and Medical Decision Making  

ERIC Educational Resources Information Center

Mathematics achievement is important in its own right, and is increasingly recognized as crucial to the nation's economy [National Mathematics Panel, 2006. "National Mathematics Advisory Panel: Strengthening Math Education Through Research." Accessed September 29, 2006 from http://www.ed.gov/about/bdscomm/list/mathpanel/factsheet.html.; National…

Reyna, Valerie F.; Brainerd, Charles J.

2007-01-01

4

Whose decision is it? The microstructure of medical decision making.  

PubMed

Medical decision making is sometimes viewed as a relatively simple process in which a decision may be made by the patient, by the physician, or by both patient and physician working together. This two-dimensional portrayal eclipses the important role that others, such as other professionals, family, and friends, may play in the process; as an example of this phenomenon, we trace the evolution of a decision of a teenager with cancer who is contemplating discontinuing chemotherapy. This example also shows how a decision can usefully be understood as consisting of a number of identifiable substeps--what we call the "microstructure" of the decision. These steps show how the physician can play an important role without usurping the patient's rightful decisional authority. PMID:19209569

Whitney, Simon N

2008-01-01

5

Medical Decision-Making by Psychiatry Residents  

ERIC Educational Resources Information Center

Objective: Several conspiring factors have resulted in an increase in the level of medical burden in psychiatric patients. Psychiatry residents require increasing levels of medical sophistication. To assess the medical decision-making of psychiatry residents, the authors examined the outcome in subjects initially seen in the emergency psychiatric…

El-Mallakh, Rif; Zinner, Jill; Mackey, Amanda; Tamas, Rebecca L.; Martin, Chanley M.; Dalton, Jerad; Dhaliwal, Nitu; Luddington, Nicole; Numan, Farhad U.; Nunes, Ross; Taylor, Stephen; Ye, Lu

2007-01-01

6

Developing a Framework to Support Shared Decision Making for Youth Mental Health Medication Treatment  

E-print Network

Abstract Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes ...

Crickard, Elizabeth L.; O'Brien, Megan S.; Rapp, Charles A.; Holmes, Cheryl L.

2010-10-01

7

BMC Medical Informatics and Decision Making  

PubMed Central

Contributing reviewers The editors of BMC Medical Informatics and Decision Making would like to thank all our reviewers who have contributed their time to the journal in Volume 13 (2013). PMID:25540033

2014-01-01

8

Uncertainty and Decisions in Medical Informatics1  

E-print Network

psz@mit.edu This paper presents a tutorial introduction to the handling of uncertainty and decision-making making is presented from the decision analysis view- point, with brief mention of recently. Nevertheless, we must make important, even critical decisions about testing and treatments, and despite our

Szolovits, Peter

9

Uncertainty and Decisions in Medical Informatics 1  

E-print Network

psz@mit.edu This paper presents a tutorial introduction to the handling of uncertainty and decision­making making is presented from the decision analysis view­ point, with brief mention of recently. Nevertheless, we must make important, even critical decisions about testing and treatments, and despite our

Szolovits, Peter

10

Measurement Decision Risk - The Importance of Definitions  

NASA Technical Reports Server (NTRS)

One of the more misunderstood areas of metrology is the Test Uncertainty Ratio (TUR) and its cousin, the Test Accuracy Ratio (TAR). There have been many definitions over the years, but why are these definitions important to a discussion on measurement decision risk? The importance lies in the clarity of communication. Problems can immediately arise in the application (or misapplication) of the definition of these terms. In other words, while it is important to understand the definitions, it is more important to understand concepts behind the definitions and to be precise in how they are applied. The objective of any measurement is a decision. Measurement Decision Risk is a way to look at the quality of a measurement and although it is not a new concept, it has generated a lot of attention since its addition as a requirement in the new U.S. National Standard, ANSI/NCSL Z540.3-2006. In addition to Measurement Decision Risk as the prime method of managing measurement risk, Z540.3 has also added, as a fall-back, an explicit definition for TUR. The impact these changes might have on calibration service providers if these requirements are levied on them has become the topic of much discussion and in some cases concern. This paper looks at the concepts behind the definitions and how they relate to Measurement Decision Risk. Using common examples, this paper will also provide a comparison of various elements of risk related to measurement science using the concepts of TAR, TUR, accuracy ratios, and Consumer Risk (False Accept Risk). The goal is to provide a better understanding of their relevance to the measurement decision process.

Mimbs, Scott M.

2007-01-01

11

Measurement Decision Risk - The Importance of Definitions  

NASA Technical Reports Server (NTRS)

One of the more misunderstood areas of metrology is the Test Uncertainty Ratio (TUR) and the Test Accuracy Ratio (TAR). There have been many definitions over the years, but why are these definitions important to a discussion on measurement decision risk? The importance lies in the clarity of communication. Problems can immediately arise in the application (or misapplication) of the definition of these terms. In other words, while it is important to understand the definitions, it is more important to understand concepts behind the definitions and to be precise in how they are applied. The objective of any measurement is a decision. Measurement Decision Risk is a way to look at the quality of a measurement, and although it is not a new concept, it has generated a lot of attention since its addition as a requirement in the new U.S. National Standard, ANSIINCSL Z540.3-2006. In addition to Measurement Decision Risk as the prime method of managing measurement risk, Z540.3 has added, as a fall-back, an explicit definition for TUR. The impact these new requirements may have on calibration service providers has become the topic of much discussion and in some cases concern. This paper will look at the concepts behind the definitions and how they relate to Measurement Decision Risk. Using common examples, this paper will also provide a comparison of various elements of risk related to measurement science using the concepts of TAR, TUR, accuracy ratios, and Consumer Risk (False Accept Risk). The goal of this paper is to provide a better understanding of their relevance to the measurement decision process.

Mimbs, Scott M.

2008-01-01

12

A Medical Data Dictionary for Decision Support Applications  

PubMed Central

Building and maintaining clinically-based medical information systems is a complex task. Advances in database management technologies, including the concept of a data dictionary, have helped support this process. A medical data dictionary is described with discussions on the role of data dictionaries within a medical information system and the conceptual model supported by the AT&T CareComm (TM) data dictionary. Additionally, a high level overview of features that we deemed important to support a medical information system with integrated decision support capabilities is presented.

Huff, S.M.; Craig, R.B.; Gould, B.L.; Castagno, D.L.; Smilan, R.E.

1987-01-01

13

Uncertainty and Decisions in Medical Informatics 1  

Microsoft Academic Search

This paper presents a tutorial introduction to the handling of uncertainty and decision-making in medical reasoning systems. It focuses on the central role of uncertainty in all of medicine and identifies the major themes that arise in re- search papers. It then reviews simple Bayesian formulations of the problem and pursues their generalization to the Bayesian network methods that are

Peter Szolovits

1995-01-01

14

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities  

PubMed Central

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation. PMID:24891953

Seyedin, Hesam; Jamshidi-Orak, Roohangiz

2014-01-01

15

Patient decision-making: medical ethics and mediation.  

PubMed Central

A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic already being used informally in good patient care, and that there is a case for developing it further. PMID:8798939

Craig, Y J

1996-01-01

16

Medical factors influencing decision making regarding radiation therapy for breast cancer.  

PubMed

Radiation therapy is an important and effective adjuvant therapy for breast cancer. Numerous health conditions may affect medical decisions regarding tolerance of breast radiation therapy. These factors must be considered during the decision-making process after breast-conserving surgery or mastectomy for breast cancer. Here, we review currently available evidence focusing on medical conditions that may affect the patient-provider decision-making process regarding the use of radiation therapy. PMID:25429241

Dilaveri, Christina A; Sandhu, Nicole P; Neal, Lonzetta; Neben-Wittich, Michelle A; Hieken, Tina J; Mac Bride, Maire Brid; Wahner-Roedler, Dietlind L; Ghosh, Karthik

2014-01-01

17

Measurement Decision Risk - The Importance of Definitions  

NASA Technical Reports Server (NTRS)

The idea behind this presentation is how the difference in definitions can change the application. 1. Look at history, concepts, and definitions. 2. Link the test uncertainty ratio (TUR) to measurement decision risk.

Mimbs, Scott

2007-01-01

18

The collaborative autonomy model of medical decision-making.  

PubMed

While the bioethical principle of beneficence originated in antiquity, the ascension of autonomy, or "self-rule," has redefined the physician-patient relationship to the extent that autonomy often dominates medical decision-making. Philosophical and social movements, medical research atrocities, consumerism, and case law have all had their influence on this paradigm shift. Consequently, the contemporary physician encounters an uncertainty in medical practice on how to resolve conflicts that arise in the pursuit of valuing both autonomy and beneficence. This is especially true in the practice of neurologic critical care where physicians may be advising comfort care measures for neurologically devastated patients while surrogates request physiologically futile interventions. This conundrum has been an important subject of the bioethics and social science literature but often this discourse is not disseminated to the clinicians confronting these issues. The purpose of this essay is to present a history of the principles of autonomy and beneficence and then present a shared medical decision-making model, collaborative autonomy, to provide guidance to neurologic critical care providers in how to resolve such dilemmas. Clinical vignettes will help illustrate the model. PMID:24233814

Rubin, Michael A

2014-04-01

19

Medical Specialty Decision Model: Utilizing Social Cognitive Career Theory  

ERIC Educational Resources Information Center

Objectives: The purpose of this study was to develop a working model to explain medical specialty decision-making. Using Social Cognitive Career Theory, we examined personality, medical specialty preferences, job satisfaction, and expectations about specialty choice to create a conceptual framework to guide specialty choice decision-making.…

Gibson, Denise D.; Borges, Nicole J.

2004-01-01

20

Virulence factors of medically important fungi.  

PubMed Central

Human fungal pathogens have become an increasingly important medical problem with the explosion in the number of immunocompromised patients as a result of cancer, steroid therapy, chemotherapy, and AIDS. Additionally, the globalization of travel and expansion of humankind into previously undisturbed habitats have led to the reemergence of old fungi and new exposure to previously undescribed fungi. Until recently, relatively little was known about virulence factors for the medically important fungi. With the advent of molecular genetics, rapid progress has now been made in understanding the basis of pathogenicity for organisms such as Aspergillus species and Cryptococcus neoformans. The twin technologies of genetic transformation and "knockout" deletion construction allowed for genetic tests of virulence factors in these organisms. Such knowledge will prove invaluable for the rational design of antifungal therapies. Putative virulence factors and attributes are reviewed for Aspergillus species, C. neoformans, the dimorphic fungal pathogens, and others, with a focus upon a molecular genetic approach. Candida species are excluded from coverage, having been the subject of numerous recent reviews. This growing body of knowledge about fungal pathogens and their virulence factors will significantly aid efforts to treat the serious diseases they cause. PMID:8894347

Hogan, L H; Klein, B S; Levitz, S M

1996-01-01

21

Why Is It Important to Know My Family Medical History?  

MedlinePLUS

... is it important to know my family medical history? A family medical history is a record of ... professional regularly. For more information about family medical history: NIHSeniorHealth, a service of the National Institutes of ...

22

Computer-aided decision making for Medical Device Reporting  

E-print Network

COMPUTER ? AIDED DECISION MAKING FOR MEDICAL DEVICE REPORTING A Thesis By JIH ? HORN CHEN Submitted . to the Graduat. e College of Texas A &. M University in partial fulfillment of the requirements 1'or the degree of MASTER OF SCIENCE May... 1987 Ma, jor Sub?ject: Bioengineering COMPUTER ? AIDED DECISION MAKING FOR MEDICAL DEVICE REPORTING A Thesis By Jih ? Horn Chen Approved as to style and content by: William A rt Hyman (Chairman Committee) Hiller (Member) William cCain i ely...

Chen, Jih-Horn

2012-06-07

23

Symbolic decision support in medical care.  

PubMed

Symbolic decision procedures offer a flexible alternative to classical quantitative procedures for decision making, particularly when precise parameters (such as probabilities) are hard to estimate. One such procedure, based on a logic of argumentation, is described. Specifications of inference methods for such functions as proposing and refining decision options, deducing and inheriting arguments for and against options, and selecting among alternatives are presented. These exploit declarative models for patient data, domain and task knowledge. A simple method for translating the specifications into executable Prolog is described. A practical and efficient toolset for using the procedure in a wide range of clinical environments is being developed within the DILEMMA project of the European Commission's Advanced Informatics in Medicine research programme. PMID:8004142

Huang, J; Fox, J; Gordon, C; Jackson-Smale, A

1993-10-01

24

Developing a framework to support shared decision making for youth mental health medication treatment.  

PubMed

Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making. The framework includes three functional areas (1) setting the stage for youth shared decision making, (2) facilitating youth shared decision making, and (3) supporting youth shared decision making. While still in the formative stages, the value of a specific framework for a youth model in support of moving from a client-practitioner value system to a systematic, intentional process is evident. PMID:20571877

Crickard, Elizabeth L; O'Brien, Megan S; Rapp, Charles A; Holmes, Cheryl L

2010-10-01

25

Disruptive medical patients. Forensically informed decision making.  

PubMed Central

Patients who disrupt medical care create problems for physicians. The risks are not entirely clinical. Although these patients may compromise sound clinical judgment, some are also litigious and express their dissatisfaction in legal or other forums. It then becomes necessary for treating physicians to be aware of the legal and ethical boundaries of their patient care responsibilities. Some disruptive patients are treated by setting limits, which is usually affirmed by health care agreements. A hospital review board may advise clinicians on these agreements and on the management of disruptive patients. If termination of the physician-patient relationship is considered, physicians must follow proper protocol. We examine these forensic considerations and place them in the context of malpractice. Communication, consultation, and documentation are the key elements in reducing liability. PMID:1595274

Sparr, L. F.; Rogers, J. L.; Beahrs, J. O.; Mazur, D. J.

1992-01-01

26

Medical Decision Making in Clinical Care: Avoiding Common Errors  

E-print Network

4/8/13 1 Medical Decision Making in Clinical Care: Avoiding Common Errors Misbah Keen, MD, MBI, MPH University of Washington School of Medicine 04/2013 Objectives · Describe types of cognitive errors · Illustrate error types with exercises and clinical examples · Discuss strategies for avoiding cognitive

Maxwell, Bruce D.

27

How Numeracy Influences Risk Comprehension and Medical Decision Making  

PubMed Central

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. PMID:19883143

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

28

Modeling time in medical decision-support programs.  

PubMed

To derive meaningful conclusions in a changing medical setting, medical decision-support systems must represent and reason about the temporal nature of the clinical environments they attempt to model. Because all difficult medical problems have significant temporal features, designers of medical decision support systems must recognize the unique problems caused by representing and reasoning with temporal concepts. This report has three goals: 1) to describe a set of fundamental issues in creating and reasoning with computer models of a changing clinical environment, 2) to present a taxonomy for characterizing the temporal characteristics of computer models of temporal reasoning, and 3) to use this taxonomy to compare the models of time used in some implemented medical decision-support programs. From this examination, it is argued that computational models of time based on a single uniform representational or inferential method are limited by the expressive power of that method. Multiple modeling formalisms that express different temporal properties of the domain task and that work cooperatively are required to capture the subtlety and diversity of temporal features used in expert clinical problem solving. As an example of this approach, the author describes a program called TOPAZ that contains two temporal models that represent different temporal features of the clinical domain. PMID:1766328

Kahn, M G

1991-01-01

29

Minimum clinically important difference in medical studies.  

PubMed

In clinical trials, minimum clinically important difference (MCID) has attracted increasing interest as an important supportive clinical and statistical inference tool. Many estimation methods have been developed based on various intuitions, while little theoretical justification has been established. This article proposes a new estimation framework of the MCID using both diagnostic measurements and patient-reported outcomes (PROs). The framework first formulates the population-based MCID as a large margin classification problem, and then extends to the personalized MCID to allow individualized thresholding value for patients whose clinical profiles may affect their PRO responses. More importantly, the proposed estimation framework is showed to be asymptotically consistent, and a finite-sample upper bound is established for its prediction accuracy compared against the ideal MCID. The advantage of our proposed method is also demonstrated in a variety of simulated experiments as well as two phase-3 clinical trials. PMID:25327276

Hedayat, A S; Wang, Junhui; Xu, Tu

2014-10-18

30

Dual processing model of medical decision-making  

PubMed Central

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories). PMID:22943520

2012-01-01

31

[Aquatic animals of medical importance in Brazil].  

PubMed

The injuries caused by venomous and poisonous aquatic animals may provoke important morbidity in the victim. The cnidarians (jellyfishes, especially cubomedusas and Portuguese-Man-of-War) caused nearly 25% of 236 accidents by marine animals, while sea urchins were responsible for about 50% and catfish, stingrays and scorpionfish nearly 25%). In freshwater, stingrays and catfish cause injuries with a very similar mechanism to the poisoning and the effects of the toxins of marine species. In a series of about 200 injuries observed among freshwater fishermen, nearly 40% were caused by freshwater catfish, 5% freshwater stingrays and 55% by traumatogenic fish, such as piranhas and traíras. The author presents the aquatic animals that cause injuries to humans in Brazil, the clinical aspects of the envenoming and the first measures for the control of the severe pain observed mainly in the accidents caused by cnidarians and venomous fishes. PMID:14576874

Haddad Junior, Vidal

2003-01-01

32

An Ethical Hierarchy for Decision Making During Medical Emergencies  

PubMed Central

Evidence from well designed clinical trials may guide clinicians, reduce regional variation, and lead to improved outcomes. Many physicians choose to ignore evidence-based practice guidelines. Using unproven therapies outside of a randomized trial slows recruitment into clinical trials that could yield information on clinical and economic efficacy. Using acute stroke therapy as an illustration, we present an ethical hierarchy for therapeutic decision making during medical emergencies. First, physicians should offer standard care. If no standard care option exists, the physician should consider enrollment into a randomized clinical trial. If no trial is appropriate, the physician should consider a non-randomized registry, or consensus based guidelines. Finally, only after considering the first three options, the physician should use best judgment based on previous personal experience and any published case series or anecdotes. Given the paucity of quality randomized clinical trial data for most medical decisions, the “best judgment” option will be used most frequently. Nevertheless, such a hierarchy is needed because of the limited time during medical emergencies for consideration of general principles of clinical decision making. There should be general agreement in advance as to the hierarchy to follow in selecting treatment for critically ill patients. Were more clinicians to follow this hierarchy, and choose to participate in clinical trials, the generation of new knowledge would accelerate, yielding rigorous data supporting or refuting the efficacy and safety of new interventions more quickly, thus benefiting far more patients over time. PMID:20437578

Lyden, Patrick D.; Meyer, Brett C.; Hemmen, Thomas M.; Rapp, Karen S.

2010-01-01

33

When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions.  

PubMed

Abstract The balance between patient autonomy and medical paternalism must be reexamined. The tension between autonomy and paternalism is both an ethical and practical issue. Autonomy is the current gold standard approach to patient communication and has grown to the point that patient preference dictates care, even when their choices are not possible or are medically nonbeneficial. Furthermore, we have observed a trend among physicians to avoid making difficult medical decisions by hiding behind a shield of patient autonomy. Paternalism, characterized as the antithesis of autonomy, is widely dismissed as having any role in medicine. We disagree and believe that paternalism still has an important role in medical decision making. PMID:24588626

Roeland, Eric; Cain, Julia; Onderdonk, Chris; Kerr, Kim; Mitchell, William; Thornberry, Kathryn

2014-04-01

34

Decision support in medical practice: a physician's perspective  

NASA Astrophysics Data System (ADS)

A physician's decision support system consists of three components: (1) a comprehensive patient record and medical knowledge database, (2) information infrastructure for data storage, transfer, and (3) an analytical inference engine, accompanied by business operation database. Medical knowledge database provides the guideline for the selection of powerful clinical features or tests to be observed so that an accurate diagnosis as well as effective treatment can be quickly reached. With a tremendous amount of information stored in multiple data centers, it takes an effective information infrastructure to provide streamlined flow of information to the physician in a timely fashion. A real-time analytical inference engine mimics the physician's reasoning process. However due to incomplete, imperfect data and medical knowledge, a realistic output from this engine will be a list of options with associated confidence level, expected risk, so that the physician can make a well-informed final decision. Physicians are challenged to pursue the objective of ensuring an acceptable quality of care in an economically restrained environment. Therefore, business operation data have to be factored into the calculation of overall loss. Follow-up of diagnosis and treatment provides retrospective assessment of the accuracy and effectiveness of the existing inference engine.

Shieh, Yao-Yang; Roberson, Glenn H.

1998-03-01

35

What are the Essential Elements to Enable Patient Participation in Medical Decision Making?  

PubMed Central

BACKGROUND Patient participation in shared decision making (SDM) results in increased patient knowledge, adherence, and improved outcomes. Despite the benefits of the SDM model, many patients do not attain the level of participation they desire. OBJECTIVE To gain a more complete understanding of the essential elements, or the prerequisites, critical to active patient participation in medical decision making from the patient’s perspective. DESIGN Qualitative study. SETTING Individual, in-depth patient interviews were conducted until thematic saturation was reached. Two analysts independently read the transcripts and jointly developed a list of codes. PATIENTS Twenty-six consecutive subjects drawn from community dwelling subjects undergoing bone density measurements. MEASUREMENTS Respondents’ experiences and beliefs related to patient participation in SDM. RESULTS Five elements were repeatedly described by respondents as being essential to enable patient participation in medical decision making: (1) patient knowledge, (2) explicit encouragement of patient participation by physicians, (3) appreciation of the patient’s responsibility/rights to play an active role in decision making, (4) awareness of choice, and (5) time. LIMITATIONS The generalizability of the results is limited by the homogeneity of the study sample. CONCLUSIONS Our findings have important clinical implications and suggest that several needs must be met before patients can become active participants in decisions related to their health care. These needs include ensuring that patients (1) appreciate that there is uncertainty in medicine and “buy in” to the importance of active patient participation in decisions related to their health care, (2) understand the trade-offs related to available options, and (3) have the opportunity to discuss these options with their physician to arrive at a decision concordant with their values. PMID:17443368

McGraw, Sarah

2007-01-01

36

A Method for Analysis of Expert Committee Decision-Making Applied to FDA Medical Device Panels  

E-print Network

A Method for Analysis of Expert Committee Decision-Making Applied to FDA Medical Device Panels-Making Applied to FDA Medical Device Panels by David André Broniatowski Submitted to the Engineering Systems by which information is communicated in order to reach a decision. In particular, we focus on medical

de Weck, Olivier L.

37

A Thin Layer Chromatography Laboratory Experiment of Medical Importance  

ERIC Educational Resources Information Center

A thin layer chromatography experiment of medical importance is described. The experiment involves extraction of lipids from simulated amniotic fluid samples followed by separation, detection, and scanning of the lecithin and sphingomyelin bands on TLC plates. The lecithin-to-sphingomyelin ratio is calculated. The clinical significance of this…

Sharma, Loretta; Desai, Ankur; Sharma, Ajit

2006-01-01

38

An Information-Centric Framework for Designing Patient-Centered Medical Decision Aids and Risk Communication  

E-print Network

An Information-Centric Framework for Designing Patient-Centered Medical Decision Aids and Risk decision aids have met with success. Such decision aids typically have been designed for a general population and evaluated based on whether or not users of the decision aid can accurately report the data

Shneiderman, Ben

39

Decision-making methods that could be used to assess the value of medical  

E-print Network

Decision-making methods that could be used to assess the value of medical devices P1 D3 V1.2 050331 product subsequently fails to sell adequately. Managers therefore need robust decision- making tools in making such complex decisions: · The need to cast the decision in words, although most analytical tools

Oakley, Jeremy

40

A theory of medical decision making and health: fuzzy trace theory.  

PubMed

The tenets of fuzzy trace theory are summarized with respect to their relevance to health and medical decision making. Illustrations are given for HIV prevention, cardiovascular disease, surgical risk, genetic risk, and cancer prevention and control. A core idea of fuzzy trace theory is that people rely on the gist of information, its bottom-line meaning, as opposed to verbatim details in judgment and decision making. This idea explains why precise information (e.g., about risk) is not necessarily effective in encouraging prevention behaviors or in supporting medical decision making. People can get the facts right, and still not derive the proper meaning, which is key to informed decision making. Getting the gist is not sufficient, however. Retrieval (e.g., of health-related values) and processing interference brought on by thinking about nested or overlapping classes (e.g., in ratio concepts, such as probability) are also important. Theory-based interventions that work (and why they work) are presented, ranging from specific techniques aimed at enhancing representation, retrieval, and processing to a comprehensive intervention that integrates these components. PMID:19015287

Reyna, Valerie F

2008-01-01

41

Recovery of medically important microorganisms from Apollo astronauts  

NASA Technical Reports Server (NTRS)

Microbiological samples were obtained from the crewmembers of the Apollo 13, 14, 15, 16, and 17 spaceflights. These specimens were analyzed for the presence of medically important microorganisms with Staphylococcus aureus, Pseudomonas aeruginosa, Tricophyton mentagrophytes, Tricophyton rubrum, and Candida albicans being discussed in detail. Preflight isolation of crewmembers was found to coincide with a complete absence of inflight disease events and is recommended for future spaceflights. No autoinfection response (microbial shock) occurred after any of the reported spaceflights.

Taylor, G. R.

1974-01-01

42

Managing scientific uncertainty in medical decision making: the case of the advisory committee on immunization practices.  

PubMed

This article explores the question of how scientific uncertainty can be managed in medical decision making using the Advisory Committee on Immunization Practices as a case study. It concludes that where a high degree of technical consensus exists about the evidence and data, decision makers act according to a clear decision rule. If a high degree of technical consensus does not exist and uncertainty abounds, the decision will be based on a variety of criteria, including readily available resources, decision-process constraints, and the available knowledge base, among other things. Decision makers employ a variety of heuristic devices and techniques, thereby employing a pragmatic approach to uncertainty in medical decision making. The article concludes with recommendations for managing scientific uncertainty in medical decision making. PMID:22198966

Martinez, J Michael

2012-02-01

43

Medical diagnostic decision support systems--past, present, and future: a threaded bibliography and brief commentary.  

PubMed Central

Articles about medical diagnostic decision support (MDDS) systems often begin with a disclaimer such as, "despite many years of research and millions of dollars of expenditures on medical diagnostic systems, none is in widespread use at the present time." While this statement remains true in the sense that no single diagnostic system is in widespread use, it is misleading with regard to the state of the art of these systems. Diagnostic systems, many simple and some complex, are now ubiquitous, and research on MDDS systems is growing. The nature of MDDS systems has diversified over time. The prospects for adoption of large-scale diagnostic systems are better now than ever before, due to enthusiasm for implementation of the electronic medical record in academic, commercial, and primary care settings. Diagnostic decision support systems have become an established component of medical technology. This paper provides a review and a threaded bibliography for some of the important work on MDDS systems over the years from 1954 to 1993. PMID:7719792

Miller, R A

1994-01-01

44

Adolescent Pregnancy Decision-Making: Are Parents Important?  

ERIC Educational Resources Information Center

This paper examines the extent to which teenagers involve their parents in decision making on the resolution of unwanted conceptions, even though legalization of abortion allows them to terminate their pregnancies without parental knowledge. (RMH)

Rosen, Raye Hudson

1980-01-01

45

Case Based Reasoning for Medical Decision-Support in a Safety Critical Environment  

Microsoft Academic Search

\\u000a Case-based reasoning systems applied to safety-critical environments justify specific measures to ensure that the assistance\\u000a provided is not dangerous to human life. This article presents a case-based reasoning system developed for medical decision-support\\u000a in a safety-critical environment, the CARE- PARTNER system. Based on the evaluation of the reliability of the system, it stresses\\u000a the importance to differentiate between reliability and

Isabelle Bichindaritz; Carol Moinpour; Emin Kansu; Gary Donaldson; Nigel Bush; Keith M. Sullivan

2003-01-01

46

The Relationship between Career Decision Status and Important Work Outcomes  

ERIC Educational Resources Information Center

This paper describes a longitudinal study exploring the relationship between career decision status and work outcomes (i.e. job satisfaction, organizational commitment and performance) in a group of newly appointed graduates. Graduates employed into similar roles in a large Multinational Consultancy were tracked over 12 months at three time…

Earl, Joanne K.; Bright, Jim E. H.

2007-01-01

47

Medical decision making systems in pulmonology: a creative environment based on artificial neural networks  

Microsoft Academic Search

A powerful formation of artificial neural networks (ANNs) for implementing a medical decision making system (MDMS) in the field of the entire spectrum of pulmonary diseases (PDs), is the topic treated in this article. These ANNs were taught by means of real-world medical data patterns given by a team of PDs medical experts. Preliminary and more elaborate experiments showed an

G.-P. K. Economou; C. Spiropoulos; N. M. Economopoulos; N. Charokopos; D. Lymberopoulos; M. Spiliopoulou; E. Haralambopulu; C. E. Goutis

1994-01-01

48

The Integrated Medical Model - A Risk Assessment and Decision Support Tool for Human Space Flight Missions  

NASA Technical Reports Server (NTRS)

The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission planners and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight.

Kerstman, Eric; Minard, Charles G.; Saile, Lynn; FreiredeCarvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Lopez, Vilma

2010-01-01

49

Modeling Medical System Threats with Conditional Probabilities using Multiple-Valued Logic Decision  

E-print Network

the medical community in 2000 when it reported that more than two million serious medical errors occur every of the patient's symptoms, wrong treatment strategy selection, and errors in administration of the treatment [3Modeling Medical System Threats with Conditional Probabilities using Multiple-Valued Logic Decision

Thornton, Mitchell

50

The importance of time in ethical decision making.  

PubMed

Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both 'dramatic' issues, which constitute the dominant focus of bioethical decision making, and 'undramatic' issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of 'synchronizing' the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors. PMID:19671647

Monteverde, Settimio

2009-09-01

51

The role of medical schools in promoting social accountability through shared decision-making  

PubMed Central

Reducing health inequalities and enhancing the social accountability of medical students and physicians is a challenge acknowledged by medical educators and professionals. It is usually perceived as a macro-level, community type intervention. This commentary suggests a different approach, an interpersonal way to decrease inequality and asymmetry in power relations to improve medical decisions and care. Shared decision-making practices are suggested as a model that requires building partnership, bi-directional sharing of information, empowering patients and enhancing tailored health care decisions. To increase the implementation of shared decision-making practices in Israel, an official policy needs to be established to encourage the investment of resources towards helping educators, researchers, and practitioners translate and integrate it into daily practice. Special efforts should be invested in medical education initiatives to train medical students and residents in SDM practices. PMID:25075274

2014-01-01

52

Import market potential, import market competitiveness and add\\/drop foreign market decisions of US exporters of sewing machines  

Microsoft Academic Search

Two hypotheses concerning two variables that potentially influence the “add\\/drop” foreign market decisions of U.S. exporters of sewing machines are developed and empirically tested. The variables are import market potential, and a surrogate measure of import market competitiveness. A third variable, concerning a developing country’s “trade regime” – Import Substituting, Export Promoting (Bhagwati, 1978) – is employed as a control

Nicholas C. Williamson; Grace Kissling; Nancy Cassill; Dmitriy Odinokov

2005-01-01

53

Development and utilization of vignettes in assessing medical students' support of older and younger patients' medical decisions.  

PubMed

Currently no appropriate vignettes exist to examine issues of age-based care among students early in their medical careers. This paper addresses that issue in two parts. First, as the development of vignettes, widely used in medical research, is rarely described, suggestions for developing reliable and valid vignettes are presented. These suggestions are derived from the development of a series of vignettes assessing the support of older and younger patients' medical decisions among first year medical students. Second, the responses to the vignettes were analyzed quantitatively and qualitatively to assess potential age-based biases. Results indicate that students do not differ in their level of support for older and younger patients' medical decisions. However, students are more supportive of patients who desired aggressive treatments than of those who wished to end treatment. Many students did not focus on the age of the patient, but instead on the patient's quality of life. PMID:15312285

Schigelone, Amy Schiller; Fitzgerald, James T

2004-09-01

54

Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review  

Microsoft Academic Search

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs.To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand

Gilad J. Kuperman; Anne M. Bobb; Thomas H. Payne; Anthony J. Avery; Tejal K. Gandhi; Gerard Burns; David C. Classen; David W. Bates

2007-01-01

55

Perceived Importance of Ethics and Ethical Decisions in Marketing  

Microsoft Academic Search

This study investigates the influences of perceptions regarding the importance of ethics and social responsibility on ethical intentions of marketing professionals. It also investigates the effects of perceived ethical problems and gender on ethical intentions. The results, based on a survey of practitioner members of the American Marketing Association, revealed that a marketing professional’s perception regarding the importance of ethics

Anusorn Singhapakdi

1999-01-01

56

The Integrated Medical Model: A Decision Support Tool for In-flight Crew Health Care  

NASA Technical Reports Server (NTRS)

This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.

Butler, Doug

2009-01-01

57

Making Decisions about Cancer Prevention Medications for Breast Cancer  

Cancer.gov

In this study, women age 35 or older who discuss the use of drugs called SERMs for breast cancer prevention with a health care provider will be asked to complete a questionnaire about their discussion and whether they have come to a decision about using a SERM for risk reduction, as well as a second questionnaire about their decision-making process.

58

Individual Differences in Decision-Making and Confidence: Capturing Decision Tendencies in a Fictitious Medical Test  

ERIC Educational Resources Information Center

Decision-making is a complex process that is largely studied from an experimental perspective or in specific organizational contexts. As such, no generalizable framework exists with which to study decision-making from an individual differences perspective for predictive/selection purposes. By generalising a context-specific decision model proposed…

Jackson, Simon A.; Kleitman, Sabina

2014-01-01

59

Targeting Continuing Medical Education on Decision Makers: Who Decides to Transfuse Blood?  

ERIC Educational Resources Information Center

Staff communication patterns were observed during 13 open-heart surgeries to identify the transfusion decision makers. It was determined that targeting decision makers for continuing medical education would improve the quality of transfusion practice and increase the efficiency of continuing education. (SK)

Goodnough, Lawrence T.; And Others

1992-01-01

60

Evaluation of Psychological Factors in Medical School Admissions Decisions.  

ERIC Educational Resources Information Center

Medical school admissions committees are expected to select physicians with specific attributes such as intelligence, altruism, dutifulness, and compassion. Besides basing these attributes on the best professional judgment of the physicians and medical school faculty, there has been little quantitative research to determine the psychological…

Jones, Bonnie J.; Borges, Nicole J.

61

Differences in Simulated Doctor and Patient Medical Decision Making: A Construal Level Perspective  

PubMed Central

Background Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. Objective This study investigated the characteristics of and differences in doctor–patient medical decision making on the basis of construal level theory. Methods A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Results Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404?=?13.92, p?=?011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404?=?22.53, p<.001). The effect of framing on independent decision making was nonsignificant (F2, 404?=?1.07, p?=?35); however the effect of framing on the provision of advice to patients was significant (F2, 404?=?12.95, p<.001). The effect of construal level was significant in the positive frame (F1, 404?=?8.06, p?=?005) and marginally significant in the neutral frame (F2, 404?=?3.31, p?=?07) but nonsignificant in the negative frame (F2, 404?=?.29, p?=?59). Conclusion Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation. PMID:24244445

Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

2013-01-01

62

The template choice decision in meiosis: is the sister important?  

Microsoft Academic Search

Recombination between homologous chromosomes is crucial to ensure their proper segregation during meiosis. This is achieved\\u000a by regulating the choice of recombination template. In mitotic cells, double-strand break repair with the sister chromatid\\u000a appears to be preferred, whereas interhomolog recombination is favoured during meiosis. However, in the last year, several\\u000a studies in yeast have shown the importance of the meiotic

Mónica Pradillo; Juan L. Santos

63

The Context of Medical Decision-Making: An Analysis of Practitioner/Patient Communication.  

ERIC Educational Resources Information Center

This paper examines how the exchange of information in medical interviews is organized, and how that organization produces and constrains the negotiation of treatment decisions. The analysis is drawn from the verbatim transcripts of audio-taped practitioner/patient communications, information gathered from medical files, and other ethnographic…

Fisher, Sue

64

Decision-analytic modeling to evaluate benefits and harms of medical tests: uses and limitations.  

PubMed

The clinical utility of medical tests is measured by whether the information they provide affects patient-relevant outcomes. To a large extent, effects of medical tests are indirect in nature. In principle, a test result affects patient outcomes mainly by influencing treatment choices. This indirectness in the link between testing and its downstream effects poses practical challenges to comparing alternate test-and-treat strategies in clinical trials. Keeping in mind the broader audience of researchers who perform comparative effectiveness reviews and technology assessments, the authors summarize the rationale for and pitfalls of decision modeling in the comparative evaluation of medical tests by virtue of specific examples. Modeling facilitates the interpretation of test performance measures by connecting the link between testing and patient outcomes, accounting for uncertainties and explicating assumptions, and allowing the systematic study of tradeoffs and uncertainty. The authors discuss challenges encountered when modeling test-and-treat strategies, including but not limited to scarcity of data on important parameters, transferring estimates of test performance across studies, choosing modeling outcomes, and obtaining summary estimates for test performance data. PMID:19734441

Trikalinos, Thomas A; Siebert, Uwe; Lau, Joseph

2009-01-01

65

Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature  

PubMed Central

Background Patients are increasingly expected and asked to be involved in health care decisions. In this decision-making process, preferences for participation are important. In this systematic review we aim to provide an overview the literature related to the congruence between patients’ preferences and their perceived participation in medical decision-making. We also explore the direction of mismatched and outline factors associated with congruence. Methods A systematic review was performed on patient participation in medical decision-making. Medline, PsycINFO, CINAHL, EMBASE and the Cochrane Library databases up to September 2012, were searched and all studies were rigorously critically appraised. In total 44 papers were included, they sampled contained 52 different patient samples. Results Mean of congruence between preference for and perceived participation in decision-making was 60% (49 and 70 representing 25th and 75th percentiles). If no congruence was found, of 36 patient samples most patients preferred more involvement and of 9 patient samples most patients preferred less involvement. Factors associated with preferences the most investigated were age and educational level. Younger patients preferred more often an active or shared role as did higher educated patients. Conclusion This review suggests that a similar approach to all patients is not likely to meet patients’ wishes, since preferences for participation vary among patients. Health care professionals should be sensitive to patients individual preferences and communicate about patients’ participation wishes on a regular basis during their illness trajectory. PMID:24708833

2014-01-01

66

Using clinical decision support to maintain medication and problem lists A pilot study to yield higher patient safety  

Microsoft Academic Search

To investigate whether clinical decision support that automates the matching of ordered drugs to problems (clinical diagnoses) on the problem list can enhance the maintenance of both medication and problem lists in the electronic medical record, we designed a clinical decision support system to match ordered drugs on the medication list and ongoing problems on the problem list. We evaluated

Chiang S Jao; Daniel B Hier; William L Galanter

2008-01-01

67

Evidence-based medicine, medical decision analysis, and pathology  

Microsoft Academic Search

Recent advances in molecular pathology and other technologies such as proteomics present pathologists with the challenge of integrating the new information generated with high-throughput methods with current diagnostic models based mostly on histopathology and clinicopathologic correlations. Parallel developments in the field of medical informatics and bioinformatics provide the technical and mathematical methods to approach these problems in a rational manner.

Alberto M. Marchevsky; Mark R. Wick

2004-01-01

68

How Numeracy Influences Risk Comprehension and Medical Decision Making  

ERIC Educational Resources Information Center

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical…

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

69

Racial-Ethnic Biases, Time Pressure, and Medical Decisions  

ERIC Educational Resources Information Center

This study examined two types of potential sources of racial-ethnic disparities in medical care: implicit biases and time pressure. Eighty-one family physicians and general internists responded to a case vignette describing a patient with chest pain. Time pressure was manipulated experimentally. Under high time pressure, but not under low time…

Stepanikova, Irena

2012-01-01

70

The Effect of How Outcomes Are Framed on Decisions about Whether to Take Antihypertensive Medication: A Randomized Trial  

PubMed Central

Background We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000); negative framing over 10 years (the number that will have CVD) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS) increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on the second decision, both within groups and overall. Conclusions For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD (70 per 1000 over 10 years), both positive and negative framing resulted in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations. Trial Registration International Standard Randomised Controlled Trial Number Register ISRCTN 33771631 PMID:20209127

Carling, Cheryl L. L.; Kristoffersen, Doris Tove; Oxman, Andrew D.; Flottorp, Signe; Fretheim, Atle; Schünemann, Holger J.; Akl, Elie A.; Herrin, Jeph; MacKenzie, Thomas D.; Montori, Victor M.

2010-01-01

71

Watchfully waiting: medical intervention as an optimal investment decision.  

PubMed

Watchfully waiting involves monitoring a patient's health state over time and deciding whether to undertake a medical intervention, or to postpone it and continue observing the patient. In this paper, we consider the timing of medical intervention as an optimal stopping problem. The development of the patient's health state in the absence of intervention follows a stochastic process (geometric Brownian motion). Spontaneous recovery occurs in case the absorbing state of "good health" is reached. We determine optimal threshold values for initiating the intervention, and derive comparative statics results with respect to the model parameters. In particular, an increase in the degree of uncertainty over the patient's development in most cases makes waiting more attractive. However, this may not hold if the patient's health state has a tendency to improve. The model can be extended to allow for risk aversion and for sudden, Poisson-type shocks to the patient's health state. PMID:22425768

Meyer, Elisabeth; Rees, Ray

2012-03-01

72

The philosophical moment of the medical decision: revisiting emotions felt, to improve ethics of future decisions  

PubMed Central

The present investigation looks for a solution to the problem of the influence of feelings and emotions on our ethical decisions. This problem can be formulated in the following way. On the one hand, emotions (fear, pity and so on) can alter our sense of discrimination and lead us to make our wrong decisions. On the other hand, it is known that lack of sensitivity can alter our judgment and lead us to sacrifice basic ethical principles such as autonomy, beneficence, non?maleficence and justice. Only emotions can turn a decision into an ethical one, but they can also turn it into an unreasonable one. To avoid this contradiction, suggest integrating emotions with the decisional factors of the process of “retrospective thinking”. During this thinking, doctors usually try to identify the nature and impact of feelings on the decision they have just made. In this retrospective moment of analysis of the decision, doctors also question themselves on the feelings they did not experience. They do this to estimate the consequences of this lack of feeling on the way they behaved with the patient. PMID:17664307

Coz, Pierre Le; Tassy, Sebastien

2007-01-01

73

Application of probabilistic and fuzzy cognitive approaches in semantic web framework for medical decision support.  

PubMed

This study aimed to focus on medical knowledge representation and reasoning using the probabilistic and fuzzy influence processes, implemented in the semantic web, for decision support tasks. Bayesian belief networks (BBNs) and fuzzy cognitive maps (FCMs), as dynamic influence graphs, were applied to handle the task of medical knowledge formalization for decision support. In order to perform reasoning on these knowledge models, a general purpose reasoning engine, EYE, with the necessary plug-ins was developed in the semantic web. The two formal approaches constitute the proposed decision support system (DSS) aiming to recognize the appropriate guidelines of a medical problem, and to propose easily understandable course of actions to guide the practitioners. The urinary tract infection (UTI) problem was selected as the proof-of-concept example to examine the proposed formalization techniques implemented in the semantic web. The medical guidelines for UTI treatment were formalized into BBN and FCM knowledge models. To assess the formal models' performance, 55 patient cases were extracted from a database and analyzed. The results showed that the suggested approaches formalized medical knowledge efficiently in the semantic web, and gave a front-end decision on antibiotics' suggestion for UTI. PMID:23953959

Papageorgiou, Elpiniki I; Huszka, Csaba; De Roo, Jos; Douali, Nassim; Jaulent, Marie-Christine; Colaert, Dirk

2013-12-01

74

Survey of the Importance of Professional Behaviors among Medical Students, Residents, and Attending Physicians  

ERIC Educational Resources Information Center

Objective: The authors compared the importance of items related to professional behavior among medical students rotating through their psychiatry clerkship, psychiatry residents, and attending psychiatrists. Method: The authors sent an electronic survey with 43 items (rated on the scale 1: Not at All Important; to 5: Very Important) to medical

Morreale, Mary K.; Balon, Richard; Arfken, Cynthia L.

2011-01-01

75

Using cluster analysis for medical resource decision making.  

PubMed

Escalating costs of health care delivery have in the recent past often made the health care industry investigate, adapt, and apply those management techniques relating to budgeting, resource control, and forecasting that have long been used in the manufacturing sector. A strategy that has contributed much in this direction is the definition and classification of a hospital's output into "products" or groups of patients that impose similar resource or cost demands on the hospital. Existing classification schemes have frequently employed cluster analysis in generating these groupings. Unfortunately, the myriad articles and books on clustering and classification contain few formalized selection methodologies for choosing a technique for solving a particular problem, hence they often leave the novice investigator at a loss. This paper reviews the literature on clustering, particularly as it has been applied in the medical resource-utilization domain, addresses the critical choices facing an investigator in the medical field using cluster analysis, and offers suggestions (using the example of clustering low-vision patients) for how such choices can be made. PMID:8544677

Dilts, D; Khamalah, J; Plotkin, A

1995-01-01

76

Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records  

PubMed Central

Background Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. Discussion As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. Summary This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications. PMID:22047175

2011-01-01

77

Overriding parents' medical decisions for their children: a systematic review of normative literature.  

PubMed

This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question 'when health professionals and parents disagree about the appropriate course of medical treatment for a child,under what circumstances is the health professional ethically justified in overriding the parents' wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. Each of these frameworks centred on a different key moral concept including harm,constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. PMID:23824967

McDougall, Rosalind J; Notini, Lauren

2014-07-01

78

"Patient informatics": creating new partnerships in medical decision making.  

PubMed

The amassing of health information on the Internet and World Wide Web continues unabated. Patients anxious to participate in decisions about their own treatment have turned to the Internet to confirm diagnoses, validate physician-recommended treatment, or seek alternative therapies. While increased information for patients has been linked to improved outcomes, there are inherent dangers associated with the kind of unauthenticated information available on the Web. The authors discuss the nature of these dangers as well as review the advantages for patients of "information therapy" (improved access to health information). They also examine how the Internet has begun to affect the physician-patient relationship, and describe how the Internet and information technology can be effectively used by physicians in patient care. They recommend that the academic health sciences community seize the opportunity to take the lead in ensuring that patients have access to reliable health information, and suggest that "patient informatics" be integrated by academic physicians and educators into the teaching of clinical skills. PMID:9580718

Bader, S A; Braude, R M

1998-04-01

79

Partnered Decisions? U.S. Couples and Medical Help-Seeking for Infertility  

ERIC Educational Resources Information Center

We examined male partners' influence on the decision to seek medical help for infertility using the National Study of Fertility Barriers. Building upon an existing help-seeking framework, we incorporated characteristics of both partners from 219 heterosexual couples who had ever perceived a fertility problem. In logistic regression analyses, we…

Johnson, Katherine M.; Johnson, David R.

2009-01-01

80

On the origins and development of evidence-based medicine and medical decision making  

Microsoft Academic Search

The aims of this paper are to identify the issues and forces that were the impetus for two recent developments in academic medicine, evidence-based medicine (EBM) and medical decision making (MDM); to make explicit their underlying similarities and differences; and to relate them to the fates of these innovations. Both developments respond to concerns about practice variation; the rapid growth

A. S. Elstein

2004-01-01

81

The Allied Health Care Professional's Role in Assisting Medical Decision Making at the End of Life  

ERIC Educational Resources Information Center

As a patient approaches the end of life, he or she faces a number of very difficult medical decisions. Allied health care professionals, including speech-language pathologists (SLPs) and occupational therapists (OTs), can be instrumental in assisting their patients to make advance care plans, although their traditional job descriptions do not…

Lambert, Heather

2012-01-01

82

Improving appropriateness of acid-suppressive medication use via computerized clinical decision support.  

PubMed

As part of the Choosing Wisely Campaign, the Society of Hospital Medicine identified reducing inappropriate use of acid-suppressive medication for stress ulcer prophylaxis as 1 of 5 key opportunities to improve the value of care for hospitalized patients. We designed a computerized clinical decision support intervention to reduce use of acid-suppressive medication for stress ulcer prophylaxis in hospitalized patients outside of the intensive care unit at an academic medical center. Using quasiexperimental interrupted time series analysis, we found that the decision support intervention resulted in a significant reduction in use of acid-suppressive medication with stress ulcer prophylaxis selected as the only indication, a nonsignificant reduction in overall use, and no change in use on discharge. We found low rates of use of acid-suppressive medication for the purpose of stress ulcer prophylaxis even before the intervention, and continuing preadmission medication was the most commonly selected indication throughout the study. Our results suggest that attention should be focused on both the inpatient and outpatient settings when designing future initiatives to improve the appropriateness of acid-suppressive medication use. Journal of Hospital Medicine 2015;10:41-45. © 2015 Society of Hospital Medicine. PMID:25603790

Herzig, Shoshana J; Guess, Jamey R; Feinbloom, David B; Adra, May; Afonso, Kevin A; Howell, Michael D; Marcantonio, Edward R

2015-01-01

83

Social values as an independent factor affecting end of life medical decision making.  

PubMed

Research shows that the physician's personal attributes and social characteristics have a strong association with their end-of-life (EOL) decision making. Despite efforts to increase patient, family and surrogate input into EOL decision making, research shows the physician's input to be dominant. Our research finds that physician's social values, independent of religiosity, have a significant association with physician's tendency to withhold or withdraw life sustaining, EOL treatments. It is suggested that physicians employ personal social values in their EOL medical coping, because they have to cope with existential dilemmas posed by the mystery of death, and left unresolved by medical decision making mechanisms such as advanced directives and hospital ethics committees. PMID:24965073

Cohen, Charles J; Chen, Yifat; Orbach, Hedi; Freier-Dror, Yossi; Auslander, Gail; Breuer, Gabriel S

2015-02-01

84

[Subjectivity, decision and neurodegenerative diseases: reflexions on the role of the clinical psychologist in medical decision making].  

PubMed

Should a patient be forced to accept a treatment, especially when suffering from a neurodegenerative disease? We argue that physicians, nurses and care givers should instead accept his or her choice in accordance with the principle that every patient is an autonomous person able to make a choice, even in case of declined cognition. Beside the legal obligation, we suggest a theoretical approach and focus on the practical impacts of the patient's decision. Our objective is to promote the value of ethical doubt and attentive listening to individual opinions, so as to improve the quality of the medical staff's work and reduce patients' distress when affected by fatal diseases. PMID:23398961

Brocq, H; Liarte, A; Soriani, M-H; Desnuelle, C

2013-01-01

85

Medically important arboviruses of the United States and Canada.  

PubMed Central

Of more than 500 arboviruses recognized worldwide, 5 were first isolated in Canada and 58 were first isolated in the United States. Six of these viruses are human pathogens: western equine encephalitis (WEE) and eastern equine encephalitis (EEE) viruses (family Togaviridae, genus Alphavirus), St. Louis encephalitis (SLE) and Powassan (POW) viruses (Flaviviridae, Flavivirus), LaCrosse (LAC) virus (Bunyaviridae, Bunyavirus), and Colorado tick fever (CTF) virus (Reoviridae, Coltivirus). Their scientific histories, geographic distributions, virology, epidemiology, vectors, vertebrate hosts, transmission, pathogenesis, clinical and differential diagnoses, control, treatment, and laboratory diagnosis are reviewed. In addition, mention is made of the Venezuelan equine encephalitis (VEE) complex viruses (family Togaviridae, genus Alphavirus), which periodically cause human and equine disease in North America. WEE, EEE, and SLE viruses are transmitted by mosquitoes between birds; POW and CTF viruses, between wild mammals by ticks; LAC virus, between small mammals by mosquitoes; and VEE viruses, between small or large mammals by mosquitoes. Human infections are tangential to the natural cycle. Such infections range from rare to focal but are relatively frequent where they occur. Epidemics of WEE, EEE, VEE, and SLE viruses have been recorded at periodic intervals, but prevalence of infections with LAC and CTF viruses typically are constant, related to the degree of exposure to infected vectors. Infections with POW virus appear to be rare. Adequate diagnostic tools are available, but treatment is mainly supportive, and greater efforts at educating the public and the medical community are suggested if infections are to be prevented. PMID:8118792

Calisher, C H

1994-01-01

86

Chronic urticaria: importance of a medical-psychological approach.  

PubMed

Chronic urticaria is often associated with psychological factors, such as depression, anxiety and stress, which may play a role not only in the genesis of the disease but also in its evolution. Aims of this study were to evaluate the utility of psychological assessments (presence of depression, impact on the quality of life and incidence of "life events" before the beginning of urticaria) in conjunction with the allergological evaluation and to provide appropriate treatment to the patients selected. Thirty subjects diagnosed as Chronic Urticaria patients were submitted to psychological assessments (semi structured interview, Beck Depression Inventory, Nottingham health Profile and Dermatology Life Quality Index). The results of the evaluation show that most of the patients experienced a "stressor" event within the six months before the onset of the cutaneous manifestation. The incidence of depression resulted very high in comparison with the general population and in three cases at a severe level. The impact on the quality of life results to be moderate, but involving different fields of life (physical image, social life, quality of sleeping and eating, etc). Despite these results, only six patients accepted to be assigned to an appropriate treatment. In conclusion, we demonstrate the usefulness of a medical- psychological approach in chronic urticaria and we confirmed the resistance of psychosomatic patients to undergo psychological treatment. PMID:17058846

Berrino, A M; Voltolini, S; Fiaschi, D; Pellegrini, S; Bignardi, D; Minale, P; Troise, C; Maura, E

2006-05-01

87

76 FR 6694 - Disclosure of Medical Information to the Surrogate of a Patient Who Lacks Decision-Making Capacity  

Federal Register 2010, 2011, 2012, 2013

...to ensure an informed medical decision...Administration Privacy Officer, Office...obtaining the written consent of the patient...representative to make an informed decision regarding...Penalties, Privacy, Reporting and...Without Patient Consent'' preceding...surrogate to make an informed decision...

2011-02-08

88

Critical Issues for Psychiatric Medication Shared Decision Making With Youth and Families  

E-print Network

The primary aims of this article are to describe the current context for youth shared decision making (SDM) within the U.S. children’s mental health system and to identify important considerations for the development of ...

O'Brien, Megan S.; Crickard, Elizabeth L.; Rapp, Charles A.; Holmes, Cheryl L.; McDonald, Thomas P.

2010-01-01

89

Influence of Illness Script Components and Medical Practice on Medical Decision Making  

ERIC Educational Resources Information Center

Illness scripts are knowledge structures composed of consequences, enabling conditions, and faults. The effects of illness script components--consequences and enabling conditions--and physician factors on referral decisions for gastrointestinal disorders were investigated. The hypothesis that consequences and enabling conditions increase the…

van Schaik, Paul; Flynn, Darren; van Wersch, Anna; Douglass, Andrew; Cann, Paul

2005-01-01

90

Tenure and Promotion Decisions: The Relative Importance of Teaching, Scholarship, and Service  

ERIC Educational Resources Information Center

Research about the relative importance of faculty performance of teaching, scholarship, and service work roles in tenure and promotion decisions is reviewed and updated. Data collected from 130 deans or directors through Internet administration of the Work Role Salience Index (Green & Baskind, 2007) suggested some variation in the weighting of…

Green, Robert G.

2008-01-01

91

Dynamic Modeling of the SSDI Application Timing Decision: The Importance of Policy Variables  

Microsoft Academic Search

This paper analyzes the importance of policy variables in the context of Social Security Disability Insurance (SSDI) application timing decision. Previously, we explicitly modeled the optimal timing of SSDI application using dynamic structural models. We estimated these models using data from the Health and Retirement Study (HRS). This paper uses option value model estimates to simulate application timing under alternative

Richard V. Burkhauser; J. S. Butler; Gulcin Gumus

2003-01-01

92

Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol  

Microsoft Academic Search

BACKGROUND: In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute

Anne-Sophie Allaire; Michel Labrecque; Anik Giguère; Marie-Pierre Gagnon; Jeremy Grimshaw

2011-01-01

93

The Adoption of Electronic Medical Records and Decision Support Systems in Korea  

PubMed Central

Objectives To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. Methods Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance. Results Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals. Conclusions Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue. PMID:22084812

Yoo, Ki Bong; Kim, Eun Sook; Chae, Hogene

2011-01-01

94

Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)  

Microsoft Academic Search

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially

Cathy Charles; Amiram Gafni; Tim Whelan

1997-01-01

95

An integrated system supporting training in medical and administrative decision making in the emergency department.  

PubMed

The aim of the present project was the development of an integrated computer-based system supporting training in medical and administrative decision making in the Emergency Department. The system comprises of, first, a module supporting on-line acquaintance with Emergency Medical Guidelines, second, a vital-signs monitoring and processing module, and finally an administrative module organizing the most relevant facts about a patient's health status in compliance with the ASTM E2369-0 Standard Specification for Continuity of Care Record, in order to be employed after discharge from the Emergency Care to a hospital ward or to homecare. PMID:17945725

Spyropoulos, B; Tzavaras, A; Botsivaly, M; Moschidis, M; Koutsourakis, K

2006-01-01

96

An expert-guided decision tree construction strategy: an application in knowledge discovery with medical databases.  

PubMed Central

With the steady growth in electronic patient records and clinical medical informatics systems, the data collected for routine clinical use have been accumulating at a dramatic rate. Inter-disciplinary research provides a new generation of computation tools in knowledge discovery and data management is in great demand. In this study, an expert-guided decision tree construction strategy is proposed to offer an user-oriented knowledge discovery environment. The strategy allows experts, based on their expertise and/or preference, to override inductive decision tree construction process. Moreover, by reviewing decision paths, experts could focus on subsets of data that may be clues to new findings, or simply contaminated cases. PMID:9357618

Tsai, Y. S.; King, P. H.; Higgins, M. S.; Pierce, D.; Patel, N. P.

1997-01-01

97

Stroke, disability, and unconscious bias: interrelationships and over-determination in medical decisions.  

PubMed

Many factors influence what and how we communicate with patients after stroke. As physicians, we have a responsibility to examine our medical decisions and prognostication regarding each stroke patient. We must understand how many factors come into play in decisions regarding care, including perspectives that reflect the specific training of physicians in various specialties. How the physician responds to the patient with a stroke is highly individual. The more familiar the physician is with stroke recovery and the more time he or she has for individualized and less automatic approaches, the less likely decisions will be reflexive, based on bias. By examining our unconscious biases, we can provide individualized care that gives patients more latitude to create their own stories of recovery. PMID:21371985

Sandel, M Elizabeth

2011-01-01

98

Learning to improve medical decision making from imbalanced data without a priori cost.  

PubMed

BackgroundIn a medical data set, data are commonly composed of a minority (positive or abnormal) group and a majority (negative or normal) group and the cost of misclassifying a minority sample as a majority sample is highly expensive. This is the so-called imbalanced classification problem. The traditional classification functions can be seriously affected by the skewed class distribution in the data. To deal with this problem, people often use a priori cost to adjust the learning process in the pursuit of optimal classification function. However, this priori cost is often unknown and hard to estimate in medical decision making.MethodsIn this paper, we propose a new learning method, named RankCost, to classify imbalanced medical data without using a priori cost. Instead of focusing on improving the class-prediction accuracy, RankCost is to maximize the difference between the minority class and the majority class by using a scoring function, which translates the imbalanced classification problem into a partial ranking problem. The scoring function is learned via a non-parametric boosting algorithm.ResultsWe compare RankCost to several representative approaches on four medical data sets varying in size, imbalanced ratio, and dimension. The experimental results demonstrate that unlike the currently available methods that often perform unevenly with different priori costs, RankCost shows comparable performance in a consistent manner.ConclusionsIt is a challenging task to learn an effective classification model based on imbalanced data in medical data analysis. The traditional approaches often use a priori cost to adjust the learning of the classification function. This work presents a novel approach, namely RankCost, for learning from medical imbalanced data sets without using a priori cost. The experimental results indicate that RankCost performs very well in imbalanced data classification and can be a useful method in real-world applications of medical decision making. PMID:25480146

Wan, Xiang; Liu, Jiming; Cheung, William K; Tong, Tiejun

2014-12-01

99

Some important factors underlying ethical decisions of Middle-Eastern marketers  

Microsoft Academic Search

This study analyzes the marketing ethics decision-making process of Middle-Eastern marketers. In particular, it examines the relative influences of ethical perceptions, perceived importance of ethics, and age on ethical intentions of marketers in the Middle East. A self-administered questionnaire was used as the data collection technique for this study. Perception of ethical problem and ethical intention were operationalized by means

Janet K. Mullin Marta; Anusorn Singhapakdi; Ashraf Attia; Scott J. Vitell

2004-01-01

100

Importance of loss-of-benefits considerations in nuclear regulatory decision-making  

SciTech Connect

This paper identifies and discusses some of the important consequences of nuclear power plant unavailability, and quantifies a number of technical measures of loss of benefits that may help the Nuclear Regulatory Commission make decisions involving nuclear power plant licensing and operation. The loss-of-benefits analysis presented here is based on the results of a series of case studies developed by Argonne National Laboratory in cooperation with four electric utilities on hypothetical nuclear plant shutdowns.

Buehring, W.A.; Peerenboom, J.P.

1982-01-01

101

To Medicate or Not to Medicate?: The Decision-Making Process of Western Australian Parents Following Their Child's Diagnosis with an Attention Deficit Hyperactivity Disorder  

ERIC Educational Resources Information Center

This article examines the decision-making processes that Western Australian parents utilise when deciding whether to medicate or not to medicate their child diagnosed with Attention Deficit Hyperactivity Disorder. Thirty-three parents (five fathers and 28 mothers) from a wide range of socio-economic status suburbs in Perth, Western Australia were…

Taylor, Myra; O'Donoghue, Tom; Houghton, Stephen

2006-01-01

102

Abstract--Due to the immense volumes of medical data, the architecture of the future healthcare decision support systems  

E-print Network

based on interoperability of heterogeneous medical information systems. These systems are united FOR INTEROPERABILITY IN HEALTH CARE ENVIRONMENT Mo decision support systems focus more on interoperability than on integration. With the raising need

103

Does medical futility matter in 'do not attempt CPR' decision-making?  

PubMed

The current demographical trend towards an increasingly elderly population combined with advances in end of life care calls for a deeper understanding and common terminology about the concept of futility and additional influences on the resuscitation decision-making process. Such improved understanding of medical futility and other contributing factors when making DNACPR orders would help to ensure that clinicians make appropriate and thoughtful decisions on whether to recommend resuscitation in a patient. When estimating medical futility a physician should consider the chance of survival over different time periods and balance this against the chance of adverse outcomes. This information can then be offered to the patient (or the relatives) so that the patient's views about what is acceptable for the survival chance, length and type of survival can be factored into the eventual decision. Given the lack of evidence in this area and the poor level of patient knowledge and the emotive nature of the topic, it is not surprising that clinicians find such discussions hard. PMID:25269949

Kidd, A C; Honney, K; Myint, P K; Holland, R; Bowker, L K

2014-10-01

104

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Human Space Flight Missions  

NASA Technical Reports Server (NTRS)

This slide presentation reviews the Integrated Medical Model (IMM) and its use as a risk assessment and decision support tool for human space flight missions. The IMM is an integrated, quantified, evidence-based decision support tool useful to NASA crew health and mission planners. It is intended to assist in optimizing crew health, safety and mission success within the constraints of the space flight environment for in-flight operations. It uses ISS data to assist in planning for the Exploration Program and it is not intended to assist in post flight research. The IMM was used to update Probability Risk Assessment (PRA) for the purpose of updating forecasts for the conditions requiring evacuation (EVAC) or Loss of Crew Life (LOC) for the ISS. The IMM validation approach includes comparison with actual events and involves both qualitative and quantitaive approaches. The results of these comparisons are reviewed. Another use of the IMM is to optimize the medical kits taking into consideration the specific mission and the crew profile. An example of the use of the IMM to optimize the medical kits is reviewed.

Kerstman, Eric L.; Minard, Charles; FreiredeCarvalho, Mary H.; Walton, Marlei E.; Myers, Jerry G., Jr.; Saile, Lynn G.; Lopez, Vilma; Butler, Douglas J.; Johnson-Throop, Kathy A.

2011-01-01

105

Parent Perspectives on the Decision to Initiate Medication Treatment of Attention-Deficit/Hyperactivity Disorder  

PubMed Central

Abstract Objectives Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. Methods Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. Results Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and distorted ideas about treatment risks. Parents, however, took pride in successfully pursuing efforts to manage their child behaviorally and to avoid medication when possible. Conclusions Focus group data identified social, cognitive, and affective influences on treatment decision making. Results support prior research comparing family/social functioning, physician characteristics, and adherence. Findings suggest that parent attitudes to psychiatric care need to be assessed comprehensively at initial evaluation to aid the development of psychoeducational messages, and a more careful consideration about how parents interpret and respond to adherence-related questioning. PMID:22537185

Pappadopulos, Elizabeth; Katsiotas, Nikki J.; Berest, Alison; Jensen, Peter S.; Kafantaris, Vivian

2012-01-01

106

Critical issues for psychiatric medication shared decision making with youth and families  

E-print Network

Abstract. The primary aims of this paper are to describe the current context for youth shared decision making (SDM) within the U.S. children’s mental health system and to identify important considerations for the development of this approach as a...

O'Brien, Megan S.; Crickard, Elizabeth L.; Rapp, Charles A.; McDonald, Thomas P.

2011-01-01

107

Service-oriented medical system for supporting decisions with missing and imbalanced data.  

PubMed

In this paper, we propose a service-oriented support decision system (SOSDS) for diagnostic problems that is insensitive to the problems of the imbalanced data and missing values of the attributes, which are widely observed in the medical domain. The system is composed of distributed Web services, which implement machine-learning solutions dedicated to constructing the decision models directly from the datasets impaired by the high percentage of missing values of the attributes and imbalanced class distribution. The issue of the imbalanced data is solved by the application of a cost-sensitive support vector machine and the problem of missing values of attributes is handled by proposing the novel ensemble-based approach that splits the incomplete data space into complete subspaces that are further used to construct base learners. We evaluate the quality of the SOSDS components using three ontological datasets. PMID:24816614

Zieba, Maciej

2014-09-01

108

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients  

PubMed Central

Purpose of the Study Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Primary Practice Setting Four medical units at one urban, university medical center. Methodology and Sample A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports Clinicians? discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the Information with case managers. The experimental phase Included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). Results After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Implications for Case Management Practice Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more . time to work with high-risk admissions. PMID:24300427

Bowles, Kathryn H.; Hanlon, Alexandra; Holland, Diane; Potashnik, Sheryl L.; Topaz, Maxim

2014-01-01

109

The family and harmonious medical decision making: cherishing an appropriate Confucian moral balance.  

PubMed

This essay illustrates what the Chinese family-based and harmony-oriented model of medical decision making is like as well as how it differs from the modern Western individual-based and autonomy-oriented model in health care practice. The essay discloses the roots of the Chinese model in the Confucian account of the family and the Confucian view of harmony. By responding to a series of questions posed to the Chinese model by modern Western scholars in terms of the basic individualist concerns and values embedded in the modern Western model, we conclude that the Chinese people have justifiable reasons to continue to apply the Chinese model to their contemporary health care and medical practice. PMID:20855426

Chen, Xiaoyang; Fan, Ruiping

2010-10-01

110

Mobile chemical detector (AP2C+SP4E) as an aid for medical decision making in the battlefield.  

PubMed

The combination of the AP2C unit with the SP4E kit composes a lightweight mobile detector of chemical warfare agents (CWA), such as nerve and mustard agents, with both vapor- and liquid-sampling capabilities. This apparatus was recently introduced into our military medical units as an aid for detection of CWA on casualties. Importantly, critical information regarding the applicability in the battlefield was absent. In view of the serious consequences that might follow a proclamation of CWA recognition in battlefield, a high false-positive rate positions the utilization of this apparatus as a medical decision tool in question. We have therefore conducted a field experiment to test the false-positive rate as well as analyze possible factors leading to false-positive readings with this device. The experiment was carried out before and after a 4-day army field exercise, using a standard AP2C device, a SP4E surface sampling kit, and a specially designed medical sampling kit for casualties, intended for medical teams. Soldiers were examined at rest, after mild exercise, and after 4 days in the field. The readings with AP2C alone were compared to the combination of AP2C and SP4E and to the medical sampling kit. Various body fluids served as negative controls. Remarkably, we found a false-positive rate of 57% at rest and after mild exercise, and an even higher rate of 64% after the 4-day field exercise with the AP2C detector alone, as compared to almost no false-positive readings with the combination of AP2C and SP4E. Strikingly, the medical sampling kit has yielded numerous false-positive readings, even in normal body fluids such as blood, urine, and saliva. We therefore see no place for using the medical sampling kit due to an unaccepted high rate of false-positive readings. Finally, we have designed an algorithm that uses the entire apparatus of AP2C and SP4E as a reliable validation tool for medical triage in the setting of exposure to nerve agents in the battlefield. PMID:17937366

Eisenkraft, Arik; Markel, Gal; Simovich, Shirley; Layish, Ido; Hoffman, Azik; Finkelstein, Arseny; Rotman, Eran; Dushnitsky, Tsvika; Krivoy, Amir

2007-09-01

111

The importance of habitat resistance for movement decisions in the common lizard, Lacerta vivipara  

PubMed Central

Background Movement behaviour can be influenced by a multitude of biotic and abiotic factors. Here, we investigate the speed of movement in relation to environmental and individual phenotypic properties in subadult common lizards (Lacerta vivipara). We aim to disentangle the importance of substrate, cover, humidity, basking opportunity and individual phenotype on moving tendencies in 12 treatment combinations, at which each lizard was tested. Results We find that movement behaviour depends on the starting conditions, the physical properties of the dispersal corridor, and on the individuals’ phenotype. Specifically, the presence of cover and substrate providing suitable traction in the corridor had positive effects on individual movement decisions. Additionally, we find high phenotypic variation in the propensity to move dependent on the presence of cover. Individual back patterns also strongly affected movement decisions in interaction with the physical properties of the dispersal corridor. Conclusions Our results highlight the importance of understanding the habitat resistance for movement patterns, with humid habitats with covering vegetation providing the best conditions to initiate movement in the common lizard. In addition, population effects, differences in back pattern phenotype and individual plasticity were identified as key parameters influencing movement behaviour. PMID:22827893

2012-01-01

112

Medical Patients’ Treatment Decision Making Capacity: A Report from a General Hospital in Greece  

PubMed Central

This study aimed to assess the decision-making capacity for treatment of patients hospitalized in an internal medicine ward of a General Hospital in Greece, and to examine the views of treating physicians regarding patients’ capacity. All consecutive admissions to an internal medicine ward within a month were evaluated. A total of 134 patients were approached and 78 patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini Mental State Examination (MMSE) questionnaire. Sixty-eight out of 134 patients (50.7%) were incompetent to decide upon their treatment. The majority of them (n=56, 41.8%) were obviously incapable because they were unconscious, or had such marked impairment that they could not give their own names, and the rest (n=12, 8.9%) were rated as incompetent according to their performance in the MacCAT-T. Neurological disorders, old age and altered cognitive function according to MMSE were negatively correlated with decision making capacity. Physicians sometimes failed to recognize patients’ incapacity. Rates of decision-making incapacity for treatment in medical inpatients are high, and incapacity may go unrecognized by treating physicians. Combined patient evaluation with the use of the MacCAT-T and MMSE, could be useful for the determination of incapable patients. PMID:25505489

Bilanakis, Nikolaos; Vratsista, Aikaterini; Athanasiou, Eleni; Niakas, Dimitris; Peritogiannis, Vaios

2014-01-01

113

Important progress for the treatment of illnesses puts new demands on medical  

E-print Network

, autoimmune diseases (e.g. rheumatoid arthritis), neurodegenera- tive diseases (e.g. Alzheimer's diseaseImportant progress for the treatment of illnesses puts new demands on medical diagnostics. Earlier body. nanoTechnology for diagnosTics and TreaTMenT. The crux of this innovative project is nanoscopic

Zhao, Yuxiao

114

DNA and the classical way: Identification of medically important molds in the 21st century  

Microsoft Academic Search

The advent of the 21st century has seen significant advances in the methods and practices used for identification of medically important molds in the clinical microbiology laboratory. Historically, molds have been identified by using observa- tions of colonial and microscopic morphology, along with tables, keys and textbook descriptions. This approach still has value for the identification of many fungal organisms,

S. Arunmozhi Balajee; Lynne Sigler; Mary E. Brandt

2007-01-01

115

Field Guide to Venomous and Medically Important Invertebrates Affecting Military Operations: Identification, Biology, Symptoms, Treatment  

NSDL National Science Digital Library

A guide to stinging and biting invertebrates (prominently featuring insects and other arthropods) of the world. This guide is not meant for public dissemination nor sale, and was created primarily for military use. Types of interactions include envenomation, myiasis, urtication, allergic reactions as well as delusory parasitosis. The guide provides a good synopsis of most of the medically important insects and associated arthropods.

0000-00-00

116

Detection of a wide range of medically important fungi by the polymerase chain reaction  

Microsoft Academic Search

Summary. A polymerase chain reaction (PCR) method was developed that was capable of detecting a wide range of medically important fungi from clinical specimens. The primer pair was designed in conserved sequences of 1 8s-ribosomal RNA genes shared by most fungi. The lower limit of detection of this PCR technique was 1 pg of Cundidu ulbicans genomic DNA by ethidium

K. Makimura; SOMAY Y. MURAYAMA; H. Yamaguchi

1994-01-01

117

Abstract --Image segmentation plays an important role in medical image processing. The aim of conventional hard  

E-print Network

Abstract -- Image segmentation plays an important role in medical image processing. The aim within each voxel, which we call a mixture, was considered in establishing an image segmentation-EM mixture segmentation methodology was tested by digital phantom MR and patient CT images with PV effect

118

Mining Hierarchical Decision Rules from Clinical Databases Using Rough Sets aaand Medical Diagnostic Model  

Microsoft Academic Search

One of the most important problems on rule induction methods is that they cannot extract rules, which plausibly represent\\u000a experts’ decision processes. On one hand, rule induction methods induce probabilistic rules, the description length of which\\u000a is too short, compared with the experts’ rules. On the other hand, construction of Bayesian networks generates too lengthy\\u000a rules. In this paper, the

Shusaku Tsumoto

2002-01-01

119

Automated Discovery of Decision Rule Chains Using Rough Sets and Medical Diagnostic Model  

Microsoft Academic Search

One of the most important problems on rule induction methods is that they cannot extract rules, which plausibly represent\\u000a experts’ decision processes. On one hand, rule induction methods induce probabilistic rules, the description length of which\\u000a is too short, compared with the experts’ rules. On the other hand, construction of Bayesian networks generates too lengthy\\u000a rules. In this paper, the

Shusaku Tsumoto

2002-01-01

120

Most Important Factors for the Implementation of Shared Decision Making in Sciatica Care: Ranking among Professionals and Patients  

PubMed Central

Introduction Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy. Methods 246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor. Results Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75–4.99); importance of quick recovery of patient (RI 4.83; CI 4.69–4.97); and knowledge about treatment options (RI 6.64; CI 4.53–4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99–8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65–8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94–7.38), which were reported as barrier and facilitator. Conclusions Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training. PMID:24710328

Hofstede, Stefanie N.; van Bodegom-Vos, Leti; Wentink, Manon M.; Vleggeert-Lankamp, Carmen L. A.; Vliet Vlieland, Thea P. M.; de Mheen, Perla J. Marang-van

2014-01-01

121

The increasing importance of risk assessment and management in environmental decision-making  

SciTech Connect

Because environmental problems are growing and resources for dealing with them are shrinking, the environmental movement is witnessing an evolutionary shift toward greater emphasis on the use of risk assessment and management tools in setting environmental standards, determining levels of cleanup and deciding environmental program funding priorities. This change has important ramifications for the Department of Energy (DOE) and its national laboratories in terms of the costs of weapons facilities cleanup, the types of cleanup technology that will be emphasized and the way the DOE programs will be run. Other Federal agencies responsible for cleanup operations [e.g., the Environmental Protection Agency (EPA) and the Department of Defense (DOD)] will be similarly affected. This paper defines risk management and risk assessment and explains why these concepts will be of growing importance in the 1990s. It also defines other relevant terms. The paper develops a rationale for why risk assessment and management will be of increasing importance in environmental decision-making in the 1990s and beyond.

Jaksch, J.A.

1992-06-01

122

Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate.  

PubMed

In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students. In the deductive analysis (based on the push-pull theory), students reported push factors in Lebanon and pull factors abroad related to five dimensions. They focused predominantly on how training abroad provides them with a competitive advantage in an oversaturated Lebanese job market. An inductive analysis revealed the following emerging concepts: repel factors abroad and retain factors locally; societal expectations that students should train abroad; marketing of abroad training; and an established culture of migration. The marketing of abroad training and the culture of migration are prevalent in the academic institutions. PMID:17125896

Akl, Elie A; Maroun, Nancy; Major, Stella; Afif, Claude; Chahoud, Bechara; Choucair, Jacques; Sakr, Mazen; Schünemann, Holger J

2007-03-01

123

Medical technology decisions in The Netherlands: How to solve the dilemma of technology foresight versus market research?  

Microsoft Academic Search

In this article, we discuss a dilemma consisting of the market-oriented perspective of users of medical technology versus the long-term technology foresight perspective. The context of medical technology is interesting, because we have to cope with complex future-oriented multi-level and multi-actor strategic decision making. In order to deal with this dilemma we suggest combining the results of a (group) expert

Theo J. B. M. Postma; Janneke C. Alers; Sijmon Terpstra; Arjan Zuurbier

2007-01-01

124

Fuzzy Trace Theory and Medical Decisions by Minors: Differences in Reasoning between Adolescents and Adults  

PubMed Central

Standard models of adolescent risk taking posit that the cognitive abilities of adolescents and adults are equivalent, and that increases in risk taking that occur during adolescence are the result of socio emotional differences in impulsivity, sensation seeking, and lack of self-control. Fuzzy-trace theory incorporates these socio emotional differences. However, it predicts that there are also cognitive differences between adolescents and adults, specifically that there are developmental increases in gist-based intuition that reflects understanding. Gist understanding, as opposed to verbatim-based analysis, generally has been hypothesized to have a protective effect on risk taking in adolescence. Gist understanding is also an essential element of informed consent regarding risks in medical decision- making. Evidence thus supports the argument that adolescents’ status as mature minors should be treated as an exception rather than a presumption, because accuracy in verbatim analysis is not mature gist understanding. Use of the exception should be accompanied by medical experts’ input on the bottom-line gist of risks involved in treatment. PMID:23606728

Wilhelms, Evan A.

2013-01-01

125

Abstract--Forecasting of future electricity demand is very important for decision making in power system operation and  

E-print Network

Abstract--Forecasting of future electricity demand is very important for decision making in power industry, accurate forecasting of future electricity demand has become an important research area for secure operation, management of modern power systems and electricity production in the power generation

Ducatelle, Frederick

126

Gondishapur School of Medicine: the most important medical center in antiquity.  

PubMed

Iran has a rich civilization and a long history during which medical science flourished at specific periods. For instance, medicine blossomed in Sassanids era (226 - 652 AD). One of the most remarkable cultural and scientific centers of Sassanids era was the city of Gondishapur located in the south-west Iran in Shah-Abad near Susa in Khuzestan Province. The city was rebuilt in the third century AD, whereupon it soon became the most important scientific focal point of the ancient world. Gondishapur Medical School was a renowned cosmopolitan institution and had a crucial impact upon the further development of Islamic medicine. Actually, at this school, the Greek, Persian, and Indian medical heritage was conserved, developed, and it was then transferred to the Islamic world and subsequently to the West. Gondishapur Hospital was also an excellent model for establishment of hospitals especially in the Islamic countries. Presented here is a brief account of the foundation of Gondishapur School of Medicine and its role in promoting medical science in antiquity. PMID:18154434

Azizi, Mohammad-Hossein

2008-01-01

127

End-of-Life Decisions: An Important Theme in the Care for People with Intellectual Disabilities  

ERIC Educational Resources Information Center

Background: While end-of-life decisions in the general population have received attention in several countries, not much is known about this in people with intellectual disabilities (IDs). Therefore, the prevalence and nature of end-of-life decisions were investigated in a Dutch centre providing residential care for 335 people with IDs. Method: A…

Wagemans, A.; van Schrojenstein Lantman-de-Valk, H.; Tuffrey-Wijne, I.; Widdershoven, G.; Curfs, L.

2010-01-01

128

The Importance and Impact of Three Significant Political Decisions upon Higher Education in Tennessee.  

ERIC Educational Resources Information Center

Three key political decisions made in Tennessee higher education that have brought about major changes in structure and have implications for the future are discussed. The decisions are: creation of the Tennessee Higher Education Commission (THEC) in 1967, the creation of the State Board of Regents (SBR) in 1972, and the establishment of the…

Tennessee Higher Education Commission, Nashville.

129

Counseling About Medication-Induced Birth Defects with Clinical Decision Support in Primary Care  

PubMed Central

Abstract Background We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior. Methods Between October 2008 and April 2010, all women aged 18–50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5–30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse. Results Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26–3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling. Conclusions Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception. PMID:23930947

Parisi, Sara M.; Handler, Steven M.; Koren, Gideon; Shevchik, Grant; Fischer, Gary S.

2013-01-01

130

Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study†  

PubMed Central

Background Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? Aims To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. Method A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool - Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability. Results Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P = 0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P = 0.02). Conclusions Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting. PMID:23969482

Owen, Gareth S.; Szmukler, George; Richardson, Genevra; David, Anthony S.; Raymont, Vanessa; Freyenhagen, Fabian; Martin, Wayne; Hotopf, Matthew

2013-01-01

131

Changing attitudes about end-of-life decision making of medical students during third-year clinical clerkships.  

PubMed

To better define the learning objectives of ethics curricula and evaluate changes in medical students' attitudes about end-of-life decision making, enrolled students (N = 96) of a pilot medical ethics program were surveyed at the beginning and end of their third-year clinical clerkship about their experiences and attitudes about end-of-life decision making. At the end of their clinical clerkship year, the majority of students had participated in end-of-life decisions, prioritized patient autonomy and quality-of-life issues, were concerned about legal liability, were polarized over issues such as physician-assisted suicide, and gained confidence in their ethical decision-making ability. To train future physicians such that clinical practice is consistent with ethical guidelines and legislation on end-of-life care, medical ethics curricula should focus on symptom relief, clarification of legal issues, and resolution of conflicts between personal beliefs and public opinion about such issues as physician-assisted suicide. Appropriate role-modeling and mentoring by residents and attending physicians should also be emphasized. PMID:10341532

Hayes, R P; Stoudemire, A S; Kinlaw, K; Dell, M L; Loomis, A

1999-01-01

132

Sequential versus concurrent computation of complex model systems for medical decision support.  

PubMed

Medical Decision Support Systems employ mathematical models to optimize therapy settings. The mathematical models are used to predict patient reactions towards alteration in the therapy regime. This prediction should not be limited to one detail but should feature a broad picture. A previously proposed framework is able to dynamically combine submodels of three model families (respiratory mechanics, gas exchange and cardiovascular dynamics) to form a complex, interacting model system. When concurrent computation of the combined submodels is employed, tests exhibited high computing costs. Therefore, a sequential computing approach is introduced. Thereby, direct interaction between the submodels is not applicable as all submodels are computed individually. To simulate submodel interaction, interface signals that are normally present in the concurrent approach were precalculated using reduced models of respiratory mechanics and cardiovascular dynamics. Evaluation of the new approach showed that results feature a discrepancy lower than 2.5% compared to the results computed by the concurrent approach. Simulation error could be decreased to 2% by improving the precalculation of the interface signals. Computing costs have been decreased by a factor of 17. PMID:22254268

Kretschmer, Joern; Moeller, Knut

2011-01-01

133

A markov decision process model for the optimal dispatch of military medical evacuation assets.  

PubMed

We develop a Markov decision process (MDP) model to examine aerial military medical evacuation (MEDEVAC) dispatch policies in a combat environment. The problem of deciding which aeromedical asset to dispatch to each service request is complicated by the threat conditions at the service locations and the priority class of each casualty event. We assume requests for MEDEVAC support arrive sequentially, with the location and the priority of each casualty known upon initiation of the request. The United States military uses a 9-line MEDEVAC request system to classify casualties as being one of three priority levels: urgent, priority, and routine. Multiple casualties can be present at a single casualty event, with the highest priority casualty determining the priority level for the casualty event. Moreover, an armed escort may be required depending on the threat level indicated by the 9-line MEDEVAC request. The proposed MDP model indicates how to optimally dispatch MEDEVAC helicopters to casualty events in order to maximize steady-state system utility. The utility gained from servicing a specific request depends on the number of casualties, the priority class for each of the casualties, and the locations of both the servicing ambulatory helicopter and casualty event. Instances of the dispatching problem are solved using a relative value iteration dynamic programming algorithm. Computational examples are used to investigate optimal dispatch policies under different threat situations and armed escort delays; the examples are based on combat scenarios in which United States Army MEDEVAC units support ground operations in Afghanistan. PMID:25223847

Keneally, Sean K; Robbins, Matthew J; Lunday, Brian J

2014-09-16

134

76 FR 63600 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...  

Federal Register 2010, 2011, 2012, 2013

...APHIS-2011-0039] Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit From South Africa Into the Continental United States Correction In notice document 2011-25490 appearing on pages 61340-61341 in the...

2011-10-13

135

The Importance of Ethical Training for the Improvement of Ethical Decision-Making: Evidence from Germany and the United States  

ERIC Educational Resources Information Center

Based on three independent samples from Germany and the United States, this exploratory, cross-cultural study examines empirically the importance of ethical training for the improvement of ethical decision-making. The results of the study reveal a significant difference in the use of corporate codes of conduct and ethical training, as well as…

Rottig, Daniel; Heischmidt, Kenneth A.

2007-01-01

136

Importance of free access to research articles on decision to submit to the BMJ: survey of authors  

Microsoft Academic Search

Objectives To determine whether free access to research articles on bmj.com is an important factor in authors' decisions on whether to submit to the BMJ, whether the introduction of access controls to part of the BMJ's content has influenced authors' perceptions of the journal, and whether the introduction of further access controls would influence authors' perceptions. Design Cross sectional electronic

Sara Schroter

2006-01-01

137

Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.  

PubMed

In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care. PMID:21391078

Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

2011-01-01

138

An effect of communication on medical decision making: answerability, and the medically induced death of Paul Mills.  

PubMed

In this essay, the occasion of a medically induced death is examined to illustrate how circumstances surrounding a medically induced death are interpreted through a theory of how social agents, on occasion, respond inappropriately. The essay illustrates and assesses an occasion when a health professional, faced with a medical crisis that was laden with professional, ethical, and even legal considerations, responded in a manner that overlooked all those standards when she injected potassium chloride into her patient, Paul Mills. In the essay, the case is chronicled and the character of the social and communicative mechanism that led to the disaster is given and used to interpret the events. PMID:17617015

Kenny, R Wade

2007-01-01

139

Recovery and Resilience After a Nuclear Power Plant Disaster: A Medical Decision model for Managing an Effective, Timely, and Balanced Response  

SciTech Connect

Based on experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, a real-time, medical decision model is presented by which to make key health-related decisions given the central role of health and medical issues in such disasters. Focus is on response and recovery activities that are safe, timely, effective, and well-organized. This approach empowers on-site decision makers to make interim decisions without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Key features of this approach include ongoing assessment, consultation, information, and adaption to the changing conditions. This medical decision model presented is compatible with the existing US National Response Framework structure.

Coleman, C. Norman [National Cancer Institute, NIH; Blumenthal, Daniel J. [National Nuclear Security Administration (NNSA), Department of Energy

2013-05-01

140

Biomass Burning Emissions ? The Importance of Reducing Uncertainties for Improved Regulatory Decision; an EPA Perspective  

EPA Science Inventory

Biomass burning emissions from wildland and prescribed fires can have far reaching impacts in several of EPA?s regulatory programs under the Clean Air Act, ultimately affecting decisions on actions taken under State Implementation Plans (SIPs), and programs such as Visibility and...

141

Protocetraric acid: an excellent broad spectrum compound from the lichen Usnea albopunctata against medically important microbes.  

PubMed

The aim of this study was to investigate the antimicrobial property of the compounds present in the lichen Usnea albopunctata. Ethyl acetate extract of the lichen was purified by column chromatography to yield a major compound which was characterised by spectroscopic methods as protocetraric acid. In this study, protocetraric acid recorded significant broad spectrum antimicrobial property against medically important human pathogenic microbes. The prominent antibacterial activity was recorded against Salmonella typhi (0.5 ?g/mL). Significant antifungal activity was recorded against Trichophyton rubrum (1 ?g/mL), which is significantly better that the standard antifungal agent. Protocetraric acid is reported here for the first time from U. albopunctata. Thus the results of this study suggest that protocetraric acid has significant antimicrobial activities and has a strong potential to be developed as an antimicrobial drug against pathogenic microbes. PMID:25174415

Nishanth, Kumar S; Sreerag, R S; Deepa, I; Mohandas, C; Nambisan, Bala

2015-03-01

142

Evaluation of commercial serologic test reagents for immunoidentification of medically important aspergilli.  

PubMed

We evaluated commercial serodiagnostic test reagents from Greer Laboratories (GL), Lenoir, NC; Immuno-mycologics, Inc. (IMI), Norman, OK; and Scott Laboratories (SL), Fiskville, RI; for their ability to detect Aspergillus spp. exoantigens and group them in their proper series. We detected 87 culture extracts from coded cultures of Aspergillus groups and heterologous fungi against anti-A. fumigatus, A. flavus, A. nidulans, A. niger, and A. terreus sera in the presence of their corresponding antigens. Parallel control studies were performed using serological reagents from both laboratories. The IMI reagents accurately grouped all the isolates. The A. nidulans and A. terreus reactions, however, were significantly weaker than those noted with the control reagents. GL and SL do not supply A. nidulans and A. terreus reagents. Their available reagents correctly grouped the A. fumigatus, A. flavus, and A. niger isolates. Our results indicate that the commercial serodiagnostic reagents for aspergillosis can be effectively used to accurately immunoidentify the medically important Aspergillus spp. PMID:3126020

Sekhon, A S; Standard, P G; Kaufman, L; Garg, A K

1987-11-01

143

Investigation on American cockroaches medically important bacteria in Khorramshahr hospital, Iran  

PubMed Central

Objective To investigate American cockroaches' infection to various bacteria in Khorramshahr Vali-e-Asr hospital, which was done in 2008. Methods In this descriptive cross-sectional study, 20 American cockroaches were caught via direct collection. Medically important bacteria were extracted from their outer surface of bodies by standard procedures. Results Culturing outer surface wash of cockroaches resulted in the separation of Klebsiella, Pseudomonas, Escherichia coli, Staphylococcus, Proteus and Streptococcus. The main common bacteria were Klebsiella (35%) and Pseudomonas (30%). Also, results of culture media showed that about 90% of cockroaches infected to at least one bacterium. Conclusions American cockroaches can transmit pathogenic and potential pathogenic bacteria, therefore their presence in hospitals may be a sanitation challenge. It is recommended to assess plans in purpose to combat these pests in the hospitals.

Kassiri, Hamid; Kassiri, Ali; Kazemi, Shahnaz

2014-01-01

144

Single-cell force spectroscopy of the medically important Staphylococcus epidermidis-Candida albicans interaction.  

PubMed

Despite the clinical importance of bacterial-fungal interactions, their molecular details are poorly understood. A hallmark of such medically important interspecies associations is the interaction between the two nosocomial pathogens Staphylococcus aureus and Candida albicans, which can lead to mixed biofilm-associated infections with enhanced antibiotic resistance. Here, we use single-cell force spectroscopy (SCFS) to quantify the forces engaged in bacterial-fungal co-adhesion, focusing on the poorly investigated S. epidermidis-C. albicans interaction. Force curves recorded between single bacterial and fungal germ tubes showed large adhesion forces (~5 nN) with extended rupture lengths (up to 500 nm). By contrast, bacteria poorly adhered to yeast cells, emphasizing the important role of the yeast-to-hyphae transition in mediating adhesion to bacterial cells. Analysis of mutant strains altered in cell wall composition allowed us to distinguish the main fungal components involved in adhesion, i.e. Als proteins and O-mannosylations. We suggest that the measured co-adhesion forces are involved in the formation of mixed biofilms, thus possibly as well in promoting polymicrobial infections. In the future, we anticipate that this SCFS platform will be used in nanomedicine to decipher the molecular mechanisms of a wide variety of pathogen-pathogen interactions and may help in designing novel anti-adhesion agents. PMID:24057018

Beaussart, Audrey; Herman, Philippe; El-Kirat-Chatel, Sofiane; Lipke, Peter N; Kucharíková, So?a; Van Dijck, Patrick; Dufrêne, Yves F

2013-11-21

145

Domains of Importance for Parents, Medical Professionals, and Youth with Cerebral Palsy Considering Treatment Outcomes  

PubMed Central

Background The aim of this study was to assess the domains of importance in therapeutic intervention for cerebral palsy (CP) using categories of the International Classification of Functioning, Disability, and Health - Version for Children & Youth (ICF-CY). Methods 17 youth, 19 parents and 39 medical professionals responded to the open-ended query: “What are the things you find most important to consider when you evaluate the effects of an intervention for yourself/your child/your patient with cerebral palsy?” Surveys were either mailed or conducted on-line. Responses were coded by two reviewers using the ICF-CY and discrepancies were resolved. Results Responses were distributed across the ICF-CY domains of Body Functions and Structures, Activities and Participation, and Environmental Factors, as well as non-ICF-CY concepts including quality of life. The most common responses overall were pain, motor function, mobility, community life, and public services. Youth identified strength, gait pattern, hand/arm use, and use of assistive technologies as priorities whereas parents were concerned with motor function, communication, mobility, and provision of public services. Medical professionals listed pain, function, mobility, community life, and participation most often. Conclusions All surveyed groups indicate a desire to see changes in body functions and structures (pain, mental function, strength, movement), activities and participation (communication, hand/arm use, walking, school, recreation/community life), and quality of life following therapeutic interventions for CP. These results demonstrate the multiple, varied concerns regarding CP across the spectrum of functioning and health. PMID:20637027

Vargus-Adams, Jilda N.; Martin, Lauren K.

2010-01-01

146

What influences clinicians' decisions about ADHD medication? Initial data from the Influences on Prescribing for ADHD Questionnaire (IPAQ).  

PubMed

Despite evidence for its efficacy and effectiveness, the use of medication for the treatment of ADHD remains controversial. Little is known about the factors that influence clinicians' decisions to use medication for ADHD. Here, we present initial data on the attitudes of prescribing clinicians from the Influences on Prescribing for ADHD Questionnaire (IPAQ)-a new clinician-completed, 40-item scale. The eight IPAQ subscales cover attitudes towards (1) treatment outcome optimisation, (2) the use of rule based over more informal approaches, (3) side effects, (4) symptoms control as the primary goal of treatment, (5) the influence of external pressure on medication-related decisions, (6) the value of taking the child's views into account, (7) long-term medication use and (8) the value of psychosocial approaches for the treatment of ADHD. Sixty-eight clinicians from Belgium and the UK took part. All subscales had acceptable levels of internal reliability (Chronbach's alpha = 0.62-0.78). Overall, clinicians reported taking a rule-based approach to prescribing with a focus on treatment optimisation, taking the child's view into account and valuing psycho-social approaches. They focused on treating broader patterns of impairment, but were wary of the potential side effects and long-term treatment. Psychiatrists scored high on their focus on symptom control and preference for long-term medication use, while paediatricians reported using more rule-based approaches. We identified four distinctive response profiles: (1) pro-psychosocial; (2) medication focused; (3) unsystematic; and (4) response optimizers. Future larger scale studies are required to replicate these profiles and to explore their relationship with prescribing behaviour and treatment outcomes. PMID:23455602

Kovshoff, Hanna; Vrijens, May; Thompson, Margaret; Yardley, Lucy; Hodgkins, Paul; Sonuga-Barke, Edmund J S; Danckaerts, Marina

2013-09-01

147

The Use of Art in the Medical Decision-Making Process of Oncology Patients  

ERIC Educational Resources Information Center

The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

Czamanski-Cohen, Johanna

2012-01-01

148

The Use of Art in the Medical Decision-Making Process of Oncology Patients  

Microsoft Academic Search

The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy group. Narrative analysis of art and interview data revealed

Johanna Czamanski-Cohen

2012-01-01

149

New Technology Provides Urgent Medical Information and Protects Privacy: Providing Important Information in Medical Situations for the Developmentally Disabled  

ERIC Educational Resources Information Center

Fernando Viesca has a 24-year-old son who suffers from Angelman Syndrome, a little known chromosomal disorder that has left him with significant functional deficiencies. When Nando lived at home, his father took care of him full time, thus alleviating any worries about medical care. However, now that Nando lives in a group home, his father is no…

Seelig, Richard

2006-01-01

150

Publication trends of shared decision making in 15 high impact medical journals: a full-text review with bibliometric analysis  

PubMed Central

Background Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. Methods We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase “shared decision making” or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. Results We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P?medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community. PMID:25106844

2014-01-01

151

The preferences of users of electronic medical records in hospitals: quantifying the relative importance of barriers and facilitators of an innovation  

PubMed Central

Background Currently electronic medical records (EMRs) are implemented in hospitals, because of expected benefits for quality and safety of care. However the implementation processes are not unproblematic and are slower than needed. Many of the barriers and facilitators of the adoption of EMRs are identified, but the relative importance of these factors is still undetermined. This paper quantifies the relative importance of known barriers and facilitators of EMR, experienced by the users (i.e., nurses and physicians in hospitals). Methods A discrete choice experiment (DCE) was conducted among physicians and nurses. Participants answered ten choice sets containing two scenarios. Each scenario included attributes that were based on previously identified barriers in the literature: data entry hardware, technical support, attitude head of department, performance feedback, flexibility of interface, and decision support. Mixed Multinomial Logit analysis was used to determine the relative importance of the attributes. Results Data on 148 nurses and 150 physicians showed that high flexibility of the interface was the factor with highest relative importance in their preference to use an EMR. For nurses this attribute was followed by support from the head of department, presence of performance feedback from the EMR and presence of decisions support. While for physicians this ordering was different: presence of decision support was relatively more important than performance feedback and support from the head of department. Conclusion Considering the prominent wish of all the intended users for a flexible interface, currently used EMRs only partially comply with the needs of the users, indicating the need for closer incorporation of user needs during development stages of EMRs. The differences in priorities amongst nurses and physicians show that different users have different needs during the implementation of innovations. Hospital management may use this information to design implementation trajectories to fit the needs of various user groups. PMID:24898277

2014-01-01

152

A method for analysis of expert committee decision-making applied to FDA medical device panels  

E-print Network

Committees of experts are critical for decision-making in engineering systems. This is because the complexity of these systems requires that information is pooled from across multiple specialties and domains of knowledge. ...

Broniatowski, David André, 1982-

2010-01-01

153

78 FR 55244 - Notice of Availability of Record of Decision for Medical Facilities Development and University...  

Federal Register 2010, 2011, 2012, 2013

...provide adequate education and research space to meet Military Health...level education to the military medical community and enable USU to serve as the core academic health research center at WRNMMC. The proposed...missions of the installation, medical center, or the USU....

2013-09-10

154

78 FR 25692 - Notice of Decision To Authorize the Importation of Fresh Barhi Dates From Israel  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh dates of the cultivar Barhi from Israel. In addition, based on the findings of a treatment...

2013-05-02

155

78 FR 42153 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation  

Federal Register 2010, 2011, 2012, 2013

...Vehicle Safety Standards. Vehicle Eligibility Number For Subject Vehicles: The importer of a vehicle admissible under any final...vehicle is eligible for entry. Vehicle eligibility numbers assigned to vehicles admissible under this...

2013-07-15

156

75 FR 34524 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation  

Federal Register 2010, 2011, 2012, 2013

...decided to grant the petitions. Vehicle Eligibility Number for Subject Vehicles The importer of a vehicle admissible under any final...vehicle is eligible for entry. Vehicle eligibility numbers assigned to vehicles admissible under this...

2010-06-17

157

Coupling Clinical Decision Support System with Computerized Prescriber Order Entry and their Dynamic Plugging in the Medical Workflow System  

E-print Network

This work deals with coupling Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE) and their dynamic plugging in the medical Workflow Management System (WfMS). First, in this paper we argue some existing CDSS representative of the state of the art in order to emphasize their inability to deal with coupling with CPOE and medical WfMS. The multi-agent technology is at the basis of our proposition since (i) it provides natural abstractions to deal with distribution, heterogeneity and autonomy which are inherent to the previous systems (CDSS, CPOE and medical WfMS), and (ii) it introduces powerful concepts such as organizations, goals and roles useful to describe in details the coordination of the different components involved in these systems. In this paper, we also propose a Multi-Agent System (MAS) to support the coupling CDSS with CPOE. Finally, we show how we integrate the proposed MAS in the medical workflow management system which is also based on collaborating agents

Bouzguenda, Lotfi

2012-01-01

158

Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology.  

PubMed

Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the application of this knowledge within the medical field in comparison to the dental field, which is heavily skill-based. PMID:24903861

Olowo-Ofayoku, Anthony; Moxham, Bernard John

2014-10-01

159

Identification of Medically Important Yeast Species by Sequence Analysis of the Internal Transcribed Spacer Regions  

PubMed Central

Infections caused by yeasts have increased in previous decades due primarily to the increasing population of immunocompromised patients. In addition, infections caused by less common species such as Pichia, Rhodotorula, Trichosporon, and Saccharomyces spp. have been widely reported. This study extensively evaluated the feasibility of sequence analysis of the rRNA gene internal transcribed spacer (ITS) regions for the identification of yeasts of clinical relevance. Both the ITS1 and ITS2 regions of 373 strains (86 species), including 299 reference strains and 74 clinical isolates, were amplified by PCR and sequenced. The sequences were compared to reference data available at the GenBank database by using BLAST (basic local alignment search tool) to determine if species identification was possible by ITS sequencing. Since the GenBank database currently lacks ITS sequence entries for some yeasts, the ITS sequences of type (or reference) strains of 15 species were submitted to GenBank to facilitate identification of these species. Strains producing discrepant identifications between the conventional methods and ITS sequence analysis were further analyzed by sequencing of the D1-D2 domain of the large-subunit rRNA gene for species clarification. The rates of correct identification by ITS1 and ITS2 sequence analysis were 96.8% (361/373) and 99.7% (372/373), respectively. Of the 373 strains tested, only 1 strain (Rhodotorula glutinis BCRC 20576) could not be identified by ITS2 sequence analysis. In conclusion, identification of medically important yeasts by ITS sequencing, especially using the ITS2 region, is reliable and can be used as an accurate alternative to conventional identification methods. PMID:16517841

Leaw, Shiang Ning; Chang, Hsien Chang; Sun, Hsiao Fang; Barton, Richard; Bouchara, Jean-Philippe; Chang, Tsung Chain

2006-01-01

160

Architecture-Level Dependability Analysis of a Medical Decision Support System  

SciTech Connect

Recent advances in techniques such as image analysis, text analysis and machine learning have shown great potential to assist physicians in detecting and diagnosing health issues in patients. In this paper, we describe the approach and findings of an architecture-level dependability analysis for a mammography decision support system that incorporates these techniques. The goal of the research described in this paper is to provide an initial understanding of the dependability issues, particularly the potential failure modes and severity, in order to identify areas of potential high risk. The results will guide design decisions and provide the basis of a dependability and performance evaluation program.

Pullum, Laura L [ORNL; Symons, Christopher T [ORNL; Patton, Robert M [ORNL; Beckerman, Barbara G [ORNL

2010-01-01

161

Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?  

PubMed

Medical practice variation and social disparities in health are pervasive features of health care systems. But what impact might everyday clinical decision making have in shaping such aggregate patterns, and could this in turn be influenced by the immediate environment in which family doctors practise? We investigate this by studying inter-practitioner variation in clinical activity across four payment types in New Zealand, a "gatekeeper" primary care system. We do this for four measures of clinical activity by patient ethnic and socio-economic status in a 2001/2002 representative sample of 9272 encounters at 185 family practices. Initial analysis showed little variation in clinical activity either by patient status or by practice type. However, with the application of multi-level statistical techniques it was evident that, while there was still little systematic difference in practitioner activity rates by patient status, inter-practitioner variation was greater for patients of ethnic minority background and from socio-economically deprived areas. Furthermore, this variability was particularly marked in fee-for-service practice settings. Thus, to the extent that family doctor decision-making behaviour within practice context helps shape aggregate patterns of medical practice variation and social disparity, treatment differences are likely associated not with the level of service but with its variability. PMID:23149333

Lay-Yee, Roy; Scott, Alastair; Davis, Peter

2013-01-01

162

Tutorial in medical decision modeling incorporating waiting lines and queues using discrete event simulation.  

PubMed

In most decision-analytic models in health care, it is assumed that there is treatment without delay and availability of all required resources. Therefore, waiting times caused by limited resources and their impact on treatment effects and costs often remain unconsidered. Queuing theory enables mathematical analysis and the derivation of several performance measures of queuing systems. Nevertheless, an analytical approach with closed formulas is not always possible. Therefore, simulation techniques are used to evaluate systems that include queuing or waiting, for example, discrete event simulation. To include queuing in decision-analytic models requires a basic knowledge of queuing theory and of the underlying interrelationships. This tutorial introduces queuing theory. Analysts and decision-makers get an understanding of queue characteristics, modeling features, and its strength. Conceptual issues are covered, but the emphasis is on practical issues like modeling the arrival of patients. The treatment of coronary artery disease with percutaneous coronary intervention including stent placement serves as an illustrative queuing example. Discrete event simulation is applied to explicitly model resource capacities, to incorporate waiting lines and queues in the decision-analytic modeling example. PMID:20345550

Jahn, Beate; Theurl, Engelbert; Siebert, Uwe; Pfeiffer, Karl-Peter

2010-01-01

163

Maternal medication, drug use, and breastfeeding.  

PubMed

This article reviews the necessary skills required for clinicians to make informed decisions about the use of medications in breastfeeding women. Even without specific data on certain medications, this review of kinetic principles, mechanisms of medication entry into breast milk, and important infant factors can aid in clinical decision making. In addition, the article reviews common medical conditions (eg, depression, hypertension, infections) in breastfeeding women and their appropriate treatment. PMID:25455573

Rowe, Hilary; Baker, Teresa; Hale, Thomas W

2015-01-01

164

Recommendations for Modeling Disaster Responses in Public Health and Medicine: A Position Paper of The Society for Medical Decision Making  

PubMed Central

Purpose Mathematical and simulation models are increasingly used to plan for and evaluate health sector responses to disasters, yet no clear consensus exists regarding best practices for the design, conduct, and reporting of such models. We examined a large selection of published health sector disaster response models to generate a set of best practice guidelines for such models. Methods We reviewed a spectrum of published disaster response models addressing public health or healthcare delivery, focusing in particular on the type of disaster and response decisions considered, decision makers targeted, choice of outcomes evaluated, modeling methodology, and reporting format. We developed initial recommendations for best practices for creating and reporting such models and refined these guidelines after soliciting feedback from response modeling experts and from members of the Society for Medical Decision Making. Results We propose six recommendations for model construction and reporting, inspired by the most exemplary models: Health sector disaster response models should address real-world problems; be designed for maximum usability by response planners; strike the appropriate balance between simplicity and complexity; include appropriate outcomes, which extend beyond those considered in traditional cost-effectiveness analyses; and be designed to evaluate the many uncertainties inherent in disaster response. Finally, good model reporting is particularly critical for disaster response models. Conclusions Quantitative models are critical tools for planning effective health sector responses to disasters. The recommendations we propose can increase the applicability and interpretability of future models, thereby improving strategic, tactical, and operational aspects of preparedness planning and response. PMID:19605887

Brandeau, Margaret L.; McCoy, Jessica H.; Hupert, Nathaniel; Holty, Jon-Erik; Bravata, Dena M.

2013-01-01

165

“Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management  

PubMed Central

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

166

The Perceived Importance of an Ethical Issue as a Determinant of Ethical Decision-making for Accounting Students in an Academic Setting  

Microsoft Academic Search

In this study, we investigate the impact of an ethical decision-making construct, the ‘perceived importance of an ethical issue’ (PIE) for accounting students in an academic setting. One objective was to test the measure of this construct for generalizability in gauging ethical decision- making. The other objective was to draw inferences on the PIE construct for pedagogical purposes. Using tests

Daryl M. Guffey; Mark W. Mccartney

2008-01-01

167

Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response.  

PubMed

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents. PMID:24618164

Coleman, C Norman; Blumenthal, Daniel J; Casto, Charles A; Alfant, Michael; Simon, Steven L; Remick, Alan L; Gepford, Heather J; Bowman, Thomas; Telfer, Jana L; Blumenthal, Pamela M; Noska, Michael A

2013-04-01

168

77 FR 22328 - Guidance for Industry on the Judicious Use of Medically Important Antimicrobial Drugs in Food...  

Federal Register 2010, 2011, 2012, 2013

...inform the public of FDA's current thinking on the use of medically important antimicrobial...However, other comments were more critical, based largely on the guidance's lack...guidance represents the Agency's current thinking on the topic. It does not create...

2012-04-13

169

“Do your homework…and then hope for the best”: the challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making  

PubMed Central

Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Conclusions Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad. PMID:24053385

2013-01-01

170

Human factors engineering: A tool for medical device evaluation in hospital procurement decision-making  

Microsoft Academic Search

A human factors evaluation was conducted to inform hospital procurement decision-making in selecting a general-purpose infusion pump to be used hospital-wide. Three infusion pumps from different vendors were involved in the evaluation, which consisted of two phases: a human factors heuristic assessment of the pumps according to several criteria, and user testing in five clinical areas. The clinical areas were:

Gill Ginsburg

2005-01-01

171

Decision support system for mass dispensing of medications for infectious disease outbreaks and bioterrorist attacks  

Microsoft Academic Search

A simulation and decision support system, RealOpt©, for planning large-scale emergency dispensing clinics to respond to biological threats and infectious disease outbreaks\\u000a is described. The system allows public health administrators to investigate clinic design and staffing scenarios quickly.\\u000a \\u000a RealOpt© incorporates efficient optimization technology seamlessly interfaced with a simulation module. The system's correctness and\\u000a computational advantage are validated via comparisons against

Eva K. Lee; Siddhartha Maheshwary; Jacquelyn Mason; William Glisson

2006-01-01

172

A Rule-based decision framework for Medical Sensor Networks Sowmya Manjanatha  

E-print Network

of providing more timely and precise therapy, with the potential for better outcome. As an example, autonomous will be an integral part of every patient's electronic medical record. The sensors that collect this information and extensible to accommodate large patient populations. In this paper, we propose a general rule-based system

Bestavros, Azer

173

Arthritis patients' motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement.  

PubMed

The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated. PMID:25392118

Nota, Ingrid; Drossaert, Constance H C; Taal, Erik; van de Laar, Mart A F J

2014-11-14

174

Gondishapur School of Medicine: The Most Important Medical Center in Antiquity  

Microsoft Academic Search

Iran has a rich civilization and a long history during which medical science flourished at specific periods. For instance, medicine blossomed in Sassanids era (226 - 652 AD). One of the most remarkable cultural and scientific centers of Sassanids era was the city of Gondishapur located in the south-west Iran in Shah-Abad near Susa in Khuzestan Province. The city was

Mohammad-Hossein Azizi

175

Abstract--Wireless communication medical implants are gaining an important role in healthcare systems by controlling  

E-print Network

due to the complex nature within the human body, such as multipath caused by the boundaries are not constant inside the entire human body. Furthermore, the use of high-band or high power signals for implant and cheaper medical wireless devices that are more convenient to be worn or implanted inside a human body

Fowler, Mark

176

Halomonas johnsoniae: review of a medically underappreciated genus of growing human importance.  

PubMed

The growing genus Halomonas includes bacteria favoring or tolerating high-saline/halide and high-pH environments. Infections are rarely reported. A patient developed Halomonas johnsoniae (previously reported only as dialysis unit environmental contaminants) bacteremia. The medical community is alerted to the pathogenic potential of the genus, particularly in a dialysis setting. PMID:22814360

Stevens, David A; Kim, Kwang Kyu; Johnson, Nancy; Lee, Jung-Sook; Hamilton, John R

2013-05-01

177

Seeking evidence to support usability principles for medication-related clinical decision support (CDS) functions.  

PubMed

There is a need for evidence-based usability principles to support the design of usable medication-related computerized CDS functions and systems. Such evidence requires establishing scientific relationships between usability principles, their violation in terms of usability flaws, issuing usage problems and their consequences or outcomes in the clinical work and patient care. This kind of evidence is not currently directly available in scientific evaluation studies of medication CDS functions. A possible proxy to seek evidence is systematic review of existing scientific evaluation reports. We rely on a four-stage framework describing the chain of consequences and inferences linking usability principles to clinical outcomes to design the systematic review methodology and interpretation principles. This paper describes the four-stage framework and the resulting consequences for the systematic review design. PMID:23920590

Marcilly, Romaric; Beuscart-Zéphir, Marie-Catherine; Ammenwerth, Elske; Pelayo, Sylvia

2013-01-01

178

Parental role in medical decision-making: fact or fiction? A comparative study of ethical dilemmas in French and American neonatal intensive care units  

Microsoft Academic Search

Neonatal intensive care has been studied from an epidemiological, ethical, medical and even sociological perspective, but little is known about the impact of parental involvement in decision-making, especially in critical cases. We rely here on a comparative, case-based approach to study the parental role in decision-making within two technologically identical but culturally and institutionally different contexts: France and the United

Kristina Orfali

2004-01-01

179

15 CFR 400.63 - Appeals to the Board of decisions of the Assistant Secretary for Import Administration and the...  

Code of Federal Regulations, 2013 CFR

...parties showing good cause. (b) Procedures. Parties appealing a decision under paragraph (a) of this section shall...documentation. After a review, the Board shall notify the appealing party of its decision in...

2013-01-01

180

Imagination and integrity: decision-making among lesbian couples to use medically provided donor insemination.  

PubMed

This paper reports findings from a pilot study of lesbian parents in the UK who used medicalised donor insemination (DI) with unknown donors. It focuses on decision-making processes in family construction: this includes lesbian parents' experiences with clinicians and their family stories as told to clinicians and to their young children. Findings reveal that parents' understanding of family, particularly the centrality of the lesbian couple as the key parenting relationship, is crucial. We suggest that this group of parents make considered decisions about how their family might be created. It is their perception of what family means and their desire to protect the integrity of their family that leads them to negotiate social questions, particularly in relation to the presence of a 'father' and the familial role/relationship of the non-biological parent. The study calls attention to the process of respondents' reflexivity about family and their 'doing' of family and highlights the integrity and imagination central to becoming lesbian parents. PMID:18821349

Donovan, Catherine; Wilson, Angelia R

2008-10-01

181

Medical leadership: why it's important, what is required, and how we develop it.  

PubMed

Good medical leadership is vital in delivering high-quality healthcare, and yet medical career progression has traditionally seen leadership lack credence in comparison with technical and academic ability. Individual standards have varied, leading to variations in the quality of medical leadership between different organisations and, on occasions, catastrophic lapses in the standard of care provided to patients. These high-profile events, plus increasing evidence linking clinical leadership to performance of units, has led recently to more focus on leadership development for all doctors, starting earlier and continuing throughout their careers. There is also an increased drive to see doctors take on more significant leadership roles throughout the healthcare system. The achievement of these aims will require doctors to develop strong personal and professional values, a range of non-technical skills that allow them to lead across professional boundaries, and an understanding of the increasingly complex environment in which 21st century healthcare is delivered. Developing these attributes will require dedicated resources and the sophisticated application of a variety of different learning methodologies such as mentoring, coaching, action learning and networking. PMID:20935344

Warren, Oliver J; Carnall, Ruth

2011-01-01

182

The Effect of Computerized Physician Order Entry and Decision Support System on Medication Errors in the Neonatal Ward: Experiences from an Iranian Teaching Hospital  

Microsoft Academic Search

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three\\u000a periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants.\\u000a Before intervention (Period 1), error rate was 53%, which did not significantly change

Alireza Kazemi; Johan Ellenius; Faramarz Pourasghar; Shahram Tofighi; Aref Salehi; Ali Amanati; Uno G. H. Fors

2011-01-01

183

[Contraception and informatics. SELF, a system to aid medical decisions applied to the prescription of contraceptive methods].  

PubMed

SELF (systeme en logique floue = system in soft discware), developed by the Computer Sciences Laboratory of the Faculté de Médecine in Nancy, is, by comparison to many systems of assistance in medical decisions already existing, a comprehensive and simple unit enabling the construction and modification of basic knowledge as well as its questioning. The first application of SELF concerned the field of gynecology, by producing a system of assistance applied to the prescription of a contraceptive method. The systematic use of this computer program along with the traditional prescription of a contraceptive method, was tested for three months in the Regional Maternity Hospital by several physicians in the Gynecology Clinic. The system was extremely well accepted and the responses have generated numerous discussions between physicians leading to an improvement of SELF and a better rationalization of the prescription. The medical and paramedical personnel in training at the hospital found SELF to be a teaching tool which, on the basis of simulated cases, permits an easier and more concrete explanation of the practical management in advising or prescribing a contraceptive method. PMID:3787068

Groussin-Weyland, M; Landes, P; Kohler, F; Monchovet, S; Martin, J

1986-10-01

184

End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations.  

PubMed

Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time. PMID:25278756

Manalo, Maria Fidelis C

2013-01-01

185

The consequences of uncertainty. An empirical approach to medical decision making in neonatal intensive care.  

PubMed

The policy of the Stanford University Medical Center on care for extremely premature neonates has been generally to initiate intensive care "based on a nonprobabilistic paradigm with a goal of saving every infant's life." Fischer and Stevenson analyzed the mortality rates, weights, gestational ages, and total costs of care for a sample of 68 low birth weight neonates. They also examined the outcomes of care in terms of degree of disability for the 24 surviving infants. They concluded that the existing policy resulted in undue suffering and in a substantial economic cost for the suffering and loss of life. They advocate use of an "individualized prognostic strategy" that takes into account the interplay of statistical prediction, the physician's assessment of clinical course, and parental responses when physicians suggest discontinuing aggressive care. PMID:3309387

Fischer, A F; Stevenson, D K

1987-10-01

186

Visual computing for medical diagnosis and treatment  

Microsoft Academic Search

Diagnostic algorithms and efficient visualization techniques are of major importance for preoperative decisions, intra-operative imaging and image-guided surgery. Complex diagnostic decisions are characterized by a high information flow and fast decisions, requiring efficient and intuitive presentation of complex medical data and precision in the visualization. For intra-operative medical treatment, the pre-operative visualization results of the diagnostic systems have to be

Jan Klein; Ola Friman; Markus Hadwiger; Bernhard Preim; Felix Ritter; Anna Vilanova; Gabriel Zachmann; Dirk Bartz

2009-01-01

187

21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.  

Code of Federal Regulations, 2012 CFR

...Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE REGISTRATION OF MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES Exceptions to Registration and Fees § 1301.26 Exemptions from import or export...

2012-04-01

188

21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.  

Code of Federal Regulations, 2010 CFR

...Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE REGISTRATION OF MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES Exceptions to Registration and Fees § 1301.26 Exemptions from import or export...

2010-04-01

189

21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.  

...Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE REGISTRATION OF MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES Exceptions to Registration and Fees § 1301.26 Exemptions from import or export...

2014-04-01

190

21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.  

Code of Federal Regulations, 2013 CFR

...Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE REGISTRATION OF MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES Exceptions to Registration and Fees § 1301.26 Exemptions from import or export...

2013-04-01

191

21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.  

Code of Federal Regulations, 2011 CFR

...Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE REGISTRATION OF MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES Exceptions to Registration and Fees § 1301.26 Exemptions from import or export...

2011-04-01

192

77 FR 19716 - Importer of Controlled Substances; Notice of Application Meridian Medical Technologies  

Federal Register 2010, 2011, 2012, 2013

...administered by the Directorate for the Quality of Medicines (EDQM). In order to ensure that its product will meet European specifications, the company seeks to import morphine supplied by EDQM to use as reference standards. This is the sole purpose...

2012-04-02

193

78 FR 30331 - Importer of Controlled Substances; Notice of Registration; Meridian Medical Technologies  

Federal Register 2010, 2011, 2012, 2013

...administered by the Directorate of the Quality of Medicines (EDQM). In order to ensure that its product will meet European specifications, the company seeks to import morphine supplied by EDQM to use as reference standards. This is the sole purpose...

2013-05-22

194

77 FR 31388 - Importer of Controlled Substances; Notice of Registration; Meridian Medical Technologies  

Federal Register 2010, 2011, 2012, 2013

...administered by the Directorate of the Quality of Medicines (EDQM). In order to ensure that its product will meet European specifications, the company seeks to import morphine supplied by EDQM to use as reference standards. This is the sole purpose...

2012-05-25

195

78 FR 15974 - Importer of Controlled Substances, Notice of Application; Meridian Medical Technologies  

Federal Register 2010, 2011, 2012, 2013

...administered by the Directorate for the Quality of Medicines (EDQM). In order to ensure that its product will meet European specifications, the company seeks to import morphine supplied by EDQM to use as reference standards. This is the sole purpose...

2013-03-13

196

Memory for medication side effects in younger and older adults: The role of subjective and objective importance.  

PubMed

Older adults often experience memory impairments, but sometimes they can use selective processing and schematic support to remember important information. In the present experiments, we investigated the degrees to which younger and healthy older adults remembered medication side effects that were subjectively or objectively important to remember. Participants studied a list of common side effects and rated how negative these effects would be if they were to experience them, and they were then given a free recall test. In Experiment 1, the severity of the side effects ranged from mild (e.g., itching) to severe (e.g., stroke), and in Experiment 2, certain side effects were indicated as being critical to remember (i.e., "contact your doctor if you experience this"). We observed no age differences in terms of free recall of the side effects, and older adults remembered more severe side effects than mild effects. However, older adults were less likely to recognize the critical side effects on a later recognition test, relative to younger adults. These findings suggest that older adults can selectively remember medication side effects but have difficulty identifying familiar but potentially critical side effects, and this has implications for monitoring medication use in older age. PMID:25331278

Friedman, Michael C; McGillivray, Shannon; Murayama, Kou; Castel, Alan D

2014-10-21

197

Modeling Just the Important and Relevant Concepts in Medicine for Medical Language Understanding: A Survey of the Issues  

E-print Network

ion The above experiment has shown the different kinds of knowledge that a concept model like GALEN can provide for NLP needs. However, the main challenge is to stress the distinction between information as it is formulated in medical texts and as it is expressed in concept models. This entails mediation between the large expressiveness, permissibility, and impliciteness of natural language on the one hand, and the generality, granularity, and conciseness of the concept model on the other hand. Such a gap between the "language of the texts" and "the language of concepts" can be filled in by considering what linguistic information must be attached to the conceptual level in order to manage the analysis of medical texts. Such syntactic attachments have been defined at different strategic points in the RECIT system. First, it is important to translate the model typology in the context of the analyzed texts. This is performed through the typology annotation which allows concepts to be an...

Anne-marie Rassinoux; Randolph A. Miller; Olph A. Miller; Robert H. Baud; Jean-raoul Scherrer

1997-01-01

198

Multidrug-Resistance and Toxic Metal Tolerance of Medically Important Bacteria Isolated from an Aquaculture System  

PubMed Central

The use of antimicrobials and toxic metals should be considered carefully in aquaculture and surrounding environments. We aimed to evaluate medically relevant bacteria in an aquaculture system and their susceptibility to antimicrobials and toxic metals. Selective cultures for enterobacteria (ENT), non-fermenting Gram-negative rods (NFR) and Gram-positive cocci (GPC) were obtained from water samples collected in two different year seasons. The isolated bacteria were biochemically identified and antimicrobial and toxic metal susceptibility patterns were determined. Overall, 407 representative strains were recovered. In general, bacteria isolated from fish ponds showed higher multiple antibiotic resistance indices when compared to those isolated from a water-fed canal. Resistance to penicillin and azithromycin was observed more frequently in the GPC group, whereas resistance to ampicillin and ampicillin/sulbactam or gentamicin was observed more frequently in the ENT and NFR groups, respectively. All the isolated bacteria were tolerant to nickel, zinc, chromium and copper at high levels (?1,024 ?g mL?1), whereas tolerance to cadmium and mercury varied among the isolated bacteria (2–1,024 ?g mL?1). Multidrug-resistant bacteria were more frequent and diverse in fish ponds than in the water-fed canal. A positive correlation was observed between antimicrobial resistance and metal tolerance. The data point out the need for water treatment associated with the aquaculture system. PMID:22972388

Resende, Juliana Alves; Silva, Vânia L.; Fontes, Cláudia Oliveira; Souza-Filho, Job Alves; de Oliveira, Tamara Lopes Rocha; Coelho, Cíntia Marques; César, Dionéia Evangelista; Diniz, Cláudio Galuppo

2012-01-01

199

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study  

PubMed Central

Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions. PMID:25317266

Nuss, Michelle A.; Hill, Janette R.; Cervero, Ronald M.; Gaines, Julie K.; Middendorf, Bruce F.

2014-01-01

200

The summer school students’ viewpoints about important factors in learning, Shiraz University of Medical Sciences  

PubMed Central

Introduction: The main goal of education is learning and change in behavior which has been revolutionized in the 21st century due to the rapid and widespread changes in science. The traditional approach to education does no longer meet the learners' needs, necessitating new changes in educational curricula. This study was designed to determine the factors influencing learning in the 21st century and find out the students' viewpoints on this issue. Methods: This is a descriptive study aiming at determining the students' views on new approaches to learning in the 21st century. To do so, a researcher-made questionnaire was designed. It contained 30 questions in 3 sections including demographic data, background questions and two open questions about their suggestions and criticisms. The reliability and validity of the questionnaire was pilot-tested and measured, which proved to be describable. 150 students participating in university summer schools in Shiraz University of Medical Sciences were enrolled. The questionnaires were sent to the students in person and through electronic mails. The students were asked to return the completed questionnaires to the given email address. The data were analyzed in SPSS, version 14, using descriptive statistics of frequency, mean, percentage and standard deviation and t-test. P<0.05 was considered as statistically significant. Results: 150 questionnaires were appropriately filled out and given to the researchers. The results indicated that, according to the students, 6 factors including the use of computer in teaching, enhancement of virtual learning, the use of mobile in relations, enjoyment of electronic learning contexts, the learning focus on attitudes and the facilitating role of the lectures were the most influential factors in learning. On the other hand, the government's responsibility and responsiveness, creativity and risk taking, increase in the social relationship among the learners, focus on practical skills, and management were considered as the least influential factors in learning in the 21st century. Conclusion: It seems that the students philosophically tend to approve constructivism and cooperative learning which is learner-centered as compared to conventional education which is teacher-contended. According to experts, this type of viewpoint is in the same line with new approaches to teaching and education in the present era. Moreover, it impacts the reforms, complementation and expansion of methodology greatly. PMID:25512924

BAZRAFCAN, LEILA; HAGHANI, FARIBA; SHOKRPOUR, NASRIN

2014-01-01

201

The impact of mass media health communication on health decision-making and medical advice-seeking behavior of u.s. Hispanic population.  

PubMed

Mass media health communication has enormous potential to drastically alter how health-related information is disseminated and obtained by different populations. However, there is little evidence regarding the influence of media channels on health decision-making and medical advice-seeking behaviors among the Hispanic population. The Pew 2007 Hispanic Healthcare Survey was used to test the hypothesis that the amount of mass media health communication (i.e., quantity of media-based health information received) is more likely to influence Hispanic adults' health decision-making and medical advice-seeking behavior compared to health literacy and language proficiency variables. Results indicated that quantity of media-based health information is positively associated with health decision-making and medical advice-seeking behavior above and beyond the influence of health literacy and English and Spanish language proficiency. In a context where physician-patient dynamics are increasingly shifting from a passive patient role model to a more active patient role model, media-based health information can serve as an influential cue to action, prompting Hispanic individuals to make certain health-related decisions and to seek more health advice and information from a health provider. Study implications are discussed. PMID:22888787

De Jesus, Maria

2013-01-01

202

15 CFR 400.47 - Appeals to the Board from decisions of the Assistant Secretary for Import Administration and the...  

Code of Federal Regulations, 2012 CFR

...b)(2) may be appealed to the Board by adversely affected parties showing good cause. (b) Procedures. Parties appealing a decision under paragraph (a) of this section shall submit a request for review to the Board in writing, stating the...

2012-01-01

203

Clinical Decision Support at Intermountain Healthcare  

Microsoft Academic Search

Decision support technologies are becoming increasingly available to medical practitioners. A variety of programs designed\\u000a to assist with drug dosing, health maintenance, diagnosis, and other clinically relevant healthcare decisions have been developed\\u000a for the medical workplace. Increasing ease of access to personal computers is partially responsible for this growth. More\\u000a important, however, is the growing dependency on computers to maintain

Peter J. Haug; Reed M. Gardner; R. Scott Evans; Beatriz H. Rocha; Roberto A. Rocha

204

[Value of local cerebral hypoperfusion in the diagnosis of frontal syndromes. Importance in medical expert assessment of head injuries].  

PubMed

The importance of the symptoms linked to a frontal disorder in the intellectual and behavioral sequelas of severe cranial trauma, is now measured carefully because these troubles are one of the most important obstacle to the social and professional come-back. The handicap linked to a disorder of the frontal lobe is not well known in all its neurological, mental and sociological dimensions because the diagnosis is not easy. To help to this diagnosis, the study of cerebral blood flow with SPECT is usefull in medical practice. We present here 4 clinical cases of post-trauma frontal syndrome not easy to measure. With a measure of cerebral blood flow with SPECT, it was observed a decrease of frontal blood flow, that allowed to link the neuropsychological symptom to a frontal lobe disorder. It seems that in these conditions the post-trauma frontal syndrome is not so uncommon. PMID:8275911

Septien, L; Didi-Roy, R; Pelletier, J L; Marin, A; Giroud, M

1993-01-01

205

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms.  

PubMed

Variation in venom composition is a ubiquitous phenomenon in snakes and occurs both interspecifically and intraspecifically. Venom variation can have severe outcomes for snakebite victims by rendering the specific antibodies found in antivenoms ineffective against heterologous toxins found in different venoms. The rapid evolutionary expansion of different toxin-encoding gene families in different snake lineages is widely perceived as the main cause of venom variation. However, this view is simplistic and disregards the understudied influence that processes acting on gene transcription and translation may have on the production of the venom proteome. Here, we assess the venom composition of six related viperid snakes and compare interspecific changes in the number of toxin genes, their transcription in the venom gland, and their translation into proteins secreted in venom. Our results reveal that multiple levels of regulation are responsible for generating variation in venom composition between related snake species. We demonstrate that differential levels of toxin transcription, translation, and their posttranslational modification have a substantial impact upon the resulting venom protein mixture. Notably, these processes act to varying extents on different toxin paralogs found in different snakes and are therefore likely to be as important as ancestral gene duplication events for generating compositionally distinct venom proteomes. Our results suggest that these processes may also contribute to altering the toxicity of snake venoms, and we demonstrate how this variability can undermine the treatment of a neglected tropical disease, snakebite. PMID:24927555

Casewell, Nicholas R; Wagstaff, Simon C; Wüster, Wolfgang; Cook, Darren A N; Bolton, Fiona M S; King, Sarah I; Pla, Davinia; Sanz, Libia; Calvete, Juan J; Harrison, Robert A

2014-06-24

206

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms  

PubMed Central

Variation in venom composition is a ubiquitous phenomenon in snakes and occurs both interspecifically and intraspecifically. Venom variation can have severe outcomes for snakebite victims by rendering the specific antibodies found in antivenoms ineffective against heterologous toxins found in different venoms. The rapid evolutionary expansion of different toxin-encoding gene families in different snake lineages is widely perceived as the main cause of venom variation. However, this view is simplistic and disregards the understudied influence that processes acting on gene transcription and translation may have on the production of the venom proteome. Here, we assess the venom composition of six related viperid snakes and compare interspecific changes in the number of toxin genes, their transcription in the venom gland, and their translation into proteins secreted in venom. Our results reveal that multiple levels of regulation are responsible for generating variation in venom composition between related snake species. We demonstrate that differential levels of toxin transcription, translation, and their posttranslational modification have a substantial impact upon the resulting venom protein mixture. Notably, these processes act to varying extents on different toxin paralogs found in different snakes and are therefore likely to be as important as ancestral gene duplication events for generating compositionally distinct venom proteomes. Our results suggest that these processes may also contribute to altering the toxicity of snake venoms, and we demonstrate how this variability can undermine the treatment of a neglected tropical disease, snakebite. PMID:24927555

Casewell, Nicholas R.; Wagstaff, Simon C.; Wüster, Wolfgang; Cook, Darren A. N.; Bolton, Fiona M. S.; King, Sarah I.; Pla, Davinia; Sanz, Libia; Calvete, Juan J.; Harrison, Robert A.

2014-01-01

207

PUB HLTH 431 Decision Analysis and Models of Decision Making  

E-print Network

PUB HLTH 431 Decision Analysis and Models of Decision Making 1.0 Credit Winter 2014 (January 8 This course will focus on the core areas underlying decision analysis and medical decision making: the use: Probabilities in medicine: explain how the concept of probability is used to make medical decisions

Contractor, Anis

208

Signal Versus Noise on the Wards: What “Messages” from the Hidden Curriculum Do Medical Students Perceive to Be Importantly Meaningful?  

PubMed Central

Interested in the hidden curriculum and the learning environment for professionalism at our school, a group of educators called the RIPPLE Team (Relationships in Positive Professional Learning Environments) created The Professionalism Journal for use by third-year medical students during their Internal Medicine and Psychiatry clerkships. The students are introduced to the online journal and encouraged to use it as a means to pause, reflect on the events of the day, and write about episodes or exchanges they find personally important and meaningful. They are informed that their journal entries will be de-identified and used as the triggers for a facilitated and confidential discussion among their peers at the end of the clerkship. This article will report on the themes of the journal entries made by Internal Medicine clerks during one academic year. PMID:23874008

Shorey, Jeannette M.

2013-01-01

209

There is No Question But That This Message --Listen to What the Patient Tells You --Is the Most Important Thing I Carried Away From Our Medical School  

E-print Network

Important Thing I Carried Away From Our Medical School Donald B. Hunton, M.D., F.A.C.P. Donald Hunton served saw a recent television program during which an enormously important exchange occurred between two participants who were discussing doctors, patients, and the relationships, which are most important. What made

Goldman, Steven A.

210

Should they have a percutaneous endoscopic gastrostomy? the importance of assessing decision-making capacity and the central role of a multidisciplinary team.  

PubMed

Decisions about percutaneous endoscopic gastrostomy (PEG) can be clinically and ethically challenging, particularly when patients lack decision-making capacity. As the age of the UK population rises, with the associated increase in prevalence of dementias and neurodegenerative diseases, it is becoming an increasingly important issue for clinicians. The recent review and subsequent withdrawal of the Liverpool Care Pathway highlighted feeding as a particular area of concern. The authors undertook a 1-year retrospective review of individuals referred to the feeding issues multidisciplinary team (FIMDT) at Addenbrooke's Hospital, Cambridge, UK, in 2011. The majority of patients referred (n = 158) had a primary diagnosis of cancer (44%). The second largest group was those who had had a stroke or brain haemorrhage (13%). Twenty-eight per cent of patients had no, or uncertain, decision-making capacity on at least one occasion during decision-making. There are reflections on the role of a multidisciplinary team in the process of decision-making for these complex patients. PMID:24889566

Clarke, Gemma; Galbraith, Sarah; Woodward, Jeremy; Holland, Anthony; Barclay, Stephen

2014-06-01

211

Use of Active Ingredient Information for Low Socioeconomic Status Parents’ Decision-making Regarding Cough and Cold Medications: Role of Health Literacy  

PubMed Central

OBJECTIVE Parent administration of multiple medications with overlapping active ingredients places children at risk for overdose. We sought to examine how parents use active ingredient information as part of the process of selecting a cough/cold medication for their child, and how health literacy plays a role. METHODS Experimental study of parents of children presenting for care in an urban public hospital pediatric clinic. Parents were asked to determine which of 3 cough/cold medications could be given to relieve a child’s cold symptoms, as part of a scenario in which they had already given a dose of acetaminophen; only 1 did not contain acetaminophen. Primary dependent variable: correct selection of cough/cold medication, using active ingredient as the rationale for choice. Primary independent variable: parent health literacy (Newest Vital Sign (NVS)). RESULTS Of 297 parents, 79.2% had low health literacy (NVS score 0–3). 35.4% correctly chose the cough/cold medication which did not contain acetaminophen. The proportion of those who made the correct choice was no different than expected from chance alone (Goodness of fit test; ?2=2.1, p=0.3). Only 7.7% chose the correct medication and used active ingredient as the rationale. Those with adequate literacy skills were more likely to have selected the correct medication and rationale (25.8% vs. 3.0% (p=0.001); AOR=11.1 [95%CI: 3.6–33.7], adjusting for sociodemographics, including English proficiency and education). CONCLUSIONS Many parents, especially those with low health literacy, do not use active ingredient information as part of decision-making related to administering multiple medications. PMID:23680341

Yin, H. Shonna; Mendelsohn, Alan L.; Nagin, Perry; van Schaick, Linda; Cerra, Maria E.; Dreyer, Benard P.

2013-01-01

212

72 FR 59241 - Notice of Decision To Issue Permits for the Importation of Ribes Species Fruits From South Africa...  

Federal Register 2010, 2011, 2012, 2013

...Importation of Ribes Species Fruits From South Africa Into the Continental United States...currants and gooseberries) from South Africa. Based on the findings of a pest...importation of Ribes species fruits from South Africa. DATES: Effective Date:...

2007-10-19

213

77 FR 76457 - Howard Hughes Medical Institute, et al.; Notice of Consolidated Decision on Applications for Duty...  

Federal Register 2010, 2011, 2012, 2013

...Central Florida, Orlando, FL 32816. Instrument: Near Ambient Pressure Scanning Probe Microscope. Manufacturer: SPECS Surface Nano Analysis, GmbH, Germany. Intended Use: See notice at 77 FR 70141-42. Comments: None received. Decision:...

2012-12-28

214

Elements’ important ranking of China drug safety management system: applying the non-structural fuzzy group decision method  

Microsoft Academic Search

Drug safety management is an important issue in China drug management system and attracts great attentions from the whole\\u000a society. In order to reduce drug incident, this study discusses some important elements associated with China drug safety\\u000a management system and analyzes the data collected by questionnaires. Besides, a methodology for rating the important elements\\u000a is described and applied. The non-structural

Xiaoping Zheng; Xiaocui Wang; Tingkuan Zhong

2010-01-01

215

In silico analysis of 16S ribosomal RNA gene sequencing?based methods for identification of medically important anaerobic bacteria  

PubMed Central

This study is the first study that provides useful guidelines to clinical microbiologists and technicians on the usefulness of full 16S rRNA sequencing, 5??end 527?bp 16S rRNA sequencing and the existing MicroSeq full and 500 16S rDNA bacterial identification system (MicroSeq, Perkin?Elmer Applied Biosystems Division, Foster City, California, USA) databases for the identification of all existing medically important anaerobic bacteria. Full and 527?bp 16S rRNA sequencing are able to identify 52–63% of 130 Gram?positive anaerobic rods, 72–73% of 86 Gram?negative anaerobic rods and 78% of 23 anaerobic cocci. The existing MicroSeq databases are able to identify only 19–25% of 130 Gram?positive anaerobic rods, 38% of 86 Gram?negative anaerobic rods and 39% of 23 anaerobic cocci. These represent only 45–46% of those that should be confidently identified by full and 527?bp 16S rRNA sequencing. To improve the usefulness of MicroSeq, bacterial species that should be confidently identified by full and/or 527?bp 16S rRNA sequencing but not included in the existing MicroSeq databases should be included. PMID:17046845

Woo, Patrick C Y; Chung, Liliane M W; Teng, Jade L L; Tse, Herman; Pang, Sherby S Y; Lau, Veronica Y T; Wong, Vanessa W K; Kam, Kwok?ling; Lau, Susanna K P; Yuen, Kwok?Yung

2007-01-01

216

77 FR 7122 - Notice of Decision To Authorize the Importation of Pomegranate From India Into the Continental...  

Federal Register 2010, 2011, 2012, 2013

...Authorize the Importation of Pomegranate From India Into the Continental United States AGENCY...States of fresh pomegranate fruit from India. Based on the findings of a pest risk...importation of fresh pomegranate fruit from India. DATES: Effective date: February...

2012-02-10

217

75 FR 52712 - Notice of Decision To Issue Permits for the Importation of Fresh Mango Fruit From Pakistan Into...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh mango fruit from Pakistan. DATES: Effective Date: August 27, 2010. FOR FURTHER...

2010-08-27

218

76 FR 81468 - Notice of Decision to Authorize the Importation of Shredded Lettuce From Egypt Into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh shredded lettuce from Egypt. DATES: Effective Date: December 28, 2011. FOR FURTHER...

2011-12-28

219

78 FR 9027 - Notice of Decision To Authorize the Importation of Litchi, Longan, and Rambutan From the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh fruit of litchi, longan, and rambutan from the Philippines. DATES: Effective Date:...

2013-02-07

220

76 FR 78231 - Notice of Decision To Authorize the Importation of Fresh Cape Gooseberry Fruit With Husks From Chile  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh Cape gooseberry fruit from Chile. DATES: Effective Date: December 16, 2011. FOR FURTHER...

2011-12-16

221

75 FR 29309 - Notice of Decision to Issue Permits for the Importation of Fresh Male Summer Squash Flowers From...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh male summer squash flowers from Israel. EFFECTIVE DATE: May 25, 2010. FOR FURTHER...

2010-05-25

222

77 FR 29588 - Notice of Decision To Issue Permits for the Importation of Fresh Celery, Arugula, and Spinach...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh celery, arugula, and spinach from Colombia. DATES: Effective Date: May 18, 2012. FOR...

2012-05-18

223

76 FR 21854 - Notice of Decision To Authorize the Importation of Fresh Rambutan Fruit From Malaysia and Vietnam  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh rambutan fruit from Malaysia and Vietnam. DATES: Effective Date: April 19, 2011. FOR...

2011-04-19

224

78 FR 13304 - Notice of Decision To Issue Permits for the Importation of Strawberry Fruit From Egypt Into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh strawberry fruit from Egypt. DATES: Effective Date: February 27, 2013. FOR FURTHER...

2013-02-27

225

76 FR 18511 - Notice of Decision To Issue Permits for the Importation of Fresh Figs From Chile into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh figs from Chile. DATES: Effective Date: April 4, 2011. FOR FURTHER INFORMATION CONTACT:...

2011-04-04

226

76 FR 61340 - Notice of Decision To Authorize the Importation of Dragon Fruit From Thailand Into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of dragon fruit from Thailand. DATES: Effective Date: October 4, 2011. FOR FURTHER INFORMATION...

2011-10-04

227

76 FR 8997 - Notice of Decision To Issue Permits for the Importation of Fresh Strawberries From Jordan Into...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh strawberries from Jordan. DATES: Effective Date: February 16, 2011. FOR FURTHER...

2011-02-16

228

76 FR 49725 - Notice of Decision To Authorize the Importation of Fresh Papaya Fruit From Malaysia into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh papaya fruit from Malaysia. DATES: Effective Date: August 11, 2011. FOR FURTHER...

2011-08-11

229

75 FR 34687 - Notice of Decision to Issue Permits for the Importation of Fresh False Coriander From Panama Into...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh false coriander from Panama. EFFECTIVE DATE: June 18, 2010. FOR FURTHER INFORMATION...

2010-06-18

230

75 FR 56981 - Notice of Decision To Issue Permits for the Importation of Sweet Limes From Mexico Into the...  

Federal Register 2010, 2011, 2012, 2013

...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of sweet limes from Mexico. EFFECTIVE DATE: September 17, 2010. FOR FURTHER INFORMATION CONTACT:...

2010-09-17

231

IONIZING RADIATION IN ABDOMINAL COMPUTED TOMOGRAPHY: UNINDICATED MULTIPHASE SCANS ARE AN IMPORTANT SOURCE OF MEDICALLY UNNECESSARY EXPOSURE  

PubMed Central

Introduction Computed tomography (CT) radiation exposure has come under increasing scrutiny due to dramatically increased utilization. Multiphase CT studies (repeated scanning before and after contrast injection) are potentially important, overlooked source of medically unnecessary radiation due to the dose-multiplier effect of extra phases. The purpose of this study is to determine the frequency of unindicated multiphase scanning and resultant excess radiation exposure in a sample referral population. Methods This study was IRB approved and HIPAA compliant. Abdomen/pelvis CT exams (n=500) performed at outside institutions submitted for tertiary interpretation were retrospectively reviewed for 1) appropriateness of each phase based on clinical indication and American College of Radiology (ACR) Appropriateness Criteria, and 2) per phase and total radiation effective dose. Results A total of 978 phases were performed in 500 patients, 52.8% (264/500) received phases that were not supported by ACR criteria. Overall, 35.8% (350/978) of phases were unindicated, most commonly being delayed imaging (272/350). The mean overall total radiation effective dose per patient was 25.8 mSv (95% CI 24.2, 27.5 mSv). Mean effective dose for unindicated phases was 13.1 (12.3, 14.0) mSv, resulting in a mean excess effective dose of 16.8 (15.5, 18.3) mSv per patient. Unindicated radiation comprised 33.3% of the total radiation effective dose in this population. Radiation effective doses exceeding 50 mSv were found in 21.2% (106/500) of patients. Discussion The results of this study suggest that a large proportion of patients undergoing abdominal/pelvic CT scanning receive unindicated additional phases that add substantial excess radiation dose with no associated clinical benefit. PMID:22051457

Guite, Kristie M.; Hinshaw, J. Louis; Ranallo, Frank N.; Lindstrom, Mary J.; Lee, Fred T.

2014-01-01

232

Human resources as an important factor in the management of medical equipment: Institutions involved and their expertise in Peru  

Microsoft Academic Search

\\u000a The lack of coordination, regulation, supervision on the Ministry of Health and Ministry of Education means that graduates\\u000a are not professionals in tune with the real needs of the health in our country, neither itself investigate and develop technologies\\u000a for health medical equipment according to the epidemiological profile, and less have medical equipment industry. We must bear\\u000a in mind that

Leopoldo Yábar Escribanel; Daniel García Romero; Emilio Villavicencio Chamorro

233

A Qualitative Study on Factors that Influence Turkish Medical Students’ Decisions to Become Family Physicians After the Health Transformation Programme  

PubMed Central

Background: In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. Aims: The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. Materials and Methods: This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. Results: Three main categories emerged from the data viewing Family Medicine ‘as a specialty’, ‘as an employment’, and finally ‘as a system’. Very few students stated that Family Medicine would be their choice for specialty. Conclusions: Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system. PMID:25006564

Tanriover, Ozlem; Hidiroglu, Seyhan; Akan, Hulya; Ay, Pinar; Erdogan, Yalcin; Karavus, Melda; Vitrinel, Ayca; Hayran, Osman

2014-01-01

234

The influence of a decision support system on the differential diagnosis of medical practitioners at three levels of training.  

PubMed Central

As computer-based diagnostic consultation systems become, available, their influence and usefulness need to be evaluated. This report, based on partial data from a larger study, examines the influence of Iliad, a diagnostic consultation system, on the differential diagnosis of fourth year medical students, residents in medicine, and attendings in general internal medicine. Our results show that when faced with difficult diagnostic cases, medical students add significantly more diagnoses from Iliad's differential than do residents or attendings. However, the quality of Iliad's diagnostic advice in terms of the presence of the correct diagnosis, is no better for consultations done by students or residents compared to attendings. PMID:8947660

Murphy, G. C.; Friedman, C. P.; Elstein, A. S.; Wolf, F. M.; Miller, T.; Miller, J. G.

1996-01-01

235

The clinical decision analysis using decision tree  

PubMed Central

The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients’ value. PMID:25358466

Bae, Jong-Myon

2014-01-01

236

Lost in the shuffle: The influence of patient classification scheme on views about the relationship between refusal of medication and involvement in important hospital-based outcomes  

Microsoft Academic Search

The approach used to classify patients into “refuser” subgroups can influence conclusions about the relationship between refusal of antipsychotic medication and involvement in important hospital-based outcomes such as the need for seclusion and restraint. Use of a cross-sectional taxonomy led to conclusions which were somewhat negatively biased against “refusers.” In contrast, use of a longitudinal taxonomy which reflects changes in

Phyllis C. Panzano; William V. Rubin

1995-01-01

237

A 2014 Medical Informatics Perspective on Clinical Decision Support Systems: Do We Hit The Ceiling of Effectiveness?  

PubMed Central

Summary Objective To summarize recent research and propose a selection of best papers published in 2013 in the field of computer-based decision support in health care. Method Two literature reviews were performed by the two section editors from bibliographic databases with a focus on clinical decision support systems (CDSSs) and computer provider order entry in order to select a list of candidate best papers to be peer-reviewed by external reviewers. Results The full review process highlighted three papers, illustrating current trends in the domain of clinical decision support. The first trend is the development of theoretical approaches for CDSSs, and is exemplified by a paper proposing the integration of family histories and pedigrees in a CDSS. The second trend is illustrated by well-designed CDSSs, showing good theoretical performances and acceptance, while failing to show a clinical impact. An example is given with a paper reporting on scorecards aiming to reduce adverse drug events. The third trend is represented by research works that try to understand the limits of CDSS use, for instance by analyzing interactions between general practitioners, patients, and a CDSS. Conclusions CDSSs can achieve good theoretical results in terms of sensibility and specificity, as well as a good acceptance, but evaluations often fail to demonstrate a clinical impact. Future research is needed to better understand the causes of this observation and imagine new effective solutions for CDSS implementation. PMID:25123737

Lamy, J.-B.

2014-01-01

238

The Impact of a Decision Support Tool Linked to an Electronic Medical Record on Glycemic Control in People with Type 2 Diabetes  

PubMed Central

Aims We retrospectively compared glycemic control and glycemic burden in type 2 diabetes patients treated by general physicians with access to decision support with those treated by general physicians without access to decision support. Methods A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed. Results There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p =.001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) ?0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI ?1.3 to ?0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI ?1.2 to ?0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI ?1.2 to ?0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI ?1.5 to ?0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI ?1.5 to ?0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI ?1.4 to ?1.0]. Conclusion Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control. PMID:23759398

Gunathilake, Waruna; Gunawardena, Sajith; Fernando, Ranga; Thomson, George; Fernando, Devaka

2013-01-01

239

Perceptions of UK medical graduates’ preparedness for practice: A multi-centre qualitative study reflecting the importance of learning on the job  

PubMed Central

Background There is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice. Methods This was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools. A sample of 60 medical graduates (20 from each school) was targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness. Results Although selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork. Conclusions Our data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work. PMID:23446055

2013-01-01

240

Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study.  

PubMed

The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account. PMID:24512735

Fornasari, Livia; Gregoraci, Giorgia; Isola, Miriam; Laura Negri, Gioia Anna; Rambaldelli, Gianluca; Cremaschi, Silvana; Faleschini, Laura; Canalaz, Francesca; Perini, Laura; Balestrieri, Matteo; Fabbro, Franco; Brambilla, Paolo

2014-04-30

241

The Physician's Role in Ethical Decisions  

ERIC Educational Resources Information Center

Many medical issues today require ethical as well as strictly medical decisions. Described is the need for the inclusion of medical ethics in the schools, beginning with science ethics in the secondary level and continuing through medical school. (MA)

Chevalier, Robert B.

1977-01-01

242

Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy  

PubMed Central

Purpose To investigate accident casualties’ long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon’s empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes. Patients and methods Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors. Results One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients with ratings of 41 points or higher had a 4.2-fold higher probability to be in the group with a better medical treatment outcome (3.5 and above) on the Cologne Patient Questionnaire scale 12 months after discharge from hospital (P=0.009, R2=33.5, 95% confidence interval: 1.440–12.629). Conclusion Physician empathy is the strongest predictor for a higher level of trauma patients’ subjective evaluation of treatment outcome 6 weeks and 12 months after discharge from the hospital. Interpersonal factors between surgeons and their patients are possible key levers for improving patient outcomes in an advanced health system. Communication trainings for surgeons might prepare them to react appropriately to their patients’ needs and lead to satisfactory outcomes for both parties. PMID:25258518

Steinhausen, Simone; Ommen, Oliver; Antoine, Sunya-Lee; Koehler, Thorsten; Pfaff, Holger; Neugebauer, Edmund

2014-01-01

243

Multimodal medical information retrieval with unsupervised rank fusion.  

PubMed

Modern medical information retrieval systems are paramount to manage the insurmountable quantities of clinical data. These systems empower health care experts in the diagnosis of patients and play an important role in the clinical decision process. However, the ever-growing heterogeneous information generated in medical environments poses several challenges for retrieval systems. We propose a medical information retrieval system with support for multimodal medical case-based retrieval. The system supports medical information discovery by providing multimodal search, through a novel data fusion algorithm, and term suggestions from a medical thesaurus. Our search system compared favorably to other systems in 2013 ImageCLEFMedical. PMID:24909951

Mourão, André; Martins, Flávio; Magalhães, João

2014-05-23

244

Markov Decision Processes: A Tool for Sequential Decision Making  

E-print Network

Markov Decision Processes: A Tool for Sequential Decision Making under Uncertainty Oguzhan Alagoz for sequential decision making under uncertainty that have been widely used in many industrial and manufacturing applications but are underutilized in medical decision making (MDM). We demonstrate the use of an MDP to solve

Schaefer, Andrew

245

Parkinson Disease Treatment Options - Medications (Beyond the Basics)  

MedlinePLUS

... person's ability to perform daily activities. Another important factor is the person's personal philosophy about the use of medications. The healthcare provider, patient, and family (if applicable) should share in the decision making process. There are six main types of medications ...

246

A Kenyan newspaper analysis of the limitations of voluntary medical male circumcision and the importance of sustained condom use  

PubMed Central

Background Since the completion of three clinical trials indicating that voluntary medical male circumcision (VMMC) is an effective method to reduce men’s chances of acquiring HIV, use of the procedure has been advocated in Kenya. Media messages shape popular understandings of the benefits and limitations of male circumcision. The objectives of this study were to (1) investigate promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gain insight into popular understandings of the limitations of this new procedure through newspaper reader comments. Methods A content analysis was conducted on 34 online media articles published by the Daily Nation between January 1, 2008 and December 31, 2010. Information about condom promotion, partial immunity, limitations and complications of the procedure, as well as emergent themes, were analyzed. Results Results demonstrated an irregular and occasionally misleading presentation of these topics and a perceived lack of objective information about the risks and limitations of VMMC. Conclusions There is a need for governmental and non-governmental public health organizations to engage with the media to improve risk messaging. PMID:22720748

2012-01-01

247

"Murder or mercy?" An innovative module helping UK medical students to articulate their own ethical viewpoints regarding end-of-life decisions.  

PubMed

This module was designed to equip UK medical students to respond ethically and sensitively to requests encountered as qualified doctors regarding euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment.The module is delivered by a multidisciplinary team, providing students with the working knowledge to actively discuss cases, articulate their own views and practice ethical reasoning. Visits to intensive care units, palliative care wards and hospices are integrated with theory. Student assessment comprises a dissertation, debate and reflection. Module impact was evaluated by analysis of student coursework and a questionnaire.Students greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to cases and debate issues with peers. They reported increased discernment of the ethical and legal position and practical considerations and greater awareness of the range of professional and lay viewpoints held. Many participants were less strongly in favor of euthanasia and assisted dying on module completion than at the outset, but all of them believed they were better equipped to justify their own viewpoint and respond to patient requests. The multi-disciplinary nature of this course helps to prepare students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position. PMID:21941154

Bell, David; Crawford, Vivienne

2011-10-01

248

Why shared decision making is not good enough: lessons from patients.  

PubMed

A closer look at the lived illness experiences of medical professionals themselves shows that shared decision making is in need of a logic of care. This paper underlines that medical decision making inevitably takes place in a messy and uncertain context in which sharing responsibilities may impose a considerable burden on patients. A better understanding of patients' lived experiences enables healthcare professionals to attune to what individual patients deem important in their lives.This will contribute to making medical decisions in a good and caring manner, taking into account the lived experience of being ill. PMID:23660518

Olthuis, Gert; Leget, Carlo; Grypdonck, Mieke

2014-07-01

249

Pupicidal and repellent activities of Pogostemon cablin essential oil chemical compounds against medically important human vector mosquitoes  

PubMed Central

Objective To determine the repellent and pupicidal activities of Pogostemon cablin (P. cablin) chemical compositions were assayed for their toxicity against selected important vector mosquitoes, viz., Aedes aegypti (Ae. aegypti), Anopheles stephensi (An. stephensi) and Culex quinquefasciatus (Cx. quinquefasciatus) (Diptera: Culicidae). Methods The plants dry aerial parts were subjected to hydrodistillation using a modified Clevenger-type apparatus. The composition of the essential oil was analyzed by Gas Chromatography (GC) and GC mass spectrophotometry. Evaluation was carried out in a net cage (45 cm×30 cm×45 cm) containing 100 blood starved female mosquitoes and were assayed in the laboratory condition by using the protocol of WHO 2010. The repellent activity of P. cablin chemical compositions at concentration of 2mg/cm2were applied on skin of fore arm in man and exposed against adult female mosquitoes. The pupicidal activity was determined against selected important vector mosquitoes to concentration of 100 mg/L and mortality of each pupa was recorded after 24 h of exposure to the compounds. Results Chemical constituents of 15 compounds were identified in the oil of P.cablin compounds representing to 98.96%. The major components in essential oil were â-patchoulene, á-guaiene, ã-patchoulene, á-bulnesene and patchouli alcohol. The repellent activity of patchouli alcohol compound was found to be most effective for repellent activity and 2 mg/cm2 concentration provided 100% protection up to 280 min against Ae. aegypti, An. stephensi and Cx. quinquefasciatus, respectively. Similarly, pupae exposed to 100 mg/L concentrations of P. cablin chemical compositions. Among five compounds tested patchouli alcoholwas found to be most effective for pupicidal activity provided 28.44, 26.28 and 25.36 against Ae.aegypti, An.stephensi and Cx. quinquefasciatus, respectively. The percent adult emergence was inversely proportional to the concentration of compounds and directly proportional to the pupal mortality. Conclusion These results suggest that the P. cablin chemical compositions have the potential to be used as an ideal eco-friendly approach for the control of mosquitoes. This is the first report on the mosquito repellent and pupicidal activities of the reported P. cablin chemical compositions.

Gokulakrishnan, J; Kuppusamy, Elumalai; Shanmugam, Dhanasekaran; Appavu, Anandan; Kaliyamoorthi, Krishnappa

2013-01-01

250

Teaching Medical Ethics to Medical Students.  

ERIC Educational Resources Information Center

The evolution and goals of teaching medical ethics, the nature of medical ethics, and integrating such teaching into the curriculum are examined. Because moral considerations are as much a part of medical decisions as technical considerations, teaching is best done in the context of real cases. (Author/MLW)

Loewy, Erich H.

1986-01-01

251

Methodology for a medical expert system on fuzzy analog ganglionar lattices. Non-approximate reasoning with multiple antecendents of different relative importance and limited uncertainty.  

PubMed

This work presents an Expert System based on fuzzy analog ganglionar lattices. Its reasoning scheme is designed analogously to the expert's mental organization and it is realized on an (analog) operator called the ganglionar lattice. It is a connectionist system that uses the medical knowledge to define its architecture. The operator evokes some similarities to higher order neural networks and performs as the knowledge base and inference engine of the expert system, in a unified manner. A main feature of this operator is that it exhibits the variables corresponding to all intermediate concepts identified by the expert; this characteristic is shown to be most valuable for assessing, explicating and prospecting in medical applications. Further, it is capable of (i) evaluating a consequent for a variety of non-approximate reasonings with multiple antecendents of different relative importance under limited uncertainty; (ii) explicating the conclusions at different levels of abstraction to suit the user; and (iii) prospecting for the best 'a priori' sequence of unevaluated antecedents, from which to choose following tests. These procedures are based on the objective criterion of the consequent's uncertainty decrease (entropy). All results are produced in numerical form and may be translated into restricted natural language. A simple example of this technology is fully developed. Finally the method's potentials are discussed for future applications. PMID:8776711

Holzmann, C A; Ehijo, A; Perez, C A

252

Decision-Making by School Psychologists: Use of the Representativeness Heuristic and Importance of Assessment Data in Determination of Special Education Eligibility  

ERIC Educational Resources Information Center

The purpose of this project was to explore the decision-making approach and types of data that school psychologists use in determining special education classification. There were three research objectives: (a) to investigate the types of conditions and measures needed to test the use of the representativeness heuristic and assessment data, (b) to…

Wilson, Sharise Mavis

2010-01-01

253

Young People's Decision-Making: The Importance of High Quality School-Based Careers Education, Information, Advice and Guidance  

ERIC Educational Resources Information Center

This paper explores the decision-making processes of young people aged 13-14?years in 30 consortia across England as they chose their options for Key Stage 4 at a time when a new qualification, the 14-19 Diploma, was being introduced. It draws on data collected as part of a longitudinal national study (January 2008-August 2011) of the introduction…

Haynes, Gill; McCrone, Tami; Wade, Pauline

2013-01-01

254

General Guide to Advance Directives and Resuscitative Status -Health care consumers and providers increasingly are discussing medical decision making and planning.  

E-print Network

or her wishes regarding treatment options in critical situations and at the end of life. Patient individual's legal way to document wishes for medical care before incapacitating illness/ injury. ·Consists of two distinct parts - Living Will (documents wishes concerning medical treatment) and Medical Power

Acton, Scott

255

Costs, Control or Just Good Clinical Practice? The Use of Antipsychotic Medications and Formulary Decision-Making in Large U.S. Prisons and Jails  

ERIC Educational Resources Information Center

Medications are central to the psychiatric armamentorium in U.S. jails and prisons. Psychiatric medications are used both to stabilize acute symptoms as well as maintain mental health once symptoms are reduced. Both jails and prisons rely heavily on traditional antipsychotics, but both have a full array of atypical medications in their…

Veysey, Bonita M.; Stenius, Vanja; Mazade, Noel; Schacht, Lucille

2007-01-01

256

[Medical technology and medical education].  

PubMed

The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented. PMID:20700785

von Mallek, D; Biersack, H-J; Mull, R; Wilhelm, K; Heinz, B; Mellert, F

2010-08-01

257

Welldefined Decision Scenarios  

Microsoft Academic Search

Influence diagrams serve as a powerful toolfor modelling symmetric decision problems.When solving an influence diagram we determinea set of strategies for the decisionsinvolved. A strategy for a decision variableis in principle a function over its past. However,some of the past may be irrelevant forthe decision, and for computational reasons itis important not to deal with redundant variablesin the strategies. We

Thomas D. Nielsen; Finn Verner Jensen

1999-01-01

258

Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.  

ERIC Educational Resources Information Center

Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

Beisecker, Analee E.; And Others

1994-01-01

259

The Integrated Medical Model  

NASA Technical Reports Server (NTRS)

This slide presentation reviews the goals and approach for the Integrated Medical Model (IMM). The IMM is a software decision support tool that forecasts medical events during spaceflight and optimizes medical systems during simulations. It includes information on the software capabilities, program stakeholders, use history, and the software logic.

Butler, Douglas J.; Kerstman, Eric

2010-01-01

260

An investigation of the relative importance of recreation, park and cultural amenities in the location decisions of (re)locating companies  

E-print Network

) explains the change: We are beginning to shift from a second wave manufacturing economy based on auto, steel, textile, apparel, and rubber to a third wave economy based on communications, genetics, aerospace, oceans, new materials, environmental..., to quality of schools, to residential areas and recreational facilities, to open political and social structures" (Conway, 1985). In the context of this research, quality of life includes climate, health and medical services, personal safety, primary...

Decker, Jill Marie

1988-01-01

261

Person autonomy and voluntariness as important factors in motivation, decision making, and astronaut safety: First results from the Mars500 LODGEAD study  

NASA Astrophysics Data System (ADS)

The present study aims to explore the influence of person autonomy and voluntariness on the level and orientation of motivation and decision making of crew members who live and work in extreme isolated conditions such as during long-term space flights. Motivation has been related to positive behavioural (e.g., goal-orientation), cognitive (e.g., attention), and psychological (e.g., well-being) outcomes and is likely to be relevant for safe and favourable extraterrestrial life- and working-conditions. The study has been carried out within the scope of the Mars500 study which includes a Mars mission simulation of 105 (pilot study) and 520 (main study) days and involves a multi-national crew of 6 men who lived and worked in hermetically sealed modules in the IBMP facilities in Moscow. Data have been collected by the use of questionnaires that evaluate the Mars experiment in terms of, e.g. information received (e.g., "My experiences here are in line with what I was told during the selection and instruction procedure"), perceived social pressure (e.g., "I don't feel free to make my own decisions"), and personal challenge (e.g., "I think that joining the first Mars mission would be a major challenge for me"). It is hypothesised that stronger (1) perceived information consistency, (2) personal expectation consistency, (3) perceived voluntariness, and (4) experienced freedom of choice will be indicative of higher motivation levels. The results will be interpreted in the light of communication, decision making processes, and mission safety. Also, moral expectations and ethical considerations regarding future participation in long duration Human missions such as Mars will be discussed. We will make use of descriptive, longitudinal pattern analyses and correlations.

Baarsen, Bernadette van

2013-06-01

262

38 CFR 1.484 - Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity.  

Code of Federal Regulations, 2011 CFR

...activity relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia to a surrogate of the patient who is the subject of such record if: (a) The patient lacks decision-making...

2011-07-01

263

38 CFR 1.484 - Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity.  

Code of Federal Regulations, 2013 CFR

...activity relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia to a surrogate of the patient who is the subject of such record if: (a) The patient lacks decision-making...

2013-07-01

264

38 CFR 1.484 - Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity.  

Code of Federal Regulations, 2012 CFR

...activity relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia to a surrogate of the patient who is the subject of such record if: (a) The patient lacks decision-making...

2012-07-01

265

38 CFR 1.484 - Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity.  

...activity relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia to a surrogate of the patient who is the subject of such record if: (a) The patient lacks decision-making...

2014-07-01

266

Is it ethical for a medical practice to dismiss a family based on their decision not to have their child immunized?  

PubMed

The parents' decision not to have their child immunized stirs up much controversy in the public sector and in the healthcare arena. Much debate surrounds not just the parents' choice but also the practitioner's decision to refuse care based on their refusal. This article presents a common and increasing scenario faced in pediatric practices and explores the ethical implications that it poses for the healthcare provider. PMID:22124471

Nulty, Dorothy

2011-01-01

267

Dissociation of decision making under ambiguity and decision making under risk: A neurocognitive endophenotype candidate for obsessive-compulsive disorder.  

PubMed

Evidence in the literature suggests that executive dysfunction is regarded as an endophenotype candidate for obsessive-compulsive disorder (OCD). Decision making is an important domain of executive function. However, few studies that have investigated whether decision making is a potential endophenotype for OCD have produced inconsistent results. Differences in the findings across these studies may be attributed to several factors: different study materials, comorbidity, medication, etc. There are at least two types of decision making that differ mainly in the degree of uncertainty and how much useful information about consequences and their probabilities are provided to the decision maker: decision making under ambiguity and decision making under risk. The aim of the present study was to simultaneously examine decision making under ambiguity as assessed by the Iowa Gambling Task (IGT) and decision making under risk as measured by the Game of Dice Task (GDT) in OCD patients and their unaffected first-degree relative (UFDR) for the first time. The study analyzed 55 medication-naïve, non-depressed OCD patient probands, 55 UFDRs of the OCD patients and 55 healthy matched comparison subjects (CS) without a family history of OCD with the IGT, the GDT and a neuropsychological test battery. While the OCD patients and the UFDRs performed worse than the CS on the IGT, they were unimpaired on the GDT. Our study supports the claim that decision making under ambiguity differs from decision making under risk and suggests that dissociation of decision making under ambiguity and decision making under risk may qualify to be a neurocognitive endophenotypes for OCD. PMID:25315855

Zhang, Long; Dong, Yi; Ji, Yifu; Zhu, Chunyan; Yu, Fengqiong; Ma, Huijuan; Chen, Xingui; Wang, Kai

2015-03-01

268

[Contemporary legislation and importance of psychophysiologic examination in system of medical support for workers engaged into production with radiation and nuclear danger].  

PubMed

In accordance with contemporary legislation, the article covers materials on specification and approbation of concept model for psychophysiologic examination in medical establishments during medical examination of workers engaged into production with raidation and nuclear danger. The authors defined methodology, examination methods and designed an order of psychophysiologic examination. The psychophysiologic examination and purpose-oriented rehabilitation appeared efficient. PMID:23210182

Torubarov, F S; Isaeva, N A; Zvereva, Z F; Denisova, E A; Metliaeva, N A

2012-01-01

269

Vectors, Bites, and Venoms: Articles on Insects and Other Arthropods of Medical Importance. Which Journals Published the Most and on Which Insects, 2007–2011?  

Microsoft Academic Search

With a goal of delineating a small, core collection of journals to cover growing domestic and worldwide interest, this study reports four findings about articles related to medical entomology that appeared from 2007–2011. First, in the study of insects as disease vectors, journals of tropical medicine and biology actually publish almost as many papers as journals of medical entomology and

Tony Stankus

2012-01-01

270

Medical Imaging.  

ERIC Educational Resources Information Center

Discusses four main types of medical imaging (x-ray, radionuclide, ultrasound, and magnetic resonance) and considers their relative merits. Describes important recent and possible future developments in image processing. (Author/MKR)

Barker, M. C. J.

1996-01-01

271

Automated Identification of Medically Important Bacteria by 16S rRNA Gene Sequencing Using a Novel Comprehensive Database, 16SpathDB?  

PubMed Central

Despite the increasing use of 16S rRNA gene sequencing, interpretation of 16S rRNA gene sequence results is one of the most difficult problems faced by clinical microbiologists and technicians. To overcome the problems we encountered in the existing databases during 16S rRNA gene sequence interpretation, we built a comprehensive database, 16SpathDB (http://147.8.74.24/16SpathDB) based on the 16S rRNA gene sequences of all medically important bacteria listed in the Manual of Clinical Microbiology and evaluated its use for automated identification of these bacteria. Among 91 nonduplicated bacterial isolates collected in our clinical microbiology laboratory, 71 (78%) were reported by 16SpathDB as a single bacterial species having >98.0% nucleotide identity with the query sequence, 19 (20.9%) were reported as more than one bacterial species having >98.0% nucleotide identity with the query sequence, and 1 (1.1%) was reported as no match. For the 71 bacterial isolates reported as a single bacterial species, all results were identical to their true identities as determined by a polyphasic approach. For the 19 bacterial isolates reported as more than one bacterial species, all results contained their true identities as determined by a polyphasic approach and all of them had their true identities as the “best match in 16SpathDB.” For the isolate (Gordonibacter pamelaeae) reported as no match, the bacterium has never been reported to be associated with human disease and was not included in the Manual of Clinical Microbiology. 16SpathDB is an automated, user-friendly, efficient, accurate, and regularly updated database for 16S rRNA gene sequence interpretation in clinical microbiology laboratories. PMID:21389154

Woo, Patrick C. Y.; Teng, Jade L. L.; Yeung, Juilian M. Y.; Tse, Herman; Lau, Susanna K. P.; Yuen, Kwok-Yung

2011-01-01

272

A Case of Intractable Left Forearm Congenital Arteriovenous Fistula Ending with Amputation: Importance of New Medical Information Obtained via the Internet  

PubMed Central

Objective: The aim of the present study was to consider the importance of medical information obtained via the Internet for difficult cases in hospitals, especially in those located in rural areas. We report here a case of congenital arteriovenous fistula (AVF) in the upper extremities. Patient: A 30-year-old lady was transported to our hospital by ambulance due to massive bleeding in her left hand. She was seen by our current cardiovascular surgery team for the first time, although she had been diagnosed with congenital AVF of the left arm 9 years previously. Because it was asymptomatic, she was followed up by observation. During 5 years of observation, symptoms such as cyanosis, pain, and refractory ulcers gradually developed. When she was 26 years old, she was referred to a university hospital in Akita, but surgery had already been judged to be impossible. When she was 30 years old, traumatic bleeding in her left hand and hemorrhagic shock led her to be taken to our hospital by ambulance. Using the Internet, we found an institution that had treated a large number of cases of AVF. After controlling the bleeding, we referred her to that institution. However, she could not be treated without an above-elbow amputation. Conclusion: Congenital AVF in the upper extremities is a rare vascular anomaly and has been generally accepted to be an extremely difficult disease to treat. Treatment should be started as early as possible before the presence of any symptoms. When a specialist is not available near the hospital, precise information must be found using the Internet and the patient should be referred without any delay.

Liu, Jiajia; Shimada, Yasuyuki

2014-01-01

273

Distributed decision making: the anatomy of decisions-in-action.  

PubMed

Conceptualising the doctor-patient relationship has been a central project for both medicine and medical sociology. This paper seeks to show how an understanding of the distributed nature of medical practice can help us research the decision-making process in doctor-patient encounters. I draw on a range of empirical studies of medical interaction, knowledge, technology and work in primary and secondary care. I describe the 'ethno-methods' (Garfinkel 1967) of patient-orientated medical decision making in order to highlight some of the fundamental facets of distributed decision making. Initially, I outline how decision making is an ongoing event that often evolves over multiple encounters. I then show how decision making is never just a solo, cognitive activity but rather distributed over a range of people. Finally, I outline how decision making is initiated, sustained and transformed over a range of encounters with both people and technologies. I argue that recognising the distributed nature of decision making shifts the focus from overly prescriptive visions of decision making to more plausible, albeit, more mundane sets of ideals. Centrally, a focus on distribution offers new opportunities actively to engage with, support and research decision-making-in-action. PMID:18194358

Rapley, Tim

2008-04-01

274

Exploring the Existential Function of Religion: The Effect of Religious Fundamentalism and Mortality Salience on Faith-Based Medical Refusals  

Microsoft Academic Search

Decisions to rely on religious faith over medical treatment for health conditions represent an important but understudied phenomenon. In an effort to understand some of the psychological underpinnings of such decisions, the present research builds from terror management theory to examine whether reminders of death motivate individuals strongly invested in a religious worldview (i.e., fundamentalists) to rely on religious beliefs

Matthew Vess; Jamie Arndt; Cathy R. Cox; Clay Routledge; Jamie L. Goldenberg

2009-01-01

275

SHARED DECISION MAKING FOR CANCER CARE AMONG RACIAL AND ETHNIC MINORITIES: A SYSTEMATIC REVIEW  

PubMed Central

To assess decision making for cancer treatment among racial/ethnic minority patients, we systematically reviewed and synthesized evidence from studies of “shared decision-making,” “cancer,” and “minority groups,” using PubMed, PsycInfo, CINAHL, and EMBASE. We identified significant themes that we compared across studies, refined, and organized into a conceptual model. Five major themes emerged: treatment decision-making, patient factors, family and important others, community, and provider factors. Thematic data overlapped categories, indicating that individuals’ preferences for medical decision-making cannot be authentically examined outside the context of family and community. The shared decision-making model should be expanded beyond the traditional patient–physician dyad to include other important stakeholders in the cancer treatment decision process, such as family or community leaders. PMID:24134353

Mead, Erin L.; Doorenbos, Ardith Z.; Javid, Sara H.; Haozous, Emily A.; Arviso Alvord, Lori; Flum, David R.; Morris, Arden M.

2013-01-01

276

Shared decision-making for cancer care among racial and ethnic minorities: a systematic review.  

PubMed

To assess decision-making for cancer treatment among racial/ethnic minority patients, we systematically reviewed and synthesized evidence from studies of "shared decision-making," "cancer," and "minority groups," using PubMed, PsycInfo, CINAHL, and EMBASE. We identified significant themes that we compared across studies, refined, and organized into a conceptual model. Five major themes emerged: treatment decision-making, patient factors, family and important others, community, and provider factors. Thematic data overlapped categories, indicating that individuals' preferences for medical decision-making cannot be authentically examined outside the context of family and community. The shared decision-making model should be expanded beyond the traditional patient-physician dyad to include other important stakeholders in the cancer treatment decision process, such as family or community leaders. PMID:24134353

Mead, Erin L; Doorenbos, Ardith Z; Javid, Sara H; Haozous, Emily A; Alvord, Lori Arviso; Flum, David R; Morris, Arden M

2013-12-01

277

Fears, Feelings, and Facts: Interactively Communicating Benefits and Risks of Medical Radiation With Patients  

PubMed Central

OBJECTIVE As public awareness of medical radiation exposure increases, there has been heightened awareness among patients and physicians of the importance of holistic benefit-and-risk discussions in shared medical decision making. CONCLUSION We examine the rationale for informed consent and risk communication, draw on the literature on the psychology of radiation risk communication to increase understanding, examine methods commonly used to communicate radiation risk, and suggest strategies for improving communication about medical radiation benefits and risk. PMID:21427321

Dauer, Lawrence T.; Thornton, Raymond H.; Hay, Jennifer L.; Balter, Rochelle; Williamson, Matthew J.; St. Germain, Jean

2013-01-01

278

Are Providers More Likely to Contribute to Healthcare Disparities Under High Levels of Cognitive Load? How Features of the Healthcare Setting May Lead to Biases in Medical Decision Making  

PubMed Central

Systematic reviews of healthcare disparities suggest that clinicians’ diagnostic and therapeutic decision making varies by clinically irrelevant characteristics, such as patient race, and that this variation may contribute to healthcare disparities. However, there is little understanding of the particular features of the healthcare setting under which clinicians are most likely to be inappropriately influenced by these characteristics. This study delineates several hypotheses to stimulate future research in this area. It is posited that healthcare settings in which providers experience high levels of cognitive load will increase the likelihood of racial disparities via 2 pathways. First, providers who experience higher levels of cognitive load are hypothesized to make poorer medical decisions and provide poorer care for all patients, due to lower levels of controlled processing (H1). Second, under greater levels of cognitive load, it is hypothesized that healthcare providers’ medical decisions and interpersonal behaviors will be more likely to be influenced by racial stereotypes, leading to poorer processes and outcomes of care for racial minority patients (H2). It is further hypothesized that certain characteristics of healthcare settings will result in higher levels of cognitive load experienced by providers (H3). Finally, it is hypothesized that minority patients will be disproportionately likely to be treated in healthcare settings in which providers experience greater levels of cognitive load (H4a), which will result in racial disparities due to lower levels of controlled processing by providers (H4b) and the influence of racial stereotypes (H4c).The study concludes with implications for research and practice that flow from this framework. PMID:19726783

Burgess, Diana J.

2014-01-01

279

An example of using a decision making framework designed for non-medical prescribers as a method for enhancing prescribing safety for inhaled corticosteroids (ICS)  

PubMed Central

Non-medical prescribing is needed especially with the increased demand for health care and the physicians’ time constrains. Also, it is not well regulated in Saudi Arabia unlike the United Kingdom. This report aims to demonstrate the urged need for regulations to maintain a safe non-medical prescribing process. It also adapts the single competency framework provided by the United Kingdom national prescribing centre (NPC, 2012) to be utilised by the respiratory therapist for a safe prescribing process for inhaled corticosteroids (ICS) to control adult asthma as an example. The framework is thought to be an effective tool for safe non-medical prescribing and it is highly recommended to develop a national Saudi framework to maintain the patients’ safety and utilise resources.

Almarshad, Saja

2014-01-01

280

Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.  

PubMed

The specificity of medication-related alerts must be improved to overcome the pernicious effects of alert fatigue. A systematic comparison of new drug orders to historical orders could improve alert specificity and relevance. Using historical order data from a computerized provider order entry system, we alerted physicians to atypical orders during the prescribing of five medications: calcium, clopidogrel, heparin, magnesium, and potassium. The percentage of atypical orders placed for these five medications decreased during the 92 days the alerts were active when compared to the same period in the previous year (from 0.81% to 0.53%; p=0.015). Some atypical orders were appropriate. Fifty of the 68 atypical order alerts were over-ridden (74%). However, the over-ride rate is misleading because 28 of the atypical medication orders (41%) were changed. Atypical order alerts were relatively few, identified problems with frequencies as well as doses, and had a higher specificity than dose check alerts. PMID:24253195

Woods, Allie D; Mulherin, David P; Flynn, Allen J; Stevenson, James G; Zimmerman, Christopher R; Chaffee, Bruce W

2014-01-01

281

Information Literacy for Users at the National Medical Library of Cuba: Cochrane Library Course for the Search of Best Evidence for Clinical Decisions  

ERIC Educational Resources Information Center

The National Medical Library of Cuba is currently developing an information literacy program to train users in the use of biomedical databases. This paper describes the experience with the course "Cochrane Library: Evidence-Based Medicine," which aims to teach users how to make the best use of this database, as well as the evidence-based medicine…

Santana Arroyo, Sonia; del Carmen Gonzalez Rivero, Maria

2012-01-01

282

The Alcohol Clinical Trials Initiative (ACTIVE): Purpose and Goals for Assessing Important and Salient Issues for Medications Development in Alcohol Use Disorders  

Microsoft Academic Search

Although progress has been made in the treatment of alcohol use disorders, more effective treatments are needed. In the last 15 years, several medications have been approved for use in alcohol dependence but have only limited effectiveness and clinical acceptance. While academics have developed some ‘standards’ for the performance of clinical trials for alcohol dependence, they vary considerably, in the

Raymond F Anton; Raye Z Litten; Daniel E Falk; Joseph M Palumbo; Raymond T Bartus; Rebecca L Robinson; Henry R Kranzler; Thomas R Kosten; Roger E Meyer; Charles P O'Brien; Karl Mann; Didier Meulien

2012-01-01

283

Designing for Decision Making  

ERIC Educational Resources Information Center

Decision making is the most common kind of problem solving. It is also an important component skill in other more ill-structured and complex kinds of problem solving, including policy problems and design problems. There are different kinds of decisions, including choices, acceptances, evaluations, and constructions. After describing the centrality…

Jonassen, David H.

2012-01-01

284

Evolution's Importance to Society  

NSDL National Science Digital Library

The thought provoking interview shows readers how evolution influences everyones life every day. Examples are decisions you make about conservation and the environment, choices in the medications you need, such as antibiotics, ensuring an adequate food supply, and learning skills to work in biotechnology or software development.

Massimo Pigliucci (State University of New York at Stony Brook;)

2005-07-01

285

Twelve tips to improve medical teaching rounds.  

PubMed

The ward round is the bread and butter of internal medicine. It forms the basis of clinical decision making and reviewing patients' progress. It is fundamental to the role of the internal medical physician. It allows for the review of the patients' notes, signs and symptoms, physiological parameters and investigation results. Most importantly, it allows for an interaction with the patient and their relatives and is a means of relating medical information back, answer queries and plan future medical management strategies. These should be integrated into the teaching round by a senior clinician so that time away from the bedside is also used to enhance the teaching and learning experience. Here, I would like to draw on my experience as a learner as well as an educator, together with the available literature, to draw up a simple 12-step teaching strategy that should help the ward round serve the dual purpose of teaching medical students and junior doctors. PMID:24004439

Abdool, Muhammad Ali; Bradley, Don

2013-11-01

286

End of life decisions and pregnant women: do pregnant women have the right to refuse life preserving medical treatment? A comparative study.  

PubMed

In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is repeated in the situation where the woman is found to be incompetent or brain dead. PMID:21133244

Lemmens, Christophe

2010-12-01

287

An Emerging Field of Research: Challenges in Pediatric Decision Making.  

PubMed

There is growing interest in pediatric decision science, spurred by policies advocating for children's involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making. Much work has been done to address gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum. PMID:25145576

Lipstein, Ellen A; Brinkman, William B; Fiks, Alexander G; Hendrix, Kristin S; Kryworuchko, Jennifer; Miller, Victoria A; Prosser, Lisa A; Ungar, Wendy J; Fox, David

2014-08-21

288

Adherence to acute migraine medication: what does it mean, why does it matter?  

PubMed

Proper use of medications is an important part of successfully managing migraine headache, yet migraineurs frequently switch, discontinue, or delay taking effective prescription therapies such as triptans. Medication persistence in the treatment of chronic-episodic disorders such as migraine is not well understood. In this article we review this topic, by critically reviewing studies conducted using pharmacy claims, clinical records, survey, and patient-reported data to explore acute medication use for migraine headache. While efficacy, cost, drug tolerability, and side effects impact whether a patient takes migraine medication, low perceived disease importance and factors related to the patient's internal decision-making process play a strong role in the sustained use of acute medication for migraine attack. We propose a model that combines the patient's perceived severity of migraine, their beliefs regarding the safety of acute medications, and factors related to the physician-patient relationship to identify migraineurs at high risk for medication adherence problems. PMID:19817884

Kati?, Bozena J; Krause, Steven J; Tepper, Stewart J; Hu, Henry X; Bigal, Marcelo E

2010-01-01

289

Neural network modeling for surgical decisions on traumatic brain injury patients  

Microsoft Academic Search

Computerized medical decision support systems have been a major research topic in recent years. Intelligent computer programs were implemented to aid physicians and other medical professionals in making difficult medical decisions. This report compares three different mathematical models for building a traumatic brain injury (TBI) medical decision support system (MDSS). These models were developed based on a large TBI patient

Yu-Chuan Li; Li Liu; Wen-Ta Chiu; Wen-Shan Jian

2000-01-01

290

[Medical geography].  

PubMed

Hippocrates already noted that geographical factors such as climate, relief, geology but also settlement patterns had influenced the distribution of diseases. The task of medical geography is to investigate the associations between geographical factors and diseases. Thereby, geographic techniques and concepts are applied on health problems. Of particular importance is the mapping of diseases whose causes are environmental-related. In addition, epidemiological, ecological but also social scientific studies play an important part in the investigation of the associations between geographical factors and diseases. In order to understand the associations between the spatial distribution of diseases and environmental exposures, geographic information systems as well as statistical analyses have recently become more important. Some authors regard medical geography merely as supporting discipline of medicine. Nevertheless, as men and environment future and as they play an important part in the diffusion of diseases being regarded as defeated, medical geography will play an important part concerning medical questions. Especially travel medicine will rely on geographic knowledge, if a patient has to be consulted who plans to travel to an unknown country of which knowledge on the geographical distribution and ecology of diseases will be necessary. PMID:17974122

Hauri, D

2007-10-17

291

Decision to Enter Pulmonology: Motives and Implications.  

ERIC Educational Resources Information Center

Responses to 281 questionnaires were analyzed from 171 fellows, faculty members, and practitioners to determine the influential factors in pulmonary subspecialty decisions, and at what point of training these career decisions are made. The specific role of medical school instruction or interaction in these decisions was of special interest.…

Gong, Henry, Jr.; Wenzel, Bernice M.

1978-01-01

292

Pitfalls of Counterfactual Thinking in Medical Practice: Preventing Errors by Using More Functional Reference Points  

PubMed Central

Background Counterfactual thinking involves mentally simulating alternatives to reality. The current article reviews literature pertaining to the relevance counterfactual thinking has for the quality of medical decision making. Although earlier counterfactual thought research concluded that counterfactuals have important benefits for the individual, there are reasons to believe that counterfactual thinking is also associated with dysfunctional consequences. Of particular focus is whether or not medical experience, and its influence on counterfactual thinking, actually informs or improves medical practice. It is hypothesized that relatively more probable decision alternatives, followed by undesirable outcomes and counterfactual thought responses, can be abandoned for relatively less probable decision alternatives. Design and Methods Building on earlier research demonstrating that counterfactual thinking can impede memory and learning in a decision paradigm with undergraduate students, the current study examines the extent to which earlier findings can be generalized to practicing physicians (N=10). Participants were asked to complete 60 trials of a computerized Monty Hall Problem simulation. Learning by experience was operationalized as the frequency of switch-decisions. Results Although some learning was evidenced by a general increase in switch-decision frequency across block trials, the extent of learning demonstrated was not ideal, nor practical. Conclusions A simple, multiple-trial, decision paradigm demonstrated that doctors fail to learn basic decision-outcome associations through experience. An agenda for future research, which tests the functionality of reference points (other than counterfactual alternatives) for the purposes of medical decision making, is proposed. Significance for public health The quality of healthcare depends heavily on the judgments and decisions made by doctors and other medical professionals. Findings from this research indicate that doctors fail to learn basic decision-outcome associations through experience, as evidenced by the sample’s tendency to select the optimal decision strategy in only 50% of 60 trials (each of which was followed by veridical feedback). These findings suggest that professional experience is unlikely to enhance the quality of medical decision making. Thus, this research has implications for understanding how doctors’ reactions to medical outcomes shape their judgments and affect the degree to which their future treatment intentions are consistent with clinical practice guidelines. The current research is integrated with earlier research on counter-factual thinking, which appears to be a primary element inhibiting the learning of decision-outcome associations. An agenda for future research is proposed. PMID:25170495

Petrocelli, John V.

2013-01-01

293

The role of decision analysis in informed consent: Choosing between intuition and systematicity  

Microsoft Academic Search

An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients'

P. A. Ubel; G. Loewenstein

1997-01-01

294

Using Medications Safely  

MedlinePLUS

... health systems play an important role in preventing medication errors. To make sure you use medicines safely and effectively, ASHP recommends that you: Keep a list of all medications that you take (prescribed drugs, nonprescription medicines, herbal ...

295

Does Childhood Use of Stimulant Medication as a Treatment for ADHD Affect the Likelihood of Future Drug Abuse and Dependence? A Literature Review  

ERIC Educational Resources Information Center

This article describes the disparate research findings regarding the effects of stimulant medication in subsequent substance abuse and dependence. A minimum of 4 to 5% of children in the United States will be diagnosed with ADHD; thus it is important for parents to be informed when making decisions about the use of stimulant medication to treat…

Golden, Shawn M.

2009-01-01

296

Community understanding of Respondent-Driven Sampling in a medical research setting in Uganda: importance for the use of RDS for public health research  

PubMed Central

Respondent-driven sampling (RDS) is a widely-used variant of snowball sampling. Respondents are selected not from a sampling frame, but from a social network of existing members of the sample. Incentives are provided for participation and for the recruitment of others. Ethical and methodological criticisms have been raised about RDS. Our purpose was to evaluate whether these criticisms were justified. In this study RDS was used to recruit male household heads in rural Uganda. We investigated community members’ understanding and experience of the method, and explored how these may have affected the quality of the RDS survey data. Our findings suggest that because participants recruit participants, the use of RDS in medical research may result in increased difficulties in gaining informed consent, and data collected using RDS may be particularly susceptible to bias due to differences in the understanding of key concepts between researchers and members of the community. PMID:24273435

McCreesh, Nicky; Tarsh, Matilda Nadagire; Seeley, Janet; Katongole, Joseph; White, Richard G

2013-01-01

297

Decision Making in Action  

NASA Technical Reports Server (NTRS)

The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relations between leadership, communication, decision making and overall crew performance. Implications of these findings for spaceflight and training for offshore installations will be discussed.

Orasanu, Judith; Statler, Irving C. (Technical Monitor)

1994-01-01

298

Medical leasing.  

PubMed

Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements. PMID:22594070

Holden, Elizabeth A

2012-01-01

299

Decision story strategy: a practical approach for teaching decision making.  

PubMed

Teachers are usually very enthusiastic in their evaluations of decision stories. Decision Story Strategies offer a change of pace, promote student involvement and stimulate creative thinking, problem solving and everpresent creative teaching-learning opportunities. The real-life problems presented within the structure of a decision story provide meaningful learning opportunities for students. Students begin to think in a broader perspective when considering other points of view and information sources. The Decision Story Strategy used with the Decision-Making Model provides a powerful tool for health educators to develop skills for making and evaluating decisions in an interesting and meaningful context. It may not be a panacea for all health educators, but is an effective strategy for the teacher concerned with developing independent decision makers. Most importantly, students are provided opportunities to solve their present problems as well as develop decision-making skills for the future. PMID:6916032

Smith, D L; Hamrick, M H; Anspaugh, D J

1981-12-01

300

Stereotactic Body Radiotherapy Versus Surgery for Medically Operable Stage I Non-Small-Cell Lung Cancer: A Markov Model-Based Decision Analysis  

SciTech Connect

Purpose: To compare the quality-adjusted life expectancy and overall survival in patients with Stage I non-small-cell lung cancer (NSCLC) treated with either stereotactic body radiation therapy (SBRT) or surgery. Methods and Materials: We constructed a Markov model to describe health states after either SBRT or lobectomy for Stage I NSCLC for a 5-year time frame. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking, and compared these with an external outcome prediction tool (Adjuvant{exclamation_point} Online). Results: Overall survival, cancer-specific survival, and other causes of death as predicted by our model correlated closely with those predicted by the external prediction tool. Overall survival at 5 years as predicted by baseline analysis of our model is in favor of surgery, with a benefit ranging from 2.2% to 3.0% for all cohorts. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and from 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard vs. palliative treatments, and the surgery- and SBRT-related mortalities. Conclusions: The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality-adjusted life expectancy as compared with surgical resection. Well-powered prospective studies comparing surgery vs. SBRT in early-stage lung cancer are warranted to further investigate the relative survival, quality of life, and cost characteristics of both treatment paradigms.

Louie, Alexander V. [Department of Oncology, University of Western Ontario, London, ON (Canada); Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca [Department of Oncology, University of Western Ontario, London, ON (Canada); Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Hannouf, Malek [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Zaric, Gregory S. [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Richard Ivey School of Business, University of Western Ontario, London, ON (Canada); Palma, David A. [Department of Oncology, University of Western Ontario, London, ON (Canada); Cao, Jeffrey Q. [Department of Oncology, University of Western Ontario, London, ON (Canada); Richard Ivey School of Business, University of Western Ontario, London, ON (Canada); Yaremko, Brian P. [Department of Oncology, University of Western Ontario, London, ON (Canada); Malthaner, Richard [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Division of Surgery, University of Western Ontario, London, ON (Canada); Mocanu, Joseph D. [Richard Ivey School of Business, University of Western Ontario, London, ON (Canada)

2011-11-15

301

Satellite vegetation index data as a tool to forecast population dynamics of medically important mosquitoes at military installations in the Continental United States  

Technology Transfer Automated Retrieval System (TEKTRAN)

The United States faces many existing and emerging mosquito-borne disease threats such as West Nile virus (WNV) and Rift Valley fever (RVF). An important component of strategic prevention and control plans for these and other mosquito-borne diseases is forecasting the distribution, timing, and abund...

302

Benjamin D. Philpot and Mark F. Bear are therefore important for understanding the neural mechanisms responsible for contour completion, in par-Howard Hughes Medical Institute  

E-print Network

Previews 667 Benjamin D. Philpot and Mark F. Bear are therefore important for understanding precision and feature resolution, these areas are Bear, M.F., and Rittenhouse, C.D. (1999). J. Neurobiol. 41., Kameyama, K., Bear, M.F., and Huganir, nothing inside the receptive field of the neurons. LeeR.L. (2000

Rubin, Nava

303

Medication errors: pharmacovigilance centres in detection and prevention  

PubMed Central

Detecting medication errors needs collaboration between various organizations, such as patient safety institutions, pharmacovigilance centres, and poison control centres. In order to evaluate the input of pharmacovigilance centres and poison control centres in detecting and evaluating medication errors a pilot project was initiated by the World Alliance for Patient Safety in collaboration with the Uppsala Monitoring Centre; the Moroccan pharmacovigilance centre acted as project coordinator. As part of this project, a questionnaire on detecting medication errors was circulated to pharmacovigilance centres and poison control centres around the world, in order to assess their ability to detect and analyse medication errors. The results showed that through their databases pharmacovigilance centres can detect, identify, analyse, and classify medication errors and carry out root cause analysis, which is an important tool in preventing medication errors. The duties of pharmacovigilance centres in preventing medication errors include informing health-care professionals about the importance of reporting such errors and creating a culture of patient safety. Pharmacovigilance centres aim to prevent medication errors in collaboration with poison control centres. Such collaboration allows improved detection and improved preventive strategies. In addition, collaboration with regulatory authorities is important in finalizing decisions. Collaboration between pharmacovigilance centres and poison control centres should be strengthened and bridges need to be built linking pharmacovigilance centres, poison control centres, and organizations dedicated to patient safety, in order to avoid duplication of workload. PMID:19594539

Bencheikh, Rachida Soulaymani; Benabdallah, Ghita

2009-01-01

304

Emotion and decision making.  

PubMed

A revolution in the science of emotion has emerged in recent decades, with the potential to create a paradigm shift in decision theories. The research reveals that emotions constitute potent, pervasive, predictable, sometimes harmful and sometimes beneficial drivers of decision making. Across different domains, important regularities appear in the mechanisms through which emotions influence judgments and choices. We organize and analyze what has been learned from the past 35 years of work on emotion and decision making. In so doing, we propose the emotion-imbued choice model, which accounts for inputs from traditional rational choice theory and from newer emotion research, synthesizing scientific models. PMID:25251484

Lerner, Jennifer S; Li, Ye; Valdesolo, Piercarlo; Kassam, Karim S

2015-01-01

305

Decision Trees Unpredictability Bias Improvements Decision Trees  

E-print Network

Decision Trees Unpredictability Bias Improvements Decision Trees #12;Decision Trees Unpredictability Bias Improvements 1 Decision Trees Using Trees Learning 2 Unpredictability Entropy Entropy for datasets Information Gain 3 Bias Bias Occam's principle Overfitting 4 Improvements #12;Decision Trees

Kjellström, Hedvig

306

University Medical Center New Orleans, Louisiana  

E-print Network

1 University Medical Center New Orleans, Louisiana FEBRUARY 6, 2014 #12;22 UNIVERSITY MEDICAL Director Facility Planning & Control SPECIALIZATIONS Healthcare Education #12;33 UNIVERSITY MEDICAL CENTER Project Team #12;44 UNIVERSITY MEDICAL CENTER 4 SEPTEMBER 5, 2005 Katrina did not make the decision

307

Medical Licensing Examinations in the United States.  

ERIC Educational Resources Information Center

Discusses examination requirements for medical licensure in the United States, focusing on the exam components related to assessment of hands-on clinical skills with patients and assessment of medical decision-making skills. Provides a brief history of medical licensing exams, describes the United States Medical Licensing Examination (USMLE), and…

Melnick, Donald E.; Dillon, Gerard F.; Swanson, David B.

2002-01-01

308

Life and Death Decision Making, by Baruch A. Brody.  

PubMed

Veatch considers the pluralistic casuistry theory advocated by Baruch Brody in his 1988 book, Life and Death Decision Making, to be an important contribution to the secular medical ethics literature. The casuistic and pluralistic elements of Brody's new model are described as intriguing but controversial because Brody both excludes several ethical appeals (i.e., classical Hippocratic ethics, virtue theory) and/or limits other questionable appeals (i.e., consequences for families and others in society, the virtue of integrity) without accounting for these decisions. Veatch also questions Brody's use of intuitional judgment to determine what ought to be done after examination of various appeals and their significance because Brody's approach raises serious problems about how various appeals are counted. Veatch does affirm the rich assessment of medical ethical problems made possible by Brody's pluralistic approach but notes the difficulties it raises. PMID:11649246

Veatch, Robert M

1989-04-01

309

British Medical Journal  

NSDL National Science Digital Library

The British Medical Association provides free and unrestricted access to all British Medical Journal articles, job announcements, editorials, and a fully searchable archive of the journal. Currently, archives extend back to 1997 but these will eventually date to 1994. Subjects range "from asthma through aging to end of life decisions." Users can also register for a free, weekly email service providing lists of full or selected content. Access will be free until at least the end of 1998.

310

Development of digital dashboard system for medical practice: maximizing efficiency of medical information retrieval and communication.  

PubMed

It is reported that digital dashboard systems in hospitals provide a user interface (UI) that can centrally manage and retrieve various information related to patients in a single screen, support the decision-making of medical professionals on a real time basis by integrating the scattered medical information systems and core work flows, enhance the competence and decision-making ability of medical professionals, and reduce the probability of misdiagnosis. However, the digital dashboard systems of hospitals reported to date have some limitations when medical professionals use them to generally treat inpatients, because those were limitedly used for the work process of certain departments or developed to improve specific disease-related indicators. Seoul National University Bundang Hospital developed a new concept of EMR system to overcome such limitations. The system allows medical professionals to easily access all information on inpatients and effectively retrieve important information from any part of the hospital by displaying inpatient information in the form of digital dashboard. In this study, we would like to introduce the structure, development methodology and the usage of our new concept. PMID:23920865

Lee, Kee Hyuck; Yoo, Sooyoung; Shin, HoGyun; Baek, Rong-Min; Chung, Chin Youb; Hwang, Hee

2013-01-01

311

A Decision Support Technology Clearinghouse  

PubMed Central

The Decision Support Technology (DST) Clearinghouse is an on-line database of current information concerning medical decision-making technologies. It makes DST knowledge easily accessible to users and potential users of the technologies. The system will minimize costly duplicated research efforts by informing developers of parallel technologies. Additionally, areas in medicine where this type of development has been lacking will become apparent. Perhaps the area where the Clearinghouse could have the greatest impact on medicine is in evaluation.

Anderson, Curtis L.; Lundsgaarde, Henry; Williamson, John; Abaunza, Marie; Warner, Homer

1988-01-01

312

The effect of a decision aid intervention on decision making about coronary heart disease risk reduction: secondary analyses of a randomized trial  

PubMed Central

Background Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence. Methods In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid. Results We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants’ intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use. Conclusions Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk. PMID:24575882

2014-01-01

313

History of Medical Physics.  

ERIC Educational Resources Information Center

Traces the development of basic radiation physics that underlies much of today's medical physics and looks separately at the historical development of two major subfields of medical physics: radiation therapy and nuclear medicine. Indicates that radiation physics has made important contributions to solving biomedical problems in medical

Laughlin, John S.

1983-01-01

314

End-of-life decision-making in India.  

PubMed

The extraordinary circumstances and the tragic life of Aruna Shanbaug, together with the landmark Supreme Court of India decision in Shanbaug v Union of India (2011) 4 SCC 454, have provided a fillip and focus to debate within India about end-of-life decision-making. This extends to passive euthanasia, decision-making about withdrawal of nutrition, hydration and medical treatment from persons in a permanent vegetative or quasi-vegetative state, the role of the courts in such matters, the risks of corruption and misconduct, the criminal status of attempted suicide, and even the contentious issue of physician-assisted active euthanasia. The debates have been promoted further by important reports of the Law Commission of India. This editorial reviews the current state of the law and debate about such issues in India. PMID:25341315

Freckelton, Ian

2014-09-01

315

Prevention of medication errors.  

PubMed

Medication error is the most frequent source of medical error that is associated with adverse events, and, in many cases, is preventable. Medication errors can occur at any step in the medication process. Medication error prevention and reduction begins with a systematic approach to their detection. An important approach to mitigating errors involves the reduction of variation in task performance using tested techniques and technologies from other industries. The most important component of error prevention and reduction is the proactive promotion of a safety culture by organizational leadership, with sustained education and support for users. PMID:15777824

Lehmann, Christoph U; Kim, George R

2005-03-01

316

An Update on the Status of Anatomical Sciences Education in United States Medical Schools  

ERIC Educational Resources Information Center

Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to…

Drake, Richard L.; McBride, Jennifer M.; Pawlina, Wojciech

2014-01-01

317

A Corpus-Based Syntactic Study of Medical Research Article Titles  

ERIC Educational Resources Information Center

English titles of medical research articles (RAs) are of great importance, the quality of which can, to a certain degree, affect impact factors of the articles, because many readers will make a decision as to whether to read on after reading titles. However, the special genre has not been extensively studied to date. This paper is designed to…

Wang, Yan; Bai, Yongquan

2007-01-01

318

[Medical leadership competency].  

PubMed

With all these changes in health care systems the physicians' professional duties are about to undergo changes as well. Especially economic, administrative and legal aspects are becoming more and more important in medical care. In order to take responsibility with respect to leadership aspects a profound professionalisation is required. The Curriculum Medical Leadership edited by the German Medical Association provides an extensive example of a framework for continuing professional development (CPD) courses in medical leadership. PMID:19545080

Barth, Sonja; Jonitz, Günther

2009-01-01

319

Fingernail Injuries and NASA's Integrated Medical Model  

NASA Technical Reports Server (NTRS)

The goal of space medicine is to optimize both crew health and performance. Currently, expert opinion is primarily relied upon for decision-making regarding medical equipment and supplies flown in space. Evidence-based decisions are preferred due to mass and volume limitations and the expense of space flight. The Integrated Medical Model (IMM) is an attempt to move us in that direction!

Kerstman, Eric; Butler, Doug

2008-01-01

320

Cognitive science contributions to decision science.  

PubMed

This article briefly reviews the history and interplay between decision theory, behavioral decision-making research, and cognitive psychology. The review reveals the increasingly important impact that psychology and cognitive science have on decision science. One of the main contributions of cognitive science to decision science is the development of dynamic models that describe the cognitive processes that underlay the evolution of preferences during deliberation phase of making a decision. PMID:25500184

Busemeyer, Jerome R

2015-02-01

321

A study of evaluation methods for hospital medical care systems.  

PubMed

When we seek to evaluate hospital medical care services, we first collect data regarding the existing system in order to gather information and to develop a method of analysis that we can use for evaluation. We took the OPD system as an example, taking into account systematic OPD services based on queuing theory and computer simulation. As a result of the computer simulation model based on experimental conditions, we were able to offer recommendations for modifications of the present system that could improve patient service. The hospital manager can use this information to aid him in the decision making processes concerning the hospital. A study of the methods for the evaluation of hospital medical care services is important. It is necessary to develop a regional medical care information system as well as a hospital medical care information system. PMID:10120546

Nobukawa, M; Eussen, M E

1992-07-01

322

The Quality/Safety Medical Index: Implementation and Analysis.  

PubMed

Medical analytics relating to quality and safety measures have become particularly timely and of high importance in contemporary medical practice. In medical imaging, the dynamic relationship between medical imaging quality and radiation safety creates challenges in quantifying quality or safety independently. By creating a standardized measurement which simultaneously accounts for quality and safety measures (i.e., quality safety index), one can in theory create a standardized method for combined quality and safety analysis, which in turn can be analyzed in the context of individual patient, exam, and clinical profiles. The derived index measures can be entered into a centralized database, which in turn can be used for comparative performance of individual and institutional service providers. In addition, data analytics can be used to create customizable educational resources for providers and patients, clinical decision support tools, technology performance analysis, and clinical/economic outcomes research. PMID:25416467

Reiner, Bruce I

2014-11-22

323

BMC Medical Informatics and Decision Making  

Microsoft Academic Search

Background: The linkage of records which refer to the same entity in separate data collections is a common requirement in public health and biomedical research. Traditionally, record linkage techniques have required that all the identifying data in which links are sought be revealed to at least one party, often a third party. This necessarily invades personal privacy and requires complete

Tim Churches; Peter Christen

324

Systems analysis of major consumer energy decisions  

E-print Network

American consumers make a number of decisions that significantly impact their energy use. Some of the most important of these decisions were identified and analyzed for the purpose of including them in a Consumer Energy ...

Sisler, Nicholas Daniel

2011-01-01

325

Treatment decisions under ambiguity.  

PubMed

Many health risks are ambiguous in the sense that reliable and credible information about these risks is unavailable. In health economics, ambiguity is usually handled through sensitivity analysis, which implicitly assumes that people are neutral towards ambiguity. However, empirical evidence suggests that people are averse to ambiguity and react strongly to it. This paper studies the effects of ambiguity aversion on two classical medical decision problems. If there is ambiguity regarding the diagnosis of a patient, ambiguity aversion increases the decision maker's propensity to opt for treatment. On the other hand, in the case of ambiguity regarding the effects of treatment, ambiguity aversion leads to a reduction in the propensity to choose treatment. PMID:23537710

Berger, Loïc; Bleichrodt, Han; Eeckhoudt, Louis

2013-05-01

326

A Mobile Decision Support System for Dynamic Group Decision-Making Problems  

Microsoft Academic Search

The aim of this paper is to present a decision support system model with two important characteristic: 1) mobile technologies are applied in the decision process and 2) the set of alternatives is not fixed over time to address dynamic decision situations in which the set of solution alternatives could change throughout the decision-making process. We implement a prototype of

Ignacio Javier Pérez; Francisco Javier Cabrerizo; Enrique Herrera-Viedma

2010-01-01

327

Overview of medically important antifungal azole derivatives.  

PubMed Central

Fungal infections are a major burden to the health and welfare of modern humans. They range from simply cosmetic, non-life-threatening skin infections to severe, systemic infections that may lead to significant debilitation or death. The selection of chemotherapeutic agents useful for the treatment of fungal infections is small. In this overview, a major chemical group with antifungal activity, the azole derivatives, is examined. Included are historical and state of the art information on the in vitro activity, experimental in vivo activity, mode of action, pharmacokinetics, clinical studies, and uses and adverse reactions of imidazoles currently marketed (clotrimazole, miconazole, econazole, ketoconazole, bifonazole, butoconazole, croconazole, fenticonazole, isoconazole, oxiconazole, sulconazole, and tioconazole) and under development (aliconazole and omoconazole), as well as triazoles currently marketed (terconazole) and under development (fluconazole, itraconazole, vibunazole, alteconazole, and ICI 195,739). PMID:3069196

Fromtling, R A

1988-01-01

328

Import Report of Medication (Year) (Month) (Date)  

E-print Network

or Active Ingredients Name) (Hyaluronic acid) (Botulinum toxin) (Slim figure, Weight Reduction) (Ascorbic acid) (Dental bleach) (Minoxidil) (Avastin, Bevacizumab) (Thalidomide) (Inactivated Poliovirus Vaccine Restoration) (Vaccine) (Topical anesthesia) (Ophthalmology treatment) (Dental treatment) (Specific disease

Laidlaw, David

329

Selecting a provider: what factors influence patients' decision making?  

PubMed

Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation. PMID:21495529

Abraham, Jean; Sick, Brian; Anderson, Joseph; Berg, Andrea; Dehmer, Chad; Tufano, Amanda

2011-01-01

330

Medical Image Segmentation Xiaolei Huang  

E-print Network

, Ultrasound, nuclear medicine, among other medical imaging technologies, enable 2D or to- mographic 3D imagesMedical Image Segmentation Xiaolei Huang Computer Science and Engineering Department, Lehigh is of immense practical importance in medical informatics. Medical images, such as Computed Axial Tomography

Huang, Xiaolei

331

Adolescent Decision Making: An Overview  

ERIC Educational Resources Information Center

An important developmental task during adolescence is learning to make decisions, experiencing the related positive and negative consequences, and learning from these outcomes. However, a youth's ability to make competent decisions is sometimes called into question because adolescence is also often a time of engagement in risky behaviors. This…

Halpern-Felsher, Bonnie

2009-01-01

332

Replacing the academic medical center's teaching hospital.  

PubMed

Addressing the need for updated teaching hospital facilities is one of the most significant issues that an academic medical center faces. The authors describe the process they underwent in deciding to build a new facility at the Medical University of South Carolina (MUSC). Initial issues included whether or not the teaching hospital would continue to play a role in clinical education and whether to replace or renovate the existing facility. Once the decision to build was reached, MUSC had to choose between an on-campus or distant site for the new hospital and determine what the function of the old hospital would be. The authors examine these questions and discuss the factors involved in different stages of decision making, in order to provide the academic medicine community guidance in negotiating similar situations. Open communication within MUSC and with the greater community was a key component of the success of the enterprise to date. The authors argue that decisions concerning site, size, and focus of the hospital must be made by developing university-wide and community consensus among many different constituencies. The most important elements in the success at MUSC were having unified leadership, incorporating constituent input, engaging an external consultant, remaining unfazed by unanticipated challenges, and adhering to a realistic, aggressive timetable. The authors share their strategies for identifying and successfully managing these complex and potentially divisive aspects of building a new teaching hospital. PMID:16249296

Reves, J G; Smith, Stuart; Greenberg, Ray; Johnson, Donald

2005-11-01

333

A Medical Ethics Assessment of the Case of Terri Schiavo  

ERIC Educational Resources Information Center

The social, legal, and political discussion about the decision to stop feeding and hydration for Terri Schiavo lacked a medical ethics assessment. The authors used the principles of medical indications, quality of life, patient preference, and contextual features as a guide to medical decision-making in this case. Their conclusions include the…

Preston, Tom; Kelly, Michael

2006-01-01

334

Aging and consumer decision making  

PubMed Central

Research on consumer decision making and aging is especially important for fostering a better understanding of ways to maintain consumer satisfaction and high decision quality across the life span. We provide a review of extant research on the effects of normal aging on cognition and decision processes and how these age-related processes are influenced by task environment, meaningfulness of the task, and consumer expertise. We consider how research centered on these topics generates insights about changes in consumption decisions that occur with aging and identify a number of gaps and directions for future research. PMID:22360794

Carpenter, Stephanie M.; Yoon, Carolyn

2013-01-01

335

Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden  

PubMed Central

Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208

Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke

2014-01-01

336

Measuring post-decision satisfaction.  

PubMed

Measuring satisfaction with a decision after a choice has been made is particularly important for difficult choice situations where there is no "right" decision and/or where long-term consequences are uncertain. While others have developed instruments that primarily focus on clinical decisions, the authors developed a scale-the decision-attitude scale-in the context of consumers' choice of health plan. They examined the reliability and validity of this scale using data from a sample of state employees. While the decision-attitude scale has been applied to a health-plan-choice problem only, it can be applied to a variety of other health-related decision problems, because it shares a core set of items with the existing Satisfaction with Decision Scale. The authors identify and discuss the similarities and differences between the two scales. They also observe that each scale uncovers an additional construct not addressed by the other, suggesting that the concept of post-decision satisfaction is multidimensional. A new instrument combining items from both scales may prove the best measure of decision satisfaction for a variety of health-related decision problems. PMID:10638537

Sainfort, F; Booske, B C

2000-01-01

337

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions  

PubMed Central

Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on “affective forecasting” consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments. We describe three specific mechanisms for affective forecasting errors that may influence health decisions: focalism, in which people focus more on what will change than on what will stay the same; immune neglect, in which they fail to envision how their own coping skills will lessen their unhappiness; and failure to predict adaptation, in which people fail to envision shifts in what they value. We discuss emotional and social factors that interact with these cognitive biases. We describe how caregivers can recognize these biases in the clinical setting and suggest interventions to help patients recognize and address affective forecasting errors. PMID:18665428

Arnold, Robert M.

2008-01-01

338

Medication adherence: WHO cares?  

PubMed

The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although these medications are effective in combating disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Factors contributing to poor medication adherence are myriad and include those that are related to patients (eg, suboptimal health literacy and lack of involvement in the treatment decision-making process), those that are related to physicians (eg, prescription of complex drug regimens, communication barriers, ineffective communication of information about adverse effects, and provision of care by multiple physicians), and those that are related to health care systems (eg, office visit time limitations, limited access to care, and lack of health information technology). Because barriers to medication adherence are complex and varied, solutions to improve adherence must be multifactorial. To assess general aspects of medication adherence using cardiovascular disease as an example, a MEDLINE-based literature search (January 1, 1990, through March 31, 2010) was conducted using the following search terms: cardiovascular disease, health literacy, medication adherence, and pharmacotherapy. Manual sorting of the 405 retrieved articles to exclude those that did not address cardiovascular disease, medication adherence, or health literacy in the abstract yielded 127 articles for review. Additional references were obtained from citations within the retrieved articles. This review surveys the findings of the identified articles and presents various strategies and resources for improving medication adherence. PMID:21389250

Brown, Marie T; Bussell, Jennifer K

2011-04-01

339

Cost-benefit analysis and medical ethics.  

PubMed Central

The issue of assessing priorities is one that has become the subject of much debate in the National Health Service particularly in the wake of various documents on priorities from central Government. It has become even more so with the prospect of real cuts in expenditure. Economists claim that their science, or perhaps more accurately art can assist in determining not only how best to achieve various ends but also whether and to what extent competing objectives should be pursued. Such choices cannot be made in the absence of some ethical considerations and it is important that health service decision makers (and in particular the medical profession) are aware if the relationship between economics (and especially cost-benefit analysis) and medical ethics. PMID:6780692

Mooney, G H

1980-01-01

340

Seeking balance: decision support needs of women without cancer and a deleterious BRCA1 or BRCA2 mutation.  

PubMed

Recommendations for women with a deleterious BRCA1 or BRCA2 gene mutation include complex medical approaches related to cancer risk reduction and detection. Current science has not yet fully elucidated decision support needs that women face when living with medical consequences associated with known hereditary cancer risk. The purpose of this study was to describe health communication and decision support needs in healthy women with BRCA1/2 gene mutations. The original researchers completed an interpretive secondary qualitative data analysis of 23 phenomenological narratives collected between 2008 and 2010. The Ottawa Decision Support and Patient Centered Communication frameworks guided the study design and analysis. Women described a pattern wherein breast and ovarian cancer risk, health related recommendations and decisions, and personal values were prioritized over time based on life contexts. Knowing versus acting on cancer risk was not a static process but an ongoing balancing act of considering current and future personal and medical values, further compounded by the complexity of recommendations. Women shared stories of anticipatory, physical and psychosocial consequences of the decision making experience. The findings have potential to generate future research questions and guide intervention development. Importantly, findings indicate a need for ongoing, long-term, support from genetics professionals and decision support interventions, which challenges the current practice paradigm. PMID:24271037

Underhill, Meghan L; Crotser, Cheryl B

2014-06-01

341

Abortion - medical  

MedlinePLUS

Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last ...

342

Medication Errors  

MedlinePLUS

... for Healthcare Research and Quality: Medical Errors and Patient Safety Centers for Disease Control and Prevention: Medication Safety Department of Veterans Affairs National Center for Patient Safety Institute for Safe Medication Practices To Err is ...

343

Parental Explicit Heuristics in Decision-making for Children With Life-threatening Illnesses  

PubMed Central

OBJECTIVE: To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. METHODS: Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children’s Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. RESULTS: All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. CONCLUSIONS: Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process. PMID:23319524

Renjilian, Chris B.; Womer, James W.; Carroll, Karen W.; Kang, Tammy I.

2013-01-01

344

Assessment of foetal risk associated with 93 non-US-FDA approved medications during pregnancy  

PubMed Central

Health care practitioners utilize the United States-Food and Drug Administration (US-FDA) pregnancy categorization (A, B, C, D, X) for making decision on the appropriateness of certain medications during pregnancy. Many non US-FDA approved medications are registered and marketed in Saudi Arabia. However, these medications do not have an assigned pregnancy risk categorization like those approved in the US. The objective of this review is to evaluate, report, and categorize the foetal risk associated with non-US-FDA approved medications registered by the Saudi Food and Drug Authority (S-FDA) according to the US-FDA pregnancy risk categorization system. We identified 109 non-US-FDA approved medications in the Saudi National Formulary (SNF) as of October 2007. We searched for data on functional or anatomical birth defects or embryocidal-associated risk using different databases and references. An algorithm for risk assessment was used to determine a pregnancy risk category for each medication. Out of 93 eligible medications, 73% were assigned category risk C, 10 medications (11%) were assigned category risk D, and 12 medications (13%) were assigned category risk B. Only three medications were judged to be safe during pregnancy based on the available evidence and were assigned category risk A. Inconsistencies in defining and reporting the foetal risk category among different drug regulatory authorities could create confusion and affect prescribing. We believe that standardization and inclusion of this information in the medication package insert is extremely important to all health care practitioners. PMID:23960803

Al-jedai, Ahmed H.; Balhareth, Sakra S.; Algain, Roaa A.

2012-01-01

345

Career toolbox - the decision paper: A tool to facilitate decision-making  

SciTech Connect

Guidelines for writing a decision paper are presented. The purpose of the decision paper is to present complex issues in an organized format; it is especially helpful when timeliness is important. The writing style and format of the decision paper are described. The format for a decision paper includes the issue or problem statement, relevant background material, options or alternatives, discussion, recommendation, coordination/endorsement, and record of decision.

Williams, J.L.; Petersen, T.P.

1996-11-12

346

42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...  

Code of Federal Regulations, 2011 CFR

...for Medicare contractors in making coverage decisions for a non-experimental...Medical Services Coverage Decisions That Relate to Health Care...for Medicare contractors in making coverage decisions for a...

2011-10-01

347

42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...  

...for Medicare contractors in making coverage decisions for a non-experimental...Medical Services Coverage Decisions That Relate to Health Care...for Medicare contractors in making coverage decisions for a...

2014-10-01

348

42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...  

Code of Federal Regulations, 2010 CFR

...for Medicare contractors in making coverage decisions for a non-experimental...Medical Services Coverage Decisions That Relate to Health Care...for Medicare contractors in making coverage decisions for a...

2010-10-01

349

42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...  

Code of Federal Regulations, 2012 CFR

...for Medicare contractors in making coverage decisions for a non-experimental...Medical Services Coverage Decisions That Relate to Health Care...for Medicare contractors in making coverage decisions for a...

2012-10-01

350

42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...  

Code of Federal Regulations, 2013 CFR

...for Medicare contractors in making coverage decisions for a non-experimental...Medical Services Coverage Decisions That Relate to Health Care...for Medicare contractors in making coverage decisions for a...

2013-10-01

351

Issues and priorities of medical education research in Asia.  

PubMed

This article addresses the roles, issues, approaches, rationale, pitfalls, priorities and balance of research in medical education, particularly its "disarray" status in Asia. Research in medical education has influenced education in many ways. Most importantly, it provides legitimate evidences to stakeholders on which to make educational decisions. It also has a wider social impact on teaching practice and subsequent clinical practice. However, in Asia, medical educational research has not substantially influenced educational policy and medical practices. Moreover, it fails to receive comparable attention as in developed countries. A number of constraints that have hampered the development of educational research in Asia are identified: low socio-economic condition of the region; cultural and religious values and beliefs of the people; lack of congruence between the mission and vision of medical schools; leadership crisis; lack of financial resources; inadequate exposure to medical educational research in undergraduate training; lack of collaboration and commitment; and unforeseeable short-term outcome of medical education. The article concludes with some specific recommendations to strengthen research and to create a research culture in the region, including active leadership and commitment of the institutes/organisations, careful assessment and strategic settings of the priorities of medical educational research, establishment of a regional centre for medical education research, availability of financial resources, wider dissemination of research findings, collaboration with the developed countries and initiative to publish regional-based medical education journals, including electronic journals. Appropriate research environment and culture will enable stakeholders to obtain evidence-based information from educational research to increase the relevance, quality, cost-effectiveness and equity of medical education and practice in Asia. PMID:15098645

Majumder, M A A

2004-03-01

352

Participation in Decision Making: A Multidimensional Perspective  

Microsoft Academic Search

The purpose of this paper is to illustrate the importance of treating participation in decision making in a multidimensional manner. Ques tionnaire results indicate that participation in different decision domains is differentially related to teacher satisfaction. A practical implication is that efforts to increase teacher influence should focus on particular kinds of decisions.Allan M. Mohrman, Jr., is on the Faculty

Allan M. Mohrman; Robert A. Cooke; Susan Albers Mohrman

1978-01-01

353

On whose shoulders we stand: lessons from Exemplar medical educators.  

PubMed

The hiring of educators in medical schools (faculty who study the educational process and prepare others to become educators) has been one of the most successful educational innovations ever. Starting in 1954, through a collaboration between the Schools of Medicine and Education at the University of Buffalo, the innovation has spread to over half of the medical schools in the United States and to medical schools in several other countries. Practically every medical school and specialty now hires educators to conduct faculty development, evaluate learners, and develop or revise curricula. This article focuses on lessons learned by six-first-generation educators hired in medical education. These individuals made unique contributions that improved the process of educating and evaluating future physicians. Among their most important contributions have been the use of standardized patients, faculty development to improve instruction, and the use of clinical decision making theory. In addition, these professional educators created a home and career path for other professionals and nurtured protégés to continue the work they started. Ten lessons are reported from structured interviews using a standardized protocol. These lessons will hopefully inform current and future medical educators to help them sustain the effective collaboration between medical schools and educators. PMID:19011984

Hitchcock, Maurice A; Anderson, William A

2008-12-01

354

Medical Matrix  

NSDL National Science Digital Library

Medical Matrix is a Web resource that offers a database of Internet clinical medicine resources. Medical Matrix categorizes resources by disease, specialty, and other interest areas. It is designed as a "home page" for a physician's or healthworker's computer. Medical Matrix is a project of the Internet Working Group of the American Medical Informatics Association.

355

MEDICAL "DEPRIVATION."  

ERIC Educational Resources Information Center

THE SOCIAL AND MEDICAL PROBLEM TODAY HAS SHIFTED FROM PROVIDING FOR THE EMERGENCY MEDICAL NEEDS OF THE INDIGENT SICK TO RAISING THE LEVEL OF LOWER CLASS PARTICIPATION IN THE BENEFITS OF MODERN MEDICINE. GREATER ATTENTION IS BEING FOCUSED ON MEDICAL DEPRIVATION SUFFERED BY LARGE SEGMENTS OF THE POPULATION WHO DO NOT SHARE EQUALLY IN MEDICAL

SUCHMAN, EDWARD A.

356

Surgery, Hospitals, and Medications  

MedlinePLUS

... products that are not commonly stocked in hospital pharmacies. Examples include: Salagen ® , Evoxac®, and Restasis® Eye drops, ... prescription and OTC medications/products in their labeled pharmacy container or packaging. This is important in case ...

357

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS (EPA/600/R-01/104)  

EPA Science Inventory

Environmental decision support tools often provide information that predicts a multitude of different human health effects due to environmental stressors. Medical decision making and health economics offer many metrics that allow aggregation of these different health outcomes. Th...

358

Making Smarter Environmental Management Decisions  

NASA Astrophysics Data System (ADS)

This paper outlines a sound, practical approach for making more informed decisions about environmental policy choices. It emphasizes the importance of using a structured decision process to specify and organize values, use these values to create alternatives, and assess tradeoffs to help achieve a desired balance across key objectives. Although these decision making steps are based on common sense, they are often neglected or poorly carried out as part of the complex evaluations of natural resource options. We discuss several reasons for this frequent neglect of decision making principles and provide examples from recent water use planning projects to demonstrate some of the benefits of using a structured, decision focused approach: new and better solutions, increased and more productive participation by stakeholders, and greater defensibility and acceptance of the resource management evaluation process and its conclusions.

Gregory, Robin S.; Keeney, Ralph L.

2002-12-01

359

Decision Making in the Airplane  

NASA Technical Reports Server (NTRS)

The Importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful In improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking In response to a problem, This presentation will examine the relations between leadership, communication, decision making and overall crew performance. Implications of these findings for training will be discussed.

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

360

Reproductive Health Decision-Making in Perinatally HIV-Infected Adolescents and Young Adults  

PubMed Central

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a “think tank” session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed. PMID:22736033

Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-01-01

361

Import.io  

NSDL National Science Digital Library

Import.io gives users the ability to transform any website into a table of data, which can be quite handy. The applications include the ability to create informed business decisions, feed data visualizations, and so on. On the site, visitors can look over six thematic areas that provide guidance on how to best use the app. This version is compatible with all operating systems.

2013-09-05

362

Medical School Research Pipeline: Medical Student Research Experience in Psychiatry  

ERIC Educational Resources Information Center

Objective: The authors discuss the importance of introducing research training in psychiatry and neurosciences to medical students. Methods: A review of existing models of research training in psychiatry with focus on those providing research training to medical students is presented. Results: Two research-training models for medical students that…

Balon, Richard; Heninger, George; Belitsky, Richard

2006-01-01

363

[Sexual child abuse: correlation between medical certificates' conclusions and judiciary sanctions].  

PubMed

Sexual child abuse, comprises of indecency attitudes and physical misbehaviours, directed towards children are dominated by rape. The objective of our study was to assess in sexual child abuse the relation between the conclusion of medical certificates and court decision. It is a retrospective study carried out from 1994 to 1998 on the clerk's office correctional repertories in Dakar regional court. An overall number of 79 cases of child abuse were collected in 5 years period. Children under 18 years old of of both sex, were concerned. Data found were correlated with a review of requisition cases received by the of gynaecology and obstetrics clinic of Aristide Dantec Hospital. This facilitates the establishement of the relationship between the offences and the pronounced sanctions, as well as the initial medical certificate and these sanctions. The sanctions were severe whenever rape had been retained. Some cases were disqualified in indecent assault and were judged as such. The judge decision, which follow the medical certificate conclusions in 11 cases out of 14 shows the importance and reliability of this medical document. All files reviewed at the medical and legal level were incomplete. The difficulty of the materiality of the rape and the psychological consequences in the long run and especially HIV infection should invite to a multidisciplinary, specialized and organized management of sexual child abuse. This study has shown the importance of a correct and complete drafting of the medical certificate, to enable the establishment by the judge the materiality of the facts. PMID:16295764

Soumah, M M; Bah, H; Mbaye, I; Fall, M C; Yetognon, C; Sow, M L

2005-01-01

364

Family and Medical Leave Act (FMLA)  

MedlinePLUS

... Medical Leave Act of 1993 (FMLA) in light of the United States Supreme Court’s decision in United States v. Windsor, which found section 3 of the Defense of Marriage Act (DOMA) to be unconstitutional. ...

365

Medical Care for Minors Without Parental Consent  

ERIC Educational Resources Information Center

Discusses the changing community and legal attitudes towards medical treatment for minors without parental consent. New state statutes and recent court decisions pertaining to this issue are cited. (ED)

Gottesman, Roberta

1975-01-01

366

Description logics in medical informatics  

Microsoft Academic Search

Description logics and related formalisms are being applied in at least v e applica- tions in medical informatics|terminology, intelligent user interfaces, decision sup- port and semantic indexing, language technology, and systems integration. Impor- tant issues include size, complexity, connectivity, and the wide range of granularity required|medical terminologies require on the order of 250,000 concepts, some in- volving a dozen or

Alan Rector

2003-01-01

367

Perceived Barriers and Facilitators of Using a Web-Based Interactive Decision Aid for Colorectal Cancer Screening in Community Practice Settings: Findings From Focus Groups With Primary Care Clinicians and Medical Office Staff  

PubMed Central

Background Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. Objective To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. Methods Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. Results All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients’ lack of Internet access or low computer literacy, and potential impediments to the clinics’ daily workflow. Expanding patients’ use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients’ screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients’ screening preferences, though some expressed concern that such a system could be difficult to keep up and running. Conclusions Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions. PMID:24351420

2013-01-01

368

The value of information for decision-making in the healthcare environment.  

PubMed

With their ever-growing importance and usability, the healthcare sector has been investing heavily in medical information systems in recent years, as part of the effort to improve medical decision-making and increase its efficiency through improved medical processes, reduced costs, integration of patients' data, etc. In light of these developments, this research aims to evaluate the contribution of information technology (IT) to improving the medical decision-making processes at the point of care of internal medicine and surgical departments and to evaluate the degree to which IT investments are worthwhile. This has been done by assessing the value of information to decision-makers (physicians) at the point of care by investigating whether the information systems improved the medical outcomes. The research included three steps (after a pilot study)--the assessment of the subjective value of information, the assessment of the realistic value of information, and the assessment of the normative value of information, the results of each step being used as the starting assumptions for the following steps. Following a discussion and integration of the results from the various steps, the results of the three assessment stages were summarized in a cost-effectiveness analysis and an overall return on investment (ROI) analysis. In addition, we tried to suggest IT strategies for decision-makers in the healthcare sector on the advisability of implementing such systems as well as the implications for managing them. This research is uniquely pioneering in the manner in which it combines an assessment of the three kinds of measures of value of information in the healthcare environment. Our aim in performing it was to contribute to researchers (by providing additional insight into the fields of decision theory, value of information and medical informatics, amongst others), practitioners (by promoting efficiency in the design of new medical IS and improving existing IS), physicians (by enhancing the efficient use of information resources), patients (by improving healthcare services) and policy decision-makers in the healthcare sector (regarding the advisability of investments in such systems and suggestions for managing them). PMID:17901602

Shabtai, Itamar; Leshno, Moshe; Blondheim, Orna; Kornbluth, Jonathan

2007-01-01

369

21 CFR 821.4 - Imported devices.  

Code of Federal Regulations, 2013 CFR

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE TRACKING REQUIREMENTS General Provisions § 821.4 Imported devices. For purposes of this...

2013-04-01

370

21 CFR 821.4 - Imported devices.  

Code of Federal Regulations, 2012 CFR

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE TRACKING REQUIREMENTS General Provisions § 821.4 Imported devices. For purposes of this...

2012-04-01

371

21 CFR 821.4 - Imported devices.  

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE TRACKING REQUIREMENTS General Provisions § 821.4 Imported devices. For purposes of this...

2014-04-01

372

21 CFR 821.4 - Imported devices.  

Code of Federal Regulations, 2010 CFR

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE TRACKING REQUIREMENTS General Provisions § 821.4 Imported devices. For purposes of this...

2010-04-01

373

21 CFR 821.4 - Imported devices.  

Code of Federal Regulations, 2011 CFR

... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE TRACKING REQUIREMENTS General Provisions § 821.4 Imported devices. For purposes of this...

2011-04-01

374

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context  

PubMed Central

Background Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia. PMID:24119237

2013-01-01

375

Influence of socioeconomic factors on medically unnecessary ambulance calls  

PubMed Central

Background Unnecessary ambulance use has become a socioeconomic problem in Japan. We investigated the possible relations between socioeconomic factors and medically unnecessary ambulance calls, and we estimated the incremental demand for unnecessary ambulance use produced by socioeconomic factors. Methods We conducted a self-administered questionnaire-based survey targeting residents of Yokohama, Japan. The questionnaire included questions pertaining to socioeconomic characteristics, dichotomous choice method questions pertaining to ambulance calls in hypothetical nonemergency situations, and questions on the city's emergency medical system. The probit model was used to analyze the data. Results A total of 2,029 out of 3,363 targeted recipients completed the questionnaire (response rate, 60.3%). Probit regression analyses showed that several demographic and socioeconomic factors influence the decision to call an ambulance. Male respondents were more apt than female respondents to state that they would call an ambulance in nonemergency situations (p < 0.05). Age was an important factor influencing the hypothetical decision to call an ambulance (p < 0.05); elderly persons were more apt than younger persons to state that they would call an ambulance. Possession of a car and hesitation to use an ambulance negatively influenced the hypothetical decision to call an ambulance (p < 0.05). Persons who do not have a car were more likely than those with a car to state that they would call an ambulance in unnecessary situations. Conclusion Results of the study suggest that several socioeconomic factors, i.e., age, gender, household income, and possession of a car, influence a person's decision to call an ambulance in nonemergency situations. Hesitation to use an ambulance and knowledge of the city's primary emergency medical center are likely to be important factors limiting ambulance overuse. It was estimated that unnecessary ambulance use is increased approximately 10% to 20% by socioeconomic factors. PMID:17655772

Kawakami, Chihiro; Ohshige, Kenji; Kubota, Katsuaki; Tochikubo, Osamu

2007-01-01

376

[Ethics, bioethics and medical sciences].  

PubMed

The aim of bioethics is to define a wise conduct for humans with regard to their environments, whether living or inanimate. However, owing to their diversity, bioethics can only deal with general problems such as biodiversity. Within the framework of bioethics as a whole, different sectorial bioethics must therefore exist to deal with problems specific to certain environments, for example the Oceans and Seas, the Forests. General bioethics and sectorial bioethics have an important contribution to make to medical sciences but official regulations should be proposed only after an attentive investigation has been made. For instance, the preservation of an apparently threatened biodiversity or the revival of a seriously damaged biodiversity must be the subject of a thorough preliminary scientific study and, if legislative decisions are taken, a very careful scientific control of their consequences must be carried out. One example is given: the decree on the protection of Larids and its impact, with regard to an abusive proliferation of certain gull populations having varied effects on public health. Sectorial bioethics can also have obvious consequences on medical sciences. Thus various harmful attacks on coral reefs (contrary to the concepts of thalassoethics) can lead to the death of corals and the appearance of ciguatera. Thalassoethics, by inciting pollution control, should help to improve the conditions of thalassotherapy. Forest ethics, particularly concerning management, can reduce the greenhouse effect and its consequences on health, as well as protecting plant and animal species inhabiting the ecosystem and bringing new chemical bodies to inspire original pharmacological research. Thus the links between general or sectorial bioethics and medical sciences must always be very close. PMID:9528189

Fontaine, M

1997-10-01

377

Bayes multiple decision functions.  

PubMed

This paper deals with the problem of simultaneously making many (M) binary decisions based on one realization of a random data matrix X. M is typically large and X will usually have M rows associated with each of the M decisions to make, but for each row the data may be low dimensional. Such problems arise in many practical areas such as the biological and medical sciences, where the available dataset is from microarrays or other high-throughput technology and with the goal being to decide which among of many genes are relevant with respect to some phenotype of interest; in the engineering and reliability sciences; in astronomy; in education; and in business. A Bayesian decision-theoretic approach to this problem is implemented with the overall loss function being a cost-weighted linear combination of Type I and Type II loss functions. The class of loss functions considered allows for use of the false discovery rate (FDR), false nondiscovery rate (FNR), and missed discovery rate (MDR) in assessing the quality of decision. Through this Bayesian paradigm, the Bayes multiple decision function (BMDF) is derived and an efficient algorithm to obtain the optimal Bayes action is described. In contrast to many works in the literature where the rows of the matrix X are assumed to be stochastically independent, we allow a dependent data structure with the associations obtained through a class of frailty-induced Archimedean copulas. In particular, non-Gaussian dependent data structure, which is typical with failure-time data, can be entertained. The numerical implementation of the determination of the Bayes optimal action is facilitated through sequential Monte Carlo techniques. The theory developed could also be extended to the problem of multiple hypotheses testing, multiple classification and prediction, and high-dimensional variable selection. The proposed procedure is illustrated for the simple versus simple hypotheses setting and for the composite hypotheses setting through simulation studies. The procedure is also applied to a subset of a microarray data set from a colon cancer study. PMID:25414762

Wu, Wensong; Peña, Edsel A

2013-01-01

378

Diabetes Control: Why It's Important  

MedlinePLUS

... Works Main Page The Pink Locker Society Diabetes Control: Why It's Important KidsHealth > Kids > Diabetes Center > Medication ... Causes Blood Sugar Levels to Be Out of Control? Managing diabetes is like a three-way balancing ...

379

Endocrinology Concepts for Medical Students  

NSDL National Science Digital Library

Medical education is constantly undergoing revision and renewal in attempts to ensure appropriate depth and breadth of knowledge of basic and clinical sciences as well as provide an environment that encourages life-long learning and integrative reasoning skills. An overview of the most recent comprehensive (130/141 accredited medical schools in the United States and Canada) report on medical education (1) compiled by M. B. Anderson, Associate Vice President - Division of Medical Education, Association of American Medical Colleges, reveals several important observations concerning the "state of modern medical education."

PhD H. Maurice Goodman (Univ of Massachusetts Med. Sch. Department of Physiology)

2001-12-01

380

[The medical autonomy of elderly in Taiwan].  

PubMed

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan. PMID:25271030

Chen, Kai-Li; Chen, Ching-Huey

2014-10-01

381

Leadership Style, Decision Context, and the Poliheuristic Theory of Decision Making: An Experimental Analysis  

ERIC Educational Resources Information Center

The poliheuristic (PH) theory of decision making has made important contributions to our understanding of political decision making but remains silent about certain key aspects of the decision process. Specifically, PH theory contends that leaders screen out politically unacceptable options, but it provides no guidance on (1) the crucial threshold…

Keller, Jonathan W.; Yang, Yi Edward

2008-01-01

382

Data-Driven Decision Making: What It Takes To Make Decisions  

NSDL National Science Digital Library

Data-driven decision making often uncovers new and important information that can be persuasive enough to move us to action. The values of data-driven decision making is suggested. The 3-stage data-driven decision model is proposed.

Philip A. Streifer

383

Oral Medication  

MedlinePLUS

... over-the-counter items. Explore: Oral Medication How Much Do Oral Medications Cost? Save money by finding the right type and ... Options? Is There a Danger of Interactions? How Much Do Oral Medications Cost? We Can Help (Long) - we-can-help-long. ...

384

Categorical and Probabilistic Reasoning in Medical Diagnosis  

Microsoft Academic Search

Medical decision making can be viewed along a spectrum, with categorical (or deterministic) reasoning at one extreme and probabilistic (or evidential) reasoning at the other. In this paper we examine the flowchart as the prototype of categorical reasoning and decision analysis as the prototype of probabil- istic reasoning. Within this context we compare PIP, INTERNIST, CASNET, and MYCZN-four of the

Peter Szolovits; Stephen G. Pauker

1978-01-01

385

Defining Decision Making: A Qualitative Study of International Experts’ Views on Surgical Trainee Decision Making  

Microsoft Academic Search

Background  Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly\\u000a established. The aim of the present study was to identify criteria that inform judgments about surgical trainees’ decision-making\\u000a skills.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education,\\u000a and Cognitive Research. Half the

Sarah C. Rennie; Andre M. van Rij; Chrystal Jaye; Katherine H. Hall

2011-01-01

386

Exploration Medical System Demonstration  

NASA Technical Reports Server (NTRS)

BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that allows for scalability, extensibility, and interoperability of data sources and data users. f. Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management. g. Provide a better standard of healthcare for crew members through reductions in the time required by crew and ground personnel to provide medical treatment and the number of crew errors experienced during treatment.

Rubin, D. A.; Watkins, S. D.

2014-01-01

387

Exploration Medical System Demonstration Project  

NASA Technical Reports Server (NTRS)

A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide better crew health via the reduction in crew errors, crew time, and ground time.

Chin, D. A.; McGrath, T. L.; Reyna, B.; Watkins, S. D.

2011-01-01

388

MEDICAL EDUCATION Medical Students Speak: A Two-Voice Comment on  

E-print Network

MEDICAL EDUCATION Medical Students Speak: A Two-Voice Comment on Learning Professionalism We are two medical students. For one of us, medical school is just beginning; for the other, it is important to understand how medical students today view professionalism and how such a construct

Maxwell, Bruce D.

389

Medical Articles in Eighteenth Century American Magazines  

PubMed Central

Formal medical publication began in the United States with The Medical Repository in 1797. Between 1741, the date of the first American magazine, and 1797 medical articles were included in general magazines. This study deals with ten representative magazines and reviews their general content. The varying content of the medical articles is analyzed into broad categories, and several important physicians, contributors to the magazines, are discussed. The Medical Repository is treated as a culmination of eighteenth century medical publication. PMID:14306031

Coggins, Clemency Chase

1965-01-01

390

Contributions of empirical research to medical ethics  

Microsoft Academic Search

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility

Robert A. Pearlman; Steven H. Miles; Robert M. Arnold

1993-01-01

391

Advanced Instruments, Inc. Applied Medical Resources  

E-print Network

3M Advanced Instruments, Inc. AltraBio Altran Applied Medical Resources ArQule, Inc. Atrium Medical Cynosure Davol - C.R. Bard, Inc. Decision Resources DEKA Research and Development Corporation DePuy Spine Medtronic, Inc. METI Minnesota State University, Mankato National Instruments Neuroptix Corporation Nu

Vajda, Sandor

392

Physicians' perception and attitude toward electronic medical record.  

PubMed

Implementation of an electronic medical record (EMR) system increases efficiency of health services, quality of care and patient satisfaction. Successful implementation of EMRs depends on many factors. The path to quality improvement and financial gain with EMRs lies in getting the greatest number of Physicians to use the system. The main objective of this research is to explore physicians, attitude and perceptions of importance EMRs function, anticipated utilization of EMR functions and also issue impact EMRs. The cross-sectional study was conducted on 133 specialist physicians of three teaching hospitals of Hormozgan Medical Sciences University. The most important finding in this study was the Entry/Display of Diagnoses and Medications (96.3%) and Prescription Alerts drug-drug, allergy and dose checking and formulary management (96.2%) were of greatest importance to respondents. Nuclear medicine, Time trended Clinical Data Display, decision support capabilities, and medical management reporting generated percentage suggesting less than weekly usage. Only a small number of respondents addressed physicians' resistance in compare to another issues impact on EMRs. Understanding physician perceptions and attitude will allow for the development of targeted education to demonstrate the advantages and implementation of EMRs in further and improve physician perceptions of EMRs. PMID:24516790

Lakbala, Parvin; Dindarloo, Kavoos

2014-01-01

393

Toward a patient-centric medical information model: issues and challenges for US adoption.  

PubMed

As the USA moves, incrementally, toward evidence-based medicine, there is growing awareness of the importance of innovation in information management. Mandates for change include improved use of resources, accelerated diffusion of knowledge and an advanced consumer role. Key among these requirements is the need for a fundamentally different patient information recording system. Within the challenges identified in the most recent national health information technology initiative, we propose a model for an electronic, patient-centric medical information infrastructure, highlighting a transportable, scalable and integrated resource. We identify resources available for technology transfer, promoting consumers as integral parts of the collaborative medical decision-making process. PMID:18048223

Lorence, Daniel; Monatesti, Sabatini; Margenthaler, Robert; Hoadley, Ellen

2005-01-01

394

Counseling for Decisions  

ERIC Educational Resources Information Center

This article presents a model for training counselors to help counselees in the process of making decisions. An effective decision-helping approach that includes processing decisions, relating values to process, and relating actions to beliefs is presented. (Author)

Smaby, Marlowe H.; Tamminen, Armas W.

1978-01-01

395

42 CFR 433.114 - Procedures for obtaining initial approval; notice of decision.  

Code of Federal Regulations, 2010 CFR

...SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.114 Procedures for obtaining initial approval; notice of decision. (a) To...

2010-10-01

396

42 CFR 433.121 - Reconsideration of the decision to reduce FFP after reapproval review.  

Code of Federal Regulations, 2010 CFR

...SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.121 Reconsideration of the decision to reduce FFP after reapproval review....

2010-10-01

397

[Medication errors: prevention strategies].  

PubMed

Medication errors are an important aspect of health care. The American Institute of Medicine informs that 44,000 to 98,000 Americans die annually as a result of medication errors and that such errors affect 2 to 14% of hospitalized patients. The American Society of Hospital Pharmacists presents strategies that, if implemented, can prevent or reduce medication errors. This review discusses four strategies: electronic prescription, the pharmacist's role, the report of errors and the patient's role. A non-punitive culture that prioritizes patient's safety should be stimulated in institutions. PMID:12138424

Cassiani, S H

2000-01-01

398

[Experience assisting an AIDS-infected homosexual patient and his same-sex partner make a do-not-resuscitate decision].  

PubMed

Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives. PMID:23034554

Wang, Shu-Jang; Lai, Pei-Yu; Liou, Siao-Ying; Ko, Wen-Chien; Ko, Nai-Ying

2012-10-01

399

Medical Imaging: A Review  

NASA Astrophysics Data System (ADS)

The rapid progress of medical science and the invention of various medicines have benefited mankind and the whole civilization. Modern science also has been doing wonders in the surgical field. But, the proper and correct diagnosis of diseases is the primary necessity before the treatment. The more sophisticate the bio-instruments are, better diagnosis will be possible. The medical images plays an important role in clinical diagnosis and therapy of doctor and teaching and researching etc. Medical imaging is often thought of as a way to represent anatomical structures of the body with the help of X-ray computed tomography and magnetic resonance imaging. But often it is more useful for physiologic function rather than anatomy. With the growth of computer and image technology medical imaging has greatly influenced medical field. As the quality of medical imaging affects diagnosis the medical image processing has become a hotspot and the clinical applications wanting to store and retrieve images for future purpose needs some convenient process to store those images in details. This paper is a tutorial review of the medical image processing and repository techniques appeared in the literature.

Ganguly, Debashis; Chakraborty, Srabonti; Balitanas, Maricel; Kim, Tai-Hoon

400

Double standards in special medical research: questioning the discrepancy between requirements for medical research involving incompetent adults and medical research involving children.  

PubMed

Medical research represents a substantial departure from conventional medical care. Medical care is patient-orientated, with decisions based on the best interests and/or wishes of the person receiving the care. In contrast, medical research is future-directed. Primarily it aims to contribute new knowledge about illness or disease, or new knowledge about interventions, such as drugs, that impact upon some human condition. Current State and Territory laws and research ethics guidelines in Australia relating to the review of medical research appropriately acknowledge that the functions of medical care and medical research differ. Prior to a medical research project commencing, the study must be reviewed and approved by a Human Research Ethics Committee (HREC). For medical research involving incompetent adults, some jurisdictions require an additional, independent safeguard by way of tribunal or court approval of medical research protocols. This extra review process reflects the uncertainty of medical research involvement, and the difficulties surrogate decision-makers of incompetent adults face in making decisions about others, and deliberating about the risks and benefits of research involvement. Parents of children also face the same difficulties when making decisions about their child's research involvement. However, unlike the position concerning incompetent adults, there are no similar safeguards under Australian law in relation to the approval of medical research involving children. This column questions why this discrepancy exists with a view to generating further dialogue on the topic. PMID:24218780

Stepanov, Nikola A; Smith, Malcolm K

2013-09-01

401

Medical Assistants  

NSDL National Science Digital Library

For a concise summary of the medical assistant profession the Medical Assistants entry in the Bureau of Labor Statistics' Occupational Outlook Handbook is must read. The site covers topics ranging from the nature of the profession, working conditions, earnings, and more. The section on training, qualifications and advancement will be of special interest to medical assistant faculty and students. The section on sources of addition information will also be a good launching point for anyone seeking additional online resources.

2006-11-01

402

Treating Ed A Medical Ethics Case Study  

NSDL National Science Digital Library

Ed is dying. How should his wishes for medical treatment be carried out? As the case unfolds, students explore the rights and responsibilities of doctors, patients, and patient representatives regarding difficult medical decisions. Specifically, students consider the ramifications of Advance Directives and Durable Powers of Attorney. The case was written for an introductory biology course, but could easily be used in or modified for a human anatomy and physiology, introductory nursing, or medical ethics course.

Ribbens, Eric

2008-01-01

403

The influence of religious beliefs on health care: between medical futility and refusal of treatment.  

PubMed

The problem of respecting the patients' religious-based decisions seems to play increasingly important role in medical practice. Most probably it happens because: (i) bioethical standards accentuate the principle of the respect for autonomy (the departure form medical paternalism) and (ii) the contacts between people belonging to different religious traditions are becoming more and more frequent (the process of globalization). Toleration, in particular toleration of patients' religious convictions, needs to be considered as a vital issue for the pluralistic societies. A four-principle approach to medical ethics is assumed as a theoretical base for this study. The main methodological steps could be described as: (i) identification of a ,considered judgment' (proper to the problem in concern), (ii) its specification, and (iii) balancing/ overriding. According to the internationally accepted proclamations of human rights, the positive obligation to tolerate religious beliefs is indicated as the principle which should govern the process of dealing with the patients' religiously motivated decisions. The special status of patients' religious-based decisions as well as the 'obliging force' of them is considered. The article concludes with guidelines on how to help doctors resolve moral dilemma related to tolerance of patients' religious-based decisions. PMID:17072052

Niebrój, L T

2006-09-01

404

Informatics Perspectives on Decision Taking  

E-print Network

A decision is an act or event of decision taking. Decision making always includes decision taking, the latter not involving significant exchanges with non-deciding agents. A decision outcome is a piece of storable information constituting the result of a decision. Decision outcomes are typed, for instance: plan, command, assertion, or boolean reply to a question. A decision effect is any consequence of putting a decision outcome into effect. Decision outcomes must be expected by the decider to lead to certain decision effects, by way of their being put into effect. The availability of a model or of a theory of the causal chain leading from a decision outcome to one or more decision effects is assumed for the decision taker, otherwise the decision outcome is merely an utterance. Decision effectiveness measures the decision effects against objectives meant to be served with the decision. Decision taking is positioned amidst many similar notions including: decision making, decision process, decision making proce...

Bergstra, J A

2011-01-01

405

Family & Medical Leave A Guide for Supervisors  

E-print Network

Family & Medical Leave A Guide for Supervisors As a supervisor, it is important for you to know how & Medical Leave Act (FMLA) &/or Wisconsin Family & Medical Leave Act (WFMLA) and to know what to do with confidential medical information. FMLA and WFMLA are leave entitlements for reasonable, job-protected leave

Saffman, Mark

406

Emulation Modeling with Bayesian Networks for Efficient Decision Support  

NASA Astrophysics Data System (ADS)

Bayesian decision networks (BDN) have long been used to provide decision support in systems that require explicit consideration of uncertainty; applications range from ecology to medical diagnostics and terrorism threat assessments. Until recently, however, few studies have applied BDNs to the study of groundwater systems. BDNs are particularly useful for representing real-world system variability by synthesizing a range of hydrogeologic situations within a single simulation. Because BDN output is cast in terms of probability—an output desired by decision makers—they explicitly incorporate the uncertainty of a system. BDNs can thus serve as a more efficient alternative to other uncertainty characterization methods such as computationally demanding Monte Carlo analyses and others methods restricted to linear model analyses. We present a unique application of a BDN to a groundwater modeling analysis of the hydrologic response of Assateague Island, Maryland to sea-level rise. Using both input and output variables of the modeled groundwater response to different sea-level (SLR) rise scenarios, the BDN predicts the probability of changes in the depth to fresh water, which exerts an important influence on physical and biological island evolution. Input variables included barrier-island width, maximum island elevation, and aquifer recharge. The variability of these inputs and their corresponding outputs are sampled along cross sections in a single model run to form an ensemble of input/output pairs. The BDN outputs, which are the posterior distributions of water table conditions for the sea-level rise scenarios, are evaluated through error analysis and cross-validation to assess both fit to training data and predictive power. The key benefit for using BDNs in groundwater modeling analyses is that they provide a method for distilling complex model results into predictions with associated uncertainty, which is useful to decision makers. Future efforts incorporate outcomes of the groundwater BDN into a larger BDN for comprehensive decision support that addresses a variety of potential physical and ecological sea-level rise impacts to Assateague Island.

Fienen, M. N.; Masterson, J.; Plant, N. G.; Gutierrez, B. T.; Thieler, E. R.

2012-12-01

407

Training for Aviation Decision Making: The Naturalistic Decision Making Perspective  

NASA Technical Reports Server (NTRS)

This paper describes the implications of a naturalistic decision making (NDM) perspective for training air crews to make flight-related decisions. The implications are based on two types of analyses: (a) identification of distinctive features that serve as a basis for classifying a diverse set of decision events actually encountered by flight crews, and (b) performance strategies that distinguished more from less effective crews flying full-mission simulators, as well as performance analyses from NTSB accident investigations. Six training recommendations are offered: (1) Because of the diversity of decision situations, crews need to be aware that different strategies may be appropriate for different problems; (2) Given that situation assessment is essential to making a good decision, it is important to train specific content knowledge needed to recognize critical conditions, to assess risks and available time, and to develop strategies to verify or diagnose the problem; (3) Tendencies to oversimplify problems may be overcome by training to evaluate options in terms of goals, constraints, consequences, and prevailing conditions; (4) In order to provide the time to gather information and consider options, it is essential to manage the situation, which includes managing crew workload, prioritizing tasks, contingency planning, buying time (e.g., requesting holding or vectors), and using low workload periods to prepare for high workload; (5) Evaluating resource requirements ("What do I need?") and capabilities ("'What do I have?" ) are essential to making good decisions. Using resources to meet requirements may involve the cabin crew, ATC, dispatchers, and maintenance personnel; (6) Given that decisions must often be made under high risk, time pressure, and workload, train under realistic flight conditions to promote the development of robust decision skills.

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

408

Intelligent Medical Systems for Aerospace Emergency Medical Services  

NASA Technical Reports Server (NTRS)

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

Epler, John; Zimmer, Gary

2004-01-01

409

DCCPS: BRP: BBPSB: Basic and Applied Decision Making  

Cancer.gov

Advances in cancer prevention, screening, treatment and end-of-life care, coupled with advances in bioinformatics, have created a wide array of health care options and sources of medical information. Whereas previously the physician was generally accepted as the locus of medical decision making, today this is no longer the case. More and more, shared decision making, in which patients and their physicians deliberate about options using the best available evidence, is replacing the traditional paternalistic model in medicine.

410

Why do patients engage in medical tourism?  

PubMed

Medical tourism is commonly perceived and popularly depicted as an economic issue, both at the system and individual levels. The decision to engage in medical tourism, however, is more complex, driven by patients' unmet need, the nature of services sought and the manner by which treatment is accessed. In order to beneficially employ the opportunities medical tourism offers, and address and contain possible threats and harms, an informed decision is crucial. This paper aims to enhance the current knowledge on medical tourism by isolating the focal content of the decisions that patients make. Based on the existing literature, it proposes a sequential decision-making process in opting for or against medical care abroad, and engaging in medical tourism, including considerations of the required treatments, location of treatment, and quality and safety issues attendant to seeking care. Accordingly, it comments on the imperative of access to health information and the current regulatory environment which impact on this increasingly popular and complex form of accessing and providing medical care. PMID:23007007

Runnels, Vivien; Carrera, P M

2012-12-01

411

TASER(®) conducted electrical weapons: misconceptions in the scientific/medical and other literature.  

PubMed

TASER(®) conducted electrical weapons (CEWs) have become an important law-enforcement tool. Controversial questions are often raised during discussion of some incidents in which the devices have been used. The main purpose of this paper is to point out some misconceptions about CEWs that have been published in the scientific/medical and other literature. This is a narrative review, using a multidisciplinary approach of analyzing reports from scientific/medical and other literature sources. In previous reports, durations of incapacitating effects and possible associations of CEWs with deaths-in-custody have often been overstated or exaggerated. Comparisons of CEW effects with "electrocution" are misleading. Clarification of these misconceptions may be important during policymaker decisions, practitioner operations, expert witness testimonies, and court proceedings. Despite misconceptions in the literature, CEWs can still be a valuable tool for law enforcement activities. Scientists, medical professionals, legal advisors, and investigators of police tactics should be aware of these misconceptions. PMID:25549958

Jauchem, James R

2015-03-01

412

Only for “purely scientific” institutions: the Medical Library Association's Exchange, 1898–1950s  

PubMed Central

Objective: Centralized exchanges of scientific materials existed by the late nineteenth century, but they did not include medical publications. North American medical leaders therefore formed an association of institutions to run their own exchange: the Medical Library Association (MLA). After providing background to the exchange concept and the importance of institutional members for MLA, this article examines archival MLA correspondence to consider the role of its Exchange in the association's professional development before the 1950s. Results: MLA's membership policy admitted only libraries open to the medical profession with a large number of volumes. But the correspondence of the MLA Executive Committee reveals that the committee constantly adjusted the definition of library membership: personal, public, sectarian, commercial, allied science, and the then-termed “colored” medical school libraries all were denied membership. Conclusion: Study of these decisions, using commercial and sectarian libraries as a focus, uncovers the primary justification for membership exclusions: a goal of operating a scientific exchange. Also, it shows that in this way, MLA shadowed policies and actions of the American Medical Association. Finally, the study suggests that the medical profession enforced its policies of exclusion through MLA, despite a proclaimed altruistic sharing of medical literature. PMID:21464849

Connor, Jennifer J

2011-01-01

413

Does young adults' preferred role in decision making about health, money, and career depend on their advisors' leadership skills?  

PubMed

Few empirical data exist on how decision making about health differs from that in other crucial life domains with less threatening consequences. To shed light on this issue we conducted a study with 175 young adults (average age 19 years). We presented the participants with scenarios involving advisors who provided assistance in making decisions about health, money, and career. For each scenario, participants were asked to what extent they wanted the advisor to exhibit several leadership styles and competencies and what role (active, collaborative, or passive) they preferred to play when making decisions. Results show that decision making about health is distinct from that in the other domains in three ways. First, most of the participants preferred to delegate decision making about their health to their physician, whereas they were willing to collaborate or play an active role in decision making about their career or money. Second, the competencies and leadership style preferred for the physician differed substantially from those desired for advisors in the other two domains: Participants expected physicians to show more transformational leadership--the style that is most effective in a wide range of environments--than those who provide advice about financial investments or career. Finally, participants' willingness to share medical decision making with their physician was tied to how strongly they preferred that the physician shows an effective leadership style. In contrast, motivation to participate in decision making in the other domains was not related to preferences regarding advisors' leadership style or competencies. Our results have implications for medical practice as they suggest that physicians are expected to have superior leadership skills compared to those who provide assistance in other important areas of life. PMID:22731631

Garcia-Retamero, Rocio; Galesic, Mirta

2013-01-01

414

Optimizing medical data quality based on multiagent web service framework.  

PubMed

One of the most important issues in e-healthcare information systems is to optimize the medical data quality extracted from distributed and heterogeneous environments, which can extremely improve diagnostic and treatment decision making. This paper proposes a multiagent web service framework based on service-oriented architecture for the optimization of medical data quality in the e-healthcare information system. Based on the design of the multiagent web service framework, an evolutionary algorithm (EA) for the dynamic optimization of the medical data quality is proposed. The framework consists of two main components; first, an EA will be used to dynamically optimize the composition of medical processes into optimal task sequence according to specific quality attributes. Second, a multiagent framework will be proposed to discover, monitor, and report any inconstancy between the optimized task sequence and the actual medical records. To demonstrate the proposed framework, experimental results for a breast cancer case study are provided. Furthermore, to show the unique performance of our algorithm, a comparison with other works in the literature review will be presented. PMID:22614723

Wu, Ching-Seh; Khoury, Ibrahim; Shah, Hemant

2012-07-01

415

Expert Witness: A system for developing expert medical testimony  

NASA Technical Reports Server (NTRS)

Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

Lewandowski, Raymond; Perkins, David; Leasure, David

1994-01-01

416

Organizational and Individual Decision Making Organizational and Individual Decision Making  

E-print Network

Organizational and Individual Decision Making Organizational and Individual Decision Making Citation: Kathleen M. Carley & Dean Behrens, 1999, "Organizational and Individual Decision Making." Ch. 18, Inc. #12;Organizational and Individual Decision Making Organizational and Individual Decision Making

Sadeh, Norman M.

417

77 FR 8260 - Agency Information Collection Activities; Proposed Collection; Comment Request; Medical Device...  

Federal Register 2010, 2011, 2012, 2013

...Collection; Comment Request; Medical Device Reporting: Manufacturer, Importer...This notice solicits comments on medical device reporting (MDR); manufacturer...forms of information technology. Medical Device Reporting: Manufacturer,...

2012-02-14

418

Practice Location Decisions of NHSC and Non-NHSC Physicians.  

ERIC Educational Resources Information Center

To ascertain the characteristics and decision-making processes of physicians who choose to practice and remain in areas that have a shortage of physicians, a study analyzed the career decisions of National Health Service Corps (NHSC) and non-NHSC physicians (and spouses) with respect to the location of their medical practices. Another objective…

Wilson, Sandra R.; And Others

419

RFID and medication care.  

PubMed

Dynamic healthcare needs new IT innovations and applications to be able to treat the rapidly growing number of patients effectively and safely. The information technology has to support healthcare in developing practices and nursing patients without confronting any complications or errors. One critical and important part of healthcare is medication care, which is very vulnerable for different kind of errors, even on fatal errors. Thus, medication care needs new methods for avoiding errors in different situations during medication administration. This poster represents an RFID-based automated identification system for medication care in a hospital environment. This work is a part of the research project MaISSI (Managing IT Services and Service Implementation) at the University of Kuopio, Department of Computer Science, Finland. PMID:19592959

Lahtela, Antti; Saranto, Kaija

2009-01-01

420

Audit of Health Data Captured Routinely in Primary Healthcare for the Clinical Decision Support System PREDICT (PREDICT CVD4)  

Microsoft Academic Search

Computerised clinical decision support systems require health data to be captured in an explicit, structured way. However, traditional patient medical records contain data that is recorded in multiple ways using coding systems, free text, medical jargon and idiosyncratic abbreviations. To be meaningful, data transferred either automatically or manually from medical records to a clinical decision support program must accurately reflect

Tania Riddell; Tim Kenealy; Sue Wells; Rod Jackson; Joanna Broad

421

Does Distributed Leadership Influence the Decision Making of Teachers in the Classroom: Examining Content and Pedagogy  

E-print Network

teachers to become involved in the decision making process within the school. Yet, research does not examine how distributed leadership influences the most important decisions teachers make, which are instructional decisions specifically relating to content...

Clutter-Shields, Jaimi Leighann

2011-12-31

422

Forensic evaluation of medical liability cases in general surgery.  

PubMed

Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not. PMID:24351525

Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

2014-10-01

423

Situational Variables in Expert Pilot Decision Making  

NASA Technical Reports Server (NTRS)

In traditional laboratory studies of decision making, the experimenter structures the problem, defines the goal and specifies available information. In contrast, when people make decisions in non-laboratory environments characterized as complex, dynamic and consequential, they must first identify the problem and determine what information and responses are relevant. The present research was designed to investigate which situational aspects are important to experienced pilots making aviation decisions. Twenty-eight professional pilots were asked to sort descriptions of 22 aircraft incidents into piles involving similar types of major decisions. Preliminary analyses suggest four underlying variables: time pressure, risk level, available resources, and certainty of goal attainment.

Fischer, Ute; Orasanu, Judith; Wich, Mike; Hart, Sandra G. (Technical Monitor)

1994-01-01

424

Medical Device Safety  

MedlinePLUS

... Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Medical Devices Print this page Share this page E-mail ... Medical Product Safety Network Emergency Situations (Medical Devices) Medical Device Safety Search the Medical Device Safety Section Medical ...

425

Bridging the gap between science and decision making  

PubMed Central

All decisions, whether they are personal, public, or business-related, are based on the decision maker’s beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers’ information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making. PMID:23940310

von Winterfeldt, Detlof

2013-01-01

426

Medication Guide  

MedlinePLUS

... for heavy smokers. Prescription First-Line Medications: Other Bupropion Bupropion, also known as Zyban®, helps to reduce nicotine withdrawal symptoms and the urge to smoke. Bupropion can be used safely with nicotine replacement products. ...

427

Botox (Medical)  

MedlinePLUS

... from any list. Close without sharing. Give Us Feedback Botox (Medical) Your name First Name MI Laast ... Your message: Close without sending Thank you. Your feedback will help us improve this site. Close What ...

428

Using Clinical Decision Support Software in Health Insurance Company  

NASA Astrophysics Data System (ADS)

This paper proposes the idea to use Clinical Decision Support software in Health Insurance Company as a tool to reduce the expenses related to Medication Errors. As a prove that this class of software will help insurance companies reducing the expenses, the research was conducted in eight hospitals in United Arab Emirates to analyze the amount of preventable common Medication Errors in drug prescription.

Konovalov, R.; Kumlander, Deniss

429

Thinking Processes Used by Nurses in Clinical Decision Making.  

ERIC Educational Resources Information Center

Interviews with eight medical and surgical nurses and audits of patient charts investigated clinical decision-making processes. Predominant thinking processes were description of facts, selection of information, inference, syntheses, and verification, with differences between medical and surgical specialties. Exemplars of thinking processes…

Higuchi, Kathryn A. Smith; Donald, Janet G.

2002-01-01

430

The 2003 Air Medical Leadership Congress  

Microsoft Academic Search

To address important concerns facing the air medical community, 149 air medical transport leaders, providers, consultants, and experts met September 4-6, 2003, in Salt Lake City, Utah, for a 3-day summit—the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community. Using data from a Web-based survey, top air medical transport issues were identified in four

Frank Thomas; Kenneth Robinson; Tom Judge; Connie Eastlee; Eileen Frazer; Stephen H Thomas; Laurie Romig; Ira Blumen; Reed Brozen; Ken Williams; Eric R Swanson; Stephen Hartsell; Jill Johnson; Kevin Hutton; J Heffernan; Michelle North; Kent Johnson; Pat Petersen; Robert Toews; Christine M Zalar

2004-01-01

431

Medication Adherence  

Microsoft Academic Search

\\u000a A key component in the management of health-care conditions is the use of prescribed medications. The effectiveness of medications\\u000a and their long-term benefits depends on adherence to the prescriber’s instructions [1]. Adherence is defined as the extent\\u000a to which people follow the instructions they are given for prescribed treatments [2]; it involves consumer choice and is intended\\u000a to be non-judgmental,

Hayden B. Bosworth

432

Evidence Based Medicine and Shared Decision Making: The challenge of getting both evidence and preferences into health care  

Microsoft Academic Search

Evidence Based Medicine (EBM) and Shared Medical Decision Making (SDM) are changing the nature of health care decisions. It is broadly accepted that health care decisions require the integration of research evidence and individual preferences. These approaches are justified on both efficacy grounds (that evidence based practice and Shared Decision Making should lead to better health outcomes and may lead

Alexandra Barratt

2008-01-01

433

Reinventing the medical librarian.  

PubMed Central

The caliber of the librarian is a health sciences library's most important resource. This paper explores factors which have influenced who has, or who has not, entered the profession of medical librarianship, and discusses several attributes which the author considers critical for restructuring the profession to meet current and future needs. PMID:2790341

Anderson, R K

1989-01-01

434

Mobile medical image retrieval  

Microsoft Academic Search

Images are an integral part of medical practice for diagnosis, treatment planning and teaching. Image retrieval has gained in importance mainly as a research domain over the past 20 years. Both textual and visual retrieval of images are essential. In the process of mobile devices becoming reliable and having a functionality equaling that of formerly desktop clients, mobile computing has

Samuel Duc; Adrien Depeursinge; Ivan Eggel; Henning Müller

2011-01-01

435

Automation: Decision Aid or Decision Maker?  

NASA Technical Reports Server (NTRS)

This study clarified that automation bias is something unique to automated decision making contexts, and is not the result of a general tendency toward complacency. By comparing performance on exactly the same events on the same tasks with and without an automated decision aid, we were able to determine that at least the omission error part of automation bias is due to the unique context created by having an automated decision aid, and is not a phenomena that would occur even if people were not in an automated context. However, this study also revealed that having an automated decision aid did lead to modestly improved performance across all non-error events. Participants in the non- automated condition responded with 83.68% accuracy, whereas participants in the automated condition responded with 88.67% accuracy, across all events. Automated decision aids clearly led to better overall performance when they were accurate. People performed almost exactly at the level of reliability as the automation (which across events was 88% reliable). However, also clear, is that the presence of less than 100% accurate automated decision aids creates a context in which new kinds of errors in decision making can occur. Participants in the non-automated condition responded with 97% accuracy on the six "error" events, whereas participants in the automated condition had only a 65% accuracy rate when confronted with those same six events. In short, the presence of an AMA can lead to vigilance decrements that can lead to errors in decision making.

Skitka, Linda J.

1998-01-01

436

[Advance medical directives].  

PubMed

A patient's rights to autonomy and to participate in the decision making process is a fundamental ethical principle. However, for the non-competent patient, participation in decision-making is more problematic. A survey carried out in Israel found that less than half of the offspring of terminally ill elderly patients knew the request of their parents regarding life-supporting measures. A solution to this problem is the use of medical advance directives (MADs). In the U.S.A (in 1991) it was required by a federal law to inform every hospitalized patient of his right to use MADs. The experience from the use of MADs in the USA during the last 10 years show that: 1) Most lay persons as well as medical staff support the use of MADs 2) The rate of the use of MADs is about 20%, and among long term care hospitalized patients it is even higher. 3) Sex, age, level of education, morbidity and income were found to be significant factors. 4) Education on the use of the MADs raised the rate of use. 5) Most of the patients who had MADs did not discuss the issue of life supporting treatment with their physicians. 6) Patients who had MADs received less aggressive treatment with reduced medical cost. 7) There is a preference to write generic MADs. Arguments supporting the use of MADs state that they: extend patient autonomy; relieve patient anxiety regarding unwanted treatment; relieve physicians' anxiety concerning legal liability; reduce interfamily conflicts, and they also lower health care costs. Arguments opposing the use claim that they: violate sanctity of life; promote an adversarial physician-patient relationship; may lead to euthanasia; fail to express the patient's current wishes and may even counteract physicians' values. On the basis of experience in the USA and the positive attitude regarding MADs, it appears that MADs can also be applicable in Israel. PMID:11905092

Sonnenblick, Moshe

2002-02-01

437

Nitinol medical devices and implants  

Microsoft Academic Search

Summary Superelastic Nitinol is now a common and well-known engineering materi al in the medical industry. While the greater flexibility of the alloy drives many of its applications, there are also a large number of lesser- known advantages of Niti nol in medical devices. This paper reviews 7 of these less-obvious but very important reasons for Nitinol's success, bot h

D. Stoeckel

2000-01-01

438

Medical psychology: Psychology's neglected child  

Microsoft Academic Search

Explores the field of medicine as an area for psychological inquiry. Evidence for the growth of medical psychology is presented, though relatively few psychologists are engaged in its pursuit. Medical topics of interest to psychologists are discussed, and the importance of more rigorous research methodologies being used in this area is stressed. It is suggested that psychology and medicine need

Michael J. Asken

1975-01-01

439

Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?  

ERIC Educational Resources Information Center

Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

2012-01-01

440

Prescription for Doctors: An Interpretive Analysis of Messages Portrayed By Websites Targeting Potential Medical Students.  

E-print Network

??This study examined communication about medical professional career decisions as depicted by 10 popular websites. Qualitative research methods, phenomenology and hermeneutics, were used to investigate… (more)

Oehler, Kelly

2015-01-01

441

Beyond "medical tourism": Canadian companies marketing medical travel  

PubMed Central

Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and “Liberation therapy” for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada’s borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. Conclusions This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada’s medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel. PMID:22703873

2012-01-01

442

Aging and decision making   

E-print Network

The study sought to clarify the effects of aging in regard to decision making abilities. Decision making is dependent upon the Frontal Cortex structures; the Orbitofrontal Cortex and the Dorsolateral Prefrontal Cortex. These structures are thought...

Miller, Sophie

2010-06-30

443

Categorization = Decision Making + Generalization  

PubMed Central

We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

Seger, Carol A; Peterson, Erik J.

2013-01-01

444

[Medical expert systems].  

PubMed

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advice to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, self-education, directing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. Though, expert systems also have certain bad features: primarily, they are not physicians i.e. they can not examine a patient. Furthermore, expert system that is good for one certain area is often not good for another one. There are some cases, when these systems can confuse a physician and make him to make a wrong decision. This occurs very often in two specific cases: when the clinical situation is urgent; and when accuracy of clinical information is not definite. PMID:9601753

Masi?, I; Ridanovi?, Z; Pandza, H

1995-01-01

445

ADHD Medication Use Following FDA Risk Warnings  

PubMed Central

Background In 2006, the U.S. Food and Drug Administration (FDA) investigated cardiac and psychiatric risks associated with attention deficit/hyperactivity disorder (ADHD) medication use. Aims of the Study To examine how disclosure of safety risks affected pediatric ADHD use, and to assess news media coverage of the issue to better understand trends in treatment patterns. Methods We used the AHRQ’s Medical Expenditure Panel Survey (MEPS), a nationally representative household panel survey, to calculate unadjusted rates of pediatric ADHD use from 2002 to 2008 overall and by parents’ education. We examined whether children (ages 0 to 20) filled a prescription for any ADHD medication during the calendar year. Next, we used content analysis methods to analyze news coverage of the issue in 10 high-circulation newspapers, the 3 major television networks and a major cable news network in the U.S. We examined 6 measures capturing information conveyed on risk and benefits of ADHD medication use. Results No declines in medication use following FDA safety warnings overall or by parental education level were observed. News media coverage was relatively balanced in its portrayal of the risks and benefits of ADHD medication use by children. Discussion ADHD risk warnings were not associated with large declines in medication use, and balanced news coverage may have contributed to the treatment patterns observed. Self-reported surveys like the MEPS rely on the recall of respondents and may be subject to reporting bias. However, the validity of these data is supported by their consistency with other data on drug use from other sources. Implications for Health Care Provision and Use These findings are in direct contrast to the substantial declines in use observed after pediatric antidepressant risk warnings in the context of a news media environment that emphasized risks over benefits. Implications for Health Policies Our findings are relevant to the ongoing discussion about improving the FDA’s ability to monitor drug safety. Safety warnings occur amid ongoing concern that the agency has insufficient authority and resources to fulfill its mission to protect the public’s health. Efforts to bolster the FDA’s postmarketing surveillance system have the potential to incorporate more data in decision making to allow for earlier detection of health risks. Implications for Further Research Further research is needed to assess whether other treatment changes occurred following risk warnings. For example, it is important to determine whether an increase in cardiac screening prior to medication initiation occurred. Likewise, the FDA advises that children experiencing hallucinations or other psychiatric responses to medication be discontinued from drug treatment. If it is determined that instead of being discontinued from medication treatment, children experiencing hallucinations are put on additional medication (e.g., antipsychotics), additional efforts by the FDA to better inform the public are warranted. PMID:23001280

Barry, Colleen L.; Martin, Andres; Busch, Susan H.

2013-01-01

446

[Historical considerations about medical helminthology].  

PubMed

A historical review of the medical helminthology beginning with the Nile religious ideas, the supremacy of the Aristotelian spontaneous generation, the Latin encyclopedism, the medieval transition, the decisive renacentist concept of "pathogenic parasite" until the new discoveries and the therapeutic progress because of the use of the microscope and the development of the experimental method. Finally, the situation in Venezuela, specially about the university teaching, is highlighted. PMID:11640678

Cardozo Soto, T

1993-06-01

447

How does age affect baseline screening mammography performance measures? A decision model  

Microsoft Academic Search

BACKGROUND: In order to promote consumer-oriented informed medical decision-making regarding screening mammography, we created a decision model to predict the age dependence of the cancer detection rate, the recall rate and the secondary performance measures (positive predictive values, total intervention rate, and positive biopsy fraction) for a baseline mammogram. METHODS: We constructed a decision tree to model the possible outcomes

John D Keen; James E Keen

2008-01-01

448

A method for interactive hypothesis testing for clinical decision support systems using Ptolemy II  

Microsoft Academic Search

This paper introduces a method for interactive knowledge testing for a clinical decision support system developed as a part of the Artemis Project. Knowledge within the medical domain is vast and continuously being defined and re-defined. The volume of modern clinical decision support systems that support a flexible and intuitive environment that recognizes this principle is shocking limited. Clinical decision

Rishikesan Kawaleswaran; Mike Eklund

2011-01-01

449

The Use of the Integrated Medical Model for Forecasting and Mitigating Medical Risks for a Near-Earth Asteroid Mission  

NASA Technical Reports Server (NTRS)

Introduction The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission managers and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight. Methods Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of medical evacuation and loss of crew life. The IMM can also optimize medical kits within the constraints of mass and volume for specified missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a near-earth asteroid (NEA) mission. An optimized medical kit for this mission was proposed based on the IMM simulation. Discussion The IMM can provide information to the space program regarding medical risks, including crew medical impairment, medical evacuation and loss of crew life. This information is valuable to mission managers and the space medicine community in assessing risk and developing mitigation strategies. Exploration missions such as NEA missions will have significant mass and volume constraints applied to the medical system. Appropriate allocation of medical resources will be critical to mission success. The IMM capability of optimizing medical systems based on specific crew and mission profiles will be advantageous to medical system designers. Conclusion The IMM is a decision support tool that can provide estimates of the impact of medical events on human space flight missions, such as crew impairment, evacuation, and loss of crew life. It can be used to support the development of mitigation strategies and to propose optimized medical systems for specified space flight missions. Learning Objectives The audience will learn how an evidence-based decision support tool can be used to help assess risk, develop mitigation strategies, and optimize medical systems for exploration space flight missions.

Kerstman, Eric; Saile, Lynn; Freire de Carvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Lopez, Vilma

2011-01-01

450

Medical Products Research  

NASA Technical Reports Server (NTRS)

Ventrex Laboratories, Inc. develops, manufactures and markets a line of medical diagnostic assays based on biochemical techniques, in particular immunochemical techniques. Their products are sold worldwide to hospitals and medical laboratories for use in testing blood samples and other biological fluids. Analysis of a patient's body fluids, compared with normal values, aids a physician in confirming or otherwise diagnosing a suspected disease condition. NERAC's rapid information retrieval has provided Ventrex invaluable up-to-date information, and has permitted large scale savings. NERAC's service was particularly important in the development of a new product in the company's Ventre/Sep line, which is used in radioimmunoassays.

1982-01-01

451

MEDRIS: The Problem Oriented Electronic Medical Record in Medical Education  

PubMed Central

MEDRIS (The Medical Record Interface System) is an object oriented HyperCard interface designed to help physicians enter patient information as comfortably and naturally as possible. It can function as a stand alone system producing its own reports or serve as an interface to a medical expert system (e.g., MEDAS). MEDRIS plays an important role in the clinical education of medical students at the Chicago Medical School. MEDRIS portrays an intuitive, graphically oriented system that will provide a learning environment for the problem oriented medical record (POMR) that forms the basis of the structure of the history and physical exam. The enthusiasm shown by the medical students for this project has garnered support for including MEDRIS in the curriculum of the Introduction to Clinical Medicine course this semester. MEDRIS, developed using HyperCard, can be used as a tool not only for teaching POMR and physical diagnosis, but also computer literacy.

Rifat, Sami F.; Robert, Shanthi; Trace, David; Prakash, Sanjeev; Naeymi-Rad, Frank; Barnett, David; Pannicia, Gregory; Hammergren, David; Carmony, Lowell; Evens, Martha

1990-01-01

452

Medication compliance in the elderly.  

PubMed

Patient compliance with physician's medication instructions has been a growing concern for nearly two decades. Elderly patients are thought to have more difficulty following prescription instructions because they generally have more medications prescribed, often suffer from cognitive decline, and frequently have physical limitations such as failing eyesight and hearing. Exhibiting a genuine concern to patients for the importance of drug therapy and adherence to directions is the first step to improve compliance. Providing adequate verbal and written medication instruction, and implementing routine assessment of medication compliance should greatly improve response to drug therapy and decrease adverse effects. PMID:2682077

Stewart, R B; Caranasos, G J

1989-11-01

453

Medical Student Mental Health Services  

PubMed Central

Medical school is a stressful and challenging time in the academic career of physicians. Because of the psychological pressure inherent to this process, all medical schools should have easily accessible medical student mental health services. Some schools of medicine provide these services through departments of psychiatry or other associated training programs. Since this stressful lifestyle often continues through residency training and life as a physician, this is a critical period in which to develop and utilize functional and effective coping strategies. When psychiatrists provide the mental health treatment to medical students, it is important to consider transference and countertransference issues, over intellectualization, and instances of strong idealization and identification. PMID:19724734

Roman, Brenda

2009-01-01

454

Dairy Cow Culling Strategies: Making Economical Culling Decisions  

Microsoft Academic Search

The purpose of this report was to examine impor- tant economic elements of culling decisions, to review progress in development of culling decision support systems, and to discern some of the potentially re- warding areas for future research on culling models. Culling decisions have an important influence on the economic performance of the dairy but are often made in a

Terry W. Lehenbauer; James W. Oltjen

1998-01-01

455

DESIGNING A GENERALIZED MULTIPLE CRITERIA DECISION SUPPORT SYSTEM  

Microsoft Academic Search

Decision support systems are of many kinds depending on themodels and techniques employed in them. Multiple criteriadecision making techniques constitute an important class of DSSwith unique software requirements. This paper stresses theimportance of interactive MCDM methods since these facilitatelearning through all stages of the decision making process. Wefirst describe some features of Multiple Criteria Decision SupportSystems ( MCDSSs) that distinguish

Mohamed Tawfik Jelassi; Matthias Jarke; Edward A. Stohr

1984-01-01

456

PARTICIPATORY DECISION MAKING FOR OPERATIONAL EARTHQUAKE FORECASTING AND  

E-print Network

1 PARTICIPATORY DECISION MAKING FOR OPERATIONAL EARTHQUAKE FORECASTING AND EARTHQUAKE EARLY WARNING. To make such decisions requires a clear framework to be defined well before the occurrence on many groups it is important that the decision making takes account of their views

457

Effects of Medications on Voice  

MedlinePLUS

... drying out the protective mucosal layer covering the vocal cords. Vocal cords must be well-lubricated to operate properly; ... is why hydration is an important component of vocal health. Medications can also affect the voice by ...

458

Decision making and neuropsychiatry  

Microsoft Academic Search

Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neuropsychiatric disorders such as mania, substance abuse and personality disorders. A neural network involving the orbitofrontal cortex, ventral striatum and

Shibley Rahman; Barbara J. Sahakian; Rudolf N. Cardinal; Robert D. Rogers; Trevor W. Robbins

2001-01-01

459

Convex Bayes decision theory  

Microsoft Academic Search

The basic concepts of Levi's epistemic utility theory and credal convexity are presented. Epistemic utility, in addition to penalizing error as is done with traditional Bayesian decision methodology, permits a unit of informational value to be distributed among the hypotheses of a decision problem. Convex Bayes decision theory retains the conditioning structure of probability-based inference, but addresses many of the

W. C. Stirling; D. R. Morrell

1991-01-01

460

Boosting Decision Trees  

Microsoft Academic Search

A new boosting algorithm of Freund and Schapire is used to improve the performance of decision trees which are constructed usin: the information ratio criterion of Quinlan's C4.5 algorithm. This boosting algorithm iteratively constructs a series of decision tress, each decision tree being trained and pruned on examples that have been filtered by previously trained trees. Examples that have been

Harris Drucker; Corinna Cortes

1995-01-01

461

Optimal decision making theories  

Microsoft Academic Search

In case of many decisions based on sensory information, the sensory stimulus or its neural representation are noisy. This chapter reviews theories proposing that the brain implements statistically optimal strategies for decision making on the basis of noisy information. These strategies maximize the accuracy and speed of decisions, as well as the rate of receiving rewards for correct choices. The

Rafal Bogacz

462

Decision-Making Skills.  

ERIC Educational Resources Information Center

The issue emphasizes decision-making skills. Human beings are constantly confronted with choices in all aspects of life. The five basic skill categories in the decision-making process are identified and explained: (1) Conceptualizing; (2) Sequencing; (3) Creating Alternative Sequences; (4) Evaluating Alternatives; and (5) Implementing a Decision.…

Hartoonian, H. Michael; Laughlin, Margaret A.

1986-01-01

463

Ethics and genomic medicine, how to navigate decisions in surgical oncology.  

PubMed

Using genetic information to make medical decisions and tailor treatments to individuals will likely provide major benefits and become an important part of health care. Surgical oncologists must ethically apply scientific genetic information in a complex and evolving environment to the benefit of their patients. In this review we address ethical issues associated with: indications for genetic testing, informed consent for testing and therapy, confidentiality, targeted therapy, prophylactic surgery, and genetic testing in children. J. Surg. Oncol. 2015 111:18-23. © 2014 Wiley Periodicals, Inc. PMID:25183289

Devon, Karen M; Lerner-Ellis, Jordan P; Ganai, Sabha; Angelos, Peter

2015-01-01

464

[Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].  

PubMed

Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service can make a significant contribution to preventative ethics in reducing the number of emerging ethical problems to the satisfaction of all parties involved. PMID:24902533

Richter, G

2014-08-01

465

Medical genetics  

SciTech Connect

This book on the subject of medical genetics is a textbook aimed at a very broad audience: principally, medical students, nursing students, graduate, and undergraduate students. The book is actually a primer of general genetics as applied to humans and provides a well-balanced introduction to the scientific and clinical basis of human genetics. The twelve chapters include: Introduction, Basic Cell Biology, Genetic Variation, Autosomal Dominant and Recessive Inheritance, Sex-linked and Mitochondrial Inheritance, Clinical Cytogenetics, Gene Mapping, Immunogenetics, Cancer Genetics, Multifactorial Inheritance and Common Disease, Genetic Screening, Genetic Diagnosis and Gene Therapy, and Clinical Genetics and Genetic Counseling.

Jorde, L.B.; Carey, J.C.; White, R.L.

1995-10-01

466

Medical Instrumentation  

NSDL National Science Digital Library

Students learn about the sorts of devices designed by biomedical engineers and the many other engineering specialties that are required in their design of medical diagnostics, therapeutic aids, surgical devices and procedures, and replacement parts. They discuss the special considerations that must be made when dealing with the human body, such as being minimally invasive, biocompatible, keeping sterile, lightweight, corrosion resistant, long lasting and electrically safe. They also explore how "form fits function." Students gain an appreciation for the amazing devices that improve our quality of life. This lesson serves as a starting point for students to begin to ponder how the medical devices in their everyday lives work.

Techtronics Program,