Sample records for important medical decisions

  1. HELPING YOU MEDICAL DECISIONS

    E-print Network

    Dennett, Daniel

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

  2. Automated modeling of medical decisions.

    PubMed Central

    Egar, J. W.; Musen, M. A.

    1993-01-01

    We have developed a graph grammar and a graph-grammar derivation system that, together, generate decision-theoretic models from unordered lists of medical terms. The medical terms represent considerations in a dilemma that confronts the patient and the health-care provider. Our current grammar ensures that several desirable structural properties are maintained in all derived decision models. PMID:8130509

  3. Medical decisions under uncertainty.

    PubMed

    Carmi, A

    1993-01-01

    The court applies the criteria of the reasonable doctor and common practice in order to consider the behaviour of a defendant physician. The meaning of our demand that the doctor expects that his or her acts or omissions will bring about certain implications is that, according to the present circumstances and subject to the limited knowledge of the common practice, the course of certain events or situations in the future may be assumed in spite of the fog of uncertainty which surrounds us. The miracles and wonders of creation are concealed from us, and we are not aware of the way and the nature of our bodily functioning. Therefore, there seems to be no way to avoid mistakes, because in several cases the correct diagnosis cannot be determined even with the most advanced application of all information available. Doctors find it difficult to admit that they grope in the dark. They wish to form clear and accurate diagnoses for their patients. The fact that their profession is faced with innumerable and unavoidable risks and mistakes is hard to swallow, and many of them claim that in their everyday work this does not happen. They should not content themselves by changing their style. A radical metamorphosis is needed. They should not be tempted to formulate their diagnoses in 'neutral' statements in order to be on the safe side. Uncertainty should be accepted and acknowledged by the profession and by the public at large as a human phenomenon, as an integral part of any human decision, and as a clear characteristic of any legal or medical diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8231694

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

    PubMed

    Whitney, Simon N

    2008-01-01

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

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

    E-print Network

    Yao, JingTao

    Incorporating Game-theoretic Rough Sets in Web-based Medical Decision Support Systems JingTao Yao with the modern Web technology. An important branch of WSS is Web-based decision support systems that provide intelligent support for decision making tasks. We focus on decision making in Web-based medical decision

  6. Does pregnancy affect medical ethical decision making?

    Microsoft Academic Search

    C Hammerman; O Lavie; E Kornbluth; J Rabinson; M S Schimmel; A I Eidelman

    1998-01-01

    OBJECTIVE: We studied and compared the attitudes of pregnant women v new mothers in an attempt to confirm changing patterns of maternal response towards medical ethical decision making in critically ill or malformed neonates. DESIGN: Data were obtained by questionnaires divided into three sections: 1. sociodemographic; 2. Theoretical principles which might be utilised in the decision-making process; 3. Hypothetical case

  7. Overview of Medical Devices:Overview of Medical Devices: The Important StuffThe Important Stuff

    E-print Network

    Carmichael, Owen

    Overview of Medical Devices:Overview of Medical Devices: The Important StuffThe Important Stuff Dan Affairs Volcano CorporationVolcano Corporation June 24, 2011June 24, 2011 #12;What is a Medical Device?What is a Medical Device? An instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent

  8. Statistical Decision In Medical Field, Two Examples

    Microsoft Academic Search

    A. Blinowska; G. Chatellier; J. Verroust; J. Bernier

    1990-01-01

    Two examples of statistical decision as applied to medical diagnosis are presented. The first one concerns the diagnosis of hypertension, i.e. essential hypertension and five types of secondary hypertension: fibrodysplasic renal artery stenosis, atheromatous renal artery stenosis, Conn's syndrome, renal cystic disease and pheochromocytoma. The second deals with the diagnosis of multiple sclerosis by visual, somatosensory and brain stem auditory

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

    PubMed Central

    Seyedin, Hesam; Jamshidi-Orak, Roohangiz

    2014-01-01

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

  10. MEDICAL DECISION MAKING LIBRARY NUMERIC CATEGORIES 1 Teaching MDM

    E-print Network

    Ford, James

    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

  11. Evaluation of a decision support system in a medical environment

    Microsoft Academic Search

    François M. H. M. Dupuits; Arie Hasman

    1995-01-01

    This paper describes the impact of a decision support system on the quality of recorded diagnoses and the completeness of medical records. The assumption is that for quality assessment purposes enough data have to be recorded in an electronic medical record so that diagnostic decisions can be justified. The hypotheses were tested that active decision support will lead to better

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

    PubMed Central

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

    2014-01-01

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

  13. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott

    2007-01-01

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

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

    PubMed

    Rubin, Michael A

    2014-04-01

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

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

    ERIC Educational Resources Information Center

    Gibson, Denise D.; Borges, Nicole J.

    2004-01-01

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

  16. Virulence factors of medically important fungi.

    PubMed Central

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

    1996-01-01

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

  17. Professional Decisions and Ethical Values in Medical and Law Students.

    ERIC Educational Resources Information Center

    Rezler, Agnes G.; And Others

    1990-01-01

    This project evaluated and compared the values used by medical and law students when dealing with ethical dilemmas in the practice of law and medicine. The Professional Decisions and Values Test was given to 77 medical students and 92 law students. Differences were noted on beneficence, professional responsibility, and harm avoidance. (MLW)

  18. Evaluation of RxNorm for Medication Clinical Decision Support

    PubMed Central

    Freimuth, Robert R.; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G.

    2014-01-01

    We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS. PMID:25954360

  19. Medical negligence: Criminal prosecution of medical professionals, importance of medical evidence: Some guidelines for medical practitioners.

    PubMed

    Pandit, M S; Pandit, Shobha

    2009-07-01

    The changing doctor-patient relationship and commercialization of modern medical practice has affected the practice of medicine. On the one hand, there can be unfavorable results of treatment and on the other hand the patient suspects negligence as a cause of their suffering. There is an increasing trend of medical litigation by unsatisfied patients. The Supreme Court has laid down guidelines for the criminal prosecution of a doctor. This has decreased the unnecessary harassment of doctors. As the medical profession has been brought under the provisions of the Consumer Protection Act, 1986, the patients have an easy method of litigation. There should be legal awareness among the doctors that will help them in the proper recording of medical management details. This will help them in defending their case during any allegation of medical negligence. PMID:19881135

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

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

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

    E-print Network

    Oliver, Douglas L.

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

  2. PHYLOGENETIC DIVERSITY OF MEDICALLY IMPORTANT FUSARIA

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Due to the paucity of phenotypic traits, morphological species recognition greatly underestimates the number of clinically important species of the opportunistic filamentous ascomycete Fusarium. To address this problem, species limits are being investigated using multilocus DNA sequence data, using...

  3. Physicians’ Views on the Importance of Patient Preferences in Surrogate Decision Making

    PubMed Central

    Torke, Alexia M.; Moloney, Rachael; Siegler, Mark; Abalos, Anna; Alexander, G. Caleb

    2012-01-01

    Objective To explore the degree to which physicians report reliance on patient preferences when making medical decisions for hospitalized patients lacking decisional capacity Design Cross-sectional survey Setting One academic and two community hospitals in a single metropolitan area. Participants 281 physicians who recently cared for hospitalized adults Measurements A self-administered survey addressing physicians’ beliefs about ethical principles guiding surrogate decision making and physicians’ recent decision making experiences. Results Overall, 73% of physicians identified a standard related to patient preferences as the most important ethical standard for surrogate decision making (61% identified advanced directives and 12% substituted judgment). Among the 73% of physicians who reported recently making a surrogate decision, 82% reported that patient preferences were highly important in decision making. However, only 29% reported that patient preference was the most important factor in the decision. Physicians were significantly more likely to base decisions on patient preferences when the patient was in the intensive care unit (odds ratio, 2.92; 95% confidence interval (CI) 1.15-7.45) and less likely when the patient was older (odds ratio, 0.76 for each decade of age; 95% CI 0.58-0.99). The presence of a living will, prior discussions with the patient, and the physicians’ beliefs about ethical guidelines did not significantly predict the physicians’ reliance on patient preferences. Conclusion Although a majority of physicians identified patient preferences as the most important general ethical guideline for surrogate decision making, physicians relied on a variety of factors when making treatment decisions for a recent patient lacking decisional capacity. PMID:20158556

  4. Using Hindsight in Medical Decision Making

    PubMed Central

    Russ, Thomas A.

    1989-01-01

    As the clinical picture of a patient evolves over time, more information becomes available. Certain procedures require time to perform, causing a delay between the time when the tests are ordered and when the results are available. Furthermore, as the patient's condition changes over time, serial measurements can be made. The availability of more data allows a more accurate assessment of the patient. Uncertainties, guesses or errors that were made early in the clinical course of patient care can also be identified and resolved when more information is available. Reasoning with a stream of data that changes over time presents a challenge to the designers of expert systems. The use of hindsight in expert systems requires that appropriate attention be paid to the temporal relations of the data and that care is exercised in revising decisions. I present a data-dependency system, the Temporal Control Structure (TCS), designed to support reasoning with data changing over time and show how it can be used to implement reasoning by hindsight.

  5. How Numeracy Influences Risk Comprehension and Medical Decision Making

    PubMed Central

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

    2009-01-01

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

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

    PubMed

    Haddad Junior, Vidal

    2003-01-01

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

  7. Dual processing model of medical decision-making

    PubMed Central

    2012-01-01

    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

  8. The Importance of Teacher Involvement in Medication Therapy

    ERIC Educational Resources Information Center

    Ryan, Joseph B.; Katsiyannis, Antonis

    2009-01-01

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

  9. Is expected utility theory normative for medical decision making?

    PubMed

    Cohen, B J

    1996-01-01

    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

  10. A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

    PubMed Central

    Wilcock, Jane; Strivens, Janet

    2015-01-01

    Aim To create sustained improvements in medical students’ critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training. PMID:26051556

  11. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation.

    PubMed

    Durif-Bruckert, C; Roux, P; Morelle, M; Mignotte, H; Faure, C; Moumjid-Ferdjaoui, N

    2015-07-01

    The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available. PMID:25040308

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

    PubMed Central

    McGraw, Sarah

    2007-01-01

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

  13. [The growing importance of ethics in medical care and research].

    PubMed

    Sass, Hans-Martin

    2009-01-01

    The integration of medical humanities into future patient care and medical research will become as importance for trust, care and health as the natural sciences were during the last 100 years. In particular, improvements of lay health literacy and responsibility, new forms of physician-nurse partnership and expert-lay interaction, also revisions of clinical research towards models of informed contract will improve trust and health on a global scale, allow for healthier and happier citizens and populations and eventually might reduce health care costs. PMID:19823790

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

    E-print Network

    Oakley, Jeremy

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

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

    E-print Network

    Shneiderman, Ben

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

  16. The Re-contextualization of the Patient: What Home Health Care Can Teach Us About Medical Decision-Making.

    PubMed

    Salter, Erica K

    2015-06-01

    This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to "re-contextualize" patients, in order that they might be better equipped to make decisions that harmonize with their real lives. PMID:25643756

  17. Recovery of medically important microorganisms from Apollo astronauts

    NASA Technical Reports Server (NTRS)

    Taylor, G. R.

    1974-01-01

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

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

    PubMed

    Bosshard, Georg

    2008-07-01

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

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

    PubMed Central

    Miller, R A

    1994-01-01

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

  20. How pressure is applied in shared decisions about antipsychotic medication: a conversation analytic study of psychiatric outpatient consultations.

    PubMed

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

    2012-01-01

    The professional identity of psychiatry depends on it being regarded as one amongst many medical specialties and sharing ideals of good practice with other specialties, an important marker of which is the achievement of shared decision-making and avoiding a reputation for being purely agents of social control. Yet the interactions involved in trying to achieve shared decision-making are relatively unexplored in psychiatry. This study analyses audiotapes of 92 outpatient consultations involving nine consultant psychiatrists focusing on how pressure is applied in shared decisions about antipsychotic medication. Detailed conversation analysis reveals that some shared decisions are considerably more pressured than others. At one end of a spectrum of pressure are pressured shared decisions, characterised by an escalating cycle of pressure and resistance from which it is difficult to exit without someone losing face. In the middle are directed decisions, where the patient cooperates with being diplomatically steered by the psychiatrist. At the other extreme are open decisions where the patient is allowed to decide, with the psychiatrist exerting little or no pressure. Directed and open decisions occurred most frequently; pressured decisions were rarer. Patient risk did not appear to influence the degree of pressure applied in these outpatient consultations. PMID:21812791

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

    PubMed Central

    van Belkum, A

    1994-01-01

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

  2. Computerised clinical decision support systems to improve medication safety in long-term care homes: a systematic review

    PubMed Central

    Marasinghe, Keshini Madara

    2015-01-01

    Objectives Computerised clinical decision support systems (CCDSS) are used to improve the quality of care in various healthcare settings. This systematic review evaluated the impact of CCDSS on improving medication safety in long-term care homes (LTC). Medication safety in older populations is an important health concern as inappropriate medication use can elevate the risk of potentially severe outcomes (ie, adverse drug reactions, ADR). With an increasing ageing population, greater use of LTC by the growing ageing population and increasing number of medication-related health issues in LTC, strategies to improve medication safety are essential. Methods Databases searched included MEDLINE, EMBASE, Scopus and Cochrane Library. Three groups of keywords were combined: those relating to LTC, medication safety and CCDSS. One reviewer undertook screening and quality assessment. Results Overall findings suggest that CCDSS in LTC improved the quality of prescribing decisions (ie, appropriate medication orders), detected ADR, triggered warning messages (ie, related to central nervous system side effects, drug-associated constipation, renal insufficiency) and reduced injury risk among older adults. Conclusions CCDSS have received little attention in LTC, as attested by the limited published literature. With an increasing ageing population, greater use of LTC by the ageing population and increased workload for health professionals, merely relying on physicians’ judgement on medication safety would not be sufficient. CCDSS to improve medication safety and enhance the quality of prescribing decisions are essential. Analysis of review findings indicates that CCDSS are beneficial, effective and have potential to improve medication safety in LTC; however, the use of CCDSS in LTC is scarce. Careful assessment on the impact of CCDSS on medication safety and further modifications to existing CCDSS are recommended for wider acceptance. Due to scant evidence in the current literature, further research on implementation and effectiveness of CCDSS is required. PMID:25967986

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

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

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

    E-print Network

    of critically injured patients. #12;Pre-hospital services such as police, fire, EMS (Emergency Medical ServicesR-CAST-MED: Applying Intelligent Agents to Support Emergency Medical Decision-making Teams Shizhuo of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA

  5. Factors Considered Important in Decision Making: A Preliminary Investigation.

    ERIC Educational Resources Information Center

    Thurlow, Martha L.; Ysseldyke, James E.

    1982-01-01

    Four groups of educational decisionmakers rated the influence of information regarding the sex, socioeconomic status, and physical attractiveness of the student as having an insignificant effect on educational placement decisions. Assessment data were believed to have a greater influence, with achievement and intelligence scores seen as having a…

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

    PubMed

    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

    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

  7. A Medical Decision Support System for the Space Station Health Maintenance Facility

    PubMed Central

    Ostler, David V.; Gardner, Reed M.; Logan, James S.

    1988-01-01

    NASA is developing a Health Maintenance Facility (HMF) to provide the equipment and supplies necessary to deliver medical care in the Space Station. An essential part of the Health Maintenance Facility is a computerized Medical Decision Support System (MDSS) that will enhance the ability of the medical officer (“paramedic” or “physician”) to maintain the crew's health, and to provide emergency medical care. The computer system has four major functions: 1) collect and integrate medical information into an electronic medical record from Space Station medical officers, HMF instrumentation, and exercise equipment; 2) provide an integrated medical record and medical reference information management system; 3) manage inventory for logistical support of supplies and secure pharmaceuticals; 4) supply audio and electronic mail communications between the medical officer and ground based flight surgeons. ImagesFigure 1

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

    NASA Technical Reports Server (NTRS)

    Butler, Doug

    2009-01-01

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

  9. Diseases of insects of medical importance in Europe

    PubMed Central

    Weiser, Jaroslav

    1963-01-01

    The biological control of insects carrying human diseases was first attempted many years ago, but the results were disappointing owing to the insufficiency of information on the ecology and pathology of such insects at the time. In recent years, however, increased knowledge of insect pathology and ecology and the development of insecticide-resistance have led to a revival of interest in this method of vector control. Most of the recent published work on this subject relates to findings in North America; comparatively little information has hitherto been available in respect of Europe. This paper, which is based on a survey of the literature and on the author's own experience, presents the results of research on diseases of insects of medical importance in Europe. Infection with viruses, rickettsiae, bacteria, fungi, protozoa and nematodes are discussed and suggested lines for future European research on biological control are put forward. ImagesFIG. 7-9FIG. 10-12FIG. 4-6FIG. 1-3 PMID:13999691

  10. Knowledge discovery from data as a framework to decision support in medical domains

    PubMed Central

    Gibert, Karina

    2009-01-01

    Introduction Knowledge discovery from data (KDD) is a multidisciplinary discipline which appeared in 1996 for “non trivial identifying of valid, novel, potentially useful, ultimately understandable patterns in data”. Pre-treatment of data and post-processing is as important as the data exploitation (Data Mining) itself. Different analysis techniques can be properly combined to produce explicit knowledge from data. Methods Hybrid KDD methodologies combining Artificial Intelligence with Statistics and visualization have been used to identify patterns in complex medical phenomena: experts provide prior knowledge (pK); it biases the search of distinguishable groups of homogeneous objects; support-interpretation tools (CPG) assisted experts in conceptualization and labelling of discovered patterns, consistently with pK. Results Patterns of dependency in mental disabilities supported decision-making on legislation of the Spanish Dependency Law in Catalonia. Relationships between type of neurorehabilitation treatment and patterns of response for brain damage are assessed. Patterns of the perceived QOL along time are used in spinal cord lesion to improve social inclusion. Conclusion Reality is more and more complex and classical data analyses are not powerful enough to model it. New methodologies are required including multidisciplinarity and stressing on production of understandable models. Interaction with the experts is critical to generate meaningful results which can really support decision-making, particularly convenient transferring the pK to the system, as well as interpreting results in close interaction with experts. KDD is a valuable paradigm, particularly when facing very complex domains, not well understood yet, like many medical phenomena.

  11. Therapeutic Decision-Making for Second-Year Medical Students.

    ERIC Educational Resources Information Center

    Peck, Carl C.; Halkin, Hillel

    1981-01-01

    A course in therapeutic decision-making, designed by the Uniformed Services University of the Health Sciences is described. Goals were to introduce the student to a rational method of making therapeutic decisions and to give the student experience in formulating therapeutic plans. (MLW)

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

    ERIC Educational Resources Information Center

    Garcia-Retamero, Rocio; Galesic, Mirta

    2012-01-01

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

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

    PubMed

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

    2012-10-01

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

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

    E-print Network

    Hauskrecht, Milos

    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

  15. Comparison of Three Databases with a Decision Tree Approach in the Medical Field of Acute Appendicitis

    Microsoft Academic Search

    Milan Zorman; Hans-peter Eich; Peter Kokol; Christian Ohmann

    Abstract Decision trees have been successfully used for years in many,medical decision making ,applications. Transparent representation of acquired ,knowledge ,and fast algorithms made,decision trees one of the ,most often used symbolic machine,learning approaches. This paper concentrates on the problem of separating acute appendicitis, which is a special problem ,of acute ,abdominal ,pain ,from ,other diseases that cause acute abdominal ,pain

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

    E-print Network

    de Weck, Olivier L.

    A Method for Analysis of Expert Committee Decision-Making Applied to FDA Medical Device Panels-Making Applied to FDA Medical Device Panels by David André Broniatowski Submitted to the Engineering Systems and electronic copies of this thesis document in whole or in part in any medium now known or hereafter created

  17. A New Instrument for Medical Decision Support and Education: The Stanford Health Information Network for Education

    Microsoft Academic Search

    Paul Godin; Robert Hubbs; Bill Woods; Mark C. Tsai; Dev Nag; Thomas C. Rindfleisch; Parvati Dev; Kenneth L. Melmon

    1999-01-01

    The information needs of physicians are complex and ever increasing in a world of rapidly expanding medical knowledge and a practice environment where physicians are required to know and do more with shrinking resources. Current strategies for providing clinical decision support and continuing medical education have failed in part, because they have not provided timely, easy access to information that

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

    ERIC Educational Resources Information Center

    Fisher, Sue

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

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

    SciTech Connect

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

    2007-02-15

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

    2014-01-01

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

  2. Effectiveness of the Medical Emergency Team: the importance of dose

    Microsoft Academic Search

    Daryl Jones; Rinaldo Bellomo; Michael A DeVita

    2009-01-01

    ABSTRACT: Up to 17% of hospital admissions are complicated by serious adverse events unrelated to the patients presenting medical condition. Rapid Response Teams (RRTs) review patients during early phase of deterioration to reduce patient morbidity and mortality. However, reports of the efficacy of these teams are varied. The aims of this article were to explore the concept of RRT dose,

  3. Ruralising Medical Curricula: The Importance of Context in Problem Design.

    ERIC Educational Resources Information Center

    Hays, Richard; Sen Gupta, Tarun

    2003-01-01

    Clinical scenarios used in rural medical education often convey inappropriate stereotypes that undermine the intent of the curriculum. Case writers should be clear about the learning or assessment objectives in each case, have access to people with appropriate expertise and understanding of the issues, and ensure that contextual and cultural…

  4. Altruism and self interest in medical decision making.

    PubMed

    Rubin, Paul H

    2009-01-01

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

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

    Microsoft Academic Search

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

    1986-01-01

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

  6. Older Patients' Perceptions of Medication Importance and Worth: An Exploratory Study

    PubMed Central

    Lau, Denys T.; Briesacher, Becky; Mercaldo, Nathaniel D.; Halpern, Leslie; Osterberg, E. Charles; Jarzebowski, Mary; McKoy, June M.; Mazor, Kathleen

    2009-01-01

    OBJECTIVES Cost-related medication non-adherence may be influenced by patients' perceived importance of their medications. This exploratory study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with medications' worth, and does expense impact that association? METHODS Study participants included individuals aged 60 and older who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense, and worth. Factors that influence medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and worth of medications, and the impact of expense on that association. RESULTS Among 143 prescription drugs reported among 20 participants, the weighted mean rating of medication importance was 8.2 (SD=1.04) on a scale from 0 (not important at all) to 10 (most important). Of all medications, 38% were considered expensive. The weighted mean rating of worth was 8.4 (SD=1.46) on a scale from 0 (not worth it at all) to 10 (definitely worth it). Three major factors influenced medication importance: drug-related (characteristics, indications, effects, and alternatives); patient-related (knowledge, attitudes, and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and worth for inexpensive medications (OR=2.23; p=0.002) and an even greater association between perceived importance and worth for expensive medications (OR=4.29; p<0.001). DISCUSSION This study provides preliminary evidence that elderly patients perceive different levels of importance among their medications based on factors beyond clinical efficacy and their perception of importance influences how they perceive their medications' worth, especially for medications of high costs. Understanding how patients perceive medication importance may help develop interventions to reduce cost-related non-adherence. PMID:19021304

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

    ERIC Educational Resources Information Center

    Stepanikova, Irena

    2012-01-01

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

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

    Microsoft Academic Search

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

    2001-01-01

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

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

    E-print Network

    Abstract -- Image segmentation plays an important role in medical image processing. The aim spatial resolution of medical imaging equipment and the complex anatomic structure of soft tissues, a single voxel in a medical image may be composed of several tissue types, which is called partial volume

  10. Watchfully waiting: medical intervention as an optimal investment decision.

    PubMed

    Meyer, Elisabeth; Rees, Ray

    2012-03-01

    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

  11. A critical review and meta-analysis of the unconscious thought effect in medical decision making

    PubMed Central

    Vadillo, Miguel A.; Kostopoulou, Olga; Shanks, David R.

    2015-01-01

    Based on research on the increasingly popular unconscious thought effect (UTE), it has been suggested that physicians might make better diagnostic decisions after a period of distraction than after an equivalent amount of time of conscious deliberation. However, published attempts to demonstrate the UTE in medical decision making have yielded inconsistent results. In the present study, we report the results of a meta-analysis of all the available evidence on the UTE in medical decisions made by expert and novice clinicians. The meta-analysis failed to find a significant contribution of unconscious thought (UT) to the accuracy of medical decisions. This result cannot be easily attributed to any of the potential moderators of the UTE that have been discussed in the literature. Furthermore, a Bayes factor analysis shows that most experimental conditions provide positive support for the null hypothesis, suggesting that these null results do not reflect a simple lack of statistical power. We suggest ways in which new studies could usefully provide further evidence on the UTE. Unless future research shows otherwise, the recommendation of using UT to improve medical decisions lacks empirical support. PMID:26042068

  12. Towards Meaningful Medication-Related Clinical Decision Support: Recommendations for an Initial Implementation

    PubMed Central

    Phansalkar, S.; Wright, A.; Kuperman, G.J.; Vaida, A.J.; Bobb, A.M.; Jenders, R.A.; Payne, T.H.; Halamka, J.; Bloomrosen, M.; Bates, D.W.

    2011-01-01

    Summary Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings. PMID:23616860

  13. How Usability of a Web-Based Clinical Decision Support System Has the Potential to Contribute to Adverse Medical Events

    PubMed Central

    Graham, Timothy A.D.; Kushniruk, Andre W.; Bullard, Michael J.; Holroyd, Brian R.; Meurer, David P.; Rowe, Brian H.

    2008-01-01

    Introduction Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events. Methods Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods. Results 422 events were recorded over 56 sessions. In total, 169 negative comments, 55 positive comments, 130 neutral comments, 21 application events, 34 problems, 6 slips, and 5 mistakes were identified. Three mistakes could have had life-threatening consequences. Conclusion Evaluation of CDSS will be of utmost importance in the future with increasing use of electronic health records. Usability engineering principles can identify interface problems that may lead to potential medical adverse events, and should be incorporated early in the software design phase. PMID:18998968

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

    PubMed Central

    2011-01-01

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

  15. Evolutionary Neural Logic Networks in Two Medical Decision Tasks Athanasios Tsakonas, and Georgios Dounias

    E-print Network

    Fernandez, Thomas

    Evolutionary Neural Logic Networks in Two Medical Decision Tasks Athanasios Tsakonas, and Georgios. Specifically, we apply evolutionary techniques for the development of neural logic networks of arbitrary length encoding for the representation of neural logic networks into population individuals. The application area

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

    ERIC Educational Resources Information Center

    Lambert, Heather

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Johnson, Katherine M.; Johnson, David R.

    2009-01-01

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

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

    E-print Network

    Zweigenbaum, Pierre

    with their clinical context, to improve alert management. Methods The AKENATON system is composed of several modules to support medical decision in telecardiology: the application ontology of the AKENATON project Anita Burguna strictly device-centered follow-up to perspectives centered on the patient. In the AKENATON project, we

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

    Microsoft Academic Search

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

    2009-01-01

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

  20. Hip Arthroplasty or Medical Management: A Challenging Treatment Decision for Younger Patients.

    PubMed

    Stake, Christine E; Talbert, Patricia Y; Hopkinson, William J; Daley, Robert J; Alden, Kris J; Domb, Benjamin G

    2015-06-01

    The two main treatment options for total hip arthroplasty (THA), medical management and surgical intervention, have advantages and disadvantages, creating a challenging decision. Treatment decisions are further complicated in a younger population (?50) as the potential need for revision surgery is probable. We examined the relationship of selected variables to the decision-making process for younger patients with symptomatic OA. Thirty-five participants chose surgical intervention and 36 selected medical management for their current treatment. Pain, activity restrictions, and total WOMAC scores were statistically significant (P < .05) for patients selecting surgical intervention. No difference in quality of life was shown between groups. Pain was the only predictor variable identified, however, activity restrictions were also influential variables as these were highly correlated with pain. PMID:25682208

  1. Fungal taxonomy: New developments in medically important fungi

    Microsoft Academic Search

    Teun Boekhout; Cécile Gueidan; Sybren de Hoog; Rob Samson; Janos Varga; Grit Walther

    2009-01-01

    Our understanding of the causative agents of fungal diseases has changed considerably in recent years due to molecular studies\\u000a that compare DNA across a wide range of fungi, including human and animal pathogens. In many cases, what had once been understood\\u000a as traditional species were found to be species complexes. Importantly, members of such complexes may differ in pathogenicity\\u000a and

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

    PubMed

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

    2013-09-01

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

  3. Süleymaniye Külliyesi: a historically important medical, scientific, and cultural center.

    PubMed

    Dinç, Gülten; Naderi, Sait; Kanpolat, Yücel

    2006-08-01

    SCIENCE HAS MANY Western and Eastern historical roots. All of these contributed to the body of academic literature. One of the most important aspects of scientific progress is educational institutions, including hospitals, schools, and libraries. Some of these institutions may offer an identity for a city, as well as contribute to its development. Süleymaniye Külliyesi is one such institution. Süleymaniye Külliyesi, established in the 16th century, contains many centers, including a mosque, surrounded by a hospital, school of medicine, central pharmacy, and library. It once served both the Ottoman Empire and the Turkish Republic. The school of medicine of this complex was the first school of medicine in the Ottoman period that functioned in coordination with the hospital and central pharmacy. The library contains many rare books and manuscripts. Currently, it is one of the richest centers in the field of oriental studies. We conclude that Süleymaniye Külliyesi, with its health-related elements and library, contributed to the development and progress of science and deserves to be cited in the literature of the Western world. PMID:16883182

  4. Re-Thinking the Role of the Family in Medical Decision-Making.

    PubMed

    Cherry, Mark J

    2015-08-01

    This paper challenges the foundational claim that the human family is no more than a social construction. It advances the position that the family is a central category of experience, being, and knowledge. Throughout, the analysis argues for the centrality of the family for human flourishing and, consequently, for the importance of sustaining (or reestablishing) family-oriented practices within social policy, such as more family-oriented approaches to consent to medical treatment. Where individually oriented approaches to medical decision-making accent an ethos of isolated personal autonomy family-oriented approaches acknowledge the central social and moral reality of the family. I argue that the family ought to be appreciated as more than a mere network of personal relations and individual undertakings; the family possesses a being that is social and moral such that it realizes a particular structure of human good and sustains the necessary conditions for core areas of human flourishing. Moreover, since the family exists as a nexus of face-to-face relationships, the consent of persons, including adults, to be members of a particular family, subject to its own respective account of family sovereignty, is significantly more amply demonstrated than the consent of citizens to be under the authority of a particular state. As a result, in the face of a general Western bioethical affirmation of the autonomy of individuals, as if adults and children were morally and socially isolated agents, this paper argues that social space must nevertheless be made for families to choose on behalf of their own members. PMID:26069283

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

    Microsoft Academic Search

    Nelson Barber; D. Christopher Taylor; Tim Dodd

    2009-01-01

    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

  6. The baby MB case: medical decision making in the context of uncertain infant suffering.

    PubMed

    Jonas, Monique

    2007-09-01

    The recent MB case involved a dispute between an infant's parents and his medical team about the appropriateness of continued life support. The dispute reflected uncertainty about two key factors that inform medical decision making for seriously ill infants: both the amount of pain MB experiences and the extent of his cognitive capacities are uncertain. Uncertainty of this order makes decision making in accordance with the best-interests principle very problematic. This article addresses two of the problems that cases such as that of MB pose for those charged with making medical decisions for infants. First, the question of the moral significance of the interest in avoiding pain is considered. It is claimed that this interest can be outweighed by higher-order interests such as those related to autonomy but that where such higher-order interests do not exist, the interest in avoiding pain should be prioritised. Second, the question of how to proceed in cases in which the level of pain or the extent of an infant's higher-order interests cannot be decisively established is considered. It is suggested that when genuine uncertainty over the interests of an infant exists, parental views about treatment should prevail. PMID:17761825

  7. Legal Briefing: Adult Orphans and the Unbefriended: Making Medical Decisions for Unrepresented Patients without Surrogates.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers recent legal developments involving medical decision making for incapacitated patients who have no available legally authorized surrogate decision maker. These individuals are frequently referred to either as "adult orphans" or as "unbefriended," "isolated," or "unrepresented" patients. The challenges involved in obtaining consent for medical treatment on behalf of these individuals have been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. In 2012, JCE published a comprehensive review of the available mechanisms by which to make medical decisions for the unbefriended. The purpose of this "Legal Briefing" is to update the 2012 study. Accordingly, this "Legal Briefing" collects and describes significant legal developments from only the past three years. My basic assessment has not changed. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform." Most facilities are "muddling through on an ad hoc basis." But the situation is not wholly negative. There have been a number of promising new initiatives. I group these developments into the following seven categories: 1. Increased Attention and Discussion 2. Prevention through Better Advance Care Planning 3. Prevention through Expanded Default Surrogate Lists 4. Statutorily Authorized Intramural Mechanisms 5. California Litigation Challenging the Team Approach 6. Public Guardianship 7. Improving Existing Guardianship Processes. PMID:26132070

  8. [The importance of individual beliefs about cancer treatments for therapeutic decisions].

    PubMed

    Charles, Cécile; Dauchy, Sarah; Bungener, Catherine

    2013-10-01

    Interest for representations about cancer treatments and their side effects is increasing because their central role has been proved in how patients cope with illness and symptoms and how they react emotionally. Through a synthesis of the literature, this paper has two objectives: firstly, to clarify the current state of knowledge in this field, and secondly to point out the manner that bringing out these individual representations during oncological consultations contributes to preventing difficulties and treatment discontinuation and facilitates medical decision processing. PMID:23883592

  9. Understanding the work of general practitioners: a social science perspective on the context of medical decision making in primary care

    PubMed Central

    Geneau, Robert; Lehoux, Pascale; Pineault, Raynald; Lamarche, Paul

    2008-01-01

    Background The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making processes in general practice. Our main objective was to better understand how organizational and environmental factors influence the work of GPs. Methods We interviewed 28 GPs working in contrasting organizational settings and environments. The data analysis involved using structuration theory to enrich the interpretation of empirical material. Results We identified four main factors that influence the practice of GPs: mode of remuneration, peer-to-peer interactions, patients' demands and the availability of other medical resources in the environment. These four conditions of action – what we call primary effects – can directly influence the performance of medical acts and time management, as well as the degree of specialization of GPs. Decisions related to each of those aspects can have a variety of both intentional and non-intentional consequences – what we call secondary effects – that are then likely to become conditions for subsequent action. Conclusion This qualitative study helps shed light on the complex causal loops of interrelated factors that shape the work of GPs. PMID:18284700

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

    Microsoft Academic Search

    Cathy Charles; Amiram Gafni; Tim Whelan

    1997-01-01

    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

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

    PubMed

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

    2013-06-01

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

  12. 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 ...

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

    PubMed Central

    Johnson, Katherine M.; Johnson, David R.

    2009-01-01

    We examined male partners’ influence on the decision to seek medical help for infertility using from the National Survey of Fertility Barriers. Building upon an existing help-seeking framework, we incorporated characteristics of both partners from 219 heterosexual couples who had ever perceived a fertility problem. In logistic regression analyses, we found an association between couple-level attitudes and medical help-seeking even when other predisposing and enabling conditions existed. Overall, the findings highlight that both partners contribute to the infertility help-seeking process, and that different factors may play a role in different stages of help-seeking. Studies of infertility help-seeking need to be more inclusive of the context that these decisions are embedded within to better understand service use. PMID:20160961

  14. SENIORS' PERCEPTIONS OF SURROGATE DECISION MAKING, MEDICAL TREATMENT AND ADVANCE HEALTH CARE DIRECTIVES

    Microsoft Academic Search

    Karen L. Barber

    1994-01-01

    This study examines community living , independent seniors' perceptions and views of preferences for surrogate decision makers, life-sustaining medical treatment, and advance health care directives. Data were collected through in-depth personal interviews with 26 seniors living in the Hamilton-Wentworth area of Ontario. This study looked for differences in these perceptions by socio-demographic background characteristics. Using case vignettes involving elderly patients

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

    PubMed Central

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

    1997-01-01

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

  16. Improving Medical Decisions for Incapacitated Persons: Does Focusing on “Accurate Predictions” Lead to an Inaccurate Picture?

    PubMed Central

    Kim, Scott Y. H.

    2014-01-01

    The Patient Preference Predictor (PPP) proposal places a high priority on the accuracy of predicting patients’ preferences and finds the performance of surrogates inadequate. However, the quest to develop a highly accurate, individualized statistical model has significant obstacles. First, it will be impossible to validate the PPP beyond the limit imposed by 60%–80% reliability of people’s preferences for future medical decisions—a figure no better than the known average accuracy of surrogates. Second, evidence supports the view that a sizable minority of persons may not even have preferences to predict. Third, many, perhaps most, people express their autonomy just as much by entrusting their loved ones to exercise their judgment than by desiring to specifically control future decisions. Surrogate decision making faces none of these issues and, in fact, it may be more efficient, accurate, and authoritative than is commonly assumed. PMID:24554777

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

    E-print Network

    Hutcheon, James M.

    Pre-Medical and Pre-Dental Checklist of Important Things to Do Medical/Dental Admissions Review Board Requirements/Recommendations Read and be familiar with the Medical/Dental Review Board's policies.edu) Campus Visits/Lunches/Meeting Attend information sessions provided by medical and dental schools Meet

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

    SciTech Connect

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

    1982-01-01

    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.

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

    PubMed

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

    2006-06-01

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

  20. Hypermedia or Hyperchaos: Using HyperCard to Teach Medical Decision Making

    PubMed Central

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

    1989-01-01

    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.

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

    PubMed Central

    Coman, Dora; Coman, Alin; Hirst, William

    2013-01-01

    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

  2. B3-2: Re-conceptualizing Medical Decisions: How Home Hospice Care Fosters Patient and Family Engagement and Decision-making

    PubMed Central

    Dillon, Ellis

    2014-01-01

    Background/Aims Despite growing acceptance that patient engagement and shared decision-making should be goals of medicine, organizational attempts to support these ideals are limited and larger institutional structures often constrain patient autonomy. Home hospice care is a subset of medical care that has consciously developed a philosophical and practical approach to encouraging patient and family engagement. This research examines how home hospice care provides a different strategy for improving patient engagement and shared decision-making. Methods This ethnographic study draws on a sample of 55 home hospice participants, including patients, family members/caregivers, staff, and volunteers, and uses in-depth interview and observation of home hospice work to examine the process of providing and receiving hospice care. Results I find that macro level hospice institutional structures and micro level daily work practices embody a holistic approach which assumes patients and family members are the critical experts in most instances of decision-making. Differences in institutional structure, such as providing care in patient homes and having an interdisciplinary team approach focused on the “whole person”, empower the patient and family members. Likewise the micro level interactions between hospice workers and patients and family members narrow the field of purely “medicaldecisions and broaden the field of decisions open to patients. Hospice workers accomplish this re-conceptualization by framing many medical decisions as being more about what is best for the patient and family and less about medical expertise. Conclusions By broadening and re-conceptualizing the idea of decision-making, hospice workers enable patients and their families to have more control over their medical care and in many cases the process of dying itself. While some attributes of home hospice care are unique, many techniques could be introduced or accentuated in other models of medical care.

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

    PubMed Central

    2011-01-01

    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

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

    NASA Technical Reports Server (NTRS)

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

    2011-01-01

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

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

    Microsoft Academic Search

    Hitoshi Kuwabara; Toshiaki Kono; Takafumi Shimada; Yukiko Kano

    Using clinical data, a retrospective investigation was carried out to elucidate factors and\\/or symptom severity affecting the clinicians’ decision-making as to whether or not psychotropic medications should be prescribed for tic disorders. For this purpose, medical records on a total of 75 patients with tic disorders were collected and scrutinized. Of the total, 36 patients were found to have been

  6. After rescue: the importance of beers criteria for medication assessment in older adults.

    PubMed

    Heintz, Phyllis; Buchholz, Malcolm

    2015-01-01

    Critical care units serve the vital function of patient rescue through life-saving and life-preserving treatments. When an older patient's life hangs in the balance, preserving life takes priority over potential serious adverse drug events. There may be a tendency to consider transfer out of the unit as a less serious event; therefore, less attention is given to medication assessment. Often thought of by nurses as an almost clerical level task, the professional nurse plays a key role in identifying potentially harmful medications or medication combinations. If older patients remain on medications considered to be potentially dangerous, then patients are at risk for adverse drug events. Once the emergent nature of critical care interventions has passed, it is important to judiciously appraise patient status and conduct a medication assessment to discontinue or change the medication regimen to safer alternatives for older adults. Nurses can be instrumental in further research, education, and awareness for practitioners, patients, and families regarding the role of medications for older adults. Beers Criteria are not intended to be a clinical mandate, rather a designated as a clinical guideline with a clinical recommendation to support a provider's clinical judgment. PMID:26039653

  7. Performance of online drug information databases as clinical decision support tools in infectious disease medication management.

    PubMed

    Polen, Hyla H; Zapantis, Antonia; Clauson, Kevin A; Clauson, Kevin Alan; Jebrock, Jennifer; Paris, Mark

    2008-01-01

    Infectious disease (ID) medication management is complex and clinical decision support tools (CDSTs) can provide valuable assistance. This study evaluated scope and completeness of ID drug information found in online databases by evaluating their ability to answer 147 question/answer pairs. Scope scores produced highest rankings (%) for: Micromedex (82.3), Lexi-Comp/American Hospital Formulary Service (81.0), and Medscape Drug Reference (81.0); lowest includes: Epocrates Online Premium (47.0), Johns Hopkins ABX Guide (45.6), and PEPID PDC (40.8). PMID:18999059

  8. Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study.

    PubMed

    Bartholomew, Terence; Carvalho, Tatiana

    2007-08-01

    Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether general practitioners (GPs) owe a duty of confidentiality to competent minors. As medical practitioners are the first point of contact in medical settings, the present study explored GPs' competence and confidentiality determinations regarding a 16-year-old female patient who presented with symptoms of an eating disorder. Questionnaires and hypothetical scenarios were sent to a sample of 1000 GPs, of which 305 responded. Results indicated that 62% of respondents would have found the patient competent, while 82% would have maintained her confidentiality. However, analysis of the rationales provided for these decisions revealed a wide discrepancy in GPs' understanding and implementation of current legal principles. This research highlights the necessity of providing GPs with clear guidelines regarding competence and confidentiality determinations when dealing with minors. PMID:17620213

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

    NSDL National Science Digital Library

    0000-00-00

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

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

    Microsoft Academic Search

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

    2007-01-01

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

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

    PubMed Central

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  13. How Important is Medical Ethics and History of Medicine Teaching in the Medical Curriculum? An Empirical Approach towards Students' Views

    PubMed Central

    Schulz, Stefan; Woestmann, Barbara; Huenges, Bert; Schweikardt, Christoph; Schäfer, Thorsten

    2012-01-01

    Objectives: It was investigated how students judge the teaching of medical ethics and the history of medicine at the start and during their studies, and the influence which subject-specific teaching of the history, theory and ethics of medicine (GTE) - or the lack thereof - has on the judgement of these subjects. Methods: From a total of 533 students who were in their first and 5th semester of the Bochum Model curriculum (GTE teaching from the first semester onwards) or followed the traditional curriculum (GTE teaching in the 5th/6th semester), questionnaires were requested in the winter semester 2005/06 and in the summer semester 2006. They were asked both before and after the 1st and 5th (model curriculum) or 6th semester (traditional curriculum). We asked students to judge the importance of teaching medical ethics and the history of medicine, the significance of these subjects for physicians and about teachability and testability (Likert scale from -2 (do not agree at all) to +2 (agree completely)). Results: 331 questionnaire pairs were included in the study. There were no significant differences between the students of the two curricula at the start of the 1st semester. The views on medical ethics and the history of medicine, in contrast, were significantly different at the start of undergraduate studies: The importance of medical ethics for the individual and the physician was considered very high but their teachability and testability were rated considerably worse. For the history of medicine, the results were exactly opposite. GTE teaching led to a more positive assessment of items previously ranked less favourably in both curricula. A lack of teaching led to a drop in the assessment of both subjects which had previously been rated well. Conclusion: Consistent with the literature, our results support the hypothesis that the teaching of GTE has a positive impact on the views towards the history and ethics of medicine, with a lack of teaching having a negative impact. Therefore the teaching of GTE should already begin in the 1st semester. The teaching of GTE must take into account that even right at the start of their studies, students judge medical ethics and the history of medicine differently. PMID:22403593

  14. 76 FR 63600 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ...Inspection Service [Docket No. APHIS-2011-0039] Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit From South Africa Into the Continental United States Correction In notice document 2011-25490...

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

    PubMed

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

    2011-01-01

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

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

    Microsoft Academic Search

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

    2007-01-01

    The fine structure of Chrysomya nigripes Aubertin, a blow fly species of medical importance, is presented using scanning electron microscopy (SEM) to contribute information\\u000a on the morphology of the adult of this fly species. The surface of the dome-shaped ommatidia exhibits a microscopic granulose\\u000a appearance. The palpus is equipped with small sensilla basiconica and sensilla chaetica, which provide sensory reception

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

    Microsoft Academic Search

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

    2006-01-01

    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 (bioMerieux) for yeast strains that could not be identified by a combination

  18. Morphology of puparia of Megaselia scalaris (Diptera: Phoridae), a fly species of medical and forensic importance

    Microsoft Academic Search

    Kabkaew L. Sukontason; Worachote Boonsriwong; Sirisuda Siriwattanarungsee; Somsak Piangjai; Kom Sukontason

    2006-01-01

    Megaselia scalaris (Loew), a scuttle fly, is a fly species of medical and forensic importance. For use in forensic investigation, fly specimens\\u000a found to associate with human corpses have to be identified at species level. Herein, we present the morphology of the puparia\\u000a of the above fly species using scanning electron microscopy. The characteristic of the intersegmental spines along the

  19. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools

    PubMed Central

    Robinson, A; Thomson, R

    2001-01-01

    While there is an increasing emphasis on patient empowerment and shared decision making, evidence suggests that many patients do not wish to be involved in decisions about their own care. Previous research has found patient preferences for involvement in decision making to vary with age, socioeconomic status, illness experience, and the gravity of the decision. Furthermore, there is evidence that certain patients may experience disutility from being involved in decision making about the treatment of their health problems. We discuss the implications of these findings for the use of decision support tools and the difficulties of targeting their use towards those patients most likely to benefit. We argue that patients may be ill informed about what participation in decision making actually entails and unaware of the benefits they stand to gain by articulating their preferences to their clinician. Furthermore, clinicians are not good at accurately assessing patients' preferences, while patients may have unrealistic expectations about their clinician's ability to "know what is best" for them. Further research is required to understand variations in patients' preferences for information and involvement in decision making, and the factors that influence them. Key Words: patient preference; informed choice; decision making; patient-caregiver communication PMID:11533436

  20. Decision Analysis and Cost-effectiveness Analysis

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

    Wilhelms, Evan A.

    2013-01-01

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

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

    E-print Network

    Ducatelle, Frederick

    Abstract--Forecasting of future electricity demand is very important for decision making in power industry, accurate forecasting of future electricity demand has become an important research area sector. This paper presents a novel approach for mid-term electricity load forecasting. It uses a hybrid

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

    PubMed Central

    2013-01-01

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

  4. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna

    Microsoft Academic Search

    Olga Ésik; Wolfgang Seitz; József Lövey; Tomas H Knocke; István Gaudi; György Németh; Richard Pötter

    1999-01-01

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  7. Medical Expertise and Patient Involvement: A Multiperspective Qualitative Observation Study of the Patient’s Role in Oncological Decision Making

    PubMed Central

    Ritter, Peter; Wäscher, Sebastian; Vollmann, Jochen; Schildmann, Jan

    2014-01-01

    Background. Decision making in oncology poses intricate ethical questions because treatment decisions should account not only for evidence-based standards but also for the patient’s individual values and preferences. However, there is a scarcity of empirical knowledge about patient involvement in oncological decision making. Methods. Direct, nonparticipant observation was used as a qualitative research method to gain an understanding of the interplay between medical expertise and patient participation in oncological decision making. Based on a multiperspective approach, observations were performed in three settings (tumor conference, ward round, and outpatient clinic) in the oncology department of a German university hospital. The observation transcripts were analyzed using central features of qualitative data analysis. Results. Major differences were identified regarding the decision-making processes in the three settings related to the patient’s presence or absence. When the patient was absent, his or her wishes were cited only irregularly; however, patients actively advanced their wishes when present. Preselection of treatments by physicians was observed, narrowing the scope of options that were finally discussed with the patient. Dealing with decisions about risky treatments was especially regarded as part of the physician’s professional expertise. Conclusion. The study reveals aspects of decision making for cancer patients that have been underexposed in the empirical and theoretical literature so far. Among these are the relevance of structural aspects for the decisions made and the practice of preselection of treatment options. It should be further discussed how far medical expertise reaches and whether therapeutic decisions can be made without consulting the patient. PMID:24760711

  8. What factors are important to parents making decisions about neonatal research?

    Microsoft Academic Search

    K S Hoehn; G Wernovsky; J Rychik; J W Gaynor; T L Spray; C Feudtner; R M Nelson

    2005-01-01

    Background: Although parents of neonates with congenital heart disease are often asked permission for their neonates to participate in research studies, little is known about the factors parents consider when making these decisions.Objective: To determine the reasons for parents’ decisions about participation in research studies.Methods: Qualitative analysis of the unsolicited comments of 34 parents regarding reasons for agreeing or declining

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  10. Influence Strategies Used When Couples Make Work-Family Decisions and Their Importance for Marital Satisfaction.

    ERIC Educational Resources Information Center

    Zvonkovic, Anisa M.; And Others

    1994-01-01

    Investigated how marital partners influenced each other concerning work and family decisions and connected influence strategies to martial satisfaction in 61 married couples who had faced work-family decisions in past 6 months. Found that gender role ideology and indirect influence strategies were related to marital satisfaction. Variables related…

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

    ERIC Educational Resources Information Center

    Bender, Soley S.

    2008-01-01

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

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

    PubMed

    Gluck, J C; Hassig, R A

    2001-07-01

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

  13. Does Size Really Matter—Using a Decision Tree Approach for Comparison of Three Different Databases from the Medical Field of Acute Appendicitis

    Microsoft Academic Search

    Milan Zorman; Hans-Peter Eich; Bruno Stiglic; Christian Ohmann; Mitja Lenic

    2002-01-01

    Decision trees have been successfully used for years in many medical decision making applications. Transparent representation of acquired knowledge and fast algorithms made decision trees one of the most often used symbolic machine learning approaches. This paper concentrates on the problem of separating acute appendicitis, which is a special problem of acute abdominal pain, from other diseases that cause acute

  14. Pharmaceuticals and personal care products alter the holobiome and development of a medically important mosquito.

    PubMed

    Pennington, Marcus J; Rivas, Nicholas G; Prager, Sean M; Walton, William E; Trumble, John T

    2015-08-01

    The increasing demand for fresh water has forced many countries to use reclaimed wastewater for agricultural purposes. This water contains pharmaceuticals and personal care products (PPCPs) that remain biologically active following passage through wastewater treatment plants. Run-off from farms and contaminated water from treatment facilities exposes aquatic ecosystems to PPCPs. This study examined the effects of PPCPs on a lower trophic organism. Culex quinquefasciatus larvae were reared in water contaminated with environmentally relevant concentrations of common PPCPs. Acetaminophen alone and a mixture of contaminants were found to increase developmental time of larvae. Susceptibility to Bti increased in larvae exposed to antibiotics, acetaminophen, or a mixture of PPCPs. Antibiotics, hormones, and the mixture altered the mosquito bacterial microbiome. Overall, the results indicate that at environmentally relevant concentrations, PPCPs in reclaimed water can have biologically important effects on an ecologically and medically important lower trophic level insect. PMID:25913146

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

    PubMed Central

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

    2012-01-01

    Background and Objective Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The United Kingdom Prospective Diabetes Study Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality-adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (0.26 percent, p = .014) relative to patients in the control arm. Intervention costs were $120 (SE = 45) per patient in the first year and $76 (SE = 45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE = 0.01) and increased lifetime costs by $112 (SE = 660), resulting in an incremental cost-effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two-way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system. PMID:22578085

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    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

    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

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

    PubMed

    Papageorgiou, Elpiniki; Stylios, Chrysostomos; Groumpos, Peter

    2007-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-09-16

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

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

    PubMed Central

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

    2012-01-01

    Background The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored. Objective To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills. Methods Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators. Results A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills. Conclusions Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective. PMID:24294427

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

    ERIC Educational Resources Information Center

    Rottig, Daniel; Heischmidt, Kenneth A.

    2007-01-01

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

  3. Waiting is the hardest part: anticipating medical test results affects processing and recall of important information.

    PubMed

    Portnoy, David B

    2010-07-01

    Waiting for medical test results that signal physical harm can be a stressful and potentially psychologically harmful experience. Despite this, interventionists and physicians often use this wait time to deliver behavior change messages and other important information about the test, possible results and its implications. This study examined how "bracing" for a medical test result impacts cognitive processing, as well as recall of information delivered during this period. Healthy U.S. university students (N = 150) were tested for a deficiency of a fictitious saliva biomarker that was said to be predictive of long-term health problems using a 2 (Test Result) x 2 (Expected immediacy of result: 10 min, 1 month) factorial design. Participants expecting to get the test result shortly should have been bracing for the result. While waiting for the test results participants completed measures of cognitive processing. After participants received the test result, recall of information about the biomarker was tested in addition to cognitive measures. One week later, participants who were originally told they did not have the deficiency had their recall assessed again. Results showed that anticipating an imminent test result increased cognitive distraction in the processing of information and lowered recall of information about the test and the biomarker. These results suggest that delivering critical information to patients after administering a test and immediately before giving the results may not be optimal. PMID:20556876

  4. Waiting is the hardest part: Anticipating medical test results affects processing and recall of important information.

    PubMed

    Portnoy, David B

    2010-05-01

    Waiting for medical test results that signal physical harm can be a stressful and potentially psychologically harmful experience. Despite this, interventionists and physicians often use this wait time to deliver behavior change messages and other important information about the test, possible results and its implications. This study examined how "bracing" for a medical test result impacts cognitive processing, as well as recall of information delivered during this period. Healthy U.S. university students (N = 150) were tested for a deficiency of a fictitious saliva biomarker that was said to be predictive of long-term health problems using a 2 (Test Result) x 2 (Expected immediacy of result: 10 min, 1 month) factorial design. Participants expecting to get the test result shortly should have been bracing for the result. While waiting for the test results participants completed measures of cognitive processing. After participants received the test result, recall of information about the biomarker was tested in addition to cognitive measures. One week later, participants who were originally told they did not have the deficiency had their recall assessed again. Results showed that anticipating an imminent test result increased cognitive distraction in the processing of information and lowered recall of information about the test and the biomarker. These results suggest that delivering critical information to patients after administering a test and immediately before giving the results may not be optimal. PMID:20570029

  5. Accuracy enhancement in a fuzzy expert decision making system through appropriate determination of membership functions and its application in a medical diagnostic decision making system.

    PubMed

    Das, Suddhasattwa; Roy Chowdhury, Shubhajit; Saha, Hiranmay

    2012-06-01

    The paper attempts to improve the accuracy of a fuzzy expert decision making system by tuning the parameters of type-2 sigmoid membership functions of fuzzy input variables and hence determining the most appropriate type-1 membership function. The current work mathematically models the variability of human decision making process using type-2 fuzzy sets. Moreover, an index of accuracy of a fuzzy expert system has been proposed and determined analytically. It has also been ascertained that there exists only one rule in the rule base whose associated mapping for the ith linguistic variable maps to the same value as the maximum value of the membership function for the ith linguistic variable. The improvement in decision making accuracy was successfully verified in a medical diagnostic decision making system for renal diagnostic applications. Based on the accuracy estimations applied over a set of pathophysiological parameters, viz. body mass index, glucose, urea, creatinine, systolic and diastolic blood pressure, appropriate type-1 fuzzy sets of these parameters have been determined assuming normal distribution of type-1 membership function values in type-2 fuzzy sets. The type-1 fuzzy sets so determined have been used to develop an FPGA based smart processor. Using the processor, renal diagnosis of patients has been performed with an accuracy of 98.75%. PMID:21107889

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

    PubMed

    Newman, M T

    1976-11-01

    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

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

    PubMed

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

    2014-10-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Seelig, Richard

    2006-01-01

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

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

    PubMed

    Fargen, Kyle M; Friedman, William A

    2014-01-01

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

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

    PubMed

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

    2013-07-01

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

  12. Planning and Decision Making for Medical Education: An Analysis of Costs and Benefits.

    ERIC Educational Resources Information Center

    Wing, Paul

    This paper clarifies the role of medical education in the large health care system, estimates the resources required to carry on medical education programs and the benefits that accrue from medical education, and answers a few fundamental policy questions. Cost estimates are developed on a program-by-program basis, using empirical economic…

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

    PubMed Central

    Franklin, Lyndsey; Plaisant, Catherine; Shneiderman, Ben

    2013-01-01

    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

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

    PubMed

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

    2013-02-01

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

  15. Studies on Paederus alfierii Koch (Coleoptera:Staphylinidae) with special reference to the medical importance.

    PubMed

    Morsy, T A; Arafa, M A; Younis, T A; Mahmoud, I A

    1996-08-01

    In Egypt, the rove beetle; Paederus alfierii Koch, is an active predator of several insects pests attacking a wide variety of cultivated plants as maize, cotton, clover ... etc. On the other hand, members of genus Paederus contain pederin (potent toxin) which in contact with human skin causes a necrotizing lesion (dermatitis linearis) and with the eye causes conjunctivitis. After the sudden flood of the year 1994, this beetle attacked a factory and about forty factors suffered a form of contact dermatitis and conjunctivitis. The majority of such factors needed hospitalization. To fill the gap in the knowledge of medical importance on such a predator, the present investigation was aimed. The aqueous extract from twenty wild collected adults (0.0101 gm) was tested on different groups of albino mice. No cutaneous reaction was seen macroscopically. On the other hand, another group of mice (3/4) showed mild conjunctival congestion faded on the next day. However, these experimental findings do not indicate the innocence of this rove-beetle from being harmful to man. The discussion was given on the light of work done abroad. PMID:8754643

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

    PubMed Central

    Ciardo, D. E.; Schär, G.; Böttger, E. C.; Altwegg, M.; Bosshard, P. P.

    2006-01-01

    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

  17. Internal transcribed spacer sequencing versus biochemical profiling for identification of medically important yeasts.

    PubMed

    Ciardo, D E; Schär, G; Böttger, E C; Altwegg, M; Bosshard, P P

    2006-01-01

    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

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

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

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

  19. Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study.

    PubMed

    Franzblau, Lauren E; Maynard, Mallory; Chung, Kevin C; Yang, Lynda J-S

    2015-06-01

    OBJECT Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time. METHODS Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. RESULTS Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. CONCLUSIONS Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with patient decision aids to foster shared decision making, increase access to information, and improve patient satisfaction with decisions. These measures could greatly benefit patients with BPI while reducing costs, improving efficiency, and generating better outcomes. PMID:25839930

  20. Jay et al. BMC Medical Informatics and Decision Making 2013, 13:130 http://www.biomedcentral.com/1472-6947/13/130

    E-print Network

    Paris-Sud XI, Université de

    Jay et al. BMC Medical Informatics and Decision Making 2013, 13:130 http approaches. Costs can be estimated from a variety of data sources, including insurance claims, billing to identify cases or estimate medical expenditures [5]. In parallel to ad hoc surveys that are often temporary

  1. Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study

    Microsoft Academic Search

    Terence Bartholomew; Tatiana Carvalho

    2007-01-01

    Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether

  2. 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

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

    2011-01-01

    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

  3. Multicenter Study Evaluating the Vitek MS System for Identification of Medically Important Yeasts

    PubMed Central

    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

    2013-01-01

    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

  4. 78 FR 25692 - Notice of Decision To Authorize the Importation of Fresh Barhi Dates From Israel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-02

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

  5. 76 FR 54290 - Decision That Certain Nonconforming Motor Vehicles Are Eligible for Importation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-31

    ...NHTSA-2011-0034: Nonconforming Vehicles: 2002 Kawasaki Ninja ZX-6R motorcycles. Because there are no substantially similar U.S.-certified version 2002 Kawasaki Ninja ZX-6R motorcycles, the petitioner sought import...

  6. Older Adults' Use of Online and Offline Sources of Health Information and Constructs of Reliance and Self-Efficacy for Medical Decision Making.

    PubMed

    Hall, Amanda K; Bernhardt, Jay M; Dodd, Virginia

    2015-07-01

    We know little about older adults' use of online and offline health information sources for medical decision making despite increasing numbers of older adults who report using the Internet for health information to aid in patient-provider communication and medical decision making. Therefore we investigated older adult users and nonusers of online and offline sources of health information and factors related to medical decision making. Survey research was conducted using random digit dialing of Florida residents' landline telephones. The Decision Self-Efficacy Scale and the Reliance Scale were used to measure relationships between users and nonusers of online health information. Study respondents were 225 older adults (age range = 50-92 years, M = 68.9, SD = 10.4), which included users (n = 105) and nonusers (n = 119) of online health information. Users and nonusers differed in frequency and types of health sources sought. Users of online health information preferred a self-reliant approach and nonusers of online health information preferred a physician-reliant approach to involvement in medical decisions on the Reliance Scale. This study found significant differences between older adult users and nonusers of online and offline sources of health information and examined factors related to online health information engagement for medical decision making. PMID:26054777

  7. Preclinical testing of three south American antivenoms against the venoms of five medically-important Peruvian snake venoms

    Microsoft Academic Search

    G. D Laing; A Yarleque; A Marcelo; E Rodriguez; D. A Warrell; R. D. G Theakston

    2004-01-01

    World Health Organization (WHO)-recommended preclinical in vivo and in vitro studies were carried out to compare the efficacy of Brazilian, Peruvian and Colombian antivenoms in neutralizing the venom toxins responsible for the lethal, haemorrhagic, necrotizing, coagulant and defibrinogenating effects of five medically-important Peruvian snake venoms. Overall, the Brazilian antivenom was found to be the most effective followed by the Peruvian

  8. Impact of larval pathogen infection on conspecific oviposition preference of three medically important mosquito species of Florida.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Oviposition responses of three medically important mosquito species were evaluated in two-choice bioassays to determine if larval pathogen infection affected oviposition site choice. Both Aedes aegypti and Ae. albopictus laid significantly fewer eggs in cups containing infected larvae, however, Cule...

  9. Architecture-Level Dependability Analysis of a Medical Decision Support System

    SciTech Connect

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

    2010-01-01

    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.

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

    PubMed Central

    Moliver, Nina; Coates, Allan L.

    1987-01-01

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

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

    PubMed

    Weber, L J

    1993-06-01

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

  12. Users' Guides to the Medical Literature XXII: How to Use Articles About Clinical Decision Rules

    Microsoft Academic Search

    Thomas G. McGinn; Gordon H. Guyatt; Peter C. Wyer; C. David Naylor; Ian G. Stiell; W. Scott Richardson

    Clinical experience provides clinicians with an intuitive sense of which find- ings on history, physical examination, and investigation are critical in mak- ing an accurate diagnosis, or an accurate assessment of a patient's fate. A clinical decision rule (CDR) is a clinical tool that quantifies the individual contributions that various components of the history, physical examina- tion, and basic laboratory

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

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

    PubMed Central

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

    2013-01-01

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

  15. The Importance of Vocational and Social Aspects of Approaches to Learning for Medical Students

    ERIC Educational Resources Information Center

    Mattick, Karen; Knight, Lynn

    2009-01-01

    Having performed research using approaches to learning and studying inventories and become familiar with the concepts they 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…

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

    E-print Network

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

    2011-03-01

    niche models, predicted geographic distributions, and climate change effects. Int J Parasitol 33: 919–931. 32. Joyner TA, Lukhnova L, Pazilov Y, Temuralyeva G, Hugh-Jones ME, et al. (2010) Modeling the potential distribution of Bacillus anthracis under... Society of America Student Research Grant (http://www.geosociety.org/grants/gradgrants.htm) for financial support to EES. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript...

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

    PubMed Central

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

    2013-01-01

    Background Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. Objective The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as “iPhone like platforms” by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. Methods The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients’ prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. Results The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the “MPR Monitor”, where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. Conclusions The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality. PMID:23876796

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

    PubMed Central

    Dickenson, D.

    2000-01-01

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

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

    PubMed

    Midttun, Linda

    2007-03-01

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

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

    PubMed

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

    2014-11-14

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

  1. 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

    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

    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

  2. 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

    Kristina Orfali

    2004-01-01

    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

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

    PubMed Central

    2014-01-01

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

  4. An Exploratory Data Analysis System for Support in Medical Decision-Making

    PubMed Central

    Copeland, J. A.; Hamel, B.; Bourne, J. R.

    1979-01-01

    An experimental system was developed to allow retrieval and analysis of data collected during a study of neurobehavioral correlates of renal disease. After retrieving data organized in a relational data base, simple bivariate statistics of parametric and nonparametric nature could be conducted. An “exploratory” mode in which the system provided guidance in selection of appropriate statistical analyses was also available to the user. The system traversed a decision tree using the inherent qualities of the data (e.g., the identity and number of patients, tests, and time epochs) to search for the appropriate analyses to employ.

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

    PubMed

    Ponnampalam, Louisa Shobhini

    2014-03-01

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

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

    PubMed

    Moja, Lorenzo; Kwag, Koren Hyogene

    2015-02-01

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

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

    PubMed Central

    Moja, Lorenzo; Kwag, Koren Hyogene

    2015-01-01

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

  8. Learned Helplessness Among Families and Surrogate Decision-Makers of Patients Admitted to Medical, Surgical, and Trauma ICUs

    PubMed Central

    Sullivan, Donald R.; Liu, Xinggang; Corwin, Douglas S.; Verceles, Avelino C.; McCurdy, Michael T.; Pate, Drew A.; Davis, Jennifer M.

    2012-01-01

    Background: We sought to determine the prevalence of and clinical variables associated with learned helplessness, a psychologic state characterized by reduced motivation, difficulty in determining causality, and depression, in family members of patients admitted to ICUs. Methods: We conducted an observational survey study of a prospectively defined cohort of family members, spouses, and partners of patients admitted to surgical, medical, and trauma ICUs at a large academic medical center. Two validated instruments, the Learned Helplessness Scale and the Perceived Stress Scale, were used, and self-report of patient clinical characteristics and subject demographics were collected. Results: Four hundred ninety-nine family members were assessed. Of these, 238 of 460 (51.7%) had responses consistent with a significant degree of learned helplessness. Among surrogate decision-makers, this proportion was 50% (92 of 184). Characteristics associated with significant learned helplessness included grade or high school education (OR, 3.27; 95% CI, 1.29-8.27; P = .01) and Perceived Stress Scale score > 18 (OR, 4.15; 95% CI, 2.65-6.50; P < .001). The presence of a patient advance directive or do not resuscitate (DNR) order was associated with reduced odds of significant learned helplessness (OR, 0.56; 95% CI, 0.32-0.98; P = .05). Conclusions: The majority of family members of patients in the ICU experience significant learned helplessness. Risk factors for learned helplessness include lower educational levels, absence of an advance directive or DNR order, and higher stress levels among family members. Significant learned helplessness in family members may have negative implications in the collaborative decision-making process. PMID:22661454

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

    PubMed

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

    2011-01-01

    Most spiders use venom to paralyze their prey and are commonly feared for their potential to cause injury to humans. In North America, one species in particular, Loxosceles reclusa (brown recluse spider, Sicariidae), causes the majority of necrotic wounds induced by the Araneae. However, its distributional limitations are poorly understood and, as a result, medical professionals routinely misdiagnose brown recluse bites outside endemic areas, confusing putative spider bites for other serious conditions. To address the issue of brown recluse distribution, we employ ecological niche modeling to investigate the present and future distributional potential of this species. We delineate range boundaries and demonstrate that under future climate change scenarios, the spider's distribution may expand northward, invading previously unaffected regions of the USA. At present, the spider's range is centered in the USA, from Kansas east to Kentucky and from southern Iowa south to Louisiana. Newly influenced areas may include parts of Nebraska, Minnesota, Wisconsin, Michigan, South Dakota, Ohio, and Pennsylvania. These results illustrate a potential negative consequence of climate change on humans and will aid medical professionals in proper bite identification/treatment, potentially reducing bite misdiagnoses. PMID:21464985

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

    PubMed

    Ikeda, Yukihiro

    2014-07-01

    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

  11. Experience with importation of electronic images into the medical record from physical media.

    PubMed

    Erickson, Bradley J

    2011-08-01

    The purpose of this article is to describe a system we developed for importing images on compact discs (CDs) from external imaging departments into our clinical image viewing system, and to report on key metrics regarding veracity of information seen on the CDs. We recommend careful attention to the process of CD importation because of the error rate we have seen. We developed a system and process for importing images on CD into our EMR. The importation system scans the CD for digital imaging and communications in medicine (DICOM) images, and collects all patient information seen. That information is presented to the patient for verification. Once validated, the image data is copied into our clinical viewing system. The importation system includes facilities for collecting instances of incorrect data. About 90% of images are now exchanged between our healthcare enterprise and other entities via CD. Data for the wrong patient (e.g., the wrong CD) is seen in about 0.1% of cases, and a similar number of CDs have data for more than one patient on the CD(s) the patient bring to our facility. Most data are now exchanged via DICOM files. DICOM images burned onto CD media are now commonly used for image exchange. However, applications to import DICOM images are not enough. One must implement a process to assure high confidence that the data imported belongs to the patient you are importing. PMID:21286776

  12. Refusal to medical interventions.

    PubMed

    Palacios, G; Herreros, B; Pacho, E

    2014-10-01

    Refusal to medical interventions is the not acceptance, voluntary and free, of an indicated medical intervention. What the physician should do in case of refusal? It is understandable that the rejection of a validated medical intervention is difficult to accept by the responsible physician when raises the conflict protection of life versus freedom of choice. Therefore it is important to follow some steps to incorporate the most relevant aspects of the conflict. These steps include: 1) Give complete information to patients, informing on possible alternatives, 2) determine whether the patient can decide (age, competency and level of capacity), 3) to ascertain whether the decision is free, 4) analyze the decision with the patient, 5) to persuade, 6) if the patient kept in the rejection decision, consider conscientious objection, 7) take the decision based on the named criteria, 8) finally, if the rejection is accepted, offer available alternatives. PMID:24880186

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

    PubMed Central

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

    2014-01-01

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

  14. Visual computing for medical diagnosis and treatment

    Microsoft Academic Search

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

    2009-01-01

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

  15. Development of an Electronic Medical Record-Based Clinical Decision Support Tool to Improve HIV Symptom Management

    PubMed Central

    Tsevat, Joel; Justice, Amy C.; Mrus, Joseph M.; Levin, Forrest; Kozal, Michael J.; Mattocks, Kristin; Farber, Steven; Rogers, Michelle; Erdos, Joseph; Brandt, Cynthia; Kudel, Ian; Braithwaite, Ronald

    2009-01-01

    Abstract Common symptoms associated with HIV disease and its management are often underrecognized and undertreated. A clinical decision support tool for symptom management was developed within the Veterans Health Administration electronic medical record (EMR), aiming at increasing provider awareness of and response to common HIV symptoms. Its feasibility was studied in March to May 2007 by implementing it within a weekly HIV clinic, comparing a 4-week intervention period with a 4-week control period. Fifty-six patients and their providers participated in the study. Patients' perceptions of providers' awareness of their symptoms, proportion of progress notes mentioning any symptom(s) and proportion of care plans mentioning any symptom(s) were measured. The clinical decision support tool used portable electronic “tablets” to elicit symptom information at the time of check-in, filtered, and organized that information into a concise and clinically relevant EMR note available at the point of care, and facilitated clinical responses to that information. It appeared to be well accepted by patients and providers and did not substantially impact workflow. Although this pilot study was not powered to detect effectiveness, 25 (93%) patients in the intervention group reported that their providers were very aware of their symptoms versuas 27 (75%) control patients (p = 0.07). The proportion of providers' notes listing symptoms was similar in both periods; however, there was a trend toward including a greater number of symptoms in intervention period progress notes. The symptom support tool seemed to be useful in clinical HIV care. The Veterans Health Administration EMR may be an effective “laboratory” for developing and testing decision supports. PMID:19538046

  16. Perception and use of complementary and alternative medicine among children and adults with epilepsy: the importance of the decision makers.

    PubMed

    Asadi-Pooya, Ali A; Emami, Mehrdad

    2014-01-01

    The aim of the current study was to assess the extent to which complementary and alternative medicine (CAM) has been used in children and adults to treat seizures and to compare the perceptions and usage of CAM between adult patients who decides for themselves and adults who decide for their sick children.In this cross-sectional study, patients who have been treated for epilepsy for at least one year at the outpatient epilepsy clinic at the Shiraz University of Medical Sciences were interviewed from January 2012 through March 2012. The questionnaire collected specific information of CAM perceptions and usage among patients. Pearson Chi-Square and Student's t-test were used to compare variables among children group with adults group. Ninety-eight children (their caregivers) and 158 adults (themselves) participated. Adult patients (53%) more frequently believed that CAM might be useful in treating seizures than adults with sick kids (35%) (P = 0.0004). Herbal drugs, traditional medicine and exercise were more often considered as being helpful in treating seizures among adult patients compared to adults with sick children. CAM usage was not different among adult patients compared to adults with sick kids (P = 0.3). CAM is an option considered by many people with epilepsy to treat seizures. The individual who makes the decision as to use any of these unconventional treatment options is probably not different when it comes to self (the patient himself) vs. non-self (the parents/care-givers), despite the observed difference that adult patients more frequently believed that CAM might be useful in treating seizures than adults with sick kids. PMID:24659074

  17. A prospective study of medical students' perspective of teaching-learning media: reiterating the importance of feedback.

    PubMed

    Dhaliwal, Upreet

    2007-11-01

    To enhance successful communication, medical teachers are increasingly using teaching-learning media. To determine medical students' perception of three such media (blackboard, overhead projector, and slides), and to generate recommendations for their optimal use, a prospective questionnaire-based study was carried out among 7th semester medical students of the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi. Students made a forced choice between: (1) The three media on 8 questions regarding their advantages and disadvantages and (2) four aspects of a lecture (teaching-learning media, topic, teacher and time of day) regarding which made the lecture most engaging. Resulting data was analysed by Chi-square and Fisher's exact tests. Chalk and blackboard was rated as best in allowing interaction and helping recall (p<0.001 each). The overhead projector was best in providing information pointwise (p<0.001; 67 students, 89.3%, considered this an advantage). More subject matter could be covered per lecture (p=0.001; 58 students, 77.3%, considered this a disadvantage). Slides were best in imparting clinical details (p=0.004), but were sleep inducing (p<0.001). The teacher's style of instruction was most important in making the lecture engaging (p<0.001). The teacher's role in the learning process is important. Students enjoy the slow pace and interaction allowed by blackboard, pointwise information presented by the overhead projector, and the clinical details a slide can provide. The results suggest that the lecture could best be a combination of two or more teaching-learning media. Students' interaction should be encouraged whatever the media used. PMID:18405087

  18. Facilitators and barriers to the active participation of clients with serious mental illnesses in medication decision making: the perceptions of young adult clients.

    PubMed

    Delman, Jonathan; Clark, Jack A; Eisen, Susan V; Parker, Victoria A

    2015-04-01

    The active participation of young adults with serious mental illnesses (SMI) in making decisions about their psychotropic medications is beneficial to their care quality and overall health. Many however report not expressing treatment preferences to psychiatrists. Qualitative methods were used to interview 24 young adults with SMI about their experiences making medication decisions with their psychiatrists. An inductive analytic approach was taken to identifying conceptual themes in the transcripts. Respondents reported that the primary facilitators to active participation were the psychiatrist's openness to the client's perspective, the psychiatrist's availability outside of office hours, the support of other mental health providers, and personal growth and self-confidence of the young adults. The primary barriers to active participation reported were the resistance of the psychiatrist, the lack of time for consultations, and limited client self-efficacy. Young adults with SMI can be active participants in making decisions about their psychiatric treatment. PMID:25056768

  19. Perceived familiarity with and importance of family health history among a medically underserved population.

    PubMed

    Ashida, Sato; Goodman, Melody S; Stafford, Jewel; Lachance, Christina; Kaphingst, Kimberly A

    2012-10-01

    Inadequate knowledge of family health history (FHH) continues to be a major obstacle limiting its usefulness in public health and clinical practice; strategies to facilitate FHH dissemination are needed. Data (N?=?1,334) were obtained through waiting-room surveys completed by a diverse sample of patients attending three community health centers. Perceptions about the importance of genetic information (??=?0.13, p?importance of FHH, respectively. Furthermore, beliefs about genetic causation of illnesses (??=?0.12, p?50 years) reported higher familiarity than those in the youngest (18-25 years). Those with higher familiarity were significantly less likely to answer "don't know" when reporting diabetes and heart disease diagnoses among immediate (OR?=?0.35 and OR?=?0.29, respectively) and extended (OR?=?0.50 and OR?=?0.46, respectively) family members. Having a wider health communication reach within a family may be beneficial in increasing familiarity with FHH; however, the reported levels of communication reach were limited among most participants. Women, older-generation family members, and those who believe in the importance of genetics in health or feel confident about using genetic information may be particularly important as targets of public health interventions to facilitate FHH dissemination within families. PMID:22569765

  20. Preclinical testing of three South American antivenoms against the venoms of five medically-important Peruvian snake venoms.

    PubMed

    Laing, G D; Yarleque, A; Marcelo, A; Rodriguez, E; Warrell, D A; Theakston, R D G

    2004-07-01

    World Health Organization (WHO)-recommended preclinical in vivo and in vitro studies were carried out to compare the efficacy of Brazilian, Peruvian and Colombian antivenoms in neutralizing the venom toxins responsible for the lethal, haemorrhagic, necrotizing, coagulant and defibrinogenating effects of five medically-important Peruvian snake venoms. Overall, the Brazilian antivenom was found to be the most effective followed by the Peruvian and Colombian antivenoms. However, it was concluded that all three antivenoms would be acceptable for use in a randomised clinical trial in envenomed humans in Peru. PMID:15225568

  1. "The ultimate decision is yours": exploring patients' attitudes about the overuse of medical interventions.

    PubMed

    Schleifer, David; Rothman, David J

    2012-01-01

    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

  2. Prevention and genetic testing for breast cancer: variations in medical decisions

    Microsoft Academic Search

    Louise Bouchard; I. Blancquaert; F. Eisinger; W. D. Foulkes; G. Evans; H. Sobol; C. Julian-Reynier

    2004-01-01

    The discovery linking the genes BRCA1&2 to familial breast cancer played an important role in the clinical practice of geneticists and physicians. The availability of genetic tests for BRCA gene mutations prompted cancer geneticists to give information about genetic risk and to assess many women with a personal or family history of breast or ovarian cancer to inform them of

  3. Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations

    Microsoft Academic Search

    Eileen Kaner; Ben Heaven; Tim Rapley; Madeleine Murtagh; Ruth Graham; Richard Thomson; Carl May

    2007-01-01

    BACKGROUND: Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making

  4. Ensemble based systems in decision making

    Microsoft Academic Search

    R. Polikar

    2006-01-01

    In matters of great importance that have financial, medical, social, or other implications, we often seek a second opinion before making a decision, sometimes a third, and sometimes many more. In doing so, we weigh the individual opinions, and combine them through some thought process to reach a final decision that is presumably the most informed one. The process of

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

    PubMed

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

    2014-06-24

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

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

    PubMed

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

    2015-04-01

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

  7. Decision making in advanced cancer of the head and neck: variation in the views of medical specialists.

    PubMed Central

    Maher, E J; Jefferis, A F

    1990-01-01

    Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices. PMID:1696315

  8. An Interactive Medical Knowledge Assistant

    NASA Astrophysics Data System (ADS)

    Czejdo, Bogdan D.; Baszun, Mikolaj

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

  9. Shared medical decision-making: considering what options to present based on an ethical analysis of the treatment of brain tumors in very young children.

    PubMed

    Levine, Deena; Cohen, Kenneth; Wendler, David

    2012-08-01

    The treatment of brain tumors in very young children poses both a therapeutic challenge and a bioethical quandary. The administration of craniospinal radiation after surgery offers the greatest chance for cure but causes severe neurocognitive damage. As a result, current practice does not offer parents the option of full-dose postoperative craniospinal radiation. Some may regard this approach as inappropriate medical paternalism, while others may consider it an example of responsible therapeutics. Evaluation of this dilemma reveals principles which can guide clinicians in determining which treatment options to present to their patients or surrogates, in the context of shared medical decision-making. PMID:22522647

  10. Decision Support: Decision Analysis

    E-print Network

    Bohanec, Marko

    1 Decision Support: Decision Analysis Jozef Stefan International Postgraduate School, Ljubljana of Nova Gorica Decision Analysis Part 1 Decision Analysis and Decision Tables Decision Analysis, Part 1 · Introduction to Decision Analysis ­ Concepts: modelling, evaluation, analysis ­ Decision Problem

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

    E-print Network

    The marketing programme includes an all-important introduction to man- agement decision-making, as well as a set of business functions. Market- ing is indispensable in top management's choice of markets to each of the following marketing policy areas: innovation and channel management, product/market

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

    PubMed Central

    Shorey, Jeannette M.

    2013-01-01

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

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

    PubMed

    Alkan, N; Demircan, T

    2001-10-01

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

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

    PubMed

    Vadász, Gábor

    2010-10-24

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

  15. PUB HLTH 431 Decision Analysis and Models of Decision Making

    E-print Network

    Contractor, Anis

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

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

    PubMed

    Collins, Sean P; Storrow, Alan B

    2013-08-01

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

  17. Rhipicephalus rossicus, a neglected tick at the margin of Europe: a review of its distribution, ecology and medical importance.

    PubMed

    Mihalca, A D; Kalmár, Z; Dumitrache, M O

    2015-09-01

    Rhipicephalus rossicus (Ixodida: Ixodidae) is a three-host tick with a broad host spectrum that includes wild animals, pets, livestock and humans. Despite its local abundance in certain areas, most of the available information on R.?rossicus was published decades ago, mainly by former soviet authors. Its distribution largely overlaps the Eurasian steppe. However, its range may be more extensive than is currently known because this species may have been misidentified as Rhipicephalus sanguineus, principally in areas where the latter species is present. Although R.?rossicus has been occasionally reported to feed on people, little attention has been given to its medical importance. It has been shown to have a vectorial role in the transmission of Francisella tularensis, Crimean-Congo haemorrhagic fever virus and West Nile virus. However, the vectorial importance of R.?rossicus may be significantly greater, mainly as the closely related species R.?sanguineus s.l. is known to transmit a very wide spectrum of pathogens. The probably underestimated vectorial role of R.?rossicus may represent a hidden public health threat. PMID:25761411

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

    PubMed Central

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

    2015-01-01

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

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

    Microsoft Academic Search

    Stephen Alexander; Warren Rissier; Susan Chun

    2007-01-01

    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

  20. Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications: A Review

    PubMed Central

    McCance-Katz, Elinore F.; Sullivan, Lynn; Nallani, Srikanth

    2012-01-01

    Drug interactions are a leading cause of morbidity and mortality. Methadone and buprenorphine are frequently prescribed for the treatment of opioid addiction. Patients needing treatment with these medications often have co-occurring medical and mental illnesses that require medication treatment. The abuse of illicit substances is also common in opioid-addicted individuals. These clinical realities place patients being treated with methadone and buprenorphine at risk for potentially toxic drug interactions. A substantial literature has accumulated on drug interactions between either methadone or buprenorphine with other medications when ingested concomitantly by humans. This review summarizes current literature in this area. PMID:20132117

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

    PubMed Central

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

    2006-01-01

    The liver fluke, Opisthorchis viverrini, is one of the major food borne trematodes in Southeast Asia, where infection causes hepatobiliary disease and subsequent development of cholangiocarcinoma. In Thailand, O. viverrini is most prevalent in the northeast where there is marked regional variation in the rate of infection in humans at provincial, district and village levels. To date, the roles of genetic variation of O. viverrini on this observed variability in infection, transmission and associated disease are not known. We have applied multilocus enzyme electrophoresis (MEE), specifically allozyme electrophoresis, to isolates of O. viverrini from Thailand and Laos to establish genetic markers to examine its systematics and population structure. Forty-six enzymes commonly found useful for genetic characterisation in parasitic helminths were screened, and of these, 33 enzymes gave sufficient staining and resolution to act as potential genetic markers. Sixteen enzymes were monomorphic and 17 enzymes were polymorphic in the pools of worms examined. Whether they are indicative of different enzyme loci, heterozygosity or unique genotypes within the pools of worms examined remains to be determined. Preliminary investigations examining five individual worms at enzyme loci where pools of worms showed multiple bands have confirmed the diagnostic value of the enzyme loci established as well as providing evidence of potential population sub structuring and heterozygosity. For the first time, we have established at least 17 enzymes that provide the basis to undertake comprehensive genetic analyses of the systematics and population structure of O. viverrini, a medically important food borne trematode in Southeast Asia. PMID:17166476

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

    E-print Network

    Paris-Sud XI, Université de

    with contextual information (such as the patient age, sex and medical history). Indeed, medical experts generally. The method is evaluated on a classified diabetic retinopathy database. On this database, results of relevant cases in a case database. This process is followed by the adaptation of the past to the new

  3. Rural Medical School Applicants: Do Their Academic Credentials and Admission Decisions Differ from Those of Nonrural Applicants?

    ERIC Educational Resources Information Center

    Longo, Daniel R.; Gorman, Robert J.; Ge, Bin

    2005-01-01

    Context and Purpose: Medical schools located in states with sizable rural areas are concerned about preparing physicians for practice in these areas; this is of particular concern for medical schools that are part of a state-owned university with a responsibility to educate physicians for rural areas. Because individuals from rural areas are most…

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

    Microsoft Academic Search

    Xiaoping Zheng; Xiaocui Wang; Tingkuan Zhong

    2010-01-01

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

  5. 77 FR 76457 - Howard Hughes Medical Institute, et al.; Notice of Consolidated Decision on Applications for Duty...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-28

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

  6. A survey of decision tree classifier methodology

    NASA Technical Reports Server (NTRS)

    Safavian, S. R.; Landgrebe, David

    1991-01-01

    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.

  7. 76 FR 81469 - Notice of Decision to Authorize Importation of Fresh Litchi From the Republic of South Africa...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ...risks of introducing or disseminating plant pests or noxious weeds via the importation of litchi from the Republic of South Africa...risks of introducing or disseminating plant pests or noxious weeds via the importation of litchi from South Africa. One...

  8. 73 FR 44216 - Notice of Decision To Issue Permits for the Importation of Dragon Fruit From Vietnam Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2008-07-30

    ...To Issue Permits for the Importation of Dragon Fruit From Vietnam Into the Continental...into the continental United States of dragon fruit from Vietnam. Based on the findings...or noxious weeds via the importation of dragon fruit from Vietnam. DATES:...

  9. 78 FR 69640 - Notice of Decision To Authorize the Importation of Swiss Chard From Colombia Into the Continental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-20

    ...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,...

  10. 78 FR 13304 - Notice of Decision To Issue Permits for the Importation of Strawberry Fruit From Egypt Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...or disseminating plant pests or noxious weeds via the importation of fresh strawberry...fields or prevent infestation. Successful control programs typically include monitoring, cultural, biological, and chemical components, all of...

  11. 75 FR 34687 - Notice of Decision to Issue Permits for the Importation of Fresh False Coriander From Panama Into...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-18

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

  12. 76 FR 61340 - Notice of Decision To Authorize the Importation of Dragon Fruit From Thailand Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

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

  13. 76 FR 8997 - Notice of Decision To Issue Permits for the Importation of Fresh Strawberries From Jordan Into...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-16

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

  14. 75 FR 52712 - Notice of Decision To Issue Permits for the Importation of Fresh Mango Fruit From Pakistan Into...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

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

  15. 75 FR 26707 - Notice of Decision to Issue Permits for the Importation of Fresh Pomegranates and Baby Kiwi from...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-12

    ...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh pomegranates and fresh baby kiwi from Chile. EFFECTIVE DATE: May 12, 2010. FOR FURTHER...

  16. 76 FR 81468 - Notice of Decision to Authorize the Importation of Shredded Lettuce From Egypt Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

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

  17. 76 FR 61340 - Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh apricot, sweet cherry, and plumcot fruit from South Africa. We are also revising a...

  18. 76 FR 49725 - Notice of Decision To Authorize the Importation of Fresh Papaya Fruit From Malaysia into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-11

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

  19. 76 FR 21854 - Notice of Decision To Authorize the Importation of Fresh Rambutan Fruit From Malaysia and Vietnam

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-19

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

  20. 76 FR 18511 - Notice of Decision To Issue Permits for the Importation of Fresh Figs From Chile into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

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

  1. 76 FR 44889 - Notice of Decision To Authorize the Importation of Fresh Persimmon From the Republic of South Africa

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh persimmon fruit from South Africa. DATES: Effective Date: July 27, 2011. FOR FURTHER...

  2. 78 FR 9027 - Notice of Decision To Authorize the Importation of Litchi, Longan, and Rambutan From the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-07

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

  3. 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, 2014

    2010-11-23

    ...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of wall rocket leaves from the United Kingdom. DATES: Effective Date: November 23, 2010. FOR...

  4. 76 FR 78231 - Notice of Decision To Authorize the Importation of Fresh Cape Gooseberry Fruit With Husks From Chile

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-16

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

  5. 78 FR 49251 - Notice of Decision To Authorize the Importation of Fresh Pitayas and Pomegranates From Mexico...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ...designated phytosanitary measures will be sufficient to mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation of fresh pitayas and pomegranates from Mexico. DATES: As of August 13, 2013. FOR FURTHER...

  6. 75 FR 56981 - Notice of Decision To Issue Permits for the Importation of Sweet Limes From Mexico Into the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

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

  7. 75 FR 29309 - Notice of Decision to Issue Permits for the Importation of Fresh Male Summer Squash Flowers From...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-25

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

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

    E-print Network

    Grishok, Alla

    Important 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 the risks of communicating with your health care provider or program via email and how Columbia University

  9. Feedback is an important part of teaching and learning. Trainees from the medical and allied healthcare programs are increasingly facing challenges

    E-print Network

    Haykin, Simon

    Feedback is an important part of teaching and learning. Trainees from the medical and allied healthcare programs are increasingly facing challenges in learning opportunities and adequate feedback re: providing effective feedback. Wednesday, September 18, 2013 3:00 to 6:00 p.m. or Wednesday

  10. Cooperative Medical Decision Making and Learning by the Sharing of Web-Based Electronic Notebooks and Logs

    Microsoft Academic Search

    Mark C. Tsai; Parvati Dev; Larry J. Leifer; Kenneth L. Melmon

    1999-01-01

    The Stanford Health Information Network for Education (SHINE) integrates online bibliographic systems, drug databases, guideline texts, textbooks, journals, medical images, digital videos, and knowledge-based systems formerly accessible individually through the Z39.50 protocol, SQL language, HTTP protocol and full-text search engines. Using a mediator-and-wrapper-based approach, SHINE is able to integrate with the patient's electronic medical record (EMR) system to support just-in-time

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    2012-01-01

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

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

    Microsoft Academic Search

    Ali M. Kanso; Richard Alan Nelson

    2007-01-01

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

  14. Integration of Pharmacogenetics and Pharmacogenomics in Drug Development: Implications for Regulatory and Medical Decision Making in Pediatric Diseases

    Microsoft Academic Search

    Chiara Piana; Linda Surh; Sabine Furst-Recktenwald; Achille Iolascon; Evelyne M. Jacqz-Aigrain; Ineke Jonker; Roberta Russo; Ron H. N. van Schaik; Judith Wessels; Oscar E. Della Pasqua

    2012-01-01

    This article aims to provide an overview of the current situation regarding pharmacogenetic and pharmacogenomic (PG) studies in pediatrics, with a special focus on the role of PG data in the regulatory decision-making process. Despite the gap in pharmacogenetic research due to the lack of translational studies in adults and children, several technologies exist in drug development and biomarkers validation,

  15. 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

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

    2013-01-01

    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

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

    PubMed

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

    2014-06-01

    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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Lamy, J.-B.

    2014-01-01

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

  19. Linguistic approach for identification of medication names and related information in clinical narratives

    Microsoft Academic Search

    Thierry Hamon; Natalia Grabar

    2010-01-01

    BackgroundPharmacotherapy is an integral part of any medical care process and plays an important role in the medical history of most patients. Information on medication is crucial for several tasks such as pharmacovigilance, medical decision or biomedical research.ObjectivesWithin a narrative text, medication-related information can be buried within other non-relevant data. Specific methods, such as those provided by text mining, must

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

    PubMed

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

    2014-01-01

    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. PMID:25242934

  1. Adherence to Medication Is a More Important Contributor to Viral Breakthrough in Chronic Hepatitis B Patients Treated with Entecavir Than in Those with Lamivudine

    PubMed Central

    Kamezaki, Hidehiro; Kanda, Tatsuo; Arai, Makoto; Wu, Shuang; Nakamoto, Shingo; Chiba, Tetsuhiro; Maruyama, Hitoshi; Fujiwara, Keiichi; Kanai, Fumihiko; Imazeki, Fumio; Nomura, Fumio; Yokosuka, Osamu

    2013-01-01

    Viral breakthrough is related to poor adherence to medication in some chronic hepatitis B patients treated with nucleos(t)ide analogues (NAs). Our study aimed to examine how adherence to medication is associated with viral breakthrough in patients treated with NAs. A total of 203 patients (135 ETV and 68 LAM) were analyzed in this retrospective analysis. Physical examination, serum liver enzyme tests, and hepatitis B virus marker tests were performed at least every 3 months. We reviewed medical records and performed medical interviews regarding to patients' adherence to medication. Adherence rates <90% were defined as poor adherence in the present study. Cumulative viral breakthrough rates were lower in the ETV-treated patients than in the LAM-treated patients (P<0.001). Seven ETV-treated (5.1%) and 6 LAM-treated patients (8.8%) revealed poor adherence to medication (P=0.48). Among ETV-treated patients, 4 (3.1%) of 128 patients without poor adherence experienced viral breakthrough and 3 (42.8%) of 7 patients with poor adherence experienced viral breakthrough (P<0.001). Only 3 of 38 (7.8%) LAM-treated patients with viral breakthrough had poor adherence, a lower rate than the ETV-treated patients (P=0.039). Nucleoside analogue resistance mutations were observed in 50.0% of ETV- and 94.1% of LAM-treated patients with viral breakthrough (P=0.047). Viral breakthrough associated with poor adherence could be a more important issue in the treatment with especially stronger NAs, such as ETV. PMID:23533048

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

    PubMed

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

    2014-04-30

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

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

    Microsoft Academic Search

    Folker Spitzenberger; Rainer Edelhäuser

    2006-01-01

    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

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

    PubMed Central

    2012-01-01

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

  5. The importance of Guthrie cards and other medical samples for the direct matching of disaster victims using DNA profiling.

    PubMed

    Hartman, D; Benton, L; Morenos, L; Beyer, J; Spiden, M; Stock, A

    2011-02-25

    The identification of disaster victims through the use of DNA analysis is an integral part of any Disaster Victim Identification (DVI) response, regardless of the scale and nature of the disaster. As part of the DVI response to the 2009 Victorian Bushfires Disaster, DNA analysis was performed to assist in the identification of victims through kinship (familial matching to relatives) or direct (self source sample) matching of DNA profiles. Although most of the DNA identifications achieved were to reference samples from relatives, there were a number of DNA identifications (12) made through direct matching. Guthrie cards, which have been collected in Australia over the past 30 years, were used to provide direct reference samples. Of the 236 ante-mortem (AM) samples received, 21 were Guthrie cards and one was a biopsy specimen; all yielding complete DNA profiles when genotyped. This publication describes the use of such Biobanks and medical specimens as a sample source for the recovery of good quality DNA for comparisons to post-mortem (PM) samples. PMID:20691551

  6. Markov Decision Processes: A Tool for Sequential Decision Making

    E-print Network

    Schaefer, Andrew

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

  7. The Closure of a Medical Practice Forces Older Patients to Make Difficult Decisions: A Qualitative Study of a Natural Experiment

    PubMed Central

    Nidiry, Mary Anne J.; Gozu, Aysegul; Carrese, Joseph A.

    2008-01-01

    Objective The closure of a primary care practice and the relocation of the physicians and staff to a new office forced patients to decide whether to follow their primary care physicians (PCP) or to transfer their care elsewhere. This study explores the perspectives of the older patients affected by this change. Design Qualitative study. Setting and Participants Two lists of patients older than 60 years from the original office were generated: (1) those who had followed their PCPs to the further practice and (2) those who chose new PCPs at an affiliated nearby clinic. One hundred forty patients from each of the two lists were randomly selected for study. Measurement Eight months after the clinic’s closure, patients responded to an open-ended question asking patients to describe the transition. Using content analysis, two investigators independently coded all of the written responses. Results Over 85% of patients in both groups had been with their original PCP for longer than 2 years. Patients that elected to transition their care to a new PCP within their community were older (75 vs 70 years) and more likely to be living alone (38% vs 18%), both p?decisions were considerably influenced by whether they imagined that convenience or their established relationship with their PCP was of a higher priority to them. PMID:18626723

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

    PubMed

    Bell, David; Crawford, Vivienne

    2011-10-01

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

  9. Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems—I-MeDeSA

    PubMed Central

    Zachariah, Marianne; Seidling, Hanna M; Neri, Pamela M; Cresswell, Kathrin M; Duke, Jon; Bloomrosen, Meryl; Volk, Lynn A; Bates, David W

    2011-01-01

    Background Medication-related decision support can reduce the frequency of preventable adverse drug events. However, the design of current medication alerts often results in alert fatigue and high over-ride rates, thus reducing any potential benefits. Methods The authors previously reviewed human-factors principles for relevance to medication-related decision support alerts. In this study, instrument items were developed for assessing the appropriate implementation of these human-factors principles in drug–drug interaction (DDI) alerts. User feedback regarding nine electronic medical records was considered during the development process. Content validity, construct validity through correlation analysis, and inter-rater reliability were assessed. Results The final version of the instrument included 26 items associated with nine human-factors principles. Content validation on three systems resulted in the addition of one principle (Corrective Actions) to the instrument and the elimination of eight items. Additionally, the wording of eight items was altered. Correlation analysis suggests a direct relationship between system age and performance of DDI alerts (p=0.0016). Inter-rater reliability indicated substantial agreement between raters (?=0.764). Conclusion The authors developed and gathered preliminary evidence for the validity of an instrument that measures the appropriate use of human-factors principles in the design and display of DDI alerts. Designers of DDI alerts may use the instrument to improve usability and increase user acceptance of medication alerts, and organizations selecting an electronic medical record may find the instrument helpful in meeting their clinicians' usability needs. PMID:21946241

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

    PubMed

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

    2013-08-01

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

  11. How to represent the decision process in a medication plan: the case of the swiss cohort of inflammatory bowel diseases.

    PubMed

    Ehrler, Frederic; Baumann, Philippe; Lovis, Christian

    2015-01-01

    Inflammatory bowel diseases (IBD) belong to healthcare problems impacting the quality of life and inducing important costs for the healthcare system. There is still no magical cure against this kind of diseases, but many promising therapies are under investigation. In order to study the efficiency and side effects of the existing drugs and to evaluate new ones, large numbers of patients are followed in long term cohort studies. The particular constraints associated to the follow up of patients with IBD require the implementation of adapted and efficient tools. On the one hand, clinicians must be able to perform daily changes to the patient treatment in order to adapt it for its best efficiency and react to side effects. On the other hand, the tool must provide long term view on the data to allow large scale analyses regarding the efficiency of the investigated treatment. There are few solutions allowing a clear visualization of the treatment plan of the patients in the long term that indicates clearly the changes and the adverse events. In this work, we propose a new integrated tool that offers a clear temporal view over the patients' treatment. PMID:25991248

  12. Importance of Self-Motivation and Social Support in Medication Adherence in HIV-Infected Adolescents in the United Kingdom and Ireland: A Multicentre HYPNet Study.

    PubMed

    Kim, Sung-Hee; McDonald, Susan; Kim, Samuel; Foster, Caroline; Fidler, Sarah

    2015-06-01

    Adolescents are a vulnerable population, not only to the acquisition of HIV, but also to poor adherence to antiretroviral therapy (ART) associated with disease progression and a increased risk of onward viral transmission. The aim of the study was to examine the factors that aid or act as barriers to adherence in a UK population of adolescents and young adults receiving ART. A cross-sectional survey was completed of 138 adolescents (12-24 years) across 14 clinical and community sites in the UK and Ireland. Analysis of results was undertaken using Chi-square testing in SPSS. Of the 138 patients, 48% were female, and 52% were born outside of the UK. Fifty-two of the 138 (43%) reported being on ART for at least 8 years. More than a third of the patients have ever interrupted treatment since initiating ART. One hundred four of the 138 (75%) patients self-reported being >85% adherent to medication for 7 day recall. Self-motivation (e.g., having a routine, specific goal) was cited as being most helpful in medication compliance (33%), followed by reminders by friends and family (25%), with 20% identifing no specific factor. Only 15% chose interventions such as an adherence diary or mobile phone reminders as helpful factors, and 1% chose healthcare professional input such as home visits. This study highlights the importance of self-motivation and social support in medication adherence in an HIV-infected adolescent population, in preference to healthcare professional input. Education and motivational strategies may confer the biggest impact on sustained ART adherence amongst this vulnerable group. PMID:25825814

  13. [In order to perform clinical trials efficiently in Japan--important issues in medical institutions raised by the GCP on-site review].

    PubMed

    Akiyama, Teppei; Furuta, Mitsuko; Yamada, Hiroshi

    2006-08-01

    The guidelines for Good Clinical Practice (GCP) in Japan have been harmonized with ICH-GCP. Both the protection of human rights and the carrying out of clinical trials ethically and scientifically, conforming to the GCP, are necessary for the safety and efficacy of clinical data of common technical documents. It is standard practice in Japan, the U.S., and the E.U. to ensure conformity with all data from raw data to application materials. In April, 2004, the new independent organization Pharmaceuticals and Medical Devices Agency (PMDA) was established in Japan. The PMDA provides services focusing on the three key areas of Review, Safety, and Relief. The Office of Conformity Audit is one of the offices in the Center for Product Evaluation of the PMDA. In the conformity audit service of the Office of Conformity Audit of the PMDA, the reliability and conformity with the GCP between case report forms (CRFs) as basis materials and application materials is confirmed by the document-based conformity review, and the conformity between medical records as raw data and CRFs is assessed through the on-site GCP review. Therefore, such application materials are considered to be consistent with international standards. The important issues raised by the GCP on-site review by the Office of Conformity Audit of the PMDA are summarized in this study. We hope that our findings at investigational sites will promote the protection of human rights and improve the quality of clinical trials in Japan. PMID:16972610

  14. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children

    PubMed Central

    Dunning, J; Daly, J Patrick; Lomas, J?P; Lecky, F; Batchelor, J; Mackway?Jones, K

    2006-01-01

    Background A quarter of all patients presenting to emergency departments are children. Although there are several large, well?conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children. Aim To conduct a prospective multicentre diagnostic cohort study to provide a rule for selection of high?risk children with head injury for computed tomography scanning. Design All children presenting to the emergency departments of 10 hospitals in the northwest of England with any severity of head injury were recruited. A tailor?made proforma was used to collect data on around 40 clinical variables for each child. These variables were defined from a literature review, and a pilot study was conducted before the children's head injury algorithm for the prediction of important clinical events (CHALICE) study. All children who had a clinically significant head injury (death, need for neurosurgical intervention or abnormality on a computed tomography scan) were identified. Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology. Results 22?772 children were recruited over 2½?years. 65% of these were boys and 56% were <5?years old. 281 children showed an abnormality on the computed tomography scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%. Conclusion A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care of children presenting with head injuries. Validation of this rule in new cohorts of patients should now be undertaken. PMID:17056862

  15. Decision Support:Decision Support: Decision AnalysisDecision Analysis

    E-print Network

    Bohanec, Marko

    Decision Support:Decision Support: Decision AnalysisDecision Analysis JoJozzef Stefanef Stefan/Algebraic/Statistical Modelling · Accounting / Financial Modelling Modelling #12;Decision Support and Decis and University of Nova Gorica Decision Analysis Part 1 Decision Analysis and Decision Tables Decision Analysis

  16. The Effects of Malpractice Pressure and Liability Reforms on Physicians' Perceptions of Medical Care

    Microsoft Academic Search

    Daniel P. Kessler; Mark McClellan

    1998-01-01

    Understanding how and why liability laws and liability reforms alter the medical treatment decision-making process is central to reforming the current U.S. malpractice liability system. Survey methods serve a valuable role in this process because they measure how malpractice pressure affects physician perceptions of appropriate practices, and thereby capture an important determinant of treatment decisions. Based on analysis of the

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

    PubMed

    Iwata, Kazuhiko

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  19. Economic Evaluation Enhances Public Health Decision Making

    PubMed Central

    Rabarison, Kristina M.; Bish, Connie L.; Massoudi, Mehran S.; Giles, Wayne H.

    2015-01-01

    Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking “how do investments in public health strategies influence or offset the need for downstream spending on medical care and/or social services?” is important when making decisions about resource allocation and scaling of interventions.

  20. Strategic investment decisions: the importance of SCM. A comparative analysis of 51 case studies in U.K., U.S. and German companies

    Microsoft Academic Search

    C. Carr; C. Tomkins

    1996-01-01

    John Shank (in this special edition) summarises the argument for complementing a capital budgeting approach to investment decisions with a broader strategic cost management (SCM) accounting approach incorporating three additional tools-value chain analysis, cost driver analysis and competitive advantage analysis. This article first discusses how this new framework might be assessed empirically and then examines the application of these techniques

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

    ERIC Educational Resources Information Center

    Haynes, Gill; McCrone, Tami; Wade, Pauline

    2013-01-01

    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…

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

    E-print Network

    Scheufele, Elisabeth Lee

    2009-01-01

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

  3. Making Sustainable Decisions Using The KONVERGENCE Framework

    SciTech Connect

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

    2003-02-25

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

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

    ERIC Educational Resources Information Center

    Beisecker, Analee E.; And Others

    1994-01-01

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

  5. Medical Imaging.

    ERIC Educational Resources Information Center

    Barker, M. C. J.

    1996-01-01

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

  6. Memories of real-life decisions

    Microsoft Academic Search

    Ola Svenson; Ilkka Salo; Kirsten van de Loo

    2007-01-01

    Three studies investigated decision makers’ memory representations of choice alternatives in most important real-life decisions. In Study 1, each participant recalled the most important decision that she or he had ever made and rated to what degree a number of characteristics could describe the decisions. In Study 2, the participants were asked to think about an important decision that they

  7. Letters of recommendation for the predoctoral internship in medical schools and other settings: do they enhance decision making in the selection process?

    PubMed

    Stedman, James M; Hatch, John P; Schoenfeld, Lawrence S

    2009-12-01

    Since the 1970s, letters of recommendation to medical and other internship settings have surfaced as important variables in the internship selection process. However, several studies have challenged their value in the selection process, specifically by pointing out that these letters have an overly positive bias and fail to address applicant weaknesses. Our study, using the Linguistic Inquiry and Word Count text analysis method, developed a quantitative profile for a sample of letters of recommendation, determined whether letters differentiated among applicants with regard to positive/negative attributions, evaluated letters for positive and negative bias, and investigated potential gender bias of writers toward applicants. Results indicated that writers apply positive and negative attributions homogeneously across applicants, thus, rendering applicant differentiation on this basis impossible. Also, results demonstrated that letters of male and female writers were not biased toward male or female applicants. These findings, in combination with previous studies, question the utility of letters of recommendation as presently structured. Possible modifications are discussed. PMID:19688252

  8. Making Sustainable Decisions Using the KONVERGENCE Framework

    SciTech Connect

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

    2003-02-01

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

  9. Information and decision-making needs among people with affective disorders – results of an online survey

    PubMed Central

    Liebherz, Sarah; Tlach, Lisa; Härter, Martin; Dirmaier, Jörg

    2015-01-01

    Background Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions. Objective This paper aims to describe patients’ information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders. Design We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses. Participants A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey. Results Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired. Discussion and conclusion Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients’ requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice. PMID:25999698

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

    PubMed

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

    2012-01-01

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

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

    PubMed

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

    2005-01-01

    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

  12. At the Medical College of Wisconsin (MCW), we understand that choosing a medical school is a critical life decision that will set the course for you to pursue your calling in life and develop the skills to become

    E-print Network

    your learning style, your lifestyle, your financial needs and your career goals. Our MCW-Green BayAt the Medical College of Wisconsin (MCW), we understand that choosing a medical school campus could be the ideal fit for you if you're interested in a high-caliber, contemporary learning

  13. 38 CFR 1.484 - Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  14. 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

    2013-07-01

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

  15. 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

    2011-07-01

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

  16. 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

    2012-07-01

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

  17. Rethinking medical humanities.

    PubMed

    Chiapperino, Luca; Boniolo, Giovanni

    2014-12-01

    This paper questions different conceptions of Medical Humanities in order to provide a clearer understanding of what they are and why they matter. Building upon former attempts, we defend a conception of Medical Humanities as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In particular, we discuss three main conceptual issues regarding the overall nature of this discipline: (i) a problem-driven approach to Medical Humanities; (ii) the need for an integration of Medical Humanities into medicine; (iii) the methodological requirements that could render Medical Humanities an effective framework for medical decision-making. PMID:24477428

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

    PubMed Central

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

    2013-01-01

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

  19. Linking patient medication data with laboratory information system

    Microsoft Academic Search

    J. J. Forsström; P. Grönroos; K. Irjala; J. Heiskanen; K. Torniainen

    1996-01-01

    Dozens of new drugs are taken into clinical use each year. Even if the clinicians were able to learn the most important therapeutic effects of the drugs they prescribe, they would still be unable to remember all of their minor effects. After storing patient related medication data on computerized patient records it is possible to build decision support modules which

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

    Microsoft Academic Search

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

    2011-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  2. In-vitro activity of 5-fluorocytosine against 1,021 Spanish clinical isolates of Candida and other medically important yeasts.

    PubMed

    Quindós, Guillermo; Ruesga, María Teresa; Martín-Mazuelos, Estrella; Salesa, Ricardo; Alonso-Vargas, Rocío; Carrillo-Muñoz, Alfonso Javier; Brena, Sonia; San Millán, Rosario; Pontón, José

    2004-06-01

    The aim of this study was to determine the prevalence of primary resistance to 5-fluorocytosine (5FC) among clinical isolates of yeasts in Spain where this drug is not currently available for therapy. We have tested the in vitro activity of 5FC against 1,021 recent yeast clinical isolates, including 522 Candida albicans, 140 Candida parapsilosis, 68 Candida glabrata, 41 Candida dubliniensis, 50 Candida guilliermondii, 34 Candida tropicalis, 28 Candida krusei, 20 Candida famata, 11 Cryptococcus neoformans, 5 Cryptococcus albidus, 43 Rhodotorula spp., 24 Trichosporon spp., 5 Saccharomyces cerevisiae, 9 Pichia spp., and 21 isolates from other 11 yeast species. The MICs were determined by the ATB Fungus agar microdilution test (bioMerieux, France) and the following interpretive breakpoints were used: susceptible, > 4 microg/ml; intermediate, 8 to 16 microg/ml; resistant, > 32 microg/ml. 5FC was very active against Candida spp. and other medically important yeasts as 852 (83.4%) of the studied isolates were susceptible (MIC < 4 microg/ml). The species most susceptible to 5FC were C. dubliniensis (100%of isolates; MIC90, 0.25 microg/ml), C. famata (100% of isolates; MIC90, 0.25 microg/ml), C. guilliermondii (98%of isolates; MIC90, 0.25 microg/ml), C. glabrata (95.5% of isolates; MIC90, 0.25 microg/ml), and C. neoformans (90.9% of isolates; MIC90, 2 microg/ml). Primary resistance to 5FC was very uncommon, and a MIC > 32 microg/ml, indicator of in vitro resistance, was observed in 106 isolates (10.4%): 77 C. albicans (16.5% of isolates; MIC90, > 128 microg/ml), 9 C. parapsilosis (6.4% of isolates; MIC90, 8 microg/ml), 4 C. albidus (80% of isolates, MIC50, > 128 microg/ml), 3 C. glabrata (4.4% of isolates; MIC90, 0.25 microg/ml), 3 C. tropicalis (8.8% of isolates; MIC90, 4 microg/ml), 2 C. krusei (7.1% of isolates; MIC90, 8 microg/ml), 2 Rhodotorula spp. (4.6% of isolates, MIC90, 1 microg/ml), 8 Trichosporon spp. (33.3% of isolates; MIC90, 64 microg/ml), and 1 C. lipolytica (50% of isolates). Interestingly, most C. albicans (67 out of 77 isolates) resistant to 5FC were serotype B isolates. PMID:15538829

  3. 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

    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

    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

  4. 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

    Burgess, Diana J.

    2014-01-01

    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

  5. Ototoxic Medications (Medication Effects)

    MedlinePLUS

    Ototoxic Medications (Medication Effects) By Barbara Cone, Patricia Dorn, Dawn Konrad-Martin, Jennifer Lister, Candice Ortiz, and ... in our Audiology Information Series [PDF]. What Is Ototoxicity? Certain medications can damage the ear, resulting in ...

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

    E-print Network

    Alpay, S. Pamir

    protection can be difficult, but is achievable with reliable and relevant data. Land use planning is the term regarding land use. Land management practices have major consequences for natural resources including water in this area: "Land research is a good example of the importance of studying a topic at a number of different

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

    ERIC Educational Resources Information Center

    Santana Arroyo, Sonia; del Carmen Gonzalez Rivero, Maria

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  9. A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system

    PubMed Central

    Colombet, Isabelle; Dart, Thierry; Leneveut, Laurence; Zunino, Sylvain; Ménard, Joël; Chatellier, Gilles

    2003-01-01

    Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. Methods The system called EsPeR (Personalised Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the help of EsPeR, and three senior investigators leaded structured discussion sessions. Results The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations. Conclusion Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials. PMID:14641924

  10. The neglected topic: presentation of cost information in patient decision AIDS.

    PubMed

    Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

    2015-05-01

    Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. PMID:25583552

  11. Advances in Medical Devices and Medical Electronics

    Microsoft Academic Search

    Michael R. Neuman; Gail D. Baura; Stuart Meldrum; Orhan Soykan; Max E. Valentinuzzi; Ron S. Leder; Silvestro Micera; Yuan-Ting Zhang

    2012-01-01

    Medical devices and medical electronics are areas that had little to offer 100 years ago. However, there were three important existing technologies that led to many further developments over the following 100 years. These are the stethoscope, electrocardiography, and X-ray medical imaging. Although these technologies had been described and were available to some extent when the Proceedings of the IEEE

  12. Decision Making in Recovery-Oriented Mental Health Care

    PubMed Central

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

    2014-01-01

    Objective Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. Methods Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. Results Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers’ preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. Conclusions and Implications for Practice While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers’ recovery. PMID:22491370

  13. Medical evaluation for respirator use.

    PubMed

    Szeinuk, J; Beckett, W S; Clark, N; Hailoo, W L

    2000-01-01

    The purpose of a respirator is to prevent the inhalation of harmful airborne substances or to provide a source of respirable air when breathing in oxygen-deficient atmospheres. For a physician to recommend the use of respirator, general background information on respiratory-protective devices is required. The first part of this clinical practice review describes the general aspects of industrial hygiene, respirators and a respirator-certification program. The second part addresses matters related to medical certification for respirator use. Medical certification for respirators is an important part of the activities of the occupational physician. To determine whether a worker is able to tolerate the added strain of a respiratory protective device is a complex process in which factors such as fitness for work, health of the individual, characteristics of the work itself, and the properties, type, and requirements of the respiratory protective device, have to be considered. Medical certification is of utmost importance for respirator use, and it should be viewed as an element in a comprehensive respiratory protection program. A comprehensive program is the key element in affording the workers' effective respiratory protection once the initial steps of the hierarchy of methods of hazard control have proved insufficient or infeasible. As a result, the need for the industrial hygiene/safety officer, the worker, the employer and the medical professional to work as a team is much more than in any other field of occupational medicine--a necessary requirement for making the right decision. PMID:10573602

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

    PubMed Central

    Karimi Khouzani, Reza

    2015-01-01

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

  15. Activity of Caspofungin and Voriconazole against Clinical Isolates of Candida and Other Medically Important Yeasts by the CLSI M-44A Disk Diffusion Method with Neo-Sensitabs Tablets

    Microsoft Academic Search

    A. J. Carrillo-Muñoz; G. Quindós; O. del Valle; P. Santos; G. Giusiano; P. A. Ezkurra; M. D. Estivill; J. B. Casals

    2008-01-01

    In vitro activity of caspofungin and vori conazole against 184 clinical isolates of Candida and other medically important yeasts in comparison with that of fluconazole, ketoconazole, itraconazole and amphotericin B was determined by using a disk diffusion method (Neo-Sensitabs) standardized according to the recommendations of the CLSI documents M44-A and M44–S1 (same medium: Mueller-Hinton plus methylene blue; inoculum and minimal

  16. An emerging field of research: challenges in pediatric decision making.

    PubMed

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

    2015-04-01

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

  17. Redundant visual information enhances group decisions.

    PubMed

    Barr, Shawn; Gold, Jason M

    2014-12-01

    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. PMID:25365569

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

    ERIC Educational Resources Information Center

    Golden, Shawn M.

    2009-01-01

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

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

    PubMed

    Kondo, Shigemi; Miida, Takashi

    2012-10-01

    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

  20. Industrial Decision Making

    E-print Network

    Elliott, R. N.; McKinney, V.; Shipley, A.

    2008-01-01

    and industrial investment decision-making. The paper will also address several important questions: • Why has industrial investment declined? • What is the outlook for industrial investment? • How can programs engage industry for future opportunities?...

  1. [The role of surgical education in pregraduate medical education.

    PubMed

    Patiño-Restrepo, José Félix

    2011-01-01

    Surgical education in pregraduate medicine is important because it is during this period where students acquire abilities that will allow them to make important future decisions when performing surgical procedures. Faculties of medicine make significant efforts to design innovative and rigorous curricula that will provide medical professionals with abilities to carryout medical procedures in a changing panorama of health systems as well as to provide scientific and technological advances. Intellectual and clinical proficiency, discipline, ethics and human values that a student acquires during pregraduate training and education will result in becoming a very efficient health professional. PMID:21477521

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

    PubMed Central

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

    2013-01-01

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

  3. Do medical students copy the drug treatment choices of their teachers or do they think for themselves?

    Microsoft Academic Search

    J. Tichelaar; M. C. Richir; H. J. Avis; H. J. Scholten; N. F. Antonini; Th. P. G. M. De Vries

    2010-01-01

    Purpose  Although the importance of rational prescribing is generally accepted, the teaching of pharmacotherapy to undergraduate medical\\u000a students is still unsatisfactory. Because clinical teachers are an important role model for medical students, it is of interest\\u000a to know whether this extends to therapeutic decision-making. The aim of this study was to find out which factors contribute\\u000a to the drug choices made

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

    Microsoft Academic Search

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

    2009-01-01

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

  5. [Prevalence and medical and social importance of disorders and diseases of the musculoskeletal systems in children and adolescents (review of literature)].

    PubMed

    Mirskaya, N B; Kolomenskaya, A N; Sinyakina, A D

    2015-01-01

    The urgency of the problem of the excess incidence of disorders and diseases of the musculoskeletal system (MSS) in contemporary children and adolescents is determined by its high medical and social significance. However, the poor quality of diagnosis of MSS disorders in children at the polyclinics level, especially at the initial stages, when timely commenced recreational and corrective-measures are most effective, do not allow to carry out remedial work timely, and this in turn is the cause of the high prevalence of violations of the MSS later With the aim of the improvement of the quality of diagnosis of early forms of musculoskeletal pathology in children and adolescents, as well as for the performance of the prevention during learning them in school there is developed an information system for health care workers "Identification, correction and prevention of disorders of the locomotor apparatus in students of educational institutions". The core of the system is formed by developed by authors a classification of functional disorders and initial forms of diseases of the MSS in students, as well as the organization of this work. PMID:26031051

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  7. University Medical Center New Orleans, Louisiana

    E-print Network

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

  8. History of Medical Physics.

    ERIC Educational Resources Information Center

    Laughlin, John S.

    1983-01-01

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

  9. Toward Personalized Smoking-Cessation Treatment: Using a Predictive Modeling Approach to Guide Decisions Regarding Stimulant Medication Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Smokers

    PubMed Central

    Luo, Sean X.; Covey, Lirio S.; Hu, Mei-Chen; Levin, Frances R.; Nunes, Edward V.; Winhusen, Theresa M.

    2015-01-01

    Background and Objectives Osmotic-release oral system methylphenidate (OROS-MPH) did not show overall benefit as an adjunct smoking cessation treatment for adult smokers with ADHD in a randomized, placebo-controlled, multicenter clinical trial. A secondary analysis revealed a significant interaction between ADHD symptom severity and treatment-response to OROS-MPH, but did not account for other baseline covariates or estimate the magnitude of improvement in outcome if treatment were optimized. This present study addressed the gaps in how this relationship should inform clinical practice. Methods Using data from the Adult Smokers with ADHD Trial (N = 255, six sites in five US States), we build predictive models to calculate the probability of achieving prolonged abstinence, verified by self-report, and expired carbon monoxide measurement. We evaluate the potential improvement in achieving prolonged abstinence with and without stratification on baseline ADHD severity. Results Predictive modeling demonstrates that the interaction between baseline ADHD severity and treatment group is not affected by adjusting for other baseline covariates. A clinical trial simulation shows that giving OROS-MPH to patients with baseline Adult ADHD Symptom Rating Scale (ADHD-RS) >35 and placebo to those with ADHD-RS ?35 would significantly improve the prolonged abstinence rate (52 ± 8% vs. 42 ± 5%, p < .001). Conclusions and Scientific Significance In smokers with ADHD, utilization of a simple decision rule that stratifies patients based on baseline ADHD severity can enhance overall achievement of prolonged smoking abstinence. Similar analysis methods should be considered for future clinical trials for other substance use disorders. PMID:25659348

  10. 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.

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

    SciTech Connect

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

    2011-11-15

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

  12. 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

    Singh, Sonal

    2013-01-01

    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

  13. Decision Making in Action

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

  14. Healthcare provider perspectives on parental refusal of medical interventions: A qualitative study

    Microsoft Academic Search

    Mary Glas Gaspers

    2008-01-01

    Background. Healthcare providers in pediatrics are faced with parents making medical decisions for their children. Refusal to consent to interventions can have life threatening sequelae, yet healthcare workers are provided little training in handling refusals. The healthcare provider's experience in parental refusal has not been well described, yet is an important first step in addressing this problem. ^ Specific aims.

  15. Stanford University Significant Risk and Nonsignificant Risk GUI-7m Research Compliance Office Medical Device Studies

    E-print Network

    Puglisi, Joseph

    Stanford University Significant Risk and Nonsignificant Risk GUI-7m Research Compliance Office Medical Device Studies File:GUI01007 rev2 09/10 1 of 2 (FDA Information Sheets October 1, 1995 requirements. The SR/NSR decision is also important to FDA because the IRB serves, in a sense, as the Agency

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

    ERIC Educational Resources Information Center

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

    2014-01-01

    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…

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

    PubMed

    Veatch, Robert M

    1989-04-01

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

  18. Legal fundamentals of surrogate decision making.

    PubMed

    Pope, Thaddeus Mason

    2012-04-01

    The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care decisions for him or herself. The law has devised several tools to promote "prospective autonomy." One mechanism is the instructional advance directive or living will. But most of us do not write such directives. Another mechanism is the proxy directive or durable power of attorney for health care, designating another person, a surrogate, to direct the course of our medical treatment upon our incapacity. But most of us do not do that either. Therefore, the most common mechanism by which our prospective autonomy is protected and promoted is through the informal selection of surrogates based on statutory priority lists. These "default" surrogates are the most numerous type of surrogate. This article explains the importance and legal fundamentals of surrogate decision making. It first describes five basic types of surrogates. The article then looks at the role of these surrogates and how they are supposed to make decisions on the patient's behalf. Unfortunately, surrogate performance is often mediocre or poor. There are significant and persistent obstacles to good surrogate decision making. After explaining these problems, the article concludes by identifying several solutions. PMID:22474149

  19. Activity of caspofungin and voriconazole against clinical isolates of Candida and other medically important yeasts by the CLSI M-44A disk diffusion method with Neo-Sensitabs tablets.

    PubMed

    Carrillo-Muñoz, A J; Quindós, G; del Valle, O; Santos, P; Giusiano, G; Ezkurra, P A; Estivill, M D; Casals, J B

    2008-01-01

    In vitro activity of caspofungin and voriconazole against 184 clinical isolates of Candida and other medically important yeasts in comparison with that of fluconazole, ketoconazole, itraconazole and amphotericin B was determined by using a disk diffusion method (Neo-Sensitabs) standardized according to the recommendations of the CLSI documents M44-A and M44-S1 (same medium: Mueller-Hinton plus methylene blue; inoculum and minimal inhibitory concentration/zone breakpoints). Seventy-two percent of clinical isolates were susceptible to caspofungin, 23.6% showed an intermediate susceptibility (most of them were Candida parapsilosis) and 4.3% were resistant (values for Candida spp. were 71.2, 23.8 and 5%, respectively). For voriconazole, 96.7% of clinical isolates were susceptible and 3.3% were resistant (Candida spp.: 96 and 3.8%, respectively). Both caspofungin and voriconazole showed high activity against a wide variety of clinically important yeasts. PMID:18073469

  20. Emotion and decision making.

    PubMed

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

    2015-01-01

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

  1. Fingernail Injuries and NASA's Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Butler, Doug

    2008-01-01

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

  2. End-of-life decision-making in India.

    PubMed

    Freckelton, Ian

    2014-09-01

    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

  3. Decision Trees Unpredictability Bias Improvements Decision Trees

    E-print Network

    Kjellström, Hedvig

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

  4. Medication Guide

    MedlinePLUS

    ... before starting any new medication. First-Line Medications: Nicotine Replacement Therapy (NRT) These medications are called "first- ... they might try a "second-line" medication instead. Nicotine replacement therapy (NRT) helps smokers quit by reducing ...

  5. Learning and transfer in dynamic decision environments

    Microsoft Academic Search

    Faison P. Gibson

    2007-01-01

    An important aspect of learning is the ability to transfer knowledge to new contexts. However, in dynamic decision tasks, such as bargaining, firefighting, and process control, where decision makers must make repeated decisions under time pressure and outcome feedback may relate to any of a number of decisions, such transfer has proven elusive. This paper proposes a two-stage connectionist model

  6. Substituted decision making: elder guardianship.

    PubMed

    Leatherman, Martha E; Goethe, Katherine E

    2009-11-01

    The goal of this column is to help experienced clinicians navigate the judicial system when they are confronted with requests for capacity evaluations that involve guardianship (conservatorship). The interface between the growing elderly medical population and increasing requests for substituted decision making is becoming more complex. This column will help practicing psychiatrists understand the medical, legal, and societal factors involved in adult guardianship. Such understanding is necessary in order to effectively perform guardianship evaluations and adequately inform courts, patients, and families about the psychiatric diagnoses central to substituted decision making. PMID:19934723

  7. Information technology and medication safety: what is the benefit?

    PubMed Central

    Kaushal, R; Bates, D

    2002-01-01

    ?? Medication errors occur frequently and have significant clinical and financial consequences. Several types of information technologies can be used to decrease rates of medication errors. Computerized physician order entry with decision support significantly reduces serious inpatient medication error rates in adults. Other available information technologies that may prove effective for inpatients include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In outpatients, computerization of prescribing and patient oriented approaches such as personalized web pages and delivery of web based information may be important. Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required. PMID:12486992

  8. Evaluation of the medically complex living kidney donor.

    PubMed

    Caliskan, Yasar; Yildiz, Alaattin

    2012-01-01

    Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of "Medically complex living donors" are made to increase the availability of organs for donation. The term "Complex living donor" is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor. PMID:22655169

  9. The electronic medical office: optimizing solutions.

    PubMed

    Kirschenbaum, Ira H; Mabrey, Jay D; Wood, George W; Alexander, A Herbert; Rhoades, Charles E; Alexander, Ian J; Golladay, Gregory J; Wheeless, Clifford

    2008-01-01

    Optimizing the care for patients in the orthopaedic clinical setting involves a wide range of issues. Surgical techniques, preoperative and postoperative care, long-term outcomes follow-up, continuing education, and patient communication are a few of the important areas that surgeons deal with on a regular basis. Successful management of this information has an impact on clinical outcomes, direct patient care, financial decisions, and management of the surgeon's time. The development of a comprehensive electronic medical office is a powerful and probably necessary tool to successfully manage such information and achieve the goals of an effective and safe orthopaedic practice. PMID:18399621

  10. Decision Management

    Microsoft Academic Search

    Joseph Antonik

    2007-01-01

    The decision making process is initiated when the current situation and past experience compels us to take some action. The purpose of the action is to somehow alter the conditions of the current situation to form a future situation that conforms to our desires. But the current situation is a consequence of previous decisions. Also, as we progress in time,

  11. AVMA guide for veterinary medical waste management.

    PubMed

    Brody, M D

    1989-08-15

    Lawmakers have enacted a variety of laws and regulations to ensure proper disposal of certain potentially infectious or otherwise objectionable waste. The veterinary medical profession supports scientifically based regulations that benefit public health. In 1988, Congress passed the Medical Waste Tracking Act, a federal program that mandates tracking certain regulated waste. Several types of waste generated in the typical clinical veterinary medical practice are considered regulated veterinary medical waste. Discarded needles, syringes, and other sharps; vaccines and vials that contained certain live or attenuated vaccines; cultures and stocks of infectious agents and culture plates; research animals that were exposed to agents that are infectious to human beings and their associated waste; and other animal waste that is known to be potentially harmful to human beings should be handled as regulated veterinary medical waste. Regulated veterinary medical waste should be handled with care. It should be decontaminated prior to disposal. The most popular, effective methods of decontamination are steam sterilization (autoclaving) and incineration. Chemical decontamination is appropriate for certain liquid waste. Waste should be packaged so that it does not spill. Sharps require rigid puncture- and leak-resistant containers that can be permanently sealed. Regulated veterinary medical waste that has not been decontaminated should be labeled with the universal biohazard symbol. Generators retain liability for waste throughout the entire disposal process. Therefore, it is essential to ensure that waste transporters and disposal facilities comply with state and federal requirements. Veterinary practices should maintain a written waste management program and accurate records of regulated veterinary medical waste disposal. Contingency planning and staff training are other important elements of a veterinary medical waste management program. The guide includes a model veterinary medical waste management program; however, it does not address all the variations in state and local regulations. Veterinarians should obtain copies of state and local laws and regulations and modify AVMA's model plan to create an individualized practice plan that complies with federal, state, and local laws and regulations. State and local veterinary medical organizations should monitor state and local regulation to influence decisions that affect veterinarians and to keep their members informed of changing requirements. Veterinarians and veterinary medical organizations must stay involved so that regulations do not unfairly burden the veterinary medical profession. PMID:2674089

  12. Patients’ participation in medical care

    Microsoft Academic Search

    Sheldon Greenfield; Sherrie H. Kaplan; John E. Ware; Elizabeth Martin Yano; Harrison J. L. Frank

    1988-01-01

    To maximize disease control, patients must participate effectively in their medical care. The authors developed an intervention\\u000a designed to increase the involvement of patients in medical decision making. In a 20-minute session just before the regular\\u000a visit to a physician, a clinic assistant reviewed the medical record of each experimental patient with him\\/her, guided by\\u000a a diabetes algorithm. Using systematic

  13. Safety and tolerability of medications approved for chronic weight management.

    PubMed

    Fujioka, Ken

    2015-04-01

    In 2014 we have 4 new weight loss medications and one older medication with very different mechanisms of action – all approved for chronic weight management. Each medication has its own unique risk profile that makes patient selection important. Knowledge of the contraindications and safety issues can guide physicians to the most appropriate choice for a particular patient. Obesity medicine is entering a new era where our available options for prescribing have been very well studied. There should be no surprises, because bupropion, naltrexone, phentermine, topiramate and liraglutide have been prescribed for many years in millions of patients and lorcaserin has high specificity for a single receptor subtype. The FDA demanded very detailed risk-oriented studies to have these medications approved. In addition, the FDA has established REMS programs or risk management strategies to help ensure that the patients do not receive inappropriate medications. These medications were approved by the US FDA after very thorough testing. The decision to approve these medications was based on the benefits out-weighing the risks. Thus, if following the appropriate guidelines according to package labels, the practitioner can feel safe in prescribing these medications. PMID:25900872

  14. The role of emotions in clinical reasoning and decision making.

    PubMed

    Marcum, James A

    2013-10-01

    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

  15. Decision making in family medicine

    PubMed Central

    Labrecque, Michel; Ratté, Stéphane; Frémont, Pierre; Cauchon, Michel; Ouellet, Jérôme; Hogg, William; McGowan, Jessie; Gagnon, Marie-Pierre; Njoya, Merlin; Légaré, France

    2013-01-01

    Abstract Objective To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process. Design Randomized trial. Setting Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que. Participants Fifteen second-year family medicine residents. Intervention Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database. Main outcome measures The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine’s effect on the decision-making process in clinical practice. Results Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either search engine. The mean (SD) time of the initial search for each question was 23.5 (7.6) minutes with InfoClinique and 22.3 (7.8) minutes with the Trip database (P = .30). Participants’ perceptions of each engine’s effect on the decision-making process were very positive and similar for both search engines. Conclusion Family medicine residents’ ability to provide correct answers to clinical questions increased dramatically and similarly with the use of both InfoClinique and the Trip database. These tools have strong potential to increase the quality of medical care. PMID:24130286

  16. Overview of medically important antifungal azole derivatives.

    PubMed Central

    Fromtling, R A

    1988-01-01

    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

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

    E-print Network

    Laidlaw, David

    acid) (Dental bleach) (Minoxidil) (Avastin, Bevacizumab) (Thalidomide) (Inactivated Poliovirus Vaccine for Depression, Anxiety Disorder, Insomnia) (Supplement) (Beauty) (Birth control) (Allergy treatment) (Hair

  18. Medically important bacterial-fungal interactions.

    PubMed

    Peleg, Anton Y; Hogan, Deborah A; Mylonakis, Eleftherios

    2010-05-01

    Whether it is in the setting of disease or in a healthy state, the human body contains a diverse range of microorganisms, including bacteria and fungi. The interactions between these taxonomically diverse microorganisms are highly dynamic and dependent on a multitude of microorganism and host factors. Human disease can develop from an imbalance between commensal bacteria and fungi or from invasion of particular host niches by opportunistic bacterial and fungal pathogens. This Review describes the clinical and molecular characteristics of bacterial-fungal interactions that are relevant to human disease. PMID:20348933

  19. The abortion decision: fantasy processes.

    PubMed

    Allanson, S; Astbury, J

    1996-09-01

    This paper considers that features intrinsic to pregnancy and to an unwanted pregnancy/abortion decision heighten the likelihood of the occurrence, and the importance, of fantasy in the decision-maker's thinking. In addition, investigation of fantasy or non-rational processes in an abortion decision emphasizes the complexity of decision-making in a way which may challenge ideas of decision-making in general. The results of a pilot study using a short fantasy inventory with 20 women facing an abortion decision are presented to highlight fantasy, not as irrational or pathological, but as legitimately coexisting with logical, reasoning, non-fantasy thought in the abortion decision. The clinical value of the fantasy inventory is explored. PMID:8892162

  20. Psychotropic Medication Management in a Residential Group Care Program

    ERIC Educational Resources Information Center

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

    2010-01-01

    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  1. A Medical Ethics Assessment of the Case of Terri Schiavo

    ERIC Educational Resources Information Center

    Preston, Tom; Kelly, Michael

    2006-01-01

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

  2. Cognitive science contributions to decision science.

    PubMed

    Busemeyer, Jerome R

    2015-02-01

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

  3. Mining level of control in medical organizations.

    PubMed

    Çalimli, Olgu; Türkeli, Serkan; Eken, Emir Gökberk; Gönen, Halil Emre

    2014-01-01

    In literature of strategic management, there are three layers of control defined in organizational structures. These layers are strategic, tactical and operational, in which resides senior, medium level and low level managers respectively. In strategic level, institutional strategies are determined according to senior managers' perceived state of organization. In tactical level, this strategy is processed into methods and activities of a business management plan. Operational level embodies actions and functions to sustain specified business management plan. An acknowledged lead organization in Turkish medical area is examined using case study and data mining method in the scope of this paper. The level of decisions regarded in managerial purposes evaluated through chosen organization's business intelligence event logs report. Hence specification of management level importance of medical organizations is made. Case study, data mining and descriptive statistical method of taken case's reports present that positions of "Chief Executive Officer", "Outpatient Center Manager", "General Manager", monitored and analyzed functions of operational level management more frequently than strategic and tactical level. Absence of strategic management decision level research in medical area distinguishes this paper and consequently substantiates its significant contribution. PMID:25160200

  4. Robust Decision Making

    SciTech Connect

    Christopher A. Dieckmann, PE, CSEP-Acq

    2010-07-01

    The Idaho National Laboratory (INL) is funded through the Department of Energy (DOE) Office of Nuclear Energy and other customers who have direct contracts with the Laboratory. The people, equipment, facilities and other infrastructure at the laboratory require continual investment to maintain and improve the laboratory’s capabilities. With ever tightening federal and customer budgets, the ability to direct investments into the people, equipment, facilities and other infrastructure which are most closely aligned with the laboratory’s mission and customers’ goals grows increasingly more important. The ability to justify those investment decisions based on objective criteria that can withstand political, managerial and technical criticism also becomes increasingly more important. The Systems Engineering tools of decision analysis, risk management and roadmapping, when properly applied to such problems, can provide defensible decisions.

  5. Fruitful or futile: intensive care nurses' experiences and perceptions of medical futility.

    PubMed

    Heland, Melodie

    2006-02-01

    The study sought to investigate the perceptions and experiences of nurses practising in adult intensive care units (ICUs) with regard to medical futility. A qualitative exploratory descriptive design was used, providing a framework which enabled information to be gathered on a relatively undefined phenomena. Data were gathered via semi-structured interviews with seven intensive care nurses. Findings concluded that there is no 'one size fits all' definition of medical futility. To arrive at the decision whether treatment is futile, participants want to understand patients' views on treatment limitation. In some ICUs, 'the decision' about whether to cease or continue treatment is unilaterally made by medical staff, raising concerns about value laden judgement. Nurses experience frustration with having to administer treatment with which they do not agree and may actually leave intensive care nursing because of their moral conflict. There are opportunities for nurses to have input into 'the decision', but they must have a cogent and articulate approach to be heard. Once treatment is deemed to be futile, nurses play a key role in treatment withdrawal and can have a significant impact on the patient and family experience if they manage the situation well; this nursing role in medically futile situations and treatment withdrawal is detailed. 'Medical futility' is not easily defined. Understanding patients' views about treatment limitation is important in deciding whether treatment is medically futile. To do this, an inclusive decision making process should be developed by ICUs which incorporates nursing and family input. Experienced ICU nurses can have a significant impact on the management of futile cases; they need to share their understanding of the processes surrounding medical futility and assist junior nurses in negotiating the difficult challenges encountered in decision making and treatment withdrawal. PMID:16544676

  6. An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

    PubMed

    Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

    2009-09-01

    The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams. PMID:19707058

  7. Abortion - medical

    MedlinePLUS

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

  8. Medication Treatments

    MedlinePLUS

    ... medications are used to treat certain symptoms of Fragile X syndrome, as shown in the chart below. The NICHD ... of these medications in treating the symptoms of Fragile X syndrome, or for other conditions for which the medications ...

  9. Towards Decentralised Clinical Decision Support Systems

    Microsoft Academic Search

    Paolo Besana; Adam Barker

    \\u000a The sheer quantity and complexity of medical information, even within a single speciality, is beyond the power of one person\\u000a to comprehend. Clinical decision support (CDS) systems have been clearly demonstrated to improve practice by removing complexity\\u000a and aiding the decision making process for clinicians. However, the specific pieces of information most relevant to a particular\\u000a clinical decision are typically

  10. Decision Analysis Using Spreadsheets.

    ERIC Educational Resources Information Center

    Sounderpandian, Jayavel

    1989-01-01

    Discussion of decision analysis and its importance in a business curriculum focuses on the use of spreadsheets instead of commercial software packages for computer assisted instruction. A hypothetical example is given of a company drilling for oil, and suggestions are provided for classroom exercises using spreadsheets. (seven references) (LRW)

  11. Adolescent Decision Making: An Overview

    ERIC Educational Resources Information Center

    Halpern-Felsher, Bonnie

    2009-01-01

    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…

  12. Implementation of shared decision making in anaesthesia and its influence on patient satisfaction.

    PubMed

    Flierler, W J; Nübling, M; Kasper, J; Heidegger, T

    2013-07-01

    There is a lack of data about the implementation of shared decision making in anaesthesia. To assess patients' preference to be involved in medical decision making and its influence on patient satisfaction, we studied 197 matched pairs (patients and anaesthetists) using two previously validated questionnaires. Before surgery, patients had to decide between general vs regional anaesthesia and, where appropriate, between conventional postoperative pain therapy vs catheter techniques. One hundred and eighty-six patients (94%) wished to be involved in shared decision making. One hundred and twenty-two patients (62%) experienced the exact amount of shared decision making that they wanted; 44 (22%) were slightly more involved and 20 (10%) slightly less involved in shared decision making than they desired. Preferences regarding involvement in shared decision making were similar between patients and anaesthetists with mean (SD) points of 54.1 (16.2) vs 56.4 (27.6) (p=0.244), respectively on a 0-100 scale; however, patients were found to have a stronger preference for a totally balanced shared decision-making process (65% vs 32%). Overall patient satisfaction was high: 88% were very satisfied and 12% satisfied with a mean (SD) value of 96.1 (10.6) on a 0-100 scale. Shared decision making is important for providing high levels of patient satisfaction. PMID:23656577

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

    PubMed

    Underhill, Meghan L; Crotser, Cheryl B

    2014-06-01

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

  14. Decision exploration lab: a visual analytics solution for decision management.

    PubMed

    Broeksema, Bertjan; Baudel, Thomas; Telea, Arthur G; Crisafulli, Paolo

    2013-12-01

    We present a visual analytics solution designed to address prevalent issues in the area of Operational Decision Management (ODM). In ODM, which has its roots in Artificial Intelligence (Expert Systems) and Management Science, it is increasingly important to align business decisions with business goals. In our work, we consider decision models (executable models of the business domain) as ontologies that describe the business domain, and production rules that describe the business logic of decisions to be made over this ontology. Executing a decision model produces an accumulation of decisions made over time for individual cases. We are interested, first, to get insight in the decision logic and the accumulated facts by themselves. Secondly and more importantly, we want to see how the accumulated facts reveal potential divergences between the reality as captured by the decision model, and the reality as captured by the executed decisions. We illustrate the motivation, added value for visual analytics, and our proposed solution and tooling through a business case from the car insurance industry. PMID:24051763

  15. Avoiding medical emergencies.

    PubMed

    Omar, Y

    2013-03-01

    Medical emergencies can occur at any time in any location. This article and associated presentation at the forthcoming British Dental Conference Exhibition provide key advice on avoiding medical emergencies in dental practice; including advice on risk assessing all patients, understanding the importance of a checklist, and using a National Early Warning Score (NEWS). PMID:23470404

  16. Aging and consumer decision making

    PubMed Central

    Carpenter, Stephanie M.; Yoon, Carolyn

    2013-01-01

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

  17. Women’s preferences for contraceptive counseling and decision making

    PubMed Central

    Dehlendorf, Christine; Levy, Kira; Kelley, Allison; Grumbach, Kevin; Steinauer, Jody

    2014-01-01

    Background Little is known about what women value in their interactions with family planning providers and in decision making about contraception. Study Design We conducted semistructured interviews with 42 black, white and Latina patients. Transcripts were coded using modified grounded theory. Results While women wanted control over the ultimate selection of a method, most also wanted their provider to participate in the decision-making process in a way that emphasized the women’s values and preferences. Women desired an intimate, friend-like relationship with their providers and also wanted to receive comprehensive information about options, particularly about side effects. More black and Spanish-speaking Latinas, as compared to whites and English-speaking Latinas, felt that providers should only share their opinion if it is elicited by a patient or if they make their rationale clear to the patient. Conclusion While, in the absence of medical contraindications, decision making about contraception has often been conceptualized as a woman’s autonomous decision, our data indicate that providers of contraceptive counseling can participate in the decision-making process within limits. Differences in preferences seen by race/ethnicity illustrate one example of the importance of individualizing counseling to match women’s preferences. PMID:23177265

  18. The research of group decision methods for product design evaluation

    Microsoft Academic Search

    Tong Wu; Xian Zhou; Sui-Huai Yu

    2008-01-01

    The product design evaluation and decision plays a very important role in product quality improvement. Having studied the product design evaluation, decision, and group decision methods, the paper put forward the theory of group decision methods for design evaluation to improve the product design evaluation. Linking with product design evaluation features the paper researched some individual evaluation and group decision

  19. Decision Aiding Wisdom, decision support and paradigms of decision making

    E-print Network

    Sommerville, Ian

    Decision Aiding Wisdom, decision support and paradigms of decision making Adrian Mackenzie; accepted 1 July 2004 Available online 13 September 2004 Abstract Many decision support tools have been.V. All rights reserved. Keywords: Decision support; Cognitive mapping; Wicked problems 1. Introduction

  20. 42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  1. 42 CFR 405.211 - Procedures for Medicare contractors in making coverage decisions for a non-experimental...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  2. DocBot: a novel clinical decision support algorithm.

    PubMed

    Ninh, Andrew Q

    2014-01-01

    DocBot is a web-based clinical decision support system (CDSS) that uses patient interaction and electronic health record analytics to assist medical practitioners with decision making. It consists of two distinct HTML interfaces: a preclinical form wherein a patient inputs symptomatic and demographic information, and an interface wherein a medical practitioner views patient information and analysis. DocBot comprises an improved software architecture that uses patient information, electronic health records, and etiologically relevant binary decision questions (stored in a knowledgebase) to provide medical practitioners with information including, but not limited to medical assessments, treatment plans, and specialist referrals. PMID:25571435

  3. Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

    PubMed Central

    Whitman, Cynthia B.; Shreay, Sanatan; Gitlin, Matthew; van Oijen, Martijn G. H.

    2013-01-01

    Summary Background and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD. Design, setting, participants, & measurements A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed. Results A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to11.1). Conclusions Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups. PMID:23929931

  4. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

    The goals of the Integrated Medical Model (IMM) are to develop an integrated, quantified, evidence-based decision support tool useful to crew health and mission planners and to help align science, technology, and operational activities intended to optimize crew health, safety, and mission success. Presentation slides address scope and approach, beneficiaries of IMM capabilities, history, risk components, conceptual models, development steps, and the evidence base. Space adaptation syndrome is used to demonstrate the model's capabilities.

  5. Medication errors in anesthesia.

    PubMed

    Prabhakar, Amit; Malapero, Raymond J; Gabriel, Rodney A; Kaye, Alan David; Elhassan, Amir O; Nelson, Ehren R; Bates, David W; Urman, Richard D

    2015-01-01

    Medication errors represent one of the most common causes of morbidity and mortality in hospitalized patients. Anesthesia has specific medication-related risks; providers must administer many potent intravenous medications quickly, often with minimal to no supervision. Well-described reasons for medication administration errors in anesthesia include medication ampoules with similar appearance and packaging, clinician inattention, ineffective communication, fatigue, and haste. Technologies that are used widely in other parts of the hospital, such as barcoding, are a challenge to implement in anesthesia, and systemic approaches, including color-coding of syringe labels and barcoding technology of syringes, have been evaluated with mixed results. Emphasis should be placed on implementing forcing functions when possible, utilizing technology, standardization, and education about the need for awareness in specific situations. More studies need to be done to define the epidemiology of medication errors in anesthesia, and more importantly, to assess interventions for preventing them. PMID:26062316

  6. Validation in Medical Image Processing 1 Introduction

    E-print Network

    Boyer, Edmond

    Validation in Medical Image Processing 1 Introduction The increasingly important role of image processing in medicine Medical imaging is one of our most powerful tools for gaining insight into normal). The importance of validation in medical image processing Validation of medical image processing methods

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

    SciTech Connect

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

    1996-11-12

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

  8. Inflight medical emergencies.

    PubMed

    Lyznicki, J M; Williams, M A; Deitchman, S D; Howe, J P

    2000-08-01

    This report responds to resolutions asking the American Medical Association (AMA) to develop recommendations for the use of medical equipment and technology onboard commercial airlines. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that, while inflight morbidity and mortality are uncommon, serious events do occur, which require immediate emergency care. Management of serious problems requires an integrated emergency response system that ensures rapid notification of medical personnel on the ground, assistance from appropriately trained flight crews and passenger volunteers (if available), and adequate medical supplies and equipment to stabilize the victim. Physicians have an important role in the preflight evaluation and counseling of potential passengers who are at risk of inflight medical complications, and in providing inflight medical assistance. Some U.S. and foreign air carriers are upgrading inflight emergency medical kits and placing automated external defibrillators aboard aircraft. Few data are available regarding the effectiveness of such improvements in improving health or survival outcomes. Recent federal legislation requires assessment of the extent of inflight medical emergencies, including the adequacy of emergency medical supplies and equipment carried onboard commercial airliners. This legislation also should alleviate liability concerns by providing immunity for physicians and others who render inflight medical assistance. PMID:10954361

  9. SPIE Medical Imaging Medical Imaging

    E-print Network

    Miga, Michael I.

    1 SPIE Medical Imaging 2006 1 Medical Imaging Fundamentals Kenneth H. Wong, Ph.D. Division of Computer Assisted Interventions and Medical Robotics (CAIMR) Imaging Science and Information Systems (ISIS) Center Department of Radiology Georgetown University SPIE Medical Imaging 2006 2 Main Themes · Describe

  10. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model

    Microsoft Academic Search

    Cathy Charles; Amiram Gafni; Tim Whelan

    1999-01-01

    In this paper we revisit and add elements to our earlier conceptual framework on shared treatment decision-making within the context of different decision-making approaches in the medical encounter (Charles, C., Gafni, A., Whelan, T., 1997. Shared decision-making in the medical encounter: what does it mean? (or, it takes at least two to tango). Social Science & Medicine 44, 681–692.). This

  11. Activity Based Costing and Decision Support

    Microsoft Academic Search

    Dick A. van Damme; Frank L. A. van der Zon

    1999-01-01

    Logistics is critical to the fulfillment of customer demands. Top management of companies is now more closely involved in logistics decisions and the importance of the consequences of these decisions is growing. It is crucial to support these decisions with relevant financial information. Companies often lack useful tools to generate this financial information. This paper presents a logistics management accounting

  12. 21 CFR 821.4 - Imported devices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  13. 21 CFR 821.4 - Imported devices.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  14. 21 CFR 821.4 - Imported devices.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  15. 21 CFR 821.4 - Imported devices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  16. 21 CFR 821.4 - Imported devices.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  17. The implications of medical ethics.

    PubMed Central

    Thompson, I. E.

    1976-01-01

    In this paper, Mr Thompson, one of the research fellows appointed to the Edinburgh Medical Group research project, seeks to define medical ethics in relation to traditional ethics in the philosophical sense of enquiring into right and wrong modes of thought and conduct, and to carry that study further into the field of moral decisions made by doctors and other professional people who care for the sick. Until very recently the Victorian definition of medical ethics - medical etiquette - served the doctor well but the complexity of modern medicine and the involvement of other professional workers in medical care appears to have swept away the old framework and left a vacuum. A new medical ethic must be evolved to fill that vacuum, taking account not only of technological advances but also of relationships between doctors and other professionals associated with them and of the role in caring for the sick. PMID:781252

  18. The Dutch model for legalizing end-of-life decisions.

    PubMed

    Kater, Loes

    2003-01-01

    The Dutch experience with euthanasia is used as a model for other countries for regulating end-of-life decisions. Several elements of the Dutch debate, for example the definition of euthanasia, are copied and imported to other debates. This paper studies the specific Dutch construction of regulating euthanasia and the concept of the requirements of prudent practice. The requirements of prudent practice embody the conditions for careful medical management in end-of-life decisions. It is argued that the requirements of prudent practice are a relatively acceptable way of regulating the Dutch practice of euthanasia as they are embedded in an elaborate network of relations, standards and values. As a consequence of this local character and the way the requirements of prudent practice relate to the Dutch practice of euthanasia it is difficult to simply transport them to other countries in order to regulate euthanasia. PMID:14626886

  19. Description logics in medical informatics

    Microsoft Academic Search

    Alan Rector

    2003-01-01

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

  20. Endocrinology Concepts for Medical Students

    NSDL National Science Digital Library

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

    2001-12-01

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

  1. Medication adherence: process for implementation

    PubMed Central

    Mendys, Phil; Zullig, Leah L; Burkholder, Rebecca; Granger, Bradi B; Bosworth, Hayden B

    2014-01-01

    Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications. PMID:25114513

  2. Medical education: changes and perspectives.

    PubMed

    Zhang, Qin; Lee, Liming; Gruppen, Larry D; Ba, Denian

    2013-08-01

    As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history. PMID:23631405

  3. Shared decision making in clinical medicine: past research and future directions

    Microsoft Academic Search

    Dominick L Frosch; Robert M Kaplan

    1999-01-01

    Content: Shared medical decision making is a process by which patients and providers consider outcome probabilities and patient preferences and reach a health care decision based on mutual agreement. Shared decision making is best used for problems involving medical uncertainty. During the process the provider-patient dyad considers treatment options and consequences and explores the fit of expected benefits and consequences

  4. A Contribution of Medical Terminology to Medical Language Processing Resources: Experiments in Morphological Knowledge Acquisition from

    E-print Network

    Zweigenbaum, Pierre

    A Contribution of Medical Terminology to Medical Language Processing Resources: Experiments'Informatique Médicale / DSI / Assistance Publique -- Paris Hospitals & Département de Biomathématiques, Université Paris. Introduction Morphological knowledge has long been acknowledged as an important area of medical language

  5. A Contribution of Medical Terminology to Medical Language Processing Resources: Experiments in Morphological Knowledge Acquisition from

    E-print Network

    Zweigenbaum, Pierre

    A Contribution of Medical Terminology to Medical Language Processing Resources: Experiments'Informatique Médicale / DSI / Assistance Publique ­ Paris Hospitals & Département de Biomathématiques, Université Paris. Introduction Morphological knowledge has long been acknowledged as an important area of medical language

  6. Institutional decision-making to select patient care devices: identifying venues to promote patient safety.

    PubMed

    Keselman, Alla; Patel, Vimla L; Johnson, Todd R; Zhang, Jiajie

    2003-01-01

    Many medical errors that involve drug infusion devices are related to classic interface problems. Although manufacturers are becoming increasingly aware of human factors design considerations, many devices that are currently on the market are still sub-optimal for human use. This places significant responsibility for device selection on institutional purchasing groups. Theories of naturalistic decision-making point to many potential strengths and pitfalls of group decision-making processes that may affect the final outcome. This paper describes a retrospective analysis of decision-making process for infusion pump selection in a large hospital and focuses on factors related to patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings show that although the process involves a number of different professional groups and committees, the information flow among them is restricted. This results in inadequate representation of critical device usability considerations in the decision-making process. While all participants view device safety as an important consideration in the selection process, administrators (who are the final decision-makers) tend to equate safety with technical accuracy and reliability, paying less attention to the role of human factors in safe device use. Findings suggest that collaborative communication technology and automated evidence-based guidelines could provide support to institutional decision-making, ensuring that the process is efficient, effective, and ultimately safe for the patients. PMID:14552845

  7. Decision ecology: foraging and the ecology of animal decision making.

    PubMed

    Stephens, David W

    2008-12-01

    In this article, I review the approach taken by behavioral ecologists to the study of animal foraging behavior and explore connections with general analyses of decision making. I use the example of patch exploitation decisions in this article in order to develop several key points about the properties of naturally occurring foraging decisions. First, I argue that experimental preparations based on binary, mutually exclusive choice are not good models of foraging decisions. Instead, foraging choices have a sequential foreground-background structure, in which one option is in the background of all other options. Second, behavioral ecologists view foraging as a hierarchy of decisions that range from habitat selection to food choice. Finally, data suggest that foraging animals are sensitive to several important trade-offs. These trade-offs include the effects of competitors and group mates, as well as the problem of predator avoidance. PMID:19033242

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

    PubMed Central

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

    2013-01-01

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

  9. Medical Management

    MedlinePLUS

    ... form Search Charcot-Marie-Tooth Disease (CMT) Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...

  10. Medication Errors

    MedlinePLUS

    ... Risk Management (PDF - 1.1MB) Draft Guidance for Industry and Food and Drug Administration Staff - Applying Human Factors and Usability Engineering to Optimize Medical Device Design Spotlight Guidance for Industry: Safety Considerations for Product Design to Minimize Medication ...

  11. The Sensitivity Analysis for Cooperative Decision by TOPSIS Method

    Microsoft Academic Search

    Leonas Ustinovichius; Ruta Simanaviciene

    2010-01-01

    \\u000a Quantitative multiattribute decision making methods are handy for making cooperative decisions, because the decision makers\\u000a are interested in finding a common solution; even some times they have diverse goals. The initial data for cooperative decision\\u000a making depend on the decision makers’ own views, therefore the input data may be inconsistent. An important step in cooperative\\u000a decision making is to perform

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

    PubMed Central

    2013-01-01

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

  13. Linguistic approach for identification of medication names and related information in clinical narratives

    PubMed Central

    Grabar, Natalia

    2010-01-01

    Background Pharmacotherapy is an integral part of any medical care process and plays an important role in the medical history of most patients. Information on medication is crucial for several tasks such as pharmacovigilance, medical decision or biomedical research. Objectives Within a narrative text, medication-related information can be buried within other non-relevant data. Specific methods, such as those provided by text mining, must be designed for accessing them, and this is the objective of this study. Methods The authors designed a system for analyzing narrative clinical documents to extract from them medication occurrences and medication-related information. The system also attempts to deduce medications not covered by the dictionaries used. Results Results provided by the system were evaluated within the framework of the I2B2 NLP challenge held in 2009. The system achieved an F-measure of 0.78 and ranked 7th out of 20 participating teams (the highest F-measure was 0.86). The system provided good results for the annotation and extraction of medication names, their frequency, dosage and mode of administration (F-measure over 0.81), while information on duration and reasons is poorly annotated and extracted (F-measure 0.36 and 0.29, respectively). The performance of the system was stable between the training and test sets. PMID:20819862

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

    E-print Network

    Maxwell, Bruce D.

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

  15. Decision Making in the Airplane

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

  16. The Accuracy of Medication Data in an Outpatient Electronic Medical Record

    Microsoft Academic Search

    Michael M Wagner; William R Hogan

    1996-01-01

    ObjectiveTo measure the accuracy of medication records stored in the electronic medical record (EMR) of an outpatient geriatric center. The authors analyzed accuracy from the perspective of a clinician using the data and the perspective of a computer-based medical decision-support system (MDSS).DesignProspective cohort study.MethodsThe EMR at the geriatric center captures medication data both directly from clinicians and indirectly using encounter

  17. Expert systems for medical applications.

    PubMed

    Holman, J G; Cookson, M J

    1987-01-01

    Expert systems, also known as intelligent knowledge based systems (IKBS), are computer programs which act as decision-support systems. They are currently being applied to a number of medical domains, most notably diagnosis and treatment planning. Their function is to assist the medical practitioner by giving ready access to the levels of skill shown by experts in a particular field. Much research effort has been expended but few systems have reached routine medical use. This paper presents a tutorial introduction to expert systems in medicine, explaining the basis of the technology, its current limitations and its prospective uses. PMID:3316658

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

    PubMed Central

    2013-01-01

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

  19. Legal process, litigation, and judicial decisions.

    PubMed

    Beresford, H Richard

    2013-01-01

    Ethically salient issues in neurologic care may have important legal overtones. This chapter considers some of these, emphasizing how law may influence the outcome of controversies over how best to promote autonomy, beneficence, and justice in the care of individuals with neurologic disorders. Constitutional, statutory, and judicial dimensions are addressed. With respect to autonomy, discussion emphasizes legal dimensions of the doctrine of informed consent and the obligations of medical professionals to protect the privacy and confidentiality of their patients. The discussion of beneficence focuses on issues relating to actual or potential conflicts of interest in the care of patients and on the conduct of research involving human subjects. The section on justice considers how law aims to define protectable rights and interests of individuals and to provide a fair and efficient process for resolving disputes. Applications of legal principles and doctrines are illustrated primarily through the examples afforded by judicial decisions. These cases demonstrate how law both promotes ethical decision-making and protects the rights and interests of those affected. The cases also highlight some of the ethical quandaries that evoke resort to litigation and the limits of law in advancing ethically appropriate outcomes. PMID:24182366

  20. Physicians' perception and attitude toward electronic medical record.

    PubMed

    Lakbala, Parvin; Dindarloo, Kavoos

    2014-01-01

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

  1. Medical paternalism and the fetus

    Microsoft Academic Search

    John Wyatt

    2001-01-01

    A number of developments in the medical field have changed the debate about the ethics of abortion. These developments include: advances in fetal physiology, the increase in neonatal intensive care and the survival rates of premature infants. This paper discusses the idea of selective termination and the effects that these decisions have on disabled people of today. It presents a

  2. Using decision trees to understand structure in missing data

    PubMed Central

    Tierney, Nicholas J; Harden, Fiona A; Harden, Maurice J; Mengersen, Kerrie L

    2015-01-01

    Objectives Demonstrate the application of decision trees—classification and regression trees (CARTs), and their cousins, boosted regression trees (BRTs)—to understand structure in missing data. Setting Data taken from employees at 3 different industrial sites in Australia. Participants 7915 observations were included. Materials and methods The approach was evaluated using an occupational health data set comprising results of questionnaires, medical tests and environmental monitoring. Statistical methods included standard statistical tests and the ‘rpart’ and ‘gbm’ packages for CART and BRT analyses, respectively, from the statistical software ‘R’. A simulation study was conducted to explore the capability of decision tree models in describing data with missingness artificially introduced. Results CART and BRT models were effective in highlighting a missingness structure in the data, related to the type of data (medical or environmental), the site in which it was collected, the number of visits, and the presence of extreme values. The simulation study revealed that CART models were able to identify variables and values responsible for inducing missingness. There was greater variation in variable importance for unstructured as compared to structured missingness. Discussion Both CART and BRT models were effective in describing structural missingness in data. CART models may be preferred over BRT models for exploratory analysis of missing data, and selecting variables important for predicting missingness. BRT models can show how values of other variables influence missingness, which may prove useful for researchers. Conclusions Researchers are encouraged to use CART and BRT models to explore and understand missing data. PMID:26124509

  3. Integrated Medical Model Overview

    NASA Technical Reports Server (NTRS)

    Myers, J.; Boley, L.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.; Saile, L.; Shah, R.; Garcia, Y.; Sirmons. B.; Walton, M.; Reyes, D.

    2015-01-01

    The Integrated Medical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed Integrated Medical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project.

  4. Decision Dissonance: Evaluating an Approach to Measuring the Quality of Surgical Decision Making

    PubMed Central

    Fowler, Floyd J.; Gallagher, Patricia M.; Drake, Keith M.; Sepucha, Karen R.

    2013-01-01

    Background Good decision making has been increasingly cited as a core component of good medical care, and shared decision making is one means of achieving high decision quality. If it is to be a standard, good measures and protocols are needed for assessing the quality of decisions. Consistency with patient goals and concerns is one defining characteristic of a good decision. A new method for evaluating decision quality for major surgical decisions was examined, and a methodology for collecting the needed data was developed. Methods For a national probability sample of fee-for-service Medicare beneficiaries who had a coronary artery bypass graft (CABG), a lumpectomy or a mastectomy for breast cancer, or surgery for prostate cancer during the last half of 2008, a mail survey of selected patients was carried out about one year after the procedures. Patients’ goals and concerns, knowledge, key aspects of interactions with clinicians, and feelings about the decisions were assessed. A Decision Dissonance Score was created that measured the extent to which patient ratings of goals ran counter to the treatment received. The construct and predictive validity of the Decision Dissonance Score was then assessed. Results When data were averaged across all four procedures, patients with more knowledge and those who reported more involvement reported significantly lower Decision Dissonance Scores. Patients with lower Decision Dissonance Scores also reported more confidence in their decisions and feeling more positively about how the treatment turned out, and they were more likely to say that they would make the same decision again. Conclusions Surveying discharged surgery patients is a feasible way to evaluate decision making, and Decision Dissonance appears to be a promising approach to validly measuring decision quality. PMID:23516764

  5. Continuing medical education.

    PubMed

    Todd, D

    1987-04-01

    With the rapid advances in medical science and increasing complexities of patient care, the need for continuing medical education (CME) is widely accepted by the profession. CME follows general and higher professional training, and should be a life long process. Teaching hospitals and postgraduate professional institutions play vital roles in organising, promoting, and monitoring this activity. CME directorates should be established. University authorities must recognise the important role of medical teachers in postgraduate and continuing medical education, and the staff establishment and terms of service should be held regularly. Medical libraries should have easy borrowing facilities. Self-assessment and audio-visual material are particularly helpful to the busy practitioner and inexpensive local or regional journals of quality can provide pertinent and up-to-date information. All charges for attending scientific meetings and educational material should be tax deductible or subsidized. The effectiveness of CME is difficult to assess and participation is almost impossible to enforce. Much depends on the standard of medical practice wanted by society. Recertification of general practitioners or specialists poses many problems. On the other hand, completion of self-assessment programmes, active participation at medical meetings, contributions to scientific literature, and membership of medical societies with built-in peer review could be monitored and regularly used to evaluate professional status. PMID:3688816

  6. Medical imaging fusion applications: An overview

    Microsoft Academic Search

    S. P. Constantinos; Marios S. Pattichis; Evangelia Micheli-Tzanakou

    2001-01-01

    Computer aided fusion of multi-modality medical images provides a very promising diagnostic tool with numerous clinical applications. The objective of this paper is to present an overview of medical imaging fusion techniques with an emphasis on the use of neural network algorithms. Case studies derived from oncology (data level fusion), microscopy and ultrasound imaging (feature level and decision level fusion),

  7. Medical technology and professional dominance theory

    Microsoft Academic Search

    Ann Lennarson Greer

    1984-01-01

    The expansion of medical technology in hospitals is commonly asserted to be a result of the preferences of medical doctors translated into organizational policies as a result of professional dominance in health care organizations. This paper examines the theoretical and empirical bases for hypotheses of professional dominance and the utility of these hypotheses in explaining hospital decisions to adopt new

  8. Clearing the Smoke Around Medical Marijuana

    Microsoft Academic Search

    M A Ware

    2011-01-01

    The hazy world of “medical marijuana” continues to cry out for clear data on which to base medical decision making and rational policy design. In this issue of Clinical Pharmacology & Therapeutics, Abrams and colleagues report that vaporized cannabis does not meaningfully affect opioid plasma levels and may even augment the efficacy of oxycodone and morphine in patients with chronic

  9. Practicing nephrology with a computerized medical record

    Microsoft Academic Search

    William W Stead; Leland E Garrett; William E Hammond

    1983-01-01

    The practice of medicine revolves around the collection, interpretation, and dissemination of data about patients. Clinical decisions are based upon information gathered from the patient in light of medical knowledge which has been gained from the physician's experiences while taking care of other patients. The didactic portion of medical education includes the transfer of the profession's cumulative clinical experience to

  10. Decision, 29 February 1988.

    PubMed

    1988-01-01

    This document contains the text of a 1988 Decision of the Chairman of the Council of Ministers of Viet Nam authorizing Vietnamese citizens to travel abroad to attend to personal business. Such business may include visiting immediate relatives, needing medical treatment, meeting and accompanying returning handicapped persons, resolving the question of marriage with foreigners or with overseas Vietnamese resident, pursuing education abroad, accompanying relatives who are old or weak or who are children, bringing home the remains of a dead relative, and tourism in foreign countries. Those who will not receive permission to travel abroad include criminals and those who oppose the socialist order. The normal period of travel abroad will not exceed three months, but extensions will be possible. PMID:12289352

  11. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment.

    PubMed

    Anandarajah, G; Hight, E

    2001-01-01

    The relationship between spirituality and medicine has been the focus of considerable interest in recent years. Studies suggest that many patients believe spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to consider these factors in their medical care. A spiritual assessment as part of a medical encounter is a practical first step in incorporating consideration of a patient's spirituality into medical practice. The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions. PMID:11195773

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

    NSDL National Science Digital Library

    Philip A. Streifer

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

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

    ERIC Educational Resources Information Center

    Keller, Jonathan W.; Yang, Yi Edward

    2008-01-01

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

  14. Bayes multiple decision functions

    PubMed Central

    Wu, Wensong; Peña, Edsel A.

    2014-01-01

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

  15. The development of a comprehensive medical-surgical distribution agreement.

    PubMed

    Weatherford, W D

    1994-02-01

    The selection of a medical-surgical distributor has become one of the most important decisions made by a hospital materiel manager today. It is therefore critical that before a distributor is selected a clearly defined development process and master plan be established. This master plan should contain, at a minimum, (1) a comprehensive strategic plan, (2) a detailed request for proposal, and (3) a detailed project implementation schedule. A well-structured, well-executed plan will help to ensure that the best distributor is selected and that the best possible distribution agreement is designed. PMID:10131691

  16. Procedure Modeling and Analyzing of Supply Chain Collaborative Decision Mode

    Microsoft Academic Search

    Yaxin Han; Xuejun Xu; Zhuojun Xie

    2006-01-01

    Information sharing and collaborative decision are important strategies for supply chain partners to realize their common profit. In order to contrast the decision process and decision effect of these strategies, information sharing mode, collaborative forecasting mode and collaborative planning, forecasting and replenishment mode, etc., several kinds of supply chain collaborative decision modes were analyzed and simulated employing procedure modeling technique.

  17. Family & Medical Leave A Guide for Supervisors

    E-print Network

    Saffman, Mark

    Family & Medical Leave A Guide for Supervisors As a supervisor, it is important for you to know how & Medical Leave Act (FMLA) &/or Wisconsin Family & Medical Leave Act (WFMLA) and to know what to do with confidential medical information. FMLA and WFMLA are leave entitlements for reasonable, job-protected leave

  18. Medical Assistants

    NSDL National Science Digital Library

    For a concise summary of the medical assistant profession the Medical Assistants entry in the Bureau of Labor Statistics' Occupational Outlook Handbook is must read. The site covers topics ranging from the nature of the profession, working conditions, earnings, and more. The section on training, qualifications and advancement will be of special interest to medical assistant faculty and students. The section on sources of addition information will also be a good launching point for anyone seeking additional online resources.

  19. Treating Ed A Medical Ethics Case Study

    NSDL National Science Digital Library

    Eric Ribbens

    2008-01-01

    Ed is dying. How should his wishes for medical treatment be carried out? As the case unfolds, students explore the rights and responsibilities of doctors, patients, and patient representatives regarding difficult medical decisions. Specifically, students consider the ramifications of Advance Directives and Durable Powers of Attorney. The case was written for an introductory biology course, but could easily be used in or modified for a human anatomy and physiology, introductory nursing, or medical ethics course.

  20. Understanding variation in primary medical care: a nine-country qualitative study of clinicians’ accounts of the non-clinical factors that shape antibiotic prescribing decisions for lower respiratory tract infection

    PubMed Central

    Brookes-Howell, Lucy; Hood, Kerenza; Cooper, Lucy; Little, Paul; Verheij, Theo; Coenen, Samuel; Godycki-Cwirko, Maciek; Melbye, Hasse; Borras-Santos, Alicia; Worby, Patricia; Jakobsen, Kristin; Goossens, Herman; Butler, Christopher C

    2012-01-01

    Objectives There is a wide variation between European countries in antibiotic prescribing for patients in primary care with lower respiratory tract infection (LRTI) that is not explained by case mix and clinical factors alone. Variation in antibiotic prescribing that is not warranted by differences in illness and clinical presentation may increase selection of resistant organisms, contributing to the problem of antibiotic resistance. This study aimed to investigate clinicians’ accounts of non-clinical factors that influence their antibiotic prescribing decision for patients with LRTI, to understand variation and identify opportunities for addressing possible unhelpful variation. Design Multicountry qualitative semistructured interview study, with data subjected to a five-stage analytic framework approach (familiarisation, developing a thematic framework from interview questions and emerging themes, indexing, charting and interpretation), and with interviewers commenting on preliminary analytic themes. Setting Primary care. Participants Eighty primary care clinicians randomly selected from primary care research networks based in nine European cities. Results Clinicians’ accounts identified non-clinical factors imposed by the healthcare system operating within specific regional primary care research networks, including patient access to antibiotics before consulting a doctor (Barcelona and Milan), systems to reduce patient expectations for antibiotics (Southampton and Antwerp) and lack of consistent treatment guidelines (Balatonfüred and ?ód?). Secondly, accounts revealed factors related to specific characteristics of clinicians regardless of network (professional ethos, self-belief in decision-making and commitment to shared decision-making). Conclusions Addressing healthcare system factors (eg, limiting patients’ self-management with antibiotics before consulting in primary care, increased public awareness and provision of more consistent guidelines) may assist in reducing unhelpful variation in antibiotic prescribing. Promoting clinicians’ receptivity to change, confidence in decision-making and readiness to invest in explaining prescribing decisions may also be beneficial. As factors were emphasised differently between networks, local flexibility in interventions is likely to maximise effectiveness. PMID:22918670

  1. [Experience assisting an AIDS-infected homosexual patient and his same-sex partner make a do-not-resuscitate decision].

    PubMed

    Wang, Shu-Jang; Lai, Pei-Yu; Liou, Siao-Ying; Ko, Wen-Chien; Ko, Nai-Ying

    2012-10-01

    Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives. PMID:23034554

  2. Expert Witness: A system for developing expert medical testimony

    NASA Technical Reports Server (NTRS)

    Lewandowski, Raymond; Perkins, David; Leasure, David

    1994-01-01

    Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

  3. Teaching medical ethics in Basra: perspective of students and graduates.

    PubMed

    Yacoub, A A; Ajeel, N A

    2000-07-01

    The University of Basra Medical College introduced a course on medical ethics for undergraduate students in 1994. We explored the opinions of 54 graduates and 52 final-year medical students about the benefits they perceive they gained from the course and its relevance to their training or practice. About 31% of students and 34% of graduates thought the course was practically and theoretically useful. Over 80% of graduates and students thought the course was either very relevant or relevant to some extent to the practice of medicine. When asked to recall the important ethical issues taught in the course, 52% of graduates and 44% of students listed patient-doctor relationship. Confidentiality, physician liability and ethical issues concerning recent medical innovations were listed by few respondents. Only 6% of both graduates and students were able to list the four principles of medical ethics as described by Raanan. The self-learning component of the course should be developed to strengthen ethical reasoning and judgment in decision-making. PMID:11794075

  4. Impact of effectiveness information format on patient choice of therapy and satisfaction with decisions about chronic disease medication: the "Influence of intervention Methodologies on Patient Choice of Therapy (IMPACT)" cluster-randomised trial in general practice

    PubMed Central

    2013-01-01

    Background Risk communication is an integral part of shared decision-making in health care. In the context of interventions for chronic diseases it represents a particular challenge for all health practitioners. By using two different quantitative formats to communicate risk level and effectiveness of a cholesterol-lowering drug, we posed the research question: how does the format of risk information influence patients’ decisions concerning therapy, patients’ satisfaction with the communication as well as confidence in the decision. We hypothesise that patients are less prone to accept therapy when the benefits of long-term intervention are presented in terms of prolongation of life (POL) in months compared to the absolute risk reduction (ARR). We hypothesise that patients presented with POL will be more satisfied with the communication and confident in their decision, suggesting understanding of the time-related term. Methods/Design In 2009 a sample of 328 general practitioners (GPs) in the Region of Southern Denmark was invited to participate in a primary care-based clinical trial among patients making real-life clinical decisions together with their GP. Interested GPs were cluster-randomised to inform patients about cardiovascular disease (CVD) risk and the effectiveness of statin therapy using either POL or ARR. The GPs attended a training session before informing their patients. Before training and after the trial period they received a questionnaire about their attitudes to risk communication and the use of numerical information. Patients’ redemptions of statin prescriptions will be registered in a regional prescription database to evaluate a possible association between redemption rates and effectiveness format. The Combined Outcome Measure for Risk Communication And Treatment Decision Making Effectiveness (COMRADE) questionnaire will be used to measure patients’ confidence and satisfaction with the risk communication immediately after the conversation with their GPs. Discussion This randomised clinical trial compares the impact of two effectiveness formats on real-life risk communication between patients and GPs, including affective patient outcomes and actual choices about acceptance of therapy. Though we found difficulties in recruiting GPs, according to the study protocol we have succeeded in engaging sufficient GPs for the trial, enabling us to perform the planned analyses. Trial registration ClinicalTrials.gov Protocol Registration System http://ww.clinicaltrials.gov/NCT01414751 PMID:23442351

  5. Medical Terminology.

    ERIC Educational Resources Information Center

    Mercer County Community Coll., Trenton, NJ.

    This document is one of a series of student workbooks developed for workplace skill development courses or workshops by Mercer County Community College (New Jersey) and its partners. Designed to help employees of medical establishments learn medical terminology, this course provides information on basic word structure, body parts, suffixes and…

  6. Where does medical education stand in nurturing the 3Rs in medical students: responsibility, resilience and resolve?

    PubMed

    Eley, Diann S; Stallman, Helen

    2014-10-01

    Over the past decade, the medical education literature has recognized the need to develop a culture that nurtures wellbeing and resilience in students. However, the introduction of or increase in student fees precipitated a shift in higher education policies toward a consumer model of education. Importantly, it has altered the expectations of students and promoted a sense of "entitlement", rather than "striving" for something where success is not guaranteed. This model is consistent with materialism and status, and removed from intrinsic goals that are associated with mental and physical wellbeing. This article challenges medical educators to reconsider the current context of student learning and realign it with the graduate attributes needed to be a competent and responsible medical practitioner by enabling students to develop the 3Rs of resilience, responsibility and resolve. We propose that brave decisions and actions must be made by medical educators to provide students with opportunities to learn independence, self-management, and self-regulation and guarantee their role in helping medical students become resilient and responsible doctors of tomorrow. PMID:25072531

  7. Medical video server construction.

    PubMed

    Da?da, Jacek; Juszkiewicz, Krzysztof; Leszczuk, Miko?aj; Loziak, Krzysztof; Papir, Zdzis?aw; Sikora, Marek; Watza, Rafal

    2003-01-01

    The paper discusses two implementation options for a Digital Video Library, a repository used for archiving, accessing, and browsing of video medical records. Two crucial issues to be decided on are a video compression format and a video streaming platform. The paper presents numerous decision factors that have to be taken into account. The compression formats being compared are DICOM as a format representative for medical applications, both MPEGs, and several new formats targeted for an IP networking. The comparison includes transmission rates supported, compression rates, and at least options for controlling a compression process. The second part of the paper presents the ISDN technique as a solution for provisioning of tele-consultation services between medical parties that are accessing resources uploaded to a digital video library. There are several backbone techniques (like corporate LANs/WANs, leased lines or even radio/satellite links) available, however, the availability of network resources for hospitals was the prevailing choice criterion pointing to ISDN solutions. Another way to provide access to the Digital Video Library is based on radio frequency domain solutions. The paper describes possibilities of both, wireless and cellular network's data transmission service to be used as a medical video server transport layer. For the cellular net-work based solution two communication techniques are used: Circuit Switched Data and Packet Switched Data. PMID:14703288

  8. 38 CFR 17.70 - Written decision following a hearing.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...MEDICAL Community Residential Care § 17.70 Written decision...completion of the hearing. An oral hearing shall be considered...determination of a community residential care facility's noncompliance with...whether the community residential care facility complies with the...

  9. 38 CFR 17.70 - Written decision following a hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...MEDICAL Community Residential Care § 17.70 Written decision...completion of the hearing. An oral hearing shall be considered...determination of a community residential care facility's noncompliance with...whether the community residential care facility complies with the...

  10. FAU Medical Amnesty Policy Division of Student Affairs

    E-print Network

    Fernandez, Eduardo

    FAU Medical Amnesty Policy Division of Student Affairs AVP/Dean of Students Office (A) Policy responsible decisions and to seek medical attention in serious or life-threatening situations that result from alcohol and/or other drug abuse. Students are also encouraged to seek help for any situation where medical

  11. Critical review of medical waste legislation in Spain

    Microsoft Academic Search

    E. Insa; M. Zamorano; R. López

    2010-01-01

    Medical waste is potentially dangerous since it may contain pathogenic agents. As a result, medical waste management requires that institutions take decisions, and implement a wide range of measures in order to reduce health risks. In this respect, many European countries have enacted legislation and good practice guidelines to define, classify, and treat medical waste. In reference to Spain, even

  12. Decision time for clinical decision support systems.

    PubMed

    O'Sullivan, Dympna; Fraccaro, Paolo; Carson, Ewart; Weller, Peter

    2014-08-01

    Clinical decision support systems are interactive software systems designed to help clinicians with decision-making tasks, such as determining a diagnosis or recommending a treatment for a patient. Clinical decision support systems are a widely researched topic in the computer science community, but their inner workings are less well understood by, and known to, clinicians. This article provides a brief explanation of clinical decision support systems and some examples of real-world systems. It also describes some of the challenges to implementing these systems in clinical environments and posits some reasons for the limited adoption of decision-support systems in practice. It aims to engage clinicians in the development of decision support systems that can meaningfully help with their decision-making tasks and to open a discussion about the future of automated clinical decision support as a part of healthcare delivery. PMID:25099829

  13. Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

    PubMed

    Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

    2014-09-01

    This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ?6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient. PMID:25179920

  14. Counseling for Decisions

    ERIC Educational Resources Information Center

    Smaby, Marlowe H.; Tamminen, Armas W.

    1978-01-01

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

  15. Constitutional limits on federal legislation practically compelling medical employment: Wong v Commonwealth; Selim v Professional Services Review Committee.

    PubMed

    Faunce, Thomas

    2009-10-01

    A recent decision by the High Court of Australia (Wong v Commonwealth; Selim v Professional Services Review Committee (2009) 236 CLR 573) (the PSR case) has not only clarified the scope of the Australian constitutional prohibition on "any form of civil conscription" in relation to federal legislation concerning medical or dental services (s 51xxiiiA), but has highlighted its importance as a great constitutional guarantee ensuring the mixed State-federal and public-private nature of medical service delivery in Australia. Previous decisions of the High Court have clarified that the prohibition does not prevent federal laws regulating the manner in which medical services are provided. The PSR case determined that the anti-overservicing provisions directed at bulk-billing general practitioners under Pt VAA of the Health Insurance Act 1973 (Cth) did not offend the prohibition. Importantly, the High Court also indicated that the s 51(xxiiiA) civil conscription guarantee should be construed widely and that it would invalidate federal laws requiring providers of medical and dental services (either expressly or by practical compulsion) to work for the federal government or any specified State, agency or private industrial employer. This decision is likely to restrict the capacity of any future federal government to restructure the Australian health care system, eg by implementing recommendations from the National Health and Hospitals Reform Commission for either federal government or private corporate control of presently State-run public hospitals. PMID:19998589

  16. Emulation Modeling with Bayesian Networks for Efficient Decision Support

    NASA Astrophysics Data System (ADS)

    Fienen, M. N.; Masterson, J.; Plant, N. G.; Gutierrez, B. T.; Thieler, E. R.

    2012-12-01

    Bayesian decision networks (BDN) have long been used to provide decision support in systems that require explicit consideration of uncertainty; applications range from ecology to medical diagnostics and terrorism threat assessments. Until recently, however, few studies have applied BDNs to the study of groundwater systems. BDNs are particularly useful for representing real-world system variability by synthesizing a range of hydrogeologic situations within a single simulation. Because BDN output is cast in terms of probability—an output desired by decision makers—they explicitly incorporate the uncertainty of a system. BDNs can thus serve as a more efficient alternative to other uncertainty characterization methods such as computationally demanding Monte Carlo analyses and others methods restricted to linear model analyses. We present a unique application of a BDN to a groundwater modeling analysis of the hydrologic response of Assateague Island, Maryland to sea-level rise. Using both input and output variables of the modeled groundwater response to different sea-level (SLR) rise scenarios, the BDN predicts the probability of changes in the depth to fresh water, which exerts an important influence on physical and biological island evolution. Input variables included barrier-island width, maximum island elevation, and aquifer recharge. The variability of these inputs and their corresponding outputs are sampled along cross sections in a single model run to form an ensemble of input/output pairs. The BDN outputs, which are the posterior distributions of water table conditions for the sea-level rise scenarios, are evaluated through error analysis and cross-validation to assess both fit to training data and predictive power. The key benefit for using BDNs in groundwater modeling analyses is that they provide a method for distilling complex model results into predictions with associated uncertainty, which is useful to decision makers. Future efforts incorporate outcomes of the groundwater BDN into a larger BDN for comprehensive decision support that addresses a variety of potential physical and ecological sea-level rise impacts to Assateague Island.

  17. [Patients facing with the decision to undergo percutaneous coronary intervention].

    PubMed

    Bobbio, Marco

    2015-03-01

    Percutaneous coronary intervention (PCI) is a common procedure to treat coronary artery stenoses. Several studies had demonstrated that PCI does not reduce the risk of death or myocardial infarction when performed to patients with stable angina. However it has been observed that most patients believe that PCI will reduce their risk for death and myocardial infarction. On the other hand, cardiologists generally acknowledge the limitation of PCI according to the current literature.Cardiologists' decision to refer a patient to PCI is based on factors other then perceived benefits such as fear of missing a needed procedure, defensive medicine, desire of demonstrating their professional competence, vested professional and economic interests, accomplish patient expectation, the so called oculo-stenotic reflex, when a lesion is dilated regardless the clinical indication. Patients' misleading perception of harm and benefits of a procedure is mainly related to the cognitive dissonance, when individuals tend to reduce the conflict of an uncomfortable decision adopting information, which are likely to reduce their discomfort. Furthermore, patients believe that doing more means doing better, that technologic intervention are better than pharmacological treatment that in turn are better than doing nothing. Finally, they assume that a procedure is really effective since their physician suggested it.It should be emphasized that physicians and patients do not communicate successfully about key decision and how little we know about patient understanding of the factors that influence important medical care decisions. Although considerable attention is given to facilitating informed consent, patients' perceived benefits of elective PCI do not match existing evidence, as they overestimated both the benefits and urgency of their procedures. These findings suggest that an even greater effort at patient education is needed prior to elective PCI to facilitate fully informed decision-making. PMID:25805221

  18. Medical marketplace

    NASA Astrophysics Data System (ADS)

    Moretti, Michael

    1991-08-01

    Solid state lasers are the real highlight of my talk today, and were really the star of the year. In every application area I can think of, people have tried with some success to introduce corturiercial solid state products. I'll go into more detail, but aside from solid state, a very significant event happened in Deceniber when one of the laser angioplasty companies (Advanced Interventional Systens) received FDA clearance to begin marketing the excimer for coronary applications (Figure 1) . This is the first time to my knowledge that an excimer has ever been cleared for a medical application in the United States. It's an event that we didn't really expect to happen so soon. It's extremely significant and we'll see where it goes from here. The system needs to be road-tested a bit but to get past the FDA is the major obstacle. Looking back to solid state laser the importance of solid state lasers is as researchers become more involved with the excimer and conduct more clinical studies in ophthalmology, they realize that it's not going to be a panacea for all refractive surgery or other ophthalmolic applications. In many cases it looks like the solid state laser may be the laser of choice in certain types of surgery; most notably perhaps in refractive surgery. We've all read about the success of the excimer at least in capturing the press's attention for corneal sculpting and vision correction. Well, it could be that actually the next generation will be a solid state laser, so let's keep an open mind here.

  19. MEDICAL TECHNOLOGY AND HEALTH

    Microsoft Academic Search

    Nicolae Tudor Racoveanu

    Health Technology (HT) or Medical Technology is at present one of the important reasons of inequity in Health Care visible in our world as demonstrated very clearly by the UNSCEAR 2000. Data of this document demonstrate that less than 25% of the world population has reasonable access to diagnostic radiology and that situation is not improving but on the contrary,

  20. INSTITUTE FOR MEDICAL EDUCATION

    E-print Network

    Engman, David M.

    of Northwestern's most important legacies. Financial Assistance Healthcare is personal. So, too, is the educational path an individual takes to become a vital contributor to the healthcare system. Northwestern efforts to recruit and retain preeminent faculty who want to be part of an academic medical center and

  1. The Neural Basis of Decision Making

    E-print Network

    Boahen, Kwabena

    @mail.med.upenn.edu 2 Howard Hughes Medical Institute and Department of Physiology and Biophysics, University is the (unknown) state of the world, given the noisy data pro- vided by the sensory systems? These decisions select among competing hypotheses h1 . . . hn (often n = 2) that each represent a state of the world (e

  2. Medication Treatment

    MedlinePLUS

    ... behavior, such as to reduce self-injury or aggression. Once a symptom is no longer a problem, ... of repetitive behaviors; decrease anxiety, irritability, tantrums, and aggressive behavior; and improve eye contact. Tricyclics These medications ...

  3. Medical Scientists

    MedlinePLUS

    ... little supervision, forming their own hypotheses and developing experiments, accordingly. They often lead teams of technicians, and ... prospective medical scientists the opportunity to develop their experiments and, sometimes, to supervise undergraduates. Ph.D. programs ...

  4. Medical Assistants

    MedlinePLUS

    ... signs, such as heart rate and blood pressure. Training Medical assistants who do not have postsecondary education ... all workers was $34,750. On-the-job Training Additional training needed (postemployment) to attain competency in ...

  5. Developments in Scandinavian and American medical sociology.

    PubMed

    Riska, Elianne

    2003-01-01

    This paper examines the similarities and differences in Scandinavian and American medical sociology. First, the issue of medicalization has not been as important in Scandinavian as it has been in American medical sociology. Second, women's health has been less explored in Scandinavian than in American medical sociology. Third, research on social inequalities and health has been a major focus in Scandinavian medical sociology since the 1990s. Fourth, cultural sociology and the poststructuralist perspective have been part of mainstream theory building in European sociology and also European and Scandinavian medical sociology during the past decade, while American medical sociology has been characterized by social-role theory and a quantitative approach. PMID:14555376

  6. Informatics Perspectives on Decision Taking

    E-print Network

    Bergstra, J A

    2011-01-01

    A decision is an act or event of decision taking. Decision making always includes decision taking, the latter not involving significant exchanges with non-deciding agents. A decision outcome is a piece of storable information constituting the result of a decision. Decision outcomes are typed, for instance: plan, command, assertion, or boolean reply to a question. A decision effect is any consequence of putting a decision outcome into effect. Decision outcomes must be expected by the decider to lead to certain decision effects, by way of their being put into effect. The availability of a model or of a theory of the causal chain leading from a decision outcome to one or more decision effects is assumed for the decision taker, otherwise the decision outcome is merely an utterance. Decision effectiveness measures the decision effects against objectives meant to be served with the decision. Decision taking is positioned amidst many similar notions including: decision making, decision process, decision making proce...

  7. [Imported histoplasmosis].

    PubMed

    Stete, Katarina; Kern, Winfried V; Rieg, Siegbert; Serr, Annerose; Maurer, Christian; Tintelnot, Kathrin; Wagner, Dirk

    2015-06-01

    Infections with Histoplasma capsulatum are rare in Germany, and mostly imported from endemic areas. Infections can present as localized or disseminated diseases in immunocompromised as well as immunocompetent hosts. A travel history may be a major clue for diagnosing histoplasmosis. Diagnostic tools include histology, cultural and molecular detection as well as serology. Here we present four cases of patients diagnosed and treated in Freiburg between 2004 and 2013 that demonstrate the broad range of clinical manifestations of histoplasmosis: an immunocompetent patient with chronic basal meningitis; a patient with HIV infection and fatal disseminated disease; a patient with pulmonary and cutaneous disease and mediastinal and cervical lymphadenopathy; and an immunosuppressed patient with disseminated involvement of lung, bone marrow and adrenal glands. PMID:26069920

  8. eMedCheck: medication screening on a PDA eMedCheck is an electronic medication screening form that can

    E-print Network

    Shapiro, Benjamin

    eMedCheck: medication screening on a PDA eMedCheck is an electronic medication screening form. The software uses decision rules to determine which medication each person should receive. It also records by the problem of resupplying PODs continuously from a central depot that has a stockpile of medication. Each

  9. The challenges and ethical dilemmas of a military medical officer serving with a peacekeeping operation in regard to the medical care of the local population

    Microsoft Academic Search

    J Tobin

    2005-01-01

    Medical Officers serving with their national contingents in peacekeeping operations are faced with difficult ethical decisions in regard to their obligations to the local civilian population. Such populations may be under-resourced in regard to medical care, and vulnerable to abuse and exploitation. Though the medical officer may support the local medical services, he\\/she should never undermine these resources. Adopting a

  10. Training for Aviation Decision Making: The Naturalistic Decision Making Perspective

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

    This paper describes the implications of a naturalistic decision making (NDM) perspective for training air crews to make flight-related decisions. The implications are based on two types of analyses: (a) identification of distinctive features that serve as a basis for classifying a diverse set of decision events actually encountered by flight crews, and (b) performance strategies that distinguished more from less effective crews flying full-mission simulators, as well as performance analyses from NTSB accident investigations. Six training recommendations are offered: (1) Because of the diversity of decision situations, crews need to be aware that different strategies may be appropriate for different problems; (2) Given that situation assessment is essential to making a good decision, it is important to train specific content knowledge needed to recognize critical conditions, to assess risks and available time, and to develop strategies to verify or diagnose the problem; (3) Tendencies to oversimplify problems may be overcome by training to evaluate options in terms of goals, constraints, consequences, and prevailing conditions; (4) In order to provide the time to gather information and consider options, it is essential to manage the situation, which includes managing crew workload, prioritizing tasks, contingency planning, buying time (e.g., requesting holding or vectors), and using low workload periods to prepare for high workload; (5) Evaluating resource requirements ("What do I need?") and capabilities ("'What do I have?" ) are essential to making good decisions. Using resources to meet requirements may involve the cabin crew, ATC, dispatchers, and maintenance personnel; (6) Given that decisions must often be made under high risk, time pressure, and workload, train under realistic flight conditions to promote the development of robust decision skills.

  11. Medication Math

    NSDL National Science Digital Library

    Joey

    2008-10-16

    Medication calculation needs to be completed accurately for proper patient treatment. In this section you will need to review and improve your medication math. Understanding math: Math and Culture Refresher: Take the amount of fluid in the bottle and times that by the dose ordered. Then divide this number by the amount of drug in the bottle. This will give you the volume of the drug that you need to administer. Diagram of formulas Math Formulas Math ...

  12. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

    ERIC Educational Resources Information Center

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-01-01

    Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

  13. Management of Medically Fragile Infants.

    ERIC Educational Resources Information Center

    Ueda, Dawn; Caulfield, Rick

    2001-01-01

    Discusses the role of the Child Life Specialist in helping to meet the special needs of medically fragile children. Argues that since many child care professionals may come into contact with medically fragile children at some point in their careers, it is important to examine child life as a specialization in the health care profession. (SD)

  14. Course Evaluation in Medical Education

    ERIC Educational Resources Information Center

    Kogan, Jennifer R.; Shea, Judy A.

    2007-01-01

    Course evaluation is integral to medical education. We discuss (1) distinctive features of medical education that impact on course evaluation, (2) a framework for course evaluations, (3) details that shape the evaluation process, (4) key measurement issues important to data gathering and interpretation, and (5) opportunities for expanding the…

  15. Nitinol medical devices and implants

    Microsoft Academic Search

    D. Stoeckel

    2000-01-01

    Summary Superelastic Nitinol is now a common and well-known engineering materi al in the medical industry. While the greater flexibility of the alloy drives many of its applications, there are also a large number of lesser- known advantages of Niti nol in medical devices. This paper reviews 7 of these less-obvious but very important reasons for Nitinol's success, bot h

  16. Medical waste management in Korea

    Microsoft Academic Search

    Yong-Chul Jang; Cargro Lee; Oh-Sub Yoon; Hwidong Kim

    2006-01-01

    The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past medical waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities (e.g. inadequately controlled incinerators) in Korea. In recent years, many efforts have been made by environmental regulatory agencies

  17. Medical selection: Auschwitz antecedents and effluent.

    PubMed

    Seidelman, W E

    1991-01-01

    Medical selection in Auschwitz represents the penultimate application of the traditional paradigm of medicine: the physician as gatekeeper and decision maker. The historical evolution of that role is considered in the context of public health, medical police, quarantine, and immigration. In Nazi Germany the physician was assigned responsibility for selection on behalf of the state. The ethical implications of medical selection are considered in the context of medicine today in an age of sophisticated biotechnology, constrained resources, and an aging population; an age in which the medical profession has yet to establish a fundamental system of values. PMID:1917203

  18. PURCHASING DECISION ON CRISIS CONDITIONS

    Microsoft Academic Search

    Ion Stancu

    2011-01-01

    Consumption suffered important mutations within the past years, due to profound changes of economic policies, as well as due to the crisis triggered in 2008. Consumption prices have suffered serious modifications every year after 1990, and since 2005 a phase shift of evolution can be noticed for various products, which makes the buying decision of consumers to be on a

  19. Highways and Business Location Decisions

    Microsoft Academic Search

    David J. Forkenbrock; Norman S. J. Foster

    1996-01-01

    Local government leaders quite often contend that upgraded highways are important to their communities' economic development potential. This article examines the degree to which investments in high-capacity highways are likely to influence business location decisions, given the mature nature of the interurban highway system in the United States. The authors examine the conceptual relationship between highway investments and facility location,

  20. An ABC for decision making*

    PubMed Central

    Garcia, Luiz Henrique Costa; Ferreira, Bruna Cortez

    2015-01-01

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. PMID:25987751

  1. Marko Bohanec Decision Support andDecision Support and

    E-print Network

    Bohanec, Marko

    ·1 Marko Bohanec Decision Support andDecision Support and Decision ModelingDecision Modeling Marko · General understanding of methods, techniques, and systems for supporting complex real-life decision-making tasks · Decision Analysis ­ Decision Modeling ­ Multi-Attribute Modeling ­ Software · Decision Support

  2. Designing Decision Support Systems for Revolutionary Command and Control A Dissertation

    E-print Network

    Virginia, University of

    and effective computer supervisory and decision aids. Emphasizing the primary importance of the environmentDesigning Decision Support Systems for Revolutionary Command and Control Domains A Dissertation collection. In contrast, designing decision support systems for revolutionary command and control domains

  3. Beyond "medical tourism": Canadian companies marketing medical travel

    PubMed Central

    2012-01-01

    Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and “Liberation therapy” for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada’s borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. Conclusions This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada’s medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel. PMID:22703873

  4. MEDICAL EMERGENCIES What is a medical emergency?

    E-print Network

    Fernandez, Eduardo

    911 for emergency assistance · Following the arrangement of emergency medical treatment of Injury form. · assists the employee in selecting the appropriate medical provider. · arrangesMEDICAL EMERGENCIES What is a medical emergency? Serious injury or illness. What do I do

  5. Bayesian Decision Theoretical Framework for Clustering

    ERIC Educational Resources Information Center

    Chen, Mo

    2011-01-01

    In this thesis, we establish a novel probabilistic framework for the data clustering problem from the perspective of Bayesian decision theory. The Bayesian decision theory view justifies the important questions: what is a cluster and what a clustering algorithm should optimize. We prove that the spectral clustering (to be specific, the…

  6. Fuzzy multicriterion decision making in irrigation planning

    Microsoft Academic Search

    K. Srinivasa Raju; D. Nagesh Kumar

    2005-01-01

    Multicriterion decision making (MCDM) has emerged as an effective methodology due to its ability to combine quantitative and qualitative criteria for selection of the best alternative. Concurrently, fuzzy logic is gaining importance due to its flexibility in handling imprecise subjective data. In the present study two fuzzy logic-based MCDM methods, namely similarity analysis (SA) and decision analysis (DA), are adopted

  7. An analysis of the drug testing decision

    Microsoft Academic Search

    Ronald J. Karren

    1989-01-01

    Two separate investigations were undertaken to better understand the factors that should be considered in the drug testing decision. In the first study, organizations were surveyed by telephone and were asked to identify the factors considered when making their decision. Safety seemed to be the most important reason for favoring a drug testing program, while employee rights was one of

  8. Development of a patient decision aid for type 2 diabetes mellitus for patients not achieving glycemic control on metformin alone

    PubMed Central

    Shillington, Alicia C; Col, Nananda; Bailey, Robert A; Jewell, Mark A

    2015-01-01

    Purpose To describe the process used to develop an evidence-based patient decision aid (PDA) that facilitates shared decision-making for treatment intensification in inadequately controlled type 2 diabetes mellitus (T2DM) consistent with International Patient Decision Aids Standards. Methods A PDA was developed by a multidisciplinary steering committee of clinicians, patient advocate, nurse, certified diabetes educators, and decision scientist, using a systematic development process. The process included defining the PDA scope and purpose, outlining the framework, content creation, and designing for integration into clinical practice. This was accomplished through a review of the literature and publically available educational materials and input from practicing clinicians and patients during development and iteratively refining content based on input. Patients with poorly controlled T2DM on metformin considering additional medication assessed the PDA during a pilot. Results Testing identified six preference-sensitive domains important for choosing T2DM treatment: degree of glycemic response, avoiding weight gain, hypoglycemia risk and other adverse events, avoiding injections, convenience of dose administration, blood glucose monitoring, and cost of therapy. Patient feedback guided content revision. Treatment options were offered after presenting medication class risk–benefit information and eliciting patient values, goals, and preferences. The PDA received the highest International Patient Decision Aids Standards global score to date, 88/100, with 100% of criteria fully met for the following dimensions: development process, disclosures, evaluation process, evidence quality, guidance for users, information quality, language/readability, testing, and eliciting patient values. Conclusion A PDA was developed to help T2DM patients make decisions regarding medication choice. This approach may be applicable to other chronic conditions. PMID:25995622

  9. Medical Transcriptionists: Making Medical Histories.

    ERIC Educational Resources Information Center

    Shniper, Lynn

    2001-01-01

    Medical transcriptionists are experts in the language of medicine. Describes what they do and what their working conditions, earnings, employment prospects, and training requirements are. Includes sources of additional information. (Author)

  10. Organizational and Individual Decision Making Organizational and Individual Decision Making

    E-print Network

    Sadeh, Norman M.

    Organizational and Individual Decision Making Organizational and Individual Decision Making Citation: Kathleen M. Carley & Dean Behrens, 1999, "Organizational and Individual Decision Making." Ch. 18, Inc. #12;Organizational and Individual Decision Making Organizational and Individual Decision Making

  11. iMed: An Intelligent Medical Web Search Engine

    Microsoft Academic Search

    Gang Luo

    Searching for medical information on the Web is becoming popular and important these days. However, medical search has its own unique requirements that are not well handled by existing medical Web search engines. In this paper, we present iMed, the first intelligent medical Web search engine that extensively uses domain-specific medical knowledge and questionnaire to facilitate ordinary Internet users to

  12. Medical Products Research

    NASA Technical Reports Server (NTRS)

    1982-01-01

    Ventrex Laboratories, Inc. develops, manufactures and markets a line of medical diagnostic assays based on biochemical techniques, in particular immunochemical techniques. Their products are sold worldwide to hospitals and medical laboratories for use in testing blood samples and other biological fluids. Analysis of a patient's body fluids, compared with normal values, aids a physician in confirming or otherwise diagnosing a suspected disease condition. NERAC's rapid information retrieval has provided Ventrex invaluable up-to-date information, and has permitted large scale savings. NERAC's service was particularly important in the development of a new product in the company's Ventre/Sep line, which is used in radioimmunoassays.

  13. Medical writing and publication.

    PubMed

    Taylor, R B

    1989-01-01

    Medical writing and publication are important in developing the scholarly base of family medicine, as well as being integral to an academic career. The author must choose the best format for the topic-research report, review article, book chapter, or other. The five steps in writing for publication are: 1) conceptualization of the topic and how best to present data; 2) organization of material; 3) composition; 4) revision of drafts; and 5) manuscript preparation and submission. The author must overcome the impediments to scholarly activity, such as lack of time, and resolve to ascribe a high priority to medical writing and publication. PMID:2792611

  14. The Use of the Integrated Medical Model for Forecasting and Mitigating Medical Risks for a Near-Earth Asteroid Mission

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Saile, Lynn; Freire de Carvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Lopez, Vilma

    2011-01-01

    Introduction The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission managers and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight. Methods Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of medical evacuation and loss of crew life. The IMM can also optimize medical kits within the constraints of mass and volume for specified missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a near-earth asteroid (NEA) mission. An optimized medical kit for this mission was proposed based on the IMM simulation. Discussion The IMM can provide information to the space program regarding medical risks, including crew medical impairment, medical evacuation and loss of crew life. This information is valuable to mission managers and the space medicine community in assessing risk and developing mitigation strategies. Exploration missions such as NEA missions will have significant mass and volume constraints applied to the medical system. Appropriate allocation of medical resources will be critical to mission success. The IMM capability of optimizing medical systems based on specific crew and mission profiles will be advantageous to medical system designers. Conclusion The IMM is a decision support tool that can provide estimates of the impact of medical events on human space flight missions, such as crew impairment, evacuation, and loss of crew life. It can be used to support the development of mitigation strategies and to propose optimized medical systems for specified space flight missions. Learning Objectives The audience will learn how an evidence-based decision support tool can be used to help assess risk, develop mitigation strategies, and optimize medical systems for exploration space flight missions.

  15. Medical waste management in Korea.

    PubMed

    Jang, Yong-Chul; Lee, Cargro; Yoon, Oh-Sub; Kim, Hwidong

    2006-07-01

    The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past medical waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities (e.g. inadequately controlled incinerators) in Korea. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better manage the waste from healthcare facilities. This paper presents an overview of the current management practices of medical waste in Korea. Information regarding generation, composition, segregation, transportation, and disposal of medical wastes is provided and discussed. Medical waste incineration is identified as the most preferred disposal method and will be the only available treatment option in late 2005. Faced with increased regulations over toxic air emissions (e.g. dioxins and furans), all existing small incineration facilities that do not have air pollution control devices will cease operation in the next few years. Large-scale medical waste incinerators would be responsible for the treatment of medical waste generated by most healthcare facilities in Korea. It is important to point out that there is a great potential to emit air toxic pollutants from such incinerators if improperly operated and managed, because medical waste typically contains a variety of plastic materials such as polyvinyl chloride (PVC). Waste minimization and recycling, control of toxic air emissions at medical waste incinerators, and alternative treatment methods to incineration are regarded to be the major challenges in the future. PMID:16338054

  16. Medical Biotechnology Trends and Achievements in Iran

    PubMed Central

    Mahboudi, Fereidoun; Hamedifar, Haleh; Aghajani, Hamideh

    2012-01-01

    A healthcare system has been the most important priority for all governments worldwide. Biotechnology products have affected the promotion of health care over the last thirty years. During the last several decades, Iran has achieved significant success in extending healthcare to the rural areas and in reducing the rates of infant mortality and increasing population growth. Biomedical technology as a converging technology is considered a helpful tool to fulfill the Iranian healthcare missions. The number of biotechnology products has reached 148 in 2012. The total sales have increased to 98 billion USD without considering vaccines and plasma derived proteins in 2012. Iran is one of the leading countries in the Middle East and North Africa in the area of Medical biotechnology. The number of biotechnology medicines launched in Iran is 13 products until 2012. More than 15 products are in pipelines now. Manufacturers are expecting to receive the market release for more than 8 products by the end of 2012. Considering this information, Iran will lead the biotechnology products especially in area of biosimilars in Asia after India in next three years. The present review will discuss leading policy, decision makers’ role, human resource developing system and industry development in medical biotechnology. PMID:23407888

  17. Medical Device Safety

    MedlinePLUS

    ... Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Medical Devices Print this page Share this page E- ... this page Home Medical Devices Medical Device Safety Medical Device Safety Search the Medical Device Safety Section ...

  18. Medical Instrumentation

    NSDL National Science Digital Library

    2014-09-18

    Students learn about the sorts of devices designed by biomedical engineers and the many other engineering specialties that are required in their design of medical diagnostics, therapeutic aids, surgical devices and procedures, and replacement parts. They discuss the special considerations that must be made when dealing with the human body, such as being minimally invasive, biocompatible, keeping sterile, lightweight, corrosion resistant, long lasting and electrically safe. They also explore how "form fits function." Students gain an appreciation for the amazing devices that improve our quality of life. This lesson serves as a starting point for students to begin to ponder how the medical devices in their everyday lives work.

  19. Medical imaging

    SciTech Connect

    Jacobs, E.R.

    1987-01-01

    Medical Imaging: A Concise Textbook is written to assist a large group of medical personnel, including students and general practitioners, in reading radiographs. The book also attempts to give this group an introduction to radiology. The book begins by examining the physics and the positioning techniques of modern radiology. The following chapters then discuss the subspecialties, ranging from chest and musculoskeletal radiology to interventional radiology and nuclear medicine. The normal features of the subject are discussed first, followed by pathologic abnormalities. With the abnormal patterns, a differential diagnosis is arranged in tables.

  20. Medical genetics

    SciTech Connect

    Jorde, L.B.; Carey, J.C.; White, R.L.

    1995-10-01

    This book on the subject of medical genetics is a textbook aimed at a very broad audience: principally, medical students, nursing students, graduate, and undergraduate students. The book is actually a primer of general genetics as applied to humans and provides a well-balanced introduction to the scientific and clinical basis of human genetics. The twelve chapters include: Introduction, Basic Cell Biology, Genetic Variation, Autosomal Dominant and Recessive Inheritance, Sex-linked and Mitochondrial Inheritance, Clinical Cytogenetics, Gene Mapping, Immunogenetics, Cancer Genetics, Multifactorial Inheritance and Common Disease, Genetic Screening, Genetic Diagnosis and Gene Therapy, and Clinical Genetics and Genetic Counseling.