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1

Patient Assessments of the Most Important Medical Decision During a Hospitalization  

Microsoft Academic Search

Background  How medical decisions are made in real-life situations is largely unexplored. We explored patients’ perceptions of decision-making\\u000a during a hospitalization and examined the conformity of the decision process with expert recommendations.\\u000a \\u000a \\u000a \\u000a Objective  To describe the conformity of the decision-making process with current expert opinion and examine the associations between\\u000a various aspects of the decision-making process and a global assessment of the

Thomas V. Perneger; Agathe Charvet-Bérard; Arnaud Perrier

2008-01-01

2

Medical Decision Making and Medical Education: Challenges and Opportunities  

Microsoft Academic Search

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or

Alan Schwartz

2011-01-01

3

Medical Decision Making and Medical Education: Challenges and Opportunities  

Microsoft Academic Search

:The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or

Alan Schwartz

2011-01-01

4

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

ERIC Educational Resources Information Center

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

Reyna, Valerie F.; Brainerd, Charles J.

2007-01-01

5

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

Microsoft Academic Search

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

Valerie F. Reyna; Charles J. Brainerd

2007-01-01

6

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

ERIC Educational Resources Information Center

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

Huyard, Caroline

2012-01-01

7

Supporting Medical Decisions with Vector Decision Trees  

Microsoft Academic Search

The article presents the extension of a common decision tree concept to a multidimensional - vector - decision tree constructed with the help of evolutionary techniques. In contrary to the common decision tree the vector decision tree can make more than just one suggestion per input sample. It has the functionality of many separate decision trees acting on a same

Peter Kokol; Norihiro Sakamoto

8

Uncertainty and Decisions in Medical Informatics1  

E-print Network

1 Uncertainty and Decisions in Medical Informatics1 Peter Szolovits, Ph.D. Laboratory for Computer critical decision. This paper surveys historical and contemporary approaches taken by medical informatics. Uncertainty and Decisions in Medical Informatics. Methods of Information in Medicine, 34:111­21, 1995 #12

Szolovits, Peter

9

Uncertainty and Decisions in Medical Informatics 1  

E-print Network

1 Uncertainty and Decisions in Medical Informatics 1 Peter Szolovits, Ph.D. Laboratory for Computer critical decision. This paper surveys historical and contemporary approaches taken by medical informatics. Uncertainty and Decisions in Medical Informatics. Methods of Information in Medicine, 34:111--21, 1995 #12; 2

Szolovits, Peter

10

Medical Decision-Making by Psychiatry Residents  

ERIC Educational Resources Information Center

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

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

2007-01-01

11

Supporting Medical Decision Making with Argumentation Tools  

ERIC Educational Resources Information Center

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

Lu, Jingyan; Lajoie, Susanne P.

2008-01-01

12

Who Should Make Medical Decisions for Incompetent Adults? A Critique of RCW 7.70.065  

Microsoft Academic Search

To show why the Revised Code of Washington (RCW) 7.70.065, Washington's medical decision-making statute should be rewritten, this Comment discusses: (1) the importance of autonomy and self-determination in medical decision-making; (2) the purpose of proxy medical decision-making statutes; (3) Washington's proxy *574 decision-making statute; and, (4) current family demographics. This Comment concludes by proposing a new medical decision-making statute for

Adrienne E. Quinn

1997-01-01

13

Polynomial-fuzzy decision tree structures for classifying medical data  

Microsoft Academic Search

Decision tree induction has been studied extensively in machine learning as a solution for classification problems. The way the linear decision trees partition the search space is found to be comprehensible and hence appealing to data modelers. Comprehensibility is an important aspect of models used in medical data mining as it determines model credibility and even acceptability. In the practical

Ernest Muthomi Mugambi; Andrew Hunter; Giles Oatley; Richard Lee Kennedy

2004-01-01

14

Identifying important concepts from medical documents  

Microsoft Academic Search

Automated medical concept recognition is important for medical informatics such as medical document retrieval and text mining research. In this paper, we present a software tool called keyphrase identification program (KIP) for identifying topical concepts from medical documents. KIP combines two functions: noun phrase extraction and keyphrase identification. The former automatically extracts noun phrases from medical literature as keyphrase candidates.

Quanzhi Li; Yi-fang Brook Wu

2006-01-01

15

Medical Decision-Making and Collaborative Reasoning  

Microsoft Academic Search

An overview is presented of different constraints in conventional medical decision-making for improving collaborative reasoning. When designing and implementing an effective assisted diagnoses system it is imperative to make a complete study of reasoning processes used by physicians every day. We are particularly interested in studying the process of conventional decision-making when, at the first stage, a physician faces a

J. M. Quintero; Antonio Aguilera; M. Abraham; H. Villegas; G. Montilla; Basel Solaiman

2001-01-01

16

[Kairos. Decision-making in medical ethics].  

PubMed

This paper assesses the decision making patterns in medical ethics: the formalized pattern of decision science, the meditative pattern of an art of judgement and lastly the still-to-be-elaborated pattern of kairology or sense of the right time. The ethical decision is to be thought out in the conditions of medical action while resorting to the philosophical concepts that shed light on the issue. And it is precisely where medicine and philosophy of human action meet that the Greek notion of kairos, or "propitious moment", evokes the critical point where decision has to do with what is vital. Reflection shows that this kairos can be thought out outside the sacrificial pattern (deciding comes down to killing a possibility) by understanding the opportune moment as a sign of ethical action, as the condition for the formation of the subject (making a decision) and finally as a new relationship to time, including in the context of medical urgency. Thus with an approach to clinical ethics centred on the relation to the individual, the focus is less on the probabilistic knowledge of the decidable than on the meaning of the decision, and the undecidable comes to be accepted as an infinite dimension going beyond the limits of our acts, which makes the contingency and the grandeur of human responsibility. PMID:25272798

Jousset, David

2014-06-01

17

Uncertainty and Decisions in Medical Informatics 1  

Microsoft Academic Search

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

Peter Szolovits

1995-01-01

18

Computer-Based Medical Decision Support System based on guidelines, clinical pathways and decision nodes.  

PubMed

A continuous and dynamic development of medical sciences which is currently taking place all over the world is associated with a considerable increase in the number of scientific reports and papers of importance in enhancing the effectiveness of treatment and quality of medical care. However, it is difficult, or, indeed, impossible, for physicians to regularly follow all recent innovations in medical knowledge and to apply the latest research findings to their daily clinical practice. More and more studies conducted both in Poland and worldwide as well as experience from clinical practice in various countries provide convincing evidence that various systems supporting medical decision-making by physicians or other medical professionals visibly improve the quality of medical care. The use of such systems is already possible and recently has been developing especially dynamically, as the level of knowledge and information and communication technology now permits their effective implementation. Currently, electronic knowledge bases, together with inference procedures, form intelligent medical information systems, which offer many possibilities for the support of medical decision-making, mainly in regard to interactive diagnostic work-up, but also the selection of the most suitable treatment plan (clinical pathway). Regardless of their scale and area of application, these systems are referred to as Computer-Based Medical Decision Support Systems (CBMDSS). PMID:22741924

Tomaszewski, Wies?aw

2012-01-01

19

Multimedia medical case retrieval using decision trees  

PubMed Central

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

Quellec, Gwenole; Lamard, Mathieu; Bekri, Lynda; Cazuguel, Guy; Cochener, Beatrice; Roux, Christian

2007-01-01

20

http://mdm.sagepub.com/ Medical Decision Making  

E-print Network

http://mdm.sagepub.com/ Medical Decision Making http://mdm.sagepub.com/content/16/4/386 The online://www.sagepublications.com On behalf of: Society for Medical Decision Making can be found at:Medical Decision MakingAdditional services://mdm.sagepub.com/subscriptionsSubscriptions: http://www.sagepub.com/journalsReprints.navReprints: http://www.sagepub.com/journals

Penny, Will

21

MEDICAL DECISION MAKING LIBRARY NUMERIC CATEGORIES 1 Teaching MDM  

E-print Network

MEDICAL DECISION MAKING LIBRARY · NUMERIC CATEGORIES 1 Teaching MDM 2 MDM by Computer 3 Medical Decision Making (general) 4 Clinical Decision Making "Rounds" · NEJM "CLinical Problem Solving" 5 Clinical Assessment · Shared Decision Making · Time Preference · Health Utilities 15 Risk 16 Conjoint Analysis 17

Ford, James

22

Incorporating patients' preferences into medical decision making.  

PubMed

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

Fraenkel, Liana

2013-02-01

23

Measurement Decision Risk - The Importance of Definitions  

NASA Technical Reports Server (NTRS)

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

Mimbs, Scott

2007-01-01

24

Medical factors influencing decision making regarding radiation therapy for breast cancer  

PubMed Central

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

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

2014-01-01

25

The collaborative autonomy model of medical decision-making.  

PubMed

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

Rubin, Michael A

2014-04-01

26

Medical Specialty Decision Model: Utilizing Social Cognitive Career Theory  

ERIC Educational Resources Information Center

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

Gibson, Denise D.; Borges, Nicole J.

2004-01-01

27

A semiotic approach to data in medical decision making  

Microsoft Academic Search

Computer-based support for medical decision making has been a subject of many research projects since the earliest days of computers. Although the early expert systems promised to automate medical diagnosis, very few systems were actually utilized in clinical settings. In the last twenty years, the intent to use computers to replace or simulate medical experts has changed to a less

M. Kwiatkowska; L. McMillan

2010-01-01

28

Incorporating risk attitude into Markov-process decision models: importance for individual decision making.  

PubMed

Most decision models published in the medical literature take a risk-neutral perspective. Under risk neutrality, the utility of a gamble is equivalent to its expected value and the marginal utility of living a given unit of time is the same regardless of when it occurs. Most patients, however, are not risk-neutral. Not only does risk aversion affect decision analyses when tradeoffs between short- and long-term survival are involved, it also affects the interpretation of time-tradeoff measures of health-state utility. The proportional time tradeoff under- or overestimates the disutility of an inferior health state, depending on whether the patient is risk-seeking or risk-averse (it is unbiased if the patient is risk-neutral). The authors review how risk attitude with respect to gambles for survival duration can be incorporated into decision models using the framework of risk-adjusted quality-adjusted life years (RA-QALYs). They present a simple extension of this framework that allows RA-QALYs to be calculated for Markov-process decision models. Using a previously published Markov-process model of surgical vs expectant treatment for benign prostatic hypertrophy (BPH), they show how attitude towards risk affects the expected number of QALYs calculated by the model. In this model, under risk neutrality, surgery was the preferred option. Under mild risk aversion, expectant treatment was the preferred option. Risk attitude is an important aspect of preferences that should be incorporated into decision models where one treatment option has upfront risks of morbidity or mortality. PMID:9219195

Cher, D J; Miyamoto, J; Lenert, L A

1997-01-01

29

Medication errors: the importance of safe dispensing  

PubMed Central

Although rates of dispensing errors are generally low, further improvements in pharmacy distribution systems are still important because pharmacies dispense such high volumes of medications that even a low error rate can translate into a large number of errors. From the perspective of pharmacy organization and quality assurance, pharmacists should intensify their checking of prescriptions, in order to reduce prescription errors, and should implement strategies to communicate adequately with patients, in order to prevent administration errors. More and better studies are still needed in these areas. More research is also required into: dispensing errors in out-patient health-care settings, such as community pharmacies in the USA and Europe; dispensing errors in hospitals and out-patient health-care settings in middle- and low-income countries; and the underlying causes of dispensing errors. PMID:19594537

Cheung, Ka-Chun; Bouvy, Marcel L; De Smet, Peter A G M

2009-01-01

30

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 ...

31

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

PubMed Central

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

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

32

Design of a goal ontology for medical decision-support  

E-print Network

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 ...

Zaccagnini, Davide

2005-01-01

33

Medical malpractice: a case study in medical and legal decision making.  

PubMed

The conference was organized in part to dispel some of the misinformation that interferes with cooperative efforts of attorneys and physicians to redress the malpractice situation. During discussion of the hypothetical case, participants identified how medical decision-making responsibilities were allocated among health care providers caring for the patient. Panel members suggested ways in which medical decision making might be affected by non-medical factors such as third-party reimbursement (e.g., selection of inpatient or outpatient setting, the opportunity to discuss issues related to informed consent prior to the day of a procedure) and potential malpractice litigation (e.g., documentation in charts, use of diagnostic procedures). The characterization of decision-making roles and responsibilities differed somewhat for purposes of malpractice litigation; that is, which caregivers might be named as defendants. Panel members reconstructed the development of the medical incident into a legal case. Plaintiff's attorney commented that it is often a hospital employee who advises the family to consult an attorney and described some of the constraints on information gathering (e.g., the rule of "discovery" requiring that suit be filed before defendants can be forced to give statements about what happened, insurance contract provisions prohibiting physicians from talking without legal counsel present to persons who indicate that they plan to file suit). He also briefly explained the rationale for the contingency fee arrangement in these cases. Describing the role of the medical expert witness and the need to review the medical record, he outlined the process of deciding whether to pursue a malpractice case. In making this decision, plaintiff's attorney evaluates the facts to identify issues in the case, to determine if there are deviations from the standard of care, and to try to predict jury reaction. If a suit is filed, defense attorneys employed by the hospital, insurance company, or individual defendants will decide, based on facts including coverage limits, possible publicity, and likelihood of successful prosecution, whether the case should be settled and for what amount. Interests represented by the defense attorneys differ and may affect settlement strategies. Physician feelings of concern for the patient/family or desire for vindication will, to varying degrees, be factors in the decision to try or settle a case. Panel members explored several important policy issues. Among these were the effect of malpractice cases on doctor-patient communications and ethical issues concerning expert witnesses.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2728499

Piccirillo, M; Graf, G J

1989-01-01

34

African American Patients' Perspectives on Medical Decision Making  

Microsoft Academic Search

Background: The medical literature offers little infor- mationabouthowolderAfricanAmericansviewthemedi- cal decision-making process. We sought to describe the perspectives of older African American patients in a pri- mary care clinic as they consider a medical decision. Methods: We interviewed 25 African American pa- tientsolderthan50yearswhohaddiscussedflexiblesig- moidoscopy with their primary care provider. Inter- views were analyzed using qualitative methods. Results:Patientslistedconcernsaboutcancerandhealth, risks and benefits, their

Alexia M. Torke; Giselle M. Corbie-Smith; William T. Branch

2004-01-01

35

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

PubMed

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

Blau, Gary; Chapman, Susan

2011-01-01

36

Molecular diagnostics of medically important bacterial infections.  

PubMed

Infectious diseases are common diseases all over the world. A recent World Health Organization report indicated that infectious diseases are now the world's biggest killer of children and young adults. Infectious diseases in non-industrialized countries caused 45% in all and 63% of death in early childhood. In developed countries, the emergence of new, rare or already-forgotten infectious diseases, such as HIV/AIDS, Lyme disease and tuberculosis, has stimulated public interest and inspired commitments to surveillance and control. Recently, it is reported that infectious diseases are responsible for more than 17 million deaths worldwide each year, most of which are associated with bacterial infections. Hence, the control of infectious diseases control is still an important task in the world. The ability to control such bacterial infections is largely dependent on the ability to detect these aetiological agents in the clinical microbiology laboratory. Diagnostic medical bacteriology consists of two main components namely identification and typing. Molecular biology has the potential to revolutionise the way in which diagnostic tests are delivered in order to optimise care of the infected patient, whether they occur in hospital or in the community. Since the discovery of PCR in the late 1980s, there has been an enormous amount of research performed which has enabled the introduction of molecular tests to several areas of routine clinical microbiology. Molecular biology techniques continue to evolve rapidly, so it has been problematic for many laboratories to decide upon which test to introduce before that technology becomes outdated. However the vast majority of diagnostic clinical bacteriology laboratories do not currently employ any form of molecular diagnostics but the use such technology is becoming more widespread in both specialized regional laboratories as well as in national reference laboratories. Presently molecular biology offers a wide repertoire of techniques and permutations of these analytical tools, hence this article wishes to explore the application of these in the diagnostic laboratory setting. PMID:17263144

Millar, Beverley Cherie; Xu, Jiru; Moore, John Edmund

2007-01-01

37

Medical Decision Making in Clinical Care: Avoiding Common Errors  

E-print Network

4/8/13 1 Medical Decision Making in Clinical Care: Avoiding Common Errors Misbah Keen, MD, MBI, MPH S2 - S23 #12;4/8/13 3 Heuristics · Heuristics are mental processes which we use every day in medical to mind. Availability Error ì Examples of Availability Error in Clinical SeCngs ì

Maxwell, Bruce D.

38

Toward understanding consumers' role in medical decisions for emerging treatments  

Microsoft Academic Search

This study utilizes consumers' perspective to examine emerging treatments—those based on genetic technology and aimed at improving the quality (rather than quantity) of life—on medical decision making. We discuss market, medical, social and consumer issues that are germane to such emerging treatments in the context of growth hormone therapy for short children. Drawing from this discussion and past literature, a

Jagdip Singh; Leona Cuttler; J. B Silvers

2004-01-01

39

Computerized system for medical decision in the perinatal period  

Microsoft Academic Search

The paper presents the motivations for the implementation of a computerized system operating in the field of medical decision, aimed at the reduction of the medical errors and the improvement of health status of the pregnant women and newborn babies. The proposed system is going to be available as an Internet accessible platform that will monitor the health status of

R. Antohi; C. Ogescu; F. Udrescu; M. Onofriescu; D. Bistriceanu; L. Stefan; S. Dumitru

2010-01-01

40

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

NASA Technical Reports Server (NTRS)

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

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

2009-01-01

41

Editorials and Commentary Shared Medical Decision Making A New Tool for Preventive Medicine  

E-print Network

The development of methods for shared medical decision-making is recognized by many groups as an important priority. 1–7 A search of PUBMED under the heading of “shared decision ” now produces about 100 hits per year. This issue of the Journal includes two important reports evaluating the potential of shared decision-making in preventive medicine. Sheridan et al. 8 offer a commentary on the relationship between shared decision-making and recommendations offered by the United States Preventive Services Task Force (USPSTF). Briss et al., 9 representing the Task Force on Community Preventive Services, reviewed shared decision-making and informed decision-making in relation to cancer screening. Both papers

Robert M. Kaplan

42

Patient decision making in the face of conflicting medication information  

PubMed Central

When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources. PMID:22943889

Elstad, Emily; Carpenter, Delesha M.; Devellis, Robert F.

2012-01-01

43

Patient decision making in the face of conflicting medication information.  

PubMed

When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources. PMID:22943889

Elstad, Emily; Carpenter, Delesha M; Devellis, Robert F; Blalock, Susan J

2012-01-01

44

Feature importance analysis for patient management decisions Michal Valkoa  

E-print Network

Systems, Clinical [L01.700.508.300.190] Decision Support Techniques [E05.245] Evidence-Based Medicine [H02 is to understand what characteris- tics and features of clinical data influence physician's deci- sion about such data. Inevitably we ask what types of features are the most important to represent the patient case

Paris-Sud XI, Université de

45

Planning Medical Therapy Using Partially Observable Markov Decision Milos Hauskrecht  

E-print Network

of patients with ischemic heart disease. 1 Introduction The diagnosis of a disease and its treatment of a pa­ tient. An example of such a problem is the management of patients with ischemic heart diseasePlanning Medical Therapy Using Partially Observable Markov Decision Processes. Milos Hauskrecht

Hauskrecht, Milos

46

How Numeracy Influences Risk Comprehension and Medical Decision Making  

PubMed Central

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

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

2009-01-01

47

A reinforcement learning approach to obtain treatment strategies in sequential medical decision problems  

Microsoft Academic Search

Medical decision problems are extremely complex owing to their dynamic nature, large number of variable factors, and the associated uncertainty. Decision support technology entered the medical field long after other areas such as the airline industry and the manufacturing industry. Yet, it is rapidly becoming an indispensable tool in medical decision making problems including the class of sequential decision problems.

Radhika Poolla

2003-01-01

48

The Ninth Circuit's Loughner decision neglected medically appropriate treatment.  

PubMed

In a previous issue of The Journal, I anticipated the decision of the Ninth Circuit in United States v. Loughner. The Ninth Circuit's opinion upheld the involuntary medication of Mr. Loughner under a Harper order, with awareness that he could thereby gain trial competence, and it allowed Mr. Loughner's extended commitment to Federal Medical Center (FMC)-Springfield for the purpose of rendering him trial competent. As also anticipated in that article, the Ninth Circuit did not comment on the medical appropriateness of the setting for involuntary medication of pretrial defendants or its own court order permitting the involuntary medication of Mr. Loughner in a nonmedical correctional facility. In this article, the Ninth Circuit's opinion is analyzed with respect to its potential effect on the medical appropriateness of the setting, medical versus nonmedical, for involuntary medication with antipsychotic agents of pretrial defendants. Although the likelihood of Supreme Court review of the Loughner case has been made nil by his guilty plea, this case raises an unresolved constitutional point as well as the question of whether involuntary medical treatment should be administered in a setting that is appropriate for such treatment. PMID:23503184

Felthous, Alan R

2013-01-01

49

Dual processing model of medical decision-making  

PubMed Central

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

2012-01-01

50

Human-Computer Interaction with Medical Decisions Support Systems  

NASA Technical Reports Server (NTRS)

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

Adolf, Jurine A.; Holden, Kritina L.

1994-01-01

51

Intuitionistic fuzzy cognitive maps for medical decision making.  

PubMed

Medical decision making can be regarded as a process, combining both analytical cognition and intuition. It involves reasoning within complex causal models of multiple concepts, usually described by uncertain, imprecise, and/or incomplete information. Aiming to model medical decision making, we propose a novel approach based on cognitive maps and intuitionistic fuzzy logic. The new model, called intuitionistic fuzzy cognitive map (iFCM), extends the existing fuzzy cognitive map (FCM) by considering the expert's hesitancy in the determination of the causal relations between the concepts of a domain. Furthermore, a modification in the formulation of the new model makes it even less sensitive than the original model to missing input data. To validate its effectiveness, an iFCM with 34 concepts representing fuzzy, linguistically expressed patient-specific data, symptoms, and multimodal measurements was constructed for pneumonia severity assessment. The results obtained reveal its comparative advantage over the respective FCM model by providing decisions that match better with the ones made by the experts. The generality of the proposed approach suggests its suitability for a variety of medical decision-making tasks. PMID:21095874

Iakovidis, Dimitris K; Papageorgiou, Elpiniki

2011-01-01

52

Virtual medical record implementation for enhancing clinical decision support.  

PubMed

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

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

2012-01-01

53

The Importance of Teacher Involvement in Medication Therapy  

ERIC Educational Resources Information Center

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

Ryan, Joseph B.; Katsiyannis, Antonis

2009-01-01

54

Computer-assisted medical decision making: A critical review  

Microsoft Academic Search

This paper presents an overview of the concepts underlying computer-assisted medical decision-making (CMD) systems. Alternative\\u000a approaches to constructing CMD systems are reviewed, including “conventional programming techniques,” statistical pattern\\u000a classification, rule-based deduction, modelling of diagnostic reasoning, and data base comparisons. Each of these methods\\u000a is illustrated with examples taken from pulmonary medicine. Although much progress has been made over the last

James A. Reggia

1981-01-01

55

Is expected utility theory normative for medical decision making?  

PubMed

Expected utility theory is felt by its proponents to be a normative theory of decision making under uncertainty. The theory starts with some simple axioms that are held to be rules that any rational person would follow. It can be shown that if one adheres to these axioms, a numerical quantity, generally referred to as utility, can be assigned to each possible outcome, with the preferred course of action being that which has the highest expected utility. One of these axioms, the independence principle, is controversial, and is frequently violated in experimental situations. Proponents of the theory hold that these violations are irrational. The independence principle is simply an axiom dictating consistency among preferences, in that it dictates that a rational agent should hold a specified preference given another stated preference. When applied to preferences between lotteries, the independence principle can be demonstrated to be a rule that is followed only when preferences are formed in a particular way. The logic of expected utility theory is that this demonstration proves that preferences should be formed in this way. An alternative interpretation is that this demonstrates that the independence principle is not a valid general rule of consistency, but in particular, is a rule that must be followed if one is to consistently apply the decision rule "choose the lottery that has the highest expected utility." This decision rule must be justified on its own terms as a valid rule of rationality by demonstration that violation would lead to decisions that conflict with the decision maker's goals. This rule does not appear to be suitable for medical decisions because often these are one-time decisions in which expectation, a long-run property of a random variable, would not seem to be applicable. This is particularly true for those decisions involving a non-trivial risk of death. PMID:8717589

Cohen, B J

1996-01-01

56

Dangerous snakes, deadly snakes and medically important snakes  

PubMed Central

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

2013-01-01

57

Bayesian Networks in Medicine: a Model-based Approach to Medical Decision Making  

E-print Network

Bayesian Networks in Medicine: a Model-based Approach to Medical Decision Making Peter Lucas of medical decision making started in the 1990s. The formalism possesses the unique quality of being both are discussed from the viewpoint of their use in medical decision making, in partic- ular diagnosis, (prognostic

Lucas, Peter

58

[Necessity of clinical decision support system created by medical staff].  

PubMed

To support patient safety, we have established a new system that collates medical facility clinical records, examination results and orders, and implementation information comprehensively in real time, checks for consistency and validity, and sends warnings to the appropriate people at the appropriate time. Because our system actually corrects inaccurate operation information, it is different from most existing facilities for patient safety in that it reconstructs information independently from the HIS (Hospital Information System). We were permitted to send warning messages not only to the doctor who entered the orders, but also to the chief of medical staff and team members. For the warning method, we tried screen flashes and chimes, mobile phone messages, and high quality interactive voice responses. We also investigated the degree of message usefulness. Therein, by not relying on "authenticity" and "readability," but by exhaustively collecting and appropriately revising in alignment with the use of information, we have created an original system that collects accurate information. This original system was established by medical staff members. The appropriate revisions mentioned herein are items which meticulously reflect the medical professional's comments and selected operation and signify why a "Clinical Decision Support System created by medical staff" is necessary. PMID:21706869

Yamamoto, Yasuhito

2011-05-01

59

Deficiency areas in decision making in undergraduate medical students  

PubMed Central

Background In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problem-solving skills, and a comprehensive and holistic approach to be taught to medical students. Purpose The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students. Materials and methods This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students’ written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale. Results The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement. Conclusion Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students’ performance should be further evaluated. PMID:25053897

Klemenc-Ketis, Zalika; Kersnik, Janko

2014-01-01

60

Decision support in medical practice: a physician's perspective  

NASA Astrophysics Data System (ADS)

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

Shieh, Yao-Yang; Roberson, Glenn H.

1998-03-01

61

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

E-print Network

in treatment decisions can prepare youth for making their own decisions as adults, can be therapeutic, and can have positive effects on their self-confidence and self-esteem. still, the complex youth–family–provider dynamic raises important issues that need..., and can have positive effects on their self-confidence and self-esteem (Butz et al., 2007; Costello, 2003; Tates et al., 2002). how- ever, more research is needed in order to adequately design a SDM model for youth mental health medication treatment...

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

2010-01-01

62

Changes in Medical Students’ Attitudes Towards End-of-Life Decisions Across Different Years of Medical Training  

Microsoft Academic Search

BACKGROUND  Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors\\u000a must face. Few studies have evaluated the impact of medical training on medical students’ attitudes towards end-of-life decisions\\u000a and none have compared them with an age-matched group of non-medical students.\\u000a \\u000a \\u000a \\u000a OBJECTIVE  To assess the effect of medical education on medical students’ attitudes towards end-of-life

Pascale C. Gruber; Charles D. Gomersall; Gavin M. Joynt; Anna Lee; Pui Yin Grace Tang; Adelina Shuan Young; Nga Yui Florrie Yu; Oi Ting Yu

2008-01-01

63

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

Microsoft Academic Search

Background: Surrogates make all medical decisions for persons with advanced dementia. This study describes the types of medical decisions that surrogates faced prior to the person's death and their perceived difficulty and satisfaction with those decisions. Methods: Seventy-six surrogates of nursing home residents meeting hospice criteria for dementia were followed longitudinally and interviewed following the death of the person with

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

2011-01-01

64

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

E-print Network

Decision-making methods that could be used to assess the value of medical devices P1 D3 V1.2 050331, indicating the need for better decision making tools that can be applied to the medical device new product product subsequently fails to sell adequately. Managers therefore need robust decision- making tools

Oakley, Jeremy

65

Comparing Methods for Multi-class Probabilities in Medical Decision Making Using  

E-print Network

Comparing Methods for Multi-class Probabilities in Medical Decision Making Using LS-SVMs and Kernel-and-white class predictions. In medical decision making, uncertainty information can influence the optimal, University of Sydney, Sydney, Australia 3 St Georges Hospital Medical School, London, UK 4 University

66

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

PubMed

We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS. PMID:8563259

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

1995-01-01

67

Performance evaluation of the machine learning algorithms used in inference mechanism of a medical decision support system.  

PubMed

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

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

2014-01-01

68

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

PubMed Central

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

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

2014-01-01

69

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

E-print Network

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

Shneiderman, Ben

70

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

E-print Network

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

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

71

Recovery of medically important microorganisms from Apollo astronauts  

NASA Technical Reports Server (NTRS)

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

Taylor, G. R.

1974-01-01

72

Running Head: Emerging cognitive paradigms in medical decision making Corresponding author:  

E-print Network

The limitations of the classical or traditional paradigm of decision research are increasingly apparent even though there has been a substantial body of empirical research on medical decision making over the past 40 years. As decision-support technology continues to proliferate in medical settings, it is imperative that “basic science ” decision research develop a broader-based and more valid foundation for the study of medical decision making as it occurs in the natural setting. This paper critically reviews both traditional and recent approaches to medical decision making, considering the integration of problem-solving and decision-making research paradigms, the role of conceptual knowledge in decision making, and the emerging paradigm of naturalistic decision making. We also provide an examination of technology-mediated decision making. Expanding the scope of decision research will better enable us to understand optimal decision processes, suitable coping mechanisms under suboptimal conditions, the development of expertise in decision making, and ways in which decision-support technology can successfully mediate decision processes.- 2-Patel, Kaufman, and Arocha July 2002

Vimla L. Patel; David R. Kaufman; Jose F. Arocha; Vimla L. Patel, Ph.D.

73

Adolescent Pregnancy Decision-Making: Are Parents Important?  

ERIC Educational Resources Information Center

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

Rosen, Raye Hudson

1980-01-01

74

Integrating Deep Biomedical Models into Medical Decision Support Systems: An Interval Constraint Approach  

Microsoft Academic Search

Knowledge representation has always been a major problem in the design of medical decision support systems. In this paper we present a new methodology to represent and reason about medical knowledge, based on the declarative specification of interval constraints over the medical concepts. This allows the integration of deep medical models involving differential equations developed in biomedical research (typical in

Jorge Cruz; Pedro Barahona; Frédéric Benhamou

1999-01-01

75

A Theory of Medical Decision Making and Health: Fuzzy Trace Theory  

PubMed Central

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

Reyna, Valerie F.

2008-01-01

76

Providing medical marijuana: the importance of cannabis clubs.  

PubMed

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 ascertain how they had benefited from the use of medical marijuana and how they had utilized the clubs. Interviews were augmented by participant observation techniques. Respondents reported highly positive health benefits from marijuana itself, and underscored even greater benefits from the social aspects of the clubs, which they described as providing important emotional supports. As such, cannabis clubs serve as crucial support mechanisms/groups for people with a wide variety of serious illnesses and conditions. The authors concluded that of the various methods so far proposed, the cannabis clubs afford the best therapeutic setting for providing medical cannabis and for offering a healing environment composed of like-minded, sympathetic friends. PMID:9692380

Feldman, H W; Mandel, J

1998-01-01

77

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

PubMed Central

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

Miller, R A

1994-01-01

78

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

PubMed Central

Background Comparative effectiveness research (CER) documents important differences in antidepressants in terms of efficacy, safety, cost, and burden to the patient. Decision aids can adapt this evidence to help patients participate in making informed choices. In turn, antidepressant therapy will more likely reflect patients’ values and context, leading to improved adherence and mood outcomes. Methods/Design The objective of this study is to develop the Depression Medication Choice decision aid for use during primary care encounters, and to test its efficacy by conducting a clustered practical randomized trial comparing the decision aid to usual depression care in primary care practices. We will use a novel practice-based, patient-centered approach based on participatory action research that involves a multidisciplinary team of designers, investigators, clinicians, patient representatives, and other stakeholders for the development of the decision aid. We will then conduct a clustered practical randomized trial enrolling clinicians and their patients (n = 300) with moderate to severe depression from rural, suburban and inner city primary care practices (n = 10). The intervention will consist of the use of the depression medication choice decision aid during the clinical encounter. This trial will generate preliminary evidence of the relative impact of the decision aid on patient involvement in decision making, decision making quality, patient knowledge, and 6-month measures of medication adherence and mental health compared to usual depression care. Discussion Upon completion of the proposed research, we will have developed and evaluated the efficacy of the decision aid depression medication choice as a novel translational tool for CER in depression treatment, engaged patients with depression in their care, and refined the process by which we conduct practice-based trials with limited research footprint. Trial registration Clinical Trials.gov: NCT01502891 PMID:23782672

2013-01-01

79

Efficient Argumentation for Medical Decision-Making Robert Craven and Francesca Toni and Cristian Cadar and Adrian Hadad  

E-print Network

Efficient Argumentation for Medical Decision-Making Robert Craven and Francesca Toni and Cristian Introduction Some forms of decision-making (e.g., medical diagnosis and treatment) require decision and have a tangible impact and substantial practical benefits on medical decision-making, an efficient

Cadar, Cristian

80

DNA fingerprinting of medically important microorganisms by use of PCR.  

PubMed Central

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

van Belkum, A

1994-01-01

81

Supporting medical decision in telecardiology: a patient-centered ontology-based approach  

E-print Network

physicians with alert potential severity by taking into account the patient clinical context. Fig 1 : Patient-centeredSupporting medical decision in telecardiology: a patient-centered ontology-based approach Anita records and support patient-centered medical decision in telecardiology by integrating information trans

Zweigenbaum, Pierre

82

Explanations for side effect aversion in preventive medical treatment decisions  

PubMed Central

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 “side effect aversion.” One was derived from mental accounting, one examined the mere presence of a side effect, and one focused on computational difficulties. Design Participants (N = 5,379) were presented with a hypothetical cancer preventive treatment situation that was or was not accompanied by one or two small side effects. The side effects were either beneficial or harmful. In all conditions the net absolute risk reduction associated with the treatment was 15%. Main Outcome Measures Participants indicated their willingness to accept treatment and their perceptions of the treatment’s effects on their overall cancer risk. Results Data were consistent only with the “mere presence” explanation of side effect aversion, the idea that side effects act as a strong negative cue that directly affects treatment appraisal. The number of negative side effects did not influence treatment willingness. Conclusion Side effect aversion is a challenge to informed decision making. Specific mechanisms that produce side effect aversion should be identified. PMID:19290712

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

2008-01-01

83

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

E-print Network

A Method for Analysis of Expert Committee Decision-Making Applied to FDA Medical Device Panels Systems Division Education Committee #12;2 A Method for Analysis of Expert Committee Decision-Making in Technology, Management, and Policy ABSTRACT Committees of experts are critical for decision-making

de Weck, Olivier L.

84

Design and implementation of a multicriteria medical decision support system for diagnosis and treatment  

Microsoft Academic Search

Health care providers face the problem of trying to make decisions with inadequate information and also with an overload of (often contradictory) information. Physicians often choose treatment long before they know which disease is present. Indeed, uncertainty is intrinsic to the practice of medicine. Decision analysis can help physicians structure and work through a medical decision problem, and can provide

Dorothy Lee Stowers

1999-01-01

85

Physician Evaluation after Medical Errors: Does Having a Computer Decision Aid Help or Hurt in Hindsight?  

Microsoft Academic Search

Objective. The authors examined whether physicians' use of computerized decision aids affects patient satisfaction and\\/ or blame for medical outcomes. Method. Experiment 1: Fifty- nine undergraduates read about a doctor who made either a correct or incorrect diagnosis and either used a decision aid or did not. All rated the quality of the doctor's decision and the likelihood of recommending

Mark V. Pezzo; Stephanie P. Pezzo

2006-01-01

86

Experience and Medical Decision-Making in Outdoor Leaders  

ERIC Educational Resources Information Center

Outdoor leaders function in naturalistic decision-making contexts and may be influenced by personal, social, and environmental factors in making critical decisions in the field. The experience level of the outdoor instructor is posited as a critical variable in the development of his/her decision-making and overall judgment. This research measures…

Galloway, Shayne

2007-01-01

87

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

Microsoft Academic Search

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

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

1994-01-01

88

Age rationing for renal transplantation? The role of age in decisions regarding scarce life extending medical resources.  

PubMed

The use of age as a selection criterion for scarce life extending medical resources is justified by some theorists and rejected by others. Qualitative research was conducted into age rationing in daily medical practice. Observations were made at two renal transplantation centres and people professionally involved in decision making about transplantation were interviewed. Age appeared to be an important factor in indication decisions concerning individual patients, because it is associated in several ways with both the risks and benefits of transplantation that are weighed against each other. This happens apart from scarcity of donor organs. However, age also appeared to be used as a selection criterion, though apparently to a slight degree. This happens in a covert, implicit way. This is possible because all the aspects of age that are important in indication decisions regarding individual patients may also be used as comparative selection criteria. PMID:9683385

Varekamp, I; Krol, L J; Danse, J A

1998-07-01

89

Perceived Importance of Ethics and Ethical Decisions in Marketing  

Microsoft Academic Search

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

Anusorn Singhapakdi

1999-01-01

90

[Toxicity of venoms from snakes of medical importance in México].  

PubMed

The characterization of the toxic activities of snake venoms is necessary to understand the physiopathology of the envenomation and to test the potency of the antivenoms used to treat this pathology. Because of the lack of data on the toxic activities of venoms from Mexican snakes of medical importance, we studied the venoms from Bothrops asper, Athropoides nummifrr, Agkistrodon billineatus, Crotalus durissus durissus, Crotalus basiliscus, Crotalus scutulatus, Crotalus atrox and Micrurus nigrocinctus. The studies performed were: SDS-PAOE, determination of lethal potency, hemorrhagic, necrotizing, coagulation on plasma and fibrinogen, phospholipasic and fibri(noge)nolytic activities. In addition we studied the neutralizing capacity of the toxic activities of an antivenom currently used for the treatment of snakebites in Mexico. The venom from viperids showed important hemorrhagic, necrotizing, coagulative on plasma, prothrombinic, fibrinogenolytic and phospholipase activities. The venoms with the highest lethal potency were those of Micrurus nigrocinctus and Crotalus scutulatus; however, the viperine venom that globally displayed the most potent toxic activities was from Bothrops asper. All the venoms showed toxic activities of similar range to those described for other American venomous snakes. The activity on plasma or fibrinogen varied widely among the different venoms but all displayed capacity to act on the coagulation system. The antivenom tested not only neutralized the lethality B. asper venom but also its other toxic activities. PMID:15754746

de Roodt, Adolfo R; Estévez-Ramírez, Judith; Paniagua-Solís, Jorge F; Litwin, Silvana; Carvajal-Saucedo, Alejandro; Dolab, Jorge A; Robles-Ortiz, Luis E; Alagón, Alejandro

2005-01-01

91

Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others  

Microsoft Academic Search

BACKGROUND  A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation\\u000a and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have\\u000a had little training in working effectively with surrogates.\\u000a \\u000a \\u000a \\u000a OBJECTIVES  To better understand the challenges of decision-making from the surrogate’s perspective.\\u000a \\u000a \\u000a \\u000a DESIGN  Semistructured telephone interview study of

Elizabeth K. Vig; Helene Starks; Janelle S. Taylor; Elizabeth K. Hopley; Kelly Fryer-Edwards

2007-01-01

92

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

Microsoft Academic Search

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

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

2007-01-01

93

Making Decisions about Cancer Prevention Medications for Breast Cancer  

Cancer.gov

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

94

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

ERIC Educational Resources Information Center

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

Jackson, Simon A.; Kleitman, Sabina

2014-01-01

95

A Decision-Making Approach to Needs Assessment and Objective Setting in Continuing Medical Education.  

ERIC Educational Resources Information Center

Develops a general model of needs assessment, objective setting, and program development processes in continuing medical education (CME). Examines the coordinative, administrative, and consultative behaviors of CME program planners in their role as facilitators of decision making. (Author/SK)

Mazmanian, Paul E.

1980-01-01

96

http://mdm.sagepub.com/ Medical Decision Making  

E-print Network

to form the core components of their decision analyses.1 Markov transition models are typically based on 3. Simulated, cost-free interventions in the rate of progression of AD indicated that large poten- tial cost

97

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

Microsoft Academic Search

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

Valerie F. Reyna

2009-01-01

98

Evaluation of Psychological Factors in Medical School Admissions Decisions.  

ERIC Educational Resources Information Center

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

Jones, Bonnie J.; Borges, Nicole J.

99

Do Continuing Medical Education Articles Foster Shared Decision Making?  

ERIC Educational Resources Information Center

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

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

2010-01-01

100

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

ERIC Educational Resources Information Center

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

Goodnough, Lawrence T.; And Others

1992-01-01

101

Dynamic Decision Making in Stochastic Partially Observable Medical Domains: Ischemic Heart Disease  

E-print Network

Dynamic Decision Making in Stochastic Partially Observable Medical Domains: Ischemic Heart Disease of the patient with chronic ischemic heart disease. Introduction Dynamic decision problems in medicine usually of diabetes [5] or chronic heart disease [6]. The assumption of perfect observability may not work well

Hauskrecht, Milos

102

Reliability analysis framework for computer-assisted medical decision systems  

SciTech Connect

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

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

2007-02-15

103

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

ERIC Educational Resources Information Center

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

Garcia-Retamero, Rocio; Galesic, Mirta

2012-01-01

104

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

PubMed Central

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

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

2013-01-01

105

Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences  

Microsoft Academic Search

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.

Clive Seale; Robert Chaplin; Paul Lelliott; Alan Quirk

2006-01-01

106

550 MEDICAL DECISION MAKING/SEPOCT 2006 The authors discuss techniques for Monte Carlo (MC)  

E-print Network

in industrial engineering and operations research models, but they are seldom used in medical models. However length with fewer replications). VRTs have a rich history in the com- puter science and operations550 · MEDICAL DECISION MAKING/SEP­OCT 2006 The authors discuss techniques for Monte Carlo (MC

Schaefer, Andrew

107

Feature importance analysis for patient management decisions Michal Valkoa and Milos Hauskrechta  

E-print Network

01.700.508.300.190] Decision Support Techniques [E05.245] Evidence-Based Medicine [H02 is to understand what characteristics and features of clinical data influence physician's decision about ordering such data. Inevitably we ask what types of features are the most important to represent the patient case

Hauskrecht, Milos

108

Life-history decisions under predation risk: Importance of a game perspective  

E-print Network

substantially dierent results in the four dierent scenarios and suggest a decision tree by which biologicalLife-history decisions under predation risk: Importance of a game perspective AMOS BOUSKILA to be environmental. A genetic algorithm is used to search for optimal solutions to the scenarios. We ®nd

Bouskila, Amos

109

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

PubMed

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

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

2004-10-01

110

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

Microsoft Academic Search

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

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

2007-01-01

111

Medical end-of-life decisions in Norway  

Microsoft Academic Search

Aim: Previous studies indicate that Norwegian physicians hold conservative attitudes towards ethically controversial end-of-life decisions. The present study was undertaken to explore whether in Norway euthanasia may be hidden under labels such as death after analgesic injections and withholding or withdrawing treatment. Methods: A postal questionnaire containing 76 questions on ethical, collegial and professional autonomy issues was sent to a

Reidun Førde; Olaf G. Aasland; Petter Andreas Steen

2002-01-01

112

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

Microsoft Academic Search

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

Pierr Le Coz; Sebastien Tassy

2007-01-01

113

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

PubMed Central

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

2014-01-01

114

[Decision-making processes and medical care at the end of life].  

PubMed

The Federal Authority, the Ministry of Public Health and Environment, charged the Ghent University and the Brussels Free University to produce a continuous recording tool of data's concerning the decision-making processes and the medical care at the end of life, after defining the present state of the art. This tool is built up from a glossary and a questionnaire made up of closed questions with a prospective part and a retrospective part, and leaving the possibility of comments. This questionnaire, first submit to experts and two ethic committees, was sent anonymously to a broad sample of doctors of which 193 answered. This study brings out important information on the application of the laws on palliative care, on the rights of the patient and on euthanasia; it would be advisable to organise in the future a further systematic recording of the end of life conditions throughout a standardized questionnaire whose first version is presented here. PMID:17091893

Abbadie, B; Roland, M; Cosyns, M; Mainil, T; Deveugele, M; De Maeseneer, J

2006-09-01

115

Evidence-based medicine, medical decision analysis, and pathology  

Microsoft Academic Search

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

Alberto M. Marchevsky; Mark R. Wick

2004-01-01

116

How Numeracy Influences Risk Comprehension and Medical Decision Making  

ERIC Educational Resources Information Center

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

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

2009-01-01

117

Racial-Ethnic Biases, Time Pressure, and Medical Decisions  

ERIC Educational Resources Information Center

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

Stepanikova, Irena

2012-01-01

118

Providing Medical Marijuana: The Importance of Cannabis Clubs  

Microsoft Academic Search

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

Harvey W. Feldman; Jerry Mandel

1998-01-01

119

Watchfully waiting: medical intervention as an optimal investment decision.  

PubMed

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

Meyer, Elisabeth; Rees, Ray

2012-03-01

120

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

PubMed Central

Background The role of patient race in medical decision-making is heavily debated. While some evidence suggests that patient race can be used by physicians to predict disease risk and determine drug therapy, other studies document bias and stereotyping by physicians based on patient race. It is critical, then, to explore physicians' attitudes regarding the medical relevance of patient race. Methods We conducted a qualitative study in the United States using ten focus groups of physicians stratified by self-identified race (black or white) and led by race-concordant moderators. Physicians were presented with a medical vignette about a patient (whose race was unknown) with Type 2 diabetes and untreated hypertension, who was also a current smoker. Participants were first asked to discuss what medical information they would need to treat the patient. Then physicians were asked to explicitly discuss the importance of race to the hypothetical patient's treatment. To identify common themes, codes, key words and physician demographics were compiled into a comprehensive table that allowed for examination of similarities and differences by physician race. Common themes were identified using the software package NVivo (QSR International, v7). Results Forty self-identified black and 50 self-identified white physicians participated in the study. All physicians - regardless of their own race - believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race. Several black physicians indicated that patient race is a central factor for choosing treatment options such as aggressive therapies, patient medication and understanding disease risk. Moreover, many black physicians considered patient race important to understand the patient's views, such as alternative medicine preferences and cultural beliefs about illness. However, few white physicians explicitly indicated that the patient's race was important over-and-above medical history. Instead, white physicians reported that the patient should be treated aggressively regardless of race. Conclusions This investigation adds to our understanding about how physicians in the United States consider race when treating patients, and sheds light on issues physicians face when deciding the importance of race in medical decision-making. PMID:21819597

2011-01-01

121

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

PubMed Central

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

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

2010-01-01

122

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

PubMed

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

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

2013-12-01

123

Designing a Decision-Making System for Exceptional Events: the Case of Medical Disaster Mutual Aid  

E-print Network

Service enterprise engineering often involves designing systems that perform routine decision-making, as in business processes. However, exceptional events, which require effective decision-making to coordinate the response, are not routine. This paper presents a systematic, scenario-based methodology for designing a decisionmaking system in which decision-makers collect information about an exceptional event and authorize necessary actions. The approach is based on the operational procedure methodology that has been used for developing avionics systems. The paper discusses an application to the case of medical disaster mutual aid, in which multiple hospitals must coordinate activities to respond to a mass casualty incident.

Jeffrey W. Herrmann; Alpa Kothari; Sana Shaikh

124

Medically important arboviruses of the United States and Canada.  

PubMed Central

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

Calisher, C H

1994-01-01

125

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

ERIC Educational Resources Information Center

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

Nieman, Linda Z.; And Others

1986-01-01

126

Competency Issues in Dementia: Medical Decision Making, Driving, and Independent Living  

Microsoft Academic Search

Among the many losses that a patient with dementia inevitably experiences is loss of competency. The patient with a degenerative dementia experiences gradual and progressive impairment of multiple abilities, which may inter fere with his or her competency in a number of realms, including medical or legal decision making, driving, and independent living. It is common for concerns about competency

Nancy R. Barbas; Elisabeth A. Wilde

2001-01-01

127

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

Microsoft Academic Search

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

A. S. Elstein

2004-01-01

128

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

ERIC Educational Resources Information Center

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

Johnson, Katherine M.; Johnson, David R.

2009-01-01

129

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

ERIC Educational Resources Information Center

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

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

2010-01-01

130

Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters  

Microsoft Academic Search

This article examines how parents and pediatricians negotiate antibiotic prescribing decisions in cases where parents overtly advocate this medication. Using the methodology of conversation analysis, this paper examines audio and videotaped acute care pediatric encounters and discusses four primary ways in which parents raise antibiotics in pediatric encounters. These formulations vary in their directness with indirect formulations being more common.

Tanya Stivers

2002-01-01

131

Medical Decision Making: A Selective Review for Child Psychiatrists and Psychologists  

ERIC Educational Resources Information Center

Physicians, including child and adolescent psychiatrists, show variability and inaccuracies in diagnosis and treatment of their patients and do not routinely implement evidenced-based medical and psychiatric treatments in the community. We believe that it is necessary to characterize the decision-making processes of child and adolescent…

Galanter, Cathryn A.; Patel, Vimla L.

2005-01-01

132

Medical Decision-Making and Minors: Issues of Consent and Assent.  

ERIC Educational Resources Information Center

After a brief discussion of legal perspectives on informed consent, the present review examines the developmental literature on children and adolescents' capacities to make medical decisions that are informed, voluntary, and rational. The purposes and benefits of assent are identified. Remaining questions of how to evaluate capacity and balance…

Kuther, Tara L.

2003-01-01

133

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

Microsoft Academic Search

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

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

2010-01-01

134

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

Microsoft Academic Search

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

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

2005-01-01

135

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

ERIC Educational Resources Information Center

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

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

2005-01-01

136

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

ERIC Educational Resources Information Center

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

Lambert, Heather

2012-01-01

137

Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel.  

PubMed

In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community. PMID:22773617

Sarmiento, Kelly; Eckstein, Daniel; Zambon, Allison

2013-03-01

138

Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results.  

PubMed

In this article we describe how patients assign meanings to medical test results and use these meanings to justify their actions. Evidence is presented from lay interpretations of medical tests for monitoring hepatitis C viral infection (HCV) to show how numeracy becomes embodied in the absence of physical symptoms. Illness narratives from 307 individuals infected with HCV were collected from the internet and analysed qualitatively. As part of standard medical care, chronically infected HCV patients are required to have periodic blood tests for laboratory testing. The lab results are presented numerically and compared with established physiological standards. HCV patients' knowledge and interpretations of test results have important consequences for their health behaviour and their medical decisions. In their stories, the patients described their decisions to begin, delay or stop treatment and developed strategies to alter their diet, exercise and use alternative therapies according to changes in their test result. The perceived meanings of test results are powerful signifiers that are capable of altering the course of HCV patients' illness, lives and stories. An interpretive model of health numeracy has the advantage of promoting understanding between patients and healthcare providers over a model that views innumeracy as a skill deficit. PMID:23009649

Perzynski, Adam T; Terchek, Joshua J; Blixen, Carol E; Dawson, Neal V

2013-05-01

139

[Future medical specialists' objectives of further education and their decision to establish a practice. A gender-specific analysis].  

PubMed

This study investigated future medical specialists' objectives of further qualification, their intention, and their decision to establish a practice. Data of 5,053 young physicians, obtained from five German Federal Chambers of Physicians, were analyzed. Data included sociodemographic variables, intended area of specialization, intention, and aspects relevant to the establishment of a practice. Based on preliminary studies, 18 questions were broken down into six factors. The relevance of each of these factors in the decision to establish a practice was analyzed from a gender perspective. Both female and male physicians prioritized general medicine and internal medicine. In addition, female physicians preferred pediatrics and gynecology, while male physicians more frequently chose surgery. Women view professional cooperation opportunities, framework conditions for their family, and job-related commitments as important factors in their decision to establish a practice; quality of life, financial and working conditions are more important to men. The results point out gender-specific approaches which are of relevance for planning medical specialty training. PMID:22286257

Stengler, K; Heider, D; Roick, C; Günther, O H; Riedel-Heller, S; König, H-H

2012-01-01

140

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

ERIC Educational Resources Information Center

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

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

2005-01-01

141

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

Microsoft Academic Search

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

Nelson Barber; D. Christopher Taylor; Tim Dodd

2009-01-01

142

Computerized Physician Order Entry - effectiveness and efficiency of electronic medication ordering with decision support systems  

PubMed Central

Health political background Computerized physician order entry (CPOE) systems are software to electronically enter medication orders. They can be equipped with tools for decision support (CDS). In Germany, various vendors offer such systems for hospitals and physicians’ offices. These systems have mostly been developed during the last five to ten years. Scientific background CPOE-systems exist since the 1970’s. Usually, clinical decision support is integrated into the CPOE to avoid errors. Research questions This HTA-report aims to evaluate the effectiveness and efficiency of CPOE-/CDS-systems and their ethical, social and legal aspects. Methods The systematic literature search (27 international data bases) yielded 791 abstracts. Following a two-part selection process, twelve publications were included in the assessment. Results All reviews and studies included in the present report show that the use of CPOE-/CDS-systems can lead to a reduction of medication errors. Minor errors can be eliminated almost completely. The effect of CPOE-/CDS-systems on the rate of adverse drug events (ADE) is evaluated in only two primary studies with conflicting results. It is difficult to compare the results of economical studies because they evaluate different settings, interventions and time frames. In addition, the documentation often is not fully transparent. All four studies included measure costs and effects from the perspective of a hospital or hospital affiliation. Concerning social aspects, the literature points at changes regard competing interests of technology and humans that result from the implementation of CPOE-systems. The experience of institutions in which the implementation of CPOE-systems leads to problems showed that the importance of considering the socio-organisational context had partly been underestimated. Discussion CPOE-/CDS-systems are able to reduce the rate of medication errors when ordering medications. The adherence to guidelines, communication, patient care and personnel satisfaction can also be affected positively. However, the literature also reports negative effects, as through the use of CPOE-/CDS-systems new errors can be generated. This makes continuous revisions of the system, as well as data-updates necessary. Concerning the cost-benefit-ratio from the hospital perspective, the two qualitatively best economic studies show contradictory results. Therefore, a positive cost-benefit-ratio for individual hospitals cannot be assumed, particularly as the study results cannot be generalized. Conclusions If the implementation of CPOE-/CDS-systems is well planned and conducted, the system adapted to the needs of the institution and continuously reviewed, and data used are updated on a regular basis, the rate of medication ordering errors can be reduced considerably by using CPOE-/CDS-systems. However, it is not clear how this results in a reduction of ADE. Prospective, systematic multi-centre evaluation-studies with clear methodology are needed, which include an analysis of the user-friendliness and of social and technical aspects of the system. Such studies should evaluate the impact a CPOE-/CDS-system has on ADE-rates and mortality. A detailed description of the system used and of the hospital evaluated is essential. If possible, costs and cost effects should be surveyed and documented transparently. PMID:21289894

Sturzlinger, Heidi; Hiebinger, Cora; Pertl, Daniela; Traurig, Peter

2009-01-01

143

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

PubMed

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

Ito, Misae; Tanida, Noritoshi; Turale, Sue

2010-09-01

144

21THIRD QUARTER 2006 1531-636X/06/$20.002006 IEEE IEEE CIRCUITS AND SYSTEMS MAGAZINE In matters of great importance that have financial, medical,  

E-print Network

of great importance that have financial, medical, social, or other implications, we often seek a second is perhaps second nature to us; yet, the extensive benefits of such a process in automated decision making selection, learning with missing features, confidence estimation, and error correcting output codes; all

Brown, Gavin

145

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

PubMed Central

Background The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Methods Data were collected in a longitudinal two-wave study (n?=?2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. Results In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist). Conclusions We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. The association between work characteristics and later medical care-seeking differed between health care providers and between men and women. If we aim at reducing health care costs for workers by preventing unnecessary or inefficient care, it is important to reduce the number of workers that report that health complaints impede their work performance. The supervisor could provide more social support, closely monitor workload in combination with work pressure and decision latitude, and when possible help to adjust working conditions. Health care providers could reduce medical costs by taking the work relatedness of health complaints into account and act accordingly, by decreasing the time to referral and waiting lists, and by providing appropriate care and avoiding unnecessary or harmful care. PMID:22938384

2012-01-01

146

10.1177/0272989X05282644 MEDICAL PEZZO JAN–FEB NEGLIGENCE DECISION AND DECISION PSYCHOLOGY PEZZO AND COMPUTER MAKING/NOV–DEC DECISION2006 AIDS DECISION PSYCHOLOGY Physician Evaluation after Medical Errors: Does Having a Computer Decision Aid Help or Hurt  

E-print Network

Objective. The authors examined whether physicians ’ use of computerized decision aids affects patient satisfaction and/ or blame for medical outcomes. Method. Experiment 1: Fiftynine undergraduates read about a doctor who made either a correct or incorrect diagnosis and either used a decision aid or did not. All rated the quality of the doctor’s decision and the likelihood of recommending the doctor. Those receiving a negative outcome also rated negligence and likelihood of suing. Experiment 2: One hundred sixty-six medical students and 154 undergraduates read negative-outcome scenarios in which a doctor either agreed with the aid, heeded the aid against his own opinion, defied the aid in favor of his own opinion, or did not use a decision aid. Subjects rated doctor fault and competence and the appropriateness of using decision aids in medicine. Medical students made judgments for themselves and for a layperson. Results. Experiment 1: Using a decision aid caused a positive outcome to be rated less positively and a negative outcome to be rated less negatively. Experiment 2: Agreeing with or heeding the aid was associated with reduced fault, whereas defying the aid was associated with roughly the same fault as not using one at all. Medical students were less harsh than undergraduates but accurately predicted undergraduate’s responses. Conclusion. Agreeing with or heeding a decision aid, but not defying it, may reduce liability after an error. However, using an aid may reduce favorability after a positive outcome. Key words: computerassisted diagnosis; decision support systems; clinical; decision support techniques; diagnostic errors; malpractice; medical errors; medical informatics; patient satisfaction.

Mark V. Pezzo; Stephanie P. Pezzo

147

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

PubMed

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

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

148

Making medical decisions in pediatric consultations : a conversation-analytic study of sequences and actions of physician-parent interaction in a Chinese hospital.  

E-print Network

???This research investigates the physician-parent interaction when making medical decisions. Specifically, it examines how the interaction during the making of treatment and prescription decisions is… (more)

Wang, Nan ( ??)

2010-01-01

149

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

Microsoft Academic Search

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

Cathy Charles; Amiram Gafni; Tim Whelan

1997-01-01

150

Important Notice from UCSD Medical Center About Your Prescription Drug Coverage and Medicare  

E-print Network

Important Notice from UCSD Medical Center About Your Prescription Drug Coverage and Medicare Please current prescription drug coverage with UCSD Medical Center and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a Medicare

Gleeson, Joseph G.

151

Evaluation of EMERGE, a Medical Decision Making Aid for Analysis of Chest Pain  

PubMed Central

EMERGE, a rule-based medical decision making aid for analysis of chest pain in the emergency room, was evaluated using retrospective patient data. The analysis consisted of two phases. In the initial phase, patient cases were run in order to make minor modifications and adjustments in the criteria used for determination of admission. In the second phase, patient cases were analyzed to determine the effectiveness of the EMERGE system in arriving at the proper conclusion.

Hudson, Donna L.; Cohen, Moses E.; Deedwania, Prakash C.; Watson, Patricia E.

1983-01-01

152

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

SciTech Connect

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

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

1982-01-01

153

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

PubMed

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

Rid, Annette; Wendler, David

2014-04-01

154

Hypermedia or Hyperchaos: Using HyperCard to Teach Medical Decision Making  

PubMed Central

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

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

1989-01-01

155

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

Outline Introduction From Bayes to Evidence theory Decision-making in real world problems Medical theory Decision-making in real world problems Medical diagnosis problem Thre Outline 1 Introduction to Evidence theory Decision-making in real world problems Medical diagnosis problem Thre

Chisci, Luigi

156

Relational autonomy or undue pressure? Family's role in medical decision-making.  

PubMed

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients' rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are most knowledgeable of and invested in their own interests, they should be the ones to make voluntary decisions regarding their care. Two results of the strong focus on autonomy are the rejection of the image of patients as passive care recipients and the suspicion against paternalistic influence anyone may have on patients' decision-making process. Although the initial focus in western bioethics was on minimizing professional coercion, there has been a steady concern of family's involvement in adult patients' medical decision-making. Many worry that family members may have divergent values and priorities from those of the patients, such that their involvement could counter patients' autonomy. Those who are heavily involved in competent patients' decision-making are often met with suspicion. Patients who defer to their families are sometimes presumed to be acting out of undue pressure. This essay argues for a re-examination of the notions of autonomy and undue pressure in the contexts of patienthood and relational identity. In particular, it examines the characteristics of families and their role in adult patients' decision-making. Building on the feminist conception of the relational self and examining the context of contemporary institutional medicine, this paper argues that family involvement and consideration of family interests can be integral in promoting patients' overall agency. It argues that, in the absence of abuse and neglect, respect for autonomy and agency requires clinicians to abide by patients' expressed wishes. PMID:18269432

Ho, Anita

2008-03-01

157

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

PubMed Central

Background Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education. Methods We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment. Results We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system. Conclusions The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer. PMID:22032775

2011-01-01

158

Memory Accessibility and Medical Decision-Making for Significant Others: The Role of Socially Shared Retrieval-Induced Forgetting  

PubMed Central

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

Coman, Dora; Coman, Alin; Hirst, William

2013-01-01

159

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

Federal Register 2010, 2011, 2012, 2013

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

2011-10-04

160

Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. Final rule.  

PubMed

This document amends Department of Veterans Affairs (VA) regulations to reflect changes made by section 504 of the Caregivers and Veterans Omnibus Health Services Act of 2010. Section 504 authorizes a VA practitioner, when the practitioner deems it necessary to ensure an informed medical decision, to share certain, otherwise protected medical information with the representative of a patient who lacks decision-making capacity. This rulemaking amends VA regulations consistent with this new authority. PMID:21351682

2011-02-01

161

Important Notice from UCSD Medical Center About Creditable Prescription Drug Coverage and Medicare  

E-print Network

Important Notice from UCSD Medical Center About Creditable Prescription Drug Coverage and Medicare The purpose of this notice is to advise you that the prescription drug coverage listed below under the UCSD prescription drug coverage will pay in 2012. This is known as "creditable coverage". Why this is important

Squire, Larry R.

162

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

E-print Network

while in medical or dental school. A strong foundation in mathematics, biology, general and organicPre-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

Hutcheon, James M.

163

Lamy et al. BMC Medical Informatics and Decision Making 2010, 10:31 http://www.biomedcentral.com/1472-6947/10/31  

E-print Network

Lamy et al. BMC Medical Informatics and Decision Making 2010, 10:31 http of the article #12;Lamy et al. BMC Medical Informatics in various medical situations, including therapeutical recommendations for drug prescription. An effective

Paris-Sud XI, Université de

164

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

PubMed

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

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

2011-01-01

165

Electronic Discovery and Electronic Medical Records: Does the Threat of Litigation aect Firm Decisions to Adopt Technology?  

Microsoft Academic Search

Firms' decision-making is increasingly leaving an electronic trail. We ask how the threat of litigation aects decisions to adopt technologies that leave more of an elec- tronic trail, like electronic medical records (EMR). On the one hand, firms may embrace a technology that allows them to easily document that their actions were appropriate if they have to defend them in

Amalia R. Miller; Catherine E. Tucker

166

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

PubMed

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

Zieba, Maciej

2014-09-01

167

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

E-print Network

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

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

2011-01-01

168

Does Culture Confirmation of High-sensitivity Rapid Streptococcal Tests Make Sense? A Medical Decision Analysis  

Microsoft Academic Search

ABSTRACT. Objective. Since the 1990 publication of a decision analysis, in which the treatment of pharyngitis in children was evaluated, a number of assumptions important in that analysis have changed. Updating many of the assumptions and costs used in that analysis to reflect the conditions currently found in a large, subur- ban pediatric practice, a cost-effectiveness analysis was performed in

Kenneth H. Webb

169

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

PubMed Central

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

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

2014-01-01

170

Asthma Medications and Pregnancy  

MedlinePLUS

... Director, Health Initiatives View full profile Asthma and Pregnancy: Asthma Medications We would like to avoid all ... mother and child. Making Decisions about Medication During Pregnancy It is important that your asthma be controlled ...

171

The Art of Building Decision Trees  

Microsoft Academic Search

2 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

Spela Hleb Babic; Peter Kokol; Vili Podgorelec; Milan Zorman; Matej Sprogar; Milojka Molan Stiglic

2000-01-01

172

Medical futility decisions and physicians' legal defensiveness: The impact of anticipated conflict on thresholds for end-of-life treatment  

Microsoft Academic Search

Does legal defensiveness significantly influence physicians' assessments of medical futility, in ways that may adversely affect the rights of patients and their family members to make their own health care decisions at the end of life? This exploratory study addresses that question with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority

Jeffrey W. Swanson; S. Van McCrary

1996-01-01

173

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

Microsoft Academic Search

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

Hai Yap Teoh; Godwin Y Shiu

1990-01-01

174

A business plan to import a medical information service to Mexico based on cell phone technology  

Microsoft Academic Search

This paper examines the feasibility of importing a medical information service based on mobile phones, called ldquoIn Touchrdquo to Mexico City. There should be interest in introducing such technology to Mexico because it may improve access to health care services, especially for those living in rural areas. At present public health services are uneven and can be of poor quality.

F. M. Leon; C. A. M. Leon; R. S. Leder

2009-01-01

175

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

NSDL National Science Digital Library

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

0002-11-30

176

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

Microsoft Academic Search

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

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

1994-01-01

177

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

E-print Network

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

Zhao, Yuxiao

178

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

SciTech Connect

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

Jaksch, J.A.

1992-06-01

179

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

PubMed

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

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

2012-06-01

180

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

PubMed Central

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

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

2014-01-01

181

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

PubMed

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

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

2011-01-01

182

Medical decision-making in membranous nephropathy: how to use limited clinical research evidence in patient management.  

PubMed

Evidence-based medicine (EBM) originally referred to the use of a combination of clinical expertise and research evidence to make medical decisions, while carefully considering the patient's preference. In Japan, however, EBM has been misunderstood as the more abstract pursuit of acquiring research evidence and building medical guidelines. This review aims to summarize the available data regarding therapy for membranous nephropathy (MN), a field in which no consensus has been reached, and to discuss medical decision-making by using a decision tree in several model cases. In clinical practice, we have to consider both the risks and benefits of treatment. These are evaluated by their therapeutic effect (the rate of improvement, no change, or worsening) and by the patients' quality of life (QOL). This process is compatible with the essential concept of EBM. PMID:16189628

Imai, Hirokazu

2005-09-01

183

Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study  

Microsoft Academic Search

This article identifies the characteristics of patients and office visits associated with decreased mutual decision-making between physicians and patients. In the baseline cross-sectional survey of the Medical Outcomes Study we measured specific patient characteristics hypothesized to influence participatory decision-making (PDM) styles of physicians. We related these characteristics to the PDM style scores for their physicians. The study was conducted in

Sherrie H. Kaplan; Barbara Gandek; Sheldon Greenfield; William H. Rogers; Ware John E. Jr

1995-01-01

184

Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care  

Microsoft Academic Search

OBJECTIVE: Greater participation in medical decision making is generally advocated for patients, and often advocated for those with\\u000a diabetes. Although some studies suggest that diabetic patients prefer to participate less in decision making than do healthy\\u000a patients, the empirical relationship between such participation and diabetic patients’ satisfaction with their care is currently\\u000a unknown. We sought to characterize the relationship between

Carol Golin; M. Robin DiMatteo; Naihua Duan; Barbara Leake; Lillian Gelberg

2002-01-01

185

The Effectiveness of Assigned Goals in Complex Financial Decision Making and the Importance of Gender  

Microsoft Academic Search

Evidence suggests that men are more confident and less risk averse in financial decision making. Researchers did not address\\u000a how men and women respond differently to goals in financial decision situations, however. In the present study, men set more\\u000a challenging personal goals and risked more resources than women in a complex financial decision task. Men did not report higher\\u000a self-efficacy

Megan Lee Endres

2006-01-01

186

Spot light survey on fresh-water snails of medical importance in Al Fayoum Governorate, Egypt.  

PubMed

In a survey carried out during Summer and Autumn of 2004, for snails of medical importance, nine species were recovered. These were Biomphalaria alexandrina, B. glabrata, B. pfeifferi, Bulinus truncatus, B. forskalii, Lymnaea natalensis, Bellamya (=Vivipara) unicolor, Physa acuta and Hydrobia musaensis. Parasitological examination revealed that B. alexandrina, B. glabrata and L. natalensis harboured immature stages of their concerned trematode parasites. Moreover, P. acuta harboured the immature stage of the nematode parasite Parastrongylus cantonensis. PMID:15880994

Abo-Madyan, Ahmed A; Morsy, Tosson A; Motawea, Saad M; El Garhy, Manal F; Massoud, Ahmed M A

2005-04-01

187

Name changes in fungi of microbiological, industrial and medical importance. Part 4.  

PubMed

This is the fourth in a series of reports bringing changes in the names of fungi of microbiological, industrial and medical importance to the attention of workers in these fields. The series is sponsored by the Division of Mycology of the International Union of Microbiological Societies (IUMS) and prepared under the auspices of the International Commission on the Taxonomy of Fungi (ICTF). The first of this series of reports included an introduction to the series explaining the need for name changes. PMID:2215633

Cannon, P F

1990-08-01

188

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

ERIC Educational Resources Information Center

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

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

2010-01-01

189

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

ERIC Educational Resources Information Center

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

Tennessee Higher Education Commission, Nashville.

190

Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).  

PubMed

This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment. PMID:17281912

da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

2005-01-01

191

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

E-print Network

heterogeneous and distributed medical IS, which includes a sense and response mechanism and facilitates evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making evidence-based guidelines (EBG) into the clinical decision making process could improve the quality

192

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

PubMed Central

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

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

2012-01-01

193

MAKING THE DECISION TO APPLY Professional programs place the highest importance on an  

E-print Network

as students evaluate whether or not to pursue a health care profession. CHOOSING A MAJOR While most students anticipating medical school admission choose a science major, medical schools also look favorably upon applicants with humanities and social sciences majors. However, those interested in admission to MD/PhD pro

Subramanian, Venkat

194

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

E-print Network

one’s life (Blanch & Parrish, 1993; Chamberlin, 1998; Leete, 1989; Reilly, 1992); (3) being able to recognize and use one’s inner strength to impact positive change (Chamberlin, 1999; Deegan, 1988; Leete, 1993; Stocks, 1995); (4) having a voice... of the participants reported any specific positive effects from their medications, but several reported how the medications reduced their level of motivation, impacted social relationships, and left them with side effects that were often worse than the distress...

Goscha, Richard J.

2009-12-01

195

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

PubMed Central

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

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

2013-01-01

196

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

PubMed Central

Objective Medical groups have invested billions of dollars in Electronic Medical Records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The UKPDS Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (.26%, p=.014) relative to patients in the control arm. Intervention costs were $120 (SE=45) per patient in the first year and $76 (SE=45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE=.01) and increased lifetime costs by $112 (SE=660), resulting in an incremental cost effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system. PMID:22578085

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

197

Detecting Critical Decision Points in Psychotherapy and Psychotherapy + Medication for Chronic Depression  

PubMed Central

Objective To quantify clinical decision points for identifying depression treatment non-remitters prior to end-of-treatment. Method Data come from the psychotherapy arms of a randomized clinical trial for chronic depression. Participants (n=352; 65.6% female; 92.3% White; mean age = 44.3 years) received 12 weeks of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or CBASP plus an antidepressant medication. In half of the sample, receiver operating curve (ROC) analyses were used to identify efficient percent symptom reduction cut points on the Inventory of Depressive Symptoms-Self Report (IDS-SR) for predicting end-of-treatment nonremission based on the Hamilton Rating Scale for Depression (HRSD). Sensitivity, specificity, predictive values and Cohen’s kappa for identified cut points were calculated using the remaining half of the sample. Results Percent IDS-SR symptom reduction at weeks 6 and 8 predicted end of treatment HRSD remission status in both the combined treatment (week 6 cut point = 50.0%, Cohen’s kappa = .42; week 8 cut point = 54.3%, Cohen’s kappa = .45), and psychotherapy only (week 6 cut point = 60.7%, Cohen’s kappa = .41; week 8 cut point = 48.7%, Cohen’s kappa = .49). Week 8 was more reliable for identifying nonremitters in psychotherapy only treatment. Conclusions Those with chronic depression who will not remit in structured, time-limited psychotherapy for depression, either alone or in combination with antidepressant medication, are identifiable prior to end-of-treatment. Findings provide an operationalized strategy for designing adaptive psychotherapy interventions. PMID:23750462

Steidtmann, Dana; Manber, Rachel; Blasey, Christine; Markowitz, John C.; Klein, Daniel N.; Rothbaum, Barbara O.; Thase, Michael E.; Kocsis, James H.; Arnow, Bruce A.

2014-01-01

198

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

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

2013-01-01

199

Examination of the importance of decision-choice criteria in the industrial purchase of occupational health programs  

SciTech Connect

The objective of this study is to examine the relative importance of five decision choice criteria to the decision to purchase an occupational-health program. A judgment sample of 110 companies that had purchased occupational health packages was selected. A total of forty-nine companies that had purchased a total of ninety-one different occupational-health programs responded. Six hypotheses were tested. The first five dealt with the relative importance of the five choice criteria under study. These criteria were: cost, benefits, reputation of the provider, flexibility of the program, and promotional efforts. A sixth hypothesis was examined to try to determine if the importance rating varied significantly dependent upon the specific occupational health program purchased. Results of the study were that the cost and benefit decision criteria were rated significantly higher than average on the seven-point importance scale, and the promotional criterion was significantly lower than average. It was also shown that the relative importance of the decision criteria varied depending upon the specific occupational health package purchased.

Horwitz, P.S.

1987-01-01

200

Decision Analysis and Cost-effectiveness Analysis  

PubMed Central

Healthcare decision-making can be complex, often requiring decision makers to weigh serious trade-offs, consider patients’ values, and incorporate evidence in the face of uncertainty. Medical decisions are made implicitly by clinicians and other decision-makers on a daily basis. Decisions based largely on personal experience are subject to many biases. Decision analysis and cost-effectiveness analysis are systematic approaches used to support decision-making under conditions of uncertainty that involve important trade-offs. These mathematical tools can provide patients, physicians and policy makers with a useful approach to complex medical decision making. PMID:23966758

Ryder, Hilary F.; McDonough, Christine; Tosteson, Anna N. A.; Lurie, Jon D.

2013-01-01

201

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

PubMed Central

Objectives Evidence-based medicine depends on the timely synthesis of research findings. An important source of synthesized evidence resides in systematic reviews. However, a bottleneck in review production involves dual screening of citations with titles and abstracts to find eligible studies. For this research, we tested the effect of various kinds of textual information (features) on performance of a machine learning classifier. Based on our findings, we propose an automated system to reduce screeing burden, as well as offer quality assurance. Methods We built a database of citations from 5 systematic reviews that varied with respect to domain, topic, and sponsor. Consensus judgments regarding eligibility were inferred from published reports. We extracted 5 feature sets from citations: alphabetic, alphanumeric+, indexing, features mapped to concepts in systematic reviews, and topic models. To simulate a two-person team, we divided the data into random halves. We optimized the parameters of a Bayesian classifier, then trained and tested models on alternate data halves. Overall, we conducted 50 independent tests. Results All tests of summary performance (mean F3) surpassed the corresponding baseline, P<0.0001. The ranks for mean F3, precision, and classification error were statistically different across feature sets averaged over reviews; P-values for Friedman's test were .045, .002, and .002, respectively. Differences in ranks for mean recall were not statistically significant. Alphanumeric+ features were associated with best performance; mean reduction in screening burden for this feature type ranged from 88% to 98% for the second pass through citations and from 38% to 48% overall. Conclusions A computer-assisted, decision support system based on our methods could substantially reduce the burden of screening citations for systematic review teams and solo reviewers. Additionally, such a system could deliver quality assurance both by confirming concordant decisions and by naming studies associated with discordant decisions for further consideration. PMID:24475099

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

2014-01-01

202

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

PubMed Central

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

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

2014-01-01

203

Modeling decision-making in single- and multi-modal medical images  

NASA Astrophysics Data System (ADS)

This research introduces a mode-specific model of visual saliency that can be used to highlight likely lesion locations and potential errors (false positives and false negatives) in single-mode PET and MRI images and multi-modal fused PET/MRI images. Fused-modality digital images are a relatively recent technological improvement in medical imaging; therefore, a novel component of this research is to characterize the perceptual response to these fused images. Three different fusion techniques were compared to single-mode displays in terms of observer error rates using synthetic human brain images generated from an anthropomorphic phantom. An eye-tracking experiment was performed with naÃve (non-radiologist) observers who viewed the single- and multi-modal images. The eye-tracking data allowed the errors to be classified into four categories: false positives, search errors (false negatives never fixated), recognition errors (false negatives fixated less than 350 milliseconds), and decision errors (false negatives fixated greater than 350 milliseconds). A saliency model consisting of a set of differentially weighted low-level feature maps is derived from the known error and ground truth locations extracted from a subset of the test images for each modality. The saliency model shows that lesion and error locations attract visual attention according to low-level image features such as color, luminance, and texture.

Canosa, R. L.; Baum, K. G.

2009-02-01

204

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

PubMed Central

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

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

2013-01-01

205

Ignoring the data and endangering children: why the mature minor standard for medical decision making must be abandoned.  

PubMed

In Roper v. Simmons (2005) the United States Supreme Court announced a paradigm shift in jurisprudence. Drawing specifically on mounting scientific evidence that adolescents are qualitatively different from adults in their decision-making capacities, the Supreme Court recognized that adolescents are not adults in all but age. The Court concluded that the overwhelming weight of the psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than adult persons. The Supreme Court further solidified its position regarding adolescents as less than fully mature and responsible decisionmakers in Graham v. Florida (2010) and Miller v. Alabama (2012). In each case, the Court concluded that the scientific evidence does not support the conclusion that children under 18 years of age possess adult capacities for personal agency, rationality, and mature choice. This study explores the implications of the Supreme Court decisions in Roper v. Simmons, Graham v. Florida, and Miller v. Alabama for the "mature minor" standard for medical decision making. It argues that the Supreme Court's holdings in Roper, Graham, and Miller require no less than a radical reassessment of how healthcare institutions, courts of law, and public policy are obliged to regard minors as medical decisionmakers. The "mature minor" standard for medical decision making must be abandoned. PMID:23615058

Cherry, Mark J

2013-06-01

206

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

PubMed Central

Background Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. Methods A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. Results 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Conclusions Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients' decisions and monitor patients' decisions over time. PMID:21554729

2011-01-01

207

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...

208

The Importance of Regionalism in the Decision-Making Style of Local Boards of Education.  

ERIC Educational Resources Information Center

This study examines some of the characteristics of decision-making on school boards, focusing on the behavior of southern school board members in comparison with their counterparts in other regions of the country. Data were collected in 1975 at the convention of the National School Boards Association (NSBA). Self-administered questionnaires were…

Blanchard, Paul D.; Kline, Robert L.

209

Evaluation of medical decisions’ effectiveness: a 4-year evidence-based study in a health care setting  

Microsoft Academic Search

Objectives  Specific studies evaluating the effectiveness of the judgement of fitness for work formulated by occupational physicians (OP)\\u000a are needed. The evaluation consists in investigating OPs’ decisions by measuring their impact on health with specific indicators.\\u000a This specific study aims at assessing, through outcome indicators, the effectiveness of medical decisions in 61 cases leading\\u000a to preventive interventions.\\u000a \\u000a \\u000a \\u000a Methods  A 3-step pre-post observational

Giuliano Franco; Pamela Grandi

2008-01-01

210

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

Federal Register 2010, 2011, 2012, 2013

...announces its decision to construct and...MFD) at Naval Support Activity (NSA...also announces its decision to construct and...Military Health System commitments to deliver...will enhance and support but not add to the...of the Record of Decision (ROD) is...

2013-09-10

211

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

PubMed Central

Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient–proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult’s preferences for cardiopulmonary resuscitation, artificial feeding and fluids, and palliative care in hypothetical illness scenarios. The responses of 34 Caucasian dyads and 30 African American dyads were compared to determine the extent to which family members could accurately predict the treatment preferences of their older relative. Results: We found higher treatment preference agreement among African American dyads compared with Caucasian dyads when considering overall raw difference scores (i.e., overtreatment errors can compensate for undertreatment errors). Prior advance care planning moderated the effect such that lower levels of advance care planning predicted undertreatment errors among African American proxies and overtreatment errors among Caucasian proxies. In contrast, no racial/ethnic differences in treatment preference agreement were found within absolute difference scores (i.e., total error, regardless of the direction of error). Implications: This project is one of the first to examine the mediators and moderators of dyadic racial/cultural differences in treatment preference agreement for end-of-life care in hypothetical illness scenarios. Future studies should use mixed method approaches to explore underlying factors for racial differences in patient–proxy agreement as a basis for developing culturally sensitive interventions to reduce racial disparities in end-of-life care options. PMID:20038541

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

2010-01-01

212

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

PubMed Central

Background Many drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation’s health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug. Methods The study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY) was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI) and expected value of parameter perfect information (EVPPI) analyses were also conducted for the hypothetical population. Results Thiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration. Conclusions The result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled. PMID:23343250

2013-01-01

213

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

PubMed Central

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

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

2009-01-01

214

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

PubMed

An important barrier to the widespread dissemination of clinical decision support (CDS) is the heterogeneity of information models and terminologies used across healthcare institutions, health information systems, and CDS resources such as knowledge bases. To address this problem, the Health Level 7 (HL7) Virtual Medical Record project (an open, international standards development effort) is developing community consensus on the clinical information exchanged between CDS engines and clinical information systems. As a part of this effort, the HL7 CDS Work Group embarked on a multinational, collaborative effort to identify a representative set of clinical data elements required for CDS. Based on an analysis of CDS systems from 20 institutions representing 4 nations, 131 data elements were identified as being currently utilized for CDS. These findings will inform the development of the emerging HL7 Virtual Medical Record standard and will facilitate the achievement of scalable, standards-based CDS. PMID:21347004

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

2010-01-01

215

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

PubMed Central

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

Kassiri, Hamid; Kassiri, Ali; Kazemi, Shahnaz

2014-01-01

216

Olfactory responses of medically and economically important mites (Acari: Epidermoptidae and Acaridae) to volatile chemicals.  

PubMed

Dermatophagoides farinae Hughes (Acari: Epidermoptidae), the American house dust mite, and Tyrophagus putrescentiae (Schrank) (Acari: Acaridae), the mold mite, are medically and economically important but controlling them has proved difficult, and recolonization is commonplace. Their behavioral responses to different sources of volatile chemicals are still not fully elucidated. For the first time, the Y-tube olfactometer, which is an enclosed bioassay to resolve responses to test and control volatiles, has been successfully used with these mites. Mites were tested individually, and both T. putrescentiae and D. farinae responded to food volatiles. Y-tube olfactometers may be used to test for potential semiochemicals, thereby increasing knowledge of our behavior of astigmatic mites. PMID:17427710

Skelton, A C; Birkett, M A; Pickett, J A; Cameron, M M

2007-03-01

217

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

Microsoft Academic Search

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

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

2006-01-01

218

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

PubMed

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

Newman, M T

1976-11-01

219

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

PubMed Central

Risk communication is a major challenge in productive patient-physician communication. Patient decision making responsibilities come with an implicit assumption that patients are sufficiently educated and confident in their abilities to make decisions about their care based on evidence based treatment recommendations. Attempts to improve health literacy in patients by way of graphical 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 points in isolation. To classify decision aids, we present an information-centric framework for assessing the content delivered to patients. We provide examples of our framework from a literature survey and suggest ways improvements can be made by considering all dimensions of our framework. PMID:24551350

Franklin, Lyndsey; Plaisant, Catherine; Shneiderman, Ben

2013-01-01

220

The Importance of Establishing Regimen Concordance in Preventing Medication Errors in Anticoagulant Care  

Microsoft Academic Search

Miscommunication between patients and providers can have serious consequences, especially where medications are concerned. We examined whether regimen discordance between patient and provider, a possible result of miscommunication, contributes to unsafe medication management.We studied 220 patients taking warfarin in an anticoagulation clinic to characterize two medication assessment methods. We measured (1) adherence by asking patients to report any missed doses

Dean Schillinger; Frances Wang; Maytrella Rodriguez; Andrew Bindman; Edward L. Machtinger

2006-01-01

221

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

PubMed

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

Fargen, Kyle M; Friedman, William A

2014-01-01

222

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

Federal Register 2010, 2011, 2012, 2013

We are advising the public of our decision to authorize the importation into the continental United States of fresh apricot, sweet cherry, and plumcot fruit from South Africa. Based on the findings of a pest risk analysis, which we made available to the public for review and comment through a previous notice, we believe that the application of one or more designated phytosanitary measures will be......

2011-10-04

223

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

PubMed

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

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

2013-07-01

224

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

ERIC Educational Resources Information Center

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

Czamanski-Cohen, Johanna

2012-01-01

225

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

E-print Network

during mass casualty incidents. During a Mass Casualty Incident (MCI), hospitals are required to deal insight into the difficulties with MCI decision-making, we conducted focus groups with both EMS and ED information is not only a major requirement but also a major challenge for decision-making during a MCI

226

Decision-making under risk is improved by both dopaminergic medication and subthalamic stimulation in Parkinson's disease.  

PubMed

Inconsistent findings regarding the effects of dopaminergic medication (MED) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) on decision making processes and impulsivity in Parkinson's disease (PD) patients have been reported. This study investigated the influence of MED and STN-DBS on decision-making under risk. Eighteen non-demented PD patients, treated with both MED and STN-DBS (64.3±10.2years, UPDRS III MED off, DBS off 45.5±17.1) were tested with the Game of Dice Task (GDT) which probes decision-making under risk during four conditions: MED on/DBS on, MED on/DBS off, MED off/DBS on, and MED off/DBS off. Task performance across conditions was compared analyzing two GDT-parameters: (i) the "net score" indicating advantageous decisions, and (ii) the patient's ability to use negative feedback. Significantly higher GDT net scores were observed in Med on in contrast to Med off conditions as well as in DBS on versus DBS off conditions. However, no effect of therapy for the patient's ability to make use of negative feedback could be detected. The data suggest a positive influence of both MED and STN-DBS on making decisions under risk in PD patients, an effect which seems to be mediated by mechanisms other than the use of negative feedback. PMID:24444545

Boller, Jana K; Barbe, Michael T; Pauls, K Amande M; Reck, Christiane; Brand, Matthias; Maier, Franziska; Fink, Gereon R; Timmermann, Lars; Kalbe, Elke

2014-04-01

227

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

PubMed Central

Background Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events as well as medication discrepancies or non-adherence with high potential for future harm (potential adverse drug events). Objective The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study sought to determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge. Design Randomized controlled trial with concealed allocation and blinded outcome assessors. Setting Two tertiary care academic hospitals. Patients Adults hospitalized with acute coronary syndromes or acute decompensated heart failure. Intervention Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. Measurements The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable adverse drug events, as well as potential adverse drug events. Results Among 851 participants, 432 (50.8%) experienced 1 or more clinically important medication errors; 23% of such errors were judged to be serious, and 2% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential adverse drug events in 253 (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (IRR=0.92; 95% CI, 0.77 to 1.10) or adverse drug events (IRR=1.09; CI, 0.86 to 1.39). Intervention patients tended to have fewer potential adverse drug events (IRR=0.80; CI, 0.61 to 1.04). Limitations The characteristics of the study hospitals and participants may limit generalizability. Conclusions Clinically important medication errors were present among half of patients after hospital discharge and were not significantly reduced by a health-literacy sensitive, pharmacist-delivered intervention. PMID:22751755

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

2013-01-01

228

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

PubMed

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

Robson, Barry

2014-08-01

229

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

Federal Register 2010, 2011, 2012, 2013

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

2013-07-15

230

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

Federal Register 2010, 2011, 2012, 2013

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

2010-06-17

231

78 FR 74225 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation  

Federal Register 2010, 2011, 2012, 2013

...NHTSA-2013-0064 Nonconforming Vehicles: 1988-1996 Alpine B10 Series Passenger Cars Because there are no substantially similar U.S.--certified version 1988-1996 Alpine B10 Series Passenger Cars the petitioner sought import...

2013-12-10

232

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

PubMed

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

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

2013-02-01

233

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

PubMed

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

Benbassat, Jochanan

2014-04-01

234

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

PubMed Central

In this study, we established an in-house database of yeast internal transcribed spacer (ITS) sequences. This database includes medically important as well as colonizing yeasts that frequently occur in the diagnostic laboratory. In a prospective study, we compared molecular identification with phenotypic identification by using the ID32C system (bioMérieux) for yeast strains that could not be identified by a combination of CHROMagar Candida and morphology on rice agar. In total, 113 yeast strains were included in the study. By sequence analysis, 98% of all strains were identified correctly to the species level. With the ID32C, 87% of all strains were identified correctly to the species or genus level, 7% of the isolates could not be identified, and 6% of the isolates were misidentified, most of them as Candida rugosa or Candida utilis. For a diagnostic algorithm, we suggest a three-step procedure which integrates morphological criteria, biochemical investigation, and sequence analysis of the ITS region. PMID:16390952

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

2006-01-01

235

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

E-print Network

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

Broniatowski, David André, 1982-

2010-01-01

236

Conflicts Credentialing: Hospitals and the Use of Financial Considerations to Make Medical Staffing Decisions  

Microsoft Academic Search

The emerging practice of conflicts credentialing represents a significant change in the economic and professional interests of physicians and in the relationship between medical staffs and hospitals. In this article, the authors explain the interrelationship between the authority of hospitals and medical staffs to manage their respective affairs and the legal developments that have led toward conflicts credentialing. The authors

James W. Marks; Jayme R. Matchinski

2005-01-01

237

Multi-objective Genetic Programming Optimization of Decision Trees for Classifying Medical Data  

Microsoft Academic Search

\\u000a Although there has been considerable study in the area of trading- off accuracy and comprehensibility of decision tree models,\\u000a the bulk of the methods dwell on sacrificing comprehensibility for the sake of accuracy, or fine-tuning the balance between\\u000a comprehensibility and accuracy. Invariably, the level of trade-off is decided {?tshape a priori}. It is possible for such\\u000a decisions to be made

Ernest Muthomi Mugambi; Andrew Hunter

2003-01-01

238

Multicenter study evaluating the Vitek MS system for identification of medically important yeasts.  

PubMed

The optimal management of fungal infections is correlated with timely organism identification. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is revolutionizing the identification of yeasts isolated from clinical specimens. We present a multicenter study assessing the performance of the Vitek MS system (bioMérieux) in identifying medically important yeasts. A collection of 852 isolates was tested, including 20 Candida species (626 isolates, including 58 C. albicans, 62 C. glabrata, and 53 C. krusei isolates), 35 Cryptococcus neoformans isolates, and 191 other clinically relevant yeast isolates; in total, 31 different species were evaluated. Isolates were directly applied to a target plate, followed by a formic acid overlay. Mass spectra were acquired using the Vitek MS system and were analyzed using the Vitek MS v2.0 database. The gold standard for identification was sequence analysis of the D2 region of the 26S rRNA gene. In total, 823 isolates (96.6%) were identified to the genus level and 819 isolates (96.1%) were identified to the species level. Twenty-four isolates (2.8%) were not identified, and five isolates (0.6%) were misidentified. Misidentified isolates included one isolate of C. albicans (n = 58) identified as Candida dubliniensis, one isolate of Candida parapsilosis (n = 73) identified as Candida pelliculosa, and three isolates of Geotrichum klebahnii (n = 6) identified as Geotrichum candidum. The identification of clinically relevant yeasts using MS is superior to the phenotypic identification systems currently employed in clinical microbiology laboratories. PMID:23658267

Westblade, Lars F; Jennemann, Rebecca; Branda, John A; Bythrow, Maureen; Ferraro, Mary Jane; Garner, Omai B; Ginocchio, Christine C; Lewinski, Michael A; Manji, Ryhana; Mochon, A Brian; Procop, Gary W; Richter, Sandra S; Rychert, Jenna A; Sercia, Linda; Burnham, Carey-Ann D

2013-07-01

239

Antigenic cross-reactivity of venoms from medically important North American Loxosceles spider species.  

PubMed

We characterized the antigenic cross-reactivity of two medically important North American Loxoxceles species: L. reclusa (native to southeastern US) and L. deserta (native to southwestern US). Dermonecrosis resulting from bites from these two North American spider species are indistinguishable clinically. Polyclonal IgG antivenins directed against L. reclusa and L. deserta were raised in rabbits and used to develop specific enzyme immunoassays (EIAs). Antigenic differences in the two venoms were evaluated as follows: (1) Comparison of the sensitivities and correlation coefficient (R(2)) of anti-L. reclusa (alpha LoxR) and anti-L. deserta antibodies (alpha LoxD) in the detection of varying concentrations of the two venoms; (2) separation and western blot comparison of venom components; (3) protein sequence analysis of L. desertavenom and comparison to the L. reclusa protein sequence analysis present in a US national database; and (4) in vivo evaluation of alpha LoxR and alpha LoxD antivenins in attenuating dermal lesions (rabbit model). Correlation coefficients for alpha LoxR (R(2)=0.99) and alpha LoxD (R(2)=0.99) polyclonal antibodies in the measurements of standard concentrations of venoms were virtually identical. Western blot analysis revealed multiple common bands between the two venoms. Amino acid data (amino acids 1-35, N-terminal) of the active venom components of the two venoms revealed only three non-identical amino acids. alpha LoxR and alpha LoxD antivenins were similarly effective in blocking the development of rabbit skin lesions (ANOVA p<0.05). In summary, L. reclusa and L deserta spider venoms possess several common protein bands as identified by western blot, greater than 90% amino acid sequence identity, and marked antigenic cross-reactivity. PMID:11137541

Gomez, H F; Miller, M J; Waggener, M W; Lankford, H A; Warren, J S

2001-06-01

240

Architecture-Level Dependability Analysis of a Medical Decision Support System  

SciTech Connect

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

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

2010-01-01

241

The importance of vocational and social aspects of approaches to learning for medical students  

Microsoft Academic Search

Having performed research using approaches to learning and studying inventories and become familiar with the concepts they\\u000a purport to measure, the authors were concerned that existing inventories might not capture the full range of intentions and motivations for learning that exist within populations of medical students. We used semi-structured interviews to explore the approaches\\u000a to learning of undergraduate medical students

Karen Mattick; Lynn Knight

2009-01-01

242

Key Role of Social Work in Effective Communication and Conflict Resolution Process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and Shared Medical Decision Making at the End of Life  

Microsoft Academic Search

In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates

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

2011-01-01

243

Critically Ill Patients and End-of-Life Decision-Making: The Senior Medical Resident Experience  

ERIC Educational Resources Information Center

In order to improve the understanding of educational needs among residents caring for the critically ill, narrative accounts of 19 senior physician trainees participating in level of care decision-making were analyzed. In this multicentre qualitative study involving 9 university centers in Canada, in-depth interviews were conducted in either…

Ahern, Stephane P.; Doyle, Tina K.; Marquis, Francois; Lesk, Corey; Skrobik, Yoanna

2012-01-01

244

The Model-based Approach to Computer-aided Medical Decision  

E-print Network

The Netherlands ACAI'09 ­ p. 1/2 #12;Introduction Clinical decision support, because . . . doctors make more) ACAI'09 ­ p. 2/2 #12;Problem ICU at Utrecht MC Diagnosis and antimicrobial treatment of patients to 50% of antibiotics in ICUs are prescribed for airway infections ACAI'09 ­ p. 3/2 #12;Software

Lucas, Peter

245

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

PubMed

Neonatal intensive care has been studied from an epidemiological, ethical, medical and even sociological perspective, but little is known about the impact of parental involvement in decision-making, especially in critical cases. We rely here on a comparative, case-based approach to study the parental role in decision-making within two technologically identical but culturally and institutionally different contexts: France and the United States. These contexts rely on two opposed models of decision-making: parental autonomy in the United States and medical paternalism in France. This paternalism model excludes parents from the decision-making process. We investigate whether parental involvement leads to different outcomes from exclusively medically determined decisions or whether "technological imperatives" outplay all other factors to shape a unique, 'medically optimal' outcome. Using empirical data generated from extensive ethnographic fieldwork, in-depth interviews with 60 clinicians and 71 parents and chart review over a year in two neonatal intensive care units (one in France and one in the US), we analyze the factors that can explain the observed differences in decision-making in medically identical cases. Parental involvement and the legal context play a less role than physicians' differential use of certainty versus uncertainty in prognosis, a conclusion that corroborates the fact that medical control over ethical dilemmas remains even in the context of autonomy. French physicians do not ask parents permission to withdraw care (as expected in a paternalistic context); but symmetrically, American neonatologists (despite the prevailing autonomy model) tend not to ask permission to continue. The study provides an analysis of the making of "ethics", with an emphasis on how decisions are conceptualized as ethical dilemmas. The final conclusion is that the ongoing medical authority on ethics remains the key issue. PMID:15020016

Orfali, Kristina

2004-05-01

246

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

PubMed Central

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

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

2013-01-01

247

The Model-based Approach to Computer-aided Medical Decision  

E-print Network

test therapy selection patient data diagnosis medical knowledge patient data therapy prediction disease; 118 (10): 543-547 Ismael A. Qushmaq, Diane Heels-Ansdell, Deborah J. Cook, Mark B. Loeb, Maureen O'09 ­ p. 10/2 #12;Example: NICE DM2 Guideline DM2 GL: ORAL GLUCOSE CONTROL THERAPIES (2

Lucas, Peter

248

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

Federal Register 2010, 2011, 2012, 2013

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

2012-04-13

249

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

E-print Network

support should be provided to parents and youth throughout the shared decision making process. Examples include the use of parent support specialists, youth peer support specialists, case managers, adult consumers, and informal peer support... becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff...

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

2010-10-01

250

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

Microsoft Academic Search

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

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

2006-01-01

251

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

Microsoft Academic Search

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

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

252

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

E-print Network

Chapter 3 System factors as correlates of medication adherence in HIV and transplant populations Development, content validity and inter-rater reliability testing of the CIMI-BRIGHT: an instrument to assess to conducting systematic reviews. I also want to thank for the friendship that evolved from our collaboration. I

Amrhein, Valentin

253

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

Microsoft Academic Search

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

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

2011-01-01

254

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

PubMed Central

Background Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. Objective To examine the role of advance directives, orally expressed wishes, or the presumed will of patients in a VS for family caregivers' decisions on life-sustaining treatment. Methods and sample A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. Results The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. Conclusions Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning. PMID:22375077

Borasio, Gian Domenico; Jox, Ralf J

2012-01-01

255

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

PubMed

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

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

2013-04-01

256

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

PubMed Central

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

2013-01-01

257

[Medical professionals on the subject of their core values: the importance of practice-based stories and intrinsic motivation].  

PubMed

In the current system for guaranteeing quality of care, emphasis is placed firmly on external control of professionals. We looked for a way to appeal to the intrinsic motivation of medical professionals and to discover what they mean by 'good work'. This was achieved with the aid of reflective sessions using the toolkit 'Good Work': in four sessions three different groups of medical professionals (medical department chairs, residents and interns) from a Dutch university hospital reflected on the topics 'excellence', 'moral responsibility' and 'personal engagement'. The participants exchanged practice-based stories during the sessions. The most important theme was moral responsibility, with its accompanying dilemmas. The sessions gave rise to feelings of mutual acknowledgement, recognition, inspiration and motivation. Sharing meaningful practice-based stories can be considered as a 'moment of learning', strengthening professional identity and stimulating intrinsic motivation. More space for this form of reflection might restore the balance with external control systems. PMID:23484516

Witman, Yolande; van den Kerkhof, Peter C M; Braat, Didi D M

2013-01-01

258

Abstract Making a decision support system for cording on the electronic medical record  

E-print Network

We have done the development of the Electronic Medical Record System. I have done the construction of the data base by XML, for the purpose of that does information interchange especially. We need the standardization of the record is necessary for information interchange. The correspondence to the tag of XML was a subject in the record of SOAP. Thereupon, it made to construct the support system of the diagnosis process which makes the tag of the record. It is operating it as the support system of the diagnosis process of nursing this time.

Yoshinori Yamashita A

259

How do high school students structure an important life decision? A short-term longitudinal study of the college decision-making process  

Microsoft Academic Search

This study details the processes students use and the information they consider as they confront what is likely to be their\\u000a first major life decision. Over the course of a year, 322 college-bound high school students participated in up to three survey\\u000a sessions in which they described their thinking about college decisions. At each session, students rated the frequency with

Kathleen M. Galotti; Melissa C. Mark

1994-01-01

260

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

PubMed Central

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

Moore, G. William; Hutchins, Grover M.

1982-01-01

261

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

PubMed Central

Background The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care. Methods Fifteen GPs, seven nurses and six physiotherapists were selected to achieve varied respondent characteristics including sex, geographical location, service duration and post-graduate specialist training. Constant-comparative qualitative analysis of data from 28 semi-structured telephone interviews was undertaken. Results The majority of respondents supported the extended role concept; however members of each professional group also rejected the notion. Respondents employed four different legitimacy claims to justify their views and define their occupational boundaries in relation to sickness certification practice. Condition-specific legitimacy, the ability to adopt a holistic approach to sickness certification, system efficiency and control-related arguments were used to different degrees by each occupation. Practical suggestions for the extension of the sickness certification role beyond the medical profession are underpinned by the sociological theory of professional identity. Conclusions Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles. There is also a need to consider the impact on, and preferences of, the specific occupations and their respective boundary claims. This paper explores the implications of extending the sick certification role beyond general practice. We conclude that the main policy challenge of such a move is to a) persuade GPs to relinquish this role (or to share it with other professions), and b) to understand the ‘boundary work’ involved. PMID:24884678

2014-01-01

262

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

PubMed Central

Objectives To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end?of?life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. Design and participants Cross?sectional postal survey of doctors in Victoria. Results 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia. Conclusions Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. PMID:18055904

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

2007-01-01

263

Informatica 29 (2005) 4151 41 Complexity-driven Evolution of Decision Graphs  

E-print Network

are becoming a very important part in medical decision making, particularly in those situations where decision of our work. The ways of finding the right decision are as many as the number of people who have to make decisions will become better and more reliable but for the individuals and groups who have to make decisions

Fernandez, Thomas

264

When Patients Lack Capacity: The Roles That Patients with Terminal Diagnoses Would Choose for Their Physicians and Loved Ones in Making Medical Decisions  

Microsoft Academic Search

Current approaches to end-of-life decision making are widely considered inadequate. We explored these complexities by examining how patients with terminal diagnoses would choose to involve their physicians and loved ones in making medical decisions, assuming they were able and unable to participate. Cross-sectional interviews of 130 patients recently diagnosed with fatal conditions were conducted. Patients were recruited from two academic

Marie T. Nolan; Mark Hughes; Derek Paul Narendra; Johanna R. Sood; Peter B. Terry; Alan B. Astrow; Joan Kub; Richard E. Thompson; Daniel P. Sulmasy

2005-01-01

265

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

Microsoft Academic Search

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

Kristina Orfali

2004-01-01

266

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

PubMed Central

Background Together, community-based participatory research (CBPR), usercentered design (UCD) and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. Objectives This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African-American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants’ homes. Methods The overlapping principles of CBPR and UCD used to develop iDecide/Decido include: a user-focused or community approach; equitable academic and community partnership in all study phases; an iterative development process that relies on input from all stakeholders; and a program experience that is specified, adapted, and implemented with the target community. Results Collaboration between community members, researchers, and developers is especially evident in the program’s design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. Conclusions Applying the principles of CBPR and UCD can be successfully employed in developing health information tools that are easy to use and understand, interactive, and target health disparities. PMID:23793248

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

2014-01-01

267

The probability of death in road traffic accidents. How important is a quick medical response?  

PubMed

The number of deaths in road traffic accidents in Spain exceeds three thousand people each year. Public authorities have implemented some policies with the aim to reducing this number. Among them, the improvement of road quality standards and some legal changes encouraging careful driving behavior. However, less attention has been focused on one of the issues that may be critical to reducing the number of fatalities caused by traffic accidents: a quick emergency medical care. In this paper, we use a sample of more than 1400 accidents occurred on Spanish roads in May 2004. Our objective is to analyze to which extent a reduction of the time interval between the crash and the arrival of the emergency services to the crash scene is related to a lower probability of death. Our results suggest that a 10 min reduction of the medical response time can be statistically associated with an average decrease of the probability of death by one third, both on motorways and conventional roads. PMID:20441812

Sánchez-Mangas, Rocío; García-Ferrrer, Antonio; de Juan, Aranzazu; Arroyo, Antonio Martín

2010-07-01

268

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

PubMed

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

Ikeda, Yukihiro

2014-07-01

269

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

PubMed

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

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

2011-01-01

270

Measurement Invariance in Careers ResearchUsing IRT to Study Gender Differences in Medical Students' Specialization Decisions  

Microsoft Academic Search

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 measurement invariance across gender. Additional analyses indicated that compared with men, women

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

2008-01-01

271

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

PubMed Central

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

Manalo, Maria Fidelis C

2013-01-01

272

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

Microsoft Academic Search

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

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

2011-01-01

273

Reformulation of an aminosalicylate: an example of the importance of pill burden on medical compliance rates.  

PubMed

Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon characterized by symptoms of bloody diarrhea and abdominal pain. Although conventional aminosalicylates have been the foundation of treatment of mild to moderate ulcerative colitis for both the induction and maintenance of remission, they are limited in a number of ways, such as which formulation and what dose are optimal, as well as the high pill burden, which often leads to low compliance with these medications. Multi-Matrix System (MMX) mesalamine (SPD476) is a promising new aminosalicylate formulation; it seems to have solved some of the problems of conventional aminosalicylates, as it is effective as a once-daily treatment in high doses and induces both clinical remission and endoscopic mucosal healing. This review article summarizes the data on the use of both conventional aminosalicylates and MMX mesalamine in the treatment of ulcerative colitis. PMID:19357797

Osterman, Mark T; Lichtenstein, Gary R

2009-01-01

274

Snakes of medical importance in India: is the concept of the "Big 4" still relevant and useful?  

PubMed

Snakebites continue to be a major medical concern in India. However, there is very little hard evidence of a numerical nature to enable us to understand which species are responsible for mortality and morbidity. For many decades, the concept of the "Big 4" Snakes of Medical Importance has reflected the view that 4 species are responsible for Indian snakebite mortality--the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), the Russell's viper (Daboia russelii) and the saw-scaled viper (Echis carinatus). However, a recent discovery that another species, the hump-nosed pit viper (Hypnale hypnale), is capable of causing lethal envenomation, and that this problem was being concealed by systematic misidentification of this species as the saw-scaled viper, has necessitated a review of the concept of the "Big 4." The concept of the "Big 4" snakes is reviewed to demonstrate its failure to include all currently known snakes of medical significance in India, and its negative effects related to clinical management of snakebite. The emergence of the hump-nosed pit viper (Hypnale hypnale) as a snake of medical significance has rendered the "Big 4" obsolete in terms of completeness. The concept of the "Big 4" is restricting sound epidemiological work and the development of effective snake antivenoms. It should be replaced by the model introduced in the 1980s by the World Health Organization, which has not received adequate circulation and implementation. PMID:17447706

Simpson, Ian D; Norris, Robert L

2007-01-01

275

"The Ultimate Decision Is Yours": Exploring Patients' Attitudes about the Overuse of Medical Interventions  

PubMed Central

Previous research has found that American patients strongly believe that more testing and more treatment lead to better outcomes and, to a lesser extent, that newer treatments are more effective. We conducted five focus groups with privately insured, healthy, middle-aged Americans (n?=?43) to explore these apparent preferences. Contrary to previous research, an unexpected distinction emerged. Participants placed enormous value on testing and screening, reacting with hostility to guidelines recommending less of either. However, they were suspicious of overmedication. The wariness of pharmaceuticals and enthusiasm for testing and screening both appear to reflect participants’ efforts to take responsibility for their health. But recommendations to test and screen less conflicted with their active, engaged, information-seeking roles. Nonetheless, given patients’ concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less. We close with suggestions about how treatment guidelines can better communicate these connections to patients. Our findings cannot necessarily be generalized beyond privately-insured, healthy, middle-aged Americans. But because we found that, among these individuals, attitudes towards pharmaceuticals differ from attitudes towards testing and screening, we maintain that future research should also distinguish among and compare attitudes towards different types of medical interventions. PMID:23300706

Schleifer, David; Rothman, David J.

2012-01-01

276

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

PubMed Central

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

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

2012-01-01

277

Comprehensive diagnostic testing for stereocilin: an approach for analyzing medically important genes with high homology.  

PubMed

Next-generation sequencing (NGS) technologies have revolutionized genetic testing by enabling simultaneous analysis of unprecedented numbers of genes. However, genes with high-sequence homology pose challenges to current NGS technologies. Because diagnostic sequencing is moving toward exome analysis, knowledge of these homologous genes is essential to avoid false positive and negative results. An example is the STRC gene, one of >70 genes known to contribute to the genetic basis of hearing loss. STRC is 99.6% identical to a pseudogene (pSTRC) and therefore inaccessible to standard NGS methodologies. The STRC locus is also known to be a common site for large deletions. Comprehensive diagnostic testing for inherited hearing loss therefore necessitates a combination of several approaches to avoid pseudogene interference. We have developed a clinical test that combines standard NGS and NGS-based copy number assessment supplemented with a long-range PCR-based Sanger or MiSeq assay to eliminate pseudogene contamination. By using this combination of assays we could identify biallelic STRC variants in 14% (95% CI, 8%-24%) of individuals with isolated nonsyndromic hearing loss who had previously tested negative on our 70-gene hearing loss panel, corresponding to a detection rate of 11.2% (95% CI, 6%-19%) for previously untested patients. This approach has broad applicability because medically significant genes for many disease areas include genes with high-sequence homology. PMID:25157971

Mandelker, Diana; Amr, Sami S; Pugh, Trevor; Gowrisankar, Sivakumar; Shakhbatyan, Rimma; Duffy, Elizabeth; Bowser, Mark; Harrison, Bryan; Lafferty, Katherine; Mahanta, Lisa; Rehm, Heidi L; Funke, Birgit H

2014-11-01

278

Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center  

PubMed Central

Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources. PMID:22011398

2011-01-01

279

AHCPR Meeting Grant for the SMDM Annual Meeting 1990. Symposium and Short Courses on Health Outcomes Research. Annual Meeting of the Society for Medical Decision Making (12th). Held in Boston, Massachusetts on November 11-14, 1990.  

National Technical Information Service (NTIS)

The Twelth Annual Meeting of the Society for Medical Decision Making (SMDM) was held in Boston, Massachusetts from November 11 through 14th, 1990. The focus of the meeting was 'Outcomes Research and Its Interfaces with Medical Decision Making.' Specific o...

E. Shortliffe

1991-01-01

280

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

PubMed Central

Herpotrichiellaceous black yeasts and relatives comprise severe pathogens flanked by nonpathogenic environmental siblings. Reliable identification by conventional methods is notoriously difficult. Molecular identification is hampered by the sequence variability in the internal transcribed spacer (ITS) domain caused by difficult-to-sequence homopolymeric regions and by poor taxonomic attribution of sequences deposited in GenBank. Here, we present a potential solution using short barcode identifiers (27 to 50 bp) based on ITS2 ribosomal DNA (rDNA), which allows unambiguous definition of species-specific fragments. Starting from proven sequences of ex-type and authentic strains, we were able to describe 103 identifiers. Multiple BLAST searches of these proposed barcode identifiers in GenBank revealed uniqueness for 100 taxonomic entities, whereas the three remaining identifiers each matched with two entities, but the species of these identifiers could easily be discriminated by differences in the remaining ITS regions. Using the proposed barcode identifiers, a 4.1-fold increase of 100% matches in GenBank was achieved in comparison to the classical approach using the complete ITS sequences. The proposed barcode identifiers will be made accessible for the diagnostic laboratory in a permanently updated online database, thereby providing a highly practical, reliable, and cost-effective tool for identification of clinically important black yeasts and relatives. PMID:22785187

Heinrichs, Guido; de Hoog, G. Sybren

2012-01-01

281

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

PubMed

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

Moore, G W; Hutchins, G M

1983-01-01

282

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

PubMed Central

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

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

2014-01-01

283

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

Microsoft Academic Search

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

Roland L Weinsier

284

Abstract--One of the most important decisions that needs to be made in a heterogeneous network is how to select the access  

E-print Network

1 Abstract-- One of the most important decisions that needs to be made in a heterogeneous network the various access networks participating in the heterogeneous environment, achieving a user friendly system-- heterogeneous network, network selection, game theory, multi-service network I. INTRODUCTION ECENT years have

Pitsillides, Andreas

285

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

PubMed

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 which constitutes the first step in extracting DNA. Examination by light microscopy showed that grinding with mortar and pestle was the most efficient means of disrupting the rigid fungal cell walls of hyphae and conidia. We then trialled several published DNA isolation protocols to ascertain the most efficient method of extraction. Optimal extraction was achieved by incorporating a lyticase and proteinase K enzymatic digestion step and adapting a DNA extraction procedure from a commercial kit (MO BIO) to generate high yields of high quality DNA from all 16 species. DNA quality was confirmed by the successful PCR amplification of the conserved region of the fungal 18S small-subunit rRNA multicopy gene. PMID:16099520

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

2006-04-01

286

Clinical Decision Support at Intermountain Healthcare  

Microsoft Academic Search

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

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

287

The Impact of Mass Media Health Communication on Health Decision-Making and Medical Advice-Seeking Behavior of U.S. Hispanic Population  

Microsoft Academic Search

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

Maria De Jesus

2012-01-01

288

Delaware Court of Chancery issues two important decisions on stock options backdating, spring-loading and bullet-dodging  

Microsoft Academic Search

Purpose – The purpose of this paper is to describe the implications of two recent decisions in Ryan v. Gifford and In Re Tyson Foods, Inc. concerning stock options backdating, “spring-loading,” and “bullet-dodging.” Design\\/methodology\\/approach – The paper summarizes the facts of the two cases, defines spring-loading and bullet-dodging, and explains how the court held in both cases that plaintiffs had

Stephen Alexander; Warren Rissier; Susan Chun

2007-01-01

289

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

PubMed

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

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

2014-06-01

290

Nurses' attitudes towards end-of-life decisions in medical practice: a nationwide study in Flanders, Belgium  

Microsoft Academic Search

We investigated on a nationwide level the attitudes of nurses towards end-of-life decisions (ELDs) that may hasten death and towards their role in those decisions. We took a representative random sample of 6000 nurses in Flanders, Belgium. Response rate was 62.5%. Most nurses agreed with the practice of withholding\\/withdrawing potentially life-prolonging treatments (93%), with decisions to alleviate symptoms with possible

E. Inghelbrecht; J. J. Bilsen; F. Mortier; L. H. J. Deliens

2009-01-01

291

Critical Decisions under Uncertainty: Representation and Structure  

E-print Network

numerical probabilities, they tend to make errors sufficiently important to result in erroneous medical substantial risk and un­ certainty? In this study, we presented a difficult medical decision to three expert of the alternatives. This strategy results in certain kinds of relevant information being under­ weighted in the final

Kuipers, Benjamin

292

Critical Decisions under Uncertainty: Representation and Structure  

E-print Network

numerical probabilities, they tend to make errors sufficiently important to result in erroneous medical substantial risk and un- certainty? In this study, we presented a difficult medical decision to three expert of the alternatives. This strategy results in certain kinds of relevant information being under- weighted in the final

Kuipers, Benjamin

293

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

PubMed

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

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

2008-06-01

294

[The importance of consultation with (medical) environment in the formation of legal adjustments of specialist doctors' education].  

PubMed

In June 2001, in Warsaw a Country--wide Conference "Doctors' Specializations" took place, which was attended by representatives of 11 medical academies, 20 institutes of the health department and 50 scientific societies. As a result a position was taken which clearly stated that general availability of doctors' specializations, standardisation of qualification and recruitment system, allocation of limits of positions granted to particular specialities as well as (unification) of the accreditation rules for the people authorised to run training are a necessity. Introduction of a "register of natural shifts of specialists", actualisation of specialisation programmes and decentralisation of the doctors' specialising process were also postulated. The Ministry of Health recognized the opinion of the Conference as an environmental consultation and took the above mentioned postulates into consideration in the revised Decree of the Minister of Health concerning specializations of doctors and stomatologists. The new regulations guarantee doctors common availability of postgraduate education, including doctors' specializations, introduce a uniform system of qualification and recruitment of doctors as well as accreditation of trainers. Also the problem of specializations made by private medical practitioners was dealt with. Presenting the content of the Position we would like to emphasize the role and significance of environmental consultation in the creation of legal regulations. It is also pointed out that doctors' associations should join in the preparation of "registers of specialists" and scientific societies should help in updating the syllabus. The Ministry of Health has got an extremely important task of coordinating the initiatives taken in this respect by the (doctors') circles. PMID:17474608

Otto, W?odzimierz; Tulczy?ski, Aleksander

2002-01-01

295

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

PubMed Central

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

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

2013-01-01

296

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

PubMed Central

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

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

2007-01-01

297

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

Federal Register 2010, 2011, 2012, 2013

...AGRICULTURE Animal and Plant Health Inspection Service...the Importation of Wall Rocket Leaves From the United...States AGENCY: Animal and Plant Health Inspection Service...introducing or disseminating plant pests or noxious weeds via the importation of wall rocket leaves from the...

2010-11-23

298

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

Federal Register 2010, 2011, 2012, 2013

...Authorize the Importation of Swiss Chard From Colombia Into the Continental United States AGENCY...continental United States of Swiss chard from Colombia. Based on the findings of a pest risk...via the importation of Swiss chard from Colombia. DATES: Effective: November 20,...

2013-11-20

299

The decision evaluation scales  

Microsoft Academic Search

There are several instruments to assess how patients evaluate their medical treatment choice. These are used to evaluate decision aids. Our objective is to investigate which psychological factors play a role when patients evaluate their medical treatment choices. A pool of 36 items was constructed, covering concepts such as uncertainty about and satisfaction with the decision, informed choice, effective decision

Peep F. M. Stalmeier; Marielle S. Roosmalen; Lia C. G. Verhoef; Josette E. H. M. Hoekstra-Weebers; Jan C. Oosterwijk; Ute Moog; Nicoline Hoogerbrugge; Willem A. J. van Daal

2005-01-01

300

Physician Medical Decision-making at the End of Life in Newborns: Insight Into Implementation at 2 Dutch Centers  

Microsoft Academic Search

OBJECTIVE.Decisions regarding end-of-life care in critically ill newborns in the Neth- erlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and when the implementation of end-of-life decisions, which are based on quality-of-life considerations, takes place. METHODS.We

A. A. Eduard Verhagen; Mark A. H. van der Hoeven; R. Corine van Meerveld; Pieter J. J. Sauer

2009-01-01

301

Medication errors.  

PubMed

Medication errors cause substantial harm to patients. We need good methods for counting errors, and we need to know how errors defined in different ways and ascertained by different methods are related to the harm that patients suffer. As errors arise within the complex and poorly designed systems of hospital and primary care, analysis of the factors that lead to error, for example by failure mode and effects analysis, may encourage better designs and reduce harms. There is almost no information on the best ways to train prescribers to be safe or to design effective computerized decision support to help them, although both are important in reducing medication errors and should be investigated. We also need to know how best to provide patients with the data they need to be part of initiatives for safer prescribing. PMID:22360355

Ferner, Robin E

2012-06-01

302

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

Federal Register 2010, 2011, 2012, 2013

...Based on the findings of a pest risk analysis, which we made available to...based on the findings of a pest- risk analysis, can be safely imported subject...announcing the availability of the pest risk analysis that evaluates the risks...

2010-06-18

303

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

Microsoft Academic Search

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

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

304

Decision theory in maintenance decision making  

Microsoft Academic Search

Advances in decision theory have allowed it to make an effective contribution to the modelling of the decision-making process. Research work on maintenance decision making using decision theory, however, has received little emphasis to date. For this reason, very little has been done in utilizing two very important decision theory topics, namely utility theory and multi-attribute utility theory. Investigates possible

A. T. de Almeida; G. A. Bohoris

1995-01-01

305

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

PubMed Central

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

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

2014-01-01

306

hy, you might ask, is having more than a passing familiarity with research so important in medical edu-  

E-print Network

creative clinical decisions based on solid evidence when symptoms don't fall into common patterns of contemporary medicine. So, once again, what kind of doctor do you want? ---Beginning with the Class of 2008 edu- cation and in the practice of today's medicine? And why do we feel so strongly about this issue

Sibille, Etienne

307

The hospital's fiduciary duty to its medical staff.  

PubMed

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

Vipperman, R M

1987-01-01

308

A survey of decision tree classifier methodology  

NASA Technical Reports Server (NTRS)

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

Safavian, S. Rasoul; Landgrebe, David

1990-01-01

309

A survey of decision tree classifier methodology  

NASA Technical Reports Server (NTRS)

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

Safavian, S. R.; Landgrebe, David

1991-01-01

310

Norms of Decision Making in the ICU: A Case Study of Two Academic Medical Centers at the Extremes of End-of-life Treatment Intensity  

PubMed Central

Purpose To explore norms of decision making regarding life-sustaining treatments (LSTs) at two academic medical centers (AMCs) that contribute to their opposite extremes of end-of-life ICU use. Methods We conducted a 4-week mixed methods case study at each AMC in 2008-2009 involving direct observation of patient care during rounds in the main medical ICU, semi-structured interviews with staff, patients, and families, and collection of artifacts (e.g., patient lists, standardized forms). We compared patterns of decision making regarding initiation, continuation, and withdrawal of LST using tests of proportions and grounded theory analysis of fieldnote and interview transcripts. Results We observed 80 patients (26 [32.5%] ? 65) staffed by 4 attendings, and interviewed 23 staff and 3 patients/families at the low-intensity AMC (LI-AMC), and observed 73 patients (26 [35.6%] ? 65) staffed by 4 attending physicians and interviewed 26 staff and 4 patients/families at the high-intensity AMC (HI-AMC). LST initiation among patients > 65 was similar, except feeding tubes (0% LI-AMC vs. 31% HI-AMC, p=.002). The LI-AMC was more likely to use a time-limited trial of LST, followed by withdrawal (27% vs. 8%, p=.01) and to have a known outcome of death (31% vs. 4%, p<.001). We identified qualitative differences in goals of LST, the determination of “dying,” concern about harms of commission versus omission, and physician self-efficacy for LST decision making. Conclusions Time-limited trials of LST at the LI-AMC and open-ended use of LST at the HI-AMC explain some of the AMCs’ nationally-profiled differences in end-of-life ICU use. PMID:22940755

Barnato, Amber E.; Tate, Judith A.; Rodriguez, Keri L.; Zickmund, Susan L.; Arnold, Robert M.

2013-01-01

311

Important Information About Patient Email As a patient at Columbia University Medical Center, you may request we communicate with you by  

E-print Network

, and / or your phone have inherent privacy risks ­ especially when your email access is provided through yourImportant Information About Patient Email As a patient at Columbia University Medical Center, you may request we communicate with you by electronic mail (email). This Fact Sheet will inform you about

Grishok, Alla

312

Demographic, Belief, and Situational Factors Influencing the Decision to Utilize Emergency Medical Services Among Chest Pain Patients  

Microsoft Academic Search

Background—Empirical evidence suggests that people value emergency medical services (EMS) but that they may not use the service when experiencing chest pain. This study evaluates this phenomenon and the factors associated with the failure to use EMS during a potential cardiac event. Methods and Results—Baseline data were gathered from a randomized, controlled community trial (REACT) that was conducted in 20

Adam L. Brown; N. Clay Mann; Mohamud Daya; Robert Goldberg

2009-01-01

313

Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication  

Microsoft Academic Search

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD\\u000a statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from\\u000a a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that\\u000a they would override a

Jeffrey W. Swanson; S. Van McCrary; Marvin S. Swartz; Richard A. Van Dorn; Eric B. Elbogen

2007-01-01

314

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

PubMed Central

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

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

2014-01-01

315

Authentic Early Experience in Medical Education: A Socio-Cultural Analysis Identifying Important Variables in Learning Interactions within Workplaces  

ERIC Educational Resources Information Center

This paper addresses the question "what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?" AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually…

Yardley, Sarah; Brosnan, Caragh; Richardson, Jane; Hays, Richard

2013-01-01

316

Core personal competencies important to entering students' success in medical school: what are they and how could they be assessed early in the admission process?  

PubMed

Assessing applicants' personal competencies in the admission process has proven difficult because there is not an agreed-on set of personal competencies for entering medical students. In addition, there are questions about the measurement properties and costs of currently available assessment tools. The Association of American Medical College's Innovation Lab Working Group (ILWG) and Admissions Initiative therefore engaged in a multistep, multiyear process to identify personal competencies important to entering students' success in medical school as well as ways to measure them early in the admission process. To identify core personal competencies, they conducted literature reviews, surveyed U.S and Canadian medical school admission officers, and solicited input from the admission community. To identify tools with the potential to provide data in time for pre-interview screening, they reviewed the higher education and employment literature and evaluated tools' psychometric properties, group differences, risk of coaching/faking, likely applicant and admission officer reactions, costs, and scalability. This process resulted in a list of nine core personal competencies rated by stakeholders as very or extremely important for entering medical students: ethical responsibility to self and others; reliability and dependability; service orientation; social skills; capacity for improvement; resilience and adaptability; cultural competence; oral communication; and teamwork. The ILWG's research suggests that some tools hold promise for assessing personal competencies, but the authors caution that none are perfect for all situations. They recommend that multiple tools be used to evaluate information about applicants' personal competencies in deciding whom to interview. PMID:23524928

Koenig, Thomas W; Parrish, Samuel K; Terregino, Carol A; Williams, Joy P; Dunleavy, Dana M; Volsch, Joseph M

2013-05-01

317

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

Microsoft Academic Search

BackgroundWe conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values.Methods and FindingsIn this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers

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

2010-01-01

318

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

The career decision-making process is an exciting one. Parents play an important role-up appointment to review assessment results with a Career Decision Making counselor. Federal Law Federal school students under 18 years old have a legal right to be present in a counseling session. Career

Harms, Kyle E.

319

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

PubMed Central

A method based on grey relational analysis and D-S theory of evidence is proposed for fuzzy soft sets in decision making. Firstly, grey relational analysis is used to calculate grey mean relational degrees and determine uncertain degrees of parameters. Then based on uncertain degrees, suitable mass functions of different independent alternatives with different parameters can be constructed. Next, D-S rule of evidence combination is applied to aggregate these alternatives into a collective alternative. Finally, these alternatives are ranked and the best alternative(s) are obtained. Moreover, the effectiveness and feasibility of this method are demonstrated by comparing with the mean potentiality approach and giving an application to medical diagnosis. PMID:24982687

Xie, Ningxin; Wen, Guoqiu; Li, Zhaowen

2014-01-01

320

Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales  

Microsoft Academic Search

Background contextThe impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed

Anne G. Copay; Steven D. Glassman; Brian R. Subach; Sigurd Berven; Thomas C. Schuler; Leah Y. Carreon

2008-01-01

321

Studies on medically important flies in Thailand. V. On 32 species belonging to the subfamilies Muscinae and Stomoxyinae including the taxonomic keys (Diptera: Muscidae).  

PubMed

Flies from different geographical parts of Thailand were collected to study their medical importance as well as making a zoogeographical study. After examination, 32 species of 10 genera, Orthellia, Mitroplatia, Morellia, Pyrellia, Rypellia, Haematobia, Haematobosca, Stygeromyia, Haematostoma and Stomoxys, belonging to Muscidae were identified and these are reported in this paper. Some of these are newly recorded ones from this country. This study is based on the specimens available in the authors' collection. PMID:282017

Tumrasvin, W; Shinonaga, S

1978-12-01

322

Development of RFLP-PCR method for the identification of medically important Aspergillus species using single restriction enzyme MwoI  

PubMed Central

In this study we attempted to modify the PCR-RFLP method using restriction enzyme MwoI for the identification of medically important Aspergillus species. Our subjects included nine standard Aspergillus species and 205 Aspergillus isolates of approved hospital acquired infections and hospital indoor sources. First of all, Aspergillus isolates were identified in the level of species by using morphologic method. A twenty four hours culture was performed for each isolates to harvest Aspergillus mycelia and then genomic DNA was extracted using Phenol-Chloroform method. PCR-RFLP using single restriction enzyme MwoI was performed in ITS regions of rDNA gene. The electrophoresis data were analyzed and compared with those of morphologic identifications. Total of 205 Aspergillus isolates included 153 (75%) environmental and 52 (25%) clinical isolates. A. flavus was the most frequently isolate in our study (55%), followed by A. niger 65(31.7%), A. fumigatus 18(8.7%), A. nidulans and A. parasiticus 2(1% each). MwoI enabled us to discriminate eight medically important Aspergillus species including A. fumigatus, A. niger, A. flavus as the most common isolated species. PCR-RFLP method using the restriction enzyme MwoI is a rapid and reliable test for identification of at least the most medically important Aspergillus species.

Diba, K.; Mirhendi, H.; Kordbacheh, P.; Rezaie, S.

2014-01-01

323

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

PubMed Central

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

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

2013-01-01

324

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

PubMed Central

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

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

2012-01-01

325

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

PubMed Central

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

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

2014-01-01

326

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

PubMed Central

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

2012-01-01

327

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

PubMed

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

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

2014-01-01

328

Case-based reasoning in Intelligent Health Decision Support Systems.  

PubMed

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

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

2013-01-01

329

WAGING MORAL WAR: THE IMPORTANCE OF PRINCIPAL-AGENT MOTIVATION ALIGNMENT AND CONSTRAINING DOCTRINE ON MORAL U.S. TARGETING DECISIONS  

Microsoft Academic Search

Should U.S. political decision-makers decide to wage a moral war, it is not as easy a merely saying go do it. To ensure moral targeting decisions, American national political leaders must suffer the costs of monitoring in terms of time and money, and provide not only detailed direction, but also constant oversight to ensure objectives are clear and subordinates carry

Tomislav Z. Ruby

2004-01-01

330

Decision analysis: A framework for critical care decision assistance  

Microsoft Academic Search

The ultimate goal of medical computer systems is to help clinicians make good decisions. Such systems must be based on sound\\u000a principles. Decision analysis is a 25-year-old discipline that provides the needed rigorous foundation for decision assistance.\\u000a Decision analysis comprises the philosophy, procedures, and tools that can correct the flaws in existing critical care decision-making\\u000a practice. Intelligent decision systems —

Adam Seiver; Samuel Holtzman

1989-01-01

331

A rapid identification guide for larvae of the most common North American container-inhabiting Aedes species of medical importance.  

PubMed

Mosquitoes are the single most important taxon of arthropods affecting human health globally, and container-inhabiting Aedes are important vectors of arthropod-borne viruses. Desiccation-resistant eggs of container Aedes have facilitated their invasion into new areas, primarily through transportation via the international trade in used tires. The public health threat from an introduced exotic species into a new area is imminent, and proactive measures are needed to identify significant vectors before onset of epidemic disease. In many cases, vector control is the only means to combat exotic diseases. Accurate identification of vectors is crucial to initiate aggressive control measures; however, many vector control personnel are not properly trained to identify introduced species in new geographic areas. We provide updated geographical ranges and a rapid identification guide with detailed larval photographs of the most common container-inhabiting Aedes in North America. Our key includes 5 native species (Aedes atropalpus, Ae. epactius, Ae. hendersoni, Ae. sierrensis, Ae. triseriatus) and 3 invasive species (Ae. aegypti, Ae. albopictus, Ae. japonicus). PMID:24199495

Farajollahi, Ary; Price, Dana C

2013-09-01

332

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

PubMed

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

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

2013-08-01

333

Why my disease is important: metrics of disease occurrence used in the introductory sections of papers in three leading general medical journals in 1993 and 2003  

E-print Network

-value = 0.99) (Table 1). Those claims that expressed the importance of a pro- blem by rank were most likely to use cause of death or membership in a grouping of diseases as the basis for ranking, e.g., “Lung cancer is the most common form of cancer” (Table 2... at the Centers for Disease Control and Prevention. Am J Prev Med 2006, 30:269-76. 7. Lamarre-Cliche M, Castilloux AM, LeLorier J: Association between the burden of disease and research funding by the Medical Research Council of Canada and the National Institutes...

Gouda, Hebe N; Powles, John W

2011-05-23

334

Prognostic importance of myelosuppression during maintenance treatment of lymphoblastic leukaemia. Leukaemia in Childhood Working Party of the Medical Research Council.  

PubMed Central

Children from the UKALL V trial were studied to assess the clinical importance of myelosuppression during uninterrupted 'maintenance' treatment of 'standard risk' lymphoblastic leukaemia. Those receiving daily 6-mercaptopurine and weekly methotrexate who were in first remission 20 months from diagnosis were divided into two groups on the basis of whether or not they had ever had an absolute neutrophil count of less than 0.5 x 10(9)/l recorded during maintenance treatment up to that time. Of 105 evaluable children, 45 (43%) became neutropenic at least once, and 60 (57%) did not. Seven (16%) of the neutropenic group subsequently relapsed compared with 27 (45%) of the remainder. This difference was still significant if the analysis was stratified by total treatment time (two or three years), age, sex, or diagnostic white cell count. Seven (16%) neutropenic children died in remission, compared with one (2%) of the non-neutropenic children. Therapeutic myelosuppression during standard maintenance treatment of 'standard risk' lymphoblastic leukaemia is associated with increased toxicity but a reduced risk of relapse. The unexplained improvement in long term survival in the United Kingdom in recent years may in large part be due to this. PMID:2684039

Dolan, G; Lilleyman, J S; Richards, S M

1989-01-01

335

Accreditation of Medical Laboratories in Europe: Statutory Framework, Current Situation and Perspectives  

Microsoft Academic Search

Due to economic and technological changes in laboratory medicine that go along with new regulatory requirements in the field of medical devices, the implementation of quality systems in medical laboratories has broadly expanded within Europe during the last decade. In the context of the New Approach, the competence of medical laboratories is of decisive importance for premarket conformity assessment of

Folker Spitzenberger; Rainer Edelhäuser

2006-01-01

336

Why my disease is important: metrics of disease occurrence used in the introductory sections of papers in three leading general medical journals in 1993 and 2003  

PubMed Central

Background We assessed the metrics used in claims about disease importance made in the introductory sections of scientific papers published in 1993 and 2003. We were interested in the choice of metric in circumstances where establishing the relative social importance of a disease was, presumptively, a primary objective. Methods This study consisted of a textual examination of the introductory statements from papers retrieved from MEDLINE. Papers were published in the New England Journal of Medicine, The Lancet, and the Journal of the American Medical Association during the first halves of 1993 and 2003, and were selected on the basis of keywords found in a pilot study to be associated with claims about disease importance. Results We found 143 papers in 1993 and 264 papers in 2003 included claims about disease importance in their introductory sections, and characteristics of these claims were abstracted. Of the quotes identified in the papers and articles examined, most used counts, prevalence, or incidence measurements. Some also used risk estimates and economic quantities to convey the importance of the disease. There was no change in the types of metrics used between 1993 and 2003. Very few articles, even in 2003, used metrics that weighted disease onsets by the expected consequent loss of healthy time -- such as years of life lost, quality-adjusted life years, and/or disability-adjusted life years. Conclusions Claims about the relative importance of diseases continued to be overwhelmingly expressed in terms of counts (of deaths and disease onsets) and comparisons of counts, rates, and risks. Where the aim is to convey the burden that a given disease imposes on a society, "event-based" metrics might be less fit for the purpose than "time-based" metrics. More attention is needed to how the choice of metric should relate to the purpose at hand. PMID:21605431

2011-01-01

337

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

ERIC Educational Resources Information Center

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

Haynes, Gill; McCrone, Tami; Wade, Pauline

2013-01-01

338

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

ERIC Educational Resources Information Center

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

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

2007-01-01

339

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

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 ...

Scheufele, Elisabeth Lee

2009-01-01

340

Towards an interoperable information infrastructure providing decision support for genomic medicine  

E-print Network

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.

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

2011-01-01

341

When being ‘tired of living’ plays an important role in a request for euthanasia or physician-assisted suicide: patient characteristics and the physician's decision  

Microsoft Academic Search

Background:In the Netherlands physicians are allowed to grant requests for euthanasia or physician-assisted suicide (EAS) if they meet several requirements of due care. According to jurisprudence, a physician is not allowed to end the life of a patient whose request for EAS is based on being ‘tired of living’, because such a request falls outside the medical domain. Our previous

Mette L. Rurup; Bregje D. Onwuteaka-Philipsen; Marijke C. Jansen-van der Weide; Gerrit van der Wal

2005-01-01

342

Gender enactment at work : The importance of gender and gender-related behavior to person-organizational fit and career decisions  

Microsoft Academic Search

Purpose – This paper seeks to explore gender-related behavior in relation to person-group fit, person-organization fit, and career decisions in order to identify relevant constructs and relationships and present suggestions for further research. Design\\/methodology\\/approach – A model was developed based on a review of several literature bases including gender theories, gender enactment, person-group fit, and person-organization fit. Findings – Propositions

Angela M. Young; David Hurlic

2007-01-01

343

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

PubMed

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

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

2013-03-01

344

Health care M&A advisory alert: Delaware court decision illustrates importance of specialized due diligence on Medicare/Medicaid issues in health care acquisition.  

PubMed

Lawyers and clients contemplating a health care transaction must have a strong working knowledge not only of the applicable law, but also of the provider's needs and culture. As illustrated by a recent Delaware court decision, Interim Healthcare, Inc. et al. v. Spherion Corporation, parties engaging in health care provider acquisitions are well advised to select a team of experienced business and legal advisors with specialized knowledge in health care practices that can find and address any suspicious activities before it is too late. PMID:18975724

Vernaglia, Lawrence W; Herman, Dimitry S; Ziegler, Rachel Schneller

2005-01-01

345

Making Better Decisions  

Microsoft Academic Search

Supply management professionals make things happen. Through your person, your position, and your style you influence other people. Success in your department or organization reflects on your ability to make sound decisions. In fact, in professional life it is often more important to be decisive than it is to be right. Decisiveness inspires support in addition to intimidating the opposition.

Preston J. Leavitt

346

Knowledge-Based Decision Making.  

ERIC Educational Resources Information Center

Argues for the use of knowledge-based decision-making in education. Provides several examples of knowledge-based decision-making from the medical profession. Asserts that knowledge-based decision-making in education, like medicine, is a combination of professional judgment and data. (PKP)

Doyle, Denis P.

2002-01-01

347

Prepared by: Octavio Avila, Director -Student Special Services/STU B1/Los Angeles, CA 90089/Phone: 213.740.4334/E-mail: oavila@usc.edu Decide itMaking an informed decision about a career path after graduation is an important step in the career develop-  

E-print Network

: 213.740.4334/E-mail: oavila@usc.edu Decide itMaking an informed decision about a career path after graduation is an important step in the career develop- ment process. It is good practice to make a decision, alumni, and resources. A select listing of resources is provided below. Decision-Making Internships

Rohs, Remo

348

DEBTSTraTEgiES for rEpaying your STuDEnT loanS LIFE AFTER MIZZOU No matter where you go when you leave Mizzou, you'll face some important life decisions. Don't let  

E-print Network

leave Mizzou, you'll face some important life decisions. Don't let student loan debt hold you back. You. knOw whAT YOU OwE Students often underestimate their outstanding debt, fail to hold onto loan recordsDEBTSTraTEgiES for rEpaying your STuDEnT loanS LIFE AFTER MIZZOU No matter where you go when you

Taylor, Jerry

349

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

PubMed

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

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

2011-07-01

350

End-of-life decisions: Christian perspectives.  

PubMed

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions. PMID:11655316

Stempsey, William E

1997-12-01

351

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

PubMed

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

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

2012-01-01

352

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

Microsoft Academic Search

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

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

353

[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

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

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

1983-12-01

354

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

PubMed Central

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

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

2011-01-01

355

OCER ANNUAL REPORT 2011 Dartmouth Medical School  

E-print Network

and decision-making precepts to medical students who are working to master fundamentals of clinical work-year integrated curriculum on shared decision making. Shared decision making (SDM) involves a set of principles, and support systems of individual patients facing medical decisions. As described in the paper, our curriculum

Myers, Lawrence C.

356

Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning Through the RAI/MDS  

PubMed Central

Purpose:?The Resident Assessment Instrument–Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process.?Design and Methods:?This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada.?Results:?PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care.?Implications:?Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care. PMID:20026525

Kontos, Pia C.; Miller, Karen-Lee; Mitchell, Gail J.

2010-01-01

357

Medical confidence.  

PubMed Central

If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves. PMID:3981576

Havard, J

1985-01-01

358

Patients with eventually fatal chronic illness: their importance within a national research agenda on improving patient safety and reducing medical errors.  

PubMed

In September 2000, the Quality Interagency Coordination (QuIC) Task Force invited the RAND Center to Improve Care of the Dying and Americans for Better Care of the Dying to testify at its National Summit on Medical Errors and Patient Safety Research. In their testimony, the organizations urged the QuIC to consider the special vulnerability and needs of individuals at the end of life in crafting their research agenda. Patients at the end of life are particularly vulnerable to medical errors and other lapses in patient safety for three reasons: (1) substantially increased exposure to medical errors; (2) more serious effects from errors because they cannot protect themselves from risks and have less reserve with which to overcome the effects; and (3) pervasive patterns of care that run counter to well-substantiated evidence-based practices. A national research agenda on preventing medical errors and increasing patient safety must include a focus on how to improve shortcomings affecting these vulnerable patients. The QuIC's preliminary research agenda, released in October 2000, included patients coming to the end of life. The Agency for Healthcare Research and Quality, the lead federal agency for researching patient safety and medical errors, released between November 2000 and April 2001 six Requests for Applications for research into medical errors. PMID:11596543

Myers, S S; Lynn, J

2001-01-01

359

The influence of socio-demographic features and rotation of plastic, reconstructive and aesthetic surgery on the attitudes of Turkish medical students’ choice of careers  

Microsoft Academic Search

The choice of specialization branch is one of the most important decisions for the medical students during the medical education all over the world. It is known that short rotation period causes insufficient information about the subspecialty branches of medicine during the rotation period of medical education. The objective of the present study was to examine the tendency of students

Hatice Odaci; Ethem Guneren; Yüksel Bek

2005-01-01

360

Examining the Effects of Differential Item (Functioning and Differential) Test Functioning on Selection Decisions: When Are Statistically Significant Effects Practically Important?  

Microsoft Academic Search

Item response theory differential test functioning (DTF) methods are often used to address issues in personnel selection, but the results are frequently difficult to interpret because statistically significant findings may have little practical importance. In this article, the authors proposed 2 effect size measures for DTF. One related DTF to mean raw score differences across groups; the other related DTF

Stephen Stark; Oleksandr S. Chernyshenko; Fritz Drasgow

2004-01-01

361

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

E-print Network

General Guide to Advance Directives and Resuscitative Status - Health care consumers and providers information is located in a red page protector in front of in-patient chart. Advance Directives (AD) ·An of Attorney ­MPOA-(names another person to make health care decisions) ·We give AD form and explanatory

Acton, Scott

362

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

Code of Federal Regulations, 2011 CFR

...diagnosis, prognosis, or treatment of a patient that is maintained...activity relating to drug abuse, alcoholism or alcohol abuse, infection...the given record necessary for the surrogate to make an informed...decision regarding the patient's treatment. (Authority: 38...

2011-07-01

363

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

Code of Federal Regulations, 2012 CFR

...diagnosis, prognosis, or treatment of a patient that is maintained...activity relating to drug abuse, alcoholism or alcohol abuse, infection...the given record necessary for the surrogate to make an informed...decision regarding the patient's treatment. (Authority: 38...

2012-07-01

364

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

Code of Federal Regulations, 2013 CFR

...diagnosis, prognosis, or treatment of a patient that is maintained...activity relating to drug abuse, alcoholism or alcohol abuse, infection...the given record necessary for the surrogate to make an informed...decision regarding the patient's treatment. (Authority: 38...

2013-07-01

365

Snake venomics and antivenomics of Bothrops colombiensis, a medically important pitviper of the Bothrops atrox-asper complex endemic to Venezuela: Contributing to its taxonomy and snakebite management.  

PubMed

The taxonomic status of the medically important pitviper of the Bothrops atrox-asper complex endemic to Venezuela, which has been classified as Bothrops colombiensis, remains incertae cedis. To help resolving this question, the venom proteome of B. colombiensis was characterized by reverse-phase HPLC fractionation followed by analysis of each chromatographic fraction by SDS-PAGE, N-terminal sequencing, MALDI-TOF mass fingerprinting, and collision-induced dissociation tandem mass spectrometry of tryptic peptides. The venom contained proteins belonging to 8 types of families. PI Zn(2+)-metalloproteinases and K49 PLA(2) molecules comprise over 65% of the venom proteins. Other venom protein families comprised PIII Zn(2+)-metalloproteinases (11.3%), D49 PLA(2)s (10.2%), l-amino acid oxidase (5.7%), the medium-sized disintegrin colombistatin (5.6%), serine proteinases (1%), bradykinin-potentiating peptides (0.8%), a DC-fragment (0.5%), and a CRISP protein (0.1%). A comparison of the venom proteomes of B. colombiensis and B. atrox did not support the suggested synonymy between these two species. The closest homologues to B. colombiensis venom proteins appeared to be toxins from B. asper. A rough estimation of the similarity between the venoms of B. colombiensis and B. asper indicated that these species share approximately 65-70% of their venom proteomes. The close kinship of B. colombiensis and B. asper points at the ancestor of B. colombiensis as the founding Central American B. asper ancestor. This finding may be relevant for reconstructing the natural history and cladogenesis of Bothrops. Further, the virtually indistinguishable immunological crossreactivity of a Venezuelan ABC antiserum (raised against a mixture of B. colombiensis and Crotalus durissus cumanensis venoms) and the Costa Rican ICP polyvalent antivenom (generated against a mixture of B. asper, Crotalus simus, and Lachesis stenophrys venoms) towards the venoms of B. colombiensis and B. asper, supports this view and suggests the possibility of indistinctly using these antivenoms for the management of snakebites by any of these Bothrops species. However, our analyses also evidenced the limited recognition capability or avidity of these antivenoms towards a number of B. colombiensis and B. asper venom components, most notably medium-size disintegrins, bradykinin-potentiating peptides, PLA(2) proteins, and PI Zn(2+)-metalloproteinases. PMID:19457355

Calvete, Juan J; Borges, Adolfo; Segura, Alvaro; Flores-Díaz, Marietta; Alape-Girón, Alberto; Gutiérrez, José María; Diez, Nardy; De Sousa, Leonardo; Kiriakos, Demetrio; Sánchez, Eladio; Faks, José G; Escolano, José; Sanz, Libia

2009-03-01

366

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

PubMed Central

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

Burgess, Diana J.

2014-01-01

367

Medical Issues: Nutrition  

MedlinePLUS

... support & care > living with sma > medical issues > nutrition Nutrition Good nutrition is essential to health and growth. ... must make decisions based on their own needs. Nutrition Considerations Since we are still waiting for clinical ...

368

Optimizing Medical Data Quality Based on Multiagent Web Service Framework  

Microsoft Academic Search

One of the most important issues in e-healthcare information systems is to optimize the medical data quality extracted from distributed and heterogeneous environments, which can extremely improve diagnostic and treatment decision making. This paper proposes a multiagent web service framework based on service-oriented architecture for the optimization of medical data quality in the e-healthcare information system. Based on the design

Ching-Seh Wu; Ibrahim Khoury; Hemant Shah

2012-01-01

369

End-of-Life Decisions  

MedlinePLUS

... circumstances. End-of-Life Decisions What is an advance directive? “Advance directive” is a general term that describes ... use of medical treatments. Why bother with an advance directive if I want my family to make the ...

370

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

Microsoft Academic Search

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

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

2009-01-01

371

Medical Acoustics  

NASA Astrophysics Data System (ADS)

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.

Beach, Kirk; Dunmire, Barbrina

372

Evolution's Importance to Society  

NSDL National Science Digital Library

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

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

2005-07-01

373

Measuring Shared Decision Making in Psychiatric Care  

PubMed Central

Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts. PMID:22854725

Salyers, Michelle P.; Matthias, Marianne S.; Fukui, Sadaaki; Holter, Mark C.; Collins, Linda; Rose, Nichole; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

374

Designing for Decision Making  

ERIC Educational Resources Information Center

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

Jonassen, David H.

2012-01-01

375

Medical ethics--a Christian view.  

PubMed Central

All ethics has a religious dimension. This paper considers how specific Christian insights concerning death, suffering, human nature and human creatureliness can help to expose more fully the moral issues at stake in some of the dilemmas faced by doctors. It ends by acknowledging the crushing burden of decision-making which rests on many in the medical profession, and indicates the importance of religious resources in dealing with this. PMID:3981562

Habgood, J S

1985-01-01

376

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

PubMed Central

Although progress has been made in the treatment of alcohol use disorders, more effective treatments are needed. In the last 15 years, several medications have been approved for use in alcohol dependence but have only limited effectiveness and clinical acceptance. While academics have developed some ‘standards' for the performance of clinical trials for alcohol dependence, they vary considerably, in the type of populations to be studied, the length of trials, salient outcome measures, and data analyses to be used (especially in the treatment of missing data). This variability impedes the commercial development of medications to treat alcohol dependence. Using a model similar to that used to develop an expert consensus for medications to improve cognitive aspects of schizophrenia (MATRICS) and in the treatment of pain (IMMPACT), a workgroup has been formed under the auspices of ACNP, known as the ACTIVE (Alcohol Clinical Trials Initiative) group, to evaluate data from completed clinical trials to develop a consensus on key issues in the conduct of clinical trials in alcohol dependence. ACTIVE consists of academic experts, industry representatives, and staff from the Food and Drug Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. This paper describes the rationale behind the effort, its history and organization, and initial key questions that have been identified as the primary focus of the workgroup. Future papers will focus on knowledge gained from the re-analysis of completed trials and provide consensus opinions regarding the performance of clinical trials that might be undertaken in the future. PMID:21900883

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

2012-01-01

377

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

PubMed

Although progress has been made in the treatment of alcohol use disorders, more effective treatments are needed. In the last 15 years, several medications have been approved for use in alcohol dependence but have only limited effectiveness and clinical acceptance. While academics have developed some 'standards' for the performance of clinical trials for alcohol dependence, they vary considerably, in the type of populations to be studied, the length of trials, salient outcome measures, and data analyses to be used (especially in the treatment of missing data). This variability impedes the commercial development of medications to treat alcohol dependence. Using a model similar to that used to develop an expert consensus for medications to improve cognitive aspects of schizophrenia (MATRICS) and in the treatment of pain (IMMPACT), a workgroup has been formed under the auspices of ACNP, known as the ACTIVE (Alcohol Clinical Trials Initiative) group, to evaluate data from completed clinical trials to develop a consensus on key issues in the conduct of clinical trials in alcohol dependence. ACTIVE consists of academic experts, industry representatives, and staff from the Food and Drug Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. This paper describes the rationale behind the effort, its history and organization, and initial key questions that have been identified as the primary focus of the workgroup. Future papers will focus on knowledge gained from the re-analysis of completed trials and provide consensus opinions regarding the performance of clinical trials that might be undertaken in the future. PMID:21900883

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

2012-01-01

378

[Importance of information from the Department of Clinical Laboratory in the treatment of infectious diseases--from the viewpoint of medical safety].  

PubMed

For the report of microbiological laboratory staff to be made more effective, developments of the entire support systems regarding hospital infection control are essential. Therefore, it should be carried out side by side with the development of a guideline support system, proper antibiotic use, a consultation system, as well as education and training of medical staff. As measures of the Department of Clinical Laboratory, antibiograms are conducted periodically and a blood culture report is taken as a 24-hour system. In addition, the blood culture report is transmitted to ensure that the attending physician performs activities according to the electronic medical records as well as through contact by telephone. In addition, the ICD reported during the day on behalf of the laboratory technician, at the stage of the first report, and the estimation of bacterial species and suggestions for additional testing were performed. For the measures described above, the current rate of two sets of blood cultures taken comprises over 90%. In addition, the use of carbapenems was reduced by half. As the result, the rate of imipenem-resistant Pseudomonas aeruginosa was reduced by about 40% in 2006 to 20% in 2010, and the development of multi-drug resistant bacteria was markedly reduced. PMID:23323468

Kondo, Shigemi; Miida, Takashi

2012-10-01

379

Medical Student Resource Guide  

E-print Network

. With this in mind, interprofessional education is another important aspect of medical education. We strive20132014 O.H.S.U. Medical Student Resource Guide #12;2013-2014 Medical Student Resource Guide 1 Oregon Health & Science University School of Medicine - Medical Student Resource Guide Welcome

Chapman, Michael S.

380

Medical Student Procedure Guide  

E-print Network

. With this in mind, interprofessional education is another important aspect of medical education. We strive20132014 O.H.S.U. Medical Student Procedure Guide #12;2013-2014 Medical Student Procedure Guide 1 Oregon Health & Science University School of Medicine - Medical Student Procedure Guide Welcome

Chapman, Michael S.

381

Redundant visual information enhances group decisions.  

PubMed

Important perceptual judgments are often made by combining the opinions of several individuals to make a collective decision, such as when teams of physicians make diagnoses based on medical images. Although group-level decisions are generally superior to the decisions made by individuals, it remains unclear whether collective decision making is most effective when information is redundantly provided to all individuals within a group, or when each individual is responsible for only a portion of the total information. Here, we test this idea by having individuals and groups of different sizes make perceptual judgments about the presence of a weak visual signal. We found that groups viewing the entirety of information significantly outperformed groups that viewed limited portions of information, and that this difference in performance could be accounted for by a simple internal noise-averaging model. However, noise averaging alone was insufficient to account for improvements in individual and group-level performance as group size varied. These results indicate that sharing redundant information can enhance the quality of individual perceptual judgments and lead to better group decision making than dividing information across members of a group. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:25365569

Barr, Shawn; Gold, Jason M

2014-12-01

382

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2011 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2011-10-01

383

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2010 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2010-10-01

384

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2012 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2012-10-01

385

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2013 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2013-10-01

386

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2013 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2013-10-01

387

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2010 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2010-10-01

388

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2012 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2012-10-01

389

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.  

Code of Federal Regulations, 2011 CFR

...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control...2 working days after the date of the final decision. UR Plan: Medical Care Evaluation...

2011-10-01

390

The functions of medical care.  

PubMed Central

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

Childs, A W

1975-01-01

391

The physically disabled medical student.  

PubMed

Previous literature on physically disabled medical students is reviewed, and its implications are examined. Although they encounter significant obstacles to their acceptance into medical school due to stereotyped attitudes, environmental barriers, and recent legal decisions, these students are nevertheless applying to and successfully completing medical school. Common coping strategies for students with mobility, visual, and hearing impairments are briefly outlined. PMID:2962981

Stiens, S

1987-01-01

392

Decision to Enter Pulmonology: Motives and Implications.  

ERIC Educational Resources Information Center

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

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

1978-01-01

393

Reassessing Accuracy Rates for Median Decision Procedures  

E-print Network

decision making in the context of radiological determi- nation of asbestosis by three B-readers. Our into the analysis of experts' judgments when using them to make final diagnosis and intervention decisions of a decision procedure in which three medical practitioners together determine the diagnosis of a patient

Reale, Marco

394

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

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

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

2014-01-01

395

Decision-making in nephrology: shared decision making?  

Microsoft Academic Search

Shared decision-making is considered an important ideal for physician–patient interaction. The ideal states that health-related values should be discussed together. It raises two questions: (a) for which decisions is the ideal of shared decision-making relevant? (b) Which aspects of treatment should be discussed? The nephrological practice under consideration in this article answers question (a) as follows: decisions about the type

Annique Lelie

2000-01-01

396

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

SciTech Connect

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

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

2011-11-15

397

Medical virology in Malaysia  

Microsoft Academic Search

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

Kaw Bing Chua

2009-01-01

398

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 ...

399

Decision Making in Action  

NASA Technical Reports Server (NTRS)

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

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

1994-01-01

400

Medication Adherence Behavior and Priorities Among Older Adults With CKD: A Semistructured Interview Study  

PubMed Central

Background Older adults with chronic kidney disease (CKD) typically take more than five medications and have multiple prescribing physicians. Little however is known about how they prioritize their medical conditions or decide which medications to take. Methods Semistructured interviews (average length 40 minutes) with twenty community-dwelling adults with CKD stages 3-5D, receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients’ decisions regarding medication prioritization, understanding, and adherence decisions. Results Participants (age range, 55–84 years; mean, 72) took 5–14 prescribed medications, had 2–9 physicians, and 5–11 comorbid conditions. All had assigned implicit priorities to their medications. While the majority expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there was often substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and on the barriers (physical, logistic, or financial) to taking the prescribed drug. Side effects of medications were common and anxiety-provoking, but discussions with the prescribing physician were often delayed or unfulfilling for the patient. Conclusions Polypharmacy in CKD patients leads to complex medication choices and adherence behaviors in this population. Most of the patients we interviewed had beliefs or priorities that were non-concordant with conventional medical opinion, but patients rarely discussed these beliefs and priorities, or the resultant poor medication adherence, with their physicians. Further study is needed to provide quantitative data on the magnitude of adherence barriers. It is likely that more effective communication about medication taking could improve patients’ health outcomes and reduce potential adverse drug events. PMID:20674113

Rifkin, Dena E.; Laws, M. Barton; Rao, Madhumathi; Balakrishnan, V. S.; Sarnak, Mark J.; Wilson, Ira B.

2010-01-01

401

Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults  

PubMed Central

Importance Hospitalized older adults often lack decisional capacity, but outside of the intensive care unit (ICU) and end-of-life care settings, little is known about the frequency of decision making by family members or other surrogates or its implications for hospital care. Objective To describe the scope of surrogate decision making, the hospital course and outcomes for older adults. Design Prospective, observational study. Setting Medical and Medical ICU services of two hospitals in one Midwest city. Participants 1083 hospitalized older adults identified by their physicians as requiring major medical decisions. Measures Clinical characteristics, hospital outcomes, nature of major medical decisions and surrogate involvement. Results Based on physician reports at 48 hours of hospitalization, 47.4% (44.4%–50.4%) of older adults required at least some surrogate involvement including 23.0% (20.6% – 25.6%) with all decisions made by a surrogate. Among patients who required a surrogate for at least one decision within 48 hours, 57.2% required decisions about life sustaining care (mostly addressing code status), 48.6% about procedures and surgeries and 46.9% about discharge planning. Patients who required a surrogate experienced a more complex hospital course with greater use of ventilators (2.5% patients who made decisions, 13.2% patients who required any surrogate decisions, p<0.0001), artificial nutrition (1.7% patient, 14.4% surrogate, p<0.0001) and greater length of stay (median 6 days patient, 7 days surrogate, p<0.0001). They were more likely to be discharged to an extended care facility (21.2% patient, 40.9% surrogate, p<0.0001), and had higher hospital mortality (0.0% patient; 5.9% surrogate, p<0.0001). Most surrogates were daughters (58.9%), sons (25.0%) or spouses (20.6%). Overall, only 7.4% had a living will and 25.0% a health care representative document in the medical record. Conclusion Surrogate decision making occurs for nearly half of hospitalized older adults and includes both complete decision making by the surrogate and joint decision making by the patient and surrogate. Surrogates commonly face a broad range of decisions in both the ICU and the hospital ward setting. Hospital functions should be redesigned to account for the large and growing role of surrogates and to support surrogates as they make health care decisions. PMID:24445375

Torke, Alexia M.; Sachs, Greg A.; Helft, Paul R.; Montz, Kianna; Hui, Siu L.; Slaven, James E.; Callahan, Christopher M.

2014-01-01

402

Simulation in medical education.  

PubMed

Studies in cognitive psychology inform us that the recall of information and its application are best when it is taught and rehearsed in environments similar to workplace. The healthcare professions are heavily task- and performance-based where non-technical skills, decision making and clinical reasoning are important alongside integrity, empathy and compassion. Most of these attributes are difficult to teach and assess in the traditional classrooms. Enhanced patient safety on one hand has to be the ultimate outcome of any medical curriculum while on the other hand, it itself can be potentially compromised in an apprenticeship-based model of medical education. A range of simulation techniques are very well placed to be used alongside clinical placements. These can be employed to enhance learning of healthcare professionals in safe environments, without compromising the patient safety, while maintaining a high degree of realism. This article builds an argument for the use of simulation techniques to enhance patient safety and points the readers to the AMEE Guide No. 50 on simulation, which is written as a practical manual on building a simulation programme in healthcare education. PMID:21182376

Khan, Kamran; Pattison, Tim; Sherwood, Morgan

2011-01-01

403

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

ERIC Educational Resources Information Center

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

Golden, Shawn M.

2009-01-01

404

Medical ethics in cross-cultural and multi-cultural perspectives.  

PubMed

Medical ethics have usually been ignored in comparative studies of medical systems; they are almost exclusively Western and based on the technocratic culture of practitioners of cosmopolitan medicine. Important values of heterogeneous and homogeneous cultural systems may appropriately be studied in a medical context. Cross-cultural medical anthropological studies have not dealt extensively with medical ethics, and have not systematically examined the values involved in decision-making by healers, although the choices made by patients have been emphasized. Studies of decision-making in the context of healing can be useful in investigations of the operation of value systems and of conflicts and changes in such systems. Western examples of ethical conflicts and bases of choice in regulation of the profession, individual vs. social obligation, obligation of the practitioner to take action, allocation of scarce resources, and the patient's right to information suggest general problems that exist in most medical systems regardless of the level of technological development or the concepts of disease prevention and cure. Ethical conflicts in medical care allow study of value ranking in decision-making. Questionnaires have been the most common method for studying ethical questions in Western medical settings, and such questionnaires could be adapted for use cross-culturally. Medical ethics in non-Western settings may also be investigated by looking at "trouble cases," by participant observation, and by intensive interviewing. PMID:7209599

Kunstadter, P

1980-11-01

405

Bioethical principles and care-based ethics in medical futility.  

PubMed

The process for solving ethical, legal, and moral dilemmas in the field of medicine is complex and time consuming. Frequently, the constraint of time forces the healthcare professional to make decisions quickly. When working with the cancer population, one faces, additionally, the dilemma of medical futility. Guidelines from the bioethical principles of autonomy, beneficence, nonmalificence, and justice help to address this dilemma. The use of care-based ethics allows healthcare professionals to establish trust, thus enabling patients and their families to be open to change and make realistic decisions. This article contrasts care-based ethical theory with justice-based ethical theory, using a case presentation to illustrate the importance of care-based ethics in making a moral decision to forgo medically futile treatment. PMID:8788770

Laffey, J

1996-01-01

406

Heuristic decision making in medicine  

PubMed Central

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

Marewski, Julian N.; Gigerenzer, Gerd

2012-01-01

407

Medication errors: pharmacovigilance centres in detection and prevention  

PubMed Central

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

Bencheikh, Rachida Soulaymani; Benabdallah, Ghita

2009-01-01

408

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.

1997-01-01

409

Clinical Decision-Support Systems  

Microsoft Academic Search

Clinical decision-support systems (CDSS) apply best-known medical knowledge to patient data for the purpose of generating case-specific decision-support advice. CDSS forms the cornerstone of health informatics research and practice. It is an embedded concept in almost all major clinical information systems and plays an instrumental role in helping health care achieve its ultimate goal: providing high- quality patient care while,

Kai Zheng

410

Medical Licensing Examinations in the United States.  

ERIC Educational Resources Information Center

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

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

2002-01-01

411

History of Medical Physics.  

ERIC Educational Resources Information Center

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

Laughlin, John S.

1983-01-01

412

Military decision modeling with conflict analysis  

Microsoft Academic Search

Conflict analysis is a powerful tool to model a conflict. Military decision is a dynamic decision process. The information perceived by the army commanders is uncertain and dynamic. The question of how to express and utilize uncertain information is a very important factor in decision making. In this paper, the use of conflict analysis to model the dynamic military decision

Li Ming

1996-01-01

413

20 CFR 404.2109 - Responsibility for making payment decisions.  

Code of Federal Regulations, 2013 CFR

...false Responsibility for making payment decisions. 404.2109 Section 404...2109 Responsibility for making payment decisions. The Commissioner will decide...program; (c) If and when medical recovery has occurred;...

2013-04-01

414

38 CFR 3.105 - Revision of decisions.  

Code of Federal Regulations, 2013 CFR

...to Central Office. However, a decision may be revised under § 3.2600...physician or physicians or other proper medical authority certifies that...adverse action and who will bear the decision-making responsibility. If a...

2013-07-01

415

20 CFR 404.2109 - Responsibility for making payment decisions.  

...false Responsibility for making payment decisions. 404.2109 Section 404...2109 Responsibility for making payment decisions. The Commissioner will decide...program; (c) If and when medical recovery has occurred;...

2014-04-01

416

38 CFR 3.105 - Revision of decisions.  

...to Central Office. However, a decision may be revised under § 3.2600...physician or physicians or other proper medical authority certifies that...adverse action and who will bear the decision-making responsibility. If a...

2014-07-01

417

38 CFR 3.105 - Revision of decisions.  

Code of Federal Regulations, 2012 CFR

...to Central Office. However, a decision may be revised under § 3.2600...physician or physicians or other proper medical authority certifies that...adverse action and who will bear the decision-making responsibility. If a...

2012-07-01

418

20 CFR 416.2209 - Responsibility for making payment decisions.  

Code of Federal Regulations, 2013 CFR

...false Responsibility for making payment decisions. 416.2209 Section 416...2209 Responsibility for making payment decisions. The Commissioner will...program; (c) If and when medical recovery has occurred;...

2013-04-01

419

20 CFR 416.2209 - Responsibility for making payment decisions.  

Code of Federal Regulations, 2012 CFR

...false Responsibility for making payment decisions. 416.2209 Section 416...2209 Responsibility for making payment decisions. The Commissioner will...program; (c) If and when medical recovery has occurred;...

2012-04-01

420

20 CFR 404.2109 - Responsibility for making payment decisions.  

Code of Federal Regulations, 2012 CFR

...false Responsibility for making payment decisions. 404.2109 Section 404...2109 Responsibility for making payment decisions. The Commissioner will decide...program; (c) If and when medical recovery has occurred;...

2012-04-01

421

20 CFR 416.2209 - Responsibility for making payment decisions.  

...false Responsibility for making payment decisions. 416.2209 Section 416...2209 Responsibility for making payment decisions. The Commissioner will...program; (c) If and when medical recovery has occurred;...

2014-04-01

422

Systematic assessment of benefits and risks: study protocol for a multi-criteria decision analysis using the Analytic Hierarchy Process for comparative effectiveness research  

PubMed Central

Background: Regulatory decision-making involves assessment of risks and benefits of medications at the time of approval or when relevant safety concerns arise with a medication. The Analytic Hierarchy Process (AHP) facilitates decision-making in complex situations involving tradeoffs by considering risks and benefits of alternatives. The AHP allows a more structured method of synthesizing and understanding evidence in the context of importance assigned to outcomes. Our objective is to evaluate the use of an AHP in a simulated committee setting selecting oral medications for type 2 diabetes.  Methods: This study protocol describes the AHP in five sequential steps using a small group of diabetes experts representing various clinical disciplines. The first step will involve defining the goal of the decision and developing the AHP model. In the next step, we will collect information about how well alternatives are expected to fulfill the decision criteria. In the third step, we will compare the ability of the alternatives to fulfill the criteria and judge the importance of eight criteria relative to the decision goal of the optimal medication choice for type 2 diabetes. We will use pairwise comparisons to sequentially compare the pairs of alternative options regarding their ability to fulfill the criteria. In the fourth step, the scales created in the third step will be combined to create a summary score indicating how well the alternatives met the decision goal. The resulting scores will be expressed as percentages and will indicate the alternative medications' relative abilities to fulfill the decision goal. The fifth step will consist of sensitivity analyses to explore the effects of changing the estimates. We will also conduct a cognitive interview and process evaluation.  Discussion: Multi-criteria decision analysis using the AHP will aid, support and enhance the ability of decision makers to make evidence-based informed decisions consistent with their values and preferences. PMID:24555077

Singh, Sonal

2013-01-01

423

An Ontology-Based Electronic Medical Record for Chronic Disease Management  

Microsoft Academic Search

Effective chronic disease management ensures better treatment and reduces medical costs. Representing knowledge through building an ontology for Electronic Medical Records (EMRs) is important to achieve semantic interoperability among healthcare information systems and to better execute decision support systems. In this paper, an ontology-based EMR focusing on Chronic Disease Management is proposed. The W3C Computer-based Patient Record ontology [7] is

Ashraf Mohammed Iqbal; Michael A. Shepherd; Syed Sibte Raza Abidi

2011-01-01

424

Medication Errors  

MedlinePLUS

... Coordinating Council for Medication Error Reporting and Prevention Medication Errors Within the Center for Drug Evaluation and ... broader product safety issues. Drug Products Associated with Medication Errors FDA Drug Safety Communication: Serious medication errors ...

425

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

PubMed Central

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

2014-01-01

426

End-of-life decision-making in India.  

PubMed

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

Freckelton, Ian

2014-09-01

427

[Importance of pharmacovigilance in current medical practice].  

PubMed

Adverse drug reactions (ADRs) are cause of significant morbi-mortality They are between the fourth and sixth cause of mortality in developed countries and cause nearly 12% of hospitalizations. The objective of this publication was to analyze the incidence of ADRs in a tertiary care hospital in Buenos Aires City. The hospital phamacovigilance database for the period June 2008- February 2012, was analyzed. The Naranjo score was applied to assess drug causality. We consider serious an ADRs when it potentially compromised life, induced hospitalization or prolonged it, caused discapacity, teratogenesis or death. In this period, a total of 2420 ADRs were detected: 469 (19.38%; CI 95%: 17.80 - 20.95) were serious, mainly because they induced hospitalization (n = 287). There were 14 ADRs- related deaths. Cardiovascular and neuropsychiatric drugs, antibiotics and corticoids were those most frequently related to toxicity. Endocrine-metabolic disorders, hepatotoxicity, nephrotoxicity and pharmacodermy were the most frequently involved. Among the ADR most frequently associated to hospitalization were Immunosuppressant-associated severe infections and upper gastrointestinal bleeding related to oral anticoagulants and non steroids anti-inflammatory drugs. The ADRs incidence in hospitalized patients and ADRs related hospital admissions were considered relatively high. Drugs involved were similar to those reported in the international bibliography except for the higher incidence of immunosuppressants related admissions here observed. PMID:23335704

Ponte, Marcelo L; Ragusa, Martín; Armenteros, Christian; Wachs, Adolfo

2013-01-01

428

Overview of medically important antifungal azole derivatives.  

PubMed Central

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

Fromtling, R A

1988-01-01

429

Medical specialty considerations by medical students early in their clinical experience  

PubMed Central

Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83%) questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in a large university medical center. Only 5% considered it important to do their residency in the country's peripheral areas, while 30% reported interest in a residency in the country's center. Conclusions The fifth year of a six-year medical school is an opportune time to provide students with information and guidance on the various specialties and selecting a residency program as they begin to solidify their perceptions and ideas about the various specialties. This study serves as an impetus to medical educators and healthcare leaders to become interested in students' career selection. PMID:22913658

2012-01-01

430

A Corpus-Based Syntactic Study of Medical Research Article Titles  

ERIC Educational Resources Information Center

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

Wang, Yan; Bai, Yongquan

2007-01-01

431

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

ERIC Educational Resources Information Center

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

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

2014-01-01

432

Fingernail Injuries and NASA's Integrated Medical Model  

NASA Technical Reports Server (NTRS)

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

Kerstman, Eric; Butler, Doug

2008-01-01

433

Motivation in medical students  

Microsoft Academic Search

Introduction The importance of motivation in learning behaviour and education is well-researched and proven in general education, but much less in medical education. There is sometimes focus on increasing the quantity of motivation, but the how and why need more evidence. The aims of this thesis were to gather insights and investigate medical students’ motivation, particularly the importance of quality

R. A. Kusurkar

2012-01-01

434

49 CFR 391.47 - Resolution of conflicts of medical evaluation.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Resolution of conflicts of medical evaluation. ...391.47 Resolution of conflicts of medical evaluation. ...field in which the medical conflict arose. The specialist should...explaining in detail why the decision of the medical...

2012-10-01

435

49 CFR 391.47 - Resolution of conflicts of medical evaluation.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Resolution of conflicts of medical evaluation. ...391.47 Resolution of conflicts of medical evaluation. ...field in which the medical conflict arose. The specialist should...explaining in detail why the decision of the medical...

2013-10-01

436

49 CFR 391.47 - Resolution of conflicts of medical evaluation.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Resolution of conflicts of medical evaluation. ...391.47 Resolution of conflicts of medical evaluation. ...field in which the medical conflict arose. The specialist should...explaining in detail why the decision of the medical...

2011-10-01

437

Interpersonal influences on patients' surgical decision making: the role of close others  

PubMed Central

Patients make medical decisions in consultation with their partner, family, and friends. However, little is known about the ways in which these close others influence their decisions, particularly with respect to discrete decisions such as those related to medical treatments. This cross-sectional study investigated their influence on the surgical decisions of inflammatory bowel disease patients referred for surgery to remove their colon (N = 91). Guided by research on social control and classic research on power and influence in close relationships, we identified four types of close other decision influence: persuasion, assistance with understanding, indirect influence, and negative influence. Linear logistic and regression analyses showed that patients were more likely to have surgery when their close other used persuasion, and they reported lower decisional conflict when their close other helped them understand the decision. Patients were less likely to have surgery and reported greater decisional conflict when their close other used negative influence tactics. Findings demonstrate the importance of considering social context when investigating patient decision making. PMID:21308408

Rini, Christine; Jandorf, Lina; Goldsmith, Rachel E.; Manne, Sharon L.; Harpaz, Noam; Itzkowitz, Steven H.

2011-01-01

438

Making Good Tenure Decisions.  

ERIC Educational Resources Information Center

Presents criteria and procedures that can help to substantially increase the probability of a good tenure decision. Notes that the tenure procedures must be designed and followed in a way that ensures, to the degree possible, validity, fairness, and equity. Stresses the importance of maintaining good records and mentoring. (SG)

Becker, Samuel L.; Galvin, Kathleen M.; Houston, Marsha; Friedrich, Gustav W.; Pearson, Judy C.; Seiler, William J.; Trent, Judith S.

2001-01-01

439

Social networks and vaccination decisions  

Microsoft Academic Search

We combine information on social networks with medical records and survey data in order to examine how friends affect one’s decision to get vaccinated against the flu. The random assignment of undergraduates to residential halls at a large private university allows us to estimate how peer effects influence health beliefs and vaccination choices. Our results indicate that social exposure to

Neel Rao; Markus M. Möbius; Tanya Rosenblat

2007-01-01

440

The role of emotions in clinical reasoning and decision making.  

PubMed

What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic (hypothetico-deductive thinking) or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention-especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper's main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care. PMID:23975905

Marcum, James A

2013-10-01

441

Systems analysis of major consumer energy decisions  

E-print Network

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

Sisler, Nicholas Daniel

2011-01-01

442

Critical Limb Ischemia: Advanced Medical Therapy  

PubMed Central

Systemic atherosclerosis and its risk factors are present in the majority of patients with critical limb ischemia. Aggressive medical therapy is an immediate and necessary part of the work-up and management of these patients and will involve a multidisciplinary approach. Risk stratification based on a patient’s current clinical cardiovascular condition is important in determining the most appropriate and safe intervention and will allow both the patient and physician to make an informed decision regarding risk- and cost-benefits of treatment. PMID:23342181

2012-01-01

443

Adolescent Decision Making: An Overview  

ERIC Educational Resources Information Center

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

Halpern-Felsher, Bonnie

2009-01-01

444

Female genital mutilation in Sierra Leone: who are the decision makers?  

PubMed

The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80