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1

Decisions, Decisions, Decisions: Is Education Important Enough.  

National Technical Information Service (NTIS)

As the society enters a critical period in its evolution, education, which is at the center of that evolution, is being severely stressed. The processes by which decisions are taken, policies are set, programs are developed, and plans are made in and for ...

M. Adelson

1968-01-01

2

The Diagnostic Importance of the History and Physical Examination as Determined by the Use of a Medical Decision Support System  

PubMed Central

Automated analysis of NEJM CPC cases was used to assess the relative importance of history and physical examination data in medical diagnosis. The Quick Medical Reference diagnostic program was used to analyze 86 NEJM CPC cases in three forms: intact cases; cases containing only history, physical, and admission type laboratory test results; and cases containing no laboratory test results. In 64% of the cases there was no significant difference in the performance of the program using the intact version of the case versus using the other two versions.

Wagner, Michael M.; Bankowitz, Richard A.; McNeil, Melissa; Challinor, Susan M.; Janosky, Janine E.; Miller, Randolph A.

1989-01-01

3

Decision-Making after Prenatal Diagnosis of a Syndrome Predisposing to Intellectual Disability: What Prospective Parents Need to Know and the Importance of Non-Medical Information  

ERIC Educational Resources Information Center

Background: Recently researchers have suggested that non-medical information may impact the decision to continue or terminate a pregnancy after a prenatal diagnosis. This study is an investigation of what type of information prospective parents need for this decision-making in the case of a condition predisposing to intellectual disability.…

Huyard, Caroline

2012-01-01

4

The Effects of Decision Reversibility and Decision Importance on Children's Decision Making.  

ERIC Educational Resources Information Center

Examines ways in which young children's decision making is affected by decision reversibility and decision importance. Results suggest that even young children are affected by manipulations of the decision situation, and that basic decision processes develop rapidly with age. (SKC)

Davidson, Denise; Hudson, Judith

1988-01-01

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

Supporting Medical Decision Making with Argumentation Tools  

ERIC Educational Resources Information Center

This study investigated the collaborative decision-making and communicative discourse of groups of learners engaged in a simulated medical emergency in two conditions. In one condition subgroups used a traditional whiteboard (TW group) to document medical arguments on how to solve a medical emergency. In the other condition subgroups used…

Lu, Jingyan; Lajoie, Susanne P.

2008-01-01

7

Consumer decision processes in emergency medical situations.  

PubMed

This paper examines the nature of the consumer decision process in the selection of emergency medical services. Through telephone interviews, 604 respondents were asked to indicate how they would respond to potentially serious medical symptoms. Consumers tend to perceive such medical situations as having high personal involvement requiring extended decision making. This decision making approach results in a delayed response to serious symptoms. Factors that influence the outcome of consumer decision making include a favorable perception of EMS and knowledge about aspects of the EMS system. The conclusion is that marketing programs that aim to improve levels of appropriate use of EMS should educate consumers about the prehospital EMS system and strategically intervene in this decision process. PMID:10283138

Sackmary, B; Wilson, E M

1987-01-01

8

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

9

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

10

Medical care treatment decision support system  

US Patent & Trademark Office Database

Exemplary embodiments of the present invention will assist patients with their investigation of, and decision making about, the treatments that are available to them using conjoint analysis methods that measure individual preferences for risk-associated treatment options, while maintaining an acceptable interview length. In exemplary embodiments, such individual preferences, known as "utilities" in economics literature, will be combined with evidence-based outcomes data regarding the probabilities of treatment outcomes; exemplary embodiments will use "decision analysis" and modified "conjoint analysis" methods, to dynamically generate for patients real-time individualized, evidence-based feedback, rankings and recommendations regarding medical treatment alternatives that are available to the patient based on the patient's medical condition and prognostic indicators.

2013-10-01

11

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.

Seyedin, Hesam; Jamshidi-Orak, Roohangiz

2014-01-01

12

Stochastic dominance and medical decision making.  

PubMed

Stochastic Dominance (SD) criteria are decision making tools which allow us to choose among various strategies with only partial information on the decision makers' preferences. The notion of Stochastic Dominance has been extensively employed and developed in the area of economics, finance, agriculture, statistics, marketing and operation research since the late 1960s. For example, it may tell us which of two medical treatments with uncertain outcomes is preferred in the absence of full information on the patients' preferences. This paper presents a short review of the SD paradigm and demonstrates how the SD criteria may be employed in medical decision making, using the case of small abdominal aortic aneurysms as an illustration. Thus, for instance by assuming risk aversion one can employ second-degree stochastic dominance to divide the set of all possible treatments into the efficient set, from which the decision makers should always choose, and the inefficient (inferior) set. By employing Prospect Stochastic Dominance (PSD) a similar division can be conducted corresponding to all S-shaped utility functions. PMID:15648563

Leshno, Moshe; Levy, Haim

2004-08-01

13

Multimedia medical case retrieval using decision trees.  

PubMed

In this paper, we present a Case Based Reasoning (CBR) system for the retrieval of medical cases made up of a series of images with contextual information (such as the patient age, sex and medical history). Indeed, medical experts generally need varied sources of information (which might be incomplete) to diagnose a pathology. Consequently, we derive a retrieval framework from decision trees, which are well suited to process heterogeneous and incomplete information. To be integrated in the system, images are indexed by their digital content. The method is evaluated on a classified diabetic retinopathy database. On this database, results are promising: the retrieval sensitivity reaches 79.5% for a window of 5 cases, which is almost twice as good as the retrieval of single images alone. As a comparison, the retrieval sensitivity is 52.3% for a standard multimodal case retrieval using a linear combination of heterogeneous distances. PMID:18003014

Quellec, Gwénolé; Lamard, Mathieu; Bekri, Lynda; Cazuguel, Guy; Cochener, Béatrice; Roux, Christian

2007-01-01

14

Incorporating Patients' Preferences into Medical Decision Making  

PubMed Central

Current models of care emphasize the importance of including patients’ values in the decision making process. This is particularly important for decisions for which there are few data supporting a clear strategy or treatment choice. Constructing preferences for complex decisions requires that patients be able to consider multiple trade-offs between specific risks and benefits. Several marketing research techniques have been recently applied to heath care settings to facilitate this process. Most can be programmed to generate patients’ preferences or priorities, which can then be used to improve patient-physician communication. In this paper, we will describe some of the currently available approaches that have been successfully used in the healthcare setting. We provide case examples to illustrate the potential value of adopting each of these approaches in clinical practice.

Fraenkel, Liana

2013-01-01

15

Importance of scientific uncertainty in decision making  

Microsoft Academic Search

Uncertainty in environmental decision making should not be thought of as a problem that is best ignored. In fact, as is illustrated\\u000a in a simple example, we often informally make use of awareness of uncertainty by hedging decisions away from large losses.\\u000a This hedging can be made explicit and formalized using the methods of decision analysis. While scientific uncertainty is

Kenneth H. Reckhow

1994-01-01

16

Geriatric Medical Decisions: Factors Influencing Allocation of Scarce Resources and the Decision to Withhold Treatment.  

ERIC Educational Resources Information Center

Examined models for predicting treatment decisions of physicians, nurses, and social workers within acute and long-term care settings. Elicited treatment choices to vignettes regarding decisions to allocate scarce medical resource and to withhold treatment from debilitated patient. Primarily medical factors predicted decision to allocate…

Wetle, Terrie; And Others

1988-01-01

17

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

18

Euthanasia and other medical decisions concerning the end of life.  

PubMed

This article presents the first results of the Dutch nationwide study on euthanasia and other medical decisions concerning the end of life (MDEL). The study was done at the request of the Dutch government in preparation for a discussion about legislation on euthanasia. Three studies were undertaken: detailed interviews with 405 physicians, the mailing of questionnaires to the physicians of a sample of 7000 deceased persons, and the collecting of information about 2250 deaths by a prospective survey among the respondents to the interviews. The alleviation of pain and symptoms with such high dosages of opioids that the patient's life might be shortened was the most important MDEL in 17.5% of all deaths. In another 17.5% a non-treatment decision was the most important MDEL. Euthanasia by administering lethal drugs at the patient's request seems to have been done in 1.8% of all deaths. Since MDEL were taken in 38% of all deaths (and in 54% of all non-acute deaths) we conclude that these decisions are common medical practice and should get more attention in research, teaching, and public debate. PMID:1715962

Van Der Maas, P J; Van Delden, J J; Pijnenborg, L; Looman, C W

1991-09-14

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.

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

1996-01-01

21

Knowledge engineering for medical decision making: A review of computer-based clinical decision aids  

Microsoft Academic Search

Computer-based models of medical decision making account for a large portion of clinical computing efforts. This article reviews representative examples from each of several major medical computing paradigms. These include 1) clinical algorithms, 2) clinical databanks that include analytic functions, 3) mathematical models of physical processes, 4) pattern recognition, 5) Bayesian statistics, 6) decision analysis, and 7) symbolic reasoning or

EDWARD H. SHORTLIFFE; BRUCE G. BUCHANAN; EDWARD A. FEIGENBAUM

1979-01-01

22

Stochastic Dominance and Medical Decision Making  

Microsoft Academic Search

Stochastic Dominance (SD) criteria are decision making tools which allow us to choose among various strategies with only partial information on the decision makers' preferences. The notion of Stochastic Dominance has been extensively employed and developed in the area of economics, finance, agriculture, statistics, marketing and operation research since the late 1960s. For example, it may tell us which of

Moshe Leshno; Haim Levy

2004-01-01

23

Medical Decision and Patient's Preference: 'Much Ethics' and More Trust Always Needed  

PubMed Central

There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice.

Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

2011-01-01

24

Retrospectively exploring the importance of items in the decision to leave the emergency medical services (EMS) profession and their relationships to life satisfaction after leaving EMS and likelihood of returning to EMS.  

PubMed

An exit survey was returned by a sample of 127 respondents in fully compensated positions who left the EMS profession, most within 12 months prior to filling out the exit survey. A very high percentage continued to work after leaving EMS. Respondents were asked to rate the importance of each of 17 items in affecting their decision to leave EMS. A higher than anticipated response to a "not applicable" response choice affected the usability of 8 of these items. Nine of the 17 items had at least 65 useable responses and were used for further analysis. Within these 9, stress/burnout and lack of job challenges had the highest importance in affecting the decision to leave EMS, while desire for better pay and benefits had the lowest importance. Desire for career change was positively related to life satisfaction after leaving EMS and negatively related to likelihood of returning to EMS. Stress/burnout was positively related to life satisfaction after leaving EMS. Study limitations and future research issues are briefly discussed. PMID:21695362

Blau, Gary; Chapman, Susan

2011-01-01

25

The precautionary principle and medical decision making.  

PubMed

The precautionary principle is a useful strategy for decision-making when physicians and patients lack evidence relating to the potential outcomes associated with various choices. According to a version of the principle defended here, one should take reasonable measures to avoid threats that are serious and plausible. The reasonableness of a response to a threat depends on several factors, including benefit vs. harm, realism, proportionality, and consistency. Since a concept of reasonableness plays an essential role in applying the precautionary principle, this principle gives physicians and patients a decision-making strategy that encourages the careful weighing and balancing of different values that one finds in humanistic approaches to clinical reasoning. Properly understood, the principle presents a worthwhile alternative to approaches to clinical reasoning that apply expected utility theory to decision problems. PMID:15512973

Resnik, David B

2004-06-01

26

Evaluation of fuzzy relation method for medical decision support.  

PubMed

The potential of computer based tools to assist physicians in medical decision making, was envisaged five decades ago. Apart from factors like usability, integration with work-flow and natural language processing, lack of decision accuracy of the tools has hindered their utility. Hence, research to develop accurate algorithms for medical decision support tools, is required. Pioneering research in last two decades, has demonstrated the utility of fuzzy set theory for medical domain. Recently, Wagholikar and Deshpande proposed a fuzzy relation based method (FR) for medical diagnosis. In their case studies for heart and infectious diseases, the FR method was found to be better than naive bayes (NB). However, the datasets in their studies were small and included only categorical symptoms. Hence, more evaluative studies are required for drawing general conclusions. In the present paper, we compare the classification performance of FR with NB, for a variety of medical datasets. Our results indicate that the FR method is useful for classification problems in the medical domain, and that FR is marginally better than NB. However, the performance of FR is significantly better for datasets having high proportion of unknown attribute values. Such datasets occur in problems involving linguistic information, where FR can be particularly useful. Our empirical study will benefit medical researchers in the choice of algorithms for decision support tools. PMID:20703722

Wagholikar, Kavishwar; Mangrulkar, Sanjeev; Deshpande, Ashok; Sundararajan, Vijayraghavan

2012-02-01

27

Systematic errors in medical decision making  

Microsoft Academic Search

Much of medical practice involves the exercise of such basic cognitive tasks as estimating probabilities and synthesizing\\u000a information. Scientists studying cognitive processes have identified impediments to accurate performance on these tasks. Together\\u000a the impediments foster “cognitive bias.” Five factors that can detract from accurate probability estimation and three that\\u000a impair accurate information synthesis are discussed. Examples of all eight factors

Neal V. Dawson; Hal R. Arkes

1987-01-01

28

The medical decision model and decision maker tools for management of radiological and nuclear incidents.  

PubMed

Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management. PMID:24776895

Koerner, John F; Norman Coleman, C; Murrain-Hill, Paula; Fitzgerald, Denis J; Sullivan, Julie M

2014-06-01

29

Forecasting errors: The importance of the decision-making context  

Microsoft Academic Search

This article demonstrates the importance of context on forecast errors. It de J.scribes the development of an unrealistic transportation planning forecast for Denver, Colorado, noting its influence on air quality planning for Denver. The importance of two contextual features, procedural rationality and conflict of interest, to the introduction of error is discussed. The case described implies that different decision-making contexts

Robin L. Dennis

1987-01-01

30

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.  

PubMed

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes. PMID:22837104

Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

2013-04-01

31

Uncertainties in real-world decisions on medical technologies.  

PubMed

Patients, clinicians, payers and policy makers face substantial uncertainties in their respective healthcare decisions as they attempt to achieve maximum value, or the greatest level of benefit possible at a given cost. Uncertainties largely come from incomplete information at the time that decisions must be made. This is true in all areas of medicine because evidence from clinical trials is often incongruent with real-world patient care. This article highlights key uncertainties around the (comparative) benefits and harms of medical technologies. Initiatives and strategies such as comparative effectiveness research and coverage with evidence development may help to generate reliable and relevant evidence for decisions on coverage and treatment. These efforts could result in better decisions that improve patient outcomes and better use of scarce medical resources. PMID:25074335

Lu, C Y

2014-08-01

32

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

NASA Technical Reports Server (NTRS)

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

2009-01-01

33

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

34

A framework for encouraging patient engagement in medical decision making.  

PubMed

Patients have a right to make decisions about their medical care because they have the most at stake. Although current social forces and policies press for greater patient participation, there is little guidance on how physicians can comply. This paper describes the current culture influencing the physician-patient relationship, offers a practical framework and strategies to physicians to engage patients in medical decision making, and discusses the implications for patient safety. We describe several barriers that make patient involvement difficult to practice, such as differences between models that define the roles of both parties in the relationship. Arguably, patients should make all medical care decisions, but there are situations when this is not feasible. Nonetheless, there is a greater imperative for patient decision making if there are multiple treatment options; if the alternatives differ relative to clinical, quality-of-life, or financial outcomes; or if there are different clinical risks and benefits. We offer 3 strategies to encourage patients to make medical decisions and suggest implications for the field of patient safety. PMID:22892584

Holzmueller, Christine G; Wu, Albert W; Pronovost, Peter J

2012-12-01

35

Needs Assessment for Computer-Based Medical Decision Support Systems  

PubMed Central

Computer-based medical decision support systems should be developed with a clear understanding of physicians' needs for such support, yet these needs are rarely assessed. In order to identify the type of information that is needed for decision support, this study examined the correspondence between the knowledge base of QMR, a diagnostic support system for Internal Medicine, and the requests from internists and family physicians to MIST, a telephone consultation service based at an academic medical center. Results showed that the QMR knowledge base contained the majority of consultation requests made by the callers and that a small number of conditions account for most of the requests.

Berner, E. S.; Brooks, C. M.

1988-01-01

36

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.

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

1992-01-01

37

Javelin diagrams: applications in veterinary medical decision analysis  

Microsoft Academic Search

This paper introduces javelin diagrams as an innovative way for depicting the results of medical decision analyses. The methods were used to determine whether, and at which values, blood lactate in Belgian White and Blue or maximum tidal volumes in Holstein calves should be measured before deciding to treat or not a calf suffering from the bovine respiratory disease complex.

Johann C. Detilleux

2004-01-01

38

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.

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

2009-01-01

39

Shared decision making and medication management in the recovery process.  

PubMed

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder. PMID:17085613

Deegan, Patricia E; Drake, Robert E

2006-11-01

40

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).

2012-01-01

41

Medical and nursing clinical decision making: a comparative epistemological analysis.  

PubMed

The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skillful conduct of clinical decision making. PMID:15189556

Rashotte, Judy; Carnevale, F A

2004-07-01

42

Human-Computer Interaction with Medical Decisions Support Systems  

NASA Technical Reports Server (NTRS)

Decision Support Systems (DSSs) have been available to medical diagnosticians for some time, yet their acceptance and use have not increased with advances in technology and availability of DSS tools. Medical DSSs will be necessary on future long duration space missions, because access to medical resources and personnel will be limited. Human-Computer Interaction (HCI) experts at NASA's Human Factors and Ergonomics Laboratory (HFEL) have been working toward understanding how humans use DSSs, with the goal of being able to identify and solve the problems associated with these systems. Work to date consists of identification of HCI research areas, development of a decision making model, and completion of two experiments dealing with 'anchoring'. Anchoring is a phenomenon in which the decision maker latches on to a starting point and does not make sufficient adjustments when new data are presented. HFEL personnel have replicated a well-known anchoring experiment and have investigated the effects of user level of knowledge. Future work includes further experimentation on level of knowledge, confidence in the source of information and sequential decision making.

Adolf, Jurine A.; Holden, Kritina L.

1994-01-01

43

Patient preferences for adherence to treatment for osteoarthritis: the MEdication Decisions in Osteoarthritis Study (MEDOS)  

PubMed Central

Background Often affecting knee joints, osteoarthritis (OA) is the most common type of arthritis and by 2020 is predicted to become the fourth leading cause of disability globally. Without cure, medication management is symptomatic, mostly with simple analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), and glucosamine sulfate. Adherence to arthritis medications is generally low. Intentional non-adherence, that is deliberate decision-making about the use of analgesics, occurs in OA patients. To date, a limited number of studies have explored medication-taking decisions in people with OA nor the extent to which individuals’ trade off one treatment factor for another in their decision-making using quantitative techniques. This study aimed to estimate the relative influence of medication-related factors and respondent characteristics on decisions to continue medications among people with symptomatic OA. Methods A discrete choice experiment (DCE) was conducted among participants attending end-of-study visits in the Long-term Evaluation of Glucosamine Sulfate (LEGS) study (ClinicalTrials.gov ID: NCT00513422). The paper-based survey was used to estimate the relative importance of seven medication specific factors (pain efficacy, mode of action, dose frequency, treatment schedule, side effects, prescription, and out-of-pocket costs) and respondent characteristics on decisions to continue medications. Results 188 (response rate 37%) completed surveys were returned. Four of the seven medication factors (side effects, out-of-pocket costs, mode of action, treatment schedule) had a significant effect on the choice to continue medication; patient characteristics did not. Assuming equivalent pain efficacy and disease-modifying properties for glucosamine, the positive relative likelihood of continuing with sustained-release acetaminophen was equivalent to glucosamine. By contrast, the negative relative likelihood of NSAID continuation was mostly driven by the side effect profile. The predicted probability of continuing with glucosamine decreased with increasing out-of-pocket costs. Conclusions This study has characterised the complexity of medication-taking decisions that potentially underpin intentional non-adherent behaviour for people with symptomatic OA. In particular, medication risks and cost were important and ought to be borne into considerations in interpreting clinical trial evidence for practice. Ultimately addressing these factors may be the way forward to realising the full potential of health and economic benefits from the efficacious and safe use of OA medications.

2013-01-01

44

Virtual medical record implementation for enhancing clinical decision support.  

PubMed

Development of clinical decision support systems (CDS) is a process which highly depends on the local databases, this resulting in low interoperability. To increase the interoperability of CDS a standard representation of clinical information is needed. The paper suggests a CDS architecture which integrates several HL7 standards and the new vMR (virtual Medical Record). The clinical information for the CDS systems (the vMR) is represented with Topic Maps technology. Beside the implementation of the vMR, the architecture integrates: a Data Manager, an interface, a decision making system (based on Egadss), a retrieving data module. Conclusions are issued. PMID:22874164

Gomoi, Valentin-Sergiu; Dragu, Daniel; Stoicu-Tivadar, Vasile

2012-01-01

45

Spiritual background and its association with the medical decision of, DNR at terminal life stages.  

PubMed

In recent years personal and clinical dilemmas relating to terminally ill patient-care medical, decisions have increased significantly. Although understanding the patient's medical, nursing and, social background is important, a comprehensive appraisal essential for treating the "whole patient" is, incomplete without a spirituality assessment. Religious beliefs and practices affect medical and health, care decisions and require recognition as a dynamic in coping with suffering, loss, life, and death. Taking a spiritual background obtains information that is meaningful to the patient's life and may, influence the medical decision-making relating to health. A study was undertaken to determine, whether assessing the spiritual background influences medical decisions-making regarding the use of, DNR. The target population was 46 family-member caregivers of non-communicative patients in the Herzog, Hospital Skilled Nursing ward located in Jerusalem. The spiritual assessment questionnaire was the, acronym FICA (faith, importance, community and addressing). Two-thirds of the families were opposed to a determination utilizing do not resuscitate (DNR). Multivariate, analysis of the findings found that only religious affiliation was statistically significant (p=0.003). The doctors recommend DNR in 67% of the cases while the family caregiver accepted this decision in, only 33% of the cases. The hypothesis was verified. People who are perceived as being religious or as being greatly influenced, by faith/spirituality opposed the recommendation implementing DNR. Obtaining a spiritual background assists the physician to understand the patient or family spirituality, facilitates sensitivity to value frameworks and preferences in making medical and health-related, decisions. PMID:24029615

Jaul, Efraim; Zabari, Yonit; Brodsky, Jenny

2014-01-01

46

Exploring Patient Values in Medical Decision Making: A Qualitative Study  

PubMed Central

Background Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. Methods and Findings We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28–67 years old. Our sample comprised 9 women and 12 men. Three main themes, ‘treatment-specific values’, ‘life goals and philosophies’, and ‘personal and social background’, emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients’ decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). Conclusions This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients’ priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

Lee, Yew Kong; Low, Wah Yun; Ng, Chirk Jenn

2013-01-01

47

Bringing doctor-patient medical decision-making into focus.  

PubMed

When I finally got eye glasses as a teenager, after denying the need for far too long, I was repeatedly surprised by the world that everyone else had been seeing all along. Leaves on the trees, graffiti by the highway-I was astonished, amazed, and suddenly informed. It is easy to assume we are seeing all we need to see, knowing all we need to know, until something jars us from this false comfort and compels us to reconsider. So it is with thinking about the current state of doctor-patient decisions. The unfocused view has physicians listening to patients and clearly communicating information about illnesses and treatment options, patients making good use of high-quality data to craft sound decisions, and doctors joining patient preference with provider beneficence to optimize decisions. The reassuring outlook finds physician paternalism defeated, patients empowered, and all right with the world. Peter Ubel cannot let that fiction stand. In Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together, Ubel reminds us that our work in actualizing patient autonomy and fostering patient participation in critical health decisions remains far from over. PMID:25043365

Stark, Meredith

2014-07-01

48

Import/Export of Medical Devices - A Workshop Manual.  

National Technical Information Service (NTIS)

This manual covers the range of basic regulatory requirements that all manufacturers must consider when they begin to import or export a medical device. The materials it contains are useful for guidance and reference on establishment registration, device ...

J. Stigi D. M. Greathouse

1983-01-01

49

Dangerous snakes, deadly snakes and medically important snakes  

PubMed Central

This correspondence argues that the dangerousness of a venomous snake species is not solely determined by the venom characteristics or the lethality of the snake, and recognizes that medical importance comprises a key variable as well. The medical importance of a snake is determined by several factors – including frequency of medical attention after a bite, local or systemic envenomation provoked by the bite, fatal bites, long term consequences, availability of antivenom therapy as well as the size of the population at risk – that may vary from one region to another.

2013-01-01

50

Dangerous snakes, deadly snakes and medically important snakes.  

PubMed

This correspondence argues that the dangerousness of a venomous snake species is not solely determined by the venom characteristics or the lethality of the snake, and recognizes that medical importance comprises a key variable as well. The medical importance of a snake is determined by several factors - including frequency of medical attention after a bite, local or systemic envenomation provoked by the bite, fatal bites, long term consequences, availability of antivenom therapy as well as the size of the population at risk - that may vary from one region to another. PMID:24099013

Silva, Anjana

2013-01-01

51

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

52

Supporting decisions in medical applications: the knowledge management perspective.  

PubMed

In the medical domain, different knowledge types are typically available. Operative knowledge, collected during every day practice, and reporting expert's skills, is stored in the hospital information system (HIS). On the other hand, well-assessed, formalised medical knowledge is reported in textbooks and clinical guidelines. We claim that all this heterogeneous information should be secured and distributed, and made available to physicians in the right form, at the right time, in order to support decision making: in our view, therefore, a decision support system cannot be conceived as an independent tool, able to substitute the human expert on demand, but should be integrated with the knowledge management (KM) task. From the methodological viewpoint, case based reasoning (CBR) has proved to be a very well suited reasoning paradigm for managing knowledge of the operative type. On the other hand, rule based reasoning (RBR) is historically one of the most successful approaches to deal with formalised knowledge. To take advantage of all the available knowledge types, we propose a multi modal reasoning (MMR) methodology, that integrates CBR and RBR, for supporting context detection, information retrieval and decision support. Our methodology has been successfully tested on an application in the field of diabetic patients management. PMID:12467793

Montani, Stefania; Bellazzi, Riccardo

2002-12-18

53

Deficiency areas in decision making in undergraduate medical students  

PubMed Central

Background In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problem-solving skills, and a comprehensive and holistic approach to be taught to medical students. Purpose The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students. Materials and methods This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students’ written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale. Results The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement. Conclusion Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students’ performance should be further evaluated.

Klemenc-Ketis, Zalika; Kersnik, Janko

2014-01-01

54

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

55

A combined Fuzzy Cognitive Map and decision trees model for medical decision making.  

PubMed

Fuzzy Cognitive Maps (FCMs) are an efficient modeling method providing flexibility on the simulated system's design. They consist of nodes-concepts and weighted edges that connect the nodes and represent the cause and effect relationships among them. The performance of FCMs is dependent on the initial weight setting and architecture. This shortcoming can be alleviated and the FCM model can be enhanced if a fuzzy rule base (IF-THEN rules) is available. This research proposes a successful attempt to combine fuzzy cognitive maps with decision tree generators. A combined Decision Tree-Fuzzy Cognitive Map (DT-FCM) model is proposed when different types of input data are available and the behavior of this model is studied. In this research work, we introduce a new hybrid modeling methodology for decision making tasks and we implement the proposed methodology at a medical problem. PMID:17946358

Papageorgiou, Elpiniki; Stylios, Chrysostomos; Groumpos, Peter

2006-01-01

56

[Justice and equity as determinants of medical decision-making].  

PubMed

Every medical decision-making is to do justice to the one who suffers and who considers his pain as nonsensical. This requirement falls into 3 universal ethical principles, governing the patient-doctor relationship: the autonomy of the person even if it is a young child, beneficence and non-maleficence. Adhering to these principles gives medical decision-making its ethical dimension. It implies that the doctor makes the best use of the emotions that he feels in front of his patient and/or in front of his relatives: respect for autonomy, the beneficent compassion and the fear of maleficence in diagnosis and care. If a paediatrician combines these 3 affects harmoniously, his attitude is in keeping with the requirement of justice, which is the quintessence of Ethics. However, reality is often more complex, a source of conflicting emotions and, in fine, a source of an anguish whose benefit is yet to alert on the necessity to carry on looking for the right decision-making: the emotional revision consists of a meta-analysis of the objective and subjective data of the problem. It preciously helps to establish a compromise of justice. Eventually, in order to be just, the doctor must include the concern of equity amongst the criteria of his decision-making, in other words a fair allocation of the goods and of the care services. Unfortunately, this concern is undermined by geopolitical, socio-economic and cultural factors, which vary greatly according to the environmental conditions that might mar what should be optimal ethical decisionmaking. The doctor cannot solve these problems on his own, but he has to know them in order to deal with them. PMID:20172455

Le Coz, P; Kachaner, J

2010-02-01

57

Determining location and size of medical departments in a hospital network: a multiobjective decision support approach.  

PubMed

Decisions on the location and size of medical departments in a given hospital network are prime examples of priority setting in health care, which is an issue of growing political importance. As such decisions are regularly characterized by multiple and often conflicting objectives in real-life, this paper integrates the fields of hospital planning and multiobjective decision support. The proposed two-phase solution procedure for our corresponding mathematical programming model does not require a priori preference information. Instead, it seeks efficient solutions by means of multiobjective tabu search in the first phase, while applying clustering in the second phase to allow the decision makers to interactively explore the solution space until the "best" configuration is determined. The real-world applicability of our approach is illustrated through a numerical example based on hospital data from Germany. PMID:14977095

Stummer, Christian; Doerner, Karl; Focke, Axel; Heidenberger, Kurt

2004-02-01

58

When medical group and HMO part company: disenrollment decisions in Medicare HMOs.  

PubMed

Medicare beneficiaries who enroll in "risk contract" Health Maintenance Organizations (HMOs) are covered for services only if they are provided or approved by the HMO. Thus, their enrollment decisions involve selecting a health care delivery system and may be influenced by whether the HMO has contracts with particular providers. Disenrollment decisions, in turn, may be influenced by breaks in contracts between the HMO and its medical groups. This study examines decisions made by Medicare HMO enrollees when their HMO terminated its relationship with a major medical group; the group then signed a contract with a competing HMO. Beneficiaries were forced to choose between remaining with their HMO and switching to another provider, and switching to the competing HMO where they could keep their provider. Beneficiaries demonstrated considerable loyalty to their providers; nearly 60% switched to the competing HMO. Previous research on health care coverage decisions has been based on models which did not address consumers' knowledge, options, and information sources. In this decision context, we found that knowledge and information sources were the most important determinants of beneficiary decisions. PMID:8366683

Sofaer, S; Hurwicz, M L

1993-09-01

59

Reasoning in the Capacity to Make Medical Decisions: The Consideration of Values  

PubMed Central

Purpose To examine the contribution of “values-based reasoning” in evaluating older adults’ capacity to make medical decisions. Design and Methods Older men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics. Results Participants varied widely in the activities and relationships they most valued, the extent to which religious beliefs would influence healthcare decisions, and in ratings of the importance of preserving quality versus length of life. Most participants preferred shared decision making with doctor, family, or both. Individuals with schizophrenia or dementia performed worse than a primary care comparison group in reasoning measured by the ability to list risks and benefits and compare choices. Individuals with dementia performed comparably to the primary care group in reasoning measured by the ability to justify choices in terms of valued abilities or activities, whereas individuals with schizophrenia performed relatively worse compared to the other two groups. Compared to primary care patients, participants with schizophrenia and with dementia were impaired on the ability to explain treatment choices in terms of valued relationships. Conclusion Medical decision making may be influenced by strongly held values and beliefs, emotions, and long life experience. To date, these issues have not been explicitly included in structured evaluations of medical decision-making capacity. This study demonstrated that it is possible to inquire of and elicit a range of healthcare related values and preferences from older adults with dementia or schizophrenia, and individuals with mild to moderate dementia may be able to discuss healthcare options in relation to their values. However, how best to incorporate a values assessment into a structured capacity evaluation deserves further research attention.

Karel, Michele J.; Gurrera, Ronald J.; Hicken, Bret; Moye, Jennifer

2010-01-01

60

Factors Considered Important in Decision Making: A Preliminary Investigation  

Microsoft Academic Search

Four groups of educational decision makers rated the influence of nine pieces of information on the decisions they made about the educational placement of a child. Information regarding the sex, socioeconomic status (SES), and physical attractiveness of the student was seen as having an insignificant effect on decisions. Assessment data were believed to have a greater influence, with achievement and

Martha L. Thurlow; James E. Ysseldyke

1982-01-01

61

The medication minefield: using computerized decision support systems to reduce preventable adverse drug events and hospitalizations.  

PubMed

Preventable adverse drug events (ADEs) are a source of avoidable hospitalizations, morbidity and mortality, especially among those older than 65 years. Computerized decision support systems (CDSSs) can identify and address ADEs, but relatively little has been written about the effectiveness of such system in the community setting. This article will review some important studies on the causes of medication-related admissions in the ambulatory setting, where a lack of communication among prescribers creates a virtual minefield of medication risk. Some preliminary data will show how the application of CDSSs can affect the outcomes of care, including a reduction in preventable admissions and readmissions. PMID:24887524

Bernstein, Richard; Kogan, Polina; Collins, Arlen

2014-01-01

62

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.

McGraw, Sarah

2007-01-01

63

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

64

Arthropods of Medical Importance in Australia and the Pacific Islands.  

National Technical Information Service (NTIS)

The occurrence of insects and other arthropods of medical importance in Australia, New Zealand, New Guinea, and the islands of Oceania is summarized on the basis of a review of most of the available references in the scientific literature. The report incl...

B. V. Travis R. M. Labadan H. H. Lee

1968-01-01

65

Arthropods of Medical Importance in America North of Mexico.  

National Technical Information Service (NTIS)

The occurrence of insects and other arthropods of medical importance in America North of Mexico is summarized on the basis of review of most of the available references in the scientific literature. The report includes, for each major group of arthropods,...

B. V. Travis H. H. Lee R. M. Labadan

1969-01-01

66

Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center.  

PubMed Central

We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS.

Jenders, R. A.; Hripcsak, G.; Sideli, R. V.; DuMouchel, W.; Zhang, H.; Cimino, J. J.; Johnson, S. B.; Sherman, E. H.; Clayton, P. D.

1995-01-01

67

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

68

The larvae of some blowflies of medical and veterinary importance.  

PubMed

Diagnostic features are described as a series of couplets that enable separation of the third instar larvae of the following pairs of closely related forms of blowflies of medical and veterinary importance: Chrysomya chloropyga (Wiedemann) and Ch.putoria (Wiedemann), Chrysomya albiceps (Wiedemann) and Ch.rufifacies (Macquart), Cochliomyia hominivorax (Coquerel) and Co.macellaria (Fabricius), Lucilia sericata (Mergen) and L. cuprina (Wiedemann), Calliphora augur (Fabricius) and C. stygia (Fabricius). PMID:2979525

Erzinclioglu, Y Z

1987-04-01

69

Medical Decisions Made by Surrogates for Persons with Advanced Dementia within Weeks or Months of Death  

PubMed Central

Background Surrogates make all medical decisions for persons with advanced dementia. This study describes the types of medical decisions that surrogates faced prior to the person’s death and their perceived difficulty and satisfaction with those decisions. Methods Seventy-six surrogates of nursing home residents meeting hospice criteria for dementia were followed longitudinally and interviewed following the death of the person with dementia. Results The most common decisions made were related to transfer to hospital, diagnostic testing, and placement of a feeding tube. Surrogates perceived decisions to not treat to be more difficult than decisions to treat. Conclusions Surrogates frequently are faced with making medical decisions for persons with advanced dementia near the end of life. Clinicians can help surrogates by acknowledging the difficulty of making decisions to not treat.

Rabins, Peter V.; Hicks, Kathryn L.; Black, Betty S.

2011-01-01

70

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

71

Translating comparative effectiveness of depression medications into practice by comparing the depression medication choice decision aid to usual care: study protocol for a randomized controlled trial  

PubMed Central

Background Comparative effectiveness research (CER) documents important differences in antidepressants in terms of efficacy, safety, cost, and burden to the patient. Decision aids can adapt this evidence to help patients participate in making informed choices. In turn, antidepressant therapy will more likely reflect patients’ values and context, leading to improved adherence and mood outcomes. Methods/Design The objective of this study is to develop the Depression Medication Choice decision aid for use during primary care encounters, and to test its efficacy by conducting a clustered practical randomized trial comparing the decision aid to usual depression care in primary care practices. We will use a novel practice-based, patient-centered approach based on participatory action research that involves a multidisciplinary team of designers, investigators, clinicians, patient representatives, and other stakeholders for the development of the decision aid. We will then conduct a clustered practical randomized trial enrolling clinicians and their patients (n = 300) with moderate to severe depression from rural, suburban and inner city primary care practices (n = 10). The intervention will consist of the use of the depression medication choice decision aid during the clinical encounter. This trial will generate preliminary evidence of the relative impact of the decision aid on patient involvement in decision making, decision making quality, patient knowledge, and 6-month measures of medication adherence and mental health compared to usual depression care. Discussion Upon completion of the proposed research, we will have developed and evaluated the efficacy of the decision aid depression medication choice as a novel translational tool for CER in depression treatment, engaged patients with depression in their care, and refined the process by which we conduct practice-based trials with limited research footprint. Trial registration Clinical Trials.gov: NCT01502891

2013-01-01

72

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.

Miller, R A

1994-01-01

73

A multilayer perceptron-based medical decision support system for heart disease diagnosis  

Microsoft Academic Search

Abstract The medical diagnosis by nature is a complex and fuzzy cognitive process, and soft computing methods, such as neural networks, have shown great potential to be applied in the development of medical decision support systems (MDSS). In this paper, a multiplayer perceptron- based decision support system is developed,to support the diagnosis of heart diseases. The input layer of the

Hongmei Yan; Yingtao Jiang; Jun Zheng; Chenglin Peng; Qinghui Li

2006-01-01

74

Multiple Attributes Decision-Making Model for Medical Service Selection: An AHP Approach  

Microsoft Academic Search

Since medical field is highly professional, the me dical service provider thus owns professional knowledge much higher than the consumers and information asymmetric nature is thus one of the major features in medical field. Systematic decision-making analysis can help decision maker to summarize and judge all information effectively and to define right question and to find out optimum and the

Chun-Chieh Tseng; Cheng-Fang Hong; Hui-Ling Chang

75

Arbitrator Decision Making: When Are Final Offers Important?  

Microsoft Academic Search

Central to understanding the effect of arbitration schemes on the process of collective bargaining is understanding the process by which arbitrators make decisions. A model of arbitrator behavior inconventional arbitration is developed that allows the arbitration award to be a function of both the offers of the parties and the(exogenous) facts of the case. The weight that the arbitrator puts

Max H. Bazerman; Henry S. Farber

1983-01-01

76

The medically important aerobic actinomycetes: epidemiology and microbiology.  

PubMed Central

The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes. Images

McNeil, M M; Brown, J M

1994-01-01

77

Analysis of medical-decision making and the use of standards of care in oncology.  

PubMed Central

Guidelines in medicine have been proposed as a way to assist physicians in the clinical decision-making process. Increasingly, they form the basis for assessing accountability in the delivery of healthcare services. However, experiences with their evaluation, as the most important step in the continuous guidelines process, are rare. Patient Care Evaluation Studies have been developed by the Commission on Cancer in the United States. As they reflect the "real-world" medical practice they are helpful in evaluating the quality of diagnosis, therapy and follow-up of tumor diseases in hospitals and cancer center and the compliance with current standards of care. In this context, they can provide an infrastructure for the analysis of the decision-making process.

Holzer, S.; Fremgen, A. M.; Hundahl, S. A.; Dudeck, J.

2000-01-01

78

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

79

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

80

Future of medical knowledge management and decision support.  

PubMed

Attempts to predict the future are typically off the mark. Beyond the challenges of forecasting the stock market or the weather, dramatic instances of notoriously inaccurate prognostications have been those by the US patent office in the late 1800s about the future of inventions, by Thomas Watson in the 1930s about the market for large computers, and by Bill Gates in the early 1990s about the significance of the Internet. When one seeks to make predictions about health care, one finds that, beyond the usual uncertainties regarding the future, additional impediments to forecasting are the discontinuities introduced by advances in biomedical science and technology, the impact of information technology, and the reorganizations and realignments attending various approaches to health care delivery and finance. Changes in all three contributing areas themselves can be measured in "PSPYs", or paradigm shifts per year. Despite these risks in forecasting, I believe that certain trends are sufficiently clear that I am willing to venture a few predictions. Further, the predictions I wish to make suggest a goal for the future that can be achieved, if we can align the prevailing political, financial, biomedical, and technical forces toward that end. Thus, in a sense this is a call to action, to shape the future rather than just let it happen. This chapter seeks to lay out the direction we are heading in knowledge management and decision support, and to delineate an information technology framework that appears desirable. I believe the framework to be discussed is of importance to the health care-related knowledge management and decision making activities of the consumer and patient, the health care provider, and health care delivery organizations and insurers. The approach is also relevant to the other dimensions of academic health care institution activities, notably the conduct of research and the processes of education and learning. PMID:12026135

Greenes, Robert A

2002-01-01

81

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.

2014-01-01

82

Naegleria fowleri: a free living amoeba of emerging medical importance.  

PubMed

Naegleria fowleri, a free-living amoeba is ubiquitous and word-wide in distribution. Infection is due to inhalation or aspiration of aerosols containing cysts found in the environment. Of late, the amoeba is emerging as a pathogen of medical importance causing primary amoebic meningoencephalitis (PAM) in humans. The diagnosis of the condition is mainly parasitic which depends on the detection and identification of Naegleria trophozoites in the cerebro-spinal fluid (CSF) or biopsied brain tissue. Serological tests are not useful in the diagnosis of PAM. Most cases are fatal and various amoebicidal agents have been tried unsuccessfully. The present paper provides a review of the recent information on the biology and epidemiology of the disease caused by the amoeba Approaches in the diagnosis, pathophysiology and treatment of the condition are also discussed. PMID:10916609

Parija, S C; Jayakeerthee, S R

1999-09-01

83

Assessment of Medical Students’ Shared Decision-Making in Standardized Patient Encounters  

Microsoft Academic Search

BACKGROUND  Shared decision-making, in which physicians and patients openly explore beliefs, exchange information, and reach explicit\\u000a closure, may represent optimal physician–patient communication. There are currently no universally accepted methods to assess\\u000a medical students’ competence in shared decision-making.\\u000a \\u000a \\u000a \\u000a \\u000a OBJECTIVE  To characterize medical students’ shared decision-making with standardized patients (SPs) and determine if students’ use of\\u000a shared decision-making correlates with SP ratings of their

Karen E. Hauer; Alicia Fernandez; Arianne Teherani; Christy K. Boscardin; George W. Saba

2011-01-01

84

Simulation modeling to derive the value-of-information for risky animal disease-import decisions.  

PubMed

Simulation modeling can be used in aiding decision-makers in deciding when to invest in additional research and when the risky animal disease-import decision should go forward. Simulation modeling to evaluate value-of-information (VOI) techniques provides a robust, objective and transparent framework for assisting decision-makers in making risky animal and animal product decisions. In this analysis, the hypothetical risk from poultry disease in chicken-meat imports was modeled. Economic criteria were used to quantify alternative confidence-increasing decisions regarding potential import testing and additional research requirements. In our hypothetical example, additional information about poultry disease in the exporting country (either by requiring additional export-flock surveillance that results in no sign of disease, or by conducting additional research into lack of disease transmittal through chicken-meat ingestion) captured >75% of the value-of-information attainable regarding the chicken-meat-import decision. PMID:14554141

Disney, W Terry; Peters, Mark A

2003-11-12

85

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

86

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

87

Medical Decision Support: An Approach in the Domain of Brachial Plexus Injuries.  

National Technical Information Service (NTIS)

The thesis deals with modeling in medical decision support. Two approaches are distinguished: data based modeling, and knowledge based modeling. The goal of the research is to assess the merits and demerits of these approaches. In order to derive general ...

R. B. M. Jaspers

1990-01-01

88

Medical and pharmacy coverage decision making at the population level.  

PubMed

Medicare is one of the largest health care payers in the United States. As a result, its decisions about coverage have profound implications for patient access to care. In this commentary, the authors describe how Medicare used evidence on heterogeneity of treatment effects to make population-based decisions on health care coverage for implantable cardiac defibrillators. This case is discussed in the context of the rapidly expanding availability of comparative effectiveness research. While there is a potential tension between population-based and patient-centered decision making, the expanded diversity of populations and settings included in comparative effectiveness research can provide useful information for making more discerning and informed policy and clinical decisions. PMID:24856592

Mohr, Penny E; Tunis, Sean R

2014-06-01

89

Do Continuing Medical Education Articles Foster Shared Decision Making?  

ERIC Educational Resources Information Center

Introduction: Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based…

Labrecque, Michel; Lafortune, Valerie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Legare, France

2010-01-01

90

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.

91

Modeling paradigms for medical diagnostic decision support: a survey and future directions.  

PubMed

Use of computer based decision tools to aid clinical decision making, has been a primary goal of research in biomedical informatics. Research in the last five decades has led to the development of Medical Decision Support (MDS) applications using a variety of modeling techniques, for a diverse range of medical decision problems. This paper surveys literature on modeling techniques for diagnostic decision support, with a focus on decision accuracy. Trends and shortcomings of research in this area are discussed and future directions are provided. The authors suggest that-(i) Improvement in the accuracy of MDS application may be possible by modeling of vague and temporal data, research on inference algorithms, integration of patient information from diverse sources and improvement in gene profiling algorithms; (ii) MDS research would be facilitated by public release of de-identified medical datasets, and development of opensource data-mining tool kits; (iii) Comparative evaluations of different modeling techniques are required to understand characteristics of the techniques, which can guide developers in choice of technique for a particular medical decision problem; and (iv) Evaluations of MDS applications in clinical setting are necessary to foster physicians' utilization of these decision aids. PMID:21964969

Wagholikar, Kavishwar B; Sundararajan, Vijayraghavan; Deshpande, Ashok W

2012-10-01

92

Diseases of insects of medical importance in Europe  

PubMed Central

The biological control of insects carrying human diseases was first attempted many years ago, but the results were disappointing owing to the insufficiency of information on the ecology and pathology of such insects at the time. In recent years, however, increased knowledge of insect pathology and ecology and the development of insecticide-resistance have led to a revival of interest in this method of vector control. Most of the recent published work on this subject relates to findings in North America; comparatively little information has hitherto been available in respect of Europe. This paper, which is based on a survey of the literature and on the author's own experience, presents the results of research on diseases of insects of medical importance in Europe. Infection with viruses, rickettsiae, bacteria, fungi, protozoa and nematodes are discussed and suggested lines for future European research on biological control are put forward. ImagesFIG. 7-9FIG. 10-12FIG. 4-6FIG. 1-3

Weiser, Jaroslav

1963-01-01

93

Relationship between metabolism and biomass of medically important zygomycetes.  

PubMed

Little is known about the relationships between metabolic activity and fungal biomass or time of incubation for medically important fungal pathogens. Understanding these relationships may be especially relevant for rapidly growing organisms, such as zygomycetes. A range of inocula of five clinical isolates of zygomycetes (one each of Rhizopus oryzae,Rhizopus microsporus, Cunninghamella bertholletiae, Mucor circinelloides and Absidia corymbifera) were incubated for 6, 8, 12, 24 and 48 h, after which hyphal mass was assessed spectrophotometrically and metabolic activity was measured using various concentrations of XTT and menadione. Both linear regression and the Boltzmann sigmoid model were used and compared for description of relationships between metabolic activity, biomass and time of incubation. Modeling was further applied to eleven additional zygomycete isolates. The relationships of biomass or metabolic activity as a function of time of incubation were well described with the Boltzmann sigmoid model. The latter was superior to linear regression in describing the relationship between metabolic activity and fungal biomass. For all isolates of zygomycetes, increases in metabolic activity preceded increases in biomass. Inter-species differences in growth patterns were observed, with Rhizopus microsporus and Mucor spp. reaching the plateau of growth earlier compared to other species. These findings on the temporal relationship and inter-species differences of hyphal growth and metabolic activity for zygomycetes may be useful in the design and interpretation of in vitro studies of these emerging pathogens. PMID:16882609

Antachopoulos, Charalampos; Meletiadis, Joseph; Roilides, Emmanuel; Sein, Tin; Sutton, Deanna A; Wickes, Brian L; Rinaldi, Michael G; Merz, William G; Shea, Yvonne R; Walsh, Thomas J

2006-08-01

94

Relative importance of metaphor in radiology versus other medical specialties.  

PubMed

The acquisition of competence in radiology often entails referring to other realms of knowledge, by which insights are acquired through the use of metaphor. One way in which compelling associations are made and retained is by linking anatomic structures and pathologic conditions with objects, places, and concepts, and codifying these relationships as metaphoric signs. An aggregate of specialty-specific signs were obtained from two general medical dictionaries and from encyclopedic texts in radiology and six other specialties: internal medicine, dermatology, pathology, general surgery, orthopedics, and pediatrics. The signs were then separated into two categories: eponymous (bearing the name of an individual or place) and metaphoric (extending meaning from one context to another). A total of 375 metaphoric signs were collected from citations in the researched dictionaries and texts, the overwhelming majority (66%) of which were radiologic in reference. In every other specialty, eponymous signs outnumbered metaphoric signs. In contrast, eponymous signs were comparatively infrequent in radiology. The striking difference observed in the data highlights the importance of metaphors for discourse and instruction in radiology. In image interpretation, the meaning of perceptual input is often discerned through associations with pictures previously encountered and understood both concretely and metaphorically. The inherent nature of radiologic images as simulacra of both normal anatomy and disease entities makes imaging findings well suited to explanation by means of named patterns borrowed from other realms of knowledge. PMID:22236904

Baker, Stephen R; Partyka, Luke

2012-01-01

95

Doc, What Would You Do If You Were Me? On Self-Other Discrepancies in Medical Decision Making  

ERIC Educational Resources Information Center

Doctors often make decisions for their patients and predict their patients' preferences and decisions to customize advice to their particular situation. We investigated how doctors make decisions about medical treatments for their patients and themselves and how they predict their patients' decisions. We also studied whether these decisions and…

Garcia-Retamero, Rocio; Galesic, Mirta

2012-01-01

96

Reliability analysis framework for computer-assisted medical decision systems  

SciTech Connect

We present a technique that enhances computer-assisted decision (CAD) systems with the ability to assess the reliability of each individual decision they make. Reliability assessment is achieved by measuring the accuracy of a CAD system with known cases similar to the one in question. The proposed technique analyzes the feature space neighborhood of the query case to dynamically select an input-dependent set of known cases relevant to the query. This set is used to assess the local (query-specific) accuracy of the CAD system. The estimated local accuracy is utilized as a reliability measure of the CAD response to the query case. The underlying hypothesis of the study is that CAD decisions with higher reliability are more accurate. The above hypothesis was tested using a mammographic database of 1337 regions of interest (ROIs) with biopsy-proven ground truth (681 with masses, 656 with normal parenchyma). Three types of decision models, (i) a back-propagation neural network (BPNN), (ii) a generalized regression neural network (GRNN), and (iii) a support vector machine (SVM), were developed to detect masses based on eight morphological features automatically extracted from each ROI. The performance of all decision models was evaluated using the Receiver Operating Characteristic (ROC) analysis. The study showed that the proposed reliability measure is a strong predictor of the CAD system's case-specific accuracy. Specifically, the ROC area index for CAD predictions with high reliability was significantly better than for those with low reliability values. This result was consistent across all decision models investigated in the study. The proposed case-specific reliability analysis technique could be used to alert the CAD user when an opinion that is unlikely to be reliable is offered. The technique can be easily deployed in the clinical environment because it is applicable with a wide range of classifiers regardless of their structure and it requires neither additional training nor building multiple decision models to assess the case-specific CAD accuracy.

Habas, Piotr A.; Zurada, Jacek M.; Elmaghraby, Adel S.; Tourassi, Georgia D. [Computational Intelligence Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky 40292 (United States); Department of Computer Engineering and Computer Science, University of Louisville, Louisville, Kentucky 40292 (United States); Digital Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27705 (United States)

2007-02-15

97

Reliability analysis framework for computer-assisted medical decision systems.  

PubMed

We present a technique that enhances computer-assisted decision (CAD) systems with the ability to assess the reliability of each individual decision they make. Reliability assessment is achieved by measuring the accuracy of a CAD system with known cases similar to the one in question. The proposed technique analyzes the feature space neighborhood of the query case to dynamically select an input-dependent set of known cases relevant to the query. This set is used to assess the local (query-specific) accuracy of the CAD system. The estimated local accuracy is utilized as a reliability measure of the CAD response to the query case. The underlying hypothesis of the study is that CAD decisions with higher reliability are more accurate. The above hypothesis was tested using a mammographic database of 1337 regions of interest (ROIs) with biopsy-proven ground truth (681 with masses, 656 with normal parenchyma). Three types of decision models, (i) a back-propagation neural network (BPNN), (ii) a generalized regression neural network (GRNN), and (iii) a support vector machine (SVM), were developed to detect masses based on eight morphological features automatically extracted from each ROI. The performance of all decision models was evaluated using the Receiver Operating Characteristic (ROC) analysis. The study showed that the proposed reliability measure is a strong predictor of the CAD system's case-specific accuracy. Specifically, the ROC area index for CAD predictions with high reliability was significantly better than for those with low reliability values. This result was consistent across all decision models investigated in the study. The proposed case-specific reliability analysis technique could be used to alert the CAD user when an opinion that is unlikely to be reliable is offered. The technique can be easily deployed in the clinical environment because it is applicable with a wide range of classifiers regardless of their structure and it requires neither additional training nor building multiple decision models to assess the case-specific CAD accuracy. PMID:17388194

Habas, Piotr A; Zurada, Jacek M; Elmaghraby, Adel S; Tourassi, Georgia D

2007-02-01

98

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

99

[Looking for a more participative healthcare: sharing medical decision making].  

PubMed

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process. PMID:24448951

Bravo, Paulina; Contreras, Aixa; Perestelo-Pérez, Lilisbeth; Pérez-Ramos, Jeanette; Málaga, Germán

2013-01-01

100

Patients' perspectives in high-risk medical decision-making.  

PubMed

People faced with making risky treatment decisions in the context of life-threatening illness are typically well-informed about their disease, alternative courses of action, and the odds. But they often need help dealing with the emotional and mental challenges of making high-stakes decisions in unfamiliar areas on an accelerated timetable at a time of personal, existential threat. Reframing the situation can help such individuals transcend ingrained perspectives, freeing them from traditional ways of thinking and, in the process restoring their ability to decide, fostering the courage they so desperately need, and even instilling hope in the darkest of times. PMID:18996318

Beasley, Michael

2008-01-01

101

[Patients as partners. Tumor patients and their participation in medical decisions].  

PubMed

Between March 2002 and August 2003 as part of the research project "Patients as partners -- tumour patients and their participation in medical decisions" tumour patients undergoing palliative therapy (n=272) were interviewed and asked about their level of information, their desired place to die and whether they had prepared an advance directive. Furthermore, 72 relatives of deceased patients who had been looked after by the project's palliative care team were given a similar questionnaire including questions concerning their knowledge about disease and prognosis, the actual place of death and the relevance of advance directives. According to patients and relatives, information particularly about prognosis is unsatisfactory. Of the inter-viewed patients, 75% said they wanted to die at home and 15% in a hospital. According to their relatives, 36% of the patients looked after by the palliative care team had an advance directive. The survey of the relatives showed a significant relation between the preparation of an advance directive and dying at the desired place. According to the relatives, medical and health reasons, hope for an improvement up to the very end,acute worsening of the condition and deficits in medical care were important reasons for dying in hospital against the patient'swish. In future, advance directives should be used as an aid for communication and the planning of care. Therefore, cooperation between doctors and patients based on a partnership is necessary. The required competence in communication should be improved. PMID:15543666

van Oorschot, B; Hausmann, C; Köhler, N; Leppert, K; Schweitzer, S; Steinbach, K; Anselm, R

2004-10-01

102

Diagnostic Decision Support by Intelligent Medical Image Retrieval with Electronic Medical Record for Dementia Treatment Enhancement  

Microsoft Academic Search

In most hospitals, medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and X-ray films are stored in Picture Archiving and Communication System (PACS). However, clinicians make differential diagnosis of patients in the Electronic Medical Record (EMR) system with references to laboratory results and the medical images reports. To establish a prototype model for intelligent access of medical

Mei-Ju SU; Heng-Shuen CHEN; Chung-Yi YANG; Sao-Jie CHEN; Robert CHEN; Wen-Jeng LEE; Po-Hsun CHENG; Ping-Kung YIP; Hon-Mon LIU; Fei-Pei LAI; Daniel RACOCEANU

2007-01-01

103

Altruism and self interest in medical decision making.  

PubMed

We seem to prefer that medicine and medical care be provided through altruistic motives. Even the pharmaceutical industry justifies its behavior in terms of altruistic purposes. But economists have known since Adam Smith that self-interested behavior can create large and growing social benefits. This is true for medical care as well as for other goods. First, I consider specifically the case of pharmaceutical promotion, both to physicians and to consumers. I argue that such promotion is highly beneficial to patients and leads to health improvements. I consider some criticisms of promotion, and show that they are misguided. I then provide some evolutionary explanations for our erroneous beliefs about medical care. PMID:19723251

Rubin, Paul H

2009-01-01

104

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

105

Decisions about Confidentiality in Medical Student Mental Health Settings.  

ERIC Educational Resources Information Center

Examined responses of psychologists and psychiatrists in medical schools (N=59) to vignettes representing student problems. Results suggested practitioners were generally unwilling to break confidentiality in response to problems involving suicidal tendencies, sexual coercion/seduction, social transgressions, or falsifying data. Only suggestions…

Lindenthal, Jacob Jay; And Others

1984-01-01

106

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

107

Distributed decision for medical alerts using wireless sensors  

Microsoft Academic Search

In this paper we study how to detect anomalies in a distributed manner by using wireless sensor networks (WSNs). We focus on a medical context, where existing works generally provide large environments to monitor patients using sensors as simple transducers. Those devices forward sensed health parameters to a main base station. This station collects received data and may perform some

N. Dessart; Hacène Fouchal; Philippe Hunel; Harry Gros-Desormeaux; Nicolas Vidot

2009-01-01

108

A Virtual Medical Record for Guideline-Based Decision Support  

Microsoft Academic Search

A major obstacle in deploying computer-based clinical guidelines at the point of care is the variability of electronic medical records and the consequent need to adapt guideline modeling languages, guideline knowledge bases, and execution engines to idiosyncratic data models in the deployment environment. This paper reports an approach, developed jointly by researchers at Newcastle and Stanford, where guideline models are

Peter D. Johnson; Samson W. Tu; Mark A. Musen

2001-01-01

109

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.

2014-01-01

110

Providing Medical Marijuana: The Importance of Cannabis Clubs  

Microsoft Academic Search

In 1996, shortly after the San Francisco Cannabis Club was raided and (temporarily) closed by state authorities, the authors conducted an ethnographic study by interviewing selected former members to ascenain how they had benefited from the use of medical marijuana and how they had utilized the clubs. Interviews were augmented by panicipant observation techniques. Respondents reponed highly positive health benefits

Harvey W. Feldman; Jerry Mandel

1998-01-01

111

Is race medically relevant? A qualitative study of physicians' attitudes about the role of race in treatment decision-making  

PubMed Central

Background The role of patient race in medical decision-making is heavily debated. While some evidence suggests that patient race can be used by physicians to predict disease risk and determine drug therapy, other studies document bias and stereotyping by physicians based on patient race. It is critical, then, to explore physicians' attitudes regarding the medical relevance of patient race. Methods We conducted a qualitative study in the United States using ten focus groups of physicians stratified by self-identified race (black or white) and led by race-concordant moderators. Physicians were presented with a medical vignette about a patient (whose race was unknown) with Type 2 diabetes and untreated hypertension, who was also a current smoker. Participants were first asked to discuss what medical information they would need to treat the patient. Then physicians were asked to explicitly discuss the importance of race to the hypothetical patient's treatment. To identify common themes, codes, key words and physician demographics were compiled into a comprehensive table that allowed for examination of similarities and differences by physician race. Common themes were identified using the software package NVivo (QSR International, v7). Results Forty self-identified black and 50 self-identified white physicians participated in the study. All physicians - regardless of their own race - believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race. Several black physicians indicated that patient race is a central factor for choosing treatment options such as aggressive therapies, patient medication and understanding disease risk. Moreover, many black physicians considered patient race important to understand the patient's views, such as alternative medicine preferences and cultural beliefs about illness. However, few white physicians explicitly indicated that the patient's race was important over-and-above medical history. Instead, white physicians reported that the patient should be treated aggressively regardless of race. Conclusions This investigation adds to our understanding about how physicians in the United States consider race when treating patients, and sheds light on issues physicians face when deciding the importance of race in medical decision-making.

2011-01-01

112

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.

Coz, Pierre Le; Tassy, Sebastien

2007-01-01

113

The importance of physics to progress in medical treatment.  

PubMed

Physics in therapy is as diverse as it is substantial. In this review, we highlight the role of physics--occasionally transitioning into engineering--through discussion of several established and emerging treatments. We specifically address minimal access surgery, ultrasound, photonics, and interventional MRI, identifying areas in which complementarity is being exploited. We also discuss some of the fundamental physical principles involved in the application of each treatment to medical practice. PMID:22516559

Melzer, Andreas; Cochran, Sandy; Prentice, Paul; MacDonald, Michael P; Wang, Zhigang; Cuschieri, Alfred

2012-04-21

114

Field trials of medical decision-aids: potential problems and solutions.  

PubMed Central

Only clinical trials can assess the impact of prototype medical decision-aids, but they are seldom performed before dissemination. Many problems are encountered when designing such studies, including ensuring generality, deciding what to measure, feasible study designs, correcting for biases caused by the trial itself and by the decision-aid, resolving the "Evaluation Paradox", and potential legal and ethical doubts. These are discussed in this paper.

Wyatt, J.; Spiegelhalter, D.

1991-01-01

115

Analysis of power in medical decision-making: an argument for physician autonomy.  

PubMed

Two of the patient's rights in a Uniform Act for the Terminally Ill should be a) the right to be treated if there is reasonable doubt of the patient's wishes until it becomes clear that the treatment is not beneficial and that the patient is indeed terminally ill, and b) the right not to be subjected to treatment with no medical benefit. A physician with appropriate supporting independent opinions would be the logical individual to whom the responsibility of protecting those rights should be given. This is particularly true when the patient is incapable of his or her own medical decisions and has left no instructions regarding his or her personal goals in medical care in the event of severe illness. Two cases and an analysis of power in medical decision-making illustrate these points. PMID:11651553

Koch, Kathryn A; Meyers, Bruce W; Sandroni, Stephen

1992-01-01

116

Advance directives and other medical decisions concerning the end of life in cancer patients in Japan.  

PubMed

The purpose of our survey was to investigate the experience of physicians regarding advance directives and other medical decisions concerning the end of life. A postal questionnaire was sent to 500 Japanese physicians who were most involved in medical care of terminal patients. A total of 339 (68%) physicians responded. In dealing with terminal patients, approximately half gave priority to their patients' wishes for medical care, if known, regardless of the patient's competency. Of the respondents, 149 had been presented with advance directives by their patients and 35% followed all advance directives presented in their practice. Cardiopulmonary resuscitation (CPR) for arrested patients to enable their family to be at the bedside at the time of the death was common. More than 60% of the respondents thought that active euthanasia and assisted suicide were never ethically justified. Our study indicates that the wishes of patients are currently not always given top priority in medical decisions concerning the end of life. PMID:9893632

Asai, A; Miura, Y; Tanabe, N; Kurihara, M; Fukuhara, S

1998-09-01

117

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

118

Demographic, medical and treatment characteristics associated with couples' decisions to donate fresh spare embryos for research  

Microsoft Academic Search

BACKGROUND: Isolation of human embryonic stem cell lines has opened a promising and pioneering area of basic and applied medical research. The issues in relation to a couple' decision in donating their supernumerary embryos for research need to be investigated further. METHODS: We carried out a prospective study of 300 couples who underwent IVF\\/ICSI treatment cycles in our unit. We

M. Choudhary; E. Haimes; M. Herbert; M. Stojkovic; A. P. Murdoch

2004-01-01

119

Power of heterogeneous computing as a vehicle for implementing E 3 medical decision support systems  

Microsoft Academic Search

A computer system of PCs, workstations, minicomputers etc. connected together via a local area network or wide area network represents a large pool of computational power. Our aim is to use this power for the implementation of an E3 (efficiency, effectiveness, efficacy) medical decision support system, which can be based on different models, the best providing an explanation together with

Vili Podgorelec; Janez Brest; Peter Kokol

2000-01-01

120

Career Preferences and Decision-Making Habits of First-Year Medical Students.  

ERIC Educational Resources Information Center

Theories of decision-making were used to study the differences between first-year medical students in North Carolina who preferred family medicine and those who preferred other specialities. Students who preferred family medicine were more interested in using medicine as a tool to help people. (Author/MLW)

Nieman, Linda Z.; And Others

1986-01-01

121

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

122

Cognitive functioning as a contraindication to organ transplant surgery: Dilemmas encountered in medical decision making  

Microsoft Academic Search

A case is presented to illustrate some of the difficulties encountered when providing psychological consultation to evaluate the readiness of patients for pediatric heart-lung transplantation. The outcome of complex medical decision making can often hinge on information provided by the psychological consultant who is attempting to simultaneously serve the needs of the patient as well as the transplant team. Ethical

Teresa L. Collins; E. Wayne Holden; Janet N. Scheel

1996-01-01

123

Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making  

ERIC Educational Resources Information Center

Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient-proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult's preferences for…

Schmid, Bettina; Allen, Rebecca S.; Haley, Philip P.; DeCoster, Jamie

2010-01-01

124

Micromanaging Death: Process Preferences, Values, and Goals in End-of-Life Medical Decision Making  

Microsoft Academic Search

Purpose: This study examined patients' and surro- gates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement pro- ject, a longitudinal study designed to investigate psychological assumptions underlying

Nikki Ayers Hawkins; Peter H. Ditto; Joseph H. Danks; William D. Smucker

2005-01-01

125

Micromanaging Death: Process Preferences, Values, and Goals in End-of-Life Medical Decision Making  

ERIC Educational Resources Information Center

Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a…

Hawkins, Nikki Ayers; Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.

2005-01-01

126

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

127

A modular framework for clinical decision support systems: medical device plug-and-play is critical  

Microsoft Academic Search

This paper describes the design and initial implementation of a modular framework for Clinical Decision Support Systems and highlights the need for medical device plug-and-play standards. The software handles the tasks of data acquisition and validation, visualization, and treatment management in order to enable the development of protocol guideline modules as \\

M. Williams; F. Wu; P. Kazanzides; K. Brady; J. Fackler

2009-01-01

128

A decision support system to deal with the medical isotopes crisis  

Microsoft Academic Search

The complexity of emerging issues in science, technology, and medicine calls for new strategies to deal with risk and uncertainty. This paper explores the production of medical isotopes in Canada as an illustration of complex issues requiring decision support. It proposes a four-feature strategy for policy makers. Tightly but inversely connected, risks generated by either the production or non-production of

Marie Lavoie

2010-01-01

129

Capacity to make medical treatment decisions in multiple sclerosis: A potentially remediable deficit  

Microsoft Academic Search

Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a

Michael R. Basso; Philip J. Candilis; Jay Johnson; Courtney Ghormley; Dennis R. Combs; Taeh Ward

2010-01-01

130

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.

Calisher, C H

1994-01-01

131

Patient participation in the medical decision-making process in haemato-oncology--a qualitative study.  

PubMed

Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship. PMID:23731258

Ernst, J; Berger, S; Weißflog, G; Schröder, C; Körner, A; Niederwieser, D; Brähler, E; Singer, S

2013-09-01

132

Role Perceptions of Freshman and Senior Nursing and Medical Students and Attitudes toward Collaborative Decision Making.  

ERIC Educational Resources Information Center

Nursing (n=109) and medical (n=108) students from a large Canadian research university were surveyed to determine differences between first- and fourth-year students' perceptions of necessary competencies. Nursing students' perceptions of competencies important for medicine were more congruent than medical students' perceptions of those important

Laschinger, Heather K. Spence; Weston, Wayne

1995-01-01

133

Computerized clinical decision support for medication prescribing and utilization in pediatrics  

PubMed Central

Background and objective Accurate and informed prescribing is essential to ensure the safe and effective use of medications in pediatric patients. Computerized clinical decision support (CCDS) functionalities have been embedded into computerized physician order entry systems with the aim of ensuring accurate and informed medication prescribing. Owing to a lack of comprehensive analysis of the existing literature, this review was undertaken to analyze the effect of CCDS implementation on medication prescribing and use in pediatrics. Materials and methods A literature search was performed using keywords in PubMed to identify research studies with outcomes related to the implementation of medication-related CCDS functionalities. Results and discussion Various CCDS functionalities have been implemented in pediatric patients leading to different results. Medication dosing calculators have decreased calculation errors. Alert-based CCDS functionalities, such as duplicate therapy and medication allergy checking, may generate excessive alerts. Medication interaction CCDS has been minimally studied in pediatrics. Medication dosing support has decreased adverse drug events, but has also been associated with high override rates. Use of medication order sets have improved guideline adherence. Guideline-based treatment recommendations generated by CCDS functionalities have had variable influence on appropriate medication use, with few studies available demonstrating improved patient outcomes due to CCDS use. Conclusion Although certain medication-related CCDS functionalities have shown benefit in medication prescribing for pediatric patients, others have resulted in high override rates and inconsistent or unknown impact on patient care. Further studies analyzing the effect of individual CCDS functionalities on safe and effective prescribing and medication use are required.

Stultz, Jeremy S

2012-01-01

134

The Importance of Wine Bottle Closures in Retail Purchase Decisions of Consumers  

Microsoft Academic Search

This study examines the importance of different wine bottle closures, such as natural cork, synthetic cork, and screw tops, in the retail purchase decision of wine by millennials and baby boomers. By segmenting consumers in this manner, it is possible to better understand their preferences and aid wine producers and retailers in directing their marketing and advertising efforts. The results

Nelson Barber; D. Christopher Taylor; Tim Dodd

2009-01-01

135

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

136

The Medication Recommendation Tracking Form: a novel tool for tracking changes in prescribed medication, clinical decision making, and use in comparative effectiveness research.  

PubMed

This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745). PMID:23911057

Reilly-Harrington, Noreen A; Sylvia, Louisa G; Leon, Andrew C; Shesler, Leah W; Ketter, Terence A; Bowden, Charles L; Calabrese, Joseph R; Friedman, Edward S; Ostacher, Michael J; Iosifescu, Dan V; Rabideau, Dustin J; Thase, Michael E; Nierenberg, Andrew A

2013-11-01

137

Clinical psychophysics: Applications of ratio scaling and signal detection methods to research on pain, fear, drugs, and medical decision making  

Microsoft Academic Search

Recent developments in psychophysics termed statistical decision theory (or signal detection theory; SDT) and magnitude estimation (ME) are being applied to an increasing variety of previously recalcitrant problems in clinical psychology and medical decision making. The SDT method separates human decision making into a discrimination accuracy measure and a criterion or bias measure. This characteristic is helpful in analyzing confusing

John M. Grossberg; Bridget F. Grant

1978-01-01

138

Perceptions of Japanese patients and their family about medical treatment decisions.  

PubMed

Internationally, nurses and physicians are increasingly expected to undertake roles in communication and patient advocacy, including in Japan, where the reigning principle underlying medical ethics is in transition from paternalism to respect for patient autonomy. The study reports the results of a survey in two Japanese teaching hospitals that clarified the perspectives of 128 patients and 41 family members regarding their current and desired involvement in health decision-making. The commonest process that was desired by patients and their family was for patients to make decisions after consultation with both the physician and their family. The decision-making preferences for competent patients varied among the participants, who believed that families have a crucial role to play in health-care decision-making, even when patients are competent to make their own decisions. The findings will inform health professionals about contemporary Japanese health-care decision-making and the ethical issues involved in this process, as well as assist the future development of a culturally relevant model to support patients' preferences for ethical decision-making. PMID:20727082

Ito, Misae; Tanida, Noritoshi; Turale, Sue

2010-09-01

139

Feminist ethics and menopause: autonomy and decision-making in primary medical care.  

PubMed

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part. PMID:12639581

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

140

Context-Aware Mobile Medical Emergency Management Decision Support System for Safe Transportation  

Microsoft Academic Search

\\u000a Management of safe and successful large-scale events requires detailed careful planning and complex system-wide decision making.\\u000a However, research into medical emergency knowledge management for just-in-time decision support in mass gatherings lags behind\\u000a the needs of the community. Unforeseen circumstances, dynamic changes in the environment, various unexpected impact factors\\u000a require immediate, real-time response that can be achieved mainly through context-aware, intelligent

Frada Burstein; Pari Delir Haghighi; Arkady Zaslavsky

141

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.

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

2011-01-01

142

The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study  

PubMed Central

Background The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Methods Data were collected in a longitudinal two-wave study (n?=?2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. Results In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist). Conclusions We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. The association between work characteristics and later medical care-seeking differed between health care providers and between men and women. If we aim at reducing health care costs for workers by preventing unnecessary or inefficient care, it is important to reduce the number of workers that report that health complaints impede their work performance. The supervisor could provide more social support, closely monitor workload in combination with work pressure and decision latitude, and when possible help to adjust working conditions. Health care providers could reduce medical costs by taking the work relatedness of health complaints into account and act accordingly, by decreasing the time to referral and waiting lists, and by providing appropriate care and avoiding unnecessary or harmful care.

2012-01-01

143

Effective follow-up consultations: the importance of patient-centered communication and shared decision making.  

PubMed

Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice. PMID:23434177

Brand, Paul L P; Stiggelbout, Anne M

2013-12-01

144

Older Adults' Preferences for Independent or Delegated End-of-Life Medical Decision-Making  

PubMed Central

Objectives This study assesses the proportions of participants who prefer independent or delegated medical decision-making at end-of-life, and examines the relationships of personal beliefs, affiliative beliefs, and end-of-life planning behaviors to decision-making preference. Methods Data are drawn from the Wisconsin Longitudinal Study, a sample of nearly 4,500 healthy white Midwestern high school graduates in their mid-60s. Results Four-fifths of participants wanted to make decisions independently. Valuing independence, being less avoidant of thoughts of death, and valuing quality of life over length of life had strong associations with a preference for independent decision-making. Those concerned about burdening a caregiver wanted to make independent decisions. Persons who both executed a living will and appointed a durable power of attorney for health care preferred independent decision-making. Discussion Older adults cite personal and affiliative beliefs, not lack of autonomy, as reasons for their choice to decide independently or delegate.

Moorman, Sara M.

2011-01-01

145

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

PubMed Central

We examined male partners’ influence on the decision to seek medical help for infertility using from the National Survey 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 found an association between couple-level attitudes and medical help-seeking even when other predisposing and enabling conditions existed. Overall, the findings highlight that both partners contribute to the infertility help-seeking process, and that different factors may play a role in different stages of help-seeking. Studies of infertility help-seeking need to be more inclusive of the context that these decisions are embedded within to better understand service use.

Johnson, Katherine M.; Johnson, David R.

2009-01-01

146

Extracting Qualitative Knowledge from Medical Guidelines for Clinical Decision-Support Systems  

Microsoft Academic Search

\\u000a Medical guidelines provide knowledge about processes that is not directly suitable for building clinical decision-support\\u000a systems. We discuss a two-step approach where knowledge from a guideline on COPD is translated into temporal logic, and augmented\\u000a with physiological background knowledge. This allows capturing the dynamics of the processes using qualitative knowledge,\\u000a while maintaining the temporal nature of the processes. As a

Maarten van der Heijden; Peter J. F. Lucas

2009-01-01

147

Factors affecting clinicians' decision as to whether to prescribe psychotropic medications or not in treatment of tic disorders.  

PubMed

Using clinical data, a retrospective investigation was carried out to elucidate factors and/or symptom severity affecting the clinicians' decision-making as to whether or not psychotropic medications should be prescribed for tic disorders. For this purpose, medical records on a total of 75 patients with tic disorders were collected and scrutinized. Of the total, 36 patients were found to have been given psychotropics on their first visit to our facility. With respect to the total scores of motor tics on the YGTSS, vocal tics on the YGTSS, the GAF score and age, the subjects were divided into two groups one with psychotropic medications prescribed and the other without any psychotropic medication at the first examination and compared by use of t-test. With respect to comorbid neuropsychiatric disorders and the sex, the two groups were compared using Chi square test. To see which one of factors had influenced the treating clinicians' decision to use or not to use psychotropic drugs at the first examination, analyses were made using the logistic regression model with those factors assigned for covariants and the prescription or no-prescription of psychotropic medications for dependent variables. Analyses using a logistic regression model revealed that vocal tics (p<0.01) and age (p<0.05) had significant correlations with the use or non-use of psychotropic drugs. This finding suggested that the severity degree of vocal tics might play the most important role as a factor that affects the clinicians' initial treatment plan with or without psychotropic drugs. And clinicians tend to avoid a drug therapy on younger children. PMID:21288673

Kuwabara, Hitoshi; Kono, Toshiaki; Shimada, Takafumi; Kano, Yukiko

2012-01-01

148

Presentation and explanation of medical decision models using the World Wide Web.  

PubMed Central

We demonstrated the use of the World Wide Web for the presentation and explanation of a medical decision model. We put on the web a treatment model developed as part of the Cardiac Arrhythmia and Risk of Death Patient Outcomes Research Team (CARD PORT). To demonstrate the advantages of our web-based presentation, we critiqued both the conventional paper-based and the web-based formats of this decision-model presentation with reference to an accepted published guide to understanding clinical decision models. A web-based presentation provides a useful supplement to paper-based publications by allowing authors to present their model in greater detail, to link model inputs to the primary evidence, and to disseminate the model to peer investigators for critique and collaborative modeling.

Sanders, G. D.; Dembitzer, A. D.; Heidenreich, P. A.; McDonald, K. M.; Owens, D. K.

1996-01-01

149

Medical decision making for patients with Parkinson disease under Average Cost Criterion  

PubMed Central

Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels.

Goulionis, John E; Vozikis, Athanassios

2009-01-01

150

A Study on User Satisfaction regarding the Clinical Decision Support System (CDSS) for Medication  

PubMed Central

Objectives Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety. Methods The study was based on survey data from 218 users (103 doctors, 103 nurses, and 15 pharmacists) at a university hospital that uses the CDSS. In order to identify the factors influencing user satisfaction with the CDSS, a multiple linear regression was performed. In order to compare the satisfaction level among the professional groups, an analysis of variance (ANOVA) was performed. Results The reliability of information, decision supporting capability, and departmental support were significant factors in influencing user satisfaction. In addition, nurses were the most satisfied group, followed by pharmacists and doctors according to the ANOVA. Areas for further improvement in enhancing drug safety were real time information searching and decision supporting capabilities to prevent adverse drug events (ADE) in a timely manner. Conclusions We found that the CDSS users were generally satisfied with the system and that it complements the nationwide drug utilization review (DUR) system in reducing ADE. Further CDSS evaluation in other hospitals is needed to improve user satisfaction and drug safety.

Kim, Junghee; Kim, Sukil; Ho, Seung Hee; Kim, Hyong Hoi; Park, Chun Bok

2012-01-01

151

Use of a patient preference predictor to help make medical decisions for incapacitated patients.  

PubMed

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient's preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients' treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient's preferred treatment option. To address this concern, the present paper proposes to incorporate the use of a "Patient Preference Predictor" (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual's characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. PMID:24526785

Rid, Annette; Wendler, David

2014-04-01

152

Medical decision-making and information needs in end-stage renal disease patients  

Microsoft Academic Search

Health information and decision-making are increasingly important to patients with diverse illnesses. The aim of this study was to examine health information needs and decision-making in individuals with end-stage renal disease (ESRD) and to examine the influence of age and gender. A self-report survey was administered to 197 consecutive ESRD patients receiving renal replacement therapy. Their mean age was 52.8

Angela Orsino; Jill I. Cameron; Maja Seidl; David Mendelssohn; Donna E. Stewart

2003-01-01

153

Hypermedia or Hyperchaos: Using HyperCard to Teach Medical Decision Making  

PubMed Central

HyperCard presents an uncoventional instructional environment for educators and students, in that it is nonlinear, nonsequential, and it provides innumerable choices of learning paths to learners. The danger of this environment is that it may frustrate learners whose cognitive and learning styles do not match this environment. Leaners who prefer guided learning rather than independent exploration may become distracted or disoriented by this environment, lost in “hyperspace.” In the context of medical education, these ill-matched styles may produce some physicians who have not mastered skills essential to the practice of medicine. The authors have sought to develop a HyperCard learning environment consisting of related programs that teach medical decision making. The environment allows total learner control until the learner demonstrates a need for guidance in order to achieve the essential objectives of the program. A discussion follows of the implications of hypermedia for instructional design and medical education.

Smith, W.R.; Hahn, J.S.

1989-01-01

154

Arthropods of Medical Importance in Europe (Exclusive of the European U.S.S.R).  

National Technical Information Service (NTIS)

The occurrence of insects and other arthropods of medical importance in Europe (excluding the European USSR) is summarized on the basis of a compilation of almost all available references in the scientific literature. The report includes, for each major g...

B. V. Travis R. M. Labadan

1970-01-01

155

Parasarcophaga (Liopygia) ruficornis (Diptera:Sarcophagidae): a flesh fly species of medical importance.  

PubMed

Parasarcophaga (Liopygia) ruficornis is a well-known flesh fly species of medical importance, both as a myiasis-producing agent and fly seen in a forensic entomology context. This study performed a comprehensive literature review of this fly species, dealing with morphology, bionomics and medical involvement. Important characteristics used to identify P. ruficornis have been provided for both its third instar and adult for identification purpose in the future. PMID:23959482

Suwannayod, S; Sanit, S; Sukontason, K; Sukontason, K L

2013-06-01

156

Virtual medical campus: the increasing importance of E-learning in medical education  

PubMed Central

In 2002, along with the integration of a new, integrated curriculum in human medicine, the Virtual Medical Campus Graz was installed. It accompanies the whole curriculum with electronic materials tailored to the needs of the students and the forthcoming examinations. To date, more than 15,000 learning objects have been developed, and students download up to 200,000 learning objects per month. Particular emphasis is placed on Web-Based Training materials, but video and simulations are also included. In part, transfer of basic knowledge is mediated by electronic learning materials, replacing several hours of classroom attendance. Face-to-face education, in turn, is focusing increasingly on small-group clinical teaching.

Smolle, Josef

2010-01-01

157

Memory accessibility and medical decision-making for significant others: the role of socially shared retrieval-induced forgetting.  

PubMed

Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1) or irrelevant (Experiment 2) advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision. PMID:23785320

Coman, Dora; Coman, Alin; Hirst, William

2013-01-01

158

Towards case-based medical learning in radiological decision making using content-based image retrieval  

PubMed Central

Background Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education. Methods We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment. Results We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system. Conclusions The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer.

2011-01-01

159

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

160

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.

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

2012-01-01

161

Cockroaches (Blattella germanica) as carriers of microorganisms of medical importance in hospitals.  

PubMed

A study was conducted to isolate and identify microorganisms of medical importance from cockroaches (Blattella germanica) and to ascertain their vector potential in the epidemiology of nosocomial infections. Bacteria, fungi and parasites of medical importance were isolated and identified. Important bacterial pathogens responsible for wound infections, were further studies by antibiograms. One hundred and fifty-eight out of 159 (99.4%) cockroaches collected from hospital (test) and 113 out of 120 (94.2%) cockroaches collected from residential areas (control) were carrying medically important microorganisms (P less than 0.05). significantly higher (P less than 0.001) number of test cockroaches were carrying a higher bacterial load (1 x 10(4) and 1 x 10(5] as compared to control cockroaches. Multiple drug-resistant bacterial were isolated from test cockroaches. The diversity of drug-resistant bacterial species isolated from test cockroaches suggests their involvement in the transmission of drug-resistant bacteria. Various fungi and parasitic cysts of medical importance were also isolated from the test and control cockroaches, but the carriage rates were low. The findings suggest that cockroaches, in hospitals, can act as potential vectors of medically important bacteria/parasites/fungi. PMID:1879483

Fotedar, R; Shriniwas, U B; Verma, A

1991-08-01

162

Factors that influence the decision to pursue an internship: the importance of mentoring.  

PubMed

The purpose of the present study was (1) to determine if students from one veterinary school who participated in a mentoring/employment program with clinical faculty were more likely to pursue internship training than their peers and (2) to determine factors via survey that were influential to veterinary interns in making their decision to pursue post-graduate clinical training. Our hypothesis was that a mentoring relationship with clinical faculty was an important influence on the decision to participate in an internship. From 2006 to 2010, graduating students who participated in a mentoring/employment program with a clinical faculty member were 6.3 times more likely than non-participating students to pursue an internship. The majority of the participating students (90%) were initially hired/mentored as first- or second-year veterinary students. In the survey, interns ranked clinical faculty as having a greater influence than basic science faculty, private practice veterinarians, or house officers on their decision to pursue an internship; 82.8% reported that clinical faculty were most responsible for encouraging them to apply for an internship. Employment by their veterinary teaching hospital (41.5%) or directly by clinical faculty (26.2%) was commonly reported. Most interns (37%) decided to pursue an internship during their fourth year of veterinary school, 29.2% decided during their first year, and 15.3% decided in their second year. These results suggest that clinical faculty play a key role in a student's decision to pursue an internship and that it might be valuable to inform students about internships early in the veterinary curriculum. PMID:22023980

Barbur, Laura; Shuman, Cindy; Sanderson, Michael W; Grauer, Gregory F

2011-01-01

163

Use of amplified fragment length polymorphism analysis to identify medically important Candida spp., including C. dubliniensis.  

PubMed

Non-Candida albicans Candida species are increasingly being isolated. These species show differences in levels of resistance to antimycotic agents and mortality. Therefore, it is important to be able to correctly identify the causative organism to the species level. Identification of C. dubliniensis in particular remains problematic due to the high degree of phenotypic similarity between this species and C. albicans. The use of amplified fragment length polymorphism (AFLP) analysis as an identification method for medically important Candida species was investigated. Our results show very clear differences among medically important Candida species. Furthermore, when screening a large collection of clinical isolates previously identified on CHROMagar as C. albicans, we found a misidentification rate of 6%. AFLP analysis is universally applicable, and the patterns can easily be stored in a general, accessible database. Therefore, AFLP might prove to be a reliable method for the identification of medically important Candida species. PMID:12682114

Borst, A; Theelen, B; Reinders, E; Boekhout, T; Fluit, A C; Savelkoul, P H M

2003-04-01

164

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.

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

2014-01-01

165

Capacity to Make Medical Treatment Decisions in Multiple Sclerosis: A Potentially Remediable Deficit  

PubMed Central

Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a core component of decisional capacity, in 36 people with MS and 16 normal controls. MS patients with diminished neuropsychological function showed poor understanding of treatment disclosures compared to the control group, and diminished new-learning and executive function correlated with poorer understanding. Nonetheless, with sufficient cueing, the MS patients with diminished neuropsychological function were able to display understanding that was equivalent to the control group. Implications of these results for clinical practice and medical research involving people with MS are discussed.

Basso, Michael R.; Candilis, Philip J.; Johnson, Jay; Ghormley, Courtney; Combs, Dennis R.; Ward, Taeh

2010-01-01

166

Coupling clinical decision support system with computerized prescriber order entry and their dynamic plugging in the medical workflow system  

Microsoft Academic Search

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 multiagent

Lotfi Bouzguenda; Manel Turki

2012-01-01

167

Cesarean section without clinical indication versus vaginal delivery as a paradigmatic model in the discourse of medical setting decisions.  

PubMed

Natural childbirth has ceased to be considered the gold standard in the delivery room. For this reason cesarean section on demand is increasing. Many obstetricians justify this phenomenon on evidence-based obstetrical practice. However, other pieces of evidence demonstrate that the data are often a product of the social milieu, and as stated by Wendland, "technology magically wards off the unpredictability and danger of birth". In a recent paper, Kalish pointed out several problems with cesarean deliveries in the absence of medical indications regarding issues of good clinical practice, autonomy, and informed consent. From the late 1990s, the medical community began to speak in favor of women's autonomy in childbirth decisions thus supporting the maternal choice and request for a cesarean section. Starting from these new considerations, it is of primary importance to understand whether emphasizing patient's autonomy is the best, or the only, way to helping the medical decisional process. This general approach may be helpful in all the other cases in which patient's autonomy and physician's responsibility appear to be intertwined in an apparent conflicting manner. We fear that the rhetoric of autonomous choice represents a fundamental shift from medicine-based beneficence toward a perilous relationship founded mainly on patient's wishes, representing a dangerous slippery slope where the physician could be reduced to the role of a functionary delegated to execute patient's claims and demands. PMID:21158491

Demontis, Roberto; Pisu, Salvatore; Pintor, Michela; D'aloja, Ernesto

2011-12-01

168

Attitudes towards corporate social responsibility and perceived importance of social responsibility information characteristics in a decision context  

Microsoft Academic Search

This study addressed the questions of perceived importance of social responsibility information (SRI) characteristics in a decision context, as well as the attitudes of institutional investors toward social responsibility involvement. The results showed that SRI presently disclosed in company annual reports did not have any significant impact on institutional investors' decisions. However, if SRI were presented in quantified, financial form,

Hai Yap Teoh; Godwin Y Shiu

1990-01-01

169

Measurement Invariance in Careers Research: Using IRT to Study Gender Differences in Medical Students' Specialization Decisions  

ERIC Educational Resources Information Center

The current study demonstrates the use of item response theory (IRT) to conduct measurement invariance analyses in careers research. A self-report survey was used to assess the importance 1,363 fourth-year medical students placed on opportunities to provide comprehensive patient care when choosing a career specialty. IRT analyses supported…

Behrend, Tara S.; Thompson, Lori Foster; Meade, Adam W.; Newton, Dale A.; Grayson, Martha S.

2008-01-01

170

Decisive factors in medical tourism destination choice: A case study of Isfahan, Iran and fertility treatments  

Microsoft Academic Search

The birth of the first in vitro fertilized baby, followed by further advances in the field of assisted reproductive technology (ART) has made this technology one of the most attractive tourism innovations among the different categories of medical tourism. In addition, factors such as legal, moral, religious and ethical issues play important roles in choosing reproductive tourism destinations. The aim

Farhad Moghimehfar; Mohammad Hossein Nasr-Esfahani

2011-01-01

171

Medical decision-making around the time of death of cognitively impaired nursing home residents: a pilot study.  

PubMed

The purpose of this article is to describe the end-of-life process in the nursing home for three groups of cognitively-impaired nursing home residents: those who died with a medical decision-making process prior to death; those who died without such a decision-making process; and those who had a status-change event and a medical decision-making process, and did not die prior to data collection. Residents had experienced a medical status-change event within the 24 hours prior to data collection, and were unable to make their own decisions due to cognitive impairment. Data on the decision-making process during the event, including the type of event, the considerations used in making the decisions, and who was involved in making these decisions were collected from the residents' charts and through interviews with their physicians or nurse practitioners. When there was no decision-making process immediately prior to death, a decision-making process was usually reported to have occurred previously, with most decisions calling either for comfort care or limitation of care. When comparing those events leading to death with other status-change events, those who died were more likely to have suffered from troubled breathing than those who remained alive. Hospitalization was used only among those who survived, whereas diagnostic tests and comfort care were used more often with those who died. Those who died had more treatments considered and chosen than did those who remained alive. For half of those who died, physicians felt that they would have preferred less treatment for themselves if they were in the place of the decedents. The results represent preliminary data concerning decision-making processes surrounding death of the cognitively-impaired in the nursing home. Additional research is needed to elucidate the trends uncovered in this study. PMID:15688544

Cohen-Mansfield, Jiska; Lipson, Steven

172

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

173

Arthrodpods of Medical Importance in Africa. Part II. Data on Arthropods Other Than Mosquitoes.  

National Technical Information Service (NTIS)

The occurrence of insects and other arthropods of medical importance in Africa is summarized on the basis of a compilation of all available references in the scientific literature. The report includes, for each major group of arthropods, a listing of spec...

B. V. Travis C. E. Mendoza R. M. Labadan

1967-01-01

174

Arthropods of Medical Importance in Africa. Part I. Introductory and Explanatory Material Data on Mosquitoes.  

National Technical Information Service (NTIS)

The occurrence of insects and other arthropods of medical importance in Africa is summarized on the basis of a compilation of all available references in the scientific literature. The report includes, for each major group of arthropods, a listing of spec...

B. V. Travis C. E. Mendoza R. M. Labadan

1967-01-01

175

Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study  

PubMed Central

Background Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. Methods We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. Results The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. Conclusions These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.

2011-01-01

176

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

177

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.

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

178

Processing single-use medical devices for use in surgery - importance, status quo and potential.  

PubMed

In summary, it is possible with the technology and scientific knowledge currently available to allow products intended for single use to be reprocessed using validated and certified processing procedures, while maintaining the full function and without any loss in quality. How many times a product can be re-processed must be determined separately for each individual medical technology device; it is not possible to make any kind of blanket statement as to the permissible number of cycles. This is due to the differing construction, the various combinations of materials and the diverse demands made of each device during clinical use. The exigency of the reprocessing issue is evident both to the user and the primary manufacturer. For the user, where there is a correspondingly high-quality primary product with suitably costed, technically-sound and certified reprocessing procedures, repeat usage can mean real savings while maintaining full functionality in each use. For the primary manufacturers of highly specialised instruments, only part of which can be represented by the medical facility in terms of a corresponding DRG (Diagnosis-Related Group), it is reprocessing that opens the door to widespread routine clinical use. The patient, in turn, benefits greatly from this, since his demand for medical treatment using the most up-to-date technology is taken into account. If processing complies in full with medical technology and hygiene directives, from the medical point of view (without being able to definitively evaluate each individual case using this criterion) the specific advantages of the reprocessing procedure are obvious. In order to establish broad acceptance for the purposes of good marketing, corresponding controlling and quality instruments have to be developed to allow the decision-making process regarding the permissibility of the reprocessing of a certain device and the number of times it can be reprocessed using this procedure to be made transparent.Taking this a step further, possibilities arise for the establishment of corresponding quality-assurance instruments on the part of the clinical establishments involved, within which reprocessed products, in the interest of quality assurance, can be referred back to the processor in the event of defective function and can also be removed from clinical use prior to completing the intended number of processing cycles. Furthermore, it can be assumed that the widespread use of reprocessing procedures in today's high-cost single-use medical device sector will have a long-term cost/price-regulating effect for the primary products, to the benefit of the users. Thus, the heated debate regarding the safety of processing procedures that have already been certified and validated in accordance with current industry standards should be evaluated in particular from the point of view of the justified fears of the leading manufacturers with regard to their currently established market share. From a purely surgical point of view, the reprocessing of disposable products should be welcomed as a revolution. The main criteria for surgeons and medics should always be the benefit for the patient. If the quality is ensured through corresponding processing and validation procedures based on recognised certificates, then economic arguments take precedence. Cases in which a DRG (and thus a payment calculation) does not fully cover the use of medical devices are conceivable. Withholding medically necessary services on grounds of the costs, or making these services available to a limited extent only, is not acceptable from the medical point of view and furthermore goes beyond what is ethically acceptable. Each procedure, even the systematic use of reprocessing of suitable medical technology disposable items, should, where the quality is guaranteed, be supported unequivocally. Taken a step further, this branch of the economy will have a long-lasting price-regulating effect on the primary producers market. PMID:20204093

Krüger, Colin M

2008-01-01

179

[Palliative chemotherapy and CUP-syndrome: medical intentions versus patients' attitudes in decision making].  

PubMed

The following case report is about a 55 year old male patient with CUP-syndrome. After developing a malignant bowel obstruction he received five cycles of a palliative chemotherapy with oxaliplatin and irinotecan. The focus is on medical intentions and goals concerning palliative chemotherapy and on discussing patients' attitudes towards chemotherapy. Communication is identified as fundamental skill in shared decision making. On the one hand it improves Patients' satisfaction and palliative care and on the other hand it reduces psychological and existential suffering. In tumors of unknown primary site regimens with different combinations of Platin, Taxol, Etoposide, Irinotecan and Gemcitabine showed responses up to 46% and a survival benefit with an overall median survival up to 12 months and even long term survival. PMID:16830247

Iglseder, Stephan

2006-05-01

180

Biomass Burning Emissions - The Importance of Reducing Uncertainties for Improved Regulatory Decisions; an EPA Perspective (Invited)  

NASA Astrophysics Data System (ADS)

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 Regional Haze, Interstate Transport and Conformity. In most instances the EPA’s National Emissions Inventory (NEI), which is developed in conjunction with other federal, state, local, and tribal agencies is a cornerstone used to support air quality decision making. Over the past several years estimated wildland and prescribed fire emissions in the NEI have evolved from a crude, state-based, climatology to fire-specific, daily-resolved estimates primarily through the use of satellite measurements. In addition to research within EPA, external research partners are providing improved knowledge in areas such as chemical composition of smoke, plume rise measurements via satellites, and the development of improved emission algorithms. Accurate inputs to characterize and model the daily and hourly biomass burning emissions across the US are necessary to reduce the uncertainty in characterizing the emissions, transport, and transformation of gases and particles from their source, with the end goal of categorizing biomass burning emissions within the EPA’s regulatory structure. Reducing the uncertainty will lead to improved decision making as this information is used to support the development and implementation of EPA’s air regulatory programs. This is especially true under the National Ambient Air Quality Standards (NAAQS) where averaging times for particulate matter (PM), ozone, and the new proposed NO2 standard are at 24 hours or less, where accurate resolution of fire emissions is critical in understanding receptor impacts. This talk will highlight the impacts of wildland and prescribed fires within EPA’s regulatory program and importance of continued research to reduce the uncertainly in the areas of chemical speciation, emission factors, plume rise, fuel loading, and fire behavior modeling. Disclaimer: Although this work was reviewed by the U.S. Environmental Protection Agency and approved for publication, it may not necessarily reflect official Agency policy.

Szykman, J. J.; Kordzi, J.; Pouliot, G.; Pierce, T. E.; Pace, T.; Rao, T.

2009-12-01

181

Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support  

PubMed Central

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3) evaluating the ability of an electronic medical record/electronic health record (EMR/EHR) to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age <18 THEN patient is a child), sufficient clinical data exists in University of Washington’s EMR systems to support 50% of PGx knowledge contained in drug labels that could be expressed as rules.

2010-01-01

182

Safety-cost trade-offs in medical device reuse: a Markov decision process model.  

PubMed

Healthcare expenditures in the US are approaching 2 trillion dollars, and hospitals and other healthcare providers are under tremendous pressure to rein in costs. One cost-saving approach which is gaining popularity is the reuse of medical devices which were designed only for a single use. Device makers decry this practice as unsanitary and unsafe, but a growing number of third-party firms are willing to sterilize, refurbish, and/or remanufacture devices and resell them to hospitals at a fraction of the original price. Is this practice safe? Is reliance on single-use devices sustainable? A Markov decision process (MDP) model is formulated to study the trade-offs involved in these decisions. Several key parameters are examined: device costs, device failure probabilities, and failure penalty cost. For each of these parameters, expressions are developed which identify the indifference point between using new and reprocessed devices. The results can be used to inform the debate on the economic, ethical, legal, and environmental dimensions of this complex issue. PMID:17323656

Sloan, Thomas W

2007-02-01

183

Physician assessments of medication adherence and decisions to intensify medications for patients with uncontrolled blood pressure: still no better than a coin toss  

PubMed Central

Background Many patients have uncontrolled blood pressure (BP) because they are not taking medications as prescribed. Providers may have difficulty accurately assessing adherence. Providers need to assess medication adherence to decide whether to address uncontrolled BP by improving adherence to the current prescribed regimen or by intensifying the BP treatment regimen by increasing doses or adding more medications. Methods We examined how provider assessments of adherence with antihypertensive medications compared with refill records, and how providers’ assessments were associated with decisions to intensify medications for uncontrolled BP. We studied a cross-sectional cohort of 1169 veterans with diabetes presenting with BP ?140/90 to 92 primary care providers at 9 Veterans Affairs (VA) facilities from February 2005 to March 2006. Using VA pharmacy records, we utilized a continuous multiple-interval measure of medication gaps (CMG) to assess the proportion of time in prior year that patient did not possess the prescribed medications; CMG ?20% is considered clinically significant non-adherence. Providers answered post-visit Likert-scale questions regarding their assessment of patient adherence to BP medications. The BP regimen was considered intensified if medication was added or increased without stopping or decreasing another medication. Results 1064 patients were receiving antihypertensive medication regularly from the VA; the mean CMG was 11.3%. Adherence assessments by providers correlated poorly with refill history. 211 (20%) patients did not have BP medication available for???20% of days; providers characterized 79 (37%) of these 211 patients as having significant non-adherence, and intensified medications for 97 (46%). Providers intensified BP medications for 451 (42%) patients, similarly whether assessed by provider as having significant non-adherence (44%) or not (43%). Conclusions Providers recognized non-adherence for less than half of patients whose pharmacy records indicated significant refill gaps, and often intensified BP medications even when suspected serious non-adherence. Making an objective measure of adherence such as the CMG available during visits may help providers recognize non-adherence to inform prescribing decisions.

2012-01-01

184

Relatedness of medically important strains of Saccharomyces cerevisiae as revealed by phylogenetics and metabolomics.  

PubMed

Ten medically important Saccharomyces strains, comprising six clinical isolates of Saccharomyces cerevisiae and four probiotic strains of Saccharomyces boulardii, were characterized at the genetic and metabolic level and compared with non-medical, commercial yeast strains used in baking and wine-making. Strains were compared by genetic fingerprinting using amplified fragment length polymorphism (AFLP) analysis, by ribosomal DNA ITS1 sequencing and by metabolic footprinting using both direct injection mass spectrometry (DIMS) and gas chromatography-time of flight-mass spectrometry (GC-ToF-MS). Overall, the clinical isolates fell into different groupings when compared with the non-medical strains, with good but not perfect correlation amongst strains at both the genetic and metabolic levels. Probiotic strains of S. boulardii that are used therapeutically to treat human gastro-intestinal tract disorders showed tight clustering both genetically and metabolically. Metabolomics was found to be of value both as a taxonomic tool and as a means to investigate anomalous links between genotype and phenotype. Key discriminatory metabolites were identified when comparing the three main groups of clinical, probiotic and non-medical strains and included molecules such as trehalose, myo-inositol, lactic acid, fumaric acid and glycerol 3-phosphate. This study confirmed the link between a subset of clinical isolates and baking or probiotic strains but also highlighted that in general the clinical strains were more diverse at both the genomic and metabolic levels. PMID:18615862

MacKenzie, Donald A; Defernez, Marianne; Dunn, Warwick B; Brown, Marie; Fuller, Linda J; de Herrera, Santiago R M Seco; Günther, Andreas; James, Steve A; Eagles, John; Philo, Mark; Goodacre, Royston; Roberts, Ian N

2008-07-01

185

Medication related computerized decision support system (CDSS): make it a clinicians' partner!  

PubMed

Medication related Computerized Decision Support System (CDSS) are known to have a positive impact on Adverse Drug Events (ADE) prevention but they face acceptance problems due to over alerting and usability issues. We present here a Human factors approach to the design of these Clinical Decision Support (CDS) functions and to their integration into different Electronic Health Record (EHR) / Computerized Physicians Order Entry (CPOE) systems, so that the resulting CDSS corresponds to the users needs and fits clinical workflows and cognitive processes. We used ethnographic observations completed with semi-structured interviews to analyse existing work situations and work processes. These were then described in detail using the SHEL (Software, Hardware, Environment & Liveware) formalism, which enables a structured description of the work system and provides an appropriate classification of human errors potentially leading to ADEs. We then propose a Unified Modelling Language (UML) model supporting the characterization by the CDSS of the drug monitoring and clinical context of patients at risk of ADE. This model combines the status of the lab test orders on the one hand with the validity and normality of the lab results on the other hand. This makes the system able to catch the context of the monitoring of the drugs through their corresponding lab tests and lab results (e.g. kalemia for potassium) and also part of the context of the clinical status of the patient (actual lab values, but also diseases and other pathologies that are identified as potential causes of the ADE e.g. renal insufficiency and potassium). We show that making the system able to catch the monitoring and clinical contexts opens interesting opportunities for the design of the CDS information content and display mode. Implementing this model would allow the CDSS to take into account the actions already engaged by the healthcare team and to adapt the information delivered to the monitoring and clinical context, thus making the CDSS a partner to the clinicians, nurses and pharmacists. PMID:21685614

Marcilly, Romaric; Leroy, Nicolas; Luyckx, Michel; Pelayo, Sylvia; Riccioli, Costanza; Beuscart-Zéphir, Marie-Catherine

2011-01-01

186

Cost Effectiveness of an Electronic Medical Record Based Clinical Decision Support System  

PubMed Central

Objective Medical groups have invested billions of dollars in Electronic Medical Records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The UKPDS Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (.26%, p=.014) relative to patients in the control arm. Intervention costs were $120 (SE=45) per patient in the first year and $76 (SE=45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE=.01) and increased lifetime costs by $112 (SE=660), resulting in an incremental cost effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system.

O'Connor, Patrick J.; Sperl-Hillen, JoAnn M.; Rush, William A.; Johnson, Paul E.; Amundson, Gerald H.; Asche, Stephen E.; Ekstrom, Heidi L.

2012-01-01

187

Feature Engineering and a Proposed Decision-Support System for Systematic Reviewers of Medical Evidence  

PubMed Central

Objectives Evidence-based medicine depends on the timely synthesis of research findings. An important source of synthesized evidence resides in systematic reviews. However, a bottleneck in review production involves dual screening of citations with titles and abstracts to find eligible studies. For this research, we tested the effect of various kinds of textual information (features) on performance of a machine learning classifier. Based on our findings, we propose an automated system to reduce screeing burden, as well as offer quality assurance. Methods We built a database of citations from 5 systematic reviews that varied with respect to domain, topic, and sponsor. Consensus judgments regarding eligibility were inferred from published reports. We extracted 5 feature sets from citations: alphabetic, alphanumeric+, indexing, features mapped to concepts in systematic reviews, and topic models. To simulate a two-person team, we divided the data into random halves. We optimized the parameters of a Bayesian classifier, then trained and tested models on alternate data halves. Overall, we conducted 50 independent tests. Results All tests of summary performance (mean F3) surpassed the corresponding baseline, P<0.0001. The ranks for mean F3, precision, and classification error were statistically different across feature sets averaged over reviews; P-values for Friedman's test were .045, .002, and .002, respectively. Differences in ranks for mean recall were not statistically significant. Alphanumeric+ features were associated with best performance; mean reduction in screening burden for this feature type ranged from 88% to 98% for the second pass through citations and from 38% to 48% overall. Conclusions A computer-assisted, decision support system based on our methods could substantially reduce the burden of screening citations for systematic review teams and solo reviewers. Additionally, such a system could deliver quality assurance both by confirming concordant decisions and by naming studies associated with discordant decisions for further consideration.

Bekhuis, Tanja; Tseytlin, Eugene; Mitchell, Kevin J.; Demner-Fushman, Dina

2014-01-01

188

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

189

Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns  

PubMed Central

Background The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored. Objective To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills. Methods Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators. Results A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills. Conclusions Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective.

Miloslavsky, Eli M.; Hayden, Emily M.; Currier, Paul F.; Mathai, Susan K.; Contreras-Valdes, Fernando; Gordon, James A.

2012-01-01

190

Medical Decision-Making Capacity in Cognitively Impaired Parkinson's Disease Patients Without Dementia  

PubMed Central

Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and non-parametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, patients with PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired PD patients without dementia, and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all PD patients with cognitive impairment.

Martin, Roy C.; Okonkwo, Ozioma C.; Hill, Joni; Griffith, H. Randall; Triebel, Kristen; Bartolucci, Alfred; Nicholas, Anthony P.; Watts, Ray L.; Stover, Natividad; Harrell, Lindy E.; Clark, David; Marson, Daniel C.

2008-01-01

191

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.

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

2013-01-01

192

[Ecology of river mollusks of medical and veterinary importance in 3 sites in La Habana province].  

PubMed

An ecological research study was carried out in freshwater mollusk populations of medical and veterinary importance, in order to determine the biotic and abiotic factors that affect their dynamics. It was observed that the principal abiotic factors influencing abundance of mollusks were total hardness, salinity, acidity, alkalinity and CO2 concentration. Both aquatic plants and specific relations among mollusk groups were the principal biotic factors that affected the molluskan fauna. Species like Fossaria cubensis and Tarebia granifera appeared affected when the site diversity increased whereas the tiarid Melanoides tuberculata prevailed in almost all the ecosystems. PMID:23427449

Vázquez Perera, Antonio Alejandro; Gutiérrez Amador, Alfredo

2007-01-01

193

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process.  

PubMed

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) "Minimum Standards for Health Sciences Libraries in Hospitals." In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team. PMID:11465686

Gluck, J C; Hassig, R A

2001-07-01

194

Novel Architecture for supporting medical decision making of different data types based on Fuzzy Cognitive Map Framework.  

PubMed

Medical problems involve different types of variables and data, which have to be processed, analyzed and synthesized in order to reach a decision and/or conclude to a diagnosis. Usually, information and data set are both symbolic and numeric but most of the well-known data analysis methods deal with only one kind of data. Even when fuzzy approaches are considered, which are not depended on the scales of variables, usually only numeric data is considered. The medical decision support methods usually are accessed in only one type of available data. Thus, sophisticated methods have been proposed such as integrated hybrid learning approaches to process symbolic and numeric data for the decision support tasks. Fuzzy Cognitive Maps (FCM) is an efficient modelling method, which is based on human knowledge and experience and it can handle with uncertainty and it is constructed by extracted knowledge in the form of fuzzy rules. The FCM model can be enhanced if a fuzzy rule base (IF-THEN rules) is available. This rule base could be derived by a number of machine learning and knowledge extraction methods. Here it is introduced a hybrid attempt to handle situations with different types of available medical and/or clinical data and with difficulty to handle them for decision support tasks using soft computing techniques. PMID:18002176

Papageorgiou, Elpiniki; Stylios, Chrysostomos; Groumpos, Peter

2007-01-01

195

Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: A qualitative study  

PubMed Central

Background Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. Methods A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. Results 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Conclusions Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients' decisions and monitor patients' decisions over time.

2011-01-01

196

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...

2011-10-13

197

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.

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

2010-01-01

198

The Creative Organization: An Empirical Investigation of the Importance of Participation in Decision-Making.  

ERIC Educational Resources Information Center

Three independent divisions of a large public agency, each with between 35 and 55 members, were randomly divided into experimental, placebo, and control groups for an intervention emphasizing decision-making and goal-setting practices that promote maximum employee interaction and participation. Results indicate increased levels of creativity after…

Plunkett, Daniel

1990-01-01

199

Uncertainty in natural resource decision support systems: sources, interpretation, and importance  

Microsoft Academic Search

Decision support systems (DSS) have been defined as computer-based systems that integrate data sources with modeling and analytical tools; facilitate development, analysis, and ranking of alternatives; assist in management of uncertainty; and enhance overall problem comprehension. Of these capabilities, uncertainty assessment is the most poorly understood and implemented. Uncertainty assessment provides methodology to estimate the reliability of recommended alternatives, to

H. Todd Mowrer

2000-01-01

200

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...

201

Ultimatum Bargaining with a Group: Underestimating the Importance of the Decision Rule  

Microsoft Academic Search

The three experiments presented here modified the standard ultimatum game by having a committee of five people either accept or reject offers made by one allocator. Although the decision rule the committee used to decide whether to accept or reject the offer had a large effect on the optimal allocation strategy, we hypothesized that allocators would have difficulty incorporating the

David M. Messick; Don A. Moore; Max H. Bazerman

1997-01-01

202

Ability of pharmacy clinical decision-support software to alert users about clinically important drug-drug interactions  

Microsoft Academic Search

ObjectivePharmacy clinical decision-support (CDS) software that contains drug–drug interaction (DDI) information may augment pharmacists' ability to detect clinically significant interactions. However, studies indicate these systems may miss some important interactions. The purpose of this study was to assess the performance of pharmacy CDS programs to detect clinically important DDIs.DesignResearchers made on-site visits to 64 participating Arizona pharmacies between December 2008

Kim R. Saverno; Lisa E. Hines; Terri L. Warholak; Amy J. Grizzle; Lauren Babits; Courtney Clark; Ann M. Taylor; Daniel C. Malone

2011-01-01

203

Adolescent decision-making about use of inhaled asthma controller medication: Results from focus groups with participants from a prior longitudinal study  

PubMed Central

Background Adherence with inhaled controller medications for asthma is known to be highly variable with many patients taking fewer doses than recommended for consistent control of lung inflammation. Adherence also worsens as children become teenagers, although the exact causes are not well established. Objective To use focus group methodology to examine beliefs, feelings, and behaviors about inhaled asthma controller medication in adolescents and young adults who had previously participated in a longitudinal study of asthma treatment adherence and outcome in order to develop more effective management strategies. Methods Twenty-six subjects participated in 6 focus groups comprised of 3-5 young adults (age range 12-20 years). Verbatim transcripts of these groups were analyzed using the long-table method of content analysis to identify key themes raised by participants. Results A variety of beliefs, feelings and behaviors influence the adolescent’s decision about how to use their asthma medication. Some of the adolescents understood the importance of daily medication and were committed to the treatment plan prescribed by their provider. Poorer adherence was the product of misinformation, incorrect assumptions about their asthma, and current life situations. Conclusions These results, by highlighting potential mechanisms underlying both better and worse adherence inform the development of strategies to improve adherence behavior in adolescents and young adults with asthma. Knowledge of the specific beliefs, feelings and behaviors that underlie adolescents’ use of inhaled asthma controller medication will help providers maximize treatment adherence in this notoriously difficult patient population.

Wamboldt, Frederick S.; Bender, Bruce G.; Rankin, Allison E.

2011-01-01

204

Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making  

PubMed Central

Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient–proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult’s preferences for cardiopulmonary resuscitation, artificial feeding and fluids, and palliative care in hypothetical illness scenarios. The responses of 34 Caucasian dyads and 30 African American dyads were compared to determine the extent to which family members could accurately predict the treatment preferences of their older relative. Results: We found higher treatment preference agreement among African American dyads compared with Caucasian dyads when considering overall raw difference scores (i.e., overtreatment errors can compensate for undertreatment errors). Prior advance care planning moderated the effect such that lower levels of advance care planning predicted undertreatment errors among African American proxies and overtreatment errors among Caucasian proxies. In contrast, no racial/ethnic differences in treatment preference agreement were found within absolute difference scores (i.e., total error, regardless of the direction of error). Implications: This project is one of the first to examine the mediators and moderators of dyadic racial/cultural differences in treatment preference agreement for end-of-life care in hypothetical illness scenarios. Future studies should use mixed method approaches to explore underlying factors for racial differences in patient–proxy agreement as a basis for developing culturally sensitive interventions to reduce racial disparities in end-of-life care options.

Schmid, Bettina; Allen, Rebecca S.; Haley, Philip P.; DeCoster, Jamie

2010-01-01

205

Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis  

PubMed Central

Background Many drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation’s health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug. Methods The study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY) was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI) and expected value of parameter perfect information (EVPPI) analyses were also conducted for the hypothetical population. Results Thiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration. Conclusions The result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled.

2013-01-01

206

Cognitive Predictors of Medical Decision-Making Capacity in Traumatic Brain Injury  

PubMed Central

Objective To identify cognitive predictors of medical decision-making capacity (MDC) in participants with traumatic brain injury (TBI) at time of acute injury (baseline) and at six-month follow-up. Participants At baseline, participants were 34 adults with moderate to severe TBI and 20 healthy adults. At six-month follow-up, participants were 24 adults with moderate to severe TBI and 20 normal adults. Main Outcome Measures Participants were administered a consent capacity instrument (Capacity to Consent to Treatment Instrument: CCTI) and neuropsychological test measures. In the TBI group, univariate and multivariate cognitive predictor models were developed at baseline and six-month follow-up for clinically relevant CCTI consent abilities/standards (S) of understanding (S5); reasoning (S4); and appreciation (S3). Results At baseline, measures of short-term verbal memory and semantic fluency predicted TBI group performance on understanding (S5); short-term verbal memory and attention predicted performance on reasoning (S4); and working memory predicted performance on appreciation (S3). Regarding six-month follow-up models, measures of basic executive function, verbal processing speed, and working memory predicted TBI performance on understanding (S5); working memory and short-term memory predicted reasoning (S4); and basic executive functioning predicted appreciation (S3). Conclusions Multiple cognitive functions are associated with acute impairment and partial recovery of MDC in patients with moderate to severe TBI. Short-term verbal memory was strongly associated with impairments in consent capacity in TBI participants at the time of acute inpatient hospitalization. As patients experience cognitive and functional recovery post-hospitalization, executive functioning and working memory abilities were associated with improved capacity at six-month follow-up. The results offer insight into the relationship between different standards of competency and cognitive changes and recovery following acute TBI.

Dreer, Laura E.; DeVivo, Michael J.; Novack, Thomas A.; Krzywanski, Sara; Marson, Daniel C.

2010-01-01

207

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

208

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties  

PubMed Central

Background The U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis. Design We developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as “CDS opportunities,” might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists’ clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics.

2012-01-01

209

Multi-National, Multi-Institutional Analysis of Clinical Decision Support Data Needs to Inform Development of the HL7 Virtual Medical Record Standard  

PubMed Central

An important barrier to the widespread dissemination of clinical decision support (CDS) is the heterogeneity of information models and terminologies used across healthcare institutions, health information systems, and CDS resources such as knowledge bases. To address this problem, the Health Level 7 (HL7) Virtual Medical Record project (an open, international standards development effort) is developing community consensus on the clinical information exchanged between CDS engines and clinical information systems. As a part of this effort, the HL7 CDS Work Group embarked on a multinational, collaborative effort to identify a representative set of clinical data elements required for CDS. Based on an analysis of CDS systems from 20 institutions representing 4 nations, 131 data elements were identified as being currently utilized for CDS. These findings will inform the development of the emerging HL7 Virtual Medical Record standard and will facilitate the achievement of scalable, standards-based CDS.

Kawamoto, Kensaku; Del Fiol, Guilherme; Strasberg, Howard R.; Hulse, Nathan; Curtis, Clayton; Cimino, James J.; Rocha, Beatriz H.; Maviglia, Saverio; Fry, Emory; Scherpbier, Harm J.; Huser, Vojtech; Redington, Patrick K.; Vawdrey, David K.; Dufour, Jean-Charles; Price, Morgan; Weber, Jens H.; White, Thomas; Hughes, Kevin S.; McClay, James C.; Wood, Carla; Eckert, Karen; Bolte, Scott; Shields, David; Tattam, Peter R.; Scott, Peter; Liu, Zhijing; McIntyre, Andrew K.

2010-01-01

210

The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills.  

PubMed

In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Québec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7865034

Page, G; Bordage, G

1995-02-01

211

From the stretcher to the pharmacy's shelf: drug leads from medically important brazilian venomous arachnid species.  

PubMed

Accidents involving venomous animals have always caught the attention of mankind due to their lethality and other clinical implications. However, since the molecules obtained from animal venoms have been the product of millions of years of evolutionary process, toxins could be used to probe physiological mechanisms and could serve as leads for drug development. The present work reviews the state of the art pertaining to venom molecules from Brazilian medically important arachnid species bearing potential biotechnological applications. Special focus is given to toxins isolated from the scorpion Tityus serrulatus and the spiders Phoneutria nigriventer and Lycosa erythrognatha, whose venoms possess molecules acting as erectile function modulators and as antihypertensive, analgesic, neuroprotective and antimicrobial agents. PMID:21824079

Rates, Breno; Verano-Braga, Thiago; Santos, Daniel Moreira; Nunes, Kênia Pedrosa; Pimenta, Adriano M C; De Lima, Maria Elena

2011-10-01

212

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

213

Aboriginal new world epidemiolgy and medical care, and the impact of Old World disease imports.  

PubMed

Various workers, including T. D. Stewart, claim that the aboriginal Americas were relatively disease-free because of the bering Strait cold-screen, eliminating many pathogens, and the paucity of zoonotic infections because of few domestic animals. Evidence of varying validity suggests that precontact Americns had their own strains of treponemic infections, bacillary and amoebic dysenteries, influenza and viral penumonia and other respiratory diseases, salmonellosis and perhaps other food poisoning, various arthritides, some endoparasites such as the ascarids, and several geographically circumscribed diseases such as the rickettsial verruca (Carrion's disease) and New World leishmaniasis and trypanosomiasis. Questionably aboriginal are tuberculosis and typhus. Accordingly, virtually all the "crowd-type" ecopathogenic diseases such as smallpox, yellow fever, typhoid, malaria, measles, pertussis, polio, etc., appear to have been absent from the New World, and were only brought in by White conquerors and their Black slaves. My hypothesis is that native American medical care systems--especially in the more culturally advanced areas--were sufficiently sophisticated to deal with native disease entities with reasonable competence. But native medical systems could not cope with the "crowd-type" disease imports that struck Indian and Eskimos as "virgin-field" populations. Reanalysis of native population losses through a genocidal combination of diease, war, slavery and attendant cultural disruption by Dobyns, Cook and others strongly suggest that traditiona estimates underplayed the death toll by a factor of the general order of ten. This would make for an immediately pre-contact Indian population of some 90-111 million instead of the tradition 8-11 million. Evidence is growing that Indians may have been no more susceptible to new pathogens that are other "virgin soil" populations, and thus their immune systems need not be considered less effective than those in other people. Present-day high mortality rates in Indians of both continents from infectious disease imports may be more socioeconomic than anything else. PMID:793420

Newman, M T

1976-11-01

214

Activity and biological effects of neem products against arthropods of medical and veterinary importance.  

PubMed

Botanical insecticides are relatively safe and degradable, and are readily available sources of biopesticides. The most prominent phytochemical pesticides in recent years are those derived from neem trees, which have been studied extensively in the fields of entomology and phytochemistry, and have uses for medicinal and cosmetic purposes. The neem products have been obtained from several species of neem trees in the family Meliaceae. Six species in this family have been the subject of botanical pesticide research. They are Azadirachta indica A. Juss, Azadirachta excelsa Jack, Azadirachta siamens Valeton, Melia azedarach L., Melia toosendan Sieb. and Zucc., and Melia volkensii Gürke. The Meliaceae, especially A. indica (Indian neem tree), contains at least 35 biologically active principles. Azadirachtin is the predominant insecticidal active ingredient in the seed, leaves, and other parts of the neem tree. Azadirachtin and other compounds in neem products exhibit various modes of action against insects such as antifeedancy, growth regulation, fecundity suppression and sterilization, oviposition repellency or attractancy, changes in biological fitness, and blocking development of vector-borne pathogens. Some of these bioactivity parameters of neem products have been investigated at least in some species of insects of medical and veterinary importance, such as mosquitoes, flies, triatomines, cockroaches, fleas, lice, and others. Here we review, synthesize, and analyze published information on the activity, modes of action, and other biological effects of neem products against arthropods of medical and veterinary importance. The amount of information on the activity, use, and application of neem products for the control of disease vectors and human and animal pests is limited. Additional research is needed to determine the potential usefulness of neem products in vector control programs. PMID:10412110

Mulla, M S; Su, T

1999-06-01

215

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

NASA Astrophysics Data System (ADS)

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.

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

2013-10-01

216

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

217

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

218

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

219

AVPdb: a database of experimentally validated antiviral peptides targeting medically important viruses.  

PubMed

Antiviral peptides (AVPs) have exhibited huge potential in inhibiting viruses by targeting various stages of their life cycle. Therefore, we have developed AVPdb, available online at http://crdd.osdd.net/servers/avpdb, to provide a dedicated resource of experimentally verified AVPs targeting over 60 medically important viruses including Influenza, HCV, HSV, RSV, HBV, DENV, SARS, etc. However, we have separately provided HIV inhibiting peptides in 'HIPdb'. AVPdb contains detailed information of 2683 peptides, including 624 modified peptides experimentally tested for antiviral activity. In modified peptides a chemical moiety is attached for increasing their efficacy and stability. Detailed information include: peptide sequence, length, source, virus targeted, virus family, cell line used, efficacy (qualitative/quantitative), target step/protein, assay used in determining the efficacy and PubMed reference. The database also furnishes physicochemical properties and predicted structure for each peptide. We have provided user-friendly browsing and search facility along with other analysis tools to help the users. Entering of many synthetic peptide-based drugs in various stages of clinical trials reiterate the importance for the AVP resources. AVPdb is anticipated to cater to the needs of scientific community working for the development of antiviral therapeutics. PMID:24285301

Qureshi, Abid; Thakur, Nishant; Tandon, Himani; Kumar, Manoj

2014-01-01

220

Biosynthesis of silver nanoparticles by Streptomyces hygroscopicus and antimicrobial activity against medically important pathogenic microorganisms.  

PubMed

Biological reduction of aqueous silver ions by extracellular components of Streptomyces hygroscopicus has facilitated the development of industrially viable greener methods for the synthesis of technologically important silver nanoparticles (AgNPs). The synthesized aqueous products showed the characteristic absorption spectra at 420 nm, which confirmed the presence of AgNPs. X-ray diffraction patterns displayed typical peaks of crystalline silver at approximately 38 degrees , approximately 45 degrees and approximately 65 degrees . The AgNPs were determined to be spherical (20-30 nm) with a purity of 70% as determined by FE-SEM, TEM, bio-AFM, XRD, and energy dispersive X-ray analysis. Furthermore, the biosynthesized AgNPs significantly inhibited the growth of medically important pathogenic gram-positive bacteria (Bacillus subtilis and Enterococcus faecalis), gram-negative bacteria (Escherichia coli and Salmonella typhimurium) and yeast (Candida albicans). Thus, bioconversion of silver nanoparticles by S. hygroscopicus could be employed as a potential nanomedicine to eliminate pathogenic microorganisms. PMID:20705438

Sadhasivam, Sathya; Shanmugam, Parthasarathi; Yun, Kyusik

2010-11-01

221

The application of the atomic force microscope to studies of medically important protozoan parasites.  

PubMed

Both living and fixed specimens of the medically-important parasitic protozoa, Trypanosoma cruzi, Toxoplasma gondii, Giardia lamblia, Entamoeba histolytica, and Acanthamoeba spp. were studied by atomic force microscopy (AFM). The preparation of fixed specimens was similar to methods used for either scanning or transmission electron microscopy. AFM scanning was performed using both contact and tapping modes. A classical fixation procedure utilizing glutaraldehyde followed by ethanol dehydration was not suitable for all parasite species. AFM images could not be obtained from fixed samples of T. cruzi, T. gondii or E. histolytica. However, excellent topographic images could be obtained from specimens of G. lamblia and Acanthamoeba under identical conditions. Critical point drying permitted AFM imaging of both trypomastigote and epimastigote stages of T. cruzi. Phase imaging of T. cruzi elucidated unique surface details at a level of resolution not visible using any other imaging modalities. AFM elasticity map imaging of T. cruzi-infected and T. gondii-infected cells demonstrated that both parasites were markedly firmer than the surrounding host cell cytoplasm. The parasitophorous vacuole surrounding replicating T. gondii tachyzoites was also visualized by elasticity map imaging. These data suggest that although much remains to be learned about preparing parasitic protozoa for AFM imaging, the technique has the potential of providing unique and important insights into these disease causing organisms. PMID:11108031

Dvorak, J A; Kobayashi, S; Abe, K; Fujiwara, T; Takeuchi, T; Nagao, E

2000-01-01

222

The importance and purpose of medical psychology in the study of medicine.  

PubMed

Medical psychology is to be understood both as an interdisciplinary science, orientated to the bio-psychosocial concept of illness as well as a basic medical attitude that encompasses the whole of a doctor's activity. In the curriculum the students must be provided with a medico-psychological training that is specific to individual phases of study. This requires a didactic process that is centered on the student, both in the teaching of medical psychology as well as in medico-psychological hospital practice, which is to be achieved in close cooperation with other medical subjects. Medical psychology is mostly described as a newer scientific discipline. It does have a history, however, that has evolved over time. Although medical psychology has always been a building block in the thinking and actions of the medical profession, it is now explicitly anchored in the training (i.e. in the curriculum) of doctors. PMID:2290882

Rossmanith, S

1990-01-01

223

Sleep timing is more important than sleep length or quality for medical school performance.  

PubMed

Overwhelming evidence supports the importance of sleep for memory consolidation. Medical students are often deprived of sufficient sleep due to large amounts of clinical duties and university load, we therefore investigated how study and sleep habits influence university performance. We performed a questionnaire-based study with 31 medical students of the University of Munich (second and third clinical semesters; surgery and internal medicine). The students kept a diary (in 30-min bins) on their daily schedules (times when they studied by themselves, attended classes, slept, worked on their thesis, or worked to earn money). The project design involved three 2-wk periods (A: during the semester; B: directly before the exam period--pre-exam; C: during the subsequent semester break). Besides the diaries, students completed once questionnaires about their sleep quality (Pittsburgh Sleep Quality Index [PSQI]), their chronotype (Munich Chronotype Questionnaire [MCTQ]), and their academic history (previous grades, including the previously achieved preclinical board exam [PBE]). Analysis revealed significant correlations between the actual sleep behavior during the semester (MS(diary); mid-sleep point averaged from the sleep diaries) during the pre-exam period and the achieved grade (p = 0.002) as well as between the grades of the currently taken exam and the PBE (p = 0.002). A regression analysis with MS(diary) pre-exam and PBE as predictors in a model explained 42.7% of the variance of the exam grade (effect size 0.745). Interestingly, MS(diary)--especially during the pre-exam period-was the strongest predictor for the currently achieved grade, along with the preclinical board exam as a covariate, whereas the chronotype did not significantly influence the exam grade. PMID:23750895

Genzel, L; Ahrberg, K; Roselli, C; Niedermaier, S; Steiger, A; Dresler, M; Roenneberg, T

2013-07-01

224

Effect of a Pharmacist Intervention on Clinically Important Medication Errors after Hospital Discharge: A Randomized Controlled Trial  

PubMed Central

Background Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events as well as medication discrepancies or non-adherence with high potential for future harm (potential adverse drug events). Objective The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study sought to determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge. Design Randomized controlled trial with concealed allocation and blinded outcome assessors. Setting Two tertiary care academic hospitals. Patients Adults hospitalized with acute coronary syndromes or acute decompensated heart failure. Intervention Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. Measurements The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable adverse drug events, as well as potential adverse drug events. Results Among 851 participants, 432 (50.8%) experienced 1 or more clinically important medication errors; 23% of such errors were judged to be serious, and 2% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential adverse drug events in 253 (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (IRR=0.92; 95% CI, 0.77 to 1.10) or adverse drug events (IRR=1.09; CI, 0.86 to 1.39). Intervention patients tended to have fewer potential adverse drug events (IRR=0.80; CI, 0.61 to 1.04). Limitations The characteristics of the study hospitals and participants may limit generalizability. Conclusions Clinically important medication errors were present among half of patients after hospital discharge and were not significantly reduced by a health-literacy sensitive, pharmacist-delivered intervention.

Kripalani, Sunil; Roumie, Christianne L.; Dalal, Anuj K.; Cawthon, Courtney; Businger, Alexandra; Eden, Svetlana K.; Shintani, Ayumi; Sponsler, Kelly Cunningham; Harris, L. Jeff; Theobald, Cecelia; Huang, Robert L.; Scheurer, Danielle; Hunt, Susan; Jacobson, Terry A.; Rask, Kimberly J.; Vaccarino, Viola; Gandhi, Tejal K.; Bates, David W.; Williams, Mark V.; Schnipper, Jeffrey L.

2013-01-01

225

Hyperbolic Dirac Nets for medical decision support. Theory, methods, and comparison with Bayes Nets.  

PubMed

We recently introduced the concept of a Hyperbolic Dirac Net (HDN) for medical inference on the grounds that, while the traditional Bayes Net (BN) is popular in medicine, it is not suited to that domain: there are many interdependencies such that any "node" can be ultimately conditional upon itself. A traditional BN is a directed acyclic graph by definition, while the HDN is a bidirectional general graph closer to a diffuse "field" of influence. Cycles require bidirectionality; the HDN uses a particular type of imaginary number from Dirac?s quantum mechanics to encode it. Comparison with the BN is made alongside a set of recipes for converting a given BN to an HDN, also adding cycles that do not usually require reiterative methods. This conversion is called the P-method. Conversion to cycles can sometimes be difficult, but more troubling was that the original BN had probabilities needing adjustment to satisfy realism alongside the important property called "coherence". The more general and simpler K-method, not dependent on the BN, is usually (but not necessarily) derived by data mining, and is therefore also introduced. As discussed, BN developments may converge to an HDN-like concept, so it is reasonable to consider the HDN as a BN extension. PMID:24954566

Robson, Barry

2014-08-01

226

Impact of Calibration Error in Medical Decision Making. Planning Report 04-1.  

National Technical Information Service (NTIS)

Calibration error, leading to analytic bias, is a key parameter affecting the number of patients passing decision thresholds in practice guidelines. The Food and Drug Administration (FDA) requires that new tests perform equivalent to previously approved m...

M. P. Gallaher L. R. Mobley G. G. Klee P. Schryver

2004-01-01

227

Machine Learning for Medical Decision Support: Evaluating Diagnostic Performance of Machine Learning Classification Algorithms  

Microsoft Academic Search

The present study explored dichotomic classification methods for medical diagnosis data through three experiments. A first experiment run in Weka used four different classification schemes on two different sets of medical test data thus permitting comparison of each scheme's performance. A second experiment tested the application of attribute selection, information gain, and boosting to Weka's support vector classification scheme (SMO).

Patrick Herron

228

Regulatory requirements important to Hanford single-shell tank waste management decisions  

SciTech Connect

This report provides an initial analysis of the regulations that may be pertinent to SST management activities (e.g., characterization, disposal, retrieval, processing, etc.) and the interrelationships among those regulations. Waste disposal decisions regarding SST waste must consider the regulatory requirements against which technical solutions will be evaluated. Regulatory requirements can also be used as guidelines for management and disposal of waste in a manner that protects human health and safety and the environment. Also, in cases where waste management regulations do not specifically address a waste form, such as radioactive mixed waste, the SST waste may come under the purview of a number of regulations related to radioactive waste management, hazardous waste management, and water and air quality protection. This report provides a comprehensive review of the environmental pollution control and radioactive waste management statutes and regulations that are relevant to SST waste characterization and management. Also, other statutes and regulations that contain technical standards that may be used in the absence of directly applicable regulations are analyzed. 8 refs., 4 figs.

Keller, J.F.; Woodruff, M.G.; Schmidt, A.J.; Hendrickson, P.L.; Selby, K.B.

1989-06-01

229

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.

2014-01-01

230

Role modeling in medical education: the importance of a reflective imitation.  

PubMed

The medical literature almost uniformly addresses the positive aspects of role modeling. Still, some authors have questioned its educational value, a disagreement that is probably due to differing definitions of role modeling. If defined as demonstration of skills, provision of feedback, and emulation of specific professional behaviors, then role modeling is an important component of clinical training. However, if it is defined as a learner's unselective imitation of role models and uncritical adoption of the messages of the learning environment, then the benefits of role modeling should be weighed against its unintended harm.In this Perspective, the author argues that imitation of role models may initially help students adapt to the clinical environment. However, if sustained, imitation may perpetuate undesirable practices, such as doctor-centered patient interviewing, and unintended institutional norms, such as discrimination between private and public patients. The author suggests that the value of role modeling can be advanced not only by targeting role models and improving faculty performance but also by enhancing students' reflective assessment of their preceptors' behaviors, especially so that they can better discern those that are worth imitating. This student-centered approach may be accomplished by first, warning students against uncritically imitating preceptors who are perceived as role models; second, showing students that their preceptors share their doubts and uncertainties; third, gaining an insight into possible undesirable messages of the learning environment; and finally, developing policies for faculty recruitment and promotion that consider whether a clinical preceptor is a role model. PMID:24556777

Benbassat, Jochanan

2014-04-01

231

Internal Transcribed Spacer Sequencing versus Biochemical Profiling for Identification of Medically Important Yeasts  

PubMed Central

In this study, we established an in-house database of yeast internal transcribed spacer (ITS) sequences. This database includes medically important as well as colonizing yeasts that frequently occur in the diagnostic laboratory. In a prospective study, we compared molecular identification with phenotypic identification by using the ID32C system (bioMérieux) for yeast strains that could not be identified by a combination of CHROMagar Candida and morphology on rice agar. In total, 113 yeast strains were included in the study. By sequence analysis, 98% of all strains were identified correctly to the species level. With the ID32C, 87% of all strains were identified correctly to the species or genus level, 7% of the isolates could not be identified, and 6% of the isolates were misidentified, most of them as Candida rugosa or Candida utilis. For a diagnostic algorithm, we suggest a three-step procedure which integrates morphological criteria, biochemical investigation, and sequence analysis of the ITS region.

Ciardo, D. E.; Schar, G.; Bottger, E. C.; Altwegg, M.; Bosshard, P. P.

2006-01-01

232

Assessment of plant lectin antifungal potential against yeasts of major importance in medical mycology.  

PubMed

The search for new compounds with antifungal activity is accelerating due to rising yeast and fungal resistance to commonly prescribed drugs. Among the molecules being investigated, plant lectins can be highlighted. The present work shows the potential of six plant lectins which were tested in vitro against yeasts of medical importance, Candida albicans, Candida tropicalis, Candida parapsilosis, Cryptococcus gattii, Cryptococcus neoformans, Malassezia pachydermatis, Rhodotorula sp. and Trichosporon sp. Broth microdilution susceptibility testing was performed in accordance with standard protocols to evaluate antifungal activity. Minimum inhibitory concentration (MIC) was determined at 80% yeast growth inhibition, whereas the minimum fungicidal concentration (MFC) was evaluated after making the subcultures of each dilution. Only C. parapsilosis growth was inhibited by the lectins tested. Abelmoschus esculentus lectin showed the highest MIC (0.97 ?g ml(-1)). Lectins from Canavalia brasiliensis, Mucuna pruriens and Clitoria fairchildiana presented the highest MFC at (3.90 ?g ml(-1)). These results encourage further studies with wider yeast strain selections, and open new perspectives for the development of pharmacological molecules. PMID:23161017

Klafke, Gabriel Baracy; Moreira, Gustavo Marçal Schmitt Garcia; Monte, Leonardo Garcia; Pereira, Juliano Lacava; Brandolt, Tchana Martinez; Xavier, Melissa Orzechowski; Santi-Gadelha, Tatiane; Dellagostin, Odir Antonio; Pinto, Luciano da Silva

2013-02-01

233

A summary of recent insecticidal tests on some insects of medical importance in Taiwan  

PubMed Central

The author describes some investigations carried out on a number of insects of medical importance in Taiwan (six species of Anopheles, one species of Culex, one of Aëdes, two subspecies of Musca domestica and one species of Cimex) with the object of finding out whether resistance to DDT and BHC had developed among them as a result of the insect-control campaigns which have been in operation in the island since 1948. Of the anophelines, certain strains of A. minimus and A. h. sinensis were found to have a relatively high and statistically significant tolerance to DDT, but whether this can be regarded as developed resistance remains to be ascertained. As to the other insects examined, some strains exhibited statistically significant differences in tolerance to DDT; in certain cases, however, the ancestors of the tolerant strains had never been exposed to DDT, and it has not been possible yet to find an explanation for this phenomenon. No significant difference in susceptibility to ?-BHC was shown by three strains of Cimex hemipterus, two of which had previously been exposed to mixtures of DDT and BHC and one of which had not.

Liu, S. Y.

1958-01-01

234

Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.  

PubMed

The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches. PMID:20086264

Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

2010-01-01

235

An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report  

PubMed Central

Background Gouty arthritis of the wrist is uncommon although gout itself is the most common inflammatory arthritis in older patients. Some known risk factors for the development of gout include trauma, alcohol use, obesity, hyperuricaemia, hypertension and diabetes mellitus. As well, certain medications have been shown to promote the development of gout. These include thiazide diuretics, low dose salicylates and cyclosporine. We present a case of gouty wrist pain possibly precipitated by a medication dosage increase as well as medication interactions. Case presentation A 77 year old male presented with right wrist pain. Redness and swelling was present at the dorsal aspect of his wrist and range of motion was full with pain at end range upon examination. One week prior, his anti-hypertensive medication dosage had been increased. The patient's situation continued to worsen. Radiographic examination revealed changes consistent with gouty arthritis. Conclusion It is important for clinicians treating joint conditions to be aware of patients' comorbidities, medication usage and changes in dosages. Education of patients with gout is of prime importance. Clinicians should educate patients that gout may occur at any joint in the body not only the lower limb. Patients should be aware of the signs and symptoms of an acute gouty attack and be made aware that changes in certain medication dosages may precipitate an attack. Awareness of radiographic changes associated with gout is still of importance although these changes are not seen as frequently as they have been in the past due to better control of the disease.

Jacobs, Craig L; Stern, Paula J

2007-01-01

236

A Management-Decision-Oriented View of Medical School Information System Requirements  

ERIC Educational Resources Information Center

At Case Western Reserve University an interdisciplinary management team has been formed of educators and management specialists to effectively organize, plan and control the medical school. (Editor/PG)

Kutina, Kenneth L.; Lee, Edgar

1973-01-01

237

Decision Support for Medical Treatment: A TPN Prescription System on a Central Hospital Computer  

PubMed Central

An interactive decision-support system for the prescription of total or partial parenteral nutrition (TPN) is described. The system is applicable to all sizes and ages of patients, from premature infants to adults. Both the physician and the pharmacist are users of the system, with the physician using rule-based safety checks and branching algorithms to make decisions in the prescription process, and the pharmacist receiving the prescription totals electronically in order to complete further calculations needed. Since its introduction, the system appears to have increased the safety of the TPN prescription, saved time, and improved the quality and appropriateness of TPN prescriptions.

Moliver, Nina; Coates, Allan L.

1987-01-01

238

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.

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

2006-01-01

239

Fine structure of Chrysomya nigripes (Diptera: Calliphoridae), a fly species of medical importance.  

PubMed

The fine structure of Chrysomya nigripes Aubertin, a blow fly species of medical importance, is presented using scanning electron microscopy (SEM) to contribute information on the morphology of the adult of this fly species. The surface of the dome-shaped ommatidia exhibits a microscopic granulose appearance. The palpus is equipped with small sensilla basiconica and sensilla chaetica, which provide sensory reception for detecting environmental information. At the apex of the mouthparts, the labellum is endowed with large numbers of sensilla trichodea and basiconic-like sensilla of variable length. The anterior (mesothoracic) spiracle is elliptical in shape and covered with extensively ramified setae except for a small dorsal aperture. The posterior (metathoracic) spiracle is shaped like a rounded isosceles triangle and covered by two valves of unequal size. The larger valve covers the upper approximately 2/3 of the spiracular opening, whereas the smaller valve covers the lower approximately 1/3 of the opening. Extensively ramified setae line and cover the valves over the entire spiracle. SEM analyses of the haltere knob and the prosternal organs, located adjacent to the cervical sclerites, revealed a striking resemblance of the morphological features of their sensilla. Each sensillum emanates from a cuticular ring, is approximately 12-15 mum in length, has a smooth surface, and terminates in a sharp tip. Various types of sensilla were associated with the ovipositor including sensilla trichodea, sensilla basiconica, sensilla placodea and probably sensilla styloconica. The possible function of sensilla distributed in particular regions of the fly integument is discussed. PMID:17216239

Ngern-klun, Radchadawan; Sukontason, Kom; Methanitikorn, Rungkanta; Vogtsberger, Roy C; Sukontason, Kabkaew L

2007-04-01

240

The importance of surveillance for informing pretravel medical advice: imported malaria in New Zealand 1997-2009.  

PubMed

Malaria has never been endemic in New Zealand, and all cases have been diagnosed in international travelers. In this paper, we describe malaria cases reported from 1997 to 2009 and discuss epidemiological changes compared to a previous report from 1980 to 1992. From 1997 to 2009, 666 malaria infections were reported, with 410 cases (61.6%) in travelers aged 20-39 and 133 (20%) in military personnel. Infections were caused by Plasmodium vivax in 436 cases (72.7%) and Plasmodium falciparum in 163 (27.2%). In the 533 civilians, common countries of infection were Papua New Guinea (24.4%), India (18.6%), the Solomon Islands (8.8%), and Indonesia (6.1%). Most common regions of malaria acquisition for civilians were Papua New Guinea and Western Pacific (39.8%), Africa (24.7%), Indian subcontinent (19.5%), and Southeast Asia (13.6%). Compared to a previous report of malaria in New Zealand from 1980 to 1992, regions of malaria acquisition have changed significantly, with a lower percentage of cases acquired from Papua New Guinea and Western Pacific (from 59.2% to 39.3%), and a higher percentage from Africa (from 8.6% to 21.3%). The ethnic groups affected also differ significantly between the two surveillance periods, with a reduction in the percentage of cases reported in Caucasians (from 80.8 to 45.9%) and an increase in cases in Indians (from 7.0 to 15.7%), Papua New Guineans and Pacific Islanders (from 5.2 to 16.9%), other Asians (from 2.3 to 5.6%), and Africans (from 0 to 8.5%). Common locations of malaria infection have evolved over time and probably reflect changing travel patterns of New Zealanders and the origins of visitors and immigrants. Therefore, local surveillance is important for informing pretravel advice by identifying vulnerable groups and common destinations for malaria infection, so that special attention on malaria prevention can be focused on travelers who are at highest risk. Ongoing surveillance is also essential for monitoring the evolving epidemiology of imported malaria over time. PMID:24456029

Lau, Colleen; Weinstein, Philip; Slaney, David

2014-02-01

241

Importance of Radiology Clerkships in Teaching Medical Students Life-Threatening Abnormalities on Conventional Chest Radiographs  

Microsoft Academic Search

Rationale and ObjectivesThe purpose of this study was to investigate the ability of medical students who had already completed medicine and surgery clerkships to identify life-threatening abnormalities on conventional chest radiographs.

Jac D. Scheiner; Richard B. Noto; Kathleen M. McCarten

2002-01-01

242

Coverage and Medical Necessity Decision-Making in Managed Care. Abstract, Executive Summary and Final Report.  

National Technical Information Service (NTIS)

This national study investigates common approaches and variation in how coverage decisions are made. The study includes two cross-sectional mail surveys conducted January to May 2001 of managed care plans and state regulators in 50 states and the District...

A. M. Gerber

2001-01-01

243

The importance of organ geometry and boundary constraints for planning of medical interventions  

Microsoft Academic Search

Realistic modeling of medical interventions involving tool–tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. Organ geometry, soft-tissue constitutive laws, and boundary conditions imposed by the connective tissues surrounding the organ are some of the factors that govern the accuracy of medical intervention planning. In this study it is demonstrated that,

S. Misra; K. J. Macura; K. T. Ramesh; A. M. Okamura

2009-01-01

244

The patient as citizen. A common-good approach to medical treatment decisions balances the emphasis on patient desires.  

PubMed

Individualism plays too strong a role in the arena of treatment decision making, frequently to the exclusion of any other consideration. Using a common-good or community-based ethic as a framework for treatment decision making may provide appropriate balance to the emphasis on patient desires. Self-determination is a good that must be balanced with other goods. When it is not, to quote Daniel Callahan, "Self-determination runs amok." For example, in the state of New Jersey, individuals are permitted to choose the criteria to be used in determining that their own death has occurred. Some of the principles that may lead to a reasonable understanding of the patient's rights in a "patient-as-citizen" ethical perspective are: Everyone has a legitimate claim to a basic level of healthcare. Everyone has a legitimate claim to respect for his or her refusal of recommended treatment. No one has a legitimate claim to nonbeneficial or futile treatment. No one has a legitimate claim to treatment that is being withheld as part of a just rationing system. No one has a legitimate claim to the ability to determine the medical criteria to be used for the diagnosis of his or her death. A just healthcare system is one in which individual desires for medical treatment beyond the basic level are accommodated whenever possible but not when they undermine the primary purpose of medicine to meet the basic healthcare needs of all persons. PMID:10126217

Weber, L J

1993-06-01

245

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.

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

2013-01-01

246

Critically ill patients and end-of-life decision-making: the senior medical resident experience  

Microsoft Academic Search

In order to improve the understanding of educational needs among residents caring for the critically ill, narrative accounts\\u000a of 19 senior physician trainees participating in level of care decision-making were analyzed. In this multicentre qualitative\\u000a study involving 9 university centers in Canada, in-depth interviews were conducted in either English or French, and the transcripts\\u000a then underwent a hermeneutic phenomenological analysis.

Stéphane P. Ahern; Tina K. Doyle; François Marquis; Corey Lesk; Yoanna Skrobik

247

Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support  

Microsoft Academic Search

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant

Casey Lynnette Overby; Peter Tarczy-Hornoch; James I Hoath; Ira J Kalet; David L Veenstra

2010-01-01

248

How family caregivers' medical and moral assumptions influence decision making for patients in the vegetative state: a qualitative interview study  

PubMed Central

Background Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. Objective To examine the role of advance directives, orally expressed wishes, or the presumed will of patients in a VS for family caregivers' decisions on life-sustaining treatment. Methods and sample A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. Results The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. Conclusions Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning.

Borasio, Gian Domenico; Jox, Ralf J

2012-01-01

249

Scalable Decision Support at the Point of Care: A Substitutable Electronic Health Record App for Monitoring Medication Adherence  

PubMed Central

Background Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. Objective The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as “iPhone like platforms” by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. Methods The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients’ prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. Results The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the “MPR Monitor”, where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. Conclusions The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality.

Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-01-01

250

Basic list of veterinary medical serials, third edition: using a decision matrix to update the core list of veterinary journals  

PubMed Central

Objective: This paper presents the methods and results of a study designed to produce the third edition of the “Basic List of Veterinary Medical Serials,” which was established by the Veterinary Medical Libraries Section in 1976 and last updated in 1986. Methods: A set of 238 titles were evaluated using a decision matrix in order to systematically assign points for both objective and subjective criteria and determine an overall score for each journal. Criteria included: coverage in four major indexes, scholarly impact rank as tracked in two sources, identification as a recommended journal in preparing for specialty board examinations, and a veterinary librarian survey rating. Results: Of the 238 titles considered, a minimum scoring threshold determined the 123 (52%) journals that constituted the final list. The 36 subject categories represented on the list include general and specialty disciplines in veterinary medicine. A ranked list of journals and a list by subject category were produced. Conclusion: Serials appearing on the third edition of the “Basic List of Veterinary Medical Serials” met expanded objective measures of quality and impact as well as subjective perceptions of value by both librarians and veterinary practitioners.

Ugaz, Ana G; Boyd, C. Trenton; Croft, Vicki F; Carrigan, Esther E; Anderson, Katherine M

2010-01-01

251

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

252

Human factors based recommendations for the design of medication related clinical decision support systems (CDSS).  

PubMed

This study is part of a research project aiming at developing advanced functions of medication related CDSS to support the monitoring of patients' therapeutic treatments based mainly on corresponding lab values. We adopted a user-centred approach to the design of these advanced CDSS functions. We collected existing recommendations in the literature and completed previous Human Factors (HF) field studies and analyses by focused observations and modeling. We present resulting HF based recommendations for the design of such advanced medication CDSS and focus more specifically on two innovative high level recommendations completing those already existing in the literature. For illustration purposes, an example of the operationalization of one of the recommendation is presented. PMID:21893783

Pelayo, Sylvia; Marcilly, Romaric; Bernonville, Stéphanie; Leroy, Nicolas; Beuscart-Zephir, Marie-Catherine

2011-01-01

253

[The vaccination of medical personnel as the most important link in the prevention of viral hepatitis B].  

PubMed

The epidemiological importance of prophylaxis of virus hepatitis B among medical personnel of therapeutic-preventive establishments is caused by often revealing of infecting markers in various groups of the population and patients and the chronization of infectious process, the peculiarities of complications, the outcomes of hepatitis and the character of ways of transfer of the virus. The authors have established non-uniformity of the frequency of revealing of infecting markers by virus hepatitis B in blood of medical personnel of various department of the hospital, have described results of immunological efficiency of the domestic vaccine hepatitis B, produced by firm "Kombitech Ltd." (Russia). PMID:9504012

Akimkin, V G; Skvortsov, S V; Samokhodskaia, L M; Lytsar', B N; Kvasovka, V V

1997-12-01

254

Statistics in Brief: The Importance of Sample Size in the Planning and Interpretation of Medical Research  

Microsoft Academic Search

The increasing volume of research by the medical community often leads to increasing numbers of contradictory findings and\\u000a conclusions. Although the differences observed may represent true differences, the results also may differ because of sampling\\u000a variability as all studies are performed on a limited number of specimens or patients. When planning a study reporting differences\\u000a among groups of patients or

David Jean Biau; Solen Kernéis; Raphaël Porcher

2008-01-01

255

Consistency versus Completeness in Medical Decision Making: Exemplar of 155 Patients Autopsied after Coronary Artery Bypass Graft Surgery  

PubMed Central

Diagnoses made at autopsy are usually yes-no (binary) decisions inferred from clinicopathologic data. A major conceptual problem in determining cause of death is that variables used in classifying some patients may be missing in other patients. A model with too few logical implications will be mathematically incomplete for small data sets; but a model too many implications may be inconsistent with large data sets. We examined the 155 patients autopsied after coronary artery bypass surgery from The Johns Hopkins Hospital autopsy database of 43200 cases. Diagnoses entered on a word processor and transmitted to a minicomputer were solved by the Quine-McCluskey algorithm. Our analysis disclosed that 41% of patients suffered a fatal complication of cardiac surgery; 43% had established surgical complications or unrelated causes of death; and in 17% of cases the cause of death was unexplained. Computerized symbolic logic analysis of medical information is useful in testing the completeness of a proposed set of causes of death.

Moore, G. William; Hutchins, Grover M.

1982-01-01

256

[New research on the practice, reporting and reviewing of euthanasia and other medical end-of-life decisions, 2001/2002].  

PubMed

In the second half of 2001, an extensive study will start which will evaluate the review procedure for euthanasia in the Netherlands. Since the end of 1998, euthanasia has to be reviewed by regional review committees, which include a physician and an ethicist, in addition to a legal expert. The aim of this study is to examine whether the reporting procedure meets the aim and whether there are any points which require improvement. This study follows on from those carried out in 1990/1991 and 1995/1996, which investigated euthanasia and other medical end-of-life decisions (assisted suicide, termination of life without the patient's explicit request, treatment of pain and symptoms with a possible life-shortening effect, and forgoing potentially life-prolonging treatment). The study consists of an analysis of cases of death (in which the numbers and nature of various medical end-of-life decisions will be established), physician interviews (to gain insight into the context in which medical end-of-life decisions are made), a study of reported cases (to give an overview of doctors' experiences with the review committees), and a study carried out amongst the general public (around 1,500 Dutch adults will be given a written questionnaire about their opinions concerning medical end-of-life decisions and the reporting procedure). In addition to this Dutch study, a European study subsidized by the European Commission is being carried out which will examine attitudes and experiences regarding medical end-of-life decisions in six European countries (Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland). This will, for the first time, enable a true comparison to be made between the Netherlands and other countries in terms of euthanasia and other medical end-of-life decisions. PMID:11582645

van der Wal, G; van der Maas, P J; Onwuteaka-Philipsen, B D; van der Heide, A

2001-09-15

257

Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: A qualitative study  

Microsoft Academic Search

Background  Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical\\u000a guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few\\u000a studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was\\u000a to examine patients'

Joanna EM Sale; Monique A Gignac; Gillian Hawker; Lucy Frankel; Dorcas Beaton; Earl Bogoch; Victoria Elliot-Gibson

2011-01-01

258

End-of-life decisions in medical practice: a survey of doctors in Victoria (Australia)  

PubMed Central

Objectives To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end?of?life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. Design and participants Cross?sectional postal survey of doctors in Victoria. Results 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia. Conclusions Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised.

Neil, D A; Coady, C A J; Thompson, J; Kuhse, H

2007-01-01

259

"Well, I Think There Is Great Variation...": A Qualitative Study of Oncologists' Experiences and Views Regarding Medical Criteria and Other Factors Relevant to Treatment Decisions in Advanced Cancer  

PubMed Central

Background. Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment. Methods. Qualitative in-depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed. Results. Physicians reported that a number of nonmedical factors influence professional decisions about the offering or limiting of cancer treatment in advanced cancer in addition to medical criteria. Physicians' individual judgments about the benefit of treatment, as well as the amount of their clinical experience, were cited as such factors. In addition, the physicians' perceptions of the patient's age and life circumstances were reported to influence their treatment decisions. Multiprofessional team discussions and the systematic collection of relevant clinical data regarding the outcomes of different treatment approaches in advanced cancer were suggested as strategies to improve the quality of treatment decisions. Conclusion. The findings of this study provide explanations for the variation in treatment in advanced cancer. Making value judgments explicit and gathering more appropriate clinical data on the outcomes of treatment near the end of life are prerequisites for improved ethical and evidence-based treatment decisions in advanced cancer.

Tan, Jacinta; Salloch, Sabine; Vollmann, Jochen

2013-01-01

260

Community-based participatory research and user-centered design in a diabetes medication information and decision tool  

PubMed Central

Background Together, community-based participatory research (CBPR), usercentered design (UCD) and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. Objectives This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African-American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants’ homes. Methods The overlapping principles of CBPR and UCD used to develop iDecide/Decido include: a user-focused or community approach; equitable academic and community partnership in all study phases; an iterative development process that relies on input from all stakeholders; and a program experience that is specified, adapted, and implemented with the target community. Results Collaboration between community members, researchers, and developers is especially evident in the program’s design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. Conclusions Applying the principles of CBPR and UCD can be successfully employed in developing health information tools that are easy to use and understand, interactive, and target health disparities.

Henderson, Vida A; Barr, Kathryn LC; An, Lawrence C; Guajardo, Claudia; Newhouse, William; Mase, Rebecca; Heisler, Michele

2014-01-01

261

Extending the authority for sickness certification beyond the medical profession: the importance of 'boundary work'  

PubMed Central

Background The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care. Methods Fifteen GPs, seven nurses and six physiotherapists were selected to achieve varied respondent characteristics including sex, geographical location, service duration and post-graduate specialist training. Constant-comparative qualitative analysis of data from 28 semi-structured telephone interviews was undertaken. Results The majority of respondents supported the extended role concept; however members of each professional group also rejected the notion. Respondents employed four different legitimacy claims to justify their views and define their occupational boundaries in relation to sickness certification practice. Condition-specific legitimacy, the ability to adopt a holistic approach to sickness certification, system efficiency and control-related arguments were used to different degrees by each occupation. Practical suggestions for the extension of the sickness certification role beyond the medical profession are underpinned by the sociological theory of professional identity. Conclusions Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles. There is also a need to consider the impact on, and preferences of, the specific occupations and their respective boundary claims. This paper explores the implications of extending the sick certification role beyond general practice. We conclude that the main policy challenge of such a move is to a) persuade GPs to relinquish this role (or to share it with other professions), and b) to understand the ‘boundary work’ involved.

2014-01-01

262

Medics and Marine Mammals - An Unlikely but Important Connection for Humanity's Survival.  

PubMed

Marine mammals, as top predators in the marine food web, are sentinels of changes in the oceans and public health. Pollution in the sea and overfishing of seafood resources affects these organisms just as much as it affects human beings. Medics, especially doctors, have an influential reach to patients, and are in an ideal position to get better acquainted with ongoing marine environmental issues and subsequently disseminating such information to them. While seemingly an out-of-the-box approach, it is one that can help with environmental conservation and preservation for the future of humanity. PMID:24876801

Ponnampalam, Louisa Shobhini

2014-03-01

263

Medics and Marine Mammals - An Unlikely but Important Connection for Humanity's Survival  

PubMed Central

Marine mammals, as top predators in the marine food web, are sentinels of changes in the oceans and public health. Pollution in the sea and overfishing of seafood resources affects these organisms just as much as it affects human beings. Medics, especially doctors, have an influential reach to patients, and are in an ideal position to get better acquainted with ongoing marine environmental issues and subsequently disseminating such information to them. While seemingly an out-of-the-box approach, it is one that can help with environmental conservation and preservation for the future of humanity.

PONNAMPALAM, Louisa Shobhini

2014-01-01

264

Medically important micro-organisms recovered from Apollo-Soyuz Test Project /ASTP/ crew members  

NASA Technical Reports Server (NTRS)

The Apollo-Soyuz Test Project (ASTP) provided an opportunity to study in-flight cross-contamination and other behavior of microbial populations carried by the crews. The medical microbiology analysis showed that although various potential pathogens were found, no disease elements were reported. Dysbacteriosis (in which sampled areas are flooded with large numbers of a single type of microorganism) was not found, although there was a large increase in the incidence of gram-negative rods in the oral cavities of the two cosmonauts. The results obtained may be applied to future space flights.

Taylor, G. R.; Zaloguev, S. N.

1977-01-01

265

Importance of patient education on home medical care waste disposal in Japan.  

PubMed

To determine current practices in the disposal and handling of home medical care (HMC) waste, a questionnaire was mailed to 1965 offices nationwide. Of the office that responded, 1283 offices were analyzed. Offices were classified by management configuration: those attached to hospitals were classified as "attached offices" and others as "independent offices". More nurses from attached offices recovered medical waste from patients' homes than those from independent offices. Most nurses educated their patients on how to store HMC waste in their homes (79.3% of total) and on how to separate HMC waste (76.5% of total). On the other hand, only around half of nurses (47.3% from attached offices and 53.2% from independent offices) educated their patients on where to dispose of their HMC waste. 66.0% of offices replied that patients had separated their waste appropriately. The need for patient education has emerged in recent years, with education for nurses under the diverse conditions of HMC being a key factor in patient education. PMID:24814769

Ikeda, Yukihiro

2014-07-01

266

Tracking a Medically Important Spider: Climate Change, Ecological Niche Modeling, and the Brown Recluse (Loxosceles reclusa)  

PubMed Central

Most spiders use venom to paralyze their prey and are commonly feared for their potential to cause injury to humans. In North America, one species in particular, Loxosceles reclusa (brown recluse spider, Sicariidae), causes the majority of necrotic wounds induced by the Araneae. However, its distributional limitations are poorly understood and, as a result, medical professionals routinely misdiagnose brown recluse bites outside endemic areas, confusing putative spider bites for other serious conditions. To address the issue of brown recluse distribution, we employ ecological niche modeling to investigate the present and future distributional potential of this species. We delineate range boundaries and demonstrate that under future climate change scenarios, the spider's distribution may expand northward, invading previously unaffected regions of the USA. At present, the spider's range is centered in the USA, from Kansas east to Kentucky and from southern Iowa south to Louisiana. Newly influenced areas may include parts of Nebraska, Minnesota, Wisconsin, Michigan, South Dakota, Ohio, and Pennsylvania. These results illustrate a potential negative consequence of climate change on humans and will aid medical professionals in proper bite identification/treatment, potentially reducing bite misdiagnoses.

Saupe, Erin E.; Papes, Monica; Selden, Paul A.; Vetter, Richard S.

2011-01-01

267

Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration  

Microsoft Academic Search

The importance of including patient preferences in decisions regarding their care has received increased emphasis over recent years. Medical informatics can play an important role in improving patient-centered care by developing decision support systems to support the inclusion of patient preferences in clinical decision making. However, development of such systems is a complex task that requires the integration of knowledge

Cornelia M. Ruland; Suzanne Bakken

2002-01-01

268

The Importance of Context: The Ethical Work Climate Construct and Models of Ethical Decision Making -- An Agenda for Research  

Microsoft Academic Search

This paper examines the role which organizational context factors play in individual ethical decision making. Two general propositions are set forth, examining the linkage between ethical work climate and decision making. An agenda for research and the potential implications of the study and practice of managerial ethics are then discussed.

David C. Wyld; Coy A. Jones

1997-01-01

269

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.

Resende, Juliana Alves; Silva, Vania L.; Fontes, Claudia Oliveira; Souza-Filho, Job Alves; de Oliveira, Tamara Lopes Rocha; Coelho, Cintia Marques; Cesar, Dioneia Evangelista; Diniz, Claudio Galuppo

2012-01-01

270

Use of amplified fragment length polymorphism analysis to identify medically important Candida spp., including C. dubliniensis  

Microsoft Academic Search

Non-Candida albicans Candida species are increasingly being isolated. These species show differences in levels of resistance to antimycotic agents and mortality. Therefore, it is important to be able to correctly identify the causative organism to the species level. Identification of C. dubliniensis in particular remains problematic due to the high degree of phenotypic similarity between this species and C. albicans.

A. Borst; B. Theelen; E. Reinders; T. Boekhout; A. C. Fluit; P. H. M. Savelkoul

2003-01-01

271

A Medical Home versus Temporary Housing: The Importance of a Stable Usual Source of Care Among Low-Income Children  

PubMed Central

Introduction Recent health care reform policies focus on finding the best medical home for everyone. Less is known about how the stability of a usual source of care (USC) over time impacts on structural access to care. Objectives To examine the prevalence of USC changes among a low-income population of children, and how these changes were associated with unmet need. Design and Methods Cross-sectional, multivariable analyses of mail-return survey data from Oregon's food stamp program in January 2005. Results from 2,681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling and non-response. The independent variable: whether a child had ever been required to change USC for insurance reasons. Dependent variables included: parents report of unmet medical need, unmet prescription need, missed medication doses, delayed urgent care, no ambulatory visits; and problems obtaining dental care, specialty care and counseling. Results Nearly 23% of children had changed their USC due to insurance reasons, and 10% had no current USC. Compared to children who had maintained a stable USC, children who had changed their USC due to insurance reasons had higher rates of unmet medical need (unadjusted odds ratio [OR] 2.69, 95% confidence interval [CI] 1.83, 3.29); unmet prescription need (OR 1.85, 95% CI 1.31, 2.61); delayed care (OR 1.87, 95% CI 1.21, 2.89); and reported more problems obtaining dental care (OR 1.66, 95% CI 1.20, 2.31) and counseling (OR 3.22, 95% CI 1.53, 6.77). Conclusions This study highlights the importance of ensuring stability with a USC. In our zeal to move people into new medical homes, we need to be wary of harming quality by disturbing existing care relationships, thus merely creating “temporary housing.”

Saultz, John W.; Krois, Lisa

2011-01-01

272

Consistency versus completeness in medical decision-making: exemplar of 155 patients autopsied after coronary artery bypass graft surgery.  

PubMed

Diagnoses made at autopsy are usually yes-no (binary) decisions inferred from clinicopathologic data. A major conceptual problem in determining cause of death is that variables used in classifying some patients may be missing in other patients. A model with too few logical implications will be mathematically incomplete for small data sets; but a model with too many implications may be inconsistent with large data sets. We examined the 155 patients autopsied after coronary artery bypass surgery from The Johns Hopkins Hospital autopsy data base of 43,200 cases. Diagnoses entered on a word processor and transmitted to a minicomputer were solved by the Quine-McCluskey algorithm. Our analysis disclosed that 41% of patients suffered a fatal complication of cardiac surgery; 43% had established surgical complications or unrelated causes of death; and in 17% of cases the cause of death was unexplained. Computerized symbolic logic analysis of medical information is useful in testing the completeness of a proposed set of causes of death. PMID:6336306

Moore, G W; Hutchins, G M

1983-01-01

273

Barcode Identifiers as a Practical Tool for Reliable Species Assignment of Medically Important Black Yeast Species  

PubMed Central

Herpotrichiellaceous black yeasts and relatives comprise severe pathogens flanked by nonpathogenic environmental siblings. Reliable identification by conventional methods is notoriously difficult. Molecular identification is hampered by the sequence variability in the internal transcribed spacer (ITS) domain caused by difficult-to-sequence homopolymeric regions and by poor taxonomic attribution of sequences deposited in GenBank. Here, we present a potential solution using short barcode identifiers (27 to 50 bp) based on ITS2 ribosomal DNA (rDNA), which allows unambiguous definition of species-specific fragments. Starting from proven sequences of ex-type and authentic strains, we were able to describe 103 identifiers. Multiple BLAST searches of these proposed barcode identifiers in GenBank revealed uniqueness for 100 taxonomic entities, whereas the three remaining identifiers each matched with two entities, but the species of these identifiers could easily be discriminated by differences in the remaining ITS regions. Using the proposed barcode identifiers, a 4.1-fold increase of 100% matches in GenBank was achieved in comparison to the classical approach using the complete ITS sequences. The proposed barcode identifiers will be made accessible for the diagnostic laboratory in a permanently updated online database, thereby providing a highly practical, reliable, and cost-effective tool for identification of clinically important black yeasts and relatives.

Heinrichs, Guido; de Hoog, G. Sybren

2012-01-01

274

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

275

Medically important venomous animals: biology, prevention, first aid, and clinical management.  

PubMed

Venomous animals are a significant health problem for rural populations in many parts of the world. Given the current level of the international mobility of individuals and the inquisitiveness of travelers, clinicians and travel clinics need to be able to give advice on the prevention, first aid, and clinical management of envenoming. Health professionals often feel overwhelmed by the taxonomy of venomous animals; however, venomous animals can be grouped, using a simple set of criteria, into cnidarians, venomous fish, sea snakes, scorpions, spiders, hymenoterans, and venomous terrestrial snakes. Geographic distribution, habitats, and circumstances of accidents further reduce the range of culprits that need to be considered in any single event. Clinical management of envenomed patients relies on supportive therapy and, if available, specific antivenoms. Supplies of life-saving antivenoms are scarce, and this scarcity particularly affects rural populations in resource-poor settings. Travel clinics and hospitals in highly industrialized areas predominantly see patients with injuries caused by accidents involving marine animals: in particular, stings by venomous fish and skin damage caused by jellyfish. However, globally, terrestrial venomous snakes are the most important group of venomous animals. PMID:17051499

Junghanss, Thomas; Bodio, Mauro

2006-11-15

276

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.

Casewell, Nicholas R.; Wagstaff, Simon C.; Wuster, 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

277

[Status quo of tumor markers and important points in medical practice].  

PubMed

Tumor markers is a term describing substances produced by tumor cells or in response to tumor cells, and new tumor markers have been found with the progress of examination modalities. Not only Bence-Jones protein and M protein by immunoelectrophoresis, and AFP and CEA by immunochemical analysis, but also hormones, enzymes, and embryonal cancer related substances have been employed for a long time. Recently, a variety of new tumor marker tests have been developed, such as those using monoclonal antibodies that recognize carbohydrate antigens, bone metabolism markers to evaluate bone metastasis of cancer by the type I collagen metabolites, and gene markers to examine oncogenes and tumor suppressor genes by gene cloning and the PCR method. Early detection and diagnosis are keys to countermeasures against cancer, and tumor markers are regarded as a powerful tool for early detection of cancer. However, any tumor marker can be positive without cancer. In addition, problems arise because tumor markers often show negative for early cancer or even advanced cancer. As a result, no ideal tumor marker has been found. Tests of tumor markers aim to screen high-risk patients, differentiate tumor types, monitor therapeutic efficacy, and detect recurrences early. It is important to raise the diagnostic efficiency by avoiding the selection of similar markers in antigenicity, and instead combining two to three markers with little association. PMID:14743745

Shimetani, Naoto

2003-12-01

278

A Point of Care Clinical Decision Support System for the Diagnosis of Neonatal Jaundice by Medical Field Personnel  

Microsoft Academic Search

This study reports the design and successful implementation of a decision support system for use by a multi-purpose health worker or in any situation where there is no immediate pediatric or neonatal care. Furthermore to aid in future decision making and service deployment as also for state of health evaluation and administration the decision support system is augmented by a

S. Srinivasan; D. P. Mital; S. Haque

2006-01-01

279

National Dairy Council Award for Excellence in Medical! Dental Nutrition Education Lecture, 1995: Medical-nutrition education-factors important for developing a successful  

Microsoft Academic Search

Currently, there are no established guidelines which define the goals, the course content, or the approach to developing a successful medical-nutrition education program. The result has been great variability in the approach to teaching nutri- tion to medical students. A common concern among medical educators is how to teach all of the material currently known. The obvious outcome of trying

Roland L Weinsier

280

Shared Medical Decision-Making: Considering what Options to Present based on an Ethical Analysis of the Treatment of Brain Tumors in Very Young Children  

PubMed Central

The treatment of brain tumors in very young children poses both a therapeutic challenge and a bioethical quandary. The administration of craniospinal radiation after surgery offers the greatest chance for cure but causes severe neurocognitive damage. As a result, current practice does not offer parents the option of full-dose post-operative craniospinal radiation. Some may regard this approach as inappropriate medical paternalism, while others may consider it an example of responsible therapeutics. Evaluation of this dilemma reveals principles which can guide clinicians in determining which treatment options to present to their patients or surrogates, in the context of shared medical decision-making.

Levine, Deena; Cohen, Kenneth; Wendler, David

2012-01-01

281

[Survey among Argentine physicians on medical decisions concerning the end of life in patients: active and passive euthanasia, and relief of symptoms].  

PubMed

Euthanasia and other medical decisions concerning the end of life (MDEL) have been poorly developed in the Argentine medical literature. On that basis, and presuming that MDEL occur frequently in the medical practice in our country (in spite of insufficient pre and postgraduate medical education on the matter), we have developed a survey on MDEL. It was conformed by a 13 multiple-choice question poll, which was answered by 172 physicians from Buenos Aires, suburban locations and La Plata. The questionnaire began with a professional profile and subsequently developed questions on medical, legal, ethical, religious and sociologic aspects of MDEL. The questions were based on the main or more frequent topics referred to MDEL, according to the medical literature between 1989 and 1994, researched through Medline. The poll was anonymous. Most of the questions could be answered based on the physician's attitudes toward MDEL; some required specific knowledge on the subject (as in the questions on legal matters). Three different MDEL were defined for this survey: active Euthanasia, Passive Euthanasia and Relief of Symptoms. Results showed that MDEL are frequent (69%) of the physicians have performed Relief of Symptoms, 58% Passive Euthanasia, and 7% Active Euthanasia) and that the physician's knowledge on the subject is poor and sparse. We concluded that more research on MDEL is needed in Argentina in order to support changes in medical education and legal background. PMID:9138341

Falcón, J L; Graciela Alvarez, M

1996-01-01

282

Moving toward comprehensive acute heart failure risk assessment in the emergency department : the importance of self-care and shared decision making.  

PubMed

Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation. PMID:24159563

Collins, Sean P; Storrow, Alan B

2013-08-01

283

The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital.  

PubMed

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three 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. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P?medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations. PMID:20703588

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

2011-02-01

284

[Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].  

PubMed

Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation. PMID:20940116

Vadász, Gábor

2010-10-24

285

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

286

Development of Multiplex Real-Time Reverse Transcriptase PCR Assays for Detecting Eight Medically Important Flaviviruses in Mosquitoes?  

PubMed Central

A multiplex real-time reverse transcriptase PCR has been developed for the rapid detection and identification of eight medically important flaviviruses from laboratory-reared, virus-infected mosquito pools. The method used involves the gene-specific amplification of yellow fever virus (YFV), Japanese encephalitis virus (JEV), West Nile virus (WNV), St. Louis encephalitis virus (SLEV), and dengue virus (DENV) serotypes 1 to 4 (DENV-1 to DENV-4, respectively) by use of the flavivirus consensus amplimers located at the RNA-dependent RNA polymerase domain of nonstructural protein 5. Virus-specific amplicons were detected by four newly characterized TaqMan fluorogenic probes (probes specific for YFV, JEV, WNV, and SLEV) and four previously published probes specific for DENV-1 to -4 (L. J. Chien, T. L. Liao, P. Y. Shu, J. H. Huang, D. J. Gubler, and G. J. Chang, J. Clin. Microbiol. 44:1295-1304, 2006). This assay had a specificity of 100% and various sensitivities of at least 3.5 PFU/ml for YFV, 2.0 PFU/ml for JEV, 10.0 PFU/ml for WNV, and 10.0 PFU/ml for SLEV. Additionally, we have developed an in vitro transcription system to generate RNase-resistant RNA templates for each of these eight viruses. These templates can be incorporated into the assay as RNA copy number controls and/or as external controls for RNA-spiked mosquito pools for quality assurance purposes. Although further study with mosquitoes collected in the field is needed, the incorporation of this assay into mosquito surveillance could be used as an early-warning system for the detection of medically important flaviviruses, particularly when the cocirculation of multiple viruses in the same region is suspected.

Chao, Day-Yu; Davis, Brent S.; Chang, Gwong-Jen J.

2007-01-01

287

Medical end-of-life decisions made for neonates and infants in the Netherlands, 1995-2001.  

PubMed

End-of-life decision-making for severely affected infants might be influenced by technical advances and societal debates. In 2001, we assessed the proportion of deaths of infants younger than 1 year that were preceded by end-of-life decisions, by replicating a questionnaire study from 1995. This proportion increased from 62% to 68% (weighted percentages), but the difference was not significant. Most of these decisions were to forgo life-sustaining treatment. Decisions to actively end the lives of infants not dependent on life-sustaining treatment remained stable at 1%. The practice of end-of-life decision-making in neonatology of 2001 has changed little since 1995. PMID:15823383

Vrakking, Astrid M; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D; Keij-Deerenberg, Ingeborg M; van der Maas, Paul J; van der Wal, Gerrit

288

[Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica].  

PubMed

Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica. Unrefined cristalised cane sugar, obtained after the filtration and evaporation of sugar cane juice, is a nutritional product of traditional consumption in Costa Rica and other Neotropical countries. It has been used in the topic treatment of infected wounds, with satisfactory results even with some antibiotic-ressistant bacteria. We studied the microbiological quality of 50 commercial samples. The analyses included total aerobic and anaerobic bacteria plate count; aerobic and anaerobic spore count; mold and yeast count; total and fecal coliforms; and presence of Clostridium botulinum. The antimicrobial effect was tested for Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC 25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) and Aspergillus niger (Asni 06). Most of the samples (76%) presented counts lower than 100 CFU/g especially for sporulated forms (90% lower than 20 CFU/g), the mold and yeast count was higher (38% higher than 10(2) CFU/g), demonstrating the importance of these microorganisms in the spoilage of the product; 76% of the samples presented fecal contamination; C. botulinum was not isolated with the methodology employed. No inhibitory effect was observed for A. niger, but all samples han an inhibitory effect over the other species, especially for P. aeruginosa and S. aureus. PMID:19256417

Pujol, Verónica; Diaz, Jendry; Rodríguez, Evelyn; Arias, María Laura

2008-06-01

289

An Interactive Medical Knowledge Assistant  

NASA Astrophysics Data System (ADS)

This paper describes an interactive medical knowledge assistant that can help a doctor or a patient in making important health related decisions. The system is Web based and consists of several modules, including a medical knowledge base, a doctor interface module, patient interface module and a the main module of the medical knowledge assistant. The medical assistant is designed to help interpret the fuzzy data using rough sets approach. The patient interface includes sub-system for real time monitoring of patients' health parameters and sending them to the main module of the medical knowledge assistant.

Czejdo, Bogdan D.; Baszun, Mikolaj

290

Rapid Extraction of Genomic DNA from Medically Important Yeasts and Filamentous Fungi by High-Speed Cell Disruption  

PubMed Central

Current methods of DNA extraction from different fungal pathogens are often time-consuming and require the use of toxic chemicals. DNA isolation from some fungal organisms is difficult due to cell walls or capsules that are not readily susceptible to lysis. We therefore investigated a new and rapid DNA isolation method using high-speed cell disruption (HSCD) incorporating chaotropic reagents and lysing matrices in comparison to standard phenol-chloroform (PC) extraction protocols for isolation of DNA from three medically important yeasts (Candida albicans, Cryptococcus neoformans, and Trichosporon beigelii) and two filamentous fungi (Aspergillus fumigatus and Fusarium solani). Additional extractions by HSCD were performed on Saccharomyces cerevisiae, Pseudallescheria boydii, and Rhizopus arrhizus. Two different inocula (108 and 107 CFU) were compared for optimization of obtained yields. The entire extraction procedure was performed on as many as 12 samples within 1 h compared to 6 h for PC extraction. In comparison to the PC procedure, HSCD DNA extraction demonstrated significantly greater yields for 108 CFU of C. albicans, T. beigelii, A. fumigatus, and F. solani (P ? 0.005), 107 CFU of C. neoformans (P ? 0.05), and 107 CFU of A. fumigatus (P ? 0.01). Yields were within the same range for 108 CFU of C. neoformans and 107 CFU of C. albicans for both HSCD extraction and PC extraction. For 107 CFU of T. beigelii, PC extraction resulted in a greater yield than did HSCD (P ? 0.05). Yields obtained from 108 and 107 CFU were significantly greater for filamentous fungi than for yeasts by the HSCD extraction procedure (P < 0.0001). By the PC extraction procedure, differences were not significant. For all eight organisms, the rapid extraction procedure resulted in good yield, integrity, and quality of DNA as demonstrated by restriction fragment length polymorphism, PCR, and random amplified polymorphic DNA. We conclude that mechanical disruption of fungal cells by HSCD is a safe, rapid, and efficient procedure for extracting genomic DNA from medically important yeasts and especially from filamentous fungi.

Muller, Frank-Michael C.; Werner, Katherine E.; Kasai, Miki; Francesconi, Andrea; Chanock, Stephen J.; Walsh, Thomas J.

1998-01-01

291

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

292

Importance-performance analysis of service attributes and its impact on decision making in the mobile telecommunication industry  

Microsoft Academic Search

Purpose – Customer relationship management (CRM) strategies rely heavily on the importance and performance of the attributes that define a service. The aim of this paper is first to investigate the asymmetric relationship between performance of service attributes and customer satisfaction, and second, through a case study in the mobile telecommunication industry to prove that the importance of a service

Vahid Pezeshki; Alireza Mousavi; Susan Grant

2009-01-01

293

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

...Permits for the Importation of Fresh Male Summer Squash Flowers From Israel Into the Continental...continental United States of fresh male summer squash flowers from Israel. Based on...weeds via the importation of fresh male summer squash flowers from Israel....

2010-05-25

294

Genetic markers for the identification and characterization of Opisthorchis viverrini, a medically important food borne trematode in Southeast Asia  

PubMed Central

The liver fluke, Opisthorchis viverrini, is one of the major food borne trematodes in Southeast Asia, where infection causes hepatobiliary disease and subsequent development of cholangiocarcinoma. In Thailand, O. viverrini is most prevalent in the northeast where there is marked regional variation in the rate of infection in humans at provincial, district and village levels. To date, the roles of genetic variation of O. viverrini on this observed variability in infection, transmission and associated disease are not known. We have applied multilocus enzyme electrophoresis (MEE), specifically allozyme electrophoresis, to isolates of O. viverrini from Thailand and Laos to establish genetic markers to examine its systematics and population structure. Forty-six enzymes commonly found useful for genetic characterisation in parasitic helminths were screened, and of these, 33 enzymes gave sufficient staining and resolution to act as potential genetic markers. Sixteen enzymes were monomorphic and 17 enzymes were polymorphic in the pools of worms examined. Whether they are indicative of different enzyme loci, heterozygosity or unique genotypes within the pools of worms examined remains to be determined. Preliminary investigations examining five individual worms at enzyme loci where pools of worms showed multiple bands have confirmed the diagnostic value of the enzyme loci established as well as providing evidence of potential population sub structuring and heterozygosity. For the first time, we have established at least 17 enzymes that provide the basis to undertake comprehensive genetic analyses of the systematics and population structure of O. viverrini, a medically important food borne trematode in Southeast Asia.

Saijuntha, Weerachai; Sithithaworn, Paiboon; Wongkham, Sopit; Laha, Thewarach; Pipitgool, Vichit; Petney, Trevor N; Andrews, Ross H

2006-01-01

295

On Behavior Strategy Solutions in Two-Person Zero-Sum Finite Extended Games with Imperfect Information. Part II. Determination of a Minimally Complex Behavior Strategy Solution in a Medical Decision Process.  

National Technical Information Service (NTIS)

A medical decision process is considered in which a doctor must make a sequence of treatment and operate-don't operate decisions for a patient on the basis of treatment and diagnosis information which the doctor gathers as he proceeds. By examining a set ...

V. A. Utgoff R. L. Kashyap

1971-01-01

296

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

297

75 FR 71415 - Notice of Decision To Issue Permits for the Importation of Wall Rocket Leaves From the United...  

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 wall rocket leaves from the United Kingdom. DATES: Effective Date: November 23, 2010. FOR...

2010-11-23

298

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

299

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

300

76 FR 61340 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...  

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 apricot, sweet cherry, and plumcot fruit from South Africa. We are also revising a...

2011-10-04

301

78 FR 69640 - Notice of Decision To Authorize the Importation of Swiss Chard From Colombia Into the Continental...  

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 Swiss chard from Colombia. DATES: Effective: November 20, 2013. FOR FURTHER INFORMATION...

2013-11-20

302

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

303

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

304

The testimony of elderly victim/witnesses and their impact on juror decisions: the importance of examining multiple stereotypes.  

PubMed

The goal of the current investigation was to determine how jurors may be influenced by elderly victim/witnesses. Stereotypes of elderly victim/witnesses were hypothesized to differentially impact jurors' perceptions and decisions. Participants (255 college and 229 community members who were jury-eligible) read a trial summary describing the aggravated assault of a man. The described case hinged on the victim's eyewitness identification of the defendant. The description of the victims was varied in order to examine five types of victim/witnesses: (1) a generic adult victim, described as being 31 years of age, (2) a generic elderly witness, described as being 66 years of age, (3) a 66-year-old senior citizen described to elicit the vulnerable-senior stereotype, (4) a 66-year-old grandfather, and (5) a 66-year-old statesman. Contrary to expectations, no significant differences were found between the college and community samples. Further, ratings of the victims' believability did not vary as a function of the different victim types. However, verdict differences were found for the different victim types. The proportion of guilty verdicts awarded in the statesman condition was significantly higher than those awarded when the victim was a generic adult, senior citizen, or grandfather. A significant difference was also found between the vulnerable senior citizen and the generic elderly case, with the generic elderly victim receiving a greater proportion of guilty verdicts than the vulnerable senior citizen. PMID:10439725

Nunez, N; McCoy, M L; Clark, H L; Shaw, L A

1999-08-01

305

Consumer involvement in nonprescription medicine purchase decisions.  

PubMed

As self-medication with nonprescription drugs becomes increasingly popular and important in this era of escalating health care costs and growing consumer sophistication, the degree of consumer involvement in the purchase decision becomes an important factor. High involvement suggests active information-seeking behavior and, therefore, a greater likelihood of appropriate nonprescription drug use. The authors assess consumer involvement in nonprescription medicine purchase decisions and the use of expert sources of information. PMID:10137123

Gore, P; Madhavan, S; McClung, G; Riley, D

1994-01-01

306

Medication regimes in the context of end-of-life decisions in neonatology: legal considerations with regard to Dutch NICU-practice.  

PubMed

Developments in legal and medical research concerning end-of-life decisions regarding severely suffering neonates in the Netherlands provide good cause for reflection on specific items of this issue. This article deals with the outcomes of the first national survey on end-of-life practice in Dutch Neonatal Intensive Care Units (NICUs) and examines the legal aspects of the use of medication as a part of this practice. The authors particularly reflect on the application of analgesics and sedatives on the one hand and neuromuscular blockers (NMBs) on the other hand. Furthermore, they focus on different elements of medicinal use such as indication, the moment of administering, dosage, effects of combinations of drugs, the relationship to the causation of death and (failures in) documentation. PMID:23447910

Dorscheidt, Jozef H H M; Verghagen, Eduard; Sauder, Pieter J J; Hubben, Joep H

2012-12-01

307

Medication regimes in the context of end-of-life decisions in neonatology: legal considerations with regard to Dutch NICU-practice.  

PubMed

Developments in legal and medical research concerning end-of-life decisions regarding severely suffering neonates in the Netherlands provide good cause for reflection on specific items of this issue. This article deals with the outcomes of the first national survey on end-of-life practice in Dutch Neonatal Intensive Care Units (NICUs) and examines the legal aspects of the use of medication as a part of this practice. The authors particularly reflect on the application of analgesics and sedatives on the one hand and neuromuscular blockers (NMBs) on the other hand. Furthermore, they focus on different elements of medicinal use such as indication, the moment of administering, dosage, effects of combinations of drugs, the relationship to the causation of death and (failures in) documentation. PMID:23967795

Dorscheidt, Jozef H H M; Verhagen, Eduard; Sauer, Pieter J J; Hubben, Joep H

2013-06-01

308

Translating Research into Practice: Organizational Issues in Implementing Automated Decision Support for Hypertension in Three Medical Centers  

PubMed Central

Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with electronic patient data to present real-time, patient-specific recommendations. However, technical success in implementing decision support systems may not translate directly into system use by clinicians. Successful technology integration into clinical work settings requires explicit attention to the organizational context. We describe the application of a “sociotechnical” approach to integration of ATHENA DSS, a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics. We applied an iterative technical design in response to organizational input and obtained ongoing endorsements of the project by the organization's administrative and clinical leadership. Conscious attention to organizational context at the time of development, deployment, and maintenance of the system was associated with extensive clinician use of the system.

Goldstein, Mary K.; Coleman, Robert W.; Tu, Samson W.; Shankar, Ravi D.; O'Connor, Martin J.; Musen, Mark A.; Martins, Susana B.; Lavori, Philip W.; Shlipak, Michael G.; Oddone, Eugene; Advani, Aneel A.; Gholami, Parisa; Hoffman, Brian B.

2004-01-01

309

In Vitro Antibacterial Screening of Six Proline-Based Cyclic Dipeptides in Combination with ?-Lactam Antibiotics Against Medically Important Bacteria.  

PubMed

The in vitro synergistic antibacterial activity of six proline-based cyclic dipeptides [cyclo(D-Pro-L-Leu), cyclo(L-Pro-L-Met), cyclo(D-Pro-L-Phe), cyclo(L-Pro-L-Phe), cyclo(L-Pro-L-Tyr), and cyclo(L-Pro-D-Tyr)] in combination imipenem and ceftazidime was investigated in the present manuscript. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the cyclic dipeptides were compared with those of the standard antibiotics (imipenem and ceftazidime). The synergistic antibacterial activities of cyclic dipeptides with imipenem or ceftazidime were assessed using the checkerboard and time-kill methods. The results of the present study showed that the combined effect of six cyclic dipeptides with imipenem predominantly recorded synergistic interaction (FIC index <0.5), whereas combination of certain cyclic dipeptides with ceftazidime recorded additive. The time-kill curve showed that the growth of the test bacteria was completely attenuated after 12-24 h of treatment with a 50:50 ratio of proline-based cyclic dipeptides and antibiotics. These synergistic effects have a potential role in delaying the development of resistance as the antibacterial activity is achieved with the very low concentrations of cyclic dipeptides and antibiotics. The cytotoxicity of cyclic dipeptides was tested against VERO cell line (African green monkey kidney cell line), and no cytotoxicity was recorded for cyclic dipeptides up to 100 ?g/mL. These findings suggest that combination of cyclic dipeptides and antibiotics might be a good strategy for the individualization of novel templates for the development of new antimicrobial agents or combinations of drugs for antimicrobial chemotherapy. Moreover, these combinations may lead to the development of a new and vital antimicrobial combination against the infections caused by pathogenic bacteria. The in vitro synergistic activity of cyclic dipeptides with antibiotics against medically important bacteria is reported here for the first time. PMID:24622848

Kumar, S Nishanth; Lankalapalli, Ravi S; Kumar, B S Dileep

2014-05-01

310

Agricultural Conservation: Farm Program Payments are an Important Factor in Landowners' Decisions to Convert Grassland to Cropland.  

National Technical Information Service (NTIS)

The nation's remaining grassland has several important benefits, such as providing land for grazing and wildlife habitat for many at-risk species. However, over the past 3 centuries about half of the grassland has been converted to other uses, principally...

2007-01-01

311

[The importance of the examination of, education on, and infection control of tuberculosis in medical school hospitals in Japan].  

PubMed

Since the incidence of tuberculosis (TB) has markedly decreased over the last half-century, dedicated TB hospitals in Japan have been reducing the beds or have been merging with other hospitals. In accordance with this situation, less than 30% of medical school hospitals (MSHs) have facilities for infectious TB patients. In the meantime, and contrary to the previous trend, elderly TB patients or those who have serious underlying diseases have been increasing. MSHs have therefore not only to take care of these patients, but at the same time they have to reform their TB education system in addition to upgrading TB infection control. To elucidate the current problem regarding TB in MSHs, the survey in the current study was performed for 80 MSHs in Japan in January 2002. Two sets of questionnaires were prepared and delivered to doctors in these hospitals. One set mainly asked about the status of TB examination and education, and was aimed at doctors in the division of respiratory diseases of the department of internal medicine (Rs); and the other mainly asked about the status of TB infection control and was aimed at doctors in the divisions of infectious diseases, or whoever in charge of hospital infection control (Is). Response rates from Rs and Is were 75.0% (60/80) and 65.0% (52/80), respectively. Seventy-three point three percent (44/60) of Rs and 73.1% (38/52) of Is were working in hospitals without TB beds. Because of the current incidence of TB, the number of TB patients they examined in a year was small (35/60 of hospitals examined less than 20 TB patients in a year). Although there were some experienced doctors on TB in each hospital, most MSHs had only a small number of experienced nurses. Nevertheless, 89.3% of doctors in MSHs (a total of 100/112 Rs and Is) believed that they required TB rooms exclusively for TB patients who have some underlying diseases, and for TB education. Regarding the role of MSHs for TB patients care, the majority of doctors (70.5% of Rs and 68.4% of Is) considered MSHs should be able to offer treatment to TB patients with underlying complications. As to the educational aspect, most medical schools (MSs) devoted little time to lectures on TB (the median was 1 to 1.5 hour); on the other hand, some MSs (31.8%: 14/44 of MSHs without TB rooms) included a clinical practices in TB hospitals for TB education, although its term was short. Regarding TB infection control issues, most of the MSHs had active infection control committees in their hospitals and TB was thought to be one of the most important targets for these committees. About 40% (20/51) of these hospitals over the past few years had experienced nosocomial TB infection due in part to the so called "Doctor's delay". As one of the strategies to prevent nosocomial TB infection, special education sessions, not only for staff and residents but also students, were therefore performed in 60.8% (31/51) of MSHs. As to the evaluation of the tuberculin skin test (TST) status of medical students, the two-step TST was performed in 47.1% (24/51) of MSs (as most Japanese underwent their BCG vaccination in their childhood) and 54.9% (28/51) of MSs had a BCG revaccination policy for TST negative students. Although steps toward reforms in TB issues in MSHs were slow, some minor progress had been made as compared with previous surveys performed by us and others. Even though the numbers of TB patients examined in MSHs have been smaller than before, MHSs still have to take care of some TB patients with some complications. A great deal of effort still needs to be expended to establish efficient and effective TB education and infection control systems. Even though many ideas have been put forward to improve the current situation, one of the most successful answers is to set up small number of special rooms, not only for TB patients but also for other airborne infectious diseases, in all MHSs. The other clue is to establish an intimate collaboration between MSHs and TB hospitals with regard to clinical TB education not only for medical students but al

Kurane, Shuji; Kudoh, Shoji

2003-09-01

312

EFFECTIVENESS OF THE EMERGENCY RESPONSE COURSE IN IMPROVING STUDENT PHYSICAL THERAPISTS' AND LICENSED PHYSICAL THERAPISTS' DECISION-MAKING RELATED TO ACUTE SPORTS INJURIES AND MEDICAL CONDITIONS  

PubMed Central

Purpose: To analyze the effectiveness of the American Red Cross Emergency Response Course (ARC ERC) in improving decision?making skills of physical therapists (PTs) and third semester clinical doctorate student physical therapists (SPTs) when assessing acute sports injuries and medical conditions. Methods: An existing questionnaire was modified, with permission from the original authors of the instrument. The questionnaire was administered to PTs and SPTs before the start of and immediately after the completion of 5 different ARC ERCs. The overall percentages of “Appropriate” responses for the 17 case scenarios were calculated for each participant for the pre?and post?tests. Participants also rated their perceived level of preparedness for managing various conditions using a 5?point Likert Scale (ranging from Prepared to Unprepared). The overall percentage of “Prepared/Somewhat Prepared” responses for the 16 medical conditions was calculated for each participant for the pre?and post?tests. In addition, mean Likert scale scores were calculated for level of perceived preparedness for each of the 16 medical conditions. Paired t?tests, calculated with SPSS 20.0, were used to analyze the data. Results: 37 of 37 (100.0%) of eligible PTs and 45 of 48 (93.8%) of eligible SPTs completed the pre? and post?test questionnaires. The percentage of “Appropriate” responses for all 17 cases in the aggregate (PTs: 76.8% pre?test, 89.0% post?test; SPTs: 68.5%, 84.3%), as well as the percentage of “Prepared/Somewhat Prepared” responses for all conditions in the aggregate (PTs: 67.5%, 96.5%; SPTs: 37.1%, 90.6%) were significantly different from pre?test to post?test (P = .000). There was also a significant difference (P < .05) in the mean overall preparedness Likert scale scores from pre?test to post?test for each medical condition for the SPT's, and 15 of the 16 medical conditions (muscle strains: P = .119) for the PTs. Conclusions: The ARC ERC appears to be effective in improving both PTs' and SPTs' decision?making skills related to acute sports injuries and medical conditions, as both “Appropriate” responses and perceived level of preparedness improved. Level of Evidence: Level 3

Cross, Patrick Stephen; Hauer, Patrick L.; Blom, Heather; Burcham, Jared; Myers, Amanda K.; Grimsrud, Casey

2013-01-01

313

A survey of decision tree classifier methodology  

NASA Technical Reports Server (NTRS)

Decision Tree Classifiers (DTC's) are used successfully in many diverse areas such as radar signal classification, character recognition, remote sensing, medical diagnosis, expert systems, and speech recognition. Perhaps, the most important feature of DTC's is their capability to break down a complex decision-making process into a collection of simpler decisions, thus providing a solution which is often easier to interpret. A survey of current methods is presented for DTC designs and the various existing issue. After considering potential advantages of DTC's over single stage classifiers, subjects of tree structure design, feature selection at each internal node, and decision and search strategies are discussed.

Safavian, S. Rasoul; Landgrebe, David

1990-01-01

314

A survey of decision tree classifier methodology  

NASA Technical Reports Server (NTRS)

Decision tree classifiers (DTCs) are used successfully in many diverse areas such as radar signal classification, character recognition, remote sensing, medical diagnosis, expert systems, and speech recognition. Perhaps the most important feature of DTCs is their capability to break down a complex decision-making process into a collection of simpler decisions, thus providing a solution which is often easier to interpret. A survey of current methods is presented for DTC designs and the various existing issues. After considering potential advantages of DTCs over single-state classifiers, subjects of tree structure design, feature selection at each internal node, and decision and search strategies are discussed.

Safavian, S. R.; Landgrebe, David

1991-01-01

315

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.

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

2014-01-01

316

Medication adherence in schizophrenia: Exploring patients', carers' and professionals' views  

Microsoft Academic Search

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping.

Martijn J. Kikkert; Aart H. Schene; Maarten W. J. Koeter; Debbie Robson; Anja Born; Hedda Helm; Michela Nose; Claudia Goss; Graham Thornicroft; Richard J. Gray

2006-01-01

317

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.

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

1996-01-01

318

Medic-Abdominal Pain: A Decision Support Program for the Management of Acute Abdominal Pain. (User's Manual).  

National Technical Information Service (NTIS)

This user's manual is designed to accompany the Medic - Abdominal Pain Program for MS-DOS computers. The manual contains introductory information, a description of equipment needed, an overview of the different parts of the system, a tutorial, a list of t...

B. G. Caras D. G. Southerland K. D. Fisherkeller

1989-01-01

319

[Choice and disclosure of preferences, towards sharing the therapeutic decision in cancerology: from economic theory to medical practice].  

PubMed

Today, as it is often difficult to demonstrate the superiority of a new molecule or a therapeutic strategy in term of plain efficacy on disease, the incitement is strong to provide some complementary argument of assessment, we are assisting to the emergence of a new concept: shared therapeutic decision making. Is the application of this concept--with make the paternalistic model questionnable--adapted to all cases? What are the different levels of participation that could be envisaged? Are there favourable methods for this participations? This shared decision making--direct (patients' choice between treatment options) or indirect (integration of elicited preferences in the decision process)--if it has to be efficient, must surround with care: to define its application limitation, to protect itself of manipulation. It shall require to consider information transmission difficulties, to establish some elicitation preference method. Some technical, such as time trade off, standard gamble or willingness to pay, supported by economic theory of expected utility, permit to help eliciting patients' preferences and to structure the therapeutic choice. Some empirical study of preference elicitation shall permit to get clear the complexity of trade off between the different choice element that could enter in the acceptability of the treatment for patients. PMID:9752336

Protière, C; Moatti, J P; Maraninchi, D; Viens, P

1998-02-01

320

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.

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

2013-01-01

321

The Epidemiology of Imported Malaria in Taiwan between 2002-2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice  

PubMed Central

The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.

Chen, Shou-Chien; Chang, Hsiao-Ling; Chen, Kow-Tong

2014-01-01

322

The epidemiology of imported malaria in Taiwan between 2002-2013: the importance of sensitive surveillance and implications for pre-travel medical advice.  

PubMed

The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20-5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan. PMID:24871257

Chen, Shou-Chien; Chang, Hsiao-Ling; Chen, Kow-Tong

2014-06-01

323

A Quantitative Assessment of "At Risk" Students and Medical School Performance: The Importance of Adequate Advising and Mentorship.  

ERIC Educational Resources Information Center

The purpose of this study was to examine the impact of mentorship and advising as related to underrepresented minority (URM) students' experience and performance in medical school. URM students (n=23) from the University of Illinois at Chicago College of Medicine who matriculated in 1994 and 1995, and who were determined to be at risk of delay or…

Tekian, Ara; Jalovecky, Michael J.; Hruska, Laura

324

PREFERENCE RANKING AND DECISIONS BASED ON FUZZY EXPERT INFORMATION  

Microsoft Academic Search

. Abstract: - This paper deals with group decisions based on the rating methods of fuzzy and regular preference rankings. The preference ranking is one of the methods to solve so -called selection problems. Selection problems are very important for decisio n making in unique systems such as medical, environmental or ecological ones. Very often the right decision is based

ALEXEY L. SADOVSKI

325

Empirical Research on Euthanasia and Other Medical End-of-Life Decisions and the Euthanasia Notification Procedure  

Microsoft Academic Search

In the Netherlands, the practice of life-termination by physicians is still subject to the penal code and yet, since the seventies\\u000a euthanasia and physician assisted death are continuing to occur more openly; this development is supported by public opinion,\\u000a the majority of doctors, and in jurisprudence. Requirements for prudent practice have been compiled in jurisprudence and by\\u000a the medical profession

Gerrit van der Wal; P. J. van der Maas

326

Medical tourism.  

PubMed

Medical tourism is becoming popular as an alternative to the high cost of health care in the United States and as an inexpensive resource for cosmetic surgery. The occupational health nurse is an excellent resource to assist in the pre-decision due diligence and post-decision travel health counseling. PMID:20102121

Tompkins, Olga S

2010-01-01

327

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized, Controlled Educational Intervention  

Microsoft Academic Search

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in

Laura Weiss Roberts; Teddy D. Warner; Laura B. Dunn; Janet L. Brody; Katherine A. Green Hammond; Brian B. Roberts

2007-01-01

328

A Method for Fuzzy Soft Sets in Decision Making Based on Grey Relational Analysis and D-S Theory of Evidence: Application to Medical Diagnosis  

PubMed Central

A method based on grey relational analysis and D-S theory of evidence is proposed for fuzzy soft sets in decision making. Firstly, grey relational analysis is used to calculate grey mean relational degrees and determine uncertain degrees of parameters. Then based on uncertain degrees, suitable mass functions of different independent alternatives with different parameters can be constructed. Next, D-S rule of evidence combination is applied to aggregate these alternatives into a collective alternative. Finally, these alternatives are ranked and the best alternative(s) are obtained. Moreover, the effectiveness and feasibility of this method are demonstrated by comparing with the mean potentiality approach and giving an application to medical diagnosis.

Xie, Ningxin; Wen, Guoqiu; Li, Zhaowen

2014-01-01

329

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.

2013-01-01

330

Decision Support Tool for Early Differential Diagnosis of Acute Lung Injury and Cardiogenic Pulmonary Edema in Medical Critically Ill Patients  

PubMed Central

Background: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. Methods: In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Results: Of 332 patients in a development cohort, expert reviewers (?, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio2 ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). Conclusions: A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.

Shahjehan, Khurram; Li, Guangxi; Dhokarh, Rajanigandha; Kashyap, Rahul; Janish, Christopher; Alsara, Anas; Jaffe, Allan S.; Hubmayr, Rolf D.; Gajic, Ognjen

2012-01-01

331

Combining decision support and image processing: a PROforma model  

Microsoft Academic Search

This paper addresses two important problems in medical image interpretation: (1) integration of numeric and symbolic information, (2) access to external sources of medical knowledge. We have developed a prototype in which image processing algorithms are combined with symbolic representations for reasoning, decision making and task management in an integrated, platform-independent system for the differential diagnosis of abnormalities in mammograms.

M. Sordo; J. Fox; C. Blum; Paul Taylor; Richard Lee; Eugenio Alberdi

332

Decisive Evidence on a Smaller-Than-You-Think Phenomenon: Revisiting the "1-in-X" Effect on Subjective Medical Probabilities.  

PubMed

Accurate perception of medical probabilities communicated to patients is a cornerstone of informed decision making. People, however, are prone to biases in probability perception. Recently, Pighin and others extended the list of such biases with evidence that "1-in-X" ratios (e.g., "1 in 12") led to greater perceived probability and worry about health outcomes than "N-in-X*N" ratios (e.g., "10 in 120"). Subsequently, the recommendation was to avoid using "1-in-X" ratios when communicating probabilistic information to patients. To warrant such a recommendation, we conducted 5 well-powered replications and synthesized the available data. We found that 3 out of the 5 replications yielded statistically nonsignificant findings. In addition, our results showed that the "1-in-X" effect was not moderated by numeracy, cognitive reflection, age, or gender. To quantify the evidence for the effect, we conducted a Bayes factor meta-analysis and a traditional meta-analysis of our 5 studies and those of Pighin and others (11 comparisons, N = 1131). The meta-analytical Bayes factor, which allowed assessment of the evidence for the null hypothesis, was very low, providing decisive evidence to support the existence of the "1-in-X" effect. The traditional meta-analysis showed that the overall effect was significant (Hedges' g = 0.42, 95% CI 0.29-0.54). Overall, we provide decisive evidence for the existence of the "1-in-X" effect but suggest that it is smaller than previously estimated. Theoretical and practical implications are discussed. PMID:24310649

Sirota, Miroslav; Juanchich, Marie; Kostopoulou, Olga; Hanak, Robert

2014-05-01

333

Real-time detection of common microbial volatile organic compounds from medically important fungi by Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS)  

Microsoft Academic Search

We describe a new method, Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) for the rapid and sensitive real-time detection and quantification of volatile organic compounds from medically important fungi, grown on a range of laboratory media.SIFT-MS utilises the chemical ionisation reactions of mass-selected ions to characterise volatile organic compounds (VOCs) that are produced as metabolites from fungi. This technique has the

Jennifer M. Scotter; Vaughan S. Langford; Paul F. Wilson; Murray J. McEwan; Stephen T. Chambers

2005-01-01

334

Multicriteria Decision Analysis in Group Decision Processes  

Microsoft Academic Search

\\u000a Important decisions are often taken by groups of decision makers who need to make choices among several alternatives, based\\u000a on an appraisal of how the alternatives are likely to perform with regard to multiple objectives. Such decision processes\\u000a can be supported by the methods of multi-criteria decision analysis (MCDA) which help generate decision recommendations and\\u000a offer process benefits in terms

Ahti Salo; Raimo P. Hämäläinen

335

Ontology driven decision support systems for medical diagnosis - an interactive form for consultation in patients with plasma cell disease.  

PubMed

Multiple myeloma (MM) is a malignant disorder characterized by the monoclonal proliferation of B cell derived plasma cells in the bone marrow. The diagnosis depends on the identification of abnormal monoclonal marrow plasma cells, monoclonal protein in the serum or urine, evidence of end-organ damage, and a clinical picture consistent with MM. The distinction between MM stages- monoclonal gammopathy of undetermined significance or indolent myeloma-is critical in guiding therapy. This paper describes how to produce ontology-driven semiological rules base (SRB) and a consultation form to aid in the diagnosis of plasma cells diseases. We have extracted the MM sub-ontology from the NCI Thesaurus. Using Protégé 3.4.2 and owl1, criteria in the literature for the diagnosis and staging of MM have been added to the ontology. All quantitative parameters have been transformed to a qualitative format. A formal description of MM variants and stages has been given. The obtained ontology has been checked by a reasoner and instantiated to obtain a SRB. The form created has been tested and evaluated utilizing 63 clinical medical reports. The likelihood for a disease being the correct diagnosis is determined by computing a ratio. The resulting tool is relevant for MM diagnosis and staging. PMID:22874162

Donfack Guefack, Valéry; Bertaud Gounot, Valérie; Duvauferrier, Régis; Bourde, Annabel; Morelli, John; Lasbleiz, Jérémy

2012-01-01

336

Case-based reasoning in Intelligent Health Decision Support Systems.  

PubMed

Decision-making is a crucial task for decision makers in healthcare, especially because decisions have to be made quickly, accurately and under uncertainty. Taking into account the importance of providing quality decisions, offering assistance in this complex process has been one of the main challenges of Artificial Intelligence throughout history. Decision Support Systems (DSS) have gained popularity in the medical field for their efficacy to assist decision-making. In this sense, many DSS have been developed, but only few of them consider processing and analysis of information contained in electronic health records, in order to identify individual or population health risk factors. This paper deals with Intelligent Decision Support Systems that are integrated into Electronic Health Records Systems (EHRS) or Public Health Information Systems (PHIS). It provides comprehensive support for a wide range of decisions with the purpose of improving quality of care delivered to patients or public health planning, respectively. PMID:23739355

González, Carolina; López, Diego M; Blobel, Bernd

2013-01-01

337

Dementia, Goals of Care, and Personhood: A Study of Surrogate Decision Makers’ Beliefs and Values  

Microsoft Academic Search

Surrogate decision makers for persons with advanced dementia play a key role in making decisions about medical treatments for their loved ones. We conducted in-depth interviews of 20 surrogates to examine their goals of care preferences and beliefs about personhood. All surrogates believed the goal of comfort was important, and 30.0% believed that curing physical problems was important. Significant proportions

Lauris C. Kaldjian; Laura A. Shinkunas; Mercedes Bern-Klug; Susan K. Schultz

2010-01-01

338

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.

2012-01-01

339

[Importance of medical treatment in second echelon during war in Croatia, example--war surgical hospital in Garesnica].  

PubMed

At beginning of 1991, the increasing necessity of emergency surgical treatment of wounded persons in Croatia led to the formation of mobile surgical teams. However, this system was abandoned due to many problems and echelon health division was formed. One of the war surgical hospitals (second echelon) was the War Surgical Hospital Garesnica. In this study, materials of the Croatian War Veterans Ministry, Ministry of Defense, Garesnica War Surgical Hospital and Garesnica Defense Office archive were used. We analyzed the number and localization of wounds, and describe the organization, work and results of the War Surgical Hospital in Garesnica. During the work of the War Surgical Hospital in Garesnica, 909 surgical examinations were performed, 521 wounded were surgically treated (45% civilians and 55% soldiers), 331 wounded were operated on, 5 lethal outcomes were recorded, 68% of wounds were localized on the extremities, 19% on the thorax and abdomen, and 13% on the head end neck. In this article the organization and work of the War Surgical Hospital in Garesnica is described, which had a major role in providing emergency medical care to people wounded in west Slavonia. PMID:19580229

Gveri?, Tugomir; Huljev, Dubravko; Zdilar, Boris; Kolak, Toni; Barisic, Jadranko; Ahmetasovic, Snjezana Gveric; Trajbar, Dubravka; Lojo, Nermin; Sever, Marko

2009-05-01

340

[Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].  

PubMed

In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results. PMID:24831432

Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

2014-01-01

341

Decision support using anesthesia information management system records and accreditation council for graduate medical education case logs for resident operating room assignments.  

PubMed

Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. A Rhinos pilot was performed for 6 weeks on 2 clinical services. One hundred sixty-five requests were entered and used in OR assignment decisions by a single attending anesthesiologist. Each request consisted of a rank ordered list of up to 3 ORs. Residents had access to detailed information about these cases including surgeon and patient name, age, procedure type, and admission status. Success rates at matching resident requests were determined by comparing requests with AIMS records. Of the 165 requests, 87 first-choice matches (52.7%), 27 second-choice matches (16.4%), and 8 third-choice matches (4.8%) were made. Forty-three requests were unmatched (26.1%). Thirty-nine first-choice requests overlapped (23.6%). Full implementation followed on 8 clinical services for 8 weeks. Seven hundred fifty-four requests were reviewed by 15 attending anesthesiologists, with 339 first-choice matches (45.0%), 122 second-choice matches (16.2%), 55 third-choice matches (7.3%), and 238 unmatched (31.5%). There were 279 overlapping first-choice requests (37.0%). The overall combined match success rate was 69.4%. Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case-log data in decision support systems for informing resident OR assignments. Additional analysis will be necessary to assess the educational impact of these systems. PMID:23749442

Wanderer, Jonathan P; Charnin, Jonathan; Driscoll, William D; Bailin, Michael T; Baker, Keith

2013-08-01

342

"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

343

Description of six new species of the genus Leptotrombidium from Mindanao Island and notes on the medically important genera of chiggers (Acari: Trombiculidae) of the Philippine Islands.  

PubMed

In the Philippine Islands, the genus Leptotrombidium currently consists of members of the subgenera Leptotrombidium and Trombiculindus. The following species are described as new: L. (L.) macacaphilus, L. (L.) longimedian, L. (L.) mindanensis, L. (L.) urogale, L. (L.) oculascutum, L. (T.) roseannleilaniae. The distribution of, and comments on, the known vectors of Rickettsia tsutsugamushi, L. (L.) deliense and L. (L.) fletcheri and the previously reported L. (L.) sandfordi, are given. Information on species of the potential scrub itch genera Blankaartia, Eutrombicula, and Schoengastia and a key to the genera and species of medically important trombiculids is provided. PMID:1495044

Brown, W A

1992-03-01

344

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

345

Genetic variation and relationships of four species of medically important echinostomes (Trematoda: Echinostomatidae) in South-East Asia.  

PubMed

Multilocus enzyme electrophoresis (MEE) and DNA sequencing of the mitochondrial cytochrome c oxidase subunit 1 (CO1) gene were used to genetically compare four species of echinostomes of human health importance. Fixed genetic differences among adults of Echinostoma revolutum, Echinostoma malayanum, Echinoparyphium recurvatum and Hypoderaeum conoideum were detected at 51-75% of the enzyme loci examined, while interspecific differences in CO1 sequence were detected at 16-32 (8-16%) of the 205 alignment positions. The results of the MEE analyses also revealed fixed genetic differences between E. revolutum from Thailand and Lao PDR at five (19%) of 27 loci, which could either represent genetic variation between geographically separated populations of a single species, or the existence of a cryptic (i.e. genetically distinct but morphologically similar) species. However, there was no support for the existence of cryptic species within E. revolutum based on the CO1 sequence between the two geographical areas sampled. Genetic variation in CO1 sequence was also detected among E. malayanum from three different species of snail intermediate host. Separate phylogenetic analyses of the MEE and DNA sequence data revealed that the two species of Echinostoma (E. revolutum and E. malayanum) did not form a monophyletic clade. These results, together with the large number of morphologically similar species with inadequate descriptions, poor specific diagnoses and extensive synonymy, suggest that the morphological characters used for species taxonomy of echinostomes in South-East Asia should be reconsidered according to the concordance of biology, morphology and molecular classification. PMID:21129506

Saijuntha, Weerachai; Sithithaworn, Paiboon; Duenngai, Kunyarat; Kiatsopit, Nadda; Andrews, Ross H; Petney, Trevor N

2011-03-01

346

Side effects of glaucoma medications.  

PubMed

The safety profile of the different glaucoma medications is an important issue when initiating therapy in glaucomatous patients. The decision on which medication to prescribe depends not only on the type of glaucoma, but also on the patient's medical history and needs a detailed knowledge of the potential side-effects of each medication. Medications side effects may be an important cause of non adherence for the individual patient The properties of the drugs, the composition of the glaucoma eyedrops and the dynamics of ocular drug absorption must be considered. The ocular surface changes induced by long-term antiglaucomatous treatment especially by their preservatives are a major cause of intolerance or poor tolerance to glaucoma eyedrops. Moreover topically applied ophthalmic medications can attain sufficient serum levels through absorption into conjunctival and nasal mucosas to have systemic effects and to potentially interact with other drugs. Then this presentation will deal with the ocular and systemic side-effects which can be encountered with the different classes of the currently available glaucoma topical medications. Recommendations than can be applied to reduce both frequency and severity of side-effects of glaucoma medications will be stressed on. Concurrently patients should be fully informed not only about their disease but also the medications they used and what side-effects they have to expect. PMID:16681086

Detry-Morel, M

2006-01-01

347

Patient satisfaction with health care decisions: the satisfaction with decision scale.  

PubMed

Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself. The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions. The six-item scale has excellent reliability (Cronbach's alpha = 0.86). Discriminant validity, tested by performing principal-components analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with "decisional confidence," and least with "desire to participate in health care decisions" and "satisfaction with provider." The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients' intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure. PMID:8717600

Holmes-Rovner, M; Kroll, J; Schmitt, N; Rovner, D R; Breer, M L; Rothert, M L; Padonu, G; Talarczyk, G

1996-01-01

348

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

349

Validity, responsiveness and the minimal clinically important difference for the de Morton Mobility Index (DEMMI) in an older acute medical population  

PubMed Central

Background The de Morton Mobility Index (DEMMI) is a new mobility instrument that overcomes the limitations of existing instruments. It is the first mobility instrument that accurately measures the mobility of all older adults. The aim of this study was to provide a detailed report of investigations of the validity, responsiveness to change and minimal clinically important difference (MCID) of the DEMMI during its development in an older acute medical population. Methods This study was conducted using a head to head comparison design in two independent samples of older acute medical patients (development sample, n = 86; validation sample, n = 106). Consecutive patients (? 65 years) were assessed using the DEMMI, Barthel Index (BI) and Hierarchical Assessment of Balance and Mobility (HABAM) within 48 hours of hospital admission and discharge. Convergent and discriminant validity were investigated using Spearman's rho and known groups validity was investigated using a independent t test to compare DEMMI scores for patients who were discharged to home compared to inpatient rehabilitation. Criterion and distribution based methods were employed for estimating instrument responsiveness to change and the MCID. Results Significant moderate to high correlations were identified between DEMMI and BI scores (r = 0.76 and r = 0.68) and DEMMI and HABAM scores (r = 0.91 and r = 0.92) in both samples. In both samples, DEMMI scores for patients who were discharged to home were significantly higher than for patients discharged to inpatient rehabilitation and provided evidence of known groups validity. Patients who were discharged to inpatient rehabilitation (n = 8) had a mean DEMMI score of 50.75 (sd = 11.29) at acute hospital discharge compared to patients who were discharged to home (n = 70) with a mean DEMMI score of 62.14 (sd = 18.41). MCID estimates were similar across samples using distribution and criterion based methods. The MCID for the DEMMI was 10 points on the 100 point interval scale. The DEMMI was significantly more responsive to change than the BI using criterion and distribution based methods in the validation sample. Conclusion This study has validated the DEMMI in two independent samples of older acute medical patients. Estimates of its responsiveness and MCID have also been established. This study confirms that the DEMMI overcomes the limitations of the BI and HABAM and provides an advanced method for objectively assessing mobility for older acute medical patients.

2010-01-01

350

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

351

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

352

Online Survey Checklist: Online Surveys Are a Time-and Cost-Efficient Way to Gather the Data You Need for Important Decision Making  

ERIC Educational Resources Information Center

In the age of data-driven decision making, collecting data and using it efficiently is key to all aspects of the education process. Online surveys are a great way to gather information on everything from lunchroom procedures to program design. This information can impact solutions for student achievement, community relations, and district…

Parsons, Catherine; DeLucia, Jodi

2005-01-01

353

Molecular detection and species-specific identification of medically important Aspergillus species by real-time PCR in experimental invasive pulmonary aspergillosis.  

PubMed

Diagnosis of invasive pulmonary aspergillosis (IPA) remains a major challenge to clinical microbiology laboratories. We developed rapid and sensitive quantitative PCR (qPCR) assays for genus- and species-specific identification of Aspergillus infections by use of TaqMan technology. In order to validate these assays and understand their potential diagnostic utility, we then performed a blinded study of bronchoalveolar lavage (BAL) fluid specimens from well-characterized models of IPA with the four medically important species. A set of real-time qPCR primers and probes was developed by utilizing unique ITS1 regions for genus- and species-specific detection of the four most common medically important Aspergillus species (Aspergillus fumigatus, A. flavus, A. niger, and A. terreus). Pan-Aspergillus and species-specific qPCRs with BAL fluid were more sensitive than culture for detection of IPA caused by A. fumigatus in untreated (P < 0.0007) and treated (P ? 0.008) animals, respectively. For infections caused by A. terreus and A. niger, culture and PCR amplification from BAL fluid yielded similar sensitivities for untreated and treated animals. Pan-Aspergillus PCR was more sensitive than culture for detection of A. flavus in treated animals (P = 0.002). BAL fluid pan-Aspergillus and species-specific PCRs were comparable in sensitivity to BAL fluid galactomannan (GM) assay. The copy numbers from the qPCR assays correlated with quantitative cultures to determine the pulmonary residual fungal burdens in lung tissue. Pan-Aspergillus and species-specific qPCR assays may improve the rapid and accurate identification of IPA in immunocompromised patients. PMID:21976757

Walsh, Thomas J; Wissel, Mark C; Grantham, Kevin J; Petraitiene, Ruta; Petraitis, Vidmantas; Kasai, Miki; Francesconi, Andrea; Cotton, Margaret P; Hughes, Johanna E; Greene, Lora; Bacher, John D; Manna, Pradip; Salomoni, Martin; Kleiboeker, Steven B; Reddy, Sushruth K

2011-12-01

354

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

355

Design of an information volatility measure for health care decision making  

Microsoft Academic Search

Health care decision makers and researchers often use reporting tools (e.g. Online Analytical Processing (OLAP)) that present data aggregated from multiple medical registries and electronic medical records to gain insights into health care practices and to understand and improve patient outcomes and quality of care. An important limitation is that the data are usually displayed as point estimates without full

Monica Chiarini Tremblay; Alan R. Hevner; Donald J. Berndt

356

[Approaches for suicide prevention in Osaka Psychiatric Medical Center: the importance of multi-disciplinary cooperation and partnerships with other organizations].  

PubMed

Suicide is a very common problem in psychiatric practice today. Therefore, almost all staff of psychiatric hospitals have encountered the suicide of one or more of their patients. Our hospital, Osaka Psychiatric Medical Center, is a public psychiatric hospital in Japan. We provide treatment and support for patients from the acute to chronic phases of psychiatric disorders, and patients range from children to the elderly. Because we accept many patients with severe mental illness from other hospitals, many of our staff are routinely confronted with patients' violence or suicidal attempts. If a patient commits suicide, the relevant staff immediately have a conference to implement measures for preventing a recurrence. At the same time, information about the incident is conveyed to the medical safety management office and made known to all staff in our hospital. This office was established in 2007. Currently, all information about incidents and accidents in our hospital (e.g., suicide, problems between patients, problems with hospital facilities) is aggregated in the office and distributed to all staff members through the hospital intranet. This system makes it possible for staff to consider countermeasures against similar incidents and accidents, even if not involved in the incident. Additionally, we make an effort to develop cooperative relationships with organizations including the police, public health centers, and the fire department. The social welfare council in Hirakata City, where our hospital is located, provides some services to prevent suicide (e.g., telephone counseling, meetings with bereaved family members). Our hospital cooperates with these services by providing lecturers. The partnerships with these organizations help regarding the mental crises of patients in our hospital and fulfill a role to prevent suicide. Multi-disciplinary cooperation and partnerships with community organizations are not special approaches to suicide prevention, but ordinary approaches in everyday clinical practice. The most important factor is the relationship between staff and organizations relevant to preventing suicide. PMID:23346818

Iwata, Kazuhiko

2012-01-01

357

Phylogenetic analyses of RPB1 and RPB2 support a middle Cretaceous origin for a clade comprising all agriculturally and medically important fusaria.  

PubMed

Fusarium (Hypocreales, Nectriaceae) is one of the most economically important and systematically challenging groups of mycotoxigenic phytopathogens and emergent human pathogens. We conducted maximum likelihood (ML), maximum parsimony (MP) and Bayesian (B) analyses on partial DNA-directed RNA polymerase II largest (RPB1) and second largest subunit (RPB2) nucleotide sequences of 93 fusaria to infer the first comprehensive and well-supported phylogenetic hypothesis of evolutionary relationships within the genus and 20 of its near relatives. Our analyses revealed that Cylindrocarpon formed a basal monophyletic sister to a 'terminal Fusarium clade' (TFC) comprising 20 strongly supported species complexes and nine monotypic lineages, which we provisionally recognize as Fusarium (hypothesis F1). The basal-most divergences within the TFC were only significantly supported by Bayesian posterior probabilities (B-PP 0.99-1). An internode of the remaining TFC, however, was strongly supported by MP and ML bootstrapping and B-PP (hypothesis F2). Analysis of seven Fusarium genome sequences and Southern analysis of fusaria elucidated the distribution of genes required for synthesis of 26 families of secondary metabolites within the phylogenetic framework. Diversification time estimates date the origin of the TFC to the middle Cretaceous 91.3 million years ago. We also dated the origin of several agriculturally important secondary metabolites as well as the lineage responsible for Fusarium head blight of cereals. Dating of several plant-associated species complexes suggests their evolution may have been driven by angiosperm diversification during the Miocene. Our results support two competing hypotheses for the circumscription of Fusarium and provide a framework for future comparative phylogenetic and genomic analyses of this agronomically and medically important genus. PMID:23357352

O'Donnell, Kerry; Rooney, Alejandro P; Proctor, Robert H; Brown, Daren W; McCormick, Susan P; Ward, Todd J; Frandsen, Rasmus J N; Lysøe, Erik; Rehner, Stephen A; Aoki, Takayuki; Robert, Vincent A R G; Crous, Pedro W; Groenewald, Johannes Z; Kang, Seogchan; Geiser, David M

2013-03-01

358

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

359

Making Sustainable Decisions Using The KONVERGENCE Framework  

SciTech Connect

Hundreds of contaminated facilities and sites must be cleaned up. ''Cleanup'' includes decommissioning, environmental restoration, and waste management. Cleanup can be complex, expensive, risky, and time-consuming. Decisions are often controversial, can stall or be blocked, and are sometimes re-done--some before implementation, some decades later. Making and keeping decisions with long time horizons involves special difficulties and requires new approaches. Our project goal is to make cleanup decisions easier to make, implement, keep, and sustain. By sustainability, we mean decisions that work better over the entire time-period-from when a decision is made, through implementation, to its end point. That is, alternatives that can be kept ''as is'' or adapted as circumstances change. Increased attention to sustainability and adaptability may decrease resistance to making and implementing decisions. Our KONVERGENCE framework addresses these challenges. The framework is based on a mental model that states: where Knowledge, Values, and Resources converge (the K, V, R in KONVERGENCE), you will find a sustainable decision. We define these areas or universes as follows: (1) Knowledge: what is known about the problem and possible solutions? (2) Values: what is important to those affected by the decision? (3) Resources: what is available to implement possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases.

Piet, S. J.; Gibson, P. L.; Joe, J. C.; Kerr, T. A.; Nitschke, R. L.; Dakins, M. E.

2003-02-25

360

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

361

Automated Medical Interviewing for Diagnostic Decision Support in the Emergency Department. Inclusive Dates: 09/01/08 - 08/31/10.  

National Technical Information Service (NTIS)

Misdiagnosis is frequent, particularly in the emergency department (ED). The goal of this research is to develop and validate a workflow-sensitive, computer-based, diagnostic decision support system for the ED that reduces critical misdiagnosis of patient...

D. E. Newman-Toker

2010-01-01

362

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

363

Making Sustainable Decisions Using the KONVERGENCE Framework  

SciTech Connect

Hundreds of contaminated facilities and sites must be cleaned up. “Cleanup” includes decommissioning, environmental restoration, and waste management. Cleanup can be complex, expensive, risky, and time-consuming. Decisions are often controversial, can stall or be blocked, and are sometimes re-done - some before implementation, some decades later. Making and keeping decisions with long time horizons involves special difficulties and requires new approaches, including: • New ways (mental model) to analyze and visualize the problem, • Awareness of the option to shift strategy or reframe from a single decision to an adaptable network of decisions, and • Improved tactical processes that account for several challenges. These include the following: • Stakeholder values are a more fundamental basis for decision making and keeping than “meeting regulations.” • Late-entry players and future generations will question decisions. • People may resist making “irreversible” decisions. • People need “compelling reasons” to take action in the face of uncertainties. Our project goal is to make cleanup decisions easier to make, implement, keep, and sustain. By sustainability, we mean decisions that work better over the entire time-period—from when a decision is made, through implementation, to its end point. That is, alternatives that can be kept “as is” or adapted as circumstances change. Increased attention to sustainability and adaptability may decrease resistance to making and implementing decisions. Our KONVERGENCE framework addresses these challenges. The framework is based on a mental model that states: where Knowledge, Values, and Resources converge (the K, V, R in KONVERGENCE), you will find a sustainable decision. We define these areas or universes as follows: • Knowledge: what is known about the problem and possible solutions? • Values: what is important to those affected by the decision? • Resources: what is available to implement possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases.

Piet, Steven James; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon; Dakins, Maxine Ellen

2003-02-01

364

From Th e F ield Clinical Use Of Medical Devices In The 'Bermuda Triangle' A proposal to keep decisions about medical devices from falling through the cracks between the CMS, the FDA, and the NIH  

Microsoft Academic Search

The pace of medical technological development shows no sign of abating. An- alyzing the effect of major federal health agencies on the availability of such technology is critical. This paper describes functions of three government health agencies: the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Certain medical

Larry Kessler; Scott D. Ramsey; Sean Tunis; Sean D. Sullivan

365

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

366

Important changes in medical x-ray imaging facility shielding design methodology. A brief summary of recommendations in NCRP Report No. 147  

Microsoft Academic Search

The recently published Report No. 147 of The National Council on Radiation Protection and Measurements entitled 'Structural shielding design for medical x-ray imaging facilities' provides an update of shielding recommendations for x rays used for medical imaging. The goal of this report is to ensure that the shielding in these facilities limits radiation exposures to employees and members of the

Joel E. Gray; Benjamin R. Archer

2005-01-01

367

Medical confidence.  

PubMed Central

If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.

Havard, J

1985-01-01

368

Medical Entomology Project.  

National Technical Information Service (NTIS)

The Medical Entomology Project (MEP), a cooperative venture between the Smithsonian Institution and the U.S. Army Medical Research and Development Command, conducts biosystematic research on arthropods of medical importance to the Army. MEP fulfills this ...

O. S. Flint

1977-01-01

369

Medical Entomology Project.  

National Technical Information Service (NTIS)

The Medical Entomology Project (MEP), a cooperative venture between the Smithsonian Institution and the U.S. Army Medical Research and Development Command, conducts biosystematic research on arthropods of medical importance to the Army. MEP fulfills this ...

O. S. Flint

1981-01-01

370

The Importance of a Proper Against-Medical-Advice (AMA) Discharge: How Signing Out AMA May Create Significant Liability Protection for Providers  

Microsoft Academic Search

BackgroundEvery year, patients leave the Emergency Department against medical advice (AMA) and before an adequate evaluation can be performed. It is well known that many of these patients are at risk of subsequent complications.

Frederick Levy; Darren P. Mareiniss; Corianne Iacovelli

371

Important changes in medical x-ray imaging facility shielding design methodology. A brief summary of recommendations in NCRP Report No. 147  

SciTech Connect

The recently published Report No. 147 of The National Council on Radiation Protection and Measurements entitled 'Structural shielding design for medical x-ray imaging facilities' provides an update of shielding recommendations for x rays used for medical imaging. The goal of this report is to ensure that the shielding in these facilities limits radiation exposures to employees and members of the public to acceptable levels. Board certified medical and health physicists, as defined in this report, are the 'qualified experts' who are competent to design radiation shielding for these facilities. As such, physicists must be aware of the new technical information and the changes from previous reports that Report No. 147 supersedes. In this article we summarize the new data, models and recommendations for the design of radiation barriers in medical imaging facilities that are presented in Report No. 147.

Archer, Benjamin R.; Gray, Joel E. [Baylor College of Medicine, Houston, Texas 77030 (United States); Landauer, Inc., Glenwood, Illinois 60425 (United States)

2005-12-15

372

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

373

Information technology and medication safety: what is the benefit?  

PubMed Central

?? Medication errors occur frequently and have significant clinical and financial consequences. Several types of information technologies can be used to decrease rates of medication errors. Computerized physician order entry with decision support significantly reduces serious inpatient medication error rates in adults. Other available information technologies that may prove effective for inpatients include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In outpatients, computerization of prescribing and patient oriented approaches such as personalized web pages and delivery of web based information may be important. Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required.

Kaushal, R; Bates, D

2002-01-01

374

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.  

PubMed

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented. PMID:23421345

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

375

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.

Burgess, Diana J.

2014-01-01

376

Surrogate decision making in neurocritical care.  

PubMed

Patients with critical neurologic illness typically have impaired capacity to make their own medical decisions. In these cases, neurologists need to make medical decisions based on advance directives (such as a living will) or the decisions of a surrogate. A hypothetical case of a 60-year-old man with an intracerebral hemorrhage is used to highlight some of the difficulties that can occur when attempting to apply general statements made in a living will to a specific medical treatment decision. The ethical and legal issues surrounding surrogate decision making as they apply to acute critical neurologic disease are discussed, along with suggestions for how to resolve potential disagreements. PMID:22810254

Adelman, Eric E; Zahuranec, Darin B

2012-06-01

377

Age and Medication Acceptance  

Microsoft Academic Search

Patients' willingness to take a newly prescribed medication is an important, but little studied, part of the medication process. The authors studied the impact of patient age on the perceived importance and interaction of three factors known to influence young people: severity of their medical condition, extent of possible medication side effects, and level of trust in their physician. A

Catherine Hervé; Etienne Mullet; Paul Clay Sorum

2004-01-01

378

How many patients in atrial fibrillation admitted to an acute medical unit will benefit from oral anticoagulation? Application of the results of the major randomized controlled trials to 141 consecutive, unselected, elderly patients using a decision support computer program.  

PubMed

BACKGROUND: Although several randomized, control trials (RTC) suggest that oral anticoagulation (OAC) benefits patients with atrial fibrillation (AF), this might not be true for hospitalized patients with co-morbid conditions. If the results of the RTCs are valid, then how many patients in AF admitted to an acute medical unit will benefit from OAC? METHODS: An RCT-based decision analysis model calculated the quality-adjusted life expectancy (QALE) gain from OAC for 141 unselected consecutive patients over 65 years of age with AF admitted to an acute medical unit. RESULTS: If treated with aspirin, all 141 patients were predicted to gain QALE compared with placebo. If the quality of life adjustment (QoLA) on OAC was the same as placebo, then 104 patients were predicted to benefit from OAC compared with aspirin, while 63 patients were predicted to benefit at a QoLA of 0.99 (overall benefit 0.13+/-0.15 QALYs, range 0.01-0.88 QALYs). These 63 patients were more likely to have had a stroke, diabetes, hypertension, heart failure or heart attack, and less likely to have impaired renal function than those predicted not to benefit. The 78 patients predicted not to benefit from OAC included 11 younger patients without heart failure, hypertension, diabetes or cerebrovascular disease; the remaining 67 patients, however, were older, more likely to have heart failure and/or renal impairment and were at high risk of both stroke and bleeding. CONCLUSION: An RCT-based decision analysis model suggests that more than half the patients in AF admitted to a small rural hospital with acute medical conditions are unlikely to benefit from OAC, while all will benefit from aspirin. PMID:15833675

Kellett, John

2005-04-01

379

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

380

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

2014-05-01

381

[Medical support of Russian Armed Forces: the results and perspectives].  

PubMed

The results of work of the Russian Federation Armed Forces medical service obtained in 2007 were summarized and the main problems of its activities in the current year and the very near future were determined. So the work at defining medical support as a type of Army and Navy support was began. The most important task of medical service in 2008 is realization of the Armed Forces medical support conception and goal-oriented program "The improvement of Russian Federation Armed Forces medical support in 2008-2012", the formation of two-level system of personnel's medical support. During the task realization the medical units and institutions are reorganized into federal state institutions. The RF DM Main Military Medical Headquarters works at significant improvement of war and military service veterans' medical attendance. The departmental program "Development of material and technical basis of military medical institutions for 2001-2010" is successfully realized. The measures to optimize the assignment of graduates from military medical higher schools are carried out. The tasks to improve the research work were outlined. The new principles of organization of military medical service control and work will be based on centralization of planning and decentralization of decision implementation, the possibility of military medical units to carry it out taking into account the common intention, safe feedback in order to make the work of army and navy medical specialists more effective in any conditions. PMID:18350788

Shappo, V V

2008-01-01

382

Using Computational Intelligence to Develop Intelligent Clinical Decision Support Systems  

Microsoft Academic Search

\\u000a Clinical Decision Support Systems have the potential to optimize medical decisions, improve medical care, and reduce costs.\\u000a An effective strategy to reach these goals is by transforming conventional Clinical Decision Support in Intelligent Clinical\\u000a Decision Support, using knowledge discovery in data and computational intelligence tools. In this paper we used genetic programming\\u000a and decision trees. Adaptive Intelligent Clinical Decision Support

Alexandru G. Floares

2009-01-01

383

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

384

Choosing family medicine. What influences medical students?  

PubMed Central

OBJECTIVE: To explore factors that influence senior medical students to pursue careers in family medicine. DESIGN: Qualitative study using semistructured interviews. SETTING: University of Western Ontario (UWO) in London. PARTICIPANTS: Eleven of 29 graduating UWO medical students matched to Canadian family medicine residency programs beginning in July 2001. METHOD: Eleven semistructured interviews were conducted with a maximum variation sample of medical students. Interviews were transcribed and reviewed independently, and a constant comparative approach was used by the team to analyze the data. MAIN FINDINGS: Family physician mentors were an important influence on participants' decisions to pursue careers in family medicine. Participants followed one of three pathways to selecting family medicine: from an early decision to pursue family medicine, from initial uncertainty about career choice, or from an early decision to specialize and a change of mind. CONCLUSION: The perception of a wide scope of practice attracts candidates to family medicine. Having more family medicine role models early in medical school might encourage more medical students to select careers in family medicine.

Jordan, John; Brown, Judith Belle; Russell, Grant

2003-01-01

385

[Medical ethics and responsibility].  

PubMed

In the matter of health, the care of a patient is not the same as that of a population. With regards to medical ethics, it is essential to differentiate that which is for the patient's well being, and that which relies on knowledge and responsibility, the principle of which is not to do harm. The health sector has become an important economic actor in our society. Any decision made must take into account the principle of well being and responsibility. The physicians' role, when making a decision, is to integrate not only the patient's quality of life but also the Public Health aspects, and to apply these notions to a well thought-out choice and shared with the patient. A triangle can be constructed with, at its base the percentage of the population concerned and at its peak the cost per beneficiary. This triangle can then be segmented at varying distance from its base, in current decisions applicable to the greatest number, and depending on the amount of resources available. PMID:12148129

Labram, Claude; Dusehu, Etienne

2002-04-20

386

X-ray diagnostic without medical indication and bodily harm: decision of the Supreme Court of Germany 3\\/12\\/97 – 2 StR 397\\/97  

Microsoft Academic Search

.   An orthopedic surgeon had been condemned for different offences to 2 years and 6 months imprisonment by the superior court\\u000a in Frankfurt\\/Main. One point of the ruling had been the use of X-rays without medical indication, which the superior court\\u000a of Frankfurt\\/Main finally did not assess as bodily harm. The supreme court of Germany overruled this interpretation and referred

M. Vogel; H. Vogel

1999-01-01

387

Perspectives on medical school admission.  

PubMed

This article is the author's formulation of important issues concerning medical school admission: that (1) in recent years, almost all applicants who have been admitted to medical school have obtained the M.D. degree and been licensed to practice; (2) given this high success rate, an accepted applicant's economic security is virtually guaranteed; (3) the admission decision contributes directly to the formation of a highly paid, high-status professional elite; (4) the link between students' academic aptitude for medical education and their achievement in medical school is weak; (5) schools pay lip-service to the importance of students' character, motivation, and other personal qualities but continue to select students with high grades in science courses and high MCAT scores; (6) admission officers and committees often confuse selecting students with predicting their achievement in medical school; (7) two core values in American culture (self-reliance and competition) encourage the use of norm-referenced measurement in all phases of education; and (8) there are alternatives to the traditional approach to defining eligibility for professional education. PMID:2306316

McGaghie, W C

1990-03-01

388

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

389

Improving Decision Making.  

ERIC Educational Resources Information Center

This collection of essays focuses on the importance of accurate and timely information for effective decision making. First, Ivan Lach considers the proliferation of statewide planning and policy formation and discusses problems with and ways to improve statewide research. Next, Cheryl Opacinch focuses on decision making for federal postsecondary…

Mehallis, Mantha, Ed.

1981-01-01

390

The Alcohol Clinical Trials Initiative (ACTIVE): purpose and goals for assessing important and salient issues for medications development in alcohol use disorders.  

PubMed

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 type of populations to be studied, the length of trials, salient outcome measures, and data analyses to be used (especially in the treatment of missing data). This variability impedes the commercial development of medications to treat alcohol dependence. Using a model similar to that used to develop an expert consensus for medications to improve cognitive aspects of schizophrenia (MATRICS) and in the treatment of pain (IMMPACT), a workgroup has been formed under the auspices of ACNP, known as the ACTIVE (Alcohol Clinical Trials Initiative) group, to evaluate data from completed clinical trials to develop a consensus on key issues in the conduct of clinical trials in alcohol dependence. ACTIVE consists of academic experts, industry representatives, and staff from the Food and Drug Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. This paper describes the rationale behind the effort, its history and organization, and initial key questions that have been identified as the primary focus of the workgroup. Future papers will focus on knowledge gained from the re-analysis of completed trials and provide consensus opinions regarding the performance of clinical trials that might be undertaken in the future. PMID:21900883

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

2012-01-01

391

Extension decision  

Microsoft Academic Search

On the viewpoint of system theory, this paper expounds connotations and characteristics about extension decision applied branch of extension science, introduces operation sequences, techniques and methods on extension decision, points out its working achievement and the direction in its development.

Bo Sun; Julong Chen

1997-01-01

392

Decision Making in Recovery-Oriented Mental Health Care  

PubMed Central

Objective Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. Methods Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. Results Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers’ preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. Conclusions and Implications for Practice While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers’ recovery.

Matthias, Marianne S.; Salyers, Michelle P.; Rollins, Angela L.; Frankel, Richard M.

2014-01-01

393

Proxy healthcare decision-making for persons with intellectual disability: perspectives of residential-agency directors.  

PubMed

Directors of residential agencies for persons with intellectual disability in one U.S. state completed a self-administered, mailed survey to assess relative importance of information sources and decision factors in proxy healthcare decision-making. The most important sources were physician recommendations and input from the person; family input, care staff recommendations, and medical records were less valued. The person's wishes and best interests and recommendations of medical experts were the most important decision factors. Less important were benefits and risks of the intervention, family wishes, and health status; little emphasis was accorded to religious affiliation and extra cost to agency. More research is needed on how best to elicit the wishes and determine what constitutes the "best interests" of these vulnerable individuals. PMID:19792056

Fisher, Kathleen M; Orkin, Fredrick K; Green, Michael J; Chinchilli, Vernon M; Bhattacharya, Anand

2009-11-01

394

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

395

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.

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

2013-01-01

396

Everyday Decision-making Ability in Older Persons with Cognitive Impairment  

PubMed Central

Objective To demonstrate the reliability and validity of the Assessment of Capacity for Everyday Decision-making (ACED), an instrument to evaluate everyday decision-making (EDM). Methods We administered the ACED to thirty-nine persons with very mild to moderate cognitive impairment and 13 cognitively intact caregivers. Results Intra-class correlation coefficients showed good reliability for the measures of understanding, appreciation and reasoning, and Cronbach alpha coefficients were ?0.84 for all three decision-making abilities. The ACED also had a moderate to strong correlation with the MacCAT-T, a validated measure of decision-making capacity for medical treatment decisions, and measures of overall cognition. Associations with measures of executive function were mixed, with moderate correlations observed only with ACED understanding and reasoning performance. Conclusion The ACED is a reliable and valid measure to assess decision-making capacity. It may serve as an important addition to current methods used to assess EDM.

Lai, James M.; Gill, Thomas M.; Cooney, Leo M.; Bradley, Elizabeth H.; Hawkins, Keith A.; Karlawish, Jason H.

2009-01-01

397

The functions of medical care.  

PubMed

Medical care has several important functions other than restoring or maintaining health. These other functions are assessment and certification of health status, prognostication, segregation of the ill to limit communication of illness, and helping to cope with the problems of illness--the caring function. Medical care serving these "paracurative" functions may legitimately be given indepedently, without associated curing or preventive intent of the provider of care. Although such services do not result in benefits to health, such as extension of life or reduction of disability, they do have other valued outcomes, outcomes not measurable as a gain in personal health status. For example, caring activities may result in satisfaction, comfort, or desirable affective states, even while the patient's health status deteriorates during an incurable illness. The physician's approach to patients, the economist's analysis of the benefits of health services, the planner's decisions about health programs, the evaluator's judgments about the quality of care, or the patient's expectations about treatment are strongly influenced by his assumptions about the purpose of medical care or the proper outcome of the process. When the health worker assumes that the only useful outcome is health, he may consider the paracurative services to be ineffective, inefficient, or undesirable. In contrast, when he recognizes and understands the paracurative functions of medical care, he may better perform his function in the medical care system. PMID:803689

Childs, A W

1975-01-01

398

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

399

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.

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

2013-01-01

400

Semantic Decision Tables: Self-organizing and Reorganizable Decision Tables  

Microsoft Academic Search

A Semantic Decision Table (SDT) provides a means to capture and examine decision makers’ concepts, as well as a tool for refining their decision knowledge and facilitating knowledge\\u000a sharing in a scalable manner. One challenge SDT faces is to organize decision resources represented in a tabular format based on the user’s needs\\u000a at different levels. It is important to make

Yan Tang; Robert Meersman; Jan Vanthienen

2008-01-01

401

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

402

Knowledge about Health Effects of Cigarette Smoking and Quitting among Italian University Students: The Importance of Teaching Nicotine Dependence and Treatment in the Medical Curriculum  

PubMed Central

Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived.

Baraldo, Massimo; Chiamulera, Christian; Culasso, Franco; Ferketich, Amy K.; Patrono, Carlo; Nencini, Paolo

2014-01-01

403

Medical virology in Malaysia  

Microsoft Academic Search

Virology is a branch of biological science dealing with the study of viruses, and medical virology focuses on the study and\\u000a control of diseases due to viruses that is of medical importance. The development of medical virology in Malaysia has its\\u000a beginning in the Institute for Medical Research (IMR), following the establishment of the Division of Medical Zoology and\\u000a Virus

Kaw Bing Chua

2009-01-01

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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