Sample records for important medical decisions

  1. HELPING YOU MEDICAL DECISIONS

    E-print Network

    Dennett, Daniel

    HELPING YOU MEDICAL DECISIONS MAKE THE When you're facing a critical medical decision, getting, the right treatment and the right care. How? By providing access to the best medical minds in the world all your records. Your images. Your test samples. You don't have to travel or deal with the healthcare

  2. The importance of mathematics in health and human judgment: Numeracy, risk communication, and medical decision making

    Microsoft Academic Search

    Valerie F. Reyna; Charles J. Brainerd

    2007-01-01

    Mathematics achievement is important in its own right, and is increasingly recognized as crucial to the nation's economy [National Mathematics Panel, 2006. National Mathematics Advisory Panel: Strengthening Math Education Through Research. Accessed September 29, 2006 from http:\\/\\/www.ed.gov\\/about\\/bdscomm\\/list\\/mathpanel\\/factsheet.html.; National Science Board, 2006. National Science Board Commission on 21st Century Education in Science, Technology, Engineering, and Mathematics. Accessed September 29, 2006 from

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

    PubMed

    Whitney, Simon N

    2008-01-01

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

  4. BMC Medical Informatics and Decision Making

    PubMed Central

    2014-01-01

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

  5. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott M.

    2008-01-01

    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.

  6. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott M.

    2007-01-01

    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.

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

    PubMed Central

    Seyedin, Hesam; Jamshidi-Orak, Roohangiz

    2014-01-01

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

  8. Dispositional optimism, self-framing and medical decision-making.

    PubMed

    Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

    2015-03-01

    Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N?=?500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. PMID:24849872

  9. Incorporating patients' preferences into medical decision making.

    PubMed

    Fraenkel, Liana

    2013-02-01

    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 article, we will describe some of the currently available approaches that have been successfully used in the health care setting. We provide case examples to illustrate the potential value of adopting each of these approaches in clinical practice. PMID:23132890

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

    PubMed Central

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

    2014-01-01

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

  11. The collaborative autonomy model of medical decision-making.

    PubMed

    Rubin, Michael A

    2014-04-01

    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

  12. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott

    2007-01-01

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

  13. Medical Specialty Decision Model: Utilizing Social Cognitive Career Theory

    ERIC Educational Resources Information Center

    Gibson, Denise D.; Borges, Nicole J.

    2004-01-01

    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.…

  14. Virulence factors of medically important fungi.

    PubMed Central

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

    1996-01-01

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

  15. Why Is It Important to Know My Family Medical History?

    MedlinePLUS

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

  16. Braving Difficult Choices Alone: Children's and Adolescents' Medical Decision Making

    PubMed Central

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

    Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. PMID:25084274

  17. The Attitude-Behavior Discrepancy in Medical Decision Making

    PubMed Central

    He, Fei; Li, Dongdong; Cao, Rong; Zeng, Juli; Guan, Hao

    2014-01-01

    Background: In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. Objectives: This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. Patients and Methods: A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\\attitude to risky plan\\attitude to conservative plan (3). Results: A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01?t attitude to surgery = 4.08?P < 0.01?t attitude to radiation = -2.15?P < 0.05). Conclusions: A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.

  18. Design of a goal ontology for medical decision-support

    E-print Network

    Zaccagnini, Davide

    2005-01-01

    Objectives: There are several ongoing efforts aimed at developing formal models of medical knowledge and reasoning to design decision-support systems. Until now, these efforts have focused primarily on representing content ...

  19. Medical Decision Making through Fuzzy Computational Intelligent Approaches

    Microsoft Academic Search

    Elpiniki I. Papageorgiou

    2009-01-01

    A new approach for the construction of Fuzzy Cognitive Maps augmented by knowledge through fuzzy rule-extraction methods for medical decision making is investigated. This new approach develops an augmented Fuzzy Cognitive Mapping based Decision Support System combining knowledge from experts and knowledge from data in the form of fuzzy rules generated from rule-based knowledge discovery methods. Fuzzy Cognitive Mapping (FCM)

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

    NASA Technical Reports Server (NTRS)

    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

    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.

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

    PubMed

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

    2014-06-01

    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

  2. 78 FR 55244 - Notice of Availability of Record of Decision for Medical Facilities Development and University...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ...Notice of Availability of Record of Decision for Medical Facilities Development...education to the military medical community and enable...of the installation, medical center, or the USU...complete text of the Record of Decision...

  3. Medical Decision-making During the Guardianship Process for Incapacitated, Hospitalized Adults: A Descriptive Cohort Study

    PubMed Central

    Helft, Paul R.; Bandy, Robert W.; Torke, Alexia M.

    2010-01-01

    Background It is sometimes necessary for courts to appoint guardians for adult, incapacitated patients. There are few data describing how medical decisions are made for such patients before and during the guardianship process. Objective To describe the process of medical decision-making for incapacitated, hospitalized adults for whom court-appointed guardians are requested. Design Retrospective, descriptive cohort study. Measurements Patients were identified from the legal files of a public, urban hospital. Medical and legal records were reviewed for demographic data, code status, diagnoses, code status orders and invasive procedures and person authorizing the order or procedure, dates of incapacitation and appointment of temporary guardian, reason for guardianship, and documentation of communication with a guardian. Results A total of 79 patients met inclusion criteria; 68.4% were male and 56.2% African-American. The median age was 65 years. Of the 71 patients with medical records available 89% of patients had a temporary guardianship petitioned because of the need for placement only. Seventeen patients had a new DNR order written during hospitalization, eight of which were ordered by physicians without consultation with a surrogate decision maker. Overall, 32 patients underwent a total of 81 documented invasive procedures, 16 of which were authorized by the patient, 15 by family or friend, and 11 by a guardian; consent was not required for 39 of the procedures because of emergency conditions or because a procedure was medically necessary and no surrogate decision maker was available. Conclusions Although most of the guardianships were requested for placement purposes, important medical decisions were made while patients were awaiting appointment of a guardian. Hospitalized, incapacitated adults awaiting guardianship may lack a surrogate decision maker when serious decisions must be made about their medical care. PMID:20422304

  4. Assessment of Unconscious Decision Aids Applied to Complex Patient-Centered Medical Decisions

    PubMed Central

    Manigault, Andrew Wilhelm; Whillock, Summer Rain

    2015-01-01

    Background To improve patient health, recent research urges for medical decision aids that are designed to enhance the effectiveness of specific medically related decisions. Many such decisions involve complex information, and decision aids that independently use deliberative (analytical and slower) or intuitive (more affective and automatic) cognitive processes for such decisions result in suboptimal decisions. Unconscious thought can arguably use both intuitive and deliberative (slow and analytic) processes, and this combination may further benefit complex patient (or practitioner) decisions as medical decision aids. Indeed, mounting research demonstrates that individuals render better decisions generally if they are distracted from thinking consciously about complex information after it is presented (but can think unconsciously), relative to thinking about that information consciously or not at all. Objective The current research tested whether the benefits of unconscious thought processes can be replicated using an Internet platform for a patient medical decision involving complex information. This research also explored the possibility that judgments reported after a period of unconscious thought are actually the result of a short period of conscious deliberation occurring during the decision report phase. Methods A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while reporting judgments. Cognitive load was manipulated by having participants memorize semi-random (high), line structured (low), or no dot patterns and recall these intermittently with their decision reports. Overall then, participants were randomly assigned to the conditions of a 3 (thought condition) by 3 (cognitive-load level) between-subjects design. Results A logistic regression analysis indicated that the odds of participants choosing the best treatment were 2.25 times higher in the unconscious-thought condition compared to the immediate-decision condition (b=.81, Wald=4.32, P=.04, 95% CI 1.048-4.836), and 2.39 times greater compared to the conscious-thought condition (b=.87, Wald=4.87, P=.027, 95% CI 1.103-5.186). No difference was observed between the conscious-thought condition compared to the immediate-decision condition, and cognitive load manipulations did not affect choices or alter the above finding. Conclusions This research demonstrates a plausible benefit of unconscious thinking as a decision aid for complex medical decisions, and represents the first use of unconscious thought processes as a patient-centered medical decision aid. Further, the quality of decisions reached unconsciously does not appear to be affected by the amount of cognitive load participants experienced. PMID:25677337

  5. Disruptive medical patients. Forensically informed decision making.

    PubMed Central

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

    1992-01-01

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

  6. Decision making support in reshaping hospital medical services.

    PubMed

    Huang, X M

    1998-10-01

    "Bed crisis" is a buzz word of the 90's in the National Health Services (NHS). Medical emergency admissions keep rising and hospital resources remain limited. Faced with such a dilemma, many hospitals have endeavoured to improve their service efficiencies in order to meet the challenge. This paper describes a real-life hospital process re-engineering project in which computer simulation and optimisation models were applied to provide decision making support in determining the size of the proposed medical assessment unit and the allocation of the available medical beds to minimise hospital bed overflows. PMID:10916596

  7. Medical Decision Making in Clinical Care: Avoiding Common Errors

    E-print Network

    Maxwell, Bruce D.

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

  8. How Numeracy Influences Risk Comprehension and Medical Decision Making

    PubMed Central

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

    2009-01-01

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

  9. DELINQUENT MEDICAL RECORD POLICY The timely completion of medical records is of importance to all institutions. It is an important

    E-print Network

    Oliver, Douglas L.

    Page 127 DELINQUENT MEDICAL RECORD POLICY The timely completion of medical records is of importance during this time. If the resident/fellow has graduated prior to completion of medical records/fellow fails to complete required patient records within the time limit determined by the relevant clinical

  10. Minimum clinically important difference in medical studies.

    PubMed

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

    2015-03-01

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

  11. Human-Computer Interaction with Medical Decisions Support Systems

    NASA Technical Reports Server (NTRS)

    Adolf, Jurine A.; Holden, Kritina L.

    1994-01-01

    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.

  12. [Aquatic animals of medical importance in Brazil].

    PubMed

    Haddad Junior, Vidal

    2003-01-01

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

  13. The Importance of Teacher Involvement in Medication Therapy

    ERIC Educational Resources Information Center

    Ryan, Joseph B.; Katsiyannis, Antonis

    2009-01-01

    Over the past several decades, there has been a steady increase in the use of medication therapy to help control student behavior within schools. While psychotropic medications do not "cure" mental illnesses, they have demonstrated efficacy in helping children function better at school and within their home environment. However, it is important

  14. Exploring Patient Values in Medical Decision Making: A Qualitative Study

    PubMed Central

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

    2013-01-01

    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. PMID:24282518

  15. The importance of research in undergraduate medical education.

    PubMed

    Ávila, Mauricio José; Rodríguez-Restrepo, Andrea

    2014-01-01

    Currently medical information flows at great speed, bombarding medical students. Students are unfamiliar with fundamental aspects of biomedical literature appraisal. We assert that research performed during medical school will help to reduce the gap between the information available and comprehension by the student. The goal of the present review is to expound the importance of performing research during the undergraduate medical years and the relevance of research in other fields of medicine. We performed a literature review searching MEDLINE with terms consistent with our objective. We discuss the conduct of research projects during medical school training. The analysis of the articles retrieved proves that research is feasible and that it is a critical process during the undergraduate period for medical students. PMID:25587714

  16. The interface: ethical decision making, medical toxicology, and emergency medicine.

    PubMed

    Kreismann, Erica; Gang, Maureen; Goldfrank, Lewis R

    2006-08-01

    The overwhelming social and economic costs of alcohol, tobacco, and other substances of abuse are discussed, as are some of the important public health interventions appropriate for emergency physicians. This article addresses the complexity of ethical decision making when toxicologic emergencies occur in emergency medicine. The management strategies for patients with apparent intoxication are addressed with regard to decision-making capacity. The balance between confidentiality and support for an individual patient and responsibility of the physician to society is discussed. The relative importance of HIPAA is compared with an individual physician's code of ethics. PMID:16877142

  17. Deficiency areas in decision making in undergraduate medical students

    PubMed Central

    Klemenc-Ketis, Zalika; Kersnik, Janko

    2014-01-01

    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. PMID:25053897

  18. Incorporating Game-theoretic Rough Sets in Web-based Medical Decision Support Systems

    E-print Network

    Yao, JingTao

    intelligent support for decision making tasks. We focus on decision making in Web-based medical decision support sys- tems (WMDSS) that can provide support for making diagno- sis and treatment decisions. The use of rough sets complimented with decision analysis abilities of game theory. The GTRS may be used to obtain

  19. Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

    PubMed Central

    2011-01-01

    Background Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making. PMID:21447199

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

    PubMed

    Papageorgiou, Elpiniki; Stylios, Chrysostomos; Groumpos, Peter

    2006-01-01

    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

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

    PubMed Central

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

    2010-01-01

    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. PMID:20465077

  2. Performance Evaluation of the Machine Learning Algorithms Used in Inference Mechanism of a Medical Decision Support System

    PubMed Central

    Bal, Mert; Amasyali, M. Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse

    2014-01-01

    The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets. PMID:25295291

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

    E-print Network

    Shneiderman, Ben

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

  4. Aligning ethics with medical decision-making: the quest for informed patient choice.

    PubMed

    Moulton, Benjamin; King, Jaime S

    2010-01-01

    Clinical evidence suggests that many patients undergo surgery that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between provider and patient, into medical decisions can satisfy physicians' ethical obligations and reduce unwanted procedures. This article proposes a three-step process for implementing a nationwide practice of shared decision-making: (1) create model integration programs; (2) provide legal incentives to ease the transition; and (3) incorporate shared decision-making into medical necessity determinations. PMID:20446987

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

    Microsoft Academic Search

    GILAD J. KUPERMAN; ANNE BOBB; T HOMAS H. PAYNE; ANTHONY J. AVERY; TEJAL K. GANDHI; GERARD BURNS; DAVID C. CLASSEN; DAVID W. BATES

    2007-01-01

    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

  6. [Medical end-of-life decisions and assisted suicide].

    PubMed

    Bosshard, Georg

    2008-07-01

    Medical end-of-life decisions that potentially shorten life (Sterbehilfe) are normally divided into four categories: Passive Sterbehilfe refers to withholding or withdrawing life-prolonging measures, indirect Sterbehilfe refers to the use of agents such as opioids or sedatives to alleviate symptoms of a terminally ill patient, assisted suicide (Suizidbeihilfe or Beihilfe zum Suizid) refers to prescribing and/or supplying a lethal drug in order to help someone to end his own life, and active euthanasia - which is illegal in any circumstances - means a doctor actively ending a patients life. In passive and indirect euthanasia, the will of a competent patient, or the presumed will of an incompetent patient respectively, is crucial. Assisted suicide is not illegal according to the Swiss Penal Code as long as there are no motives of self-interest of the individual assisting, and the individual assisted has decisional capacity. However, for doctors participating in assisted suicide, specific requirements of medical due care have to be met. What this means in the context of assisted suicide has recently been elaborated by the Swiss Federal Court of Justice. PMID:18622926

  7. The larvae of some blowflies of medical and veterinary importance.

    PubMed

    Erzinclioglu, Y Z

    1987-04-01

    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

  8. Recovery of medically important microorganisms from Apollo astronauts

    NASA Technical Reports Server (NTRS)

    Taylor, G. R.

    1974-01-01

    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.

  9. Including Emotionality in Tests of Competence: How Does Neurodiversity Affect Measures of Free Will and Agency in Medical Decision Making?

    Microsoft Academic Search

    Robin Mackenzie; John Watts

    2011-01-01

    Medical decision making by patients is respected as a lawful exercise of free will and agency unless patients are found to lack “competence.” Yet measures of competence in medical decision making typically assess only cognitive abilities. Emotionality is involved in decision making and may affect how far patients’ decisions to accept or refuse medical treatment embody free will. Moreover, neurodivergence,

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

    PubMed Central

    Miller, R A

    1994-01-01

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

  11. A Comparative Study of Medical Data Classification Methods Based on Decision Tree and System Reconstruction Analysis

    Microsoft Academic Search

    Tzung-I Tang; Gang Zheng; Yalou Huang; Guangfu Shu

    2005-01-01

    This paper studies medical data classification methods, comparing decision tree and system recon- struction analysis as applied to heart disease medical data mining. The data we study is collected from patients with coronary heart disease. It has 1,723 records of 71 attributes each. We use the system-reconstruction method to weight it. We use decision tree algorithms, such as induction of

  12. Finding Common Ground: Exploring the Experiences of Client Involvement in Medication Decisions Using a Shared Decision Making Model

    E-print Network

    Goscha, Richard J.

    2009-12-01

    be involved in all phases of client decision making around psychiatric medications. Social workers currently account for the largest single profession in the field of mental health (Gambrill, 2002). Yet, social workers have traditionally played a... with schizophrenia who live with family members or with people who supervise their medications (Buchanan, 1992; Owen et al., 1996; Razali & Yahya, 1995). One study found that clients whose families are ambivalent about antipsychotic medications...

  13. Lessons learned by (from?) an economist working in medical decision making.

    PubMed

    Wakker, Peter P

    2008-01-01

    This article is a personal account of the author's experiences as an economist working in medical decision making. He discusses the differences between economic decision theory and medical decision making and gives examples of the mutual benefits resulting from interactions. In particular, he discusses the pros and cons of different methods for measuring quality of life (or, as economists would call it, utility), including the standard gamble, the time tradeoff, and the healthy-years equivalent methods. PMID:18812584

  14. DNA fingerprinting of medically important microorganisms by use of PCR.

    PubMed Central

    van Belkum, A

    1994-01-01

    Selected segments of any DNA molecule can be amplified exponentially by PCR. This technique provides a powerful tool to detect and identify minimal numbers of microorganisms. PCR is applicable both in diagnosis and in epidemiology. By amplification of hypervariable DNA domains, differences can be detected even among closely related strains. PCR fingerprinting is a valuable tool for medical microbiologists, epidemiologists, and microbial taxonomists. The current state of PCR-mediated genotyping is reviewed, and a comparison with conventional molecular typing methods is included. Because of its speed and versatility, PCR fingerprinting will play an important role in microbial genetics, epidemiology, and systematics. Images PMID:8055466

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

    Microsoft Academic Search

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

    1994-01-01

    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

  16. The medically important aerobic actinomycetes: epidemiology and microbiology.

    PubMed Central

    McNeil, M M; Brown, J M

    1994-01-01

    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 PMID:7923055

  17. The Relationship between Career Decision Status and Important Work Outcomes

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  18. The importance of telehealth for directors and other decision makers.

    PubMed

    Adriano Moran, Juan J; Roudsari, Abdul

    2015-01-01

    Innovation in healthcare services and clinical service redesign is a must because currently gaps exist between the care that people should receive for disease management and the actual care they receive. Directors and other decision makers should be aware of key challenges in the design, implementation and deployment of telehealth. In this paper, we discuss how telehealth enable chronic disease management, population health management and patient engagement, and what are the biggest challenges with getting value out of telehealth. PMID:25676938

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

    Microsoft Academic Search

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

    2005-01-01

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

  20. Exploring the experiences of client involvement in medication decisions using a shared decision making model: results of a qualitative study.

    PubMed

    Goscha, Richard; Rapp, Charles

    2015-04-01

    This qualitative study explored a newly introduced model of shared decision making (CommonGround) and how psychiatric medications were experienced by clients, prescribers, case managers and peer support staff. Of the twelve client subjects, six were highly engaged in shared decision-making and six were not. Five notable differences were found between the two groups including the presence of a goal, use of personal medicine, and the behavior of case managers and prescribers. Implications for a shared decision making model in psychiatry are discussed. PMID:25033796

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

    NASA Technical Reports Server (NTRS)

    Butler, Doug

    2009-01-01

    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.

  2. Making Medical Decisions for a Loved One at the End of Life

    MedlinePLUS

    ... 60611, 800-272-3900 Patient Education And Caring: End-of-Life (PEACE) Series This is general educational ... Medical Decisions for a Loved One at the End of Life Things to Think About When You ...

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

    PubMed

    Disney, W Terry; Peters, Mark A

    2003-11-12

    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

  4. MEDICAL DECISION MAKING LIBRARY NUMERIC CATEGORIES 1 Teaching MDM

    E-print Network

    Ford, James

    Decision Making (general) 4 Clinical Decision Making "Rounds" · NEJM "CLinical Problem Solving" 5 Clinical Clinical Prediction Rules 9 Algorithms · Guidelines 10 Calculating Posttest Probability 11 Test Performance · Informatics 26 Pros and Cons of MDM 27 Uncertainty 28 Critical Appraisal · Evidence-based Medicine 29 Outcomes

  5. Theories of Medical Decision Making and Health: An Evidence Based Approach

    Microsoft Academic Search

    Valerie F. Reyna

    2009-01-01

    In this special section of Medical Decision Making, 3 developers of evidence-based theories of medical decision making and health present their approaches: Fishbein (theory of reasoned action); Prochaska (transtheoretical model); and Reyna (fuzzy-trace theory). Spring, chair of the Evidence-Based Practice Committee of the Society for Behavioral Medicine, follows with a commentary on the 3 approaches and many other topics of

  6. Are economic evaluations an important tool in vaccine policy decisions?

    PubMed

    Jacobs, Philip

    2011-10-01

    In the 1980s, drug prices began rising considerably worldwide, and in the 1990s, countries began incorporating health economics into the scientific review process. Rising prices in vaccines began around the year 2000 and national bodies began to use health economics to review vaccines in the next decade. Health economics is a discipline that evaluates alternative interventions, balancing costs and health outcomes. There are characteristics of infectious diseases that differ from other illnesses, most notably the herd effect. We reviewed the role of economics in conducting vaccine scientific reviews. We conclude that health economics can move some of the considerations in vaccine policy decision-making from the political to the scientific arena, but there are still many unresolved issues. Health economists will continue to address these issues in the coming years, but there will always be a need for a separate policy review. PMID:21958095

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

    ERIC Educational Resources Information Center

    Garcia-Retamero, Rocio; Galesic, Mirta

    2012-01-01

    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…

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

    ERIC Educational Resources Information Center

    Goodnough, Lawrence T.; And Others

    1992-01-01

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

  9. Decision support system in a Patient-Centered Medical Home

    Microsoft Academic Search

    Kalyan S. Pasupathy; Karl M. Kochendorfer; Gordon D. Brown; Lanis L. Hicks; Linsey M. Barker; Ricky C. Leung

    2011-01-01

    Patient-Centered Medical Home is a care delivery model to transform how primary care is delivered in the United States. The information technology revolution has brought about several advancements and solutions for medicine and care delivery, and medical homes are no exception to this. Traditionally, such information technology solutions tend to be isolated in development and fragmented in implementation. However, it

  10. Evaluation of Psychological Factors in Medical School Admissions Decisions.

    ERIC Educational Resources Information Center

    Jones, Bonnie J.; Borges, Nicole J.

    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…

  11. Do Continuing Medical Education Articles Foster Shared Decision Making?

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  12. An integrative model of shared decision making in medical encounters

    Microsoft Academic Search

    Gregory Makoul; Marla L. Clayman

    2006-01-01

    ObjectiveGiven the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions.

  13. Integrating clinical data with information transmitted by implantable cardiac defibrillators to support medical decision in telecardiology

    E-print Network

    Zweigenbaum, Pierre

    to support medical decision in telecardiology: the application ontology of the AKENATON project Anita Burguna strictly device-centered follow-up to perspectives centered on the patient. In the AKENATON project, we of atrial fibrillation, e.g., where the thromboembolic risk depends on the medications taken by the patient

  14. Decision-Making in Basic Medical Sciences ExaminationsSingle versus Multiple Cutoff Scores

    Microsoft Academic Search

    James Algina; Leon J. Gross

    1979-01-01

    This study was prompted by concern that the criterion of an overall cutoff score on Basic Medical Sciences (BMS) examinations allows students to advance to their clinical training despite possible deficien cies in specific disciplines. To examine the validity of this concern, pass-fail decisions on four Basic Medical Sciences comprehensive examinations were compared with the passing criterion based on the

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

    PubMed

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

    2009-01-01

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

  16. Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions

    Microsoft Academic Search

    Malcolm H Parker; Colleen M Cartwright; Gail M Williams

    2008-01-01

    Objective: To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life.\\u000aDesign, setting and participants: As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically

  17. Reliability analysis framework for computer-assisted medical decision systems

    SciTech Connect

    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

    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.

  18. Explanations for Side Effect Aversion in Preventive Medical Treatment Decisions

    Microsoft Academic Search

    Erika A. Waters; Neil D. Weinstein; Graham A. Colditz; Karen Emmons

    2009-01-01

    Objective: Many laypeople demonstrate excessive sensitivity to negative side effects of medical treatments, which may lead them to refuse beneficial therapies. This Internet-based experiment investigated three possible explanations for such \\

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

    Microsoft Academic Search

    Mónica Pradillo; Juan L. Santos

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

  20. Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence

    PubMed Central

    2014-01-01

    Background Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. Methods We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Results Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p?=?0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p?=?0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p?Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p?decision support usage and adherence. Conclusion Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs. PMID:25167807

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

    Microsoft Academic Search

    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

    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

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

    Microsoft Academic Search

    Pierr Le Coz; Sebastien Tassy

    2007-01-01

    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

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

    PubMed Central

    2014-01-01

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

  4. A Virtual Medical Record for Guideline-Based Decision Support

    Microsoft Academic Search

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

    2001-01-01

    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

  5. How Numeracy Influences Risk Comprehension and Medical Decision Making

    ERIC Educational Resources Information Center

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

    2009-01-01

    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…

  6. Racial-Ethnic Biases, Time Pressure, and Medical Decisions

    ERIC Educational Resources Information Center

    Stepanikova, Irena

    2012-01-01

    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…

  7. 76 FR 6694 - Disclosure of Medical Information to the Surrogate of a Patient Who Lacks Decision-Making Capacity

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-08

    ...Medical Information to the Surrogate of a Patient Who Lacks Decision-Making Capacity AGENCY...information with the representative of a patient who lacks decision-making capacity...disclose certain protected information to a patient's representative under the...

  8. Providing Medical Marijuana: The Importance of Cannabis Clubs

    Microsoft Academic Search

    Harvey W. Feldman; Jerry Mandel

    1998-01-01

    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

  9. A psychiatric medication decision support guide for social work practice with pregnant and postpartum women.

    PubMed

    Bentley, Kia J; Price, Sarah Kye; Cummings, Cory R

    2014-10-01

    In their work in human services organizations and community agencies across service sectors, social workers encounter pregnant and postpartum women experiencing mental health challenges. This article offers an evidence-informed Decision Support Guide designed for use by social workers working with pregnant and postpartum women who are struggling with complicated decisions about psychiatric medication use. The guide is built on contemporary notions of health literacy and shared decision making and is informed by three areas: (1) research into the lived experiences of pregnant and postpartum women and health care providers around psychiatric medication decision making, (2) a critical review of existing decision aids, and (3) feedback on the strategy from social work practitioners who work with pregnant and postpartum women. Emphasizing the relational nature of social work in supporting effective health-related decision making, the guide relies on maintaining a collaborative practice milieu and using a decision aid that engages clients in discussions about mental health during and around the time of pregnancy. The guide offers social workers a practice tool to support responsive and compassionate care by embracing their roles in problem solving and decision making, providing emotional and psychosocial support, and making appropriate referrals to prescribers. PMID:25365831

  10. Preparing Children for Medical Examinations: The Importance of Previous Medical Experience

    Microsoft Academic Search

    Lynnda M. Dahlquist; Karen M. Gil; F. Daniel Armstrong; David D. DeLawyer; Paul Greene; Donald Wuori

    1986-01-01

    The relationship between past medical experience and children’s response to preparation for medical examinations was investigated in 79 pediatric outpatients aged 3 to 12 years. Children were randomly assigned to one of five preparation conditions prior to receiving a medical examination and a throat culture: sensory information about the exam, training in coping skills (deep breathing and positive self-talk), combined

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

    PubMed Central

    2011-01-01

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

  12. The growing dependency in health care. Recent changes in medical technology imports and exports in Turkey.

    PubMed

    Semin, S; Güldal, D

    1996-01-01

    This study investigates recent changes related to the import and export of medical technology and their results in Turkey. Between 1980 and 1993 the number of medical technology imports in Turkey rose, and there was a parallel rise in its ratio to total imports and health expenditures. In contrast the ratio of medical technology exports to total exports decreased significantly in the same period. The liberalization of foreign trade and the changes of health services toward free market policy has caused growing import of medical technology in Turkey. PMID:9136482

  13. Importance of the Medicaid Medical Directors’ Multistate Collaborative for Improving Care in Medicaid

    PubMed Central

    Zerzan, Judy; Griffith, Katherine; Trudnak, Tara; Fairbrother, Gerry

    2014-01-01

    Introduction: There are many benefits of multistate collaboratives or networks to states, but at the center is that they allow for the opportunity to learn from other states and experts about the practices and policies states have implemented without the significant time lag of published research. This commentary examines these benefits and illustrates the importance of quality improvement collaborations to decision-making in state Medicaid programs. Background: In 2007, the Medicaid Medical Directors Learning Network (MMDLN) began conducting quality improvement studies using their own state-level administrative data to better understand the major clinical issues facing the Medicaid populations and to work together on policies to improve outcomes. Rationale and Results: The three issues selected by MMDs for quality improvement monitoring to date involved an important national problem – including both morbidity and cost – and were amenable to policy solutions. The studies examined the use of antipsychotic medication in children, hospital admissions and readmissions, and early elective deliveries (i.e., elective deliveries occurring before 39 weeks). Importance and Utility: The multistate clinical quality projects conducted offer a key mechanism for achieving the goal of helping the Medicaid program deliver value-driven, high-quality, cost-effective health care in an efficient manner. These projects also provide the participating states with data to inform policies internally. Conclusions: In order for the quality of health care to improve, the system needs to be structured as a learning health care system; one that is always accessing evidence, implementing a variation of it (i.e., with new data sources or tools such as electronic clinical data), assessing effectiveness, and sharing results for others to repeat the cycle. PMID:25848592

  14. Taking a Broader Perspective on Medication Adherence: The Importance of System Factors

    E-print Network

    Amrhein, Valentin

    s 1 Taking a Broader Perspective on Medication Adherence: The Importance of System Factors Chapter 3 System factors as correlates of medication adherence in HIV and transplant populations are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey

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

    ERIC Educational Resources Information Center

    Lambert, Heather

    2012-01-01

    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…

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

    E-print Network

    de Weck, Olivier L.

    A Method for Analysis of Expert Committee Decision-Making Applied to FDA Medical Device Panels by David André Broniatowski S.B., Aeronautics and Astronautics, Massachusetts Institute of Technology, 2004 S.M., Aeronautics and Astronautics, Massachusetts Institute of Technology, 2006 S.M., Technology

  17. Model selection for a medical diagnostic decision support system: a breast cancer detection case

    Microsoft Academic Search

    David West; Vivian West

    2000-01-01

    There are a number of different quantitative models that can be used in a medical diagnostic decision support system (MDSS) including parametric methods (linear discriminant analysis or logistic regression), non-parametric models (K nearest neighbor, or kernel density) and several neural network models. The complexity of the diagnostic task is thought to be one of the prime determinants of model selection.

  18. Medical decision making in symptoms of type 2 diabetes mellitus in general practice

    PubMed Central

    de Cruppé, W.; von dem Knesebeck, O.; Gerstenberger, E.; Link, C.; Marceau, L.; Siegrist, J.; Geraedts, M.; McKinlay, J.

    2013-01-01

    Background Patient and physician attributes influence medical decisions as non-medical factors. The current study examines the influence of patient age and gender and physicians' gender and years of clinical experience on medical decision making in patients with undiagnosed diabetes type 2. Method A factorial experiment was conducted to estimate the influence of patient and physician attributes. An identical physician patient encounter with a patient presenting with diabetes symptoms was videotaped with varying patient attributes. Professional actors played the “patients”. A sample of 64 randomly chosen and stratified (gender and years of experience) primary care physicians was interviewed about the presented videos. Results Results show few significant differences in diagnostic decisions: Younger patients were asked more frequently about psychosocial problems while with older patients a cancer diagnosis was more often taken into consideration. Female physicians made an earlier second appointment date compared to male physicians. Physicians with more years of professional experience considered more often diabetes as the diagnosis than physicians with less experience. Conclusion Medical decision making in patients with diabetes type 2 is only marginally influenced by patients' and physicians' characteristics under study. PMID:21332034

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

    ERIC Educational Resources Information Center

    Johnson, Katherine M.; Johnson, David R.

    2009-01-01

    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…

  20. End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases

    PubMed Central

    Burkle, Christopher M.; Benson, Jeffre J.

    2012-01-01

    Two recent and unfortunate North American cases involving end-of-life treatment highlight the difficulties surrounding medical futility conflicts. As countries have explored the greater influence that patients and their representatives may play on end-of-life treatment decisions, the benefits and struggles involved with such a movement must be appreciated. These 2 cases are used to examine the present systems existing in the United States and Canada for resolving end-of-life decisions, including the difficulty in defining medical futility, the role of medical ethics committees, and controversies involving surrogate decision making. PMID:23127734

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

    PubMed

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

    2015-02-01

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

  2. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education

    Microsoft Academic Search

    Scott A. Simpson; Judith A. Long

    2007-01-01

    \\u000a Background  Despite the popularity of medical student-run health clinics among U.S. medical schools, there is no information about how\\u000a many clinics exist, how many students volunteer there, or how many patients they see and what services they offer.\\u000a \\u000a \\u000a \\u000a Objective  We describe, for the first time, the prevalence and operation of medical student-run health clinics nationwide.\\u000a \\u000a \\u000a \\u000a Design and participants  A web-based survey was sent

  3. Guided medication dosing for elderly emergency patients using real-time, computerized decision support

    PubMed Central

    Lo, Helen G; Burdick, Elisabeth; Keohane, Carol; Bates, David W

    2011-01-01

    Objective To evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs). Design A prospective controlled trial was conducted over 26?weeks. The status of the decision support tool alternated OFF (7/17/06–8/29/06), ON (8/29/06–10/10/06), OFF (10/10/06–11/28/06), and ON (11/28/06–1/16/07) in consecutive blocks during the study period. In patients ?65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations. Measurements The primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review. Results 2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p?0.0001). 673 (43%) visits were reviewed for ADEs. The rate of ADEs was lower during ON (8/237; 3.4%) compared with OFF (31/436; 7.1%) periods (p=0.02). The remaining secondary outcomes showed no difference. Limitations Single institution study, retrospective chart review for ADEs. Conclusion Though overall agreement with recommendations was low, real-time computerized decision support resulted in greater acceptance of medication recommendations. Fewer ADEs were observed when computerized decision support was active. PMID:22052899

  4. Medically important arboviruses of the United States and Canada.

    PubMed Central

    Calisher, C H

    1994-01-01

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

  5. Medical decision-making for incapacitated elders: A "therapeutic interests" standard.

    PubMed

    Kapp, Marshall B

    2010-01-01

    Some older individuals lack sufficient present cognitive and/or emotional ability to make and express autonomous decisions personally. In those situations, health-care providers routinely turn to available formal or informal surrogates who often must apply the best interests standard in making decisions for the incapacitated person. This article contends that defining the best interests standard of surrogate decision-making for older adults in terms of optimal or ideal choices (truly the patient's "best" interests) frequently sets out an unrealizable goal for surrogates to satisfy. Instead, a decision-making standard based on the incapacitated person's "therapeutic" interests is more realistic and hence more honest to adopt and apply from legal, ethical, and medical perspectives. PMID:20884051

  6. Patients' Preferences for Risk Disclosure and Role in Decision Making for Invasive Medical Procedures

    Microsoft Academic Search

    Dennis J. Mazur; David H. Hickam

    1997-01-01

    \\u000a OBJECTIVE:  To assess the level of involvement patients want in decision making related to the acceptance or rejection of an invasive\\u000a medical intervention and whether their preference for decision making is related to their preference for qualitative (verbal)\\u000a or quantitative (numeric) information about the risks of the procedure.\\u000a \\u000a \\u000a \\u000a DESIGN:  Cross-sectional study using structured interviews of consecutive patients seen for continuity care visits

  7. Quantitative and Qualitative Approaches to Reasoning under Uncertainty in Medical Decision Making

    Microsoft Academic Search

    John Fox; David Glasspool; Jonathan Bury

    2001-01-01

    Medical decision making frequently requires the effective management and communication of uncertainty and risk. However a\\u000a tension exists between classical probability theory, which is precise and rigorous but which people find non-intuitive and\\u000a difficult to use, and qualitative approaches which are ad hoc but can be more versatile and easily comprehensible. In this paper we review a range of approaches

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

    Goulionis, John E; Vozikis, Athanassios

    2009-01-01

    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. PMID:19549341

  10. Decision-making deficit in chronic migraine patients with medication overuse.

    PubMed

    Biagianti, B; Grazzi, L; Gambini, O; Usai, S; Muffatti, R; Scarone, S; Bussone, G

    2012-05-01

    Patients with chronic migraine developing medication-overuse headache (MOH) show dependency-like behaviors such as loss of control over analgesics despite adverse consequences on headaches, high rates of relapse after withdrawal from symptomatic medications, and compromised social functioning. Neuroimaging research suggests a common pathophysiology between substance-use disorders and MOH, which involves functional alterations in fronto-striatal networks, particularly in the orbitofrontal region of prefrontal cortex. These findings could explain the impaired decision-making observed in substance-use disorders. We hypothesize that MOH could share fronto-striatal circuit dysfunction and relative decision-making deficit with addiction. We further examine whether this deficit is a persistent cognitive trait or a reversible consequence of medication overuse. This study shows a dataset of 50 patients with MOH before the detoxification. All patients underwent a complete neurological and psychiatric examination. Psychiatric examination consisted of a clinical interview, Structured Clinical Interview for DSM-IV TR Axis II Personality Disorders, Anxiety and Depression Hamilton Scales, Severity of Dependence Scale. The neurological examination included the migraine disability assessment questionnaire. Neuropsychological assessment of fronto-striatal circuits was investigated using the Iowa gambling task (IGT). Twenty patients monitored for any relapse into medication overuse had 12 months of follow-up. Our sample, characterized by high rates of disability and dependency-like behaviors, exhibited a deficit in IGT performance, indicating an overall impairment in decision-making. All the 20 patients showed neurological and psychiatric improvement at 12-month follow-up, notwithstanding the overuse relapse, but a persistent IGT deficit was found. To our knowledge this is the first study that assesses this cognitive function in patients with MOH. Medication-overuse headache seems to share a persistent decision-making deficit with substance abuse that confirms the orbitofrontal cortex hypometabolism described in literature from a neuropsychological perspective. Looking at these shared neurocognitive features, our results suggest that MOH could belong to the addiction spectrum. Fronto-striatal dysfunction could be a premorbid psychobiological condition of vulnerability explaining the clinical onset of medication overuse and recurrent relapses. We propose that IGT could be used to identify chronic migraine patients with higher risk for medication overuse and relapse. PMID:22644192

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

    PubMed

    Elstein, A S

    2004-08-01

    The aims of this paper are to identify the issues and forces that were the impetus for two recent developments in academic medicine, evidence-based medicine (EBM) and medical decision making (MDM); to make explicit their underlying similarities and differences; and to relate them to the fates of these innovations. Both developments respond to concerns about practice variation; the rapid growth of medical technology, leading to a proliferation of diagnostic and treatment options; the patient empowerment movement; and psychological research that raised questions about the quality of human judgment and decision making. Their commonalities include: use of Bayesian principles in diagnostic reasoning, and the common structure embedded in an answerable clinical question and a decision tree. Major differences include: emphasis on knowledge or judgment as the fundamental problem; the status of formal models and utility assessment; and the spirit and tone of the innovation. These differences have led to broader acceptance of EBM within academic medicine, while decision analysis, the fundamental tool of MDM, has been less welcomed in clinical circles and has found its place in guideline development, cost-effectiveness analysis, and health policy. PMID:15338074

  12. Personal digital assistant with a barcode reader - A medical decision support system for nurses in home care

    Microsoft Academic Search

    Pauline E. Johansson; Göran I. Petersson; Gunilla C. Nilsson

    2010-01-01

    IntroductionInappropriate medication among elderly people increases the risk of adverse drug–drug interactions, drug-related falls and hospital admissions. In order to prevent these effects it is necessary to obtain a profile of the patients’ medication. A personal digital assistant (PDA) can be used as a medical decision support system (MDSS) to obtain a profile of the patients’ medication and to check

  13. Sharing decisions in consultations involving anti-psychotic medication: a qualitative study of psychiatrists' experiences.

    PubMed

    Seale, Clive; Chaplin, Robert; Lelliott, Paul; Quirk, Alan

    2006-06-01

    In psychiatry, and in treating people with a diagnosis of schizophrenia in particular, there are obstacles to achieving concordant, shared decision making and in building a co-operative therapeutic alliance where mutual honesty is the norm. Studies of people with a diagnosis of schizophrenia have revealed critical views of medical authority, particularly over the issue of enforced compliance with antipsychotic medication. Psychiatrists are known to place particular value on such medication. This qualitative study reports the views of 21 general adult psychiatrists working in UK about their experiences of consultations involving discussion of antipsychotic medication. Interviewees reported a general commitment to achieving concordant relationships with patients and described a number of strategies they used to promote this. In this respect, their self-perception differs from the picture of authoritarian practice painted by critics of psychiatry, and by some studies reporting patients' views. Interviewees also described obstacles to achieving concordance, including adverse judgements of patients' competence and honesty about their medication use. Explaining the adverse effects of medication was perceived to discourage some patients from accepting this treatment. Moments of strategic dishonesty were reported. Psychiatrists perceived that trust could be damaged by episodes of coercion, or by patients' perception of coercive powers. We conclude that a self-perception of patient-centredness may not preclude psychiatrists from fulfilling a social control function. PMID:16343722

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  15. Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

    Microsoft Academic Search

    Marjan J Bruins; Gijs JHM Ruijs; Maurice JHM Wolfhagen; Peter Bloembergen; Jos ECM Aarts

    2011-01-01

    Background  Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical\\u000a microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results\\u000a will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious\\u000a disease management. The

  16. A preface on advances in diagnostics for infectious and parasitic diseases: detecting parasites of medical and veterinary importance.

    PubMed

    Stothard, J Russell; Adams, Emily

    2014-12-01

    There are many reasons why detection of parasites of medical and veterinary importance is vital and where novel diagnostic and surveillance tools are required. From a medical perspective alone, these originate from a desire for better clinical management and rational use of medications. Diagnosis can be at the individual-level, at close to patient settings in testing a clinical suspicion or at the community-level, perhaps in front of a computer screen, in classification of endemic areas and devising appropriate control interventions. Thus diagnostics for parasitic diseases has a broad remit as parasites are not only tied with their definitive hosts but also in some cases with their vectors/intermediate hosts. Application of current diagnostic tools and decision algorithms in sustaining control programmes, or in elimination settings, can be problematic and even ill-fitting. For example in resource-limited settings, are current diagnostic tools sufficiently robust for operational use at scale or are they confounded by on-the-ground realities; are the diagnostic algorithms underlying public health interventions always understood and well-received within communities which are targeted for control? Within this Special Issue (SI) covering a variety of diseases and diagnostic settings some answers are forthcoming. An important theme, however, throughout the SI is to acknowledge that cross-talk and continuous feedback between development and application of diagnostic tests is crucial if they are to be used effectively and appropriately. PMID:25415359

  17. Chemical mixtures from a public health perspective: the importance of research for informed decision making.

    PubMed

    Sexton, K; Beck, B D; Bingham, E; Brain, J D; DeMarini, D M; Hertzberg, R C; O'Flaherty, E J; Pounds, J G

    1995-12-28

    When considered from a public health perspective, the central question regarding chemical mixtures is deceptively simple: Are current approaches to risk assessment for chemical mixtures affording effective (adequate) and efficient (cost-effective) protection for members of our society? Answering this question realistically depends on an understanding of the hierarchical goals of public health (i.e. prevention, intervention, treatment) and an accurate evaluation of the extent to which these goals are being achieved. To allow decision makers to make informed judgments about the health risks of chemical mixtures, adequate scientific knowledge and understanding must be available to support risk assessment activities, which are an integral part of the regulatory decision making process. Designing and implementing relevant research depends on the existence of a feedback loop between researchers and regulators, where the information needs of regulators influence the nature and direction of research and the information and understanding generated by researchers improves the scientific basis for public health decisions. A clear, consistent, commonly accepted taxonomy for describing important mixture-related phenomena is a key factor in creating and maintaining the necessary feedback loop. Ultimately, both researchers and regulators share a common goal with regard to chemical mixtures; improving the state-of-the-science so that we can make informed decisions about protecting public health. A survey of research issues and needs that are crucial to attaining this goal is presented. PMID:8571378

  18. Religious and Spiritual Beliefs of Gynecologic Oncologists May Influence Medical Decision Making

    PubMed Central

    Ramondetta, Lois; Brown, Alaina; Richardson, Gwyn; Urbauer, Diana; Thaker, Premal H.; Koenig, Harold G.; Gano, Jacalyn B.; Sun, Charlotte

    2011-01-01

    Background Religious and spiritual (R/S) beliefs often affect patients' health care decisions, particularly with regards care at the end of life (EOL). Furthermore, patients desire more R/S involvement by the medical community however; physicians typically do not incorporate R/S assessment into medical interviews with patients. The effects of physicians' R/S beliefs on willingness to participate in controversial clinical practices such as medical abortions and physician assisted suicide has been evaluated, but how a physicians' R/S beliefs may affect other medical decision-making is unclear. Methods Using SurveyMonkey, an online survey tool, we surveyed 1972 members of the International Gynecologic Oncologists Society and the Society of Gynecologic Oncologists to determine the R/S characteristics of gynecologic oncologists and whether their R/S beliefs affected their clinical practice. Demographics, religiosity and spirituality data were collected. Physicians were also asked to evaluate 5 complex case scenarios. Results Two hundred seventy-three (14%) physicians responded. Sixty percent “agreed” or “somewhat agreed” that their R/S beliefs were a source of personal comfort. Forty-five percent reported that their R/S beliefs (“sometimes,” “frequently,” or “always”) play a role in the medical options they offered patients, but only 34% “frequently” or “always” take a R/S history from patients. Interestingly, 90% reported that they consider patients' R/S beliefs when discussing EOL issues. Responses to case scenarios largely differed by years of experience although age and R/S beliefs also had influence. Conclusions Our results suggest that gynecologic oncologists' R/S beliefs may affect patient care but that the majority of physicians fail to take a R/S history from their patients. More work needs to be done in order to evaluate possible barriers that prevent physicians from taking a spiritual history and engaging in discussions over these matters with patients. PMID:21436706

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

    NASA Technical Reports Server (NTRS)

    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

    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.

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

    PubMed Central

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

    2012-01-01

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

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

    Microsoft Academic Search

    Donald A. MacKenzie; Marianne Defernez; Warwick B. Dunn; Marie Brown; Linda J. Fuller; Andreas Günther; Steve A. James; John Eagles; Mark Philo; Royston Goodacre; Ian N. Roberts

    2008-01-01

    Ten medically important Saccharomyces strains, comprising six clinical isolates of Saccharomyces cerevisiae and four probiotic strains of Saccharomyces boulardii ,w ere 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2010-01-01

    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. PMID:20446143

  4. Outline Introduction From Bayes to Evidence theory Decision-making in real world problems Medical diagnosis problem Thre Modelling and efficient fusion of uncertain

    E-print Network

    Chisci, Luigi

    Dempster-Shafer theory Bayes vs. Dempster-Shafer 3 Decision-making in real world problems Modelling real to Evidence theory Decision-making in real world problems Medical diagnosis problem ThreModelling Bayes to Evidence theory Decision-making in real world problems Medical diagnosis problem ThreModelling

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

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

    PubMed Central

    2012-01-01

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

  7. Name changes in medically important fungi and their implications for clinical practice.

    PubMed

    de Hoog, G Sybren; Chaturvedi, Vishnu; Denning, David W; Dyer, Paul S; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meis, Jacques F; Meyer, Wieland; Pitt, John I; Samson, Robert A; Taylor, John W; Tintelnot, Kathrin; Vitale, Roxana G; Walsh, Thomas J; Lackner, Michaela

    2015-04-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability. PMID:25297326

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

    Microsoft Academic Search

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

    1994-01-01

    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

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

    NSDL National Science Digital Library

    0000-00-00

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

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

    Microsoft Academic Search

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

    2007-01-01

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

  11. Pre-Medical and Pre-Dental Checklist of Important Things to Do Medical/Dental Admissions Review Board Requirements/Recommendations

    E-print Network

    Hutcheon, James M.

    Pre-Medical and Pre-Dental Checklist of Important Things to Do Medical/Dental Admissions Review Board Requirements/Recommendations Read and be familiar with the Medical/Dental Review Board's policies study habits ­ learn for the long term. o Use study groups, Academic Success Center, tutoring, meet

  12. An architecture for linking medical decision-support applications to clinical databases and its evaluation.

    PubMed

    German, Efrat; Leibowitz, Akiva; Shahar, Yuval

    2009-04-01

    We describe and evaluate a framework, the Medical Database Adaptor (MEIDA), for linking knowledge-based medical decision-support systems (MDSSs) to multiple clinical databases, using standard medical schemata and vocabularies. Our solution involves a set of tools for embedding standard terms and units within knowledge bases (KBs) of MDSSs; a set of methods and tools for mapping the local database (DB) schema and the terms and units relevant to the KB of the MDSS into standardized schema, terms and units, using three heuristics (choice of a vocabulary, choice of a key term, and choice of a measurement unit); and a set of tools which, at runtime, automatically map standard term queries originating from the KB, to queries formulated using the local DB's schema, terms and units. The methodology was successfully evaluated by mapping three KBs to three DBs. Using a unit-domain matching heuristic reduced the number of term-mapping candidates by a mean of 71% even after other heuristics were used. Runtime access of 10,000 records required one second. We conclude that mapping MDSSs to different local clinical DBs, using the three-phase methodology and several term-mapping heuristics, is both feasible and efficient. PMID:19027088

  13. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    PubMed

    Godény, Sándor

    2012-01-22

    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed. PMID:22236414

  14. Computer-based medical decision support system in diagnosis and treatment of musculoskeletal disorders and injuries.

    PubMed

    Tomaszewski, Wies?aw; Bli?niuk, Grzegorz; Czamara, Andrzej; Amelja?czyk, Andrzej; Widuchowski, Wojciech; Klukowski, Krzysztof

    2011-01-01

    The use of information technologies in health care systems around the world dates back to the 1970s. But it was only the dynamic development of information technology in the 1990s that enabled significant development of IT systems supporting broadly defined medical activity. The ongoing process of transformation of the Polish healthcare system has been forcing health care providers to expend financial, material and human resources increasing efficiency. At the same time, the very dynamic development of medical sciences and information technologies has brought about a significant increase in the number of papers of importance for the effectiveness and quality of medical care. As a result, medical specialists are not able to keep up with the constantly updated medical knowledge. These factors are making standardization of health care processes a growing necessity. This paper is an introductory work presenting, on the basis of the available literature and the authors' research experience, a historical outline, stages of development and state of the art of information technology in medicine, as well as theoretical objectives of the project, which are specified in the title of this paper. PMID:21750352

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

    PubMed

    Krüger, Colin M

    2008-01-01

    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

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

    PubMed

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

    2007-03-01

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

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

    PubMed Central

    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

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

  18. What are the important decisions in the lives of german and Indian university students? The structure of real-life decision-making processes.

    PubMed

    Tipandjan, Arun; Schäfer, Thomas; Sundaram, Suresh; Sedlmeier, Peter

    2012-06-01

    In intercultural research, bias is sometimes introduced when a methodological approach that was mostly developed within one of the cultures (usually the Western one) is chosen. Instead of identifying and controlling such bias after data collection and during analysis, eliminating and minimizing bias during planning and while conducting the research is much more advisable. Particularly cross-cultural decision-making research has been hindered by the lack of instruments that are equally applicable in different cultures, resulting in biased findings. We have proposed a methodology for comparing cultures that uses qualitative methods and have used it in a comparison of German and Indian students' most important decision-making situations. In the first study, we identified common and different decision-making situations and recommended major areas for further cross-cultural research on decision making. In the second study, we made an attempt to explore the factors underlying important decision-making areas in the two cultures. Semi-structured interviews were conducted to look for strong similarities and differences between cultures. Transcribed interview data were analyzed qualitatively using thematic analysis. Several themes were identified and descriptions of factors influencing decision making were derived inductively from interviews with students. Similarities and differences are explained in detail and a further, quantitative survey in different cultures is recommended. PMID:22083653

  19. Isolation and characterization of medically important aerobic actinomycetes in soil of iran (2006 - 2007).

    PubMed

    Aghamirian, Mohammad Reza; Ghiasian, Seyed Amir

    2009-01-01

    The aerobic actinomycetes are a large group of soil-inhabiting bacteria that occur worldwide. Some of them are the main cause of two important diseases, nocardiosis and actinomycetoma. To identify the prevalence and geographic distribution of aerobic actinomycetes in soil of Qazvin province, a study was carried out during 2006-2007. In this study, the incidence and diversity of medically important aerobic actinomycetes was determined in 300 soil samples of different parts of Qazvin. The suspensions of superficial soil samples were prepared by adding of normal saline, streptomycin and chloramphenicol and the supernatants were cultured on brain-heart infusion agar and Sabouraud's dextrose agar contain cycloheximide. The isolated microorganisms were examined by Gram and acid-fast stains and were identified biochemically and morphologically. Of 96 aerobic actinomycetes isolates identified, Actinomadura madurae and Streptomyces somaliensis were the most frequently isolated species each representing 19.8% of isolates, followed by Nocardia asteroides (15.6%), N. otitidiscaviarum (9.4%), N. brasiliensis (7.3%), A. peletieri, S. griseus, and Nocardia spp. (each 5.2%), and N. transvalensis, Nocardiopsis dassonvillei, Actinomadura spp. and Streptomyces spp. (each 3.1%). To the best of our knowledge, this is the first report on epidemiological investigation of medically important aerobic actinomycetes in soil samples from Iran. In recent years, mycetoma and nocardiosis have been increasingly reported in Iran. The results showed that medically important actinomycetes occur in the environment of Iran and soil could be potential source of actinomycotic infections. PMID:19440253

  20. Neural Correlates of Effective Learning in Experienced Medical Decision-Makers

    PubMed Central

    Montague, P. Read

    2011-01-01

    Accurate associative learning is often hindered by confirmation bias and success-chasing, which together can conspire to produce or solidify false beliefs in the decision-maker. We performed functional magnetic resonance imaging in 35 experienced physicians, while they learned to choose between two treatments in a series of virtual patient encounters. We estimated a learning model for each subject based on their observed behavior and this model divided clearly into high performers and low performers. The high performers showed small, but equal learning rates for both successes (positive outcomes) and failures (no response to the drug). In contrast, low performers showed very large and asymmetric learning rates, learning significantly more from successes than failures; a tendency that led to sub-optimal treatment choices. Consistently with these behavioral findings, high performers showed larger, more sustained BOLD responses to failed vs. successful outcomes in the dorsolateral prefrontal cortex and inferior parietal lobule while low performers displayed the opposite response profile. Furthermore, participants' learning asymmetry correlated with anticipatory activation in the nucleus accumbens at trial onset, well before outcome presentation. Subjects with anticipatory activation in the nucleus accumbens showed more success-chasing during learning. These results suggest that high performers' brains achieve better outcomes by attending to informative failures during training, rather than chasing the reward value of successes. The differential brain activations between high and low performers could potentially be developed into biomarkers to identify efficient learners on novel decision tasks, in medical or other contexts. PMID:22132137

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

    PubMed Central

    Wilhelms, Evan A.

    2013-01-01

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

  2. “I didn’t even know what I was looking for”: A qualitative study of the decision-making processes of Canadian medical tourists

    PubMed Central

    2012-01-01

    Background Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists’ decision-making processes. Methods Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed. Results Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites. Conclusions While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients’ private international medical travel. PMID:22769723

  3. Critical Thinking about Adverse Drug Effects: Lessons from the Psychology of Risk and Medical Decision-Making for Clinical Psychopharmacology

    Microsoft Academic Search

    Andrew A. Nierenberg; Jordan W. Smoller; Polina Eidelman; Yelena P. Wu; Claire A. Tilley

    2008-01-01

    Systematic biases in decision-making have been well characterized in medical and nonmedical fields but mostly ignored in clinical psychopharmacology. The purpose of this paper is to sensitize clinicians who prescribe psychiatric drugs to the issues of the psychology of risk, especially as they pertain to the risk of side effects. Specifically, the present analysis focuses on heuristic organization and framing

  4. Understanding Disparities in Health Care: Non-Medical Factors Influencing Physicians' Clinical Decision-Making for the Uninsured

    Microsoft Academic Search

    Robin Naugher Cleeland

    2006-01-01

    Lack of health insurance is a significant public health concern in the U.S. Currently more than 45 million Americans do not have any health insurance, and many more are underinsured. Public policy approaches that seek to improve access to medical care for the uninsured and underinsured must be based on an understanding of physician decision-making because physicians are gatekeepers who

  5. Comparative evaluation of different medication safety measures for the emergency department: physicians’ usage and acceptance of training, poster, checklist and computerized decision support

    PubMed Central

    2013-01-01

    Background Although usage and acceptance are important factors for a successful implementation of clinical decision support systems for medication, most studies only concentrate on their design and outcome. Our objective was to comparatively investigate a set of traditional medication safety measures such as medication safety training for physicians, paper-based posters and checklists concerning potential medication problems versus the additional benefit of a computer-assisted medication check. We concentrated on usage, acceptance and suitability of such interventions in a busy emergency department (ED) of a 749 bed acute tertiary care hospital. Methods A retrospective, qualitative evaluation study was conducted using a field observation and a questionnaire-based survey. Six physicians were observed while treating 20 patient cases; the questionnaire, based on the Technology Acceptance Model 2 (TAM2), has been answered by nine ED physicians. Results During field observations, we did not observe direct use of any of the implemented interventions for medication safety (paper-based and electronic). Questionnaire results indicated that the electronic medication safety check was the most frequently used intervention, followed by checklist and posters. However, despite their positive attitude, physicians most often stated that they use the interventions in only up to ten percent for subjectively “critical” orders. Main reasons behind the low usage were deficits in ease-of-use and fit to the workflow. The intention to use the interventions was rather high after overcoming these barriers. Conclusions Methodologically, the study contributes to Technology Acceptance Model (TAM) research in an ED setting and confirms TAM2 as a helpful diagnostic tool in identifying barriers for a successful implementation of medication safety interventions. In our case, identified barriers explaining the low utilization of the implemented medication safety interventions - despite their positive reception - include deficits in accessibility, briefing for the physicians about the interventions, ease-of-use and compatibility to the working environment. PMID:23890121

  6. An Arden-Syntax-based clinical decision support framework for medical guidelines--Lyme borreliosis as an example.

    PubMed

    Seitinger, Alexander; Fehre, Karsten; Adlassnig, Klaus-Peter; Rappelsberger, Andrea; Wurm, Elisabeth; Aberer, Elisabeth; Binder, Michael

    2014-01-01

    Medicine is evolving at a very fast pace. The overwhelming quantity of new data compels the practician to be consistently informed about the most recent scientific advances. While medical guidelines have proven to be an acceptable tool for bringing new medical knowledge into clinical practice and also support medical personnel, reading them may be rather time-consuming. Clinical decision support systems have been developed to simplify this process. However, the implementation or adaptation of such systems for individual guidelines involves substantial effort. This paper introduces a clinical decision support platform that uses Arden Syntax to implement medical guidelines using client-server architecture. It provides a means of implementing different guidelines without the need for adapting the system's source code. To implement a prototype, three Lyme borreliosis guidelines were aggregated and a knowledge base created. The prototype employs transfer objects to represent any text-based medical guideline. As part of the implementation, we show how Fuzzy Arden Syntax can improve the overall usability of a clinical decision support system. PMID:24825694

  7. Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

    PubMed Central

    Niederau, Claus; Hüppe, Dietrich; Zehnter, Elmar; Möller, Bernd; Heyne, Renate; Christensen, Stefan; Pfaff, Rainer; Theilmeier, Arno; Alshuth, Ulrich; Mauss, Stefan

    2012-01-01

    AIM: To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not. METHODS: This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon ? 2a/ribavirin, involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings). A structured questionnaire had to be answered prior to the treatment decision, which included demographic data, information about the personal life situation of the patients, anamnesis and symptomatology of hepatitis C, virological data, laboratory data and data on concomitant diseases. A second part of the study analyzes patients treated with pegylated interferon ?2a. All questionnaires included reasons against treatment mentioned by the physician. RESULTS: Overall treatment uptake was 45%. By multivariate analysis, genotype 1/4/5/6, HCV-RNA ? 520?000 IU/mL, normal alanine aminotransferase (ALT), platelets ? 142 500/?L, age > 56 years, female gender, infection length > 12.5 years, concomitant diseases, human immunodeficiency virus co-infection, liver biopsy not performed, care in private practice, asymptomatic disease, and unemployment were factors associated with reduced treatment rate. Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems. Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low. CONCLUSION: Some reasons against treatment were medically based whereas others were related to fears, socio-economical problems, and information deficits both on the side of physicians and patients. PMID:22493547

  8. Three Cases of Adolescent Childbearing Decision-Making: The Importance of Ambivalence

    ERIC Educational Resources Information Center

    Bender, Soley S.

    2008-01-01

    Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted…

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

    ERIC Educational Resources Information Center

    Tennessee Higher Education Commission, Nashville.

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    PubMed Central

    Gilmer, Todd P; 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

    Background and 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 United Kingdom Prospective Diabetes Study 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 (0.26 percent, 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 = 0.01) 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. PMID:22578085

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  14. Detection of Medically Important Candida Species by Absolute Quantitation Real-Time Polymerase Chain Reaction

    PubMed Central

    Than, Leslie Thian Lung; Chong, Pei Pei; Ng, Kee Peng; Seow, Heng Fong

    2014-01-01

    Background: The number of invasive candidiasis cases has risen especially with an increase in the number of immunosuppressed and immunocom promised patients. The early detection of Candida species which is specific and sensitive is important in determining the correct administration of antifungal drugs to patients. Objectives: This study aims to develop a method for the detection, identification and quantitation of medically important Candida species through quantitative polymerase chain reaction (qPCR). Materials and Methods: The isocitrate lyase (ICL) gene which is not found in mammals was chosen as the target gene of real-time PCR. Absolute quantitation of the gene copy number was achieved by constructing the plasmid containing the ICL gene which is used to generate standard curve. Twenty fungal species, two bacterial species and human DNA were tested to check the specificity of the detection method. Results: All eight Candida species were successfully detected, identified and quantitated based on the ICL gene. A seven-log range of the gene copy number and a minimum detection limit of 103 copies were achieved. Conclusions: A one-tube absolute quantification real-time PCR that differentiates medically important Candida species via individual unique melting temperature was achieved. Analytical sensitivity and specificity were not compromised. PMID:25789129

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

    PubMed

    Gluck, J C; Hassig, R A

    2001-07-01

    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

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

    PubMed Central

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

    2014-01-01

    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. PMID:24475099

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

    PubMed

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

    2014-09-16

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

  18. Contamination of Medical Charts: An Important Source of Potential Infection in Hospitals

    PubMed Central

    Chen, Kuo-Hu; Chen, Li-Ru; Wang, Ying-Kuan

    2014-01-01

    Objective This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital. Methods All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline. Results For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (p?=?0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97–4.00]. Conclusions Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions. PMID:24558355

  19. A hybrid approach to medical decision support systems: combining feature selection, fuzzy weighted pre-processing and AIRS.

    PubMed

    Polat, Kemal; Güne?, Salih

    2007-11-01

    This paper presents a hybrid approach based on feature selection, fuzzy weighted pre-processing and artificial immune recognition system (AIRS) to medical decision support systems. We have used the heart disease and hepatitis disease datasets taken from UCI machine learning database as medical dataset. Artificial immune recognition system has shown an effective performance on several problems such as machine learning benchmark problems and medical classification problems like breast cancer, diabetes, and liver disorders classification. The proposed approach consists of three stages. In the first stage, the dimensions of heart disease and hepatitis disease datasets are reduced to 9 from 13 and 19 in the feature selection (FS) sub-program by means of C4.5 decision tree algorithm (CBA program), respectively. In the second stage, heart disease and hepatitis disease datasets are normalized in the range of [0,1] and are weighted via fuzzy weighted pre-processing. In the third stage, weighted input values obtained from fuzzy weighted pre-processing are classified using AIRS classifier system. The obtained classification accuracies of our system are 92.59% and 81.82% using 50-50% training-test split for heart disease and hepatitis disease datasets, respectively. With these results, the proposed method can be used in medical decision support systems. PMID:17884235

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

    PubMed Central

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

    2011-01-01

    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. PMID:21854323

  1. Veterinary decision making in relation to metritis - a qualitative approach to understand the background for variation and bias in veterinary medical records

    PubMed Central

    Lastein, Dorte B; Vaarst, Mette; Enevoldsen, Carsten

    2009-01-01

    Background Results of analyses based on veterinary records of animal disease may be prone to variation and bias, because data collection for these registers relies on different observers in different settings as well as different treatment criteria. Understanding the human influence on data collection and the decisions related to this process may help veterinary and agricultural scientists motivate observers (veterinarians and farmers) to work more systematically, which may improve data quality. This study investigates qualitative relations between two types of records: 1) 'diagnostic data' as recordings of metritis scores and 2) 'intervention data' as recordings of medical treatment for metritis and the potential influence on quality of the data. Methods The study is based on observations in veterinary dairy practice combined with semi-structured research interviews of veterinarians working within a herd health concept where metritis diagnosis was described in detail. The observations and interviews were analysed by qualitative research methods to describe differences in the veterinarians' perceptions of metritis diagnosis (scores) and their own decisions related to diagnosis, treatment, and recording. Results The analysis demonstrates how data quality can be affected during the diagnostic procedures, as interaction occurs between diagnostics and decisions about medical treatments. Important findings were when scores lacked consistency within and between observers (variation) and when scores were adjusted to the treatment decision already made by the veterinarian (bias). The study further demonstrates that veterinarians made their decisions at 3 different levels of focus (cow, farm, population). Data quality was influenced by the veterinarians' perceptions of collection procedures, decision making and their different motivations to collect data systematically. Conclusion Both variation and bias were introduced into the data because of veterinarians' different perceptions of and motivations for decision making. Acknowledgement of these findings by researchers, educational institutions and veterinarians in practice may stimulate an effort to improve the quality of field data, as well as raise awareness about the importance of including knowledge about human perceptions when interpreting studies based on field data. Both recognitions may increase the usefulness of both within-herd and between-herd epidemiological analyses. PMID:19715614

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

    SciTech Connect

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

    2013-05-01

    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.

  3. 76 FR 63600 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ...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...

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

    ERIC Educational Resources Information Center

    Rottig, Daniel; Heischmidt, Kenneth A.

    2007-01-01

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

  5. The perceived importance of an ethical issue as an influence on the ethical decision-making of ad managers

    Microsoft Academic Search

    P. J. Forrest; R. Eric Reidenbach

    1996-01-01

    We explored the impact of a proposed new construct “perceived importance of an ethical issue” (PIE) on the ethical decision-making process. This construct parallels similar constructs in involvement literature popular in consumer behavior. The PIE construct was found to exhibit reasonable characteristics for preliminary judgments about validity, and it produced a significant and substantial impact on both ethical judgment and

  6. Tracking Managed Care: The Importance of a Cash Incentive for Medical Director Response to a Survey

    Microsoft Academic Search

    Jennifer L. Malin; Jeffrey Rideout; Patricia A. Ganz

    Objective: To assess the impact of a monetary incentive in a survey mailed to medical directors of large medical groups and independent practice asso- ciations (IPAs). Study Design: Mailed survey. Methods: We mailed a survey to the medical directors of all medical groups and IPAs contracted with Blue Cross CaliforniaCare, a large California managed care health plan (n = 174).

  7. A Multipurpose Interactive Videodisc with Ethical, Legal, Medical, Educational and Research Implications: The Informed Patient Decision-Making Procedure

    PubMed Central

    Lyon, Harold C.; Henderson, Joseph V.; Beck, J. Robert; Mulley, Albert G.; Barry, Michael J.; Fowler, Floyd J.; Wennberg, Coralea N.; Wennberg, John E.

    1989-01-01

    An interactive videodisc (using a single screen Macintosh II, HyperCard driven, Level III, CAV interactive videodisc) has been designed, produced, and pretested to permit patients with benign prostatic hyperplasia (BPH), facing a choice of surgery or watchful waiting, to take an active role in decision-making. The Informed Patient Decision-Making Procedure (IPDP) educates the patient about the benefits and harms of two treatment choices: prostatectomy and watchful waiting for BPH, by presenting patient-specific data derived from an analysis of medical outcomes. and video testimonials from patients with good and unfortunate outcomes of the therapeutic options. The IPDP standardizes the information provided to the patients, provides informed consent, gathers follow-up outcomes research data, and permits automated assessment of patient preferences and utilities. In this demonstration, the development of the IPDP is discussed, the videodisc program is presented, and lessons learned in creating medical videodiscs are shared.

  8. An assessment of the efficiency of fungal DNA extraction methods for maximizing the detection of medically important fungi using PCR

    Microsoft Academic Search

    A. Karakousis; L. Tan; D. Ellis; H. Alexiou; P. J. Wormald

    2006-01-01

    To date, no single reported DNA extraction method is suitable for the efficient extraction of DNA from all fungal species. The efficiency of extraction is of particular importance in PCR-based medical diagnostic applications where the quantity of fungus in a tissue biopsy may be limited. We subjected 16 medically relevant fungi to physical, chemical and enzymatic cell wall disruption methods

  9. Research Paper: Computerized Clinical Decision Support During Medication Ordering for Long-term Care Residents with Renal Insufficiency

    Microsoft Academic Search

    Terry S. Field; Paula Rochon; Monica Lee; Linda Gavendo; Joann L. Baril; Jerry H. Gurwitz

    2009-01-01

    ObjectiveTo determine whether a computerized clinical decision support system providing patient-specific recommendations in real-time improves the quality of prescribing for long-term care residents with renal insufficiency.DesignRandomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the

  10. Medical decision-making of the patient in the context of the family: results of a survey

    Microsoft Academic Search

    Christof Schäfer; Kurt Putnik; Barbara Dietl; Peter Leiberich; Thomas H. Loew; Oliver Kölbl

    2006-01-01

    Goals of the study  From the perspective of patient autonomy, the family is often looked upon as a troublemaker in medical decision-making. The question remains open as to whether it is possible to do justice to the autonomy of the individual patient and to the claims of his family at the same time.Patients and methods  A clinical study was undertaken when both

  11. The Importance of Organ Geometry and Boundary Constraints for Planning of Medical Interventions

    PubMed Central

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

    2009-01-01

    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, the 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 (for needle path planning) the organ geometry and boundary constraints surrounding the organ are the most important factors inuencing the deformation. As an example, the procedure of needle insertion into the prostate (e.g. for biopsy or brachytherapy) is considered. Image segmentation is used to extract the anatomical details from magnetic resonance images, while object-oriented finite element analysis (OOF) software is used to generate finite element (FE) meshes from the segmented images. Two-dimensional FE simulations that account for complex anatomical details along with relative motion between the prostate and its surrounding structure using cohesive zone models are compared with traditional simulation models having simple organ geometry and boundary constraints. Nodal displacements for these simpler models were observed to be up to 14 times larger than those obtained from the anatomically accurate models. PMID:18815068

  12. Key to the identification of East and Central African freshwater snails of medical and veterinary importance*

    PubMed Central

    Mandahl-Barth, G.

    1962-01-01

    This identification key has been prepared to enable field workers in eastern and centra Africa to identify the species and subspecies of snails acting as intermediate hosts of various flukes causing bilharziasis and related diseases in man and his domestic stock. The area covered by the key is eastern Africa from the Sudan and Somalia in the north to Southern Rhodesia in the south. The key includes all species and subspecies of the three medically and veterinarily important genera, Lymnaea, Bulinus and Biomphalaria. All other freshwater pulmonates of the area can be identified as to genus only. Those features of the shells and soft parts of snails which are used in identification are discussed in some detail, and indications are given as to methods of collection, preservation and dissection of snails. PMID:14469160

  13. Status and prospects of DNA barcoding in medically important parasites and vectors.

    PubMed

    Ondrejicka, Danielle A; Locke, Sean A; Morey, Kevin; Borisenko, Alex V; Hanner, Robert H

    2014-12-01

    For over 10 years, DNA barcoding has been used to identify specimens and discern species. Its potential benefits in parasitology were recognized early, but its utility and uptake remain unclear. Here we review studies using DNA barcoding in parasites and vectors affecting humans and find that the technique is accurate (accords with author identifications based on morphology or other markers) in 94-95% of cases, although aspects of DNA barcoding (vouchering, marker implicated) have often been misunderstood. In a newly compiled checklist of parasites, vectors, and hazards, barcodes are available for 43% of all 1403 species and for more than half of 429 species of greater medical importance. This is encouraging coverage that would improve with an active campaign targeting parasites and vectors. PMID:25447202

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

    PubMed Central

    Kassiri, Hamid; Kassiri, Ali; Kazemi, Shahnaz

    2014-01-01

    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.

  15. 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...

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

    NASA Astrophysics Data System (ADS)

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

    2013-10-01

    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.

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

    PubMed Central

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

    2013-01-01

    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 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 designing novel anti-adhesion agents. PMID:24057018

  18. The science of medical decision making: neurosurgery, errors, and personal cognitive strategies for improving quality of care.

    PubMed

    Fargen, Kyle M; Friedman, William A

    2014-01-01

    During the last 2 decades, there has been a shift in the U.S. health care system towards improving the quality of health care provided by enhancing patient safety and reducing medical errors. Unfortunately, surgical complications, patient harm events, and malpractice claims remain common in the field of neurosurgery. Many of these events are potentially avoidable. There are an increasing number of publications in the medical literature in which authors address cognitive errors in diagnosis and treatment and strategies for reducing such errors, but these are for the most part absent in the neurosurgical literature. The purpose of this article is to highlight the complexities of medical decision making to a neurosurgical audience, with the hope of providing insight into the biases that lead us towards error and strategies to overcome our innate cognitive deficiencies. To accomplish this goal, we review the current literature on medical errors and just culture, explain the dual process theory of cognition, identify common cognitive errors affecting neurosurgeons in practice, review cognitive debiasing strategies, and finally provide simple methods that can be easily assimilated into neurosurgical practice to improve clinical decision making. PMID:24650488

  19. Cuban Medical Internationalism: A Case for International Solidarity in Foreign Policy Decision Making

    Microsoft Academic Search

    Eric James Fiske

    2011-01-01

    Since the beginning of the Revolutionary government in Cuba, a comprehensive foreign policy involving medical personal and equipment has been implemented worldwide. Known as medical internationalism, thousands of doctors have been sent to developed and less developed nations in the spirit of solidarity and humanitarian aid. Even more, thousands of students have been given free medical education in Cuba at

  20. 77 FR 19716 - Importer of Controlled Substances; Notice of Application Meridian Medical Technologies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ...Controlled Substances; Notice of Application Meridian Medical Technologies Pursuant to 21 U.S.C. 958(i), the Attorney...this is notice that on January 4, 2012, Meridian Medical Technologies, 2555 Hermelin Drive, St. Louis, Missouri...

  1. 78 FR 15974 - Importer of Controlled Substances, Notice of Application; Meridian Medical Technologies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-13

    ...Controlled Substances, Notice of Application; Meridian Medical Technologies Pursuant to Title 21 Code of Federal Regulations...this is notice that on January 8, 2013, Meridian Medical Technologies, 2555 Hermelin Drive, St. Louis, Missouri...

  2. Decision making about change of medication for comorbid disease at the end of life: an integrative review.

    PubMed

    van Nordennen, Ronald T C M; Lavrijsen, Jan C M; Vissers, Kris C P; Koopmans, Raymond T C M

    2014-07-01

    The main goal of palliative care is to improve quality of life by treating symptoms in patients with life-threatening illnesses. Most patients suffer from more than five severe comorbidities in the last 6 months of life. However, for patients receiving palliative care, interventions to prevent possible long-term complications of these comorbidities are no longer the primary aim of care. This paper aimed to review the literature regarding decision making about medication for comorbid disease at the end of life, defined as a life expectancy <3 months, and to formulate preliminary recommendations based on the existing literature. An integrative review approach was used. We searched the MEDLINE, EMBASE, and CINAHL databases. Papers were included if they had been published in the English language between 1 January 1995 and 31 December 2013, with an abstract. Additional studies were identified by searching bibliographies. Factors to consider when systematically reviewing medications are the goals of care, remaining life expectancy, treatment targets, time until benefit, number needed to treat, number needed to harm, and adverse drug reactions. Existing research focuses particularly on the use of certain drug classes during end-of-life care, including statins, antihypertensive agents, anticoagulants, antihyperglycaemic agents and antibiotics. Based on the results of this review, we made preliminary recommendations for these medication groups. Medication that does not benefit the patient in any way should be avoided. The aim of medication at the end of life should be symptom control. There is a need for prospective trials to give further insight into the decision-making process of medication management at the end of life. PMID:24825615

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

    ERIC Educational Resources Information Center

    Seelig, Richard

    2006-01-01

    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…

  4. Using importance performance analysis to understand and guide e-business decision making in SMEs

    Microsoft Academic Search

    Simha R. Magal; Parag Kosalge; Nancy M. Levenburg

    2009-01-01

    Purpose – E-business adoption among small and medium-sized enterprises (SMEs) has been limited because of resource constraints and a failure to understand the strategic value of e-business. To facilitate decision making concerning e-business applications and their implementation, simple, low cost tools are needed to assist in analyzing and developing effective e-business strategies. This paper aims to evaluate the use of

  5. Ultrastructure of immature stages of Cochliomyia macellaria (Diptera: Calliphoridae), a fly of medical and veterinary importance.

    PubMed

    Mendonça, Paloma Martins; Barbosa, Rodrigo Rocha; Cortinhas, Lucas Barbosa; dos Santos-Mallet, Jacenir Reis; de Carvalho Queiroz, Margareth Maria

    2014-10-01

    Cochliomyia macellaria (Diptera: Calliphoridae) is known as the secondary screwworm because it causes secondary or facultative myiasis when the larvae feed on necrotic tissues. This fly has a significant medical and veterinary importance since it has been reported to transport eggs of Dermatobia hominis (human botfly), which can cause significant economic losses to livestock. Since this screwworm has been collected colonizing both pig carcasses and human cadavers, it is considered one of the most important species for forensic entomology studies. Scanning electron microscopy (SEM) gives detailed information on the morphological characteristics which can help identify the immature forms of the flies. The aim of this study was to describe and analyze the morphological characteristics of the eggs, all the larval instars, and the puparia of Cochliomyia macellaria using SEM. The egg is ellipsoid and the dorsal surface is concave. The islands inside the median area had no anastomosis, but some perforations could be observed. From the second larval instar onwards, besides the intersegmental spines, other bands of spines were observed at the abdominal segments. Two spiracular openings were visible on the first and second larval instars, which were not expected. These characteristics are specific to Cochliomyia genus. The number and the general aspect of the spine tips in the cephalic region, the intersegmental bands on the abdomen, and the number of the spiracular openings could together help identify C. macellaria. PMID:25028212

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

    PubMed

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

    2014-01-01

    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

  7. Rapid Identification of Medically Important Candida Isolates Using High Resolution Melting Analysis

    PubMed Central

    Nemcova, Eva; Cernochova, Michaela; Ruzicka, Filip; Malisova, Barbora

    2015-01-01

    An increasing trend in non albicans infections and various susceptibility patterns to antifungal agents implies a requirement for the quick and reliable identification of a number of medically important Candida species. Real-time PCR followed by high resolution melting analysis (HRMA) was developed, tested on 25 reference Candida collection strains and validated on an additional 143 clinical isolates in this study. All reference strains and clinical isolates inconclusive when using phenotypic methods and/or HRMA were analysed using ITS2 sequencing. Considering reference and clinical strains together, 23 out of 27 Candida species could be clearly distinguished by HRMA, while the remaining 4 species were grouped in 2 pairs, when applying the mean Tm ± 3 SD values, the shape of the derivative melting curve (dMelt curve) and, in some cases, the normalized and temperature—shifted difference plot against C. krusei. HRMA as a simple, rapid and inexpensive tool was shown to be useful in identifying a wide spectrum of clinically important Candida species. It may complement the current clinical diagnostic approach based on commercially available biochemical kits. PMID:25689781

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

    PubMed Central

    2014-01-01

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

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

    Microsoft Academic Search

    Johanna Czamanski-Cohen

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

    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…

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

    PubMed

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

    2013-07-01

    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

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

    PubMed Central

    2014-01-01

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

  13. Career choice motivations of medical students and some characteristics of the decision process in Hungary

    Microsoft Academic Search

    Regina Molnár; Tibor Nyári; Anikó Hazag; Adriána Csinády; Péter Molnár

    2008-01-01

    The changed circumstances of medical work, raises the question of how socio-economic changes over the last few decades has\\u000a affected the professional socialisation of medical students. This paper explores the career choice motivations of medical\\u000a students, as well as some characteristics of the process of making that choice and their effects on professional socialisation.\\u000a The study was carried out with

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

    PubMed

    Robson, Barry

    2014-08-01

    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

  15. Ethical issues in surgical decision making concerning children with medically intractable epilepsy

    Microsoft Academic Search

    George M. Ibrahim; Aria Fallah; O. Carter Snead; Irene Elliott; James M. Drake; Mark Bernstein; James T. Rutka

    2011-01-01

    The widespread inclusion of surgical strategies in the treatment of medically intractable epilepsy is largely justified by the medical and psychosocial burden of the illness. Performing these procedures in pediatric populations is associated with distinct challenges ranging from unique seizure etiologies to issues surrounding brain development and functional plasticity. As the trend toward more aggressive surgical intervention continues, the ethical

  16. IEEE TITB-00027-2008 1 Medical case retrieval from a committee of decision

    E-print Network

    Boyer, Edmond

    solutions: interpreting a new situation involves retrieving similar cases in a case database. Relevance -- contextual information, such as the patient age, sex and medical history [3], [4]. Consequently, medical CBR textual information. Another system lets the user restrict a CBIR search to images acquired from the same

  17. Decision-Making in Basic Medical Sciences Examinations: Single versus Multiple Cutoff Scores.

    ERIC Educational Resources Information Center

    Algina, James; Gross, Leon J.

    1979-01-01

    To examine the premise that an overall cutting score on Basic Medical Sciences (BMS) tests allows medical students to enter clinical training despite deficiencies in certain subjects, cutting scores on four BMS tests were compared with those of discipline subtests. The original premise was not supported. (MH)

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

    PubMed

    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

    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

  19. Sexual reproduction in Aspergillus species of medical or economical importance: Why so fastidious?

    PubMed Central

    Kwon-Chung, Kyung J.; Sugui, Janyce A.

    2009-01-01

    Heterothallism, which is dependent upon the obligatory cross-mating between self-sterile homokaryotic individuals, represents a common pattern of sexuality in yeasts and molds. Heterothallic reproductive cycles have recently been discovered in three Aspergillus species of medical and economic importance, namely Aspergillus fumigatus, A. parasiticus and A. flavus. Together with Aspergillus udagawae (Neosartorya udagawae), heterothallism has now been discovered in a total of four aspergilli that affect human health or economy. These fungi appear to express relatively low-levels of fertility compared to other heterothallic or homothallic aspergilli and require unusually fastidious environmental parameters to complete the sexual cycle. Since the purpose of sex is to reproduce, we favor the hypothesis that while fertility of these species is on the decline it is compensated by their proficiency to reproduce asexually in wider range of environmental conditions. Heterothallism in these species could provide an invaluable tool for recombinational analysis of factors relevant to pathogenicity or toxin production. There is concern, however, whether extensive recombinational analysis can be very practical in light of the fact that formation of ascospores in these species requires a long period of time and construction of genetically marked strains will likely decrease fertility even further. PMID:19783441

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

    PubMed

    Benbassat, Jochanan

    2014-04-01

    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

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

    E-print Network

    Broniatowski, David André, 1982-

    2010-01-01

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

  2. [Would patients want to be informed and participate in medical decision?].

    PubMed

    Susnjara, Ivana Marasovi?

    2012-10-01

    Significant changes in the patient-physician relationship occurred during the 20th century. Modern health systems are inconceivable without the existence of laws on the protection of patient rights. Although the present trend emphasizes the rights of patients and their participation in decision-making, there are studies that report conflicting conclusions. The fact that some patients are not willing to participate in decisions about their health does not mean that physicians should have a paternalistic attitude toward them. PMID:23814978

  3. Are clinician's ever biased in their judgments of the capacity of older adult's to make medical decisions?

    PubMed

    Braun, Michelle; Gurrera, Ronald; Karel, Michele; Armesto, Jorge; Moye, Jennifer

    2009-01-01

    Capacity assessment is a growing area of practice in geriatrics. In this pilot study we illustrate the potential relationship between clinician variables and capacity ratings. Twelve older adults with mild dementia or schizophrenia were rated by six clinicians from diverse disciplinary backgrounds. Capacity ratings were associated with clinician values regarding patient involvement in medical decisions, clinician-patient mismatches on such values, and emotional reactions to patients. Expanding our understanding of the impact of clinician variables on capacity ratings may enhance the reliability and validity of capacity assessments and help to promote autonomy when appropriate. PMID:21037935

  4. Medication Sleuth: An Important Role for Pharmacists in Determining the Etiology of Delirium Case Study

    Microsoft Academic Search

    Rebeccah J. Collins

    Delirium is characterized by disturbances of consciousness, attention, cognition, and perception and is the most com- mon reason for acute cognitive dysfunction in hospitalized elderly patients. Causes of delirium can be multifactorial, and a careful medical and medication history can help determine the underlying cause of behavioral disturbances. A 65-year-old patient with a history of chronic pain, insomnia, and multiple

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

    E-print Network

    Bouzguenda, Lotfi

    2012-01-01

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

  6. 78 FR 42153 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-15

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

  7. 75 FR 34524 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

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

  8. 78 FR 25692 - Notice of Decision To Authorize the Importation of Fresh Barhi Dates From Israel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-02

    ...Barhi dates to the Plant Protection and Quarantine Treatment Manual. DATES: Effective...are set out in the Plant Protection and Quarantine...PPQ) Treatment Manual.\\2\\ Section 305...import_export/plants/manuals/index.shtml...

  9. Insects associated with hospital environment in Egypt with special reference to the medically important species.

    PubMed

    Kenawy, Mohamed A; Amer, Hanan S; Lotfy, Nadia M; Khamis, Nagwa; Abdel-Hamid, Yousrya M

    2014-12-01

    A study was planned to examine the insect fauna associated with two hospitals: urban (A) in Cairo and rural (B) in Banha, Egypt with varying hygienic levels and their adjacent residential areas (AC) and (BC), respectively and to investigate the effect of hygienic level on species composition and relative abundance. A total of 22 species belonging to 7 orders and 15 families were reported in the four study areas of which, Dipterous flies were the most common (8/22, 36.36% species). A total of 5257 adults were collected of which Dipterous flies were the abundant (3800, 72.28% insect) and Musca domestica was the most abundant species (3535, 67.24% insect) which was present in all areas where it was more common / predominant species (21.94%-90.91% insect). Moreover, higher densities of M domestica were in (B) and BC than in (A) or (AC). The heavily infested area was AC (54.55% species) followed by (A), (BC) and (B) however, the total number of the collected insects was higher in (BC) and (B) than in (AC) and (A). This was confirmed by finding maximum diversity indices in (AC) and minimum ones in B. In all areas, means of M domestica was more common during summer/autumn and spring than in the winter. Periplaneta americana collected oily during autumn in AC and was more common in autumn in (BC) while Blatella germanica collected only during summer in (AC) and was more common in autumn in (B). The prevalence and higher abundance of the medically important species mainly M domestica, P. americana and B. germanica in rural hospital than in urban one attribute mainly to the lower hygienic level of rural hospital This require a control program based mainly on sanitation supplemented by other measures to overcome the risk of disease transmission by such insects PMID:25643508

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

    SciTech Connect

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

    1989-06-01

    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.

  11. How Important Is ‘Accuracy’ of Surrogate Decision-Making for Research Participation?

    PubMed Central

    Kim, Scott Y. H.; Kim, H. Myra; Ryan, Kerry A.; Appelbaum, Paul S.; Knopman, David S.; Damschroder, Laura; De Vries, Raymond

    2013-01-01

    Background There is a longstanding concern about the accuracy of surrogate consent in representing the health care and research preferences of those who lose their ability to decide for themselves. We sought informed, deliberative views of the older general public (?50 years old) regarding their willingness to participate in dementia research and to grant leeway to future surrogates to choose an option contrary to their stated wishes. Methodology/Principal Findings 503 persons aged 50+ recruited by random digit dialing were randomly assigned to one of three groups: deliberation, education, or control. The deliberation group attended an all-day education/peer deliberation session; the education group received written information only. Participants were surveyed at baseline, after the deliberation session (or equivalent time), and one month after the session, regarding their willingness to participate in dementia research and to give leeway to surrogates, regarding studies of varying risk-benefit profiles (a lumbar puncture study, a drug randomized controlled trial, a vaccine randomized controlled trial, and an early phase gene transfer trial). At baseline, 48% (gene transfer scenario) to 92% (drug RCT) were willing to participate in future dementia research. A majority of respondents (57–71% depending on scenario) were willing to give leeway to future surrogate decision-makers. Democratic deliberation increased willingness to participate in all scenarios, to grant leeway in 3 of 4 scenarios (lumbar puncture, vaccine, and gene transfer), and to enroll loved ones in research in all scenarios. On average, respondents were more willing to volunteer themselves for research than to enroll their loved ones. Conclusions/Significance Most people were willing to grant leeway to their surrogates, and this willingness was either sustained or increased after democratic deliberation, suggesting that the attitude toward leeway is a reliable opinion. Eliciting a person’s current preferences about future research participation should also involve eliciting his or her leeway preferences. PMID:23382969

  12. The Importance of the Physician in the Generic Versus Trade-Name Prescription Decision

    Microsoft Academic Search

    Judith K. Hellerstein

    1998-01-01

    I examine the importance of physicians in the process by which patients receive either trade-name or generic drugs. Using a dataset on physicians, their patients, and the multisource drugs prescribed, I find that almost all physicians prescribe both types of drugs to their patients, but some physicians are more likely to prescribe generic drugs while other physicians are more likely

  13. Decision making preferences in the medical encounter – a factorial survey design

    Microsoft Academic Search

    Meike Müller-Engelmann; Tanja Krones; Heidi Keller; Norbert Donner-Banzhoff

    2008-01-01

    BACKGROUND: Up to now it has not been systematically investigated in which kind of clinical situations a consultation style based on shared decision making (SDM) is preferred by patients and physicians. We suggest the factorial survey design to address this problem. This method, which so far has hardly been used in health service research, allows to vary relevant factors describing

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

    PubMed

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

    2010-01-01

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

  15. Tutorial in Medical Decision Modeling Incorporating Waiting Lines and Queues Using Discrete Event Simulation

    Microsoft Academic Search

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

    2010-01-01

    In most decision-analytic models in health care, it is assumed that there is treatment without delay and availability of all required resources. Therefore, waiting times caused by limited resources and their impact on treatment effects and costs often remain unconsidered. Queuing theory enables mathematical analysis and the derivation of several performance measures of queuing systems. Nevertheless, an analytical approach with

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-04-01

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

  18. Competition, the consumer, and local decision making: Public power`s important role

    SciTech Connect

    Penn, D.W.

    1997-11-01

    Public power will continue to have to deal with its internal marketplace and external political challenges. Regardless, for the next several years, the municipal electric option is likely to be the best path to bring the benefits of competition to residential and small business customers. But the race toward privatization is a race in the wrong direction. All signs point toward the overriding importance of access to, and knowledge of, consumers - combined with responsiveness and accountability - that is the essence of a municipal electric utility. All signs point toward consumers wanting to reclaim sovereignty and some important measure of control over their lives. A city owning a municipal distributor of electricity will be even more valuable in the newly restructuring industry, both for its community owner-consumers and for the positive spillover benefits to the market and all other electricity customers in the form of pro-competitive yardstick pressure for lower prices. Eight years after its inauguration, the results of the electricity industry experiment in the U.K. remind us of how important it is for a society to set the train on the right track rather than mindlessly repeat cliches about trains leaving the station. The United States has to get the industry structure right and pay particular attention to the crucial formative years of transition. The United States is in that transition period and has a huge but fleeting opportunity to benefit all of its citizens by de-monopolizing rather than merely deregulating the electricity industry.

  19. 77 FR 22328 - Guidance for Industry on the Judicious Use of Medically Important Antimicrobial Drugs in Food...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-13

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

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

    PubMed Central

    2013-01-01

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

  1. Are medical ethicists out of touch? Practitioner attitudes in the US and UK towards decisions at the end of life

    PubMed Central

    Dickenson, D.

    2000-01-01

    Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect Design, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Results–Practitioners accept the relevance of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. Key Words: Death and dying • withdrawal of care • refusal of treatment PMID:10951920

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

    PubMed Central

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

    2010-01-01

    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. PMID:20936066

  3. R-CAST-MED: Applying Intelligent Agents to Support Emergency Medical Decision-making Teams

    E-print Network

    Flitch2 1 College of Information Sciences and Technology, The Pennsylvania State University, Unversity-care personnel during such crises, both individually and collectively, significantly impact the mortality rate of critically injured patients. #12;Pre-hospital services such as police, fire, EMS (Emergency Medical Services

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

    Microsoft Academic Search

    Daryl M. Guffey; Mark W. Mccartney

    2008-01-01

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

  5. The Importance of "High Valence" Events in a Successful Program for Teaching Geriatrics to Medical Students

    ERIC Educational Resources Information Center

    Boling, Peter A.; Willett, Rita M.; Gentili, Angela; Abbey, Linda J.; Lawson, Sonya R.; Schlesinger, Jeanne B.; Meyers, Elizabeth M.

    2008-01-01

    Virginia Commonwealth University developed an enhanced medical student geriattic curriculum that includes required home visits and nursing home visits for second year students (180 per year), an annual Forum on Aging for all first and second year students, and small group exercises. We added 30 hours of basic science material to pre-clinical…

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

    E-print Network

    Fowler, Mark

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

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

    Microsoft Academic Search

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

    2011-01-01

    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

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

    PubMed

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

    2014-11-14

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

  9. Training Neural Network Classifiers for Medical Decision Making: The Effects of Imbalanced Datasets on Classification Performance?

    PubMed Central

    Mazurowski, Maciej A.; Habas, Piotr A.; Zurada, Jacek M.; Lo, Joseph Y.; Baker, Jay A.; Tourassi, Georgia D.

    2008-01-01

    This study investigates the effect of class imbalance in training data when developing neural network classifiers for computer aided medical diagnosis. The investigation is performed in the presence of other characteristics that are typical among medical data, namely small training sample size, large number of features, and correlations between features. Two methods of neural network training are explored: classical backpropagation (BP) and particle swarm optimization (PSO) with clinically relevant training criteria. An experimental study is performed using simulated data and the conclusions are further validated on real clinical data for breast cancer diagnosis. The results show that classifier performance deteriorates with even modest class imbalance in the training data. Further, it is shown that BP is generally preferable over PSO for imbalanced training data especially with small data sample and large number of features. Finally, it is shown that there is no clear preference between oversampling and no compensation approach and some guidance is provided regarding a proper selection. PMID:18272329

  10. Selecting an Optimal Region by Fuzzy Group Decision Making: Empirical Evidence from Medical Investors

    Microsoft Academic Search

    Meng-Chuan Tsai; Chin-Tsai Lin

    Since China opened its medical services market in 1989, its health care industry has become the focus of international investment.\\u000a This study employs the fuzzy analytic hierarchy process to establish an evaluation model of optimal region selection for joint-venture\\u000a hospitals or clinics in China. On the basis of the combined perspectives of thirty experts, this study adopts six criteria\\u000a and

  11. Implementation pearls from a new guidebook on improving medication use and outcomes with clinical decision support. Effective CDS is essential for addressing healthcare performance improvement imperatives.

    PubMed

    Sirajuddin, Anwar M; Osheroff, Jerome A; Sittig, Dean F; Chuo, John; Velasco, Ferdinand; Collins, David A

    2009-01-01

    Effective clinical decision support (CDS) is essential for addressing healthcare performance improvement imperatives, but care delivery organizations (CDO) typically struggle with CDS deployment. Ensuring safe and effective medication delivery to patients is a central focus of CDO performance improvement efforts, and this article provides an overview of best-practice strategies for applying CDS to these goals. The strategies discussed are drawn from a new guidebook, co-published and co-sponsored by more than a dozen leading organizations. Developed by scores of CDS implementers and experts, the guidebook outlines key steps and success factors for applying CDS to medication management. A central thesis is that improving outcomes with CDS interventions requires that the CDS five rights be addressed successfully. That is, the interventions must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow. This paper provides further details about these CDS five rights, and highlights other important strategies for successful CDS programs. PMID:19894486

  12. Media coverage of medical decision making at the end of life: a Belgian case study.

    PubMed

    Van Brussel, Leen; Van Landeghem, Paul; Cohen, Joachim

    2014-01-01

    This article presents a content analysis of Belgian media coverage of end-of-life decision making. The authors examine a selection of press articles and the differences among media genres in covering the issue. In general terms, they found an overreporting of euthanasia; a focus on dying processes resulting from cancer and Alzheimer's disease; and an attention to political discussions and political voices, which outnumber patient voices. In genre-specific terms, unlike mainstream media, niche media reported less mediagenic aspects of the end of life. Finally, although popular mainstream media focus on personal aspects of the end-of-life, elite mainstream media privilege political aspects. PMID:24517711

  13. An improved medical decision support system to identify the breast cancer using mammogram.

    PubMed

    Suganthi, Muthusamy; Madheswaran, Muthusamy

    2012-02-01

    An improved Computer Aided Clinical Decision Support System has been developed to classify the tumor and identify the stages of the cancer using neural network and presented in this paper. The texture and shape features have been extracted and the optimal feature set has been obtained using multiobjective genetic algorithm (MOGA). The multilayer back propagation neural network with Ant Colony Optimization and Particle Swarm Optimization has been used. The accuracy of the proposed system has been verified and found that the accuracy of 99.5% can be achieved. The proposed system can provide valuable information to the physicians in clinical pathology. PMID:20703746

  14. Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists.

    PubMed

    Midttun, Linda

    2007-03-01

    In the aftermath of the Norwegian hospital reform of 2002, the private supply of specialized healthcare has increased substantially. This article analyses the likelihood of medical specialists working in the private sector. Sector choice is operationalized in two ways: first, as the likelihood of medical specialists working in the private sector at all (at least 1% of the total work hours), and second, as the likelihood of working full-time (90-100%) privately. The theoretical framework is embedded in work values theory and the results suggest that work values are important predictors of sector choice. All analyses are based on a postal questionnaire survey of medical specialists working in private contract practices and for-profit hospitals and a control group of specialists selected from the Norwegian Medical Association's member register. The analyses revealed that while autonomy values impact positively on the propensity for allocating any time at all to the private sector, professional values have a negative effect. Given that the medical specialist already works in the private sector, a high valuation of professional values and payment and benefit values increases the likelihood of having a dual sector job rather than a full-time private position. However, due to the cross-sectional structure of the data and limitations in the dataset, causality questions cannot be fully settled on the basis of the analyses. The relationship between work values and sector choice should, therefore, be regarded as associations rather than causality links. Finally, the likelihood of working in the private sector varies significantly at the municipality level, suggesting that medical specialist's location is important for sector choice. PMID:17161892

  15. Point of care information services: a platform for self-directed continuing medical education for front line decision makers

    PubMed Central

    Moja, Lorenzo; Kwag, Koren Hyogene

    2015-01-01

    The structure and aim of continuing medical education (CME) is shifting from the passive transmission of knowledge to a competency-based model focused on professional development. Self-directed learning is emerging as the foremost educational method for advancing competency-based CME. In a field marked by the constant expansion of knowledge, self-directed learning allows physicians to tailor their learning strategy to meet the information needs of practice. Point of care information services are innovative tools that provide health professionals with digested evidence at the front line to guide decision making. By mobilising self-directing learning to meet the information needs of clinicians at the bedside, point of care information services represent a promising platform for competency-based CME. Several points, however, must be considered to enhance the accessibility and development of these tools to improve competency-based CME and the quality of care. PMID:25655251

  16. Medically important mosquitoes in the rubber plantation belt of central Kerala, India.

    PubMed

    Jomon K V; Valamparampil T T

    2014-07-01

    Entomological surveys were carried out in the rubber plantation belt of Kerala to record mosquito fauna. Samples were collected from 23 randomly selected localities using standard methods for a period of three years, from Feb- ruary 2008 to January 2011. Thirty-two species belonging to nine genera: Aedes, Anopheles, Armigeres, Coquillettidia, Culex, Heizmannia, Mansonia, Toxorhynchites, and Uranotaenia were recorded. Many of the recorded species were medically im- portant as potential vectors of dengue fever, chikungunya, Japanese encephalitis, malaria and filariasis. PMID:25507596

  17. Medically important mosquitoes in the rubber plantation belt of central Kerala, India.

    PubMed

    Jomon K V; Valamparampil T T

    2014-07-01

    Entomological surveys were carried out in the rubber plantation belt of Kerala to record mosquito fauna. Samples were collected from 23 randomly selected localities using standard methods for a period of three years, from Feb- ruary 2008 to January 2011. Thirty-two species belonging to nine genera: Aedes, Anopheles, Armigeres, Coquillettidia, Culex, Heizmannia, Mansonia, Toxorhynchites, and Uranotaenia were recorded. Many of the recorded species were medically im- portant as potential vectors of dengue fever, chikungunya, Japanese encephalitis, malaria and filariasis. PMID:25427346

  18. Hepatitis B and influenza vaccines: important occupational vaccines differently perceived among medical students.

    PubMed

    Wicker, Sabine; Rabenau, Holger F; von Gierke, Laura; François, Guido; Hambach, Ramona; De Schryver, Antoon

    2013-10-17

    Healthcare personnel (HCP) are at risk from occupational exposure to airborne and bloodborne pathogens, and the risk of infection among HCP is greater than among the general population. The aim of the study was to characterize attitudes toward occupational recommended vaccines as well as the perception of risks of occupationally acquired infections. We surveyed 650 medical students to assess their perception of influenza and hepatitis B and their opinions and beliefs about influenza and hepatitis B vaccines. We found differences between pre-clinical and clinical students regarding the uptake of influenza and hepatitis B vaccines, about the chances of being occupationally infected with influenza or hepatitis B, and about the likelihood of suffering from severe side-effects following immunization. Interestingly, the risk perception varied drastically between the two vaccine-preventable diseases hepatitis B and influenza. Medical students rated the probability of contracting hepatitis B due to a work-related exposure and the severity of disease significantly higher than for influenza, and this may be an explanation for the greater acceptance of the hepatitis B vaccine. Furthermore, our findings suggest that medical students are frequently inaccurate in assessing their own risk level, and their specific knowledge about both diseases and the severity of these diseases proved to be unsatisfactory. PMID:24016807

  19. Medical liability, safety and confidentiality in maritime telemedicine--the MERMAID position on issues of importance.

    PubMed

    Ladas, P; Giatagatzidis, P; Anogianakis, G; Maglavera, S

    1997-01-01

    Telemedicine dates to the days of "wireless telegraphy". As an "extraordinary" arrangement for medical services delivered at time of need, telemedicine has thus far escaped the developments that have taken place over the last 50 years in the areas of medical liability, safety and confidentiality. Today, however, telemedicine is also used to increase quality and cost effectiveness of healthcare provision. This trend is set by the U.S. where the U.S. federal government funds telemedicine at an annual rate of more than $100 million i.e., at a rate 30 times or more than what the EU does while state and local agency support and private business investment in telemedicine is 3 to 4 times larger than that of the U.S. federal government. In this respect it must be stressed that technology tends to satisfy the relevant demand for telecommunications. Telemedicine is used in diverse areas such as pathology, surgery, physical therapy, and psychiatry. It is expected to revolutionise health care in the coming decade and, therefore, it will certainly take into account requirements for medical liability, safety and confidentiality in the same way as traditional "establishment" medicine does. PMID:10179533

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

    PubMed

    Warren, Oliver J; Carnall, Ruth

    2011-01-01

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

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

    E-print Network

    Decker, Jill Marie

    1988-01-01

    AN INVESTIGATION OF THE RELATIVE IMPORTANCE OF RECREATION, PARK AND CULTURAL AMENITIES IN THE LOCATION DECISIONS OF (RE)LOCATING COMPANIES A Thesis by JILL MARIE DECKER Submitted to the Office of Graduate Studies of Texas A&M University... An Investigation of the Relative Importance of Recreation, Park and Cultural Amenities in the Location Decisions of (Re)Locating Compani. es. (May 1988) Jill Marie Decker, B. S. , Texas A&M University; Chair of Advisory Committee: Dr. John Crompton The purpose...

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

    PubMed Central

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

    2014-01-01

    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. PMID:23793248

  3. 'It's time she stopped torturing herself': Structural constraints to decision-making about life-sustaining treatment by medical trainees.

    PubMed

    Jenkins, Tania M

    2015-05-01

    This article explores how structural factors associated with the profession and organization of medicine can constrain internal medicine residents, leading them to sometimes limit or terminate treatment in end-of-life care in ways that do not always embrace patient autonomy. Specifically, it examines the opportunities and motivations that explain why residents sometimes arrogate decision-making for themselves about life-sustaining treatment. Using ethnographic data drawn from over two years at an American community hospital, I contend that unlike previous studies which aggregate junior and senior physicians' perspectives, medical trainees face unique constraints that can lead them to intentionally or unintentionally overlook patient preferences. This is especially salient in cases where they misunderstand their patients' wishes, disagree about what is in their best interest, and/or lack the standing to pursue alternative ethical approaches to resolving these tensions. The study concludes with recommendations that take into account the structural underpinnings of arrogance in decision-making about life-sustaining treatment. PMID:25813727

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

    PubMed Central

    Manalo, Maria Fidelis C

    2013-01-01

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

  5. Parasitoids of Ophyra aenescens (Wiedemann) (Diptera: Muscidae): fly of medical-sanitary importance collected in State of Goiás, Brazil.

    PubMed

    Marchiori, Carlos H; Pereira, Luiz A; Silva Filho, Otacilio M; Ribeiro, Lalyne C S; Borges, Vanessa R

    2003-01-01

    The objective of the study was to report the first occurrence of the parasitoid Brachymeria podagrica in pupae of Ophyra aenescens, a fly of medical-sanitary importance. Human feces was used as bait to collect the insects. In the study 20 pupae of Ophyra aenescens (Wiedemann) (Diptera: Muscidae) were obtained, of which 20% of the total yielded the parasitoid Brachymeria podagrica (Hymenoptera: Chalcididae). PMID:14576881

  6. Rapid Differentiation of Aspergillus Species from Other Medically Important Opportunistic Molds and Yeasts by PCR-Enzyme Immunoassay

    Microsoft Academic Search

    Liliana de Aguirre; Steven F. Hurst; Jong Soo Choi; Jong Hee Shin; Hans Peter Hinrikson; Christine J. Morrison

    2004-01-01

    We developed a PCR-based assay to differentiate medically important species of Aspergillus from one another and from other opportunistic molds and yeasts by employing universal, fungus-specific primers and DNA probes in an enzyme immunoassay format (PCR-EIA). Oligonucleotide probes, directed to the internal transcribed spacer 2 region of ribosomal DNA from Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus niger, Aspergillus terreus,

  7. Extending the authority for sickness certification beyond the medical profession: the importance of ‘boundary work’

    PubMed Central

    2014-01-01

    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. PMID:24884678

  8. Medics and Marine Mammals – An Unlikely but Important Connection for Humanity’s Survival

    PubMed Central

    PONNAMPALAM, Louisa Shobhini

    2014-01-01

    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

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

    NASA Technical Reports Server (NTRS)

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

    1977-01-01

    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.

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

    PubMed

    Ponnampalam, Louisa Shobhini

    2014-03-01

    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

  11. [Efficient treatment of breakthrough pain in adults: the importance of timing and medication choice].

    PubMed

    Berna, Chantal; Luthy, Christophe; Samer, Caroline F; Spechbach, Hervé; Pautex, Sophie; Piguet, Valérie

    2013-06-26

    Diagnostic or therapeutic procedures can lead to breakthrough pain. Thanks to a wise choice of analgesic medication started in due time, this type of pain can be avoided or decreased. The therapeutic options of this preventive approach are presented according to the expected breakthrough pain type and intensity. Specific situations are presented through case discussions. The main pharmacokinetic information needed to prescribe the right analgesic at the right time is summarized in a convenient table. When associated to non-pharmacological measures such as empathy, patient positioning and high quality procedures, preventive analgesia provides patients the best possible relief from breakthrough pain. PMID:23882913

  12. Tracking a medically important spider: climate change, ecological niche modeling, and the brown recluse (Loxosceles reclusa).

    PubMed

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

    2011-01-01

    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. PMID:21464985

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

    PubMed Central

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

    2011-01-01

    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. PMID:21464985

  14. Improving Patient Safety through Medical Alert Management: An Automated Decision Tool to Reduce Alert Fatigue

    PubMed Central

    Lee, Eva K.; Mejia, Amanda F.; Senior, Tal; Jose, James

    2010-01-01

    Drug safety alerts, a feature of electronic medical records (EMRs), are increasingly recognized as valuable tools for reducing adverse drug events and improving patient safety. However, there has also been increased understanding that alert fatigue, a state in which users become overwhelmed and unresponsive to alerts in general, is a threat to patient safety. In this paper, we seek to mitigate alert fatigue by filtering superfluous alerts. We design a method of predicting alert overrides based on past alert override rate, range in override rate, and sample size. Using a dataset from a large pediatric network, we retroactively test and validate our method. For the test implementation, alerts are filtered with 91–96% accuracy, depending on the parameter values selected. By filtering these alerts, we reduce alert fatigue and allow users to refocus resources to potentially vital alerts, reducing the occurrence of adverse drug events. PMID:21347012

  15. 77 FR 31388 - Importer of Controlled Substances; Notice of Registration; Meridian Medical Technologies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-25

    ...manufactures a product containing morphine in the United States. The...the company seeks to import morphine supplied by EDQM to use as...authorized by DEA to import morphine. No comments or objections...company's background and history. Therefore, pursuant to...

  16. 78 FR 30331 - Importer of Controlled Substances; Notice of Registration; Meridian Medical Technologies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-22

    ...manufactures a product containing morphine in the United States. The...the company seeks to import morphine supplied by EDQM to use as...authorized by DEA to import morphine. No comments or objections...company's background and history. Therefore, pursuant to...

  17. Argumentation-Based Inference and Decision Making--A Medical Perspective

    Microsoft Academic Search

    John Fox; David Glasspool; Dan Grecu; Sanjay Modgil; Matthew South; Vivek Patkar

    2007-01-01

    The argumentation services platform with integrated components (Aspic) project aims to provide advanced argumentation-based computational capabilities. Argumentation is a potentially important paradigm for developing commercial and public services that are flexible and easily understood by human users.

  18. Medical data capture and display: the importance of clinicians' workstation design.

    PubMed

    Dayhoff, R; Kirin, G; Pollock, S; Miller, C; Todd, S

    1994-01-01

    The Department of Veterans Affairs is developing, testing and evaluating the benefits of physicians' workstations as an aid to medical data capture in an outpatient clinic setting. The physician's workstation uses a graphical user interface to aid the clinician in recording encounter data. Various input devices including keyboard, mouse, pen, voice, barcode reader, and tablet are available on the workstations, and user preferences will be examined. Access to general services such as electronic mail and reference databases is also available. The workstation provides a wide variety of patient specific data from the hospital information system, including image data. The single data collection process by the clinician will also provide data for the cost recovery process. PMID:7949987

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

    PubMed

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

    2015-02-01

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

  20. Medical Computing Science at the University of Aberdeen

    E-print Network

    Lucas, Peter

    obtaining an increasingly important role in medical research, as well as in primary and secondary care, clinical research, medical imaging, medical decision-support and protocol-based care, it seems inevitableMedical Computing Science at the University of Aberdeen Department of Computing Science

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    BAZRAFCAN, LEILA; HAGHANI, FARIBA; SHOKRPOUR, NASRIN

    2014-01-01

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

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

    PubMed

    De Jesus, Maria

    2013-01-01

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

  5. The importance of assessing medication exposure to the definition of refractory disease in systemic lupus erythematosus.

    PubMed

    Arnaud, Laurent; Zahr, Noël; Costedoat-Chalumeau, Nathalie; Amoura, Zahir

    2011-09-01

    Treatment of patients with Systemic Lupus Erythematosus (SLE) who have active disease refractory to current therapeutic strategies continues to be a real challenge. Here, we propose that the classic definition of refractory SLE patients - failure to achieve adequate response to the standard of care - should be further refined to incorporate the dimension of adequate drug exposure. Inter-individual pharmacokinetic variability may induce insufficient exposure to many drugs used in SLE, leading to both apparent inefficacy of treatments and inappropriate therapeutic escalation. Among others, we have shown that individual assessment of exposure to mycophenolic acid, the active metabolite of mycophenolate mofetil (MMF) could be used to determine whether a given patient received adequate doses of MMF. We have also shown that measuring blood concentrations of hydroxychloroquine could be used as an efficient way to assess observance, which is a critical issue since a significant proportion of refractory SLE patients is likely to have poor observance as the primary source of treatment failure. Finally, we have underlined the importance of assessing drug interactions as SLE patients often require, in addition to immunosuppressants, several other drugs to prevent or treat associated conditions, which may result in decreased exposure to immunosuppressants. Considering these data, we believe that refractory SLE patients should not only be defined as the failure to achieve adequate therapeutic response to the standard of care, but should also incorporate the dimension of inadequate pharmacokinetic exposure and include drug blood level, interaction and observance monitoring. PMID:21575744

  6. MicroRNAs of two medically important mosquito species: Aedes aegypti and Anopheles stephensi.

    PubMed

    Hu, W; Criscione, F; Liang, S; Tu, Z

    2014-11-24

    MicroRNAs (miRNAs) are endogenous, single-stranded small RNAs that have important regulatory functions at the post-transcriptional level. In the present study, we characterize miRNAs in two divergent mosquito species, Aedes aegypti and Anopheles stephensi, through deep sequencing of small RNAs spanning all developmental stages. We discovered eight novel miRNAs in Ae. aegypti and 20 novel miRNAs in An. stephensi, which enabled the first systematic analysis of miRNA evolution in mosquitos. We traced the phylogenetic history of all miRNAs in both species and report a rate of 0.055-0.13 miRNA net gain per million years. Most novel miRNAs originate de novo. Duplications that produced miRNA clusters and families are more common in Ae. aegypti than in An. stephensi. We also identified arm-switch as a source of new miRNAs. Expression profile analysis identified mosquito-specific miRNAs that showed strong stage-specific expression in one or both lineages. For example, the aae-miR-2941/2946 family represents the most abundant maternally deposited and zygotically transcribed miRNAs in Ae. aegypti. miR-2943 is a highly expressed zygotic miRNA in both Ae. aegypti and An. stephensi. Such information provides the basis from which to study the function of these miRNAs in biology common to all mosquitos or unique to one particular lineage. PMID:25420875

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

    PubMed Central

    Heinrichs, Guido; de Hoog, G. Sybren

    2012-01-01

    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. PMID:22785187

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

    PubMed Central

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

    2014-01-01

    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

  9. Accuracy Enhancement in a Fuzzy Expert Decision Making System Through Appropriate Determination of Membership Functions and Its Application in a Medical Diagnostic Decision Making System

    Microsoft Academic Search

    Suddhasattwa Das; Shubhajit Roy Chowdhury; Hiranmay Saha

    The paper attempts to improve the accuracy of a fuzzy expert decision making system by tuning the parameters of type-2 sigmoid\\u000a membership functions of fuzzy input variables and hence determining the most appropriate type-1 membership function. The current\\u000a work mathematically models the variability of human decision making process using type-2 fuzzy sets. Moreover, an index of\\u000a accuracy of a fuzzy

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

    PubMed Central

    Shorey, Jeannette M.

    2013-01-01

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

  11. [Determination of blood alcohol level of people who are involved in a judicial event of medical importance (case report)].

    PubMed

    Alkan, N; Demircan, T

    2001-10-01

    In some cases, determination of blood alcohol level is very important. The alcohol level at the time of an event, can affect the court decision and may lead to aggravate the penalty or on the contrary an acquittal. In this article, a criminal action, in one of Turkish High Criminal Court is examined. The case was about the death of a drunk person who had fallen down from the window of his girl friend's house which is on the third floor of an apartment. This person's parent applied to public prosecutor saying that their child did not fall down but was murdered by his girl friend. During this trial, in the victim's autopsy, no alcohol detected in blood in contrast with his girl friend's testimony. Because of this contradiction, a reasonable doubt has emerged that she was the murderer in this suspicious death. However, in the further stages of trial, the reasons of no alcohol detection in the autopsy is investigated. In the basis of this case, the importance and techniques of alcohol detection in blood is discussed with literature. PMID:11705087

  12. Electronic medical record data to identify variables associated with a fibromyalgia diagnosis: importance of health care resource utilization

    PubMed Central

    Masters, Elizabeth T; Mardekian, Jack; Emir, Birol; Clair, Andrew; Kuhn, Max; Silverman, Stuart L

    2015-01-01

    Background Diagnosis of fibromyalgia (FM) is often challenging. Identifying factors associated with an FM diagnosis may guide health care providers in implementing appropriate diagnostic and management strategies. Methods This retrospective study used the de-identified Humedica electronic medical record (EMR) database to identify variables associated with an FM diagnosis. Cases (n=4,296) were subjects ?18 years old with ?2 International Classification of Diseases, Ninth Revision (ICD-9) codes for FM (729.1) ?30 days apart during 2012, associated with an integrated delivery network, with ?1 encounter with a health care provider in 2011 and 2012. Controls without FM (no-FM; n=583,665) did not have the ICD-9 codes for FM. Demographic, clinical, and health care resource utilization variables were extracted from structured EMR data. Univariate analysis identified variables showing significant differences between the cohorts based on odds ratios (ORs). Results Consistent with FM epidemiology, FM subjects were predominantly female (78.7% vs 64.5%; P<0.0001) and slightly older (mean age 53.3 vs 52.7 years; P=0.0318). Relative to the no-FM cohort, the FM cohort was characterized by a higher prevalence of nearly all evaluated comorbidities; the ORs suggested a higher likelihood of an FM diagnosis (P<0.0001), especially for musculoskeletal and neuropathic pain conditions (OR 3.1 for each condition). Variables potentially associated with an FM diagnosis included higher levels of use of specific health care resources including emergency-room visits, outpatient visits, hospitalizations, and medications. Units used per subject for emergency-room visits, outpatient visits, hospitalizations, and medications were also significantly higher in the FM cohort (P<0.0001), confirming resource utilization as an important variable associated with an FM diagnosis. Conclusion Significant differences between the FM and no-FM cohorts were observed for nearly all the demographic, clinical, and health care resource variables, suggesting an association with FM diagnosis. These results also support use of EMR data for identifying variables associated with FM, which may help in the diagnosis and management of this condition. PMID:25784819

  13. The art of building decision trees.

    PubMed

    Babic, S H; Kokol, P; Podgorelec, V; Zorman, M; Sprogar, M; Stiglic, M M

    2000-02-01

    Decision support systems that help physicians are becoming a very important part of medical decision making. They are based on different models and the best of them are providing an explanation together with an accurate, reliable, and quick response. One of the most viable among models are decision trees, already successfully used for many medical decision-making purposes. Although effective and reliable, the traditional decision tree construction approach still contains several deficiencies. Therefore we decided to develop and compare several decision support models using four different approaches. We took statistical analysis, a MtDeciT, in our laboratory developed tool for building decision trees with a classical method, the well-known C5.0 tool and a self-adapting evolutionary decision support model that uses evolutionary principles for the induction of decision trees. Several solutions were evolved for the classification of metabolic and respiratory acidosis (MRA). A comparison between developed models and obtained results has shown that our approach can be considered as a good choice for different kinds of real-world medical decision making. PMID:10782443

  14. The hospital's fiduciary duty to its medical staff.

    PubMed

    Vipperman, R M

    1987-01-01

    California courts have recognized that hospitals have a fiduciary duty when dealing with medical staff privileges. This article discusses the rationale for requiring this higher standard of conduct in privileging decisions, noting the importance to the physicians of medical staff privileges and the fact that medical services are a matter of significant public interest. PMID:10284646

  15. 76 FR 21854 - Notice of Decision To Authorize the Importation of Fresh Rambutan Fruit From Malaysia and Vietnam

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-19

    ...Authorize the Importation of Fresh Rambutan Fruit From Malaysia and Vietnam AGENCY: Animal...continental United States of fresh rambutan fruit (Nephelium lappaceum) from Malaysia and...weeds via the importation of fresh rambutan fruit from Malaysia and Vietnam. DATES:...

  16. 76 FR 61340 - Notice of Decision To Authorize the Importation of Dragon Fruit From Thailand Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ...To Authorize the Importation of Dragon Fruit From Thailand Into the Continental United...the continental United States of dragon fruit (multiple genera and species) from Thailand...noxious weeds via the importation of dragon fruit from Thailand. DATES: Effective...

  17. Wolbachia supergroups A and B in natural populations of medically important filth flies (diptera: muscidae, calliphoridae, and sarcophagidae) in Thailand.

    PubMed

    Mingchay, Pichanon; Sai-Ngam, Arkhom; Phumee, Atchara; Bhakdeenuan, Payu; Lorlertthum, Kittitouch; Thavara, Usavadee; Tawatsin, Apiwat; Choochote, Wej; Siriyasatien, Padet

    2014-03-01

    Filth flies, belonging to suborder Brachycera (Family; Muscidae, Calliphoridae and Sarcophagidae), are a major cause of nuisance and able to transmit pathogens to humans and animals. These insects are distributed worldwide and their populations are increasing especially in sub-tropical and tropical areas. One strategy for controlling insects employs Wolbachia, which is a group of maternally inherited intracellular bacteria, found in many insect species. The bacteria can cause reproductive abnormalities in their hosts, such as cytoplasmic incompatibility, feminization, parthenogenesis, and male lethality. In this study we determined Wolbachia endosymbionts in natural population of medically important flies (42 females and 9 males) from several geographic regions of Thailand. Wolbachia supergroups A or B were detected in 7 of female flies using PCR specific for wsp. Sequence analysis of wsp showed variations between and within the Wolbachia supergroup. Phylogenetics demonstrated that wsp is able to diverge between Wolbachia supergroups A and B. These data should be useful in future Wolbachia-based programs of fly control. PMID:24968670

  18. The importance of religious affiliation and culture on end-of-life decisions in European intensive care units

    Microsoft Academic Search

    Charles L. Sprung; Paulo Maia; Hans-Henrik Bulow; Bara Ricou; Apostolos Armaganidis; Mario Baras; Elisabet Wennberg; Konrad Reinhart; Simon L. Cohen; Dietmar R. Fries; George Nakos; Lambertius G. Thijs

    2007-01-01

    Objective  To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units\\u000a (ICUs).\\u000a \\u000a \\u000a \\u000a Design and setting  A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy.\\u000a Prospectively defined end-of-life practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000\\u000a were compared for frequencies,

  19. Multimedia medical case retrieval using decision trees Gwenole Quellec, Mathieu Lamard, Lynda Bekri, Guy Cazuguel, Beatrice Cochener, Christian Roux

    E-print Network

    Paris-Sud XI, Université de

    . The method is evaluated on a classified diabetic retinopathy database. On this database, results indexing, contextual information, incomplete information, decision trees, diabetic retinopathy I, to diagnose Diabetic Retinopathy (DR), physicians analyze multimodal series of images together with structured

  20. Are clinician’s ever biased in their judgments of the capacity of older adult’s to make medical decisions?

    PubMed Central

    Braun, Michelle; Gurrera, Ronald; Karel, Michele; Armesto, Jorge; Moye, Jennifer

    2010-01-01

    Capacity assessment is a growing area of practice in geriatrics. In this pilot study we illustrate the potential relationship between clinician variables and capacity ratings. Twelve older adults with mild dementia or schizophrenia were rated by six clinicians from diverse disciplinary backgrounds. Capacity ratings were associated with clinician values regarding patient involvement in medical decisions, clinician-patient mismatches on such values, and emotional reactions to patients. Expanding our understanding of the impact of clinician variables on capacity ratings may enhance the reliability and validity of capacity assessments and help to promote autonomy when appropriate. PMID:21037935

  1. JEDI - an executive dashboard and decision support system for lean global military medical resource and logistics management.

    PubMed

    Sloane, Elliot B; Rosow, Eric; Adam, Joe; Shine, Dave

    2006-01-01

    Each individual U.S. Air Force, Army, and Navy Surgeon General has integrated oversight of global medical supplies and resources using the Joint Medical Asset Repository (JMAR). A Business Intelligence system called the JMAR Executive Dashboard Initiative (JEDI) was developed over a three-year period to add real-time interactive data-mining tools and executive dashboards. Medical resources can now be efficiently reallocated to military, veteran, family, or civilian purposes and inventories can be maintained at lean levels with peaks managed by interactive dashboards that reduce workload and errors. PMID:17947142

  2. A survey of decision tree classifier methodology

    NASA Technical Reports Server (NTRS)

    Safavian, S. Rasoul; Landgrebe, David

    1990-01-01

    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.

  3. HIV-seropositivity is not important in childbearing decision-making among HIV-positive Ghanaian women receiving antiretroviral therapy.

    PubMed

    Laar, Amos K; Taylor, Araba E; Akasoe, Bismark A

    2015-07-01

    Women in their reproductive years make up about 50% of all HIV-positive persons globally. These women, just as their HIV-negative counterparts, wield the right to procreate. However, HIV infection and lack of appropriate information on reproductive options may negatively impact women's procreative decision-making. This study assessed fertility intentions of HIV-positive women receiving antiretroviral therapy (ART) in southern Ghana. Quantitative methods were used to collect data from HIV-positive women receiving ART at four treatment centers. HIV-positive aged 18-49 years, and receiving ART were selected using systematic random sampling technique. Three hundred eighteen women were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Bivariate analysis and logistic regression modeling respectively produced unadjusted and adjusted associations between background attributes of respondents and their childbearing decision-making. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Irrespective of age, reproductive history, and duration of HIV diagnosis, 46% of the women were desirous of procreating. The bivariate level analysis shows that women in their late reproductive ages (30-39 years) had the strongest desire to procreate (p < 0.001). After controlling for a number of covariates, primiparous and secundiparious women were about twice as likely to desire children (aOR = 2.553; 95% CI 1.480-4.401), and so were women aged 30-39 years (aOR = 2.149; 95% CI 1.202-3.843). Of 54% women who do not wish to procreate, achievement of desired family size (64.3%) was more popular a reason than fear of vertical transmission of HIV (7.5%), poor health status (5%), and pregnancy-related complications (1.6%). PMID:25650646

  4. 78 FR 13304 - Notice of Decision To Issue Permits for the Importation of Strawberry Fruit From Egypt Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...Permits for the Importation of Strawberry Fruit From Egypt Into the Continental United...continental United States of fresh strawberry fruit from Egypt. Based on the findings of a...via the importation of fresh strawberry fruit from Egypt. DATES: Effective Date:...

  5. 76 FR 49725 - Notice of Decision To Authorize the Importation of Fresh Papaya Fruit From Malaysia into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-11

    ...Authorize the Importation of Fresh Papaya Fruit From Malaysia into the Continental United...continental United States of fresh papaya fruit from Malaysia. Based on the findings of...weeds via the importation of fresh papaya fruit from Malaysia. DATES: Effective...

  6. 75 FR 52712 - Notice of Decision To Issue Permits for the Importation of Fresh Mango Fruit From Pakistan Into...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

    ...Permits for the Importation of Fresh Mango Fruit From Pakistan Into the Continental United...continental United States of fresh mango fruit from Pakistan. Based on the findings of...weeds via the importation of fresh mango fruit from Pakistan. DATES: Effective...

  7. 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, 2014

    2011-12-16

    ...the Importation of Fresh Cape Gooseberry Fruit With Husks From Chile AGENCY: Animal and...United States of fresh Cape gooseberry fruit (Physalis peruviana L.) with husks from...the importation of fresh Cape gooseberry fruit from Chile. DATES: Effective Date:...

  8. 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, 2014

    2010-05-25

    ...Importation of Fresh Male Summer Squash Flowers From Israel Into the Continental United...United States of fresh male summer squash flowers from Israel. Based on the findings of...importation of fresh male summer squash flowers from Israel. EFFECTIVE DATE: May...

  9. 76 FR 8997 - Notice of Decision To Issue Permits for the Importation of Fresh Strawberries From Jordan Into...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-16

    ...fresh strawberries from Jordan. Based on the findings of a pest risk...Senior Import Specialist, RPM, PHP, PPQ, APHIS, 4700 River Road...regulations contains a performance-based process for approving the importation of commodities that, based on the findings of a pest...

  10. 77 FR 7122 - Notice of Decision To Authorize the Importation of Pomegranate From India Into the Continental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-10

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

  11. Decision Support: Decision Analysis

    E-print Network

    Bohanec, Marko

    -Solving: Stages ­ Relation of DA to some other Disciplines · Decision-Making under Uncertainty ­ Decision-Making under Strict Uncertainty · Decision Table · Various Decision Criteria ­ Decision-Making under Risk · Expected Value · Sensitivity Analysis Decision Analysis Decision Analysis: Applied Decision Theory Provides

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

    Microsoft Academic Search

    Jeffrey N Katz; Nancy Lyons; Lisa S Wolff; Jodie Silverman; Parastu Emrani; Holly L Holt; Kelly L Corbett; Agustin Escalante; Elena Losina

    2011-01-01

    Background  Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening,\\u000a decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic\\u000a Whites with respect to key decision making preferences.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban

  13. 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

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

    2013-01-01

    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 PMID:23772344

  14. 76 FR 44889 - Notice of Decision To Authorize the Importation of Fresh Persimmon From the Republic of South Africa

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ...Persimmon From the Republic of South Africa AGENCY: Animal and Plant Health...persimmon fruit from the Republic of South Africa. Based on the findings of a pest...importation of fresh persimmon fruit from South Africa. DATES: Effective Date:...

  15. 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, 2014

    2010-09-17

    ...that states that the fruit was inspected in the packinghouse and found free of Brevipalpus californicus, B. phoenicus, Diaphorina citri, and Coniothecium scabrum. These conditions will be listed in the Fruits and Vegetables Import Requirements...

  16. 78 FR 9027 - Notice of Decision To Authorize the Importation of Litchi, Longan, and Rambutan From the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-07

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

  17. 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, 2014

    2010-06-18

    ...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...

  18. 78 FR 69640 - Notice of Decision To Authorize the Importation of Swiss Chard From Colombia Into the Continental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-20

    ...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...

  19. 76 FR 61340 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ...treatment schedule in the Plant Protection and Quarantine Treatment Manual. DATES: Effective...import_export/plants/manuals/index.shtml or...Inspection Service, Plant Protection and Quarantine, Manuals Unit, 92...

  20. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients’ rights and end of life

    PubMed Central

    2012-01-01

    Background The “Patients’ Rights and End of Life Care” Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients’ and physicians’ characteristics, and describes the decision-making processes. Methods We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Results Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient’s request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor’s age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. Conclusions This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries). Nonetheless, the study revealed cases where not all legal obligations were met or where the decision was totally illegal. There is still a lot to be done through medical education and population awareness-raising to ensure that the decision-making process is compatible with current legislation, the physician's duty of care and the patient’s rights. PMID:23206428

  1. Molding Transactional Data into Decision Making Information in the Medical Industry: The Case of Laberman General Hospital

    Microsoft Academic Search

    Lael Dickinson; Irina Ilovici

    2000-01-01

    This case is about constructing a data warehouse model for a hospital. The Chief Executive Officer (CEO) at Laberman General Hospital is facing a combination of business analysis and information sharing issues. The hospital is experiencing diminishing profitability and market share. Hospital management cannot analyze the problems and make effective decisions because of their inability to combine data from independent

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

    PubMed Central

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

    2014-01-01

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

  3. Young Adult Ecstasy Users Who Forego Necessary Medical Care: A Fairly Common Occurrence with Important Health Implications

    PubMed Central

    Elifson, Kirk W.; Klein, Hugh; Sterk, Claire E.

    2013-01-01

    In this paper, we examine the practice of foregoing necessary medical care in a population of young adult Ecstasy users. The objectives of the paper are to (1) investigate how the failure to receive needed medical care is related to drug-related outcomes, and (2) identify factors that are associated with receiving versus foregoing needed medical care. Face-to-face, computer-assisted, structured interviews were conducted with 283 active young adult Ecstasy users in Atlanta, Georgia between August 2002 and October 2007. Study participants were recruited using a targeted sampling approach. Results indicated that almost one-third of the young adult Ecstasy users interviewed did not receive the medical care that they needed during the preceding year. Foregoing such care was associated with a variety of adverse drug-related outcomes, including experiencing a greater number of negative effects from using Ecstasy, experiencing a larger number of drug dependency symptoms, a greater likelihood of ever having binged on Ecstasy, and a greater likelihood of being classified as a “high end” polydrug abuser. Several factors were found to be associated with a greater tendency not to receive the medical care they needed, including race (not being African American), educational attainment (having completed at least high school), self-identification as belonging to the lowest socioeconomic status grouping, low self-esteem, and having experienced sexual abuse during one’s formative years. PMID:20464807

  4. The importance of brand in the industrial purchase decision: a case study of the UK tractor market

    Microsoft Academic Search

    Keith Walley; Paul Custance; Sam Taylor; Adam Lindgreen; Martin Hingley

    2007-01-01

    Purpose – With brands being an important source of competitive advantage, knowledge of branding is needed to inform their management. After reviewing the literature, the article aims to report the findings of a case study that investigated the role of branding in the industrial purchase of agricultural tractors in the UK. The study's overall conclusion is that branding can play

  5. Multinational corporations and the challenge of global advertising : What do US headquarters consider important in making media-selection decisions?

    Microsoft Academic Search

    Ali M. Kanso; Richard Alan Nelson

    2007-01-01

    Purpose – Despite the increasing volume of scholarly work in international advertising, media selection has received very little attention. This study seeks to address three fundamental issues in media selection for non-domestic markets: the relative importance of cultural factors, the relationships between organization structure, and the relative weight that executives place on cultural and non-cultural factors in their media selection,

  6. Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations

    Microsoft Academic Search

    GREG ABERNATHY; SIU L. HUI; CAROL KEMPF; MICHAEL WEINER

    Objectives: Only half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation. Measurements: The tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N 20) and intervention (after pilot;

  7. The clinical decision analysis using decision tree

    PubMed Central

    Bae, Jong-Myon

    2014-01-01

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

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

    PubMed Central

    Lamy, J.-B.

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  10. Research Paper: Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations

    Microsoft Academic Search

    Martin C. Were; Greg Abernathy; Siu L. Hui; Carol Kempf; Michael Weiner

    2009-01-01

    ObjectivesOnly half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.MeasurementsThe tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N = 20) and intervention (after pilot; N =

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

    PubMed Central

    2013-01-01

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

  12. 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

    Xie, Ningxin; Wen, Guoqiu; Li, Zhaowen

    2014-01-01

    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. PMID:24982687

  13. The Physician's Role in Ethical Decisions

    ERIC Educational Resources Information Center

    Chevalier, Robert B.

    1977-01-01

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

  14. In this revealing interview, Chester Arnold reviews the importance of instilling knowledge in land use decision makers and outlines the contributions his centre is making in this area

    E-print Network

    Alpay, S. Pamir

    use decision makers and outlines the contributions his centre is making in this area The Center for Land Use Education and Research (CLEAR) helps to inform decision makers about land use. Could you or ecosystem scales. These local decision makers need a tremendous amount of support to understand all

  15. Multicriteria Decision Analysis in Group Decision Processes

    Microsoft Academic Search

    Ahti Salo; Raimo P. Hämäläinen

    \\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

  16. Clinical evaluation of the ADE scorecards as a decision support tool for adverse drug event analysis and medication safety management

    PubMed Central

    Hackl, Werner O; Ammenwerth, Elske; Marcilly, Romaric; Chazard, Emmanuel; Luyckx, Michel; Leurs, Pascale; Beuscart, Regis

    2013-01-01

    Aims The prevention of adverse drug events (ADEs) demands co-ordination of different health care professionals. ADE scorecards are a novel approach to raise the team awareness regarding ADE risks and causes. It makes information on numbers and on possible causes of possible ADE cases available to the clinical team. The aim of the study was to investigate the usage and acceptance of ADE scorecards by healthcare professionals and their impact on rates of possible ADEs. Methods ADE scorecards were introduced in three departments of a French hospital. A controlled time series analysis of ADE data was conducted to assess the impact of the ADE scorecards. In addition, qualitative interviews and a standardized survey with all participating staff members were performed. Results Physicians, nurses and pharmacists found ADE scorecards effective to increase medication safety and recommended future usage. The time-series analysis did not show changes in rates of possible ADEs. Conclusion ADE scorecards appear to be useful to raise awareness of ADE-related issues among professionals. Although the evaluation did not show significant reductions of ADE rates, the participating physicians, nurses and pharmacists believed that the ADE scorecards could contribute to increased patient safety and to a reduction in ADE rates. Strategies need to be designed to integrate ADE scorecards better into the clinical routine and to increase the precision of ADE detection. PMID:24007454

  17. Recent Advances in the Use of Drosophila melanogaster as a Model to Study Immunopathogenesis of Medically Important Filamentous Fungi

    PubMed Central

    Hamilos, Georgios; Samonis, George; Kontoyiannis, Dimitrios P.

    2012-01-01

    Airborne opportunistic fungi, including Aspergillus and other less common saprophytic molds, have recently emerged as important causes of mortality in immunocompromised individuals. Understanding the molecular mechanisms of host-fungal interplay in robust experimental pathosystems is becoming a research priority for development of novel therapeutics to combat these devastating infections. Over the past decade, invertebrate hosts with evolutionarily conserved innate immune signaling pathways and powerful genetics, such as Drosophila melanogaster, have been employed as a means to overcome logistic restrains associated with the use mammalian models of fungal infections. Recent studies in Drosophila models of filamentous fungi demonstrated that several genes implicated in fungal virulence in mammals also play a similarly important pathogenic role in fruit flies, and important host-related aspects in fungal pathogenesis are evolutionarily conserved. In view of recent advances in Drosophila genetics, fruit flies will become an invaluable surrogate model to study immunopathogenesis of fungal diseases. PMID:22518146

  18. Unawareness of a Prolonged Retained Capsule Endoscopy: The Importance of Careful Follow-Up and Cooperation between Medical Institutions

    PubMed Central

    Saigusa, Susumu; Ohi, Masaki; Imaoka, Hiroki; Shimura, Tadanobu; Uratani, Ryo; Inoue, Yasuhiro; Kusunoki, Masato

    2014-01-01

    A 50-year-old man with anemia was referred to our hospital to undergo capsule endoscopy (CE), which revealed small intestinal ulcers. After 5 months of CE, he returned because of recurrent anemia without abdominal symptoms. Abdominal X-ray and computed tomography showed capsule retention in the small intestine at the pelvic cavity. The capsule remained at the same place for 7 days. We performed capsule retrieval by laparoscopy-assisted surgery with resection of the involved small intestine, including an ileal stricture. Resected specimen showed double ulcers with different morphologies, an ulcer scar with stricture, and a wide ulcer at the proximal side of the others. Each ulcer had different histopathological findings such as the degree of fibrosis and monocyte infiltration. These differences led us to consider that the proximal ulcer may have been secondarily induced by capsule retention. Our experience indicated that careful follow-up and the cooperation between medical institutions after CE examination should be undertaken for patients with incomplete examination, unknown excretion of the capsule, and/or ulcerative lesions despite the lack of abdominal symptoms. Additionally, a retained CE remaining over long periods and at the same place in the small intestine may lead to secondary ulceration. PMID:25254123

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

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    2009-05-01

    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

  1. Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support

    PubMed Central

    Berntsen, G; Lassen, K; Bellika, J G; Wootton, R; Lindsetmo, R O

    2011-01-01

    Introduction The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS). Methods A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score. Result 32 of 3784 papers identified in the primary search were included in the final review. 181?702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21–38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (?3 points). Six trials (18%) reported on long-term implementation of CDS. Conclusion The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics. PMID:21803926

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

    PubMed

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

    2013-08-01

    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

  3. Teaching Medical Ethics to Medical Students.

    ERIC Educational Resources Information Center

    Loewy, Erich H.

    1986-01-01

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

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

    PubMed Central

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

    2013-01-01

    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.

  5. The demand for preventive medical care

    Microsoft Academic Search

    Donald S. Kenkel

    1994-01-01

    The idea that people invest in health capital is an essential part of models of the demand for health, but the investment motives behind health decision are often obscured by other factors. This empirical paper investigates the demand for adult preventive medical care, where the investment motives are relatively clear cut. Several important results demonstrate the usefulness of the approach.

  6. Towards an interoperable information infrastructure providing decision support for genomic medicine

    E-print Network

    Samwald, Matthias; Dumontier, Michel; Marshall, M Scott; Luciano, Joanne; Adlassnig, Klaus-Peter; 10.3233/978-1-60750-806-9-165

    2011-01-01

    Genetic dispositions play a major role in individual disease risk and treatment response. Genomic medicine, in which medical decisions are refined by genetic information of particular patients, is becoming increasingly important. Here we describe our work and future visions around the creation of a distributed infrastructure for pharmacogenetic data and medical decision support, based on industry standards such as the Web Ontology Language (OWL) and the Arden Syntax.

  7. Patients' understanding of shared decision making in a mental health setting.

    PubMed

    Eliacin, Johanne; Salyers, Michelle P; Kukla, Marina; Matthias, Marianne S

    2015-05-01

    Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients' perspectives. We examined patients' accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients' understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient-provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient-provider relationship as a fundamental element of shared decision making and point to areas for potential improvement. PMID:25246333

  8. 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

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

    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

  9. The career decision-making process is an exciting one. Parents play an important role by encouraging and listening, but the student must take the lead. Thank you for helping us

    E-print Network

    Harms, Kyle E.

    The career decision-making process is an exciting one. Parents play an important role of our counseling sessions by adhering to our parent policy, following. Student Appointments Student appointments should be scheduled and kept by students. A parent(s) may be present in a counseling session only

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  11. Medication recommendations vs. peer practice in pediatric levothyroxine dosing : a study of collective intelligence from a clinical data warehouse as a potential model for clinical decision support

    E-print Network

    Scheufele, Elisabeth Lee

    2009-01-01

    Clinical decision support systems (CDSS) are developed primarily from knowledge gleaned from evidence-based research, guidelines, trusted resources and domain experts. While these resources generally represent information ...

  12. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Butler, Douglas J.; Kerstman, Eric

    2010-01-01

    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.

  13. 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

    Wilson, Sharise Mavis

    2010-01-01

    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…

  14. 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

    Beisecker, Analee E.; And Others

    1994-01-01

    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…

  15. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors' expert forum.

    PubMed

    Cefalu, William T; Buse, John B; Del Prato, Stefano; Home, Philip D; LeRoith, Derek; Nauck, Michael A; Raz, Itamar; Rosenstock, Julio; Riddle, Matthew C

    2014-09-01

    The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors' Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists' opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most-metformin, SUs, insulin, and perhaps now also TZDs-are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients' clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs. PMID:25147257

  16. Making Sustainable Decisions Using The KONVERGENCE Framework

    SciTech Connect

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

    2003-02-25

    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.

  17. Important statistical points to improve and promote the methodology of the articles on medical sciences, particularly nephrology and kidney; a review article

    PubMed Central

    Ahmadi, Ali; Soori, Hamid

    2015-01-01

    Background: Quality of articles’ methodology is one of the important factors which is considered by researchers. Objectives: This study was conducted to determine statistical guidelines on promotion of methodology’s quality in the articles concerning medical sciences, particularly nephrology, to assist authors and reviewers. Materials and Methods: This study is a systematic review. Initially, the keywords "Epidemiologic Methods/analysis" [Mesh] OR "Epidemiologic Methods/epidemiology" and "reporting" were selected in Medline database. Then, reliable databases were searched for relevant publications. Being relevant, containing viewpoints, and recommending statistical guidelines as well as approval of at least two of the three examiners of articles were determined as the inclusion criteria into the study. Results: Two hundred relevant articles were retrieved. Thirty-two articles met the inclusion criteria. By the examined articles, 30 applied points have determinative role for improving and promoting quality of articles methodology. Of the important points, introducing and describing target community and statistical population, mentioning article title, introducing independent and dependent variables as well as confounders, reporting sample size for subgroups and the whole study, summarizing the data according to their statistical distribution (reporting mean and standard deviation for data with normal distribution), reporting the type of rate (incidence, survival), ratio (odds, hazard) or risk (absolute, relative, difference) with 95% CI and the used software could be mentioned. Conclusion: The most important factors contributing greatly to the quality of articles’ methodology on nephrology were reported in the present study. Applying these factors by articles authors and reviewers could lead to improve articles’ and journals’ quality. In addition, use of the findings of the present study in articles’ materials and methods could avoid research errors.

  18. Making Sustainable Decisions Using the KONVERGENCE Framework

    SciTech Connect

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

    2003-02-01

    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.

  19. [Medical and medical ethical basis of precautionary options].

    PubMed

    May, A T; Brokmann, J C

    2010-02-01

    The main activities of anesthesiologists in addition to the operation theatre are intensive and emergency treatment as well as pain and palliative care. Discussions and decisions about strategies and enforcement of therapy are indispensable in all areas. Acknowledgment of the patients' wishes and protection of patient autonomy are very important in the context of medical fiduciary duty. Determination of the aim of therapy and the patient's prognosis are of special importance. Against the background of the current amendments of patient advance directives different possibilities, such as advance directive and emergency forms in different areas of anesthesiology will be discussed. PMID:20151100

  20. Differentiation of medically important Euro-Asian tick species Ixodes ricinus, Ixodes persulcatus, Ixodes hexagonus, and Dermacentor reticulatus by polymerase chain reaction.

    PubMed

    Rumer, Leonid; Sheshukova, Olga; Dautel, Hans; Donoso Mantke, Oliver; Niedrig, Matthias

    2011-07-01

    Understanding epidemiology of the tick-borne pathogens requires the accurate identification of the vector ticks. Morphological analysis of ticks is difficult and often leads to misidentification. Molecular techniques offer an alternative approach of tick identification. To date, no practical and reliable molecular assays for discrimination of Euro-Asian ticks are available. Our aim was to develop such an assay for discrimination between four Euro-Asian tick species of high medical importance such as Ixodes ricinus, Ixodes persulcatus, Ixodes hexagonus, and Dermacentor reticulatus. As a basis, we have chosen conventional species-specific polymerase chain reaction (PCR), a technique providing a good combination of simplicity and reliability. The DNA information available on ticks was searched for orthologous loci containing stretches of sequence dissimilarity sufficient for designing species-specific primers. ITS2 locus (second internal transcribed region of the rRNA gene cluster) was found to be the most favorable for primer design. Finally, for each of the three Ixodes species a PCR was developed amplifying only for the targeted species. One PCR amplified the entire ITS2 locus of the four species and allowed discrimination of D. reticulatus from the Ixodes species on the basis of the size difference of the respective PCR products. This PCR system was successfully tested for discrimination of the ticks at different maturation stages (larva, nymph, and adult) in engorged and unfed conditions, and therefore it may be useful for large-scale epidemiological studies. Differentiation between the closely related I. ricinus and I. persulcatus, the two species most often occurring in the tick-borne diseases in Eurasia, is of special importance. PMID:21028959

  1. Medical Imaging.

    ERIC Educational Resources Information Center

    Barker, M. C. J.

    1996-01-01

    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)

  2. Factors influencing decisions about the state in which doctors plan to practise: additional results from the 2002 Australian Medical Workforce Advisory Committee national survey

    Microsoft Academic Search

    Mary Harris; Paul H Gavel

    2005-01-01

    As a result of growing doctor shortages, postgradu- ate doctor recruitment and retention within Austral- ian states and territories has become an issue of concern. Australia's policy of national self-suffi- ciency in health workforce supply implies that state medical schools will, at a minimum, enrol a suffi- cient number of locally born students to meet future medical workforce requirements. This

  3. 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

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

    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

  4. Decision Support:Decision Support: Decision AnalysisDecision Analysis

    E-print Network

    Bohanec, Marko

    Problem-Solving: Stages ­ Relation of DA to some other Disciplines · Decision-Making under Uncertainty ­ Decision-Making under Strict Uncertainty · Decision Table · Various Decision Criteria ­ Decision-Making Theory Provides a framework for analyzing decision problems by · structuring and breaking them down

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

    PubMed

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

    2012-01-01

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

  6. 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

    Tony Stankus

    2012-01-01

    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

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

    PubMed

    Shappo, V V

    2008-01-01

    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

  8. Funding for medical care research.

    PubMed

    Shapiro, M F; Larson, E B

    1987-01-01

    Funding for medical care research in the interrelated fields of health services research, clinical decision-making, clinical epidemiology, the medical humanities and social sciences, and medical education has been unstable, and relatively little is available in the form of investigator-initiated grants. Stable funding for these fields is important to society and critical to the healthy development of academic general internal medicine. Strategies to augment funding can include political interventions to increase support for the National Center for Health Services Research and Health Care Technology Assessment and to secure designated funds within the National Institutes of Health. Public funding is also needed for career development awards in these fields. Research support also could be enhanced by establishing a consortium of foundations interested in funding investigator-initiated grants through open competition, by developing a mechanism for reviewing proposals from small foundations, by developing consortia in the private sector to support focused research, and by developing endowments to support research. PMID:3559775

  9. 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)

    Baarsen, Bernadette van

    2013-06-01

    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.

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

    PubMed

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

    2015-03-01

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

  11. Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial

    Microsoft Academic Search

    Annie LeBlanc; Michel Labrecque; Gaston Godin; Robert Thivierge; Claudine Laurier; Luc Côté; Annette M O’Connor; Michel Rousseau

    2011-01-01

    BACKGROUND: The misuse and limited effectiveness of antibiotics for acute respiratory infections (ARIs) are well documented, and current approaches targeting physicians or patients to improve appropriate use have had limited effect. Shared decision-making could be a promising strategy to improve appropriate antibiotic use for ARIs, but very little is known about its implementation processes and outcomes in clinical settings. In

  12. [Distribution Of Medically Important Freshwater Snails And Larval Trematodes From Parafossarulus Manchouricus And Semisulcospira Libertina Around The Jinyang Lake In Kyongsang-Nam-Do, Korea

    PubMed

    Cho, Hae Chang; Chung, Pyung Rim; Lee, Keun Tae

    1983-12-01

    The Jinyang Lake is dammed up Nam River, and surrounded by Jinju city and four counties; Jinyang, Sanchong, Hadong, and Sachon in Kyongsang-Nam-Do, Korea. The area around this man-made lake have been known as an endemic focus of clonorchiasis in Korea. The present study was first aimed to know the distribution of freshwater mollusks including medically important snails, and larval trematodes shed from Parafossarulus manchouricus and Semisulcospira libertina. In addtion to above studies, water analyses in each snail habitat were carried out in order to figure out a part of their environmental factors. This malaco-ecological survey was done at the six areas around upper, middle and lower parts of the lake for 4 months, August-November, 1983. Total nine species of freshwater mollusks were collected throughout the study: 4 species of gastropods; Semisulcospira libertina, Cipangopaludina chinensis, Parafossarulus manchouricus and Radix auricularia, and 5 species of bivalves; Unio douglasiae, Anodonta woodiana, Lamprotula gottschei, Corbicula fluminea and Limnoperma lucustris. Out of nine species of freshwater mollusks, three species of gastropods; S. libertina, P. manchouricus and R. auricularia were medically important in terms of the transmission of digenetic trematodes to humans. P. manchouricus and R. auricularia were mainly collected from the shallow ponds and the irrigation channels with the muddy basin, but S. libertina and the bivalves were only collected from the stream of Nam river where the gravels and rocks were dominant. The levels of dissolved oxygen(D.O.) and biochemical oxygen demand (B.O.D.(5)) of the water specimens sampled from the study areas ranged from 6.0 to 9.6 ppm and from 0.4 to 1.6 ppm respectively. As a result, it is considered that water system around the Jinyang Lake might be relatively clean without any heavy pollution of aquatic microorganisms and organic materials during the period of this study. On the other hand, eight metalic constituents from the water samples were also assayed, and all metalic ions detected were remarkably low below the legal criteria. However, calcium ion in the water samples from the habitats of P. manchouricus was considerably higher than others. Infection rates of digenetic trematodes in the snails were 6.9 % in P. manchouricus and 4.8 poercent in S. libertina, respectively. P. manchouricus snails harboring with the cercariae of Clonorchis sinensis were only 0.14 % among the snails examined and other trematode cercariae except cercaria of C. sinensis were; furcocercus cercariae, cercaria of Loxogenes liberum type I and II. S. libertina snails parasitized with the cercariae of Metagonimus yokogawai were 1.5 % out of the snails examined and no cercaria of Paragonimus westermani was found in S. libertina snails in the present study. Digenetic trematode cercariae other then M. yokogawai in S. libertina snails were: Cercaria yoshidae (B type), Cercaria cristata, Cercaria innominatum, Cercaria of Centrocestus formosanus and Cercaria nipponensis. PMID:12902649

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

    PubMed

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

    2013-05-01

    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

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

    PubMed Central

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

    2011-01-01

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

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

    Microsoft Academic Search

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

    2009-01-01

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

  16. A typology of shared decision making, informed consent, and simple consent.

    PubMed

    Whitney, Simon N; McGuire, Amy L; McCullough, Laurence B

    2004-01-01

    Enhancing patient choice is a central theme of medical ethics and law. Informed consent is the legal process used to promote patient autonomy; shared decision making is a widely promoted ethical approach. These processes may most usefully be seen as distinct in clinically and ethically important respects. The approach outlined in this article uses a model that arrays all medical decisions along 2 axes: risk and certainty. At the extremes of these continua, 4 decision types are produced, each of which constrains the principal actors in predictable ways. Shared decision making is most appropriate in situations of uncertainty, in which 2 or more clinically reasonable alternatives exist. When there is only 1 realistic choice, patient and physician may gather and exchange information; however, the patient cannot be empowered to make choices that do not exist. In contrast, informed consent does not require the presence of clinical choice; it is appropriate for all decisions of significant risk, even if there is only one option. When a clinical decision contains both risk and uncertainty, shared decision making and informed consent are both appropriate. For decisions of lower risk, consent should still be present, but it can be simple rather than informed. Clinicians may use this analysis as a guide to their own interactions with patients. In the continuing effort to provide patients with appropriate decisional authority over their own medical choices, shared decision making, informed consent, and simple consent each has a distinct role to play. PMID:14706973

  17. The marketing programme includes an all-important introduction to man-agement decision-making, as well as a set of business functions. Market-

    E-print Network

    performance, and the role of measuring and managing customer satisfaction, customer loyalty and customer courses related to research, strategy, buying behaviour and more, and these are relevant for all jobs. The international perspective was important for my choice of study programme and will be important for my future job

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

    PubMed Central

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

    2013-01-01

    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

  19. The influence of children's vocal expressions, age, medical diagnosis and information obtained from parents on nurses' pain assessments and decisions regarding interventions

    Microsoft Academic Search

    Jan P. H. Hamers; Huda Huijer Abu-Saad; Marcel A. van den Hout; Ruud J. G. Halfens; Arnold D. M. Kester

    1996-01-01

    This article reports on a study that examines the influence of task-related factors on nurses' pain assessments and decisions regarding interventions. In an experimental design pediatric nurses (n = 202), were exposed to different cases, each case being a combination of a vignette and a videotape. For every case subjects were asked to assess the child's pain and to state

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

    PubMed Central

    Almarshad, Saja

    2014-01-01

    Non-medical prescribing is needed especially with the increased demand for health care and the physicians’ time constrains. Also, it is not well regulated in Saudi Arabia unlike the United Kingdom. This report aims to demonstrate the urged need for regulations to maintain a safe non-medical prescribing process. It also adapts the single competency framework provided by the United Kingdom national prescribing centre (NPC, 2012) to be utilised by the respiratory therapist for a safe prescribing process for inhaled corticosteroids (ICS) to control adult asthma as an example. The framework is thought to be an effective tool for safe non-medical prescribing and it is highly recommended to develop a national Saudi framework to maintain the patients’ safety and utilise resources. PMID:25685042

  1. Medical Acoustics

    NASA Astrophysics Data System (ADS)

    Beach, Kirk; Dunmire, Barbrina

    Medical acoustics can be subdivided into diagnostics and therapy. Diagnostics are further separated into auditory and ultrasonic methods, and both employ low amplitudes. Therapy (excluding medical advice) uses ultrasound for heating, cooking, permeablizing, activating and fracturing tissues and structures within the body, usually at much higher amplitudes than in diagnostics. Because ultrasound is a wave, linear wave physics are generally applicable, but recently nonlinear effects have become more important, even in low-intensity diagnostic applications.

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

    PubMed

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

    2014-01-01

    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

  3. 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

    Santana Arroyo, Sonia; del Carmen Gonzalez Rivero, Maria

    2012-01-01

    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…

  4. Using Decision Tools Suite to estimate the probability of introduction of Bactrocera correcta (Bezzi) with the imported host fruit into China

    Microsoft Academic Search

    Xingli Ma; Zhihong Li; Jiajiao Wu; Jun Ma; Ke Chen; Yuliang Deng

    Guava fruit fly, Bactrocera correcta (Bezzi) (Diptera: Tephritidae), originates from the tropical or subtropical regions of Asia and hazards a huge variety of fruit. It is regarded as a dangerous fruit fly and regulated by quarantine measures in China. This study assessed the introduction risk of guava fruit fly associated with the imported host fruit into China. The risk assessment

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

    Microsoft Academic Search

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

    2012-01-01

    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

  6. Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

    PubMed Central

    Karimi Khouzani, Reza

    2015-01-01

    Study Design The prevalence of disc herniation is estimated to be about 100,000 new cases per year in France and disc herniation accounts for 25% to 30% of surgical activity in Departments of Neurosurgery. Classically, sciatica is expected to follow its specific dermatome-L5 or S1-. In clinical practice, we regularly encounter patients showing discrepancy between clinical sciatica and imaging findings. Purpose The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. Overview of Literature To the best of our knowledge, this subject has not yet been discussed in the medical literature. Methods The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. Results We found an apparent clinicoradiological discrepancy between sciatica described by patients on one side and magnetic resonance imaging (MRI) finding on the other side in 27 (11.20%) patients. We did not find any other abnormalities in the preoperative and postoperative period. All of these patients underwent lumbar discectomy via posterior interlaminar approach. Three months after surgery, 25 patients (92.59%) had been totally relieved of sciatica pain. Two patients (7.41%) continued to experience sciatica in spite of the surgery. Conclusions The discrepancy between clinical sciatica and disc herniation level on MRI is not rare. Management of this discrepancy requires further investigation in order to avoid missing the diagnosis and treatment failure. PMID:25901230

  7. Evolution's Importance to Society

    NSDL National Science Digital Library

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

    2005-07-01

    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.

  8. Designing for Decision Making

    ERIC Educational Resources Information Center

    Jonassen, David H.

    2012-01-01

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

  9. Technology and Export Decision

    Microsoft Academic Search

    Chih-Hai Yang; Jong-Rong Chen; Wen-Bin Chuang

    2004-01-01

    Taiwan has played an important role in international trade in the world and its manufacturing industries are dominantly composed of SMEs, yet little is known about the export decision of Taiwanese SMEs, especially the role of technology. This paper aims to explore the role of technology on the export decision of Taiwanese SMEs. In addition, whether there are differences in

  10. Development and Implementation of an Electronic Decision Support to Manage the Health of a High-Risk Population: The enhanced Electronic Medical Record Aging Brain Care Software (eMR-ABC)

    PubMed Central

    Frame, Amie; LaMantia, Michael; Reddy Bynagari, Bharath B.; Dexter, Paul; Boustani, Malaz

    2013-01-01

    Introduction: Health care systems in the United States are transitioning from volume-based purchasing models to value-based purchasing models that demand both delivery of personalized care for each patient and cost-effective population health management. The enhanced medical record for aging brain care (eMR-ABC) software is an electronic decision support system that facilitates the management of a high-risk population suffering from aging brain disorders such as dementia. Methods: Using the lenses of the Complex Adaptive System and the Reflective Adaptive Process, we assembled an interdisciplinary team of clinicians, health services researchers, and software developers who designed, implemented, evaluated, and continuously modified the eMR-ABC to meet the needs of care coordinators who manage the health of a targeted high-risk population. Results: The eMR-ABC captures and monitors the cognitive, functional, behavioral, and psychological symptoms of a registry of patients suffering from dementia or depression as well as the burden of patients’ family caregivers. It provides decision support to care coordinators to create a personalized care plan that includes evidence-based nonpharmacological protocols, self-management handouts, and alerts of medications with potentially adverse cognitive effects. The software’s built-in engine tracks patient visits and on-demand functionality to generate population reports for specified indicators. Discussion: Population health programs depend on data collection and information systems with the ability to provide valuable and timely feedback on an ongoing basis. Following these guidelines, the eMR-ABC was designed specifically to meet the management needs of a high-risk population.

  11. The Clinical Decision Support Consortium

    Microsoft Academic Search

    Blackford Middleton

    2009-01-01

    Abstract.Clinical decision support (CDS) can impact the outcomes of care when used at the point of care in el ectronic medical re cords (EMR). CDS has been shown to increase quality and patientsafety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. S ystematic reviews have shown,that CDS can be useful across a va riety of clinical

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

    PubMed Central

    Petrocelli, John V.

    2013-01-01

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

  13. Using Medications Safely

    MedlinePLUS

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

  14. The Importance of Taking a History of Over-the-Counter Medication Use: A Brief Review and Case Illustration of “PRN” Antihistamine Dependence in a Hospitalized Adolescent

    PubMed Central

    Abe, Naomi; Sundberg, Jane

    2010-01-01

    Abstract Over-the-counter (OTC) and prescription medication abuse has been rapidly increasing, yet publications on OTC abuse in adolescents are limited. We present a brief literature review and a novel report of antihistamine dependence emerging after admission in an adolescent, subsequently treated with naltrexone. This case highlights the need to take a thorough history of OTC, herbal, and prescription drug use from parents and patients separately and repeatedly, at initial presentation, and again if withdrawal symptoms emerge. General strategies for combating OTC and prescription abuse are given. PMID:21186972

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

    ERIC Educational Resources Information Center

    Golden, Shawn M.

    2009-01-01

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

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

    Microsoft Academic Search

    Shawn M. Golden

    2009-01-01

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

  17. Decision to Enter Pulmonology: Motives and Implications.

    ERIC Educational Resources Information Center

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

    1978-01-01

    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.…

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

    Microsoft Academic Search

    P. A. Ubel; G. Loewenstein

    1997-01-01

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

  19. Medical Image Segmentation Xiaolei Huang

    E-print Network

    Huang, Xiaolei

    Medical Image Segmentation Xiaolei Huang Computer Science and Engineering Department, Lehigh is of immense practical importance in medical informatics. Medical images, such as Computed Axial Tomography in EHR clinical management systems. Research efforts have been devoted to processing and analyzing

  20. 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

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

    2013-01-01

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

  1. OFFICE OF MEDICAL EDUCATION CLERKSHIP EDUCATOR'S

    E-print Network

    Puglisi, Joseph

    Policies pertinent to clerkship education · Definition of the medical student decision-making PATIENT CARE 1. Conduct a thorough, accurate, and patientMEDICINE OFFICE OF MEDICAL EDUCATION CLERKSHIP EDUCATOR

  2. Research of Medication Use during Pregnancy

    MedlinePLUS

    ... Results of these studies give women and their healthcare providers better information on the safety or risk of using specific medications during pregnancy. This information supports their ability to make informed decisions about treatment options. Learning the Effects of Medication ...

  3. Poor Decision Making Among Older Adults Is Related to Elevated Levels of Neuroticism

    Microsoft Academic Search

    N. L. Denburg; J. A. Weller; T. H. Yamada; D. M. Shivapour; A. R. Kaup; A. LaLoggia; C. A. Cole; D. Tranel; A. Bechara

    2009-01-01

    Background  A well-studied index of reasoning and decision making is the Iowa Gambling Task (IGT). The IGT possesses many features important\\u000a to medical decision making, such as weighing risks and benefits, dealing with unknown outcomes, and making decisions under\\u000a uncertainty.\\u000a \\u000a \\u000a \\u000a Purpose  There exists a great deal of individual variability on the IGT, particularly among older adults, and the present study examines\\u000a the

  4. Religion and medical ethics.

    PubMed

    Green, Ronald M

    2013-01-01

    Religious traditions of medical ethics tend to differ from more secular approaches by stressing limitations on autonomous decision-making, by more positively valuing the experience of suffering, and by drawing on beliefs and values that go beyond empiric verification. I trace the impact of these differences for some of the world's great religious traditions with respect to four issues: (1) religious conscientious objection to medical treatments; (2) end-of life decision-making, including euthanasia, physician-assisted suicide, and the withholding or withdrawing of life-sustaining treatments; (3) definitions of moral personhood (defining life's beginning and end); and (4) human sexuality. PMID:24182368

  5. Medical Licensing Examinations in the United States.

    ERIC Educational Resources Information Center

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

    2002-01-01

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

  6. 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

    Grassi, Maria Caterina; Baraldo, Massimo; Chiamulera, Christian; Culasso, Franco; Raupach, Tobias; Ferketich, Amy K; Patrono, Carlo; Nencini, Paolo

    2014-01-01

    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. PMID:24804212

  7. 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

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

    2014-01-01

    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. PMID:24804212

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

    SciTech Connect

    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

    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.

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

    E-print Network

    Goldman, Steven A.

    saw a recent television program during which an enormously important exchange occurred between two previously unknown in our culture. They said that what helps patients the very most is talking a physician who really understood what I'm talking about here. He said he understood, so we agreed

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  11. Association of Patient Preferences for Participation in Decision Making With Length of Stay and Costs Among Hospitalized Patients

    PubMed Central

    Tak, Hyo Jung; Ruhnke, Gregory W.; Meltzer, David O.

    2015-01-01

    Importance Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. Objective To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. Design and Setting Survey study in an academic research setting. Participants A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21 754 (69.6%) of admitted patients. Main Outcomes and Measures The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. Results The mean length of stay was 5.34 days, and the mean hospitalization costs were $14 576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P =.01) and $865 (95% CI, $155-$1575) higher total hospitalization costs (P =.02). Conclusions and Relevance Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination. PMID:23712712

  12. Decision Making in Action

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

  13. British Medical Journal

    NSDL National Science Digital Library

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

  14. History of Medical Physics.

    ERIC Educational Resources Information Center

    Laughlin, John S.

    1983-01-01

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

  15. The Parent Perspective: “Being a Good Parent” When Making Critical Decisions in the PICU

    PubMed Central

    October, Tessie W.; Fisher, Kiondra R.; Feudtner, Chris; Hinds, Pamela S.

    2015-01-01

    Objective To identify factors important to parents making decisions for their critically ill child. Design Prospective cross-sectional study. Setting Single center, tertiary care PICU. Subjects Parents making critical treatment decisions for their child. Intervention One-on-one interviews that used the Good Parent Tool-2 open-ended question that asks parents to describe factors important for parenting their ill child and how clinicians could help them achieve their definition of “being a good parent” to their child. Parent responses were analyzed thematically. Parents also ranked themes in order of importance to them using the Good Parent Ranking Exercise. Measurement and Main Results Of 53 eligible parents, 43 (81%) participated. We identified nine themes through content analysis of the parent’s narrative statements from the Good Parent Tool. Most commonly (60% of quotes) components of being a good parent described by parents included focusing on their child’s quality of life, advocating for their child with the medical team, and putting their child’s needs above their own. Themes key to parental decision making were similar regardless of parent race and socioeconomic status or child’s clinical status. We identified nine clinician strategies identified by parents as helping them fulfill their parenting role, most commonly, parents wanted to be kept informed (32% of quotes). Using the Good Parent Ranking Exercise, fathers ranked making informed medical decisions as most important, whereas mothers ranked focusing on the child’s health and putting their child’s needs above their own as most important. However, mothers who were not part of a couple ranked making informed medical decisions as most important. Conclusion These findings suggest a range of themes important for parents to “be a good parent” to their child while making critical decisions. Further studies need to explore whether clinician’s knowledge of the parent’s most valued factor can improve family-centered care. PMID:24583502

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

    PubMed

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

    1981-12-01

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

  17. The Presence of N-Terminal Secretion Signal Sequences Leads to Strong Stimulation of the Total Expression Levels of Three Tested Medically Important Proteins during High-Cell-Density Cultivations of Escherichia coli

    Microsoft Academic Search

    H. Sletta; A. Tondervik; S. Hakvag; T. E. Vee Aune; A. Nedal; R. Aune; G. Evensen; S. Valla; T. E. Ellingsen; T. Brautaset

    2007-01-01

    Genetic optimizations to achieve high-level production of three different proteins of medical importance for humans, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon alpha 2b (IFN-2b), and single-chain antibody variable fragment (scFv-phOx), were investigated during high-cell-density cultivations of Escherichia coli. All three proteins were poorly expressed when put under control of the strong Pm\\/xylS promoter\\/regulator system, but high volumetric yields of GM-CSF and

  18. Emotion and decision making.

    PubMed

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

    2015-01-01

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

  19. Decision Trees Unpredictability Bias Improvements Decision Trees

    E-print Network

    Kjellström, Hedvig

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

  20. Heuristic decision making in medicine

    PubMed Central

    Marewski, Julian N.; Gigerenzer, Gerd

    2012-01-01

    Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care. PMID:22577307

  1. A Corpus-Based Syntactic Study of Medical Research Article Titles

    ERIC Educational Resources Information Center

    Wang, Yan; Bai, Yongquan

    2007-01-01

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

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

    PubMed Central

    2014-01-01

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

  3. Design of a Medication Reconciliation Application

    PubMed Central

    Cadwallader, J.; Spry, K.; Morea, J.; Russ, A. L.; Duke, J.; Weiner, M.

    2013-01-01

    Background Medication reconciliation is an essential, but resource-intensive process without a “gold standard” to measure medication adherence. Medication reconciliation applications that focus on facilitating clinicians’ decision-making are needed. Since no single available source of medication information is adequate, combining data sources may improve usefulness and outcomes. Objectives We aimed to design a medication reconciliation application that could incorporate multiple data sources and convey information about patients’ adherence to prescribed medications. We discuss design decisions integral to developing medication reconciliation applications for the electronic health record. The discussion is relevant for health IT developers, clinical providers, administrators, policy makers, and patients. Three hypotheses drove our design of this application: 1) Medication information comes from a variety of sources, each having benefits and limitations; 2) improvements in patient safety can result from reducing the cognitive burden and time required to identify medication changes; 3) a well-designed user interface can facilitate clinicians’ understanding and clinical decision making. Methods Relying on evidence about interface design and medication reconciliation, an application for the electronic health record at an academic medical center in the U.S. was designed. Multiple decisions that considered the availability, value, and display of the medication data are explored: Information from different sources; interval changes in medications; the sorting of information; and the user interface. Results The prototype medication reconciliation application design reflects the visual organization, categorization, modality of interactions, and presentation of medication information from three data sources: patient, electronic health record, and pharmacy. Conclusions A new medication reconciliation user interface displays information from multiple sources, indicates discrepancies among sources, displays information about adherence, and sorts the medication list in a useful display for clinical decision making. Gathering, verifying, and updating medication data are resource-intensive processes. The outcomes of integrating, interpreting, and presenting medication information from multiple sources remain to be studied. PMID:23650492

  4. Substituted decision making: elder guardianship.

    PubMed

    Leatherman, Martha E; Goethe, Katherine E

    2009-11-01

    The goal of this column is to help experienced clinicians navigate the judicial system when they are confronted with requests for capacity evaluations that involve guardianship (conservatorship). The interface between the growing elderly medical population and increasing requests for substituted decision making is becoming more complex. This column will help practicing psychiatrists understand the medical, legal, and societal factors involved in adult guardianship. Such understanding is necessary in order to effectively perform guardianship evaluations and adequately inform courts, patients, and families about the psychiatric diagnoses central to substituted decision making. PMID:19934723

  5. Networked medical monitoring in the battlefield

    Microsoft Academic Search

    Dae-Ki Cho; Chia-Wei Chang; Min-Hsieh Tsai; Mario Gerla

    2008-01-01

    With critical data gathered during the battlefields, commanders are able to generate more plans and make better decisions more swiftly. Providing up-to-minute medical information such as physical and psychological fitness of each soldier can significantly help these decisions. The most of current medical information gathering system is in a format of speech or text. To collect this data with mobile

  6. Fingernail Injuries and NASA's Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Butler, Doug

    2008-01-01

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

  7. Association of environmental traits with the geographic ranges of ticks (Acari: Ixodidae) of medical and veterinary importance in the western Palearctic. A digital data set.

    PubMed

    Estrada-Peña, A; Farkas, Robert; Jaenson, Thomas G T; Koenen, Frank; Madder, Maxime; Pascucci, Ilaria; Salman, Mo; Tarrés-Call, Jordi; Jongejan, Frans

    2013-03-01

    We compiled information on the distribution of ticks in the western Palearctic (11°W, 45°E; 29°N, 71°N), published during 1970-2010. The literature search was filtered by the tick's species name and an unambiguous reference to the point of capture. Records from some curated collections were included. We focused on tick species of importance to human and animal health, in particular: Ixodes ricinus, Dermacentor marginatus, D. reticulatus, Haemaphysalis punctata, H. sulcata, Hyalomma marginatum, Hy. lusitanicum, Rhipicephalus annulatus, R. bursa, and the R. sanguineus group. A few records of other species (I. canisuga, I. hexagonus, Hy. impeltatum, Hy. anatolicum, Hy. excavatum, Hy. scupense) were also included. A total of 10,280 records was included in the data set. Almost 42 % of published references are not adequately referenced (and not included in the data set), host is reported for only 61 % of records and a reference to time of collection is missed for 84 % of published records. Ixodes ricinus accounted for 44.3 % of total records, with H. marginatum and D. marginatus accounting for 7.1 and 8.1 % of records, respectively. The lack of homogeneity of the references and potential pitfalls in the compilation were addressed to create a digital data set of the records of the ticks. We attached to every record a coherent set of quantitative descriptors for the site of reporting, namely gridded interpolated monthly climate and remotely sensed data on vegetation (NDVI). We also attached categorical descriptors of the habitat: a standard classification of land biomes and an ad hoc classification of the target territory from remotely sensed temperature and NDVI data. A descriptive analysis of the data revealed that a principal components reduction of the environmental (temperature and NDVI) variables described the distribution of the species in the target territory. However, categorical descriptors of the habitat were less effective. We stressed the importance of building reliable collections of ticks with specific references as to collection point, host and date of capture. The data set is freely downloadable. PMID:22843316

  8. Medical Issues: Nutrition

    MedlinePLUS

    ... or specialist can help you make the right decision. Support & Care For Newly Diagnosed Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life Grief & Loss Community & Local Support For Healthcare Providers Support & Care Publications Related news January 21, ...

  9. High-throughput multiplexed xMAP Luminex array panel for detection of twenty two medically important mosquito-borne arboviruses based on innovations in synthetic biology.

    PubMed

    Glushakova, Lyudmyla G; Bradley, Andrea; Bradley, Kevin M; Alto, Barry W; Hoshika, Shuichi; Hutter, Daniel; Sharma, Nidhi; Yang, Zunyi; Kim, Myong-Jung; Benner, Steven A

    2015-03-01

    Mosquito-borne arboviruses are emerging world-wide as important human and animal pathogens. This makes assays for their accurate and rapid identification essential for public health, epidemiological, ecological studies. Over the past decade, many mono- and multiplexed assays targeting arboviruses nucleic acids have been reported. None has become established for the routine identification of multiple viruses in a "single tube" setting. With increasing multiplexing, the detection of viral RNAs is complicated by noise, false positives and negatives. In this study, an assay was developed that avoids these problems by combining two new kinds of nucleic acids emerging from the field of synthetic biology. The first is a "self-avoiding molecular recognition system" (SAMRS), which enables high levels of multiplexing. The second is an "artificially expanded genetic information system" (AEGIS), which enables clean PCR amplification in nested PCR formats. A conversion technology was used to place AEGIS component into amplicon, improving their efficiency of hybridization on Luminex beads. When Luminex "liquid microarrays" are exploited for downstream detection, this combination supports single-tube PCR amplification assays that can identify 22 mosquito-borne RNA viruses from the genera Flavivirus, Alphavirus, Orthobunyavirus. The assay differentiates between closely-related viruses, as dengue, West Nile, Japanese encephalitis, and the California serological group. The performance and the sensitivity of the assay were evaluated with dengue viruses and infected mosquitoes; as few as 6-10 dengue virions can be detected in a single mosquito. PMID:25680538

  10. Political and medical views on medical marijuana and its future.

    PubMed

    Rubens, Muni

    2014-01-01

    The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of marijuana has always been political, rather than scientific. Federal law has barred the use of medical marijuana though 18 state governments and Washington, DC, support the medical use of marijuana. Unfortunately, not many studies exist on medical marijuana to back these laws and policies. The judiciary, on the other hand, has elicited a diverse response to medical marijuana through its rulings over several decades. Some rulings favored the federal government's opinion, and others supported the larger public view and many state governments with legalized medical marijuana. Public opinion on legalizing medical marijuana has always favored the use of medical marijuana. The movement of scientific knowledge of medical marijuana follows an erratic, discontinuous pathway. The future place of medical marijuana in U.S. society remains unknown. The three forces-scientific knowledge, social-political acceptance, and laws-play a role in the direction that medical marijuana takes in society. Overcoming political-social forces requires a concerted effort from the scientific community and political leaders. The results of scientific research must guide the decisions for laws and medical use of marijuana. This article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana by tracing the past history of medical marijuana with its bumpy pathway in the social-political arena. PMID:24405197

  11. [Exploring medical futility].

    PubMed

    Hsu, Ming-Yi; Chiang, Lien-Ying

    2014-02-01

    Although able to extend the life of some critical patients, advanced medical technology is limited in terms of scope and extent of effectiveness. Some patients die despite the best efforts of medical teams. Medical futility describes treatments that are both extremely unlikely to benefit a patient and costly to provide. Clearly defining futile treatments and considering this concept in patient care strategies is important to provide quality patient care. Taiwan is currently formulating a policy on medical futility. While accepting that the term "futile" is used in many different ways and that this term is difficult to define in clinical practice, this article discusses the various ethical views on medical futility and its definition, the debate among these different views, and related research. We hope this article may help medical care staff better understand the importance of medical futility. PMID:24519349

  12. [Neural mechanisms of decision making].

    PubMed

    Funahashi, Shintaro

    2008-09-01

    Decision-making plays an important role in the transformation of incoming sensory information to purposeful actions. Many decisions have important biological and social consequences, while others may have a more limited impact on our everyday life. The neural mechanisms of decision-making currently constitute an important subject under intense investigation in the field of cognitive and behavioral neuroscience. Among the investigations, on this topic, those involving sensory discrimination tasks using visual motion have provided a wealth of information about the nature of the neural circuitry required to perform perceptual decision-making. For example, by using a motion discrimination task, Shadlen and Newsome have shown an essential role of area LIP in perceptual decision-making. On the other hand, the importance of reward and reward expectations as determinants of decision-making is increasingly appreciated. In particular, reinforcement learning and economic theories, such as game theory, have provided valuable insights into the brain functions related to decision-making. By using a competitive game analogous to matching pennies against a computer, Lee's group showed that in monkeys, previous selections modulated prefrontal neural activity and that this modulation affected the current choice behavior. The prefrontal cortex has been shown to participate in decision-making in free-choice conditions. By using a task involving the free choice of 1 target from multiple saccade targets, Funahashi's group examined the prefrontal participation in decision-making in a free-choice condition. They compared the activities of prefrontal neurons during an oculomotor delay task with forced-choice conditions and free-choice conditions and identified the neural components reflecting the underlying decision-making processes. Although several attempts have been made to understand the neural mechanisms of decision-making, further investigations are required to fully understand these mechanisms. Future studies should evaluate the effects of emotions on decision-making and attempt to integrate the neurophysiological, psychological, and computational approaches to decision-making. PMID:18807936

  13. A study of evaluation methods for hospital medical care systems.

    PubMed

    Nobukawa, M; Eussen, M E

    1992-07-01

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

  14. Informed consent: corner stone in ethical medical and dental practice.

    PubMed

    Kakar, Heena; Gambhir, Ramandeep Singh; Singh, Simarpreet; Kaur, Amarinder; Nanda, Tarun

    2014-01-01

    Progress in health care technologies has enabled patients to be better informed about all aspects of health care. Patients' informed consent is a legal regulation and a moral principle which represents patients' rights to take part in the clinical decisions concerning their treatment. With increasing awareness among the patients, the concept of informed consent is also evolving in developing countries like India. It is important for the medical and dental practitioners to have a written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed consent is also needed when providing medical care to children, foreign patients, and incorporating images of the patients while conducting medical and dental research. The present review addresses some of the vital issues regarding informed consent when providing medical and dental care with current review of the literature. PMID:24791241

  15. Evaluation of the Medically Complex Living Kidney Donor

    PubMed Central

    Caliskan, Yasar; Yildiz, Alaattin

    2012-01-01

    Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor. PMID:22655169

  16. The quality/safety medical index: implementation and analysis.

    PubMed

    Reiner, Bruce I

    2015-02-01

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

  17. The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity

    PubMed Central

    Batistatou, A; Doulis, E A; Tiniakos, D; Anogiannaki, A; Charalabopoulos, K

    2010-01-01

    Background and Aim: Medical humanities is a multidisciplinary field, consisting of humanities (theory of literature and arts, philosophy, ethics, history and theology), social sciences (anthropology, psychology and sociology) and arts (literature, theater, cinema, music and visual arts), integrated in the undergraduate curriculum of Medical schools. The aim of the present study is to discuss medical humanities and support the necessity of introduction of a medical humanities course in the curriculum of Greek medical schools. Materials, Methods and Results: Through the relevant Pub-Med search as well as taking into account various curricula of medical schools, it is evident that medical education today is characterized by acquisition of knowledge and skills and development of medical values and attitudes. Clinical observation with the recognition of key data and patterns in the collected information, is crucial in the final medical decision, i.e. in the complex process, through which doctors accumulate data, reach conclusions and decide on therapy. All sciences included in medical humanities are important for the high quality education of future doctors. The practice of Medicine is in large an image-related science. The history of anatomy and art are closely related, already from the Renaissance time. Studies have shown that attendance of courses on art critics improves the observational skills of medical students. Literature is the source of information about the nature and source of human emotions and behavior and of narratives of illness, and increases imagination. Philosophy aids in the development of analytical and synthetical thinking. Teaching of history of medicine develops humility and aids in avoiding the repetition of mistakes of the past, and quite often raises research and therapeutic skepticism. The comprehension of medical ethics and professional deontology guides the patient-doctor relationship, as well as the relations between physicians and their colleagues. The Medical Humanities course, which is already integrated in the undergraduate curriculum of many medical schools of Europe, USA and Australia, includes lectures by experts and students presentations on the above-mentioned areas and could be offered, for a semester, during the first years. Conclusion: The aim of Medical Humanities course is the development of imagination and interpretation of data through analytical complex procedures, the development of skills of close observation and careful interpretation of the patient "language" and the enhancement of empathy for the patients, as well as the development of the physician-patient relationship and finally the conceptualization/construction of personal and professional values. PMID:21311630

  18. Magnetic resonance propulsion, control and tracking at 24 Hz of an untethered device in the carotid artery of a living animal: an important step in the development of medical micro- and nanorobots.

    PubMed

    Martel, Sylvain

    2007-01-01

    Our recent demonstration of a ferromagnetic bead being navigated automatically inside the carotid artery of a living animal at an average speed of 10 cm/s using a clinical MRI system may be considered as a significant step in the field of medical micro- and nanorobotics. This is particularly true when we consider that an appropriate tracking method was embedded in the closed-loop control process allowing the blood vessels to be considered as navigational routes, providing maximum access for conducting operations inside the human body. But more importantly, this demonstration not only validates preliminary theoretical models but provides us with initial insights about the strategies and approaches that are likely to be used to navigate under computer control, micro- and nanodevices including nanorobots from the largest to the smallest diameter blood vessels that could be used to reach targets inside the human body. Here, based on these initial experimental data obtained in vivo, such strategies and methods are briefly described with some initial design concepts of medical interventional micro- and nanorobots. PMID:18002245

  19. Cellular Decision Making and Biological Noise: From Microbes to Mammals

    E-print Network

    Balázsi, Gábor

    Cellular decision making is the process whereby cells assume different, functionally important and heritable fates without an associated genetic or environmental difference. Such stochastic cell fate decisions generate ...

  20. Cognitive science contributions to decision science.

    PubMed

    Busemeyer, Jerome R

    2015-02-01

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

  1. A Medical Ethics Assessment of the Case of Terri Schiavo

    ERIC Educational Resources Information Center

    Preston, Tom; Kelly, Michael

    2006-01-01

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

  2. Unbiased consideration of applicants to medical schools.

    PubMed

    Schweiker, R S

    1977-05-01

    Medical schools are discriminating against prospective students who do not support abortion on demand. Abortion is an important issue concerning the question of when life begins, the power of the goverment to protect the unborn, and a woman's decision to terminate her pregnancy. Congress enacted legislation that guaranteed freedom of conscience of medical practitioners. Dr. Eugene Diamond reported that on a survey of medical schools he found that a large number asked students their views on abortion and sterilization. Some reported that opposition to abortion would be a detriment to admission. Medical schools are discriminating on the basis of a person's opinion founded on religious or moral grounds. Medical schools may "by the actions they take today, eliminate...dissent" of many doctors who do not approve of the current state of the law on abortion. Senator Schweiker has introduced S 784 "to prevent any school or other institution that receives federal funds from inquiring into the abortion views of prospective students." PMID:852850

  3. The power of paperwork: how Philip Morris neutralized the medical code for secondhand smoke.

    PubMed

    Cook, Daniel M; Tong, Elisa K; Glantz, Stanton A; Bero, Lisa A

    2005-01-01

    A new medical diagnostic code for secondhand smoke exposure became available in 1994, but as of 2004 it remained an invalid entry on a common medical form. Soon after the code appeared, Philip Morris hired a Washington consultant to influence the governmental process for creating and using medical codes. Tobacco industry documents reveal that Philip Morris budgeted more than $2 million for this "ICD-9 Project." Tactics to prevent adoption of the new code included third-party lobbying, Paperwork Reduction Act challenges, and backing an alternative coding arrangement. Philip Morris's reaction reveals the importance of policy decisions related to data collection and paperwork. PMID:16136637

  4. FAMILY AND MEDICAL LEAVE IMPORTANT INFORMATION

    E-print Network

    must be granted for any of the following reasons: · to care for the employee's child after birth a serious health condition; or · for a serious health condition that makes the employee unable to perform certification to support a request for leave because of a serious health condition, and may require second

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

    E-print Network

    Laidlaw, David

    ) (Lidocaine) (Melatonin) (Potassium iodine) (Tamiflu, Oseltamivir) (Sildenafil, Viagra) (Kampo products with blanket Treatment for sleep apnea syndrome CPAP Machine Phillips Respironics REMstar Auto A-Flex M Series

  6. Systems analysis of major consumer energy decisions

    E-print Network

    Sisler, Nicholas Daniel

    2011-01-01

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

  7. Fuzzy SLIQ decision tree algorithm.

    PubMed

    Chandra, B; Varghese, P Paul

    2008-10-01

    Traditional decision tree algorithms face the problem of having sharp decision boundaries which are hardly found in any real-life classification problems. A fuzzy supervised learning in Quest (SLIQ) decision tree (FS-DT) algorithm is proposed in this paper. It is aimed at constructing a fuzzy decision boundary instead of a crisp decision boundary. Size of the decision tree constructed is another very important parameter in decision tree algorithms. Large and deeper decision tree results in incomprehensible induction rules. The proposed FS-DT algorithm modifies the SLIQ decision tree algorithm to construct a fuzzy binary decision tree of significantly reduced size. The performance of the FS-DT algorithm is compared with SLIQ using several real-life datasets taken from the UCI Machine Learning Repository. The FS-DT algorithm outperforms its crisp counterpart in terms of classification accuracy. FS-DT also results in more than 70% reduction in size of the decision tree compared to SLIQ. PMID:18784012

  8. Mining level of control in medical organizations.

    PubMed

    Çalimli, Olgu; Türkeli, Serkan; Eken, Emir Gökberk; Gönen, Halil Emre

    2014-01-01

    In literature of strategic management, there are three layers of control defined in organizational structures. These layers are strategic, tactical and operational, in which resides senior, medium level and low level managers respectively. In strategic level, institutional strategies are determined according to senior managers' perceived state of organization. In tactical level, this strategy is processed into methods and activities of a business management plan. Operational level embodies actions and functions to sustain specified business management plan. An acknowledged lead organization in Turkish medical area is examined using case study and data mining method in the scope of this paper. The level of decisions regarded in managerial purposes evaluated through chosen organization's business intelligence event logs report. Hence specification of management level importance of medical organizations is made. Case study, data mining and descriptive statistical method of taken case's reports present that positions of "Chief Executive Officer", "Outpatient Center Manager", "General Manager", monitored and analyzed functions of operational level management more frequently than strategic and tactical level. Absence of strategic management decision level research in medical area distinguishes this paper and consequently substantiates its significant contribution. PMID:25160200

  9. Medication Adherence: WHO Cares?

    PubMed Central

    Brown, Marie T.; Bussell, Jennifer K.

    2011-01-01

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

  10. Medical Assistants

    MedlinePLUS

    ... clinical work. Administrative medical assistants often fill out insurance forms or code patients’ medical information. They often ... may update a patient’s medical file, fill out insurance forms, and answer telephone calls in a practitioner’s ...

  11. Deregulating mandatory medical prescription.

    PubMed

    Mitchell, C N

    1986-01-01

    This Article links the legal evolution of mandatory medical prescription since 1900 to the police-power's prohibition of alcohol and the opiates as well as to the self-interested monopolization of new drugs by physicians. The Article advances a theory of professionalization consistent with the evidence that mandatory prescription is not in the public interest. The Article suggests that the supremacy of self-medication is consistent with competition policy, the medical profession's fiduciary duty to clients, reduced medical costs and improved health. The author analyzes the consequences of regulating drug production, testing, marketing and consumtion by granting decision-making authority to the lowest-cost risk avoider, suggesting this as a plausible basis for legal reform. PMID:3327377

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

    PubMed Central

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

    2014-01-01

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

  13. An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

    PubMed

    Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

    2009-09-01

    The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams. PMID:19707058

  14. Decision exploration lab: a visual analytics solution for decision management.

    PubMed

    Broeksema, Bertjan; Baudel, Thomas; Telea, Arthur G; Crisafulli, Paolo

    2013-12-01

    We present a visual analytics solution designed to address prevalent issues in the area of Operational Decision Management (ODM). In ODM, which has its roots in Artificial Intelligence (Expert Systems) and Management Science, it is increasingly important to align business decisions with business goals. In our work, we consider decision models (executable models of the business domain) as ontologies that describe the business domain, and production rules that describe the business logic of decisions to be made over this ontology. Executing a decision model produces an accumulation of decisions made over time for individual cases. We are interested, first, to get insight in the decision logic and the accumulated facts by themselves. Secondly and more importantly, we want to see how the accumulated facts reveal potential divergences between the reality as captured by the decision model, and the reality as captured by the executed decisions. We illustrate the motivation, added value for visual analytics, and our proposed solution and tooling through a business case from the car insurance industry. PMID:24051763

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

    PubMed Central

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

    2012-01-01

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

  16. Medical technology horizon scanning

    Microsoft Academic Search

    I. T. Brown; A. Smale; A. Verma; S. Momandwall

    2005-01-01

    Horizon scanning is becoming particularly important in the medical industry, in the identification and evaluation of emerging\\u000a technologies. This paper examines the role biomedical engineers may have in horizon scanning new medical technologies and\\u000a considers whether this is a useful activity for biomedical engineers. A horizon scanning methodology for conducting studies\\u000a of emerging medical technologies is introduced, consisting of the

  17. Aging and consumer decision making

    PubMed Central

    Carpenter, Stephanie M.; Yoon, Carolyn

    2013-01-01

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

  18. An industry perspective on Canadian patients' involvement in Medical Tourism: implications for public health

    PubMed Central

    2011-01-01

    Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Methods Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Results Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. Conclusions No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for a comprehensive public health response to medical tourism and its effects should be coupled with a clear understanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators as important stakeholders in medical tourism. PMID:21627830

  19. The training and expectations of medical students in Mozambique

    PubMed Central

    Sousa, Fernando; Schwalbach, João; Adam, Yussuf; Gonçalves, Luzia; Ferrinho, Paulo

    2007-01-01

    Background This paper describes the socio-economic profile of medical students in the 1998/99 academic year at the Universidade Eduardo Mondlane (UEM) Medical Faculty in Maputo. It aims to identify their social and geographical origins in addition to their expectations and difficulties regarding their education and professional future. Methods The data were collected through a questionnaire administered to all medical students at the faculty. Results Although most medical students were from outside Maputo City and Maputo Province, expectations of getting into medical school were already associated with a migration from the periphery to the capital city, even before entering medical education. This lays the basis for the concentration of physicians in the capital city once their term of compulsory rural employment as junior doctors is completed. The decision to become a doctor was taken at an early age. Close relatives, or family friends seem to have been an especially important variable in encouraging, reinforcing and promoting the desire to be a doctor. The academic performance of medical students was dismal. This seems to be related to several difficulties such as lack of library facilities, inadequate financial support, as well as poor high school preparation. Only one fifth of the students reported receiving financial support from the Mozambican government to subsidize their medical studies. Conclusion Medical students seem to know that they will be needed in the public sector, and that this represents an opportunity to contribute to the public's welfare. Nevertheless, their expectations are, already as medical students, to combine their public sector practice with private medical work in order to improve their earnings. PMID:17445263

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

    PubMed

    Underhill, Meghan L; Crotser, Cheryl B

    2014-06-01

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

  1. Avoiding medical emergencies.

    PubMed

    Omar, Y

    2013-03-01

    Medical emergencies can occur at any time in any location. This article and associated presentation at the forthcoming British Dental Conference Exhibition provide key advice on avoiding medical emergencies in dental practice; including advice on risk assessing all patients, understanding the importance of a checklist, and using a National Early Warning Score (NEWS). PMID:23470404

  2. Medical Matrix

    NSDL National Science Digital Library

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

  3. [Quality assurance in head and neck medical oncology].

    PubMed

    Digue, Laurence; Pedeboscq, Stéphane

    2014-05-01

    In medical oncology, how can we be sure that the right drug is being administered to the right patient at the right time? The implementation of quality assurance criteria is important in medical oncology, in order to ensure that the patient receives the best treatment safely. There is very little literature about quality assurance in medical oncology, as opposed to radiotherapy or cancer surgery. Quality assurance must cover the entire patient care process, from the diagnosis, to the therapeutic decision and drug distribution, including its selection, its preparation and its delivery to the patient (administration and dosage), and finally the potential side effects and their management. The dose-intensity respect is crucial, and its reduction can negatively affect overall survival rates, as shown in breast and testis cancers for example. In head and neck medical oncology, it is essential to respect the few well-standardized recommendations and the dose-intensity, in a population with numerous comorbidities. We will first review quality assurance criteria for the general medical oncology organization and then focus on head and neck medical oncology. We will then describe administration specificities of head and neck treatments (chemoradiation, radiation plus cetuximab, postoperative chemoradiation, induction and palliative chemotherapy) as well as their follow-up. Lastly, we will offer some recommendations to improve quality assurance in head and neck medical oncology. PMID:24886900

  4. The Medication Life

    PubMed Central

    Powell, Alicia D.

    2001-01-01

    The therapist conducting psychodynamic psychotherapy often recommends medication for the patient, but the medication is frequently treated as separate from the therapy and not worth exploring. By not inviting the patient's and our own feelings about medication into the treatment dialogue, we may solicit the development of split transference, the loss of important unconscious material, and noncompliance. Much like a patient's dream life, the medication life is rich in detail that may be fruitfully used to gain information about the patient's experience, strengthen the alliance, and improve treatment outcome. PMID:11696647

  5. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

    The goals of the Integrated Medical Model (IMM) are to develop an integrated, quantified, evidence-based decision support tool useful to crew health and mission planners and to help align science, technology, and operational activities intended to optimize crew health, safety, and mission success. Presentation slides address scope and approach, beneficiaries of IMM capabilities, history, risk components, conceptual models, development steps, and the evidence base. Space adaptation syndrome is used to demonstrate the model's capabilities.

  6. Use of computerized decision support systems to improve antibiotic prescribing

    Microsoft Academic Search

    Karin Thursky

    2006-01-01

    This decade will see the emergence of the electronic medical record, electronic prescribing and computerized decision support in the hospital setting. Current opinion from key infectious diseases bodies supports the use of computerized decision support systems as potentially useful tools in antibiotic stewardship programs. However, although antibiotic decision support systems appear beneficial for improving the quality of prescribing and reducing

  7. Complexity in Decision Making: The Case of the Rotterdam Harbour Expansion. Connecting Decisions, Arenas and Actors in Spatial Decision Making

    Microsoft Academic Search

    Marcel Van Gils; Erik-Hans Klijn

    2007-01-01

    Decision making about spatial projects is very complex. Decisions to develop the Rotterdam harbour are taken in the context of a network of local, regional, national, European and international actors, both public and private. These decision-making processes exhibit a lot of complexity and the outcomes are of great importance for the development of the harbour. The complexity is the consequence

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

    SciTech Connect

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

    1996-11-12

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

  9. Ethics and genomic medicine, how to navigate decisions in surgical oncology.

    PubMed

    Devon, Karen M; Lerner-Ellis, Jordan P; Ganai, Sabha; Angelos, Peter

    2015-01-01

    Using genetic information to make medical decisions and tailor treatments to individuals will likely provide major benefits and become an important part of health care. Surgical oncologists must ethically apply scientific genetic information in a complex and evolving environment to the benefit of their patients. In this review we address ethical issues associated with: indications for genetic testing, informed consent for testing and therapy, confidentiality, targeted therapy, prophylactic surgery, and genetic testing in children. PMID:25183289

  10. Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review

    Microsoft Academic Search

    Wayne J. G. HellstromDarius; Darius Paduch; Craig F. Donatucci

    Evaluation of potential candidates for testosterone replacement therapy (TRT) includes a complete medical history, physical\\u000a examination, and hormonal screening. The choice of testosterone assay is important in clinical decision making. TRT should,\\u000a in theory, approximate natural endogenous production of the hormone. There is no apparent association between TRT and the\\u000a development of prostate cancer. The administration of exogenous testosterone is

  11. Ethical Decision Making and The Law

    Microsoft Academic Search

    Barbara Libby; Vincent Agnello

    2000-01-01

    This paper will examine the effects of gender, age, work experience, academic status and legality on certain ethical decisions. Six scenarios representing ethical dilemmas were presented to both undergraduate and MBA students in an attempt to determine if various demographic factors influenced ethical decision making. While some past studies have suggested that gender has an important effect on ethical decision

  12. An approach for assessing human decision reliability

    Microsoft Academic Search

    P Pyy

    2000-01-01

    This paper presents a method to study human reliability in decision situations related to nuclear power plant disturbances. Decisions often play a significant role in handling of emergency situations. The method may be applied to probabilistic safety assessments (PSAs) in cases where decision making is an important dimension of an accident sequence. Such situations are frequent e.g. in accident management.

  13. Ascertaining Problems with Medication Histories

    PubMed Central

    Halapy, Henry; Kertland, Heather

    2012-01-01

    Background: Accurate and complete medication histories are not always obtained in clinical practice. Objective: This qualitative research study was undertaken to explore the barriers to and facilitators of obtaining accurate medication histories. Methods: Individual interviews, based on a structured interview guide, were conducted with 25 patients from both inpatient and ambulatory care clinic settings. Focus groups, based on a semistructured interview guide, were conducted with pharmacists, medical residents, and nurses. Transcribed data were analyzed by forming coded units and assessing these units for emerging themes. Results: Major themes that emerged from the patient interviews included patient ownership of health and medication knowledge (with knowledge of medications and their side effects and how to take medications being seen as important), patient-specific strategies to improve medication histories (e.g., use of regularly updated medication lists), and suggestions for system-level facilitators to improve medication histories (e.g., centralized databases of medication histories, increased patient education regarding the use and purpose of medications). Major themes also emerged from focus groups with health care professionals, including shared responsibility for medication history-taking among all 3 health care professions, perceptions about the barriers to medication history-taking (including patients not knowing their medications and not bringing their medication lists), and suggestions to improve medication histories (e.g., educating patients to bring medication vials to hospital admissions and appointments, using a centralized computer database for medication histories). Conclusions: Key recommendations resulting from this study include using standardized documentation techniques for medication histories, recording of medication history information in centralized electronic databases, educating patients to bring medications to every health care visit, and establishing criteria for pharmacist referral for cases involving complex medication histories. PMID:23129864

  14. Decision Making and Decision Support for Hereditary Breast-Ovarian Cancer Susceptibility

    Microsoft Academic Search

    Marc D. Schwartz; Beth N. Peshkin; Kenneth P. Tercyak; Kathryn L. Taylor; Heiddis Valdimarsdottir

    2005-01-01

    Genetic testing for disease susceptibility has the potential to revolutionize health care by allowing for individually tailored disease prevention strategies. To achieve this promise, patients and physicians must use the information obtained through genetic testing to make medical decisions that are consistent with patient preferences and that lead to reduced disease morbidity and mortality. However, decisions associated with genetic testing

  15. Assuring the Safety, Security, and Reliability of Medical-Device Cyber-

    E-print Network

    Hu, Fei

    Assuring the Safety, Security, and Reliability of Medical-Device Cyber- Physical Systems (MDCPS Finance Healthcare Transportation Energy Large-scale Infrastructure ... #12;Monitoring Medical Devices Treatment Delivery Medical Devices Smart Alarm Caregiver Patient Smart Controller Decision Support (ICE

  16. Qualitative variables in medical school admission.

    PubMed

    McGaghie, W C

    1990-03-01

    Personal qualities, character traits, life experience, and adaptive capacities are all associated with effective professional life and work. Despite widespread acknowledgement that qualitative factors are crucial for success as a medical student and physician, the variables are rarely measured or considered when medical schools reach decisions about student admission. This essay examines the qualitative variables that medical school admission committees might consider when filling their classes, and it offers recommendations about using qualitative data for admission decisions. It concludes with an agenda for research on medical school admission. PMID:2407255

  17. Medical School Research Pipeline: Medical Student Research Experience in Psychiatry

    ERIC Educational Resources Information Center

    Balon, Richard; Heninger, George; Belitsky, Richard

    2006-01-01

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

  18. The Dutch model for legalizing end-of-life decisions.

    PubMed

    Kater, Loes

    2003-01-01

    The Dutch experience with euthanasia is used as a model for other countries for regulating end-of-life decisions. Several elements of the Dutch debate, for example the definition of euthanasia, are copied and imported to other debates. This paper studies the specific Dutch construction of regulating euthanasia and the concept of the requirements of prudent practice. The requirements of prudent practice embody the conditions for careful medical management in end-of-life decisions. It is argued that the requirements of prudent practice are a relatively acceptable way of regulating the Dutch practice of euthanasia as they are embedded in an elaborate network of relations, standards and values. As a consequence of this local character and the way the requirements of prudent practice relate to the Dutch practice of euthanasia it is difficult to simply transport them to other countries in order to regulate euthanasia. PMID:14626886

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

    EPA Science Inventory

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

  20. Decisions without blinders.

    PubMed

    Bazerman, Max H; Chugh, Dolly

    2006-01-01

    By the time Merck withdrew its pain relief drug Vioxx from the market in 2004, more than 100 million prescriptions had been filled in the United States alone. Yet researchers now estimate that Vioxx may have been associated with as many as 25,000 heart attacks and strokes. Evidence of the drug's risks was available as early as 2000, so why did so many doctors keep prescribing it? The answer, say the authors, involves the phenomenon of bounded awareness--when cognitive blinders prevent a person from seeing, seeking, using, or sharing highly relevant, easily accessible, and readily perceivable information during the decision-making process. Doctors prescribing Vioxx, for instance, more often than not received positive feedback from patients. So, despite having access to information about the risks, physicians may have been blinded to the actual extent of the risks. Bounded awareness can occur at three points in the decision-making process. First, executives may fail to see or seek out the important information needed to make a sound decision. Second, they may fail to use the information that they do see because they aren't aware of its relevance. Third, executives may fail to share information with others, thereby bounding the organization's awareness. Drawing on examples such as the Challenger disaster and Citibank's failures in Japan, this article examines what prevents executives from seeing what's right in front of them and offers advice on how to increase awareness. Of course, not every decision requires executives to consciously broaden their focus. Collecting too much information for every decision would waste time and other valuable resources. The key is being mindful. If executives think an error could generate almost irrecoverable damage, then they should insist on getting all the information they need to make a wise decision. PMID:16447372

  1. The Importance of Eyelid Closure and Nasolacrimal Occlusion Following the Ocular Instillation of Topical Glaucoma Medications, and the Need for the Universal Inclusion of One of these Techniques in All Patient Treatments and Clinical Studies

    PubMed Central

    Flach, Allan J.

    2008-01-01

    Purpose To review the effects of nasolacrimal occlusion (NLO) and eyelid closure (ELC) on the ocular and systemic absorption of topically applied glaucoma medications and emphasize the need for the universal application of these techniques during patient treatment and in clinical studies of topically applied glaucoma medications. Methods Following a review of data suggesting great clinical benefit from NLO and ELC, the absence of inclusion of these simple techniques in published studies of topical glaucoma medications is identified. The effect of this oversight on these studies is noted with reference to each of the 5 major groups of glaucoma medications. Results A review of the literature suggests that NLO and ELC improve intraocular penetration of topically applied glaucoma medications and discourage systemic absorption. The US Food and Drug Administration and the National Institutes of Health discourage the inclusion of these techniques in studies of the efficacy and toxicity of topically applied glaucoma medications. Consequently, all glaucoma studies reported in the literature lack the inclusion of these techniques for 5 minutes. This omission has major implications for patient informed consent, study protocol consistency, and the value of clinical studies, and directly affects the therapeutic index of glaucoma medications in unpredictable and undesirable ways. The undesirable influence on the therapeutic index of each drug influences the safety and efficacy and has implications for the cost of medical treatments, the reproducibility of clinical study results, and dosing regimens, including those of combination therapy, as reflected in the peer-reviewed literature. Conclusions Patients should use NLO or ELC for 5 minutes following eye drop treatment with topically applied glaucoma medications. Furthermore, it is essential that these techniques be included in all clinical studies of topically applied glaucoma medications to ensure the most favorable therapeutic index and its accurate determination. This will also help provide the most consistent, reliable, and reproducible study results. PMID:19277229

  2. Endocrinology Concepts for Medical Students

    NSDL National Science Digital Library

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

    2001-12-01

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

  3. Medication adherence: process for implementation

    PubMed Central

    Mendys, Phil; Zullig, Leah L; Burkholder, Rebecca; Granger, Bradi B; Bosworth, Hayden B

    2014-01-01

    Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications. PMID:25114513

  4. Medical Management

    MedlinePLUS

    ... form Search Charcot-Marie-Tooth Disease (CMT) Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...

  5. Oral Medication

    MedlinePLUS

    ... doctor before starting anything new — even over-the-counter items. Explore: Oral Medication How Much Do Oral Medications Cost? Save money by finding the right type and dosage of medicine for your needs. In this section Treatment and ...

  6. Medication Errors

    MedlinePLUS

    ... Reviewers - Medical Device Use-Safety: Incorporating Human Factors Engineering into Risk Management (PDF - 1.1MB) Draft Guidance ... Drug Administration Staff - Applying Human Factors and Usability Engineering to Optimize Medical Device Design Spotlight Guidance for ...

  7. Medical Transcriptionists

    MedlinePLUS

    ... an understanding of medical terminology, anatomy and physiology, grammar, and word-processing software. Pay The median annual ... an understanding of medical terminology, anatomy and physiology, grammar, and word-processing software. Education Employers prefer to ...

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

    PubMed Central

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

    2013-01-01

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

  9. Decision Making in the Airplane

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

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

    PubMed Central

    2013-01-01

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

  11. Import.io

    NSDL National Science Digital Library

    2013-09-05

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

  12. The presence of N-terminal secretion signal sequences leads to strong stimulation of the total expression levels of three tested medically important proteins during high-cell-density cultivations of Escherichia coli.

    PubMed

    Sletta, H; Tøndervik, A; Hakvåg, S; Aune, T E Vee; Nedal, A; Aune, R; Evensen, G; Valla, S; Ellingsen, T E; Brautaset, T

    2007-02-01

    Genetic optimizations to achieve high-level production of three different proteins of medical importance for humans, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon alpha 2b (IFN-alpha2b), and single-chain antibody variable fragment (scFv-phOx), were investigated during high-cell-density cultivations of Escherichia coli. All three proteins were poorly expressed when put under control of the strong Pm/xylS promoter/regulator system, but high volumetric yields of GM-CSF and scFv-phOx (up to 1.7 and 2.3 g/liter, respectively) were achieved when the respective genes were fused to a translocation signal sequence. The choice of signal sequence, pelB, ompA, or synthetic signal sequence CSP, displayed a high and specific impact on the total expression levels for these two proteins. Data obtained by quantitative PCR confirmed relatively high in vivo transcript levels without using a fused signal sequence, suggesting that the signal sequences mainly stimulate translation. IFN-alpha2b expression remained poor even when fused to a signal sequence, and an alternative IFN-alpha2b coding sequence that was optimized for effective expression in Escherichia coli was therefore synthesized. The total expression level of this optimized gene remained low, while high-level production (0.6 g/liter) was achieved when the gene was fused to a signal sequence. Together, our results demonstrate a critical role of signal sequences for achieving industrial level expression of three human proteins in E. coli under the conditions tested, and this effect has to our knowledge not previously been systematically investigated. PMID:17142370

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

    PubMed Central

    2013-01-01

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

  14. A critical analysis of workplace medical screening practices, privacy and self-disclosure: Assessing individual and organizational concerns in the 1990s

    Microsoft Academic Search

    Michele Anne Simms

    1991-01-01

    Workplace privacy rights of public and private sector employees are becoming the most dynamic and one of the most important areas of employment law in the United States. Currently, employers are increasingly using testing as a predictive and diagnostic tool in employment decision-making. This study seeks to examine the issues of medical screening and its impact on the concept of

  15. Exploration Medical System Demonstration

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  16. Decision Point #28 -1 Decision Point

    E-print Network

    Kark, Salit

    and ideas on environmental decision making, biodiversity, conservation planning and monitoring times at the recent Fenner Conference on good environmental decision making. `The Great Divide. For example, many of our papers on decision theory are not directly applicable to any specific decision "Very

  17. Categorical and Probabilistic Reasoning in Medical Diagnosis

    Microsoft Academic Search

    Peter Szolovits; Stephen G. Pauker

    1978-01-01

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

  18. The clinical decision support consortium.

    PubMed

    Middleton, Blackford

    2009-01-01

    Clinical decision support (CDS) can impact the outcomes of care when used at the point of care in electronic medical records (EMR). CDS has been shown to increase quality and patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Systematic reviews have shown that CDS can be useful across a variety of clinical purposes and topics. Despite broad national policy objectives to increase EMR adoption in the US, current adoption of advanced clinical decision support is limited due to a variety of reasons, including: limited implementation of EMR, CPOE, PHR, etc., difficulty developing clinical practice guidelines ready for implementation in EMR, lack of standards, absence of a central repository or knowledge resource, poor support for CDS in commercial EMRs, challenges in integrating CDS into the clinical workflow, and limited understanding of organizational and cultural issues relating to clinical decision support. To better understand and overcome these barriers, and accelerate the translation of clinical practice guideline knowledge into CDS in EMRs, the CDS Consortium is established to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and EHR technology platforms. PMID:19745260

  19. The Accuracy of Medication Data in an Outpatient Electronic Medical Record

    Microsoft Academic Search

    Michael M Wagner; William R Hogan

    1996-01-01

    ObjectiveTo measure the accuracy of medication records stored in the electronic medical record (EMR) of an outpatient geriatric center. The authors analyzed accuracy from the perspective of a clinician using the data and the perspective of a computer-based medical decision-support system (MDSS).DesignProspective cohort study.MethodsThe EMR at the geriatric center captures medication data both directly from clinicians and indirectly using encounter

  20. Building Decision Models that Modify Decision Systems

    PubMed Central

    Reed, John O.

    1989-01-01

    Two criticisms of decision analysis are that the amount of effort expended and time spent on modeling a problem is too burdensome and that the resulting model is applicable to only one specific problem. It can be helpful to use the information learned in one decision problem to solve another similar problem. Transferring information across problems, however, can require a time commitment comparable to analyzing that problem anew. These criticisms may be great enough to convince decision makers that practical application of decision analysis is infeasible. To address these criticisms, we designed an intelligent decision system that automatically builds decision models using an alternative form of decision trees known as influence diagrams. The system aids clinicians in evaluating alternatives in ventilator management. We believe that this intelligent decision system can decrease the amount of time users spend (and frustration they experience) in applying decision analysis and thus, it should increase the acceptance of decision analysis as a useful tool.

  1. Role of state medical boards in continuing medical education.

    PubMed

    Johnson, David A; Austin, Dale L; Thompson, James N

    2005-01-01

    The evaluation of physician competency prior to issuing an initial medical license has been a fundamental responsibility of medical boards. Growing public expectation holds that medical boards will ensure competency throughout a physician's career. The Federation of State Medical Boards (FSMB) strongly supports the right of state medical boards to require physicians to demonstrate continuing qualification for medical licensure. The FSMB views continuing medical education (CME) as an important component of any maintenance-of-competence initiative. Most medical boards require CME as part of their license renewal process. Learner-focused CME with measurable outcomes enables the medical profession's emphasis on core competencies, training, and assessment, and the general public's expectation for maintenance of physician competence. To effectively move their licensee populations toward the most effective CME tools and structure, medical boards must recognize physicians' educational needs and preferences. Medical boards can be proactive by fostering educational consortia involving medical boards, medical societies, and academic medical centers and featuring educational sessions that represent the best in current CME practices. PMID:16173067

  2. Linguistic approach for identification of medication names and related information in clinical narratives

    PubMed Central

    Grabar, Natalia

    2010-01-01

    Background Pharmacotherapy is an integral part of any medical care process and plays an important role in the medical history of most patients. Information on medication is crucial for several tasks such as pharmacovigilance, medical decision or biomedical research. Objectives Within a narrative text, medication-related information can be buried within other non-relevant data. Specific methods, such as those provided by text mining, must be designed for accessing them, and this is the objective of this study. Methods The authors designed a system for analyzing narrative clinical documents to extract from them medication occurrences and medication-related information. The system also attempts to deduce medications not covered by the dictionaries used. Results Results provided by the system were evaluated within the framework of the I2B2 NLP challenge held in 2009. The system achieved an F-measure of 0.78 and ranked 7th out of 20 participating teams (the highest F-measure was 0.86). The system provided good results for the annotation and extraction of medication names, their frequency, dosage and mode of administration (F-measure over 0.81), while information on duration and reasons is poorly annotated and extracted (F-measure 0.36 and 0.29, respectively). The performance of the system was stable between the training and test sets. PMID:20819862

  3. Exploration Medical System Demonstration Project

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

  4. Medical paternalism and the fetus

    Microsoft Academic Search

    John Wyatt

    2001-01-01

    A number of developments in the medical field have changed the debate about the ethics of abortion. These developments include: advances in fetal physiology, the increase in neonatal intensive care and the survival rates of premature infants. This paper discusses the idea of selective termination and the effects that these decisions have on disabled people of today. It presents a

  5. Space Management for Medical Education.

    ERIC Educational Resources Information Center

    Agro, Dino

    1978-01-01

    A reference on current methods and procedures for managing space in academic medical centers is provided. Focus is on elements of space management systems that can enhance the effectiveness of space allocation decisions. These include: space inventory, space standards, evaluation of space utilization, and space allocation. A bibliography is…

  6. Parent decision making for life support for extremely premature infants: from the prenatal through end-of-life period.

    PubMed

    Moro, Teresa T; Kavanaugh, Karen; Savage, Teresa A; Reyes, Maria R; Kimura, Robert E; Bhat, Rama

    2011-01-01

    Most deaths of extremely premature infants occur in the perinatal period. Yet, little is known about how parents make life support decisions in such a short period of time. In the paper, how parents make life support decisions for extremely premature infants from the prenatal period through death from the perspectives of parents, nurses, and physicians is described. Five cases, comprised of five mothers, four neonatologists, three nurses, and one neonatal nurse practitioner, are drawn from a larger collective case study. Prenatal, postnatal and end-of-life interviews were conducted, and medical record data were obtained. In an analysis by two research team members, mothers were found to exhibit these characteristics: desire for and actual involvement in life support decisions, weighing pain, suffering and hope in decision making, and wanting everything done for their infants. All mothers received decision making help and support from partners and family, but relationships with providers were also important. Finally, external resources impacted parental decision making in several of the cases. By understanding what factors contribute to parents' decision making, providers may be better equipped to prepare and assist parents when making life support decisions for their extremely premature infants. PMID:21311270

  7. Integrated Medical Model Overview

    NASA Technical Reports Server (NTRS)

    Myers, J.; Boley, L.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.; Saile, L.; Shah, R.; Garcia, Y.; Sirmons. B.; Walton, M.; Reyes, D.

    2015-01-01

    The Integrated Medical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed Integrated Medical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project.

  8. Sequential Three-way Decisions with Probabilistic Rough Sets Yiyu Yao and Xiaofei Deng

    E-print Network

    Yao, Yiyu

    models [20, 21, 22]. It is based on the Bayesian decision theory that minimizing This work is partially-way decision- making, in which the cost of obtaining required evi- dence or information is also considered. 1 process [15], medical decision-making [8, 9], statisti- cal inference, statistical decision-making

  9. Sometimes doing the right thing sucks: frame combinations and multi-fetal pregnancy reduction decision difficulty.

    PubMed

    Britt, David W; Evans, Mark I

    2007-12-01

    Data are analyzed for 54 women who made an appointment with a North American Center specializing in multifetal pregnancy reduction (MFPR) to be counseled and possibly have a reduction. The impact on decision difficulty of combinations of three frames through which patients may understand and consider their options and use to justify their decisions are examined: a conceptional frame marked by a belief that life begins at conception; a medical frame marked by a belief in the statistics regarding risk and risk prevention through selective reduction; and a lifestyle frame marked by a belief that a balance of children and career has normative value. All data were gathered through semi-structured interviews and observation during the visit to the center over an average 2.5h period. Decision difficulty was indicated by self-assessed decision difficulty and by residual emotional turmoil surrounding the decision. Qualitative comparative analysis was used to analyze the impact of combinations of frames on decision difficulty. Separate analyses were conducted for those reducing only to three fetuses (or deciding not to reduce) and women who chose to reduce below three fetuses. Results indicated that for those with a non-intense conceptional frame, the decision was comparatively easy no matter whether the patients had high or low values of medical and lifestyle frames. For those with an intense conceptional frame, the decision was almost uniformly difficult, with the exception of those who chose to reduce only to three fetuses. Simplifying the results to their most parsimonious scenarios oversimplifies the results and precludes an understanding of how women can feel pulled in different directions by the dictates of the frames they hold. Variations in the characterization of intense medical frames, for example, can both pull toward reduction to two fetuses and neutralize shame and guilt by seeming to remove personal responsibility for the decision. We conclude that the examination of frame combinations is an important tool for understanding the way women carrying multiple fetuses negotiate their way through multi-fetal pregnancies, and that it may have more general relevance for understanding pregnancy decisions in context. PMID:17698273

  10. Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

    Microsoft Academic Search

    Deborah F. Pencarinha; Nora K. Bell; Janice G. Edwards; Robert G. Best

    1992-01-01

    New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar

  11. Visual PROMETHEE: Developments of the PROMETHEE & GAIA multicriteria decision aid methods

    Microsoft Academic Search

    B. Mareschal; Y. De Smet

    2009-01-01

    PROMETHEE and GAIA are multicriteria decision aid methods belonging to the family of outranking methods. PROMETHEE is prescriptive: it provides the decision-maker with rankings of a set of alternative decisions evaluated on several often conflicting criteria. GAIA is descriptive: it uncovers important features of the decision problem and assists the decision-maker in eliciting preferences and finalizing the decision. After a

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

    Microsoft Academic Search

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

    2011-01-01

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

  13. Assessing Personal Qualities in Medical School Admissions.

    ERIC Educational Resources Information Center

    Albanese, Mark A.; Snow, Mikel H.; Skochelak, Susan E.; Huggett, Kathryn N.; Farrell, Philip M.

    2003-01-01

    Analyzes the challenges to using academic measures (MCAT scores and GPAs) as thresholds for medical school admissions and, for applicants exceeding the threshold, using personal qualities for admission decisions; reviews the literature on using the medical school interview and other admission data to assess personal qualities of applicants;…

  14. Medical technology and professional dominance theory

    Microsoft Academic Search

    Ann Lennarson Greer

    1984-01-01

    The expansion of medical technology in hospitals is commonly asserted to be a result of the preferences of medical doctors translated into organizational policies as a result of professional dominance in health care organizations. This paper examines the theoretical and empirical bases for hypotheses of professional dominance and the utility of these hypotheses in explaining hospital decisions to adopt new

  15. Contributions of empirical research to medical ethics

    Microsoft Academic Search

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

    1993-01-01

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

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

    NSDL National Science Digital Library

    Philip A. Streifer

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

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

    Microsoft Academic Search

    Jonathan W. Keller; Yi Edward Yang

    2008-01-01

    The poliheuristic (PH) theory of decision making has made important contributions to our understanding of political decision making but remains silent about certain key aspects of the decision process. Specifically, PH theory contends that leaders screen out politically unacceptable options, but it provides no guidance on (1) the crucial threshold at which leaders reject options as politically unacceptable, (2) whether

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

    ERIC Educational Resources Information Center

    Keller, Jonathan W.; Yang, Yi Edward

    2008-01-01

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

  19. Intelligent medical information filtering.

    PubMed

    Quintana, Y

    1998-01-01

    This paper describes an intelligent information filtering system to assist users to be notified of updates to new and relevant medical information. Among the major problems users face is the large volume of medical information that is generated each day, and the need to filter and retrieve relevant information. The Internet has dramatically increased the amount of electronically accessible medical information and reduced the cost and time needed to publish. The opportunity of the Internet for the medical profession and consumers is to have more information to make decisions and this could potentially lead to better medical decisions and outcomes. However, without the assistance from professional medical librarians, retrieving new and relevant information from databases and the Internet remains a challenge. Many physicians do not have access to the services of a medical librarian. Most physicians indicate on surveys that they do not prefer to retrieve the literature themselves, or visit libraries because of the lack of recent materials, poor organisation and indexing of materials, lack of appropriate and available material, and lack of time. The information filtering system described in this paper records the online web browsing behaviour of each user and creates a user profile of the index terms found on the web pages visited by the user. A relevance-ranking algorithm then matches the user profiles to the index terms of new health care web pages that are added each day. The system creates customised summaries of new information for each user. A user can then connect to the web site to read the new information. Relevance feedback buttons on each page ask the user to rate the usefulness of the page to their immediate information needs. Errors in relevance ranking are reduced in this system by having both the user profile and medical information represented in the same representation language using a controlled vocabulary. This system also updates the user profiles, automatically relieving this burden from the user, but also allowing the user to explicitly state preferences. An initial evaluation of this system was done with health consumers using a web site on consumer health. It was found that users often modified their criteria for what they considered relevant not only between browsing sessions but also during a session. A user's criteria for what is relevant is constantly changing as they interact with the information. New revised metrics of recall and precision are needed to account for the partially relevant judgements and the dynamically changing criteria of users. Future research, development, and evaluation of interactive information retrieval systems will need to take into account the users' dynamically changing criteria of relevance. PMID:9794334

  20. Understanding variation in primary medical care: a nine-country qualitative study of clinicians’ accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection

    PubMed Central

    Brookes-Howell, Lucy; Hood, Kerenza; Cooper, Lucy; Little, Paul; Verheij, Theo; Coenen, Samuel; Godycki-Cwirko, Maciek; Melbye, Hasse; Borras-Santos, Alicia; Worby, Patricia; Jakobsen, Kristin; Goossens, Herman; Butler, Christopher C

    2012-01-01

    Objectives There is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation. Design Multicountry qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes. Setting Primary care. Participants Eighty primary care clinicians randomly selected from primary care research networks based in nine European cities. Results Clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and ?ód?). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making). Conclusions Addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness. PMID:22918670