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Sample records for important medical decisions

  1. Patient Assessments of the Most Important Medical Decision During a Hospitalization

    PubMed Central

    Charvet-Bérard, Agathe; Perrier, Arnaud

    2008-01-01

    Background How medical decisions are made in real-life situations is largely unexplored. We explored patients’ perceptions of decision-making during a hospitalization and examined the conformity of the decision process with expert recommendations. Objective To describe the conformity of the decision-making process with current expert opinion and examine the associations between various aspects of the decision-making process and a global assessment of the decision. Methods Mail survey of patients discharged from a teaching hospital in Geneva, Switzerland. Patients identified the main medical decision during their stay, and rated the decision process (11-item “decision process score”) and their satisfaction with the decision (five-item “decision satisfaction score”). Both scores were scaled between 0 (worst) and 100 (best). Participants The survey had 1467 respondents. Main Results In total 862 (58.8%) of 1467 respondents reported having made a medical decision while in the hospital. The decision process score (mean 78.5, SD 21.5) and the decision satisfaction score (mean 86.5, SD 20.4) were moderately correlated (?=?0.62). Men, healthier patients, patients discharged from the department of surgery, and those who reported sharing the decision with their doctor gave the highest ratings on both scales. Five process variables were independently associated with high satisfaction with the decision: the doctor explained all possible treatments and examinations, the patient was aware of risks at the time of the decision, the doctor’s explanations were easy to understand, the patient was involved in the decision as much as desired or more, and the patient was not pressured into the decision. Conclusions A majority of patients discharged from a general hospital were able to identify and rate a medical decision. Recommended features of the process of medical decision-making were associated with greater satisfaction with the decision. PMID:18663541

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

    ERIC Educational Resources Information Center

    Reyna, Valerie F.; Brainerd, Charles J.

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Huyard, Caroline

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Huyard, Caroline

    2012-01-01

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


  6. 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

  7. The importance of decision onset.

    PubMed

    Teichert, Tobias; Grinband, Jack; Ferrera, Vincent

    2016-02-01

    The neural mechanisms of decision making are thought to require the integration of evidence over time until a response threshold is reached. Much work suggests that response threshold can be adjusted via top-down control as a function of speed or accuracy requirements. In contrast, the time of integration onset has received less attention and is believed to be determined mostly by afferent or preprocessing delays. However, a number of influential studies over the past decade challenge this assumption and begin to paint a multifaceted view of the phenomenology of decision onset. This review highlights the challenges involved in initiating the integration of evidence at the optimal time and the potential benefits of adjusting integration onset to task demands. The review outlines behavioral and electrophysiolgical studies suggesting that the onset of the integration process may depend on properties of the stimulus, the task, attention, and response strategy. Most importantly, the aggregate findings in the literature suggest that integration onset may be amenable to top-down regulation, and may be adjusted much like response threshold to exert cognitive control and strategically optimize the decision process to fit immediate behavioral requirements. PMID:26609111

  8. Influence of framing on medical decision making

    PubMed Central

    Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

    2013-01-01

    Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

  9. Supporting Medical Decision Making with Argumentation Tools

    ERIC Educational Resources Information Center

    Lu, Jingyan; Lajoie, Susanne P.

    2008-01-01

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

  10. Medical Decision-Making by Psychiatry Residents

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  11. Medical informatics and pediatrics. Decision-support systems.

    PubMed

    Johnson, K B; Feldman, M J

    1995-12-01

    Decision support is an important area of medical informatics research. Computer-based decision-support tools facilitate diagnosis and the management of patients after a diagnosis has been established. Diagnostic decision-support tools, such as Meditel, Quick Medical Reference, DXplain, Iliad, and PEM-DXP are potentially useful "expert systems." Other management-support tools, such as systems that use clinical practice guidelines to create reminders and alerts, also have been developed and evaluated. We do the following: (1) to provide an overview of diagnostic and management decision-support systems; (2) explore the background of and motivation behind these systems; (3) survey the uses of decision-support technology in office-based and inpatient pediatric practices; and (4) discuss the virtues and problems associated with some of these tools, and current controversies and future goals for computer-based decision support. PMID:7489077

  12. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott M.

    2007-01-01

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

  13. Measurement Decision Risk - The Importance of Definitions

    NASA Technical Reports Server (NTRS)

    Mimbs, Scott M.

    2008-01-01

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

  14. 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

  15. Use of influence diagrams to structure medical decisions.

    PubMed

    Nease, R F; Owens, D K

    1997-01-01

    Influence diagrams are compact representations of decision problems that are mathematically equivalent to decision trees. The authors present five important principles for structuring a decision as an influence diagram: 1) start at the value node and work back to the decision nodes; 2) draw the arcs in the direction that makes the probabilities easiest to assess; 3) use informational arcs to specify which events will have been observed at the time each decision is made; 4) ensure that missing arcs reflect intentional assertions about conditional independence and the timing of observations; and 5) ensure that there are no cycles in the influence diagram. They then build an influence diagram for the problem of staging non-small-cell lung cancer as an illustration. Influence diagrams offer several strengths for structuring medical decisions. They represent graphically and compactly the probabilistic relationships between parameters in the model. Influence diagrams also allow the model to be structured in a fashion that eases the necessary probability assessments, regardless of whether the assessments are based on available evidence or on expert judgment. Influence diagrams provide an important complement to decision trees, especially for representing probabilistic relationships among variables in a decision model. PMID:9219186

  16. 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.

  17. 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

  18. 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

  19. 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.


  20. 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

  1. [Decision process in oncology: the importance of multidisciplinary meeting].

    PubMed

    Orgerie, M-B; Duchange, N; Pélicier, N; Chapet, S; Dorval, E; Rosset, P; Lemarié, E; Hervé, C; Moutel, G

    2010-02-01

    Multidisciplinary meeting (MDM) in oncology has been institutionalised in France by the Cancer Plan. This study aims to determine the place of MDM in the decision process. From November 2004 to July 2005, we observed 29 meetings at the Tours Hospital and 324 case presentations, 80 in orthopaedics, 151 in gastroenterology and 93 in chest medicine. Forty physicians attending the meetings answered a questionnaire exploring their opinions on MDM and the collegial decision. We found that MDM is mostly the place for technical discussions and that patients' wishes are rarely addressed. The different medical specialities are well represented but we observed that only physicians attend MDM. Decisions for straightforward cases are rapidly validated. For more complex clinical situations (25 to 40% of case presentations), the multidisciplinary approach allows to adapt guidelines or to choose alternative treatments. All the physicians interviewed express that MDM legitimates the medical decision. It occurs that they disagree with the RCP decision. We discuss how MDM impacts on the medical decision as well as the shift from the individual decision to the collective one, particularly in term of responsibility. PMID:19825531

  2. Decision time for retiree medical accounting.

    PubMed

    LaBombarde, A R

    1991-01-01

    An employer's initial response to the new accounting rules for employer-sponsored retiree medical plans can irreversibly shape the retiree medical costs and liabilities that will emerge over the next several decades. PMID:10117174

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

    PubMed Central

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

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

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

    MedlinePLUS

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

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

    MedlinePLUS

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

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

    PubMed

    Piccirillo, M; Graf, G J

    1989-01-01

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

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

    PubMed

    Blau, Gary; Chapman, Susan

    2011-01-01

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

  8. Symbolic decision support in medical care.

    PubMed

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

    1993-10-01

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

  9. Evaluation of fuzzy relation method for medical decision support.

    PubMed

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

    2012-02-01

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

  10. 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

  11. Modelling medical decisions in DynaMoL: a new general framework of dynamic decision analysis.

    PubMed

    Leong, T Y; Cao, C

    1998-01-01

    Dynamic decision analysis concerns decision problems in which both time and uncertainty are explicitly considered. We present a new dynamic decision analysis framework, called DynamoL, that supports graphical presentation of the decision factors in multiple perspectives. To alleviate the difficulty in assessing conditional probabilities over time in dynamic decision models, DynaMoL incorporates a Bayesian learning system to automatically learn the probabilistic parameters from large medical databases. We describe the DynaMoL modeling and learning architecture through a medical decision problem on the optimal follow-up schedule for patients after curative colorectal cancer surgery. We also show that the modeling experience and results indicate practical promise for the framework. PMID:10384503

  12. The Attitude-Behavior Discrepancy in Medical Decision Making

    PubMed Central

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

    2014-01-01

    Background: In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. Objectives: This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. Patients and Methods: A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) Ś decision making behavior\\attitude to risky plan\\attitude to conservative plan (3). Results: A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01?t attitude to surgery = 4.08?P < 0.01?t attitude to radiation = -2.15?P < 0.05). Conclusions: A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making. PMID:25763230

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

    PubMed

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

    2014-06-01

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

  14. 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.

  15. Iliad: moving medical decision-making into new frontiers.

    PubMed

    Warner, H R

    1989-11-01

    If the essence of clinical practice is a process of sequential problem-solving, whereby a physician works with a patient to formulate a series of decisions about diagnostic treatment, then it would naturally follow that the essence of medical education should evolve around the training of would-be clinicians in the difficult art of diagnostic decision-making. Yet this is not often the case. PMID:2695788

  16. Medical decision support systems and therapeutics: The role of autopilots.

    PubMed

    Woosley, R L; Whyte, J; Mohamadi, A; Romero, K

    2016-02-01

    For decades, medical practice has increasingly relied on prescription medicines to treat, cure, or prevent illness but their net benefit is reduced by prescribing errors that result in adverse drug reactions (ADRs) and tens of thousands of deaths each year. Optimal prescribing requires effective management of massive amounts of data. Clinical decision support systems (CDSS) can help manage information and support optimal therapeutic decisions before errors are made by operating as the prescribers' "autopilot." PMID:26352903

  17. Needs Assessment for Computer-Based Medical Decision Support Systems

    PubMed Central

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

    1988-01-01

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

  18. 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...

  19. Patient decision making in the face of conflicting medication information

    PubMed Central

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

    2012-01-01

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

  20. Translating Medical Evidence to Promote Informed Health Care Decisions

    PubMed Central

    McCormack, Lauren; Treiman, Katherine; Bann, Carla; Williams-Piehota, Pamela; Driscoll, David; Poehlman, Jon; Soloe, Cindy; Lohr, Kathleen; Sheridan, Stacey; Golin, Carol; Cykert, Samuel; Harris, Russell

    2011-01-01

    Objective To examine the effects of a community-based intervention on decisions about prostate-specific antigen (PSA) screening using multiple measures of informed decision making (IDM). Data Sources/Study Setting Nonequivalent control group time series design collecting primary data in late 2004 and 2005. Study Design We developed a multimodal intervention designed to convey the medical uncertainty about the benefits of PSA screening and early treatment and the limited predictive ability of both the PSA test and pathological specimens collected from prostate biopsy. We examined (1) patients' recognition that there is a decision to be made about PSA screening, (2) prostate cancer knowledge levels, (3) their preferred and actual levels of participation in decision making about screening at three points in time, and (4) screening decision. Data Collection Baseline data collection occurred in community-based organizations. These organizations served as recruiting sources and as sites for the intervention. We collected follow-up data by mail with telephone reminders. Principal Findings Our intervention was associated with greater recognition of the PSA test as a decision to be made, levels of knowledge, both preferred and actual levels of involvement in decision making, but did not have an impact on the screening decision. Conclusions Community-based interventions can influence key measures of IDM about PSA screening. PMID:21352225

  1. 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

  2. How numeracy influences risk comprehension and medical decision making.

    PubMed

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

    2009-11-01

    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

  3. Evaluation of GPs' medical knowledge by a decision support system.

    PubMed

    Dupuits, F M

    1995-01-01

    This paper deals with the EValuator which is a multipurpose DSS. EV can be applied by creators of automated disease and therapy models to get insight into knowledge necessary for diagnosis and treatment of diseases. GPs, trainees/interns, hospital clinicians, and students can test their medical knowledge with EV. If necessary, EV offers decision support. In a functionality test, EV was used by GPs to assess their knowledge of thyroid disorders. Test conclusions referred to the GPs' level of medical knowledge of thyroid disorders, differences in EV usage by urban and rural GPs, use of thyroid disorder indices and the GPs' commendations that EV is capable of providing automated decision support to medical professionals in daily practice, and that it can very well be used in the education of students and in GP refresher courses. PMID:8846719

  4. Medical ethics and the Romanian law. Surrogate decisions regarding life-saving medical interventions

    PubMed Central

    CRI?AN, HORA?IU

    2013-01-01

    Romanian doctors who encounter controversial surrogate decisions such as refusal of life-saving interventions react differently from an ethical perspective. Some do not take into account the surrogates’ rejection of treatment, while others respect and abide by the surrogates’ decision and withhold the refused procedures, forgoing their ethical responsibilities. In this article we will defend the ethical position that doctors should consider and, therefore, thoroughly evaluate the surrogate decisions in cases where the medical intervention is life-saving and the benefits for the patient are significant and certain. The doctors who choose to obey the controversial decisions of surrogates usually invoke the Romanian medical law. In the following we argue that in today’s Romanian medical framework there is a conflict between ethical (professional) obligations and the some of the legal provisions and we provide two ethical arguments, one principlist and one contractualist, that prompt for the overriding of refusals which concern life-saving interventions. PMID:26527966

  5. [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

  6. 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

  7. Human-Computer Interaction with Medical Decisions Support Systems

    NASA Technical Reports Server (NTRS)

    Adolf, Jurine A.; Holden, Kritina L.

    1994-01-01

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

  8. Medical students' decisions about authorship in disputable situations: intervention study.

    PubMed

    Hren, Darko; Sambunjak, Dario; Maruši?, Matko; Maruši?, Ana

    2013-06-01

    In medicine, professional behavior and ethics are often rule-based. We assessed whether instruction on formal criteria of authorship affected the decision of students about authorship dilemmas and whether they perceive authorship as a conventional or moral concept. A prospective non-randomized intervention study involved 203s year medical students who did (n = 107) or did not (n = 96) received a lecture on International Committee of Medical Journal editors (ICMJE) authorship criteria. Both groups had to read 3 vignettes and answer 4 questions related to the distinction between conventional and moral domains. Written justification of student' choices whether the authorship in a vignette was right or wrong was rated by 4 independent raters as based on justice or a rule. Formal instruction had no effect on students' decisions on authorship in the vignettes (44, 34 and 39% ICMJE-consistent answers for 3 vignettes, respectively, by students receiving instruction vs. 38, 42 and 30% for those without instruction; P > 0.161 for all vignettes). For all dilemmas, more students decided contrary to ICMJE criteria and considered their decisions to be a matter of obligation and not a choice and to be general across situations and sciences. They were willing to change their decision if a rule was different only for peer situations but not for mentor-mentee situations. The number of students who used rule-based justification of their ICMJE criteria-consistent decisions was significantly higher in the instructed than in the uninstructed group. Instruction about formal authorship criteria had no effect on student's decisions about authorship dilemmas and their decisions were related to the moral rather than a conventional domain. Teaching about authorship and other professionalism and integrity issues may benefit from interventions that bring intuitive processes into awareness instead of those fostering rule-based reasoning. PMID:22382923

  9. Racial-ethnic biases, time pressure, and medical decisions.

    PubMed

    Stepanikova, Irena

    2012-09-01

    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 pressure, implicit biases regarding blacks and Hispanics led to a less serious diagnosis. In addition, implicit biases regarding blacks led to a lower likelihood of a referral to specialist when physicians were under high time pressure. The results suggest that when physicians face stress, their implicit biases may shape medical decisions in ways that disadvantage minority patients. PMID:22811465

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

    PubMed

    Jaul, Efraim; Zabari, Yonit; Brodsky, Jenny

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

    Background Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. Methods and Findings We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28–67 years old. Our sample comprised 9 women and 12 men. Three main themes, ‘treatment-specific values’, ‘life goals and philosophies’, and ‘personal and social background’, emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients’ decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). Conclusions This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients’ priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values. PMID:24282518

  12. The Importance of the Library in Medical Education *

    PubMed Central

    Ravdin, I. S.

    1965-01-01

    The medical library assumes increasing importance to teaching and research. While funds for research, medical education, and improved facilities for patients have been increasing and are relatively easy to obtain, however, it has been extraordinarily difficult to obtain funds for the building and maintenance of medical libraries. The National Library of Medicine is attempting to preserve the record of medical knowledge and by means of mechanization provide more efficient service to physicians and scientists, but one, or a few, great libraries cannot serve the medical interests of the country. Federal support such as the program of grants in the proposed Medical Library Assistance Act is needed to assist local and regional efforts to improve library service. PMID:5832700

  13. Decisions concerning the allocation of scarce medical resources.

    PubMed

    Furnham, A; Simmons, K; McClelland, A

    2000-06-01

    This paper aimed to determine the criteria participants use to make decisions about scarce medical resources (allocation to use a kidney machine). It varied information about patients on 4 factors (sex, smoking, employment status, community service). It also set out to see if decisions made in groups differed from aggregated decisions of those made alone. In the first study, participants completed a simple questionnaire requiring them to rank-order sixteen hypothetical patients. In the second study, a group discussion (in groups of three participants) preceded the group putting an agreed rating on the identical questionnaire. Participants favoured patients who were employed, non-smokers and participated in community service. This suggests that participants adopted a utilitarian moral ideology. Participants' smoking habits interacted with the hypothetical patients' smoking habits, indicating in-group favouritism. In the second study it was found that when the decision was made in a group of three it amplifies the decision made by an individual. In this sense there was clear evidence of group polarization. PMID:12452158

  14. 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

  15. Effectively marketing prepaid medical care with decision support systems.

    PubMed

    Forgionne, G A

    1991-01-01

    The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches. PMID:10111964

  16. Deficiency areas in decision making in undergraduate medical students

    PubMed Central

    Klemenc-Ketis, Zalika; Kersnik, Janko

    2014-01-01

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

  17. Collective Intelligence Meets Medical Decision-Making: The Collective Outperforms the Best Radiologist

    PubMed Central

    Wolf, Max; Krause, Jens; Carney, Patricia A.; Bogart, Andy; Kurvers, Ralf H. J. M.

    2015-01-01

    While collective intelligence (CI) is a powerful approach to increase decision accuracy, few attempts have been made to unlock its potential in medical decision-making. Here we investigated the performance of three well-known collective intelligence rules (“majority”, “quorum”, and “weighted quorum”) when applied to mammography screening. For any particular mammogram, these rules aggregate the independent assessments of multiple radiologists into a single decision (recall the patient for additional workup or not). We found that, compared to single radiologists, any of these CI-rules both increases true positives (i.e., recalls of patients with cancer) and decreases false positives (i.e., recalls of patients without cancer), thereby overcoming one of the fundamental limitations to decision accuracy that individual radiologists face. Importantly, we find that all CI-rules systematically outperform even the best-performing individual radiologist in the respective group. Our findings demonstrate that CI can be employed to improve mammography screening; similarly, CI may have the potential to improve medical decision-making in a much wider range of contexts, including many areas of diagnostic imaging and, more generally, diagnostic decisions that are based on the subjective interpretation of evidence. PMID:26267331

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

    PubMed Central

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

    2010-01-01

    Purpose To examine the contribution of “values-based reasoning” in evaluating older adults’ capacity to make medical decisions. Design and Methods Older men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics. Results Participants varied widely in the activities and relationships they most valued, the extent to which religious beliefs would influence healthcare decisions, and in ratings of the importance of preserving quality versus length of life. Most participants preferred shared decision making with doctor, family, or both. Individuals with schizophrenia or dementia performed worse than a primary care comparison group in reasoning measured by the ability to list risks and benefits and compare choices. Individuals with dementia performed comparably to the primary care group in reasoning measured by the ability to justify choices in terms of valued abilities or activities, whereas individuals with schizophrenia performed relatively worse compared to the other two groups. Compared to primary care patients, participants with schizophrenia and with dementia were impaired on the ability to explain treatment choices in terms of valued relationships. Conclusion Medical decision making may be influenced by strongly held values and beliefs, emotions, and long life experience. To date, these issues have not been explicitly included in structured evaluations of medical decision-making capacity. This study demonstrated that it is possible to inquire of and elicit a range of healthcare related values and preferences from older adults with dementia or schizophrenia, and individuals with mild to moderate dementia may be able to discuss healthcare options in relation to their values. However, how best to incorporate a values assessment into a structured capacity evaluation deserves further research attention. PMID:20465077

  19. [The importance of the Czech Medical Society yesterday and today].

    PubMed

    Fejfar, Z

    1992-10-23

    Fourteen physicians headed by Jan Evangelista Purkyn? signed the proposed by-laws of the Czech medical society in october 1861. Emperor's approval was received 26th june 1862 and in july Purkyn? was elected the first president. The same illuminated personalities were the founders of the Casopis lékar? ceskęch--the Czech medical Journal which has remained the most important Czech periodical until the present time. The aims of the Society were to cultivate medical science and promote Czech language in medicine. Weekly scientific sessions, medical periodical and publication of monographs related to medicine were the means how to achieve the aims. The Czech Medical Society became soon the centre of medical science in Bohemia. Its members were among the foremost fighters for the use of Czech language in Charles university and their relentless effort helped much to the establishment of the Czech Univerzity in 1882 and Czech medical faculty a year later. In subsequent years the Society was also involved in professional problems related to social health insurance, medical fees, ethical problems and other relevant questions such as the establishment of medical chambers. The activity of the Czech medical Society was never interrupted during its 130 years of existence, although there were several difficult periods in its life, mainly during the first and second world war and also in the past 40 years. In spite of the atomization of medicine the Czech medical Society has been continuing its eminent mission to create communication and establish close links between the medical science and practical medicine by systematically bringing new knowledge in medicine and biology to general physicians and by putting together physicians, surgeons and basic scientists. The task for the future is seen in optimal transfer of new knowledge and ideas from scientists to practicians and vice versa; and to take care of the highest possible moral and ethical standard required for humane medicine. Tradition and achievements of our teachers is binding and we are looking forward to better future in united Europe. PMID:1477863

  20. A Thin Layer Chromatography Laboratory Experiment of Medical Importance

    ERIC Educational Resources Information Center

    Sharma, Loretta; Desai, Ankur; Sharma, Ajit

    2006-01-01

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


  1. A Thin Layer Chromatography Laboratory Experiment of Medical Importance

    ERIC Educational Resources Information Center

    Sharma, Loretta; Desai, Ankur; Sharma, Ajit

    2006-01-01

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

  2. A sequential decision-theoretic model for medical diagnostic system.

    PubMed

    Li, Aiping; Jin, Songchang; Zhang, Lumin; Jia, Yan

    2015-01-01

    Although diagnostic expert systems using a knowledge base which models decision-making of traditional experts can provide important information to non-experts, they tend to duplicate the errors made by experts. Decision-Theoretic Model (DTM) is therefore very useful in expert system since they prevent experts from incorrect reasoning under uncertainty. For the diagnostic expert system, corresponding DTM and arithmetic are studied and a sequential diagnostic decision-theoretic model based on Bayesian Network is given. In the model, the alternative features are categorized into two classes (including diseases features and test features), then an arithmetic for prior of test is provided. The different features affect other features weights are also discussed. Bayesian Network is adopted to solve uncertainty presentation and propagation. The model can help knowledge engineers model the knowledge involved in sequential diagnosis and decide evidence alternative priority. A practical example of the models is also presented: at any time of the diagnostic process the expert is provided with a dynamically updated list of suggested tests in order to support him in the decision-making problem about which test to execute next. The results show it is better than the traditional diagnostic model which is based on experience. PMID:26410326

  3. 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

  4. 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

  5. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS

    PubMed Central

    CHEN, JONATHAN H; GOLDSTEIN, MARY K; ASCH, STEVEN M; ALTMAN, RUSS B

    2015-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)<0.35 (e.g., pneumonia) to stable admissions for planned procedures (e.g., chemotherapy, surgery) with comparatively high RBO>0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10−10). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

  6. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS.

    PubMed

    Chen, Jonathan H; Goldstein, Mary K; Asch, Steven M; Altman, Russ B

    2016-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)<0.35 (e.g., pneumonia) to stable admissions for planned procedures (e.g., chemotherapy, surgery) with comparatively high RBO>0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10-10). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  9. 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.

  10. Adolescent Pregnancy Decision-Making: Are Parents Important?

    ERIC Educational Resources Information Center

    Rosen, Raye Hudson

    1980-01-01

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

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

    PubMed

    Reyna, Valerie F

    2008-01-01

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

  12. Preferences for involvement in medical decision making: comparing British and German views.

    PubMed

    Rüdell, K; Myers, L; Newman, S

    2006-05-01

    Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control - Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role. PMID:17129906

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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


  14. 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

  15. On the Importance and Validity of Medical Accreditation Standards.

    ERIC Educational Resources Information Center

    Kassebaum, Donald G.; Cutler, Ellen R.; Eaglen, Robert H.

    1998-01-01

    A survey of 701 medical-school administrators, medical-residency program directors, medical students and residents, and practicing physicians investigated the perceived clarity and validity of 44 medical school accreditation standards as indicators of the quality of undergraduate medical education. Predictive validity of some standards was also…

  16. 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

  17. Identification of nocardiae and streptomycetes of medical importance.

    PubMed Central

    Mishra, S K; Gordon, R E; Barnett, D A

    1980-01-01

    During a taxonomic investigation of Nocardia spp. and Streptomyces spp., we received 658 isolates from laboratories of both human and veterinary medicine. Our procedure leading to the identification of 92% of these isolates, the species that they represented, and a characteristic pattern of properties of the strains of these species are presented. A key devised for the tentative identification of species of nocardiae and streptomycetes that are believed to be of medical importance is included to assist clinical microbiologists in identifying their strains. Images PMID:7000820

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

    PubMed Central

    McNeil, M M; Brown, J M

    1994-01-01

    The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes. Images PMID:7923055

  19. Experience and Medical Decision-Making in Outdoor Leaders

    ERIC Educational Resources Information Center

    Galloway, Shayne

    2007-01-01

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

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

    PubMed Central

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

    2000-01-01

    Guidelines in medicine have been proposed as a way to assist physicians in the clinical decision-making process. Increasingly, they form the basis for assessing accountability in the delivery of healthcare services. However, experiences with their evaluation, as the most important step in the continuous guidelines process, are rare. Patient Care Evaluation Studies have been developed by the Commission on Cancer in the United States. As they reflect the "real-world" medical practice they are helpful in evaluating the quality of diagnosis, therapy and follow-up of tumor diseases in hospitals and cancer center and the compliance with current standards of care. In this context, they can provide an infrastructure for the analysis of the decision-making process. PMID:11079906

  1. Future of medical knowledge management and decision support.

    PubMed

    Greenes, Robert A

    2002-01-01

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

  2. The importance of self-determination theory for medical education.

    PubMed

    Williams, G C; Saizow, R B; Ryan, R M

    1999-09-01

    While some theories of human motivation focus exclusively on levels of motivation, self-determination theory argues that different types of motivators, even when the resulting motivation is high, will lead to very different outcomes. This theory differentiates between two primary kinds of motivation, controlled and autonomous. Controlled motivation depends either on explicit or implicit rewards or punishment or on people's internalized beliefs about what is expected of them. Learning in controlled situations, in which students act under pressure and anxiety, is likely to be rote, short-lived, and poorly integrated into students' long-term values and skills. In contrast, autonomous motivation, as its name implies, is personally endorsed and reflects what people find interesting and important. While controlled motivation involves compliance with pressures, autonomous motivation involves behaving with a sense of volition, agency, and choice. Autonomously motivated learning leads to better educational outcomes. There is evidence that medical students who learn in autonomy-supportive environments act in more autonomy-supportive ways in their interactions with patients. Because the reliable implementation of practice guidelines and physicians' use of an autonomy-supportive style have been associated with more positive health outcomes (particularly in the behavior-related areas of smoking cessation, weight loss, etc.), more autonomy-supportive medical education may result in more effective health care delivery. PMID:10498090

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

    PubMed Central

    2014-01-01

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

  5. 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

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

    PubMed

    Disney, W Terry; Peters, Mark A

    2003-11-12

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

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

    PubMed

    Jones, Daryl; Bellomo, Rinaldo; DeVita, Michael A

    2009-01-01

    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, to assess whether RRT dose improves patient outcomes, and to assess whether there is evidence that inclusion of a physician in the team impacts on the effectiveness of the team. A review of available literature suggested that the method of reporting RRT utilization rate, (RRT dose) is calls per 1,000 admissions. Hospitals with mature RRTs that report improved patient outcome following RRT introduction have a RRT dose between 25.8 and 56.4 calls per 1,000 admissions. Four studies report an association between increasing RRT dose and reduced in-hospital cardiac arrest rates. Another reported that increasing RRT dose reduced in-hospital mortality for surgical but not medical patients. The MERIT study investigators reported a negative relationship between MET-like activity and the incidence of serious adverse events. Fourteen studies reported improved patient outcome in association with the introduction of a RRT, and 13/14 involved a Physician-led MET. These findings suggest that if the RRT is the major method for reviewing serious adverse events, the dose of RRT activation must be sufficient for the frequency and severity of the problem it is intended to treat. If the RRT dose is too low then it is unlikely to improve patient outcomes. Increasing RRT dose appears to be associated with reduction in cardiac arrests. The majority of studies reporting improved patient outcome in association with the introduction of an RRT involve a MET, suggesting that inclusion of a physician in the team is an important determinant of its effectiveness. PMID:19825203

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

    ERIC Educational Resources Information Center

    Jackson, Simon A.; Kleitman, Sabina

    2014-01-01

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


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

    ERIC Educational Resources Information Center

    Jackson, Simon A.; Kleitman, Sabina

    2014-01-01

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

  10. Primer on medical decision analysis: Part 2--Building a tree.

    PubMed

    Detsky, A S; Naglie, G; Krahn, M D; Redelmeier, D A; Naimark, D

    1997-01-01

    This part of a five-part series covering practical issues in the performance of decision analysis outlines the basic strategies for building decision trees. The authors offer six recommendations for building and programming decision trees. Following these six recommendations will facilitate performance of the sensitivity analyses required to achieve two goals. The first is to find modeling or programming errors, a process known as "debugging" the tree. The second is to determine the robustness of the qualitative conclusions drawn from the analysis. PMID:9107607

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

    ERIC Educational Resources Information Center

    Jones, Bonnie J.; Borges, Nicole J.

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


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

    ERIC Educational Resources Information Center

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

    2010-01-01

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


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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  14. 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.

  15. In search of tools to aid logical thinking and communicating about medical decision making.

    PubMed

    Hunink, M G

    2001-01-01

    To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults. PMID:11475383

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

    PubMed Central

    MĂŒller-Engelmann, Meike; Krones, Tanja; Keller, Heidi; Donner-Banzhoff, Norbert

    2008-01-01

    Background Up to now it has not been systematically investigated in which kind of clinical situations a consultation style based on shared decision making (SDM) is preferred by patients and physicians. We suggest the factorial survey design to address this problem. This method, which so far has hardly been used in health service research, allows to vary relevant factors describing clinical situations as variables systematically in an experimental random design and to investigate their importance in large samples. Methods/Design To identify situational factors for the survey we first performed a literature search which was followed by a qualitative interview study with patients, physicians and health care experts. As a result, 7 factors (e.g. "Reason for consultation" and "Number of therapeutic options") with 2 to 3 levels (e.g. "One therapeutic option" and "More than one therapeutic option") will be included in the study. For the survey the factor levels will be randomly combined to short stories describing different treatment situations. A randomized sample of all possible short stories will be given to at least 300 subjects (100 GPs, 100 patients and 100 members of self-help groups) who will be asked to rate how the decision should be made. Main outcome measure is the preference for participation in the decision making process in the given clinical situation. Data analysis will estimate the effects of the factors on the rating and also examine differences between groups. Discussion The results will reveal the effects of situational variations on participation preferences. Thus, our findings will contribute to the understanding of normative values in the medical decision making process and will improve future implementation of SDM and decision aids. PMID:19091091

  17. 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


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

    SciTech Connect

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

    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.

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

    ERIC Educational Resources Information Center

    Goodnough, Lawrence T.; And Others

    1992-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  1. 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


  2. 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…

  3. 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…

  4. Development of a Test of Cognitive Bias in Medical Decision Making.

    ERIC Educational Resources Information Center

    Hershberger, Paul J.; And Others

    1994-01-01

    Poor performance of medical students, residents, and faculty on a newly developed Inventory of Cognitive Biases in Medicine, suggests that cognitive biases detract from reliance on logical and statistical strategies in medical decision making. The test shows promise for use in instructional and research efforts to reduce such bias. (Author/MSE)

  5. Using decision support systems to market prepaid medical plans.

    PubMed

    Forgionne, G A

    1991-12-01

    A decision support system (DSS) is described that enables executives quickly and easily to (1) manage relevant marketing information and (2) convert the information into market-effective health plans. Because the system primarily uses available records and routine transactions, it can be implemented cost efficiently. PMID:10115899

  6. 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

  7. Considering Research Outcomes as Essential Tools for Medical Education Decision Making.

    PubMed

    Miller, Karen Hughes; Miller, Bonnie M; Karani, Reena

    2015-11-01

    As medical educators face the challenge of incorporating new content, learning methods, and assessment techniques into the curriculum, the need for rigorous medical education research to guide efficient and effective instructional planning increases. When done properly, well-designed education research can provide guidance for complex education decision making. In this Commentary, the authors consider the 2015 Research in Medical Education (RIME) research and review articles in terms of the critical areas in teaching and learning that they address. The broad categories include (1) assessment (the largest collection of RIME articles, including both feedback from learners and instructors and the reliability of learner assessment), (2) the institution's impact on the learning environment, (3) what can be learned from program evaluation, and (4) emerging issues in faculty development. While the articles in this issue are broad in scope and potential impact, the RIME committee noted few studies of sufficient rigor focusing on areas of diversity and diverse learners. Although challenging to investigate, the authors encourage continuing innovation in research focused on these important areas. PMID:26505095

  8. 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

  9. 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…

  10. How Numeracy Influences Risk Comprehension and Medical Decision Making

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  11. Decisions about Confidentiality in Medical Student Mental Health Settings.

    ERIC Educational Resources Information Center

    Lindenthal, Jacob Jay; And Others

    1984-01-01

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

  12. The Appleton Consensus: suggested international guidelines for decisions to forego medical treatment.

    PubMed Central

    Stanley, J M

    1989-01-01

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. PMID:2677379

  13. Industry Support of Medical Research: Important Opportunity or Treacherous Pitfall?

    PubMed

    Tierney, William M; Meslin, Eric M; Kroenke, Kurt

    2016-02-01

    Pharmaceutical and device manufacturers fund more than half of the medical research in the U.S. Research funding by for-profit companies has increased over the past 20 years, while federal funding has declined. Research funding from for-profit medical companies is seen as tainted by many academicians because of potential biases and prior misbehavior by both investigators and companies. Yet NIH is encouraging partnerships between the public and private sectors to enhance scientific discovery. There are instances, such as methods for improving drug adherence and post-marketing drug surveillance, where the interests of academician researchers and industry could be aligned. We provide examples of ethically performed industry-funded research and a set of principles and benchmarks for ethically credible academic-industry partnerships that could allow academic researchers, for-profit companies, and the public to benefit. PMID:26307387

  14. Importance and benefits of the doctoral thesis for medical graduates

    PubMed Central

    Giesler, Marianne; Boeker, Martin; Fabry, Götz; Biller, Silke

    2016-01-01

    Introduction: The majority of medical graduates in Germany complete a doctorate, even though a doctoral degree is not necessary for the practice of medicine. So far, little is known about doctoral candidates’ view on the individual benefit a doctoral thesis has for them. Consequently, this is the subject of the present investigation. Method: Data from surveys with graduates of the five medical faculties of Baden-WĂŒrttemberg from the graduation years 2007/2008 (N=514) and 2010/2011 (N=598) were analysed. Results: One and a half years after graduating 53% of those interviewed had completed their doctorate. When asked about their motivation for writing a doctoral thesis, participants answered most frequently “a doctorate is usual” (85%) and “improvement of job opportunities” (75%), 36% said that an academic career has been their primary motive. Less than 10% responded that they used their doctoral thesis as a means to apply for a job. The proportion of graduates working in health care is equally large among those who have completed a thesis and those who have not. Graduates who pursued a thesis due to scientific interest are also currently more interested in an academic career and recognise more opportunities for research. An implicit benefit of a medical thesis emerged with regard to the self-assessment of scientific competences as those who completed a doctorate rated their scientific competencies higher than those who have not. Discussion: Although for the majority of physicians research interest is not the primary motivation for completing a doctorate, they might nevertheless achieve some academic competencies. For graduates pursuing an academic career the benefit of completing a medical thesis is more obvious. PMID:26958656

  15. 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

  16. [Medical management of uncomplicated benign prostatic hyperplasia: a new decision algorithm].

    PubMed

    Desgrandchamps, François; De la Taille, Alexandre; Azouzi, Rahmène; Fourmarier, Marc; Haillot, Olivier; Lukacs, Bertrand; Saussine, Christian

    2007-03-01

    Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medical treatment is not only symptomatic, but may also seek to modify the natural history of the disease, especially by reducing the risk of acute urinary retention. Medical treatment is no longer limited to a single drug: the combination of 2 different drugs from different treatment categories appears superior to single-drug treatment in some patients. Two instrumental techniques - microwave or radiofrequency thermotherapy, previously proposed as alternatives to surgery - are more appropriate as alternatives to medical treatment. These various items make it possible to construct a decision algorithm that is based at each stage on a decision shared with the patient. This algorithm to provide decision aid in management of uncomplicated symptomatic HBP takes initial disease indicators and other patient indicators into account together with its course under treatment, which has not previously been considered by international guidelines. PMID:17336856

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

    PubMed

    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

  18. Understanding Behavioral Intent to Participate in Shared Decision-Making in Medically Uncertain Situations

    PubMed Central

    Maffei, Roxana; Dunn, Kim; Zhang, Jiajie; Hsu, C E; Holmes, John

    2015-01-01

    Objective This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent of men between the ages of 45–70 with regard to participating in shared decision-making in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and contemplates potential future uses of this information which may facilitate greater understanding, efficiency and effectiveness of doctor-patient consultations. Design Qualitative Study using deductive content analysis Setting Individual semi-structure patient interviews were conducted until data saturation was reached. Three analysts read the transcripts and developed a list of codes. Subjects 25 subjects drawn from the Philadelphia community. Measurements Qualitative indicators were developed to measure respondents’ experiences and beliefs related to behavioral intent to participate in shared decision-making during medically uncertainty. Subjects were also asked to complete the Krantz Health Opinion Survey as a method of triangulation. Results Several factors were repeatedly described by respondents as being essential to participate in shared decision-making in medically uncertainty. These factors included past experience with medically uncertainty, an individual’s personality, and the relationship between the patient and his physician. Conclusions The findings of this study led to the development of a category framework that helped understand an individual’s needs and motivational factors in their intent to participate in shared decision-making. The three main categories include 1) an individual’s representation of medically uncertainty, 2) how the individual copes with medically uncertainty, and 3) the individual’s behavioral intent to seek information and participate in shared decision-making during times of medically uncertain situations. PMID:22814528

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

    PubMed

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

    2013-12-01

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

  20. Patients’ perceptions of their “most” and “least” important medications: a retrospective cohort study

    PubMed Central

    2012-01-01

    Background Despite benefits of adherence, little is known about the degree to which patients will express their perceptions of medications as more or less important to take as prescribed. We determined the frequency with which Veteran patients would explicitly identify one of their medications as “most important” or “least important.” Findings We conducted a retrospective cohort study of patients from ambulatory clinics at VA Boston from April 2010-July 2011. Patients answered two questions: “Which one of your medicines, if any, do you think is the most important? (if none, please write ‘none’)” and “Which one of your medicines, if any, do you think is the least important? (if none, please write ‘none’).” We determined the prevalence of response categories for each question. Our cohort of 104 patients was predominantly male (95%), with a mean of 9 medications (SD 5.7). Regarding their most important medication, 41 patients (39%) identified one specific medication; 26 (25%) selected more than one; 21 (20%) wrote “none”; and 16 (15%) did not answer the question. For their least important medication, 31 Veterans (30%) chose one specific medication; two (2%) chose more than one; 51 (49%) wrote “none”; and 20 (19%) did not directly answer the question. Conclusions Thirty-five percent of patients did not identify a most important medication, and 68% did not identify a least important medication. Better understanding of how patients prioritize medications and how best to elicit this information will improve patient-provider communication, which may in turn lead to better adherence. PMID:23121715

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed Central

    Calisher, C H

    1994-01-01

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

  3. My lived experiences are more important than your probabilities: The role of individualized risk estimates for decision making about participation in the Study of Tamoxifen and Raloxifene (STAR)

    PubMed Central

    Holmberg, Christine; Waters, Erika A.; Whitehouse, Katie; Daly, Mary; McCaskill-Stevens, Worta

    2015-01-01

    Background Decision making experts emphasize that understanding and using probabilistic information is important for making informed decisions about medical treatments involving complex risk-benefit tradeoffs. Yet empirical research demonstrates that individuals may not use probabilities when making decisions. Objectives To explore decision making and the use of probabilities for decision making from the perspective of women who were risk-eligible to enroll in the Study of Tamoxifen and Raloxifene (STAR). Methods We conducted narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The project was based on a narrative approach. Analysis included the development of summaries of each narrative, and thematic analysis with developing a coding scheme inductively to code all transcripts to identify emerging themes. Results Interviewees explained and embedded their STAR decisions within experiences encountered throughout their lives. Such lived experiences included but were not limited to breast cancer family history, personal history of breast biopsies, and experiences or assumptions about taking tamoxifen or medicines more generally. Conclusions Women’s explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations In addition to precise risk information, clinicians and risk communicators should recognize the importance and legitimacy of lived experience in individual decision making. PMID:26183166

  4. 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

  5. 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


  6. A Case Study of Career Emegency Medical Technicians: Factors That Influenced Their Decision to Stay

    ERIC Educational Resources Information Center

    Miller, Denine V.

    2013-01-01

    This case study (Stake, 1995) examined the perceptions of long-term Emergency Medical Technicians (EMTs) to identify factors influencing their decision to remain employed as EMTs for the duration of a career. EMT retention plans frequently utilize data from either employee exit interviews or workers with intent to leave, and since privacy law…

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

    ERIC Educational Resources Information Center

    Galanter, Cathryn A.; Patel, Vimla L.

    2005-01-01

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

  8. 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…

  9. A Case Study of Career Emegency Medical Technicians: Factors That Influenced Their Decision to Stay

    ERIC Educational Resources Information Center

    Miller, Denine V.

    2013-01-01

    This case study (Stake, 1995) examined the perceptions of long-term Emergency Medical Technicians (EMTs) to identify factors influencing their decision to remain employed as EMTs for the duration of a career. EMT retention plans frequently utilize data from either employee exit interviews or workers with intent to leave, and since privacy law


  10. 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…

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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


  13. 78 FR 28631 - Experian, Experian Healthcare (Medical Present Value (MPV)-Credit Services and Decision Analytics...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Experian, Experian Healthcare (Medical Present Value (MPV)-- Credit Services and Decision Analytics) Including On-Site Leased Workers From Tapfin, Manpower and Experis Austin, Texas; Experian, Oakland Cheetahmail...

  14. Identification of Medically Important Molds by an Oligonucleotide Array†

    PubMed Central

    Hsiao, Chen Ren; Huang, Liyin; Bouchara, Jean-Philippe; Barton, Richard; Li, Hsin Chieh; Chang, Tsung Chain

    2005-01-01

    Infections caused by fungi have increased in recent years. Accurate and rapid identification of fungal pathogens is important for appropriate treatment with antifungal agents. On the basis of the internal transcribed spacer 1 (ITS 1) and ITS 2 sequences of the rRNA genes, an oligonucleotide array was developed to identify 64 species (32 genera) of clinically important filamentous (or dimorphic) fungi. These 64 species included fungi causing superficial, cutaneous, subcutaneous, and invasive infections. The method consisted of PCR amplification of the ITS regions using a pair of universal primers, followed by hybridization of the digoxigenin-labeled PCR products to a panel of species- or group-specific oligonucleotides immobilized on a nylon membrane. Of 397 fungal strains (290 target and 107 nontarget strains) tested, the sensitivity and specificity of the array was 98.3% (285/290) and 98.1% (105/107), respectively. Misidentified strains were usually those belonging to the same genus of the target species or having partial homology with oligonucleotide probes on the membrane. The whole procedure can be finished within 24 h starting from isolated colonies; reproductive structures, which are essential for the conventional identification methods, are not needed. In conclusion, the present array is a powerful tool for identification of clinically important filamentous fungi and may have the potential to be continually extended by adding further oligonucleotides to the array without significantly increasing the cost or complexity. PMID:16081907

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  16. Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy

    PubMed Central

    Pennec, Sophie; Monnier, Alain; Stephan, Amandine; Brouard, Nicolas; Bilsen, Johan; Cohen, Joachim

    2016-01-01

    Background Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France (“End of Life in France,” or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. Objective To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. Methods EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. Results The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Conclusions Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field. PMID:26892632

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

    PubMed

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

    2013-05-01

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

  18. Decisions about knowledge in medical practice: the effect of temporal features of a task.

    PubMed

    Menchik, Daniel A

    2014-11-01

    A classic question of social science is how knowledge informs practice. Research on physicians' decisions about medical knowledge has focused on doctors' personal capabilities and features of the knowledge corpus, producing divergent findings. This study asks, instead, How is decision making about the use of knowledge influenced by features of work? From observations of one team's decisions in multiple clinical and administrative contexts, the author argues that making decisions is contingent upon temporal features of physicians' tasks. Physicians receive feedback at different speeds, and they must account for these speeds when judging what they can prioritize. This finding explains doctors' perceived uncertainty in other studies as a product of the long feedback loop in tasks, and their certainty or pragmatism as a product of shorter feedback loops. In these latter scenario's, physicians consider and deploy scientific knowledge after--and not before, as is usually assumed--determining a fruitful plan of action. PMID:25848669

  19. 21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Exemptions from import or export requirements for personal medical use. 1301.26 Section 1301.26 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF... Registration and Fees § 1301.26 Exemptions from import or export requirements for personal medical use....

  20. 21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Exemptions from import or export requirements for personal medical use. 1301.26 Section 1301.26 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF... Registration and Fees § 1301.26 Exemptions from import or export requirements for personal medical use....

  1. 21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Exemptions from import or export requirements for personal medical use. 1301.26 Section 1301.26 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF... Registration and Fees § 1301.26 Exemptions from import or export requirements for personal medical use....

  2. 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

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

    ERIC Educational Resources Information Center

    Green, Robert G.

    2008-01-01

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

  4. 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

  5. Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations

    PubMed Central

    Angell, Beth; Bolden, Galina B.

    2015-01-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients’ concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists’ orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  6. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations.

    PubMed

    Angell, Beth; Bolden, Galina B

    2015-08-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

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

    PubMed

    Murtagh, Madeleine J; Hepworth, Julie

    2003-04-01

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

  8. Physicians’ Anxiety Due to Uncertainty and Use of Race in Medical Decision-Making

    PubMed Central

    Cunningham, Brooke A.; Bonham, Vence L.; Sellers, Sherrill L.; Yeh, Hsin-Chieh; Cooper, Lisa A.

    2014-01-01

    Background The explicit use of race in medical decision-making is contested. Researchers have hypothesized that physicians use race in care when they are uncertain. Objectives To investigate whether physician anxiety due to uncertainty is associated with a higher propensity to use race in medical decision-making. Research Design A national cross-sectional survey of general internists Subjects A national sample of 1738 clinically active general internists drawn from the SK&A physician database Measures Anxiety Due to Uncertainty (ADU) is a 5-item measure of emotional reactions to clinical uncertainty. Bonham and Sellers Racial Attributes in Clinical Evaluation (RACE) scale includes 7 items that measure self-reported use of race in medical decision-making. We used bivariate regression to test for associations between physician characteristics, ADU and RACE. Multivariate linear regression was performed to test for associations between ADU and RACE while adjusting for potential confounders. Results The mean score on ADU was 19.9 (SD=5.6). Mean score on RACE was 13.5 (SD=5.6). After adjusting for physician demographics, physicians with higher levels of ADU scored higher on RACE (+ÎČ=0.08 in RACE, p=0.04, for each 1-point increase in ADU), as did physicians who understand “race” to mean biological or genetic ancestral, rather than sociocultural, group. Physicians who graduated from a US medical school, completed fellowship, and had more white patients, scored lower on RACE. Conclusions This study demonstrates positive associations between physicians’ anxiety due to uncertainty, meanings attributed to race, and self-reported use of race in medical decision-making. Future research should examine the potential impact of these associations on patient outcomes and healthcare disparities. PMID:25025871

  9. Web-based medical facilitators in medical tourism: the third party in decision-making.

    PubMed

    Wagle, Suchitra

    2013-01-01

    The emergence of web-based medical tourism facilitators (MTFs) has added a new dimension to the phenomenon of cross-border travel. These facilitators are crucial connectors between foreign patients and host countries. They help patients navigate countries, doctors and specialties. However, little attention has been paid to the authenticity of information displayed on the facilitators' web portals, and whether they follow ethical guidelines and standards. This paper analyses the available information on MTF portals from an ethics perspective. It compares 208 facilitators across 47 countries for the services offered. Data were collected from the databases of the Medical Tourism Association and World Medical Resources. India was the most common destination country linked to 81 facilitators. The five countries with the maximum number of facilitators were the USA, the UK, India, Canada and Poland. This paper identifies concerns regarding the information displayed about patients' safety, and the maintenance of confidentiality. There is a need to develop ethical standards for this field. PMID:23439194

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

    PubMed Central

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

    2011-01-01

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

  11. An aggregation of pro and con evidence for medical decision support systems.

    PubMed

    Kuncheva, L

    1993-11-01

    One promising way to increase the classification accuracy of medical decision support systems is to implement heuristic combinations of pattern recognition and artificial intelligence tools. A parallel between "cognition" model and differential diagnostic task is sketched accentuating the aggregation of activating and restraining inputs and corresponding PRO and CON evidence in medicine. On the basis of this paradigm a trainable model of a fuzzy neuron is proposed which resembles some elements from the physician's decision process. An example from aviation medicine is presented which demonstrates the enhanced performance. PMID:8306621

  12. Assessing task importance and anxiety in medical school: an instrument development and initial validation study.

    PubMed

    Phillips, Henry L; Dong, Ting; Durning, Steven J; Artino, Anthony R

    2015-04-01

    Recent research in medical education suggests that students' motivational beliefs, such as their beliefs about the importance of a task, and their emotions are meaningful predictors of learning and performance. The primary purpose of this study was to develop a self-report measure of "task importance" and "anxiety" in relation to several medical education competencies and to collect validity evidence for the new measures. The secondary purpose was to evaluate differences in these measures by year of medical school. Exploratory factor analysis of scores from 368 medical school students suggested two task importance factors and three anxiety factors. The task importance and anxiety subscales were weakly related to each other and exhibited consistently negative and positive correlations, respectively, with three self-efficacy subscales. The task importance subscales were positively related to "metacognition," whereas "interpersonal skills anxiety" and "health knowledge anxiety" were positively related to "procrastination." All three anxiety factors were positively related to "avoidance of help seeking," whereas "interpersonal skills and professionalism importance" was negatively related to help avoidance behaviors. Finally, comparisons across the 4 years of medical school indicated that some aspects of task importance and anxiety varied significantly. Overall, findings from this study provide validity evidence for the psychometric quality of these scales, which capture task importance and anxiety in medical students. Limitations and implications for medical education research are discussed. PMID:25850124

  13. Discrepancies between the medical record and the reports of patients with acute coronary syndrome regarding important aspects of the medical history

    PubMed Central

    2012-01-01

    Background Many critical treatment decisions are based on the medical history of patients with an acute coronary syndrome (ACS). Discrepancies between the medical history documented by a health professional and the patient's own report may therefore have important health consequences. Methods Medical histories of 117 patients with an ACS were documented. A questionnaire assessing the patient's health history was then completed by 62 eligible patients. Information about 13 health conditions with relevance to ACS management was obtained from the questionnaire and the medical record. Concordance between these two sources and reasons for discordance were identified. Results There was significant variation in agreement, from very poor in angina (kappa < 0) to almost perfect in diabetes (kappa = 0.94). Agreement was substantial in cerebrovascular accident (kappa = 0.76) and hypertension (kappa = 0.73); moderate in cocaine use (kappa = 0.54), smoking (kappa = 0.46), kidney disease (kappa = 0.52) and congestive heart failure (kappa = 0.54); and fair in arrhythmia (kappa = 0.37), myocardial infarction (kappa = 0.31), other cardiovascular diseases (kappa = 0.37) and bronchitis/pneumonia (kappa = 0.31). The odds of agreement was 42% higher among individuals with at least some college education (OR = 1.42; 95% CI, 1.00 - 2.01, p = 0.053). Listing of a condition in medical record but not in the questionnaire was a common cause of discordance. Conclusion Discrepancies in aspects of the medical history may have important effects on the care of ACS patients. Future research focused on identifying the most effective and efficient means to obtain accurate health information may improve ACS patient care quality and safety. PMID:22448755

  14. Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing

    PubMed Central

    Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

    2015-01-01

    Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called “threshold probability” at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today’s clinical practice. PMID:26244571

  15. Attitudes to risk taking in medical decision making among British, Dutch and Belgian general practitioners.

    PubMed Central

    Grol, R; Whitfield, M; De Maeseneer, J; Mokkink, H

    1990-01-01

    The attitudes of groups of general practitioners in Belgium, the UK and the Netherlands to risk taking in medical decision making have been determined. The results indicate that many doctors seek to minimize the risks that they take when treating patients. Doctors in Belgium had the highest levels of 'no risk-taking' attitudes with 60% preferring not to take risks; Dutch doctors had the lowest levels with only 24% preferring not to take risks. Possible explanations for this difference include the differences in doctor-patient relationship and the systems of medical education in these two countries. PMID:2115347

  16. Medical Alert Management: A Real-Time Adaptive Decision Support Tool to Reduce Alert Fatigue

    PubMed Central

    Lee, Eva K.; Wu, Tsung-Lin; Senior, Tal; Jose, James

    2014-01-01

    With the adoption of electronic medical records (EMRs), drug safety alerts are increasingly recognized as valuable tools for reducing adverse drug events and improving patient safety. However, even with proper tuning of the EMR alert parameters, the volume of unfiltered alerts can be overwhelming to users. In this paper, we design an adaptive decision support tool in which past cognitive overriding decisions of users are learned, adapted and used for filtering actions to be performed on current alerts. The filters are designed and learned based on a moving time window, number of alerts, overriding rates, and monthly overriding fluctuations. Using alerts from two separate years to derive filters and test performance, predictive accuracy rates of 91.3%–100% are achieved. The moving time window works better than a static training approach. It allows continuous learning and capturing of the most recent decision characteristics and seasonal variations in drug usage. The decision support system facilitates filtering of non-essential alerts and adaptively learns critical alerts and highlights them prominently to catch providers’ attention. The tool can be plugged into an existing EMR system as an add-on, allowing real-time decision support to users without interfering with existing EMR functionalities. By automatically filtering the alerts, the decision support tool mitigates alert fatigue and allows users to focus resources on potentially vital alerts, thus reducing the occurrence of adverse drug events. PMID:25954391

  17. 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

  18. Development of a decision support system for the practice of responsible self-medication.

    PubMed

    da Rocha, Chiara E; Lessa, Felipe A S; Venceslau, Daniel O; Sakuraba, Celso S; Barros, Izadora M C; de Lyra, Divaldo P

    2016-02-01

    Background Responsible self-medication is an integral part of the health system that consists of community pharmacists counseling patients on treating minor illness using non-prescription medications. Systems for properly managing information can assist disease identification and clinical decision-making. Objective To develop a software program to assist community pharmacists in clinical decision-making regarding selfmedication. Setting The study was conducted in northeastern Brazil. Methods The study was conducted from February 2012 to January 2014. System development included identifying minor illnesses commonly treated by community pharmacists and creating simulations of community pharmacies using a simulated patient methodology. Clinical pharmacists, production engineering students, professors, and a pharmacist researcher comprised the development group. Five meetings were held to develop the software, and the system was completed in December 2013. Main outcome measure Minor illnesses commonly treated by community pharmacists, and simulated patient methodology. Results In the first meeting the final list of topics for inclusion in the algorithm indicated the exact questions to be addressed by the community pharmacist to properly manage the complaint. In the second meeting, the discussions in the focus group indicated consensus among pharmacists as to the medications on the list of Groups and Specified Therapeutic Indications of Brazilian Legislation. In the third meeting were defined the parameters to refer patients to the doctor. In the fourth meeting the algorithm was tested using a simulated patient, to observe whether the question order ensures an effective, efficient, and safe decision process for the patient. In the fifth meeting, the algorithm was tested again using a simulated patient with the flu, and all group members agreed upon its final incarnation after refinements to the situations that determined referral to the doctor. Conclusion The software may contribute to identifying health risk situations (potentially unsafe medications based on clinical history, clinical hazards, and past adverse events) requiring medical treatment. PMID:26715550

  19. 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.

  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. 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

  2. 21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Exemptions from import or export requirements for... Registration and Fees § 1301.26 Exemptions from import or export requirements for personal medical use. Any... States resident may import into the United States no more than 50 dosage units combined of all...

  3. 21 CFR 1301.26 - Exemptions from import or export requirements for personal medical use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Exemptions from import or export requirements for... Registration and Fees § 1301.26 Exemptions from import or export requirements for personal medical use. Any... States resident may import into the United States no more than 50 dosage units combined of all...

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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


  5. The attitudes of medical students in Europe toward the clinical importance of embryology.

    PubMed

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Standley, Henrietta; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Chirculescu, Andy

    2016-03-01

    Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession. Clin. Anat. 29:144-150, 2016. © 2015 Wiley Periodicals, Inc. PMID:26538399

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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


  7. Parental decision-making for medically complex infants and children: An integrated literature review

    PubMed Central

    Allen, Kimberly A.

    2014-01-01

    Background Many children with life-threatening conditions who would have died at birth are now surviving months to years longer than previously expected. Understanding how parents make decisions is necessary to prevent parental regret about decision-making, which can lead to psychological distress, decreased physical health, and decreased quality of life for the parents. Objective The aim of this integrated literature review was to describe possible factors that affect parental decision-making for medically complex children. The critical decisions included continuation or termination of a high-risk pregnancy, initiation of life-sustaining treatments such as resuscitation, complex cardiothoracic surgery, use of experimental treatments, end-of-life care, and limitation of care or withdrawal of support. Design PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO were searched using the combined key terms ‘parents and decision-making’ to obtain English language publications from 2000 to June 2013. Results The findings from each of the 31 articles retained were recorded. The strengths of the empirical research reviewed are that decisions about initiating life support and withdrawing life support have received significant attention. Researchers have explored how many different factors impact decision-making and have used multiple different research designs and data collection methods to explore the decision-making process. These initial studies lay the foundation for future research and have provided insight into parental decision-making during times of crisis. Conclusions Studies must begin to include both parents and providers so that researchers can evaluate how decisions are made for individual children with complex chronic conditions to understand the dynamics between parents and parent–provider relationships. The majority of studies focused on one homogenous diagnostic group of premature infants and children with complex congenital heart disease. Thus comparisons across other child illness categories cannot be made. Most studies also used cross-sectional and/or retrospective research designs, which led to researchers and clinicians having limited understanding of how factors change over time for parents. PMID:24636443

  8. The sensitivity of medical diagnostic decision-support knowledge bases in delineating appropriate terms to document in the medical record.

    PubMed

    Feldman, M J; Barnett, G O; Morgan, M M

    1991-01-01

    A pertinent, legible and complete medical record facilitates good patient care. The recording of the symptoms, signs and lab findings which are relevant to a patient's condition contributes importantly to the medical record. The consideration and documentation of other disease states known to be related to the patient's primary illness provide further enhancement. We propose that developing sets of disease-specific core elements which a physician may want to document in the medical record can have many benefits. We hypothesize that for a given disease, terms with high importance (TI) and frequency (TF) in the DX-plain, QMR and Iliad knowledge bases (KBs) are terms which are used commonly in the medical record, and may be, in fact, terms which physicians would find useful to document. A study was undertaken to validate ten such sets of disease-specific core elements. For each of ten prevalent diseases, high TI and TF terms from the three KBs mentioned were pooled to derive the set of core elements. For each disease, all patient records (range 385 to 16,972) from a computerized ambulatory medical record database were searched to document the actual use by physicians of each of these core elements. A significant percentage (range 50 to 86%) of each set of core elements was confirmed as being used by the physicians. In addition, all medical concepts from a selection of full text records were identified, and an average of 65% of the concepts were found to be core elements.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1807600

  9. Factors affecting decision concerning influenza vaccination among students of medical faculties.

    PubMed

    Wo?niak-Kosek, Agnieszka; Kempi?ska-Miros?awska, Bogumi?a; Mendrycka, Mariola; Saracen, Agnieszka; Hoser, Gra?yna

    2014-01-01

    Influenza is one of the most common cyclic respiratory diseases in humans. Methods of prevention are multidirectional, but the most effective and most efficacious way to prevent influenza and its complications is through preventive vaccination. This work aims to determine different factors affecting the decision concerning influenza vaccine. The percentage of people vaccinated against the flu was evaluated, as well as their knowledge of post-influenza complications, etc. among full-time students and bridging studies of nursing and physiotherapy (full-time and part-time) at the University of Technology and Life Sciences in Radom, and students of medicine and pharmacy at the Medical University of ?ód?. The research tool was the authors' questionnaire with 18 questions. The surveys conducted, consisting of multiple choice questions, were anonymous. In total, the survey involved 470 students. Overall, the number of people who were vaccinated against influenza in the 2012/13 epidemic season numbered 15 respondents, representing 5.84% of the total group of respondents. For the group of nursing students it was 6%, for physiotherapy students 5%, for students of medicine and pharmacy 14%. The percentage of respondents who said they would get vaccinated if the vaccinaton was free of charge was also low. Increasing the percentage of people vaccinated against influenza (immunization coverage) is a very important measure in preventing influenza epidemics. Therefore, it is necessary to identify the reasons why people are reluctant to be vaccinated against influenza, particularly among students who will work in the future in the health care services sector. PMID:25522225

  10. 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

  11. 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.

  12. Educational applications of a knowledge-based expert system for medical decision making in hepatology.

    PubMed

    Molino, G; Ripa Di Meana, V; Torchio, M; Console, L; Torasso, P

    1990-04-01

    An expert system for medical decision making in hepatology has been developed with the aim of assisting medical education. The knowledge representation is based on different slots respectively concerned with structural and protypical description, and system control. Reasoning is performed at two levels considering in sequence syndromes and diseases. Explanations are available at any time during the reasoning process. Educational facilities are provided by using the help sections of the system, which include definitions and descriptions of finding in both health and disease, as well as summaries defining essential clinical and pathophysiological features of all diagnostic hypotheses. The system provides the following educational functions: support to medical decision making, differential diagnosis, knowledge-base consultation, system description and clinical simulation. A good correspondence was found between the conclusions and suggestions provided by the system and those of the attending physicians. The program, which was written in PROLOG and developed under MS-DOS Operating System, runs on IBM-compatible personal computers equipped with hard-disk and mouse. PMID:2131940

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

    Stothard, J Russell; Adams, Emily

    2014-12-01

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

  15. 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

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE International Trade Administration Howard Hughes Medical Institute, et al.; Notice of Consolidated Decision on Applications for Duty-Free Entry of Scientific Instruments This is a decision pursuant to Section 6(c) of the Educational, Scientific,...

  16. Evaluation of the Uni-Yeast-Tek kit for the identification of medically important yeasts.

    PubMed Central

    Bowman, P I; Ahearn, D G

    1975-01-01

    The Uni-Yeast-Tek system, a commercially prepared kit and scheme for the rapid identification of medically important yeasts (Corning Medical), was evaluated in comparison with a conventional procedure in the identification of 623 yeasts. The system permitted the presumptive identification of 99.8% of 436 isolates representing 16 common species commonly isolated in the clinical laboratory. Correct biochemical and morphological analyses were obtained with 48 other species, but their specific identification required additional data. Images PMID:1102563

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

    PubMed Central

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

    2014-01-01

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

  18. A JAVA implementation of a medical knowledge base for decision support.

    PubMed

    Ambrosiadou, V; Goulis, D; Shankararaman, V; Shamtani, G

    1999-01-01

    Distributed decision support is a challenging issue requiring the implementation of advanced computer science techniques together with tools of development which offer ease of communication and efficiency of searching and control performance. This paper presents a JAVA implementation of a knowledge base model called ARISTOTELES which may be used in order to support the development of the medical knowledge base by clinicians in diverse specialised areas of interest. The advantages that are evident by the application of such a cognitive model are ease of knowledge acquisition, modular construction of the knowledge base and greater acceptance from clinicians. PMID:10724955

  19. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    PubMed

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment.In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109

  20. Evaluation of inherent performance of intelligent medical decision support systems: utilising neural networks as an example.

    PubMed

    Smith, A E; Nugent, C D; McClean, S I

    2003-01-01

    Researchers who design intelligent systems for medical decision support, are aware of the need for response to real clinical issues, in particular the need to address the specific ethical problems that the medical domain has in using black boxes. This means such intelligent systems have to be thoroughly evaluated, for acceptability. Attempts at compliance, however, are hampered by lack of guidelines. This paper addresses the issue of inherent performance evaluation, which researchers have addressed in part, but a Medline search, using neural networks as an example of intelligent systems, indicated that only about 12.5% evaluated inherent performance adequately. This paper aims to address this issue by concentrating on the possible evaluation methodology, giving a framework and specific suggestions for each type of classification problem. This should allow the developers of intelligent systems to produce evidence of a sufficiency of output performance evaluation. PMID:12473389

  1. Using PICO to align medical evidence with MDs decision making models.

    PubMed

    O'Sullivan, Dympna; Wilk, Szymon; Michalowski, Wojtek; Farion, Ken

    2013-01-01

    Modern medicine is characterized by an "explosion" in clinical research information making practical application of Evidence-Based Medicine (EBM), problematic for many clinicians. We have developed a PICO-(evidence based search strategy focusing on Patient/Population, Intervention, Comparison and Outcome)-based framework for (indexing and retrieving medical evidence and we posit that the use of PICO allows for organizing evidence that is aligned with an MD's decision making model. We describe a study where medical students evaluated our PICO-based approach and results show that students are eager to apply EBM but are hindered by a lack of specialist skills. Students reported that the PICO-based framework for organizing evidence provided an intuitive way of accessing and evaluating evidence and would be useful for their clinical tasks. PMID:23920831

  2. 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

  3. 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

  4. Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making.

    PubMed

    Jahn Kassim, Puteri Nemie; Alias, Fadhlina

    2016-02-01

    Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions. PMID:25576401

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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


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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2015-04-01

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

  8. The Importance of Undergraduate General and Organic Chemistry to the Study of Biochemistry in Medical School.

    ERIC Educational Resources Information Center

    Scimone, Anthony; Scimone, Angelina A.

    1996-01-01

    Investigates chemistry topics necessary to facilitate the study of biochemistry in U.S. medical schools. Lists topics considered especially important and topics considered especially unimportant in general chemistry and organic chemistry. Suggests that in teaching undergraduate general or organic chemistry, the topics categorized as exceptionally…

  9. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    PubMed Central

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

    2014-01-01

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

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

    SciTech Connect

    Jaksch, J.A.

    1992-06-01

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

  11. 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

    ...; ] DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service Notice of Decision To Authorize the Importation of Fresh Apricot, Sweet Cherry, and Plumcot Fruit From South Africa Into the Continental...

  12. What is a medical decision? A taxonomy based on physician statements in hospital encounters: a qualitative study

    PubMed Central

    Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, PĂ„l

    2016-01-01

    Objective The medical literature lacks a comprehensive taxonomy of decisions made by physicians in medical encounters. Such a taxonomy might be useful in understanding the physician-centred, patient-centred and shared decision-making in clinical settings. We aimed to identify and classify all decisions emerging in conversations between patients and physicians. Design Qualitative study of video recorded patient–physician encounters. Participants and setting 380 patients in consultations with 59 physicians from 17 clinical specialties and three different settings (emergency room, ward round, outpatient clinic) in a Norwegian teaching hospital. A randomised sample of 30 encounters from internal medicine was used to identify and classify decisions, a maximum variation sample of 20 encounters was used for reliability assessments, and the remaining encounters were analysed to test for applicability across specialties. Results On the basis of physician statements in our material, we developed a taxonomy of clinical decisions—the Decision Identification and Classification Taxonomy for Use in Medicine (DICTUM). We categorised decisions into 10 mutually exclusive categories: gathering additional information, evaluating test results, defining problem, drug-related, therapeutic procedure-related, legal and insurance-related, contact-related, advice and precaution, treatment goal, and deferment. Four-coder inter-rater reliability using Krippendorff's α was 0.79. Conclusions DICTUM represents a precise, detailed and comprehensive taxonomy of medical decisions communicated within patient–physician encounters. Compared to previous normative frameworks, the taxonomy is descriptive, substantially broader and offers new categories to the variety of clinical decisions. The taxonomy could prove helpful in studies on the quality of medical work, use of time and resources, and understanding of why, when and how patients are or are not involved in decisions. PMID:26868946

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

    PubMed

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

    2012-06-01

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

  14. Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions.

    PubMed

    Garcia, Theresa J; Harrison, Tracie C; Goodwin, James S

    2016-04-01

    Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717

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

    NASA Astrophysics Data System (ADS)

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

    2009-12-01

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

  16. In vitro importance of probiotic Lactobacillus plantarum related to medical field

    PubMed Central

    Arasu, Mariadhas Valan; Al-Dhabi, Naif Abdullah; Ilavenil, Soundharrajan; Choi, Ki Choon; Srigopalram, Srisesharam

    2015-01-01

    Lactobacillus plantarum is a Gram positive lactic acid bacterium commonly found in fermented food and in the gastro intestinal tract and is commonly used in the food industry as a potential starter probiotic. Recently, the consumption of food together with probiotics has tremendously increased. Among the lactic acid bacteria, L. plantarum attracted many researchers because of its wide applications in the medical field with antioxidant, anticancer, anti-inflammatory, antiproliferative, anti-obesity and antidiabetic properties. The present study aimed to investigate the in vitro importance of L. plantarum toward medical applications. Moreover, this report short listed various reports related to the applications of this promising strain. In conclusion, this study would attract the researchers in commercializing this strain toward the welfare of humans related to medical needs. PMID:26858567

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

    PubMed

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

    2007-03-01

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

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

    PubMed Central

    Montague, P. Read

    2011-01-01

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

  19. Medical Decision-Making Among Adolescents with Neonatal Brachial Plexus Palsy and their Families: A Qualitative Study

    PubMed Central

    Squitieri, Lee; Larson, Bradley P.; Chang, Kate W-C; Yang, Lynda J-S.; Chung, Kevin C.

    2016-01-01

    Background Elective surgical management of neonatal brachial plexus palsy is complex, variable, and often individualized. Little is known about the medical decision-making process among adolescents with NBPP and their families faced with making complex treatment decisions. The experiences of these patients and their parents were analyzed to identify key factors in the decision-making process. Patients and Methods Eighteen adolescents with residual NBPP deficits between the ages of 10 to 17 years along with their parents were included in the present study. A qualitative research design was employed involving the use of separate one hour, in person, semi-structured interviews, which were audio recorded and transcribed. Grounded theory was applied by two independent members of the research team to identify recurrent themes and ultimately create a codebook that was then applied to the data. Results Medical decision-making among adolescents with NBPP and their families is multifaceted and individualized, comprised of both patient and system dependent factors. Four codes pertaining to the medical decision-making process were identified: 1) knowledge acquisition, 2) multidisciplinary care, 3) adolescent autonomy, and 4) patient expectations and treatment desires. Overall, parental decision-making was heavily influenced by system dependent factors, while adolescents largely based their medical decision-making on individual treatment desires to improve function and/or aesthetics. Conclusions There are many areas for improving the delivery of information and health care organization among adolescents with NBPP and their families. We recommend the development of educational interdisciplinary programs and decision aids containing evidence-based management guidelines targeted toward primary care providers and patients. We believe that a computer-based learning module may provide the best avenue to achieve maximum penetrance and convenience of information sharing. PMID:23714810

  20. Nonmedical influences on medical decision making: an experimental technique using videotapes, factorial design, and survey sampling.

    PubMed Central

    Feldman, H A; McKinlay, J B; Potter, D A; Freund, K M; Burns, R B; Moskowitz, M A; Kasten, L E

    1997-01-01

    OBJECTIVE: To study nonmedical influences on the doctor-patient interaction. A technique using simulated patients and "real" doctors is described. DATA SOURCES: A random sample of physicians, stratified on such characteristics as demographics, specialty, or experience, and selected from commercial and professional listings. STUDY DESIGN: A medical appointment is depicted on videotape by professional actors. The patient's presenting complaint (e.g., chest pain) allows a range of valid interpretation. Several alternative versions are taped, featuring the same script with patient-actors of different age, sex, race, or other characteristics. Fractional factorial design is used to select a balanced subset of patient characteristics, reducing costs without biasing the outcome. DATA COLLECTION: Each physician is shown one version of the videotape appointment and is asked to describe how he or she would diagnose or treat such a patient. PRINCIPAL FINDINGS: Two studies using this technique have been completed to date, one involving chest pain and dyspnea and the other involving breast cancer. The factorial design provided sufficient power, despite limited sample size, to demonstrate with statistical significance various influences of the experimental and stratification variables, including the patient's gender and age and the physician's experience. Persistent recruitment produced a high response rate, minimizing selection bias and enhancing validity. CONCLUSION: These techniques permit us to determine, with a degree of control unattainable in observational studies, whether medical decisions as described by actual physicians and drawn from a demographic or professional group of interest, are influenced by a prescribed set of nonmedical factors. PMID:9240285

  1. A decision support software package for medical treatment of I.C.U. patients.

    PubMed

    Sphiris, N; Nanas, S; Paraskevopoulou, H; Lymberis, A; Kyprianou, T; Liakopoulou, E; Roussos, C

    1997-01-01

    Critically ill patients admitted in I.C.U. often have multiple complicated problems which necessitate the use of a large number of drugs. The multiple potential interactions between substances and underlying pathologies as well as between substances themselves, obviate the need for a decision support system. We therefore developed a software package for medical treatment support in I.C.U. environment which is based on Microsoft Visual Basic 3.0 and it is organised around the commercially available RDBMS Access 2.0. The database consist of: a) all available substances, b) all generic names of medications available in Greece for each substance, c) incompatibilities (2,300 cases), d) interactions (50,000 cases) and e) cost information for each drug. This system assures the safety of the administered treatment, helps to adjust the dose according to the situation of each patient (anthropometric data, laboratory result, prognostic/severity score e.t.c.) and screens for possible interactions and incompatibilities between the administered drugs. It could also be used for education, treatment algorithms application and it will serve cost-reduction policy. It is a useful and powerful tool for ICU staff which does not impose additional work to the daily practice routine and it is currently under evaluation in clinical settings. PMID:10179801

  2. 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


  3. 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


  4. 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…

  5. 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…

  6. Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts.

    PubMed

    Mikesell, Lisa; Bromley, Elizabeth; Young, Alexander S; Vona, Pamela; Zima, Bonnie

    2016-06-01

    Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM). PMID:26529605

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

    PubMed

    Azizi, Mohammad-Hossein

    2008-01-01

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

  8. The importance of health advocacy in Canadian postgraduate medical education: current attitudes and issues

    PubMed Central

    Poulton, Alexander; Rose, Heather

    2015-01-01

    Background Health advocacy is currently a key component of medical education in North America. In Canada, Health Advocate is one of the seven roles included in the Royal College of Physicians and Surgeons of Canada’s CanMEDS competency framework. Method A literature search was undertaken to determine the current state of health advocacy in Canadian postgraduate medical education and to identify issues facing educators and learners with regards to health advocacy training. Results The literature revealed that the Health Advocate role is considered among the least relevant to clinical practice by educators and learners and among the most challenging to teach and assess. Furthermore learners feel their educational needs are not being met in this area. A number of key barriers affecting health advocacy education were identified including limited published material on the subject, lack of clarity within the role, insufficient explicit role modeling in practice, and lack of a gold standard for assessment. Health advocacy is defined and its importance to medical practice is highlighted, using pediatric emergency medicine as an example. Conclusions Increased published literature and awareness of the role, along with integration of the new 2015 CanMEDS framework, are important going forward to address concerns regarding the quality of postgraduate health advocacy education in Canada.

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

    PubMed Central

    Ritter, Peter; WĂ€scher, 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

  10. 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

  11. An Automated and Intelligent Medical Decision Support System for Brain MRI Scans Classification

    PubMed Central

    Siddiqui, Muhammad Faisal; Reza, Ahmed Wasif; Kanesan, Jeevan

    2015-01-01

    A wide interest has been observed in the medical health care applications that interpret neuroimaging scans by machine learning systems. This research proposes an intelligent, automatic, accurate, and robust classification technique to classify the human brain magnetic resonance image (MRI) as normal or abnormal, to cater down the human error during identifying the diseases in brain MRIs. In this study, fast discrete wavelet transform (DWT), principal component analysis (PCA), and least squares support vector machine (LS-SVM) are used as basic components. Firstly, fast DWT is employed to extract the salient features of brain MRI, followed by PCA, which reduces the dimensions of the features. These reduced feature vectors also shrink the memory storage consumption by 99.5%. At last, an advanced classification technique based on LS-SVM is applied to brain MR image classification using reduced features. For improving the efficiency, LS-SVM is used with non-linear radial basis function (RBF) kernel. The proposed algorithm intelligently determines the optimized values of the hyper-parameters of the RBF kernel and also applied k-fold stratified cross validation to enhance the generalization of the system. The method was tested by 340 patients’ benchmark datasets of T1-weighted and T2-weighted scans. From the analysis of experimental results and performance comparisons, it is observed that the proposed medical decision support system outperformed all other modern classifiers and achieves 100% accuracy rate (specificity/sensitivity 100%/100%). Furthermore, in terms of computation time, the proposed technique is significantly faster than the recent well-known methods, and it improves the efficiency by 71%, 3%, and 4% on feature extraction stage, feature reduction stage, and classification stage, respectively. These results indicate that the proposed well-trained machine learning system has the potential to make accurate predictions about brain abnormalities from the individual subjects, therefore, it can be used as a significant tool in clinical practice. PMID:26280918

  12. An Automated and Intelligent Medical Decision Support System for Brain MRI Scans Classification.

    PubMed

    Siddiqui, Muhammad Faisal; Reza, Ahmed Wasif; Kanesan, Jeevan

    2015-01-01

    A wide interest has been observed in the medical health care applications that interpret neuroimaging scans by machine learning systems. This research proposes an intelligent, automatic, accurate, and robust classification technique to classify the human brain magnetic resonance image (MRI) as normal or abnormal, to cater down the human error during identifying the diseases in brain MRIs. In this study, fast discrete wavelet transform (DWT), principal component analysis (PCA), and least squares support vector machine (LS-SVM) are used as basic components. Firstly, fast DWT is employed to extract the salient features of brain MRI, followed by PCA, which reduces the dimensions of the features. These reduced feature vectors also shrink the memory storage consumption by 99.5%. At last, an advanced classification technique based on LS-SVM is applied to brain MR image classification using reduced features. For improving the efficiency, LS-SVM is used with non-linear radial basis function (RBF) kernel. The proposed algorithm intelligently determines the optimized values of the hyper-parameters of the RBF kernel and also applied k-fold stratified cross validation to enhance the generalization of the system. The method was tested by 340 patients' benchmark datasets of T1-weighted and T2-weighted scans. From the analysis of experimental results and performance comparisons, it is observed that the proposed medical decision support system outperformed all other modern classifiers and achieves 100% accuracy rate (specificity/sensitivity 100%/100%). Furthermore, in terms of computation time, the proposed technique is significantly faster than the recent well-known methods, and it improves the efficiency by 71%, 3%, and 4% on feature extraction stage, feature reduction stage, and classification stage, respectively. These results indicate that the proposed well-trained machine learning system has the potential to make accurate predictions about brain abnormalities from the individual subjects, therefore, it can be used as a significant tool in clinical practice. PMID:26280918

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

    PubMed Central

    2012-01-01

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

  14. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids

    PubMed Central

    Donnelly, Kyla Z; Thompson, Rachel

    2015-01-01

    Introduction Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). Methods and analysis For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. Ethics and dissemination As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. Trial registration number This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717). PMID:26173718

  15. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Vázquez Perera, Antonio Alejandro; Gutiérrez Amador, Alfredo

    2007-01-01

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

  18. 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

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

    PubMed Central

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

    2013-01-01

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

  20. Physicians' personal values in determining medical decision-making capacity: a survey study.

    PubMed

    Hermann, Helena; Trachsel, Manuel; Biller-Andorno, Nikola

    2015-09-01

    Decision-making capacity (DMC) evaluations are complex clinical judgements with important ethical implications for patients' self-determination. They are achieved not only on descriptive grounds but are inherently normative and, therefore, dependent on the values held by those involved in the DMC evaluation. To date, the issue of whether and how physicians' personal values relate to DMC evaluation has never been empirically investigated. The present survey study aimed to investigate this question by exploring the relationship between physicians' value profiles and the use of risk-relative standards in capacity evaluations. The findings indicate that physicians' personal values are of some significance in this regard. Those physicians with relatively high scores on the value types of achievement, power-resource, face and conformity to interpersonal standards were more likely to apply risk-relative criteria in a range of situations, using more stringent assessment standards when interventions were riskier. By contrast, those physicians who strongly emphasise hedonism, conformity to rules and universalism concern were more likely to apply equal standards regardless of the consequences of a decision. Furthermore, it has been shown that around a quarter of all respondents do not appreciate that their values impact on their DMC evaluations, highlighting a need to better sensitise physicians in this regard. The implications of these findings are discussed, especially in terms of the moral status of the potential and almost unavoidable influence of physicians' values. PMID:25784707

  1. The Importance of the Lateral Prefrontal Cortex for Strategic Decision Making in the Prisoner's Dilemma.

    PubMed

    Soutschek, Alexander; Sauter, Marian; Schubert, Torsten

    2015-12-01

    Previous functional imaging studies investigating the neural basis of strategic decision making in the prisoner's dilemma reported a correlation between cooperative behavior and dorsolateral prefrontal cortex (DLPFC) activity; however, the precise function of the DLPFC in establishing cooperation remains unclear so far. The present study investigated the causal role of the DLPFC in an iterative prisoner's dilemma game with transcranial magnetic stimulation (TMS). We discovered that disrupting the DLPFC with TMS decreased cooperation rates in comparison to control conditions, with this effect being most pronounced when the partner had defected previously. Thus, the current results suggest that the DLPFC contributes to strategic decision making in the prisoner's dilemma game. PMID:26238626

  2. 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

  3. Ectoparasites of medical and veterinary importance: drug resistance and the need for alternative control methods.

    TOXLINE Toxicology Bibliographic Information

    McNair CM

    2015-03-01

    OBJECTIVES: Despite multiple attempts at eradication, many ectoparasites of humans and domestic livestock remain a persistent problem in the modern world. For many years, a range of pesticide drugs including organophosphates, organochlorides and synthetic pyrethroids provided effective control of these parasites; but intensive use of these drugs has led to the evolution of resistance in many target species. This paper aims to review the effectiveness of current control methods and discuss potential alternatives for the long term sustainable control of ectoparasites.KEY FINDINGS: Important medical ectoparasites such as scabies mites, head lice and bed bugs present a significant public health problem, and so adequate control methods are essential. Ectoparasites of domestic livestock and farmed fish (for example sheep scab mites, poultry mites and sea lice) are also of concern given the increasing strain on the world's food supply. These parasites have become resistant to several classes of pesticide, making control very difficult. Recently, an increasing amount of research has focussed on alternative control methods such as insect growth regulators, biological control using essential oils or fungi, as well as vaccine development against some ectoparasites of medical and veterinary importance.SUMMARY: Drug resistance is prevalent in all of the ectoparasites discussed in this review. A wide variety of alternative control methods have been identified, however further research is necessary in order for these to be used to successfully control ectoparasitic diseases in the future.

  4. 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

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service Notice of Decision to Authorize the Importation of Shredded Lettuce From Egypt Into the Continental United States AGENCY: Animal and Plant Health Inspection...

  5. 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

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service Notice of Decision To Issue Permits for the Importation of Strawberry Fruit From Egypt Into the Continental United States AGENCY: Animal and Plant Health...

  6. 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…

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

    EPA Science Inventory

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

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

    EPA Science Inventory

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

  9. Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

    PubMed Central

    Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S

    2016-01-01

    Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs. PMID:26869776

  10. Rough set based rule induction in decision making using credible classification and preference from medical application perspective.

    PubMed

    Tseng, Tzu-Liang Bill; Huang, Chun-Che; Fraser, Kym; Ting, Hsien-Wei

    2016-04-01

    This paper presents a new heuristic algorithm for reduct selection based on credible index in the rough set theory (RST) applications. This algorithm is efficient and effective in selecting the decision rules particularly the problem to be solved in a large scale. This algorithm is capable to derive the rules with multi-outcomes and identify the most significant features simultaneously, which is unique and useful in solving predictive medical problems. The end results of the proposed approach are a set of decision rules that illustrates the causes for solitary pulmonary nodule and results of the long term treatment. PMID:26810236

  11. Patients' participation in decision-making in the medical field--'projectification' of patients in a neoliberal framed healthcare system.

    PubMed

    Glasdam, Stinne; Oeye, Christine; Thrysoee, Lars

    2015-10-01

    This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A 'projectification' of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de-professionalization. In that light, participation of patients in decision-making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective. PMID:25943450

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2010-01-01

    Objective To identify cognitive predictors of medical decision-making capacity (MDC) in participants with traumatic brain injury (TBI) at time of acute injury (baseline) and at six-month follow-up. Participants At baseline, participants were 34 adults with moderate to severe TBI and 20 healthy adults. At six-month follow-up, participants were 24 adults with moderate to severe TBI and 20 normal adults. Main Outcome Measures Participants were administered a consent capacity instrument (Capacity to Consent to Treatment Instrument: CCTI) and neuropsychological test measures. In the TBI group, univariate and multivariate cognitive predictor models were developed at baseline and six-month follow-up for clinically relevant CCTI consent abilities/standards (S) of understanding (S5); reasoning (S4); and appreciation (S3). Results At baseline, measures of short-term verbal memory and semantic fluency predicted TBI group performance on understanding (S5); short-term verbal memory and attention predicted performance on reasoning (S4); and working memory predicted performance on appreciation (S3). Regarding six-month follow-up models, measures of basic executive function, verbal processing speed, and working memory predicted TBI performance on understanding (S5); working memory and short-term memory predicted reasoning (S4); and basic executive functioning predicted appreciation (S3). Conclusions Multiple cognitive functions are associated with acute impairment and partial recovery of MDC in patients with moderate to severe TBI. Short-term verbal memory was strongly associated with impairments in consent capacity in TBI participants at the time of acute inpatient hospitalization. As patients experience cognitive and functional recovery post-hospitalization, executive functioning and working memory abilities were associated with improved capacity at six-month follow-up. The results offer insight into the relationship between different standards of competency and cognitive changes and recovery following acute TBI. PMID:20686627

  14. The importance of imagination (or lack thereof) in artificial, human and quantum decision making.

    PubMed

    Gustafson, Karl

    2016-01-13

    Enlarging upon experiments and analysis that I did jointly some years ago, in which artificial (symbolic, neural-net and pattern) learning and generalization were compared with that of humans, I will emphasize the role of imagination (or lack thereof) in artificial, human and quantum cognition and decision-making processes. Then I will look in more detail at some of the 'engineering details' of its implementation (or lack thereof) in each of these settings. In other words, the question posed is: What is actually happening? For example, we previously found that humans overwhelmingly seek, create or imagine context in order to provide meaning when presented with abstract, apparently incomplete, contradictory or otherwise untenable decision-making situations. Humans are intolerant of contradiction and will greatly simplify to avoid it. They can partially correlate but do not average. Human learning is not Boolean. These and other human reasoning properties will then be taken to critique how well artificial intelligence methods and quantum mechanical modelling might compete with them in decision-making tasks within psychology and economics. PMID:26621986

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

    PubMed Central

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

    2011-01-01

    Background Adherence with inhaled controller medications for asthma is known to be highly variable with many patients taking fewer doses than recommended for consistent control of lung inflammation. Adherence also worsens as children become teenagers, although the exact causes are not well established. Objective To use focus group methodology to examine beliefs, feelings, and behaviors about inhaled asthma controller medication in adolescents and young adults who had previously participated in a longitudinal study of asthma treatment adherence and outcome in order to develop more effective management strategies. Methods Twenty-six subjects participated in 6 focus groups comprised of 3-5 young adults (age range 12-20 years). Verbatim transcripts of these groups were analyzed using the long-table method of content analysis to identify key themes raised by participants. Results A variety of beliefs, feelings and behaviors influence the adolescent’s decision about how to use their asthma medication. Some of the adolescents understood the importance of daily medication and were committed to the treatment plan prescribed by their provider. Poorer adherence was the product of misinformation, incorrect assumptions about their asthma, and current life situations. Conclusions These results, by highlighting potential mechanisms underlying both better and worse adherence inform the development of strategies to improve adherence behavior in adolescents and young adults with asthma. Knowledge of the specific beliefs, feelings and behaviors that underlie adolescents’ use of inhaled asthma controller medication will help providers maximize treatment adherence in this notoriously difficult patient population. PMID:21854323

  16. Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

    PubMed

    Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

    2015-08-01

    This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts. PMID:26133480

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

    PubMed

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

    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 in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care. PMID:21391078

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed

    Mulla, M S; Su, T

    1999-06-01

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

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

    NASA Astrophysics Data System (ADS)

    Beaussart, Audrey; Herman, Philippe; El-Kirat-Chatel, Sofiane; Lipke, Peter N.; KucharĂ­kovĂĄ, Soƈa; van Dijck, Patrick; DufrĂȘne, Yves F.

    2013-10-01

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

  2. 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

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

    SciTech Connect

    Coleman, C. Norman; Blumenthal, Daniel J.

    2013-05-01

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

  4. Interspecific shared collective decision-making in two forensically important species.

    PubMed

    Boulay, Julien; Deneubourg, Jean-Louis; Hédouin, Valéry; Charabidzé, Damien

    2016-02-10

    To date, the study of collective behaviour has mainly focused on intraspecific situations: the collective decision-making of mixed-species groups involving interspecific aggregation-segregation has received little attention. Here, we show that, in both conspecific and heterospecific groups, the larvae of two species (Lucilia sericata and Calliphora vomitoria, calliphorid carrion-feeding flies) were able to make a collective choice. In all groups, the choice was made within a few minutes and persisted throughout the period of the experiment. The monitoring of a focal individual within a group showed that these aggregations were governed by attractive and retentive effects of the group. Furthermore, the similarity observed between the conspecific and heterospecific groups suggested the existence of shared aggregation signals. The group size was found to have a stronger influence than the species of necrophagous larvae. These results should be viewed in relation to the well-known correlation between group size and heat generation. This study provides the first experimental examination of the dynamics of collective decision-making in mixed-species groups of invertebrates, contributing to our understanding of the cooperation-competition phenomenon in animal social groups. PMID:26865296

  5. 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


  6. 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…

  7. 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

  8. 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…

  9. 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


  10. 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

  11. 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

  12. Bullet Fragment of the Lumbar Spine: The Decision Is More Important Than the Incision.

    PubMed

    Moisi, Marc D; Page, Jeni; Gahramanov, Seymour; Oskouian, Rod J

    2015-12-01

    Study Design?Case report. Objective?Treatment of gunshot wounds to the spine is a topic of continued discussion and controversy. The following case study provides a description of a patient with a gunshot wound to the lumbar spine with a retained bullet in the intrathecal space. Methods?Immediately after gunshot injury, a patient developed lumbar and radicular pain, as well as neurologic deficits. He was taken for surgery to remove the retained bullet. Results?Following surgery, pain and neurologic function improved. The operative techniques and the postoperative clinical management are discussed in this report. Conclusion?In our opinion, it was necessary to remove the bullet to avoid migration and possible worsening of neurologic function. However, surgical intervention is not appropriate in every case, and ultimately decisions should be based on patient presentation, symptomology, and imaging. PMID:26682104

  13. Bullet Fragment of the Lumbar Spine: The Decision Is More Important Than the Incision

    PubMed Central

    Moisi, Marc D.; Page, Jeni; Gahramanov, Seymour; Oskouian, Rod J.

    2015-01-01

    Study Design Case report. Objective Treatment of gunshot wounds to the spine is a topic of continued discussion and controversy. The following case study provides a description of a patient with a gunshot wound to the lumbar spine with a retained bullet in the intrathecal space. Methods Immediately after gunshot injury, a patient developed lumbar and radicular pain, as well as neurologic deficits. He was taken for surgery to remove the retained bullet. Results Following surgery, pain and neurologic function improved. The operative techniques and the postoperative clinical management are discussed in this report. Conclusion In our opinion, it was necessary to remove the bullet to avoid migration and possible worsening of neurologic function. However, surgical intervention is not appropriate in every case, and ultimately decisions should be based on patient presentation, symptomology, and imaging. PMID:26682104

  14. Further insights into the roles of the medical educator: the importance of scholarly management.

    PubMed

    Bligh, John; Brice, Julie

    2009-08-01

    Medical educators need to be able to define excellence within the various roles they occupy so that they can demonstrate internationally recognized, high-quality scholarship. Previous definitions of scholarship have focused on research and teaching but have been unable to integrate other roles such as leadership, management, and administration. Clearer definition of the various roles of the medical educator, coupled with a broader understanding of medical education scholarship that is able to encompass management, as well as teaching and research, will help institutions to evaluate and reward faculty members appropriately. We propose that management should now be introduced as a third "priority of the professoriate." We outline the concept of the scholarly manager, particularly as it applies to management in medical education. We offer a new conceptual model which situates the role of the academic manager within the scholarship of medical education and shows it to be an essential part of the skills and competences of the excellent medical educator. We emphasize that at the heart of all scholarly activity in medical education lie the core skills, values, and behaviors shared by all involved in the education of doctors and medical students. Future research is needed to explore and, where possible, achieve consensus on the core skills, values, and behaviors of an excellent medical educator. In addition, work should commence to define and categorize the various stages in the development of a significant management portfolio in medical education teaching and research. PMID:19638788

  15. Selecting health insurance: the importance of prescription drug coverage and pharmacy factors in consumer decision making.

    PubMed

    Kreling, D H; Wiederholt, J B

    1987-01-01

    This study determined how important prescription drug coverage was to consumers in selecting their health insurance plans, the specific pharmacy factors they considered, and the importance of factors considered. A mail survey questionnaire was sent to 800 state government and university employees residing in the Madison, Wisconsin area; 453 questionnaires were returned. The majority (59.0 percent) of respondents aware of health insurance prescription coverage placed at least moderate importance on that coverage when selecting their health insurance plan. The specific factors considered most often were cost, location, convenience, and flexibility to choose or change pharmacies. The importance ratings for cost, location, flexibility, and the pharmacist varied among respondents enrolled in different health insurance plans. PMID:10283522

  16. 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

    ... published a notice \\1\\ in the Federal Register on January 9, 2013 (78 FR 1825-1826, Docket No. APHIS- 2012... or disseminating plant pests or noxious weeds via the importation of fresh dates of the...

  17. Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure.

    PubMed

    Knudsen, Hannah K; Abraham, Amanda J; Oser, Carrie B

    2011-11-01

    Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results. PMID:21371752

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

    SciTech Connect

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

    1989-06-01

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

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

    ERIC Educational Resources Information Center

    Algina, James; Gross, Leon J.

    1979-01-01

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

  20. Design of decision support system when undertaking medical-diagnostic action

    NASA Astrophysics Data System (ADS)

    Povoroznyuk, Anatoliy I.; Filatova, Anna E.; Surtel, Wojciech; Burlibay, Aron; Zhassandykyzy, Maral

    2015-12-01

    In the work the formalization of the problem of diagnostic and treatment activities (DTA) steps complex estimation for increasing of their efficiency and minimization of the risk of doctor's mistakes was completed. The decision support system during conducting of DTA based on formalizations of steps of DTA performing with theirs complex estimation was developed that allows to minimize the risks of doctor's mistakes, raise validity of decisions.

  1. 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

  2. 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

  3. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    SciTech Connect

    Shakespeare, Thomas P. . E-mail: ThomasShakespeare@gmail.com; Back, Michael F.; Lu, Jiade J.; Lee, Khai Mun; Mukherjee, Rahul K.

    2006-03-01

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs.

  4. Making the connection: the importance of engagement and retention in HIV medical care.

    PubMed

    Tobias, Carol; Cunningham, William E; Cunningham, Chinazo O; Pounds, Moses B

    2007-01-01

    Despite the availability and proven efficacy of medical treatment, many individuals living with HIV in the United States today are not engaged in regular HIV medical care or receiving antiretroviral medications. This journal supplement highlights results of a national 5-year multisite Outreach Initiative, funded by the Health Resources and Services Administration (HRSA) in 2001 to "engage people in HIV care, turn sporadic users of care into regular users, and promote retention in care." The introductory paper for the supplement provides background information on the characteristics of individuals who are not engaged in regular HIV care, the barriers they face, intervention options, and the public policy implications of this issue. Interventions to engage and retain underserved populations living with HIV in medical care are essential to ensure access to medical care and to reduce disparities in health outcomes. PMID:17563287

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

    PubMed Central

    2014-01-01

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

  6. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation

    PubMed Central

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony FT; Mulder, Cornelis L

    2016-01-01

    Background Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Methods Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Results Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Conclusion Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed. PMID:26893565

  7. Using STD Electronic Medical Record Data to Drive Public Health Program Decisions in New York City

    PubMed Central

    Schillinger, Julia A.; Borrelli, Jessica M.; Handel, Shoshanna; Pathela, Preeti; Blank, and Susan

    2010-01-01

    Electronic medical records can house patient information gathered over time and at multiple sites, thus they have the potential to increase continuity of care and improve service delivery in a multiclinic system. The New York City Department of Health and Mental Hygiene implemented an electronic medical record system in its 10 sexually transmitted disease clinics during 2004 and 2005. We examine the use of real-time electronic medical record data analyses to evaluate clinical services or program activities and present 3 examples of such analyses that have led to program improvements. Analyses of electronic medical record data have produced changes in clinical practice that in turn have resulted in more effective staff use, increased disease detection, and increased clinic capacity. PMID:20167884

  8. Research on Medical Diagnosis Decision Support System for Acid-base Disturbance Based on Support Vector Machine.

    PubMed

    Guo, Lei; Yan, Weili; Li, Ying; Wu, Youxi; Shen, Xueqin

    2005-01-01

    Support Vector Machine (SVM) is a new learning technique based on Statistical Learning Theory (SLT). In this paper, a Medical Diagnosis Decision System (MDDSS) based on SVM has been established to intellectively diagnose 4 types of acid-base disturbance. SVM was originally developed for two-class classification. It is extended to solve multi-class classification problem named hierarchical SVM with clustering algorithm based on stepwise decomposition. Compared with other classical classification techniques, SVM not only has more solid theoretical foundation, it also has greater generalization ability as our experiment demonstrates. Thus, SVM exhibits its great potential in MDDSS. PMID:17282724

  9. How Older Persons Structure Information in the Decision to Seek Medical Care

    PubMed Central

    Veazie, Peter J.

    2014-01-01

    Typical models of the decision to seek care consider information as a single conceptual object. This paper presents an alternative that allows multiple objects. For older persons seeking care, results support this alternative. Older decision-makers that segregate information into multiple conceptual objects assessed separately are characterized by socio-demographic (younger age, racial category, non-Hispanic, higher education, higher income, and not married), health status (better general health for men and worse general health for women, fewer known illnesses), and neuropsychological (less memory loss for men, trouble concentrating and trouble making decisions for men) factors. Results of this study support the conclusion that older persons are more likely to integrate information, and individuals with identifiable characteristics are more likely to do so than others. The theory tested in this study implies a potential explanation for misutilization of care (either over or under-utilization). PMID:26973941

  10. DNA barcoding and molecular evolution of mosquito vectors of medical and veterinary importance.

    PubMed

    Murugan, Kadarkarai; Vadivalagan, Chithravel; Karthika, Pushparaj; Panneerselvam, Chellasamy; Paulpandi, Manickam; Subramaniam, Jayapal; Wei, Hui; Aziz, Al Thabiani; Alsalhi, Mohamad Saleh; Devanesan, Sandhanasamy; Nicoletti, Marcello; Paramasivan, Rajaiah; Parajulee, Megha N; Benelli, Giovanni

    2016-01-01

    Mosquitoes (Diptera: Culicidae) are a key threat for millions of people worldwide, since they act as vectors for devastating pathogens and parasites. The standard method of utilisation of morphological characters becomes challenging due to various factors such as phenotypical variations. We explored the complementary approach of CO1 gene-based identification, analysing ten species of mosquito vectors belonging to three genera, Aedes, Culex and Anopheles from India. Analysed nucleotide sequences were found without pseudo genes and indels; they match with high similarity in nucleotide Basic Local Alignment Search Tool (BLASTn) search. The partial CO1 sequence of Anopheles niligricus was the first time record submitted to National Center for Biotechnology Information (NCBI). Mean intra- and interspecies divergence was found to be 1.30 and 3.83 %, respectively. The congeneric divergence was three times higher than the conspecifics. Deep intraspecific divergence was noted in three of the species, and the reason could be explained more accurately in the future by improving the sample size across different locations. The transitional and transversional substitutions were tested individually. Ts and Tv substitutions in all the 1st, 2nd and 3rd codons were estimated to be (0.44, 99.51), (40.35, 59.66) and (59.16, 40.84), respectively. Saturation of the sequences was resolved, since both the Ts and Tv exhibited a linear relationship suggesting that the sequences were not saturated. NJ and ML tree analysis showed that the individuals of the same species clustered together based on the CO1 sequence similarity, regardless of their collection site and geographic location. Overall, this study adds basic knowledge to molecular evolution of mosquito vectors of medical and veterinary importance and may be useful to improve biotechnological tools employed in Culicidae control programmes. PMID:26358100

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

    PubMed Central

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

    2006-01-01

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

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

    PubMed

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

    2013-07-01

    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

  13. 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

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

    PubMed

    Lau, Colleen; Weinstein, Philip; Slaney, David

    2014-02-01

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

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

    SciTech Connect

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

    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.

  16. 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.

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

    PubMed

    Olowo-Ofayoku, Anthony; Moxham, Bernard John

    2014-10-01

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

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

    PubMed

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

    2010-01-01

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

  19. 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…

  20. Interface Psychology: Touchscreens Change Attribute Importance, Decision Criteria, and Behavior in Online Choice

    PubMed Central

    Gips, James

    2015-01-01

    Abstract As the rise of tablets and smartphones move the dominant interface for digital content from mouse or trackpad to direct touchscreen interaction, work is needed to explore the role of interfaces in shaping psychological reactions to online content. This research explores the role of direct-touch interfaces in product search and choice, and isolates the touch element from other form factor changes such as screen size. Results from an experimental study using a travel recommendation Web site show that a direct-touch interface (vs. a more traditional mouse interface) increases the number of alternatives searched, and biases evaluations toward tangible attributes such as décor and furniture over intangible attributes such as WiFi and employee demeanor. Direct-touch interfaces also elevate the importance of internal and subjective satisfaction metrics such as instinct over external and objective metrics such as reviews, which in turn increases anticipated satisfaction metrics. Findings suggest that interfaces can strongly affect how online content is explored, perceived, remembered, and acted on, and further work in interface psychology could be as fruitful as research exploring the content itself. PMID:26348814

  1. Interface Psychology: Touchscreens Change Attribute Importance, Decision Criteria, and Behavior in Online Choice.

    PubMed

    Brasel, S Adam; Gips, James

    2015-09-01

    As the rise of tablets and smartphones move the dominant interface for digital content from mouse or trackpad to direct touchscreen interaction, work is needed to explore the role of interfaces in shaping psychological reactions to online content. This research explores the role of direct-touch interfaces in product search and choice, and isolates the touch element from other form factor changes such as screen size. Results from an experimental study using a travel recommendation Web site show that a direct-touch interface (vs. a more traditional mouse interface) increases the number of alternatives searched, and biases evaluations toward tangible attributes such as décor and furniture over intangible attributes such as WiFi and employee demeanor. Direct-touch interfaces also elevate the importance of internal and subjective satisfaction metrics such as instinct over external and objective metrics such as reviews, which in turn increases anticipated satisfaction metrics. Findings suggest that interfaces can strongly affect how online content is explored, perceived, remembered, and acted on, and further work in interface psychology could be as fruitful as research exploring the content itself. PMID:26348814

  2. [Assessment of the sterilization of medical devices--an important challenge to health care in Poland].

    PubMed

    Röhm-Rodowald, Ewa; Jakimiak, Bozenna

    2004-01-01

    The aim of the study was the evaluation of sterilization of medical devices in Polish hospitals. The system that we use to establish which sterilization procedures should be employed to reduce the risk of hospital infections associated with medical devices. Based on inquiries, the conditions for the sterilization of medical devices in 21 Warsaw hospitals were assessed. The following issues were taken into consideration: preparation of medical supplies for sterilization, methods of sterilization and the monitoring system. In order to evaluate hygienic conditions due to sterilization points system was applied. 10% of the hospitals had Central Sterilization Service Department with 3 zones where automatic washing and disinfection, sorting, packaging, sterilization and storage of medical devices had been performed. The other 20% had CSSD without zones. In more than 65% there were common services for sterilization only. Instruments were delivered already prepared for sterilization. In remaining hospitals all steps, including sterilization were performed in words. According preparation of medical devices for sterilization it was established that mainly chemical disinfection just after use and than manual cleaning was used; the automatic cleaning in washer-disinfectors is used mainly in CSSD. Steam was the preferred method of sterilization, but also low temperature methods were used for heat sensitive devices. The monitoring of sterilization processes was satisfactory. There were first trials of the validation of the sterilization processes. There is still a need for improvement in the sterilization of medical devices, especially including: the organisation of CSSD in all Polish hospitals; replacement of manual cleaning processes by automatic cleaning; organisation of advanced training courses for the heads and staff of the CSSD. PMID:15730015

  3. 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

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

    SciTech Connect

    Ikeda, Yukihiro

    2014-07-15

    Highlights: ‱ Attached office nurses more recovered medical waste from patients’ homes. ‱ Most nurses educated their patients on how to store home medical care waste in their homes and on how to separate them. ‱ Around half of nurses educated their patients on where to dispose of their home medical care waste. - Abstract: 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.

  5. 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

  6. Helping Smokers Make Decisions: The Enhancement of Brief Intervention for General Medical Practice.

    ERIC Educational Resources Information Center

    Rollnick, Stephen; Butler, Chris C.; Stott, Nigel

    1997-01-01

    Patient-centered strategies derived from the stages of change model, and motivational interviewing are used to develop a structured, teachable, and acceptable intervention for clinicians to help patients consider their smoking during general medical consultations. The method is described. Results for the model, tested on 270 smokers, are…

  7. Employer-sponsored health plans and experimental medical treatments: life and death cost/benefit decisions.

    PubMed

    Mrkonich, M J; Engstrom, G A

    1994-06-01

    The process of determining whether--and how--to limit coverage for certain expensive, experimental medical treatments is complex and involves social, legal and economic considerations. However, employers do have several options for responsibly containing their health plan costs while meeting their employees' basic health care needs. PMID:10171852

  8. The utility of a Personal Values Report for medical decision-making.

    PubMed

    Henderson, W; Corke, C

    2015-09-01

    Our aim was to determine if a patient's Personal Values Report (PVR) has a positive impact on a doctor's decisions regarding treatment. We conducted a prospective cohort study delivering a short, web-based hypothetical case-centred questionnaire to intensive care doctors practising in Australia and New Zealand. One hundred and twenty-four intensive care consultants and registrars agreed to participate in an online questionnaire in two routine mailings between November 2013 and February 2014. We evaluated the effect of a PVR on clinical decision-making in a case-based scenario. In addition, participants rated the utility of the PVR on their decision-making process. Participants were presented with a difficult scenario in a frail elderly man where death was almost inevitable without aggressive support but survival with severe disability was possible with significant intervention. Most doctors (52.4%) elected to continue ventilation and admit to ICU. After the PVR was made available, only 8.1% of doctors continued to choose to admit the patient to the ICU. In all cases where admission to the ICU was chosen after seeing the PVR, the admission to the ICU was stated to be to permit family to arrive before withdrawing support (an approach which was consistent with the values stated in the PVR). One hundred and twenty-one of the 124 participants (97.6%) agreed or strongly agreed that the PVR helped them get an understanding of the patient's wishes, whereas none of the participants (0%) were unsure, disagreed or strongly disagreed with this statement. The remaining 2.4% did not answer the question. It is surmised that PVRs pre-written by patients are potentially an effective and valuable tool for use in helping doctors make decisions regarding patient care. PMID:26310411

  9. Decisions about the use of psychotropic medication during pregnancy: a qualitative study

    PubMed Central

    Stevenson, Fiona; Hamilton, Sarah; Pinfold, Vanessa; Walker, Charlotte; Dare, Ceri R J; Kaur, Harminder; Lambley, Ruth; Szymczynska, Paulina; Nicolls, Vicky; Petersen, Irene

    2016-01-01

    Objective To understand the perspectives of women with severe mental illness concerning the use of psychotropic medicines while pregnant. Design Interviews conducted by female peer researchers with personal experience of making or considering decisions about using psychotropic medicines in pregnancy, supported by professional researchers. Participants 12 women who had had a baby in the past 5 years and had taken antipsychotics or mood-stabilisers for severe mental illness within the 12-month period immediately prior to that pregnancy. Recruitment to the study was via peer networks and the women interviewed came from different regions of England. Setting Interviews were arranged in places where women felt comfortable and that accommodated their childcare needs including their home, local library and the research office. Results The views expressed demonstrated complex attempts to engage with decision-making about the use of psychotropic medicines in pregnancy. In nearly all cases, the women expressed the view that healthcare professionals had access to limited information leaving women to rely on experiential and common sense evidence when making decisions about medicine taking during pregnancy. Conclusions The findings complement existing work using electronic health records by providing explanations for the discontinuation of psychotropic medicines in pregnancy. Further work is necessary to understand health professionals’ perspectives on the provision of services and care to women with severe mental illness during pregnancy. PMID:26817641

  10. Medical decision analysis for first-line therapy of chronic myeloid leukemia.

    PubMed

    Rochau, Ursula; Sroczynski, Gaby; Wolf, Dominik; Schmidt, Stefan; Conrads-Frank, Annette; Jahn, Beate; Saverno, Kim; Brixner, Diana; Radich, Jerald; Gastl, Guenther; Siebert, Uwe

    2014-08-01

    Several tyrosine kinase inhibitors (TKIs) are approved for the treatment of chronic myeloid leukemia (CML). Our goal was to develop a clinical decision-analytic model for evaluation of the long-term effectiveness of different therapy regimens. We developed a Markov cohort model with a lifelong time horizon for first-line treatment with imatinib, dasatinib or nilotinib. Seven strategies including combinations of TKIs, chemotherapy and stem cell transplant were evaluated. The model was parameterized using published trial data, the Austrian CML registry and practice patterns estimated by experts. Health outcomes evaluated were life-years (LYs) and quality-adjusted LYs (QALYs). Based on our decision analysis, dasatinib following nilotinib failure was the most effective treatment in terms of LYs (19.8 LYs) and QALYs (16.1 QALYs). Sensitivity analyses showed that the ranking of strategies was mostly influenced by the duration of first- and second-line therapies. Our results may support decision-making regarding the sequential application of TKIs. PMID:24160847

  11. The Importance of Preparing Medical Students to Manage Different Types of Uncertainty.

    ERIC Educational Resources Information Center

    Fargason, Crayton A., Jr.; Evans, H. Hughes; Ashworth, Carolyn S.; Capper, Stuart A.

    1997-01-01

    To design effective academic health centers for the future, medical leaders must define the competencies needed by tomorrow's physicians, including the ability to manage the uncertainty associated with creating clinical models and the uncertainty associated with managing care delivery. Currently, focus is on the former, but there is increasing…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  13. Medical Students and Faculty Perceptions of Importance of Academic Milestones and Markers.

    ERIC Educational Resources Information Center

    Blumberg, Phyllis; And Others

    Faculty and medical students' conceptions of an optimal progression toward graduation as defined by academic and psychosocial markers were compared. Twenty-four academic indicators of success or difficulty, primarily examination scores or clerkship evaluations, and 10 other indicators of progress toward graduation were assessed by 23 faculty and…

  14. 77 FR 22328 - Guidance for Industry on the Judicious Use of Medically Important Antimicrobial Drugs in Food...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-13

    ... thinking on the use of medically important antimicrobial drugs in animal agriculture. DATES: Submit either... Register of June 29, 2010 (75 FR 37450), FDA published the notice of availability for a draft guidance... announcing: (1) The availability of a draft guidance entitled ``New Animal Drugs and New Animal...

  15. Field evaluations of residual pesticide applications and misting system on militarily relevant materials against medically important mosquitoes in Thailand

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A key strategy to reduce insect-borne disease is to reduce contact between disease vectors and hosts. In the current study, residual pesticide application and misting system were applied on militarily relevant materials and evaluated against medically important mosquitoes. Field evaluations were car...

  16. 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...

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

    PubMed Central

    Borasio, Gian Domenico; Jox, Ralf J

    2012-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

    Suganthi, Muthusamy; Madheswaran, Muthusamy

    2012-02-01

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

  20. 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.

  1. Optimizing medical device buying. Value analysis models can help you improve decision-making process.

    PubMed

    Feldstein, Josh; Brooks, Elizabeth

    2010-05-01

    Value Analysis Models (VAMs) are a burgeoning analytical tool that can help materials managers, operating room managers, CFOs and others to make comparative value assessments before reaching a critical purchasing decision. Although relatively new to the hospital field, more and more manufacturers are supporting these initiatives to bring critical information to their customers and the health care industry. VAMs aren't designed to conclude that one product is better than another but to be a tool that can help make the product acquisition process much easier. PMID:20593688

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2013-04-01

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

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

    PubMed Central

    2013-01-01

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

  5. Medical decision making for older adults: an international perspective comparing the United States and India

    PubMed Central

    Kalra, Ankur; Forman, Daniel E; Goodlin, Sarah J

    2015-01-01

    There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutaneous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advantages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac disease with comparisons of West to East, focusing particularly on the United States versus India. PMID:26346983

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

    PubMed

    Warren, Oliver J; Carnall, Ruth

    2011-01-01

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

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

    PubMed

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

    1997-01-01

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

  8. [Telling the bad news: do the elderly want to know their diagnoses and participate in medical decision making?].

    PubMed

    Carmel, S; Lazar, A

    1997-12-01

    In view of reported changes in western countries in the preferred model of doctor-patient relations, we evaluated the wishes of elderly persons for open doctor-patient communication with regard to terminal disease. Data was collected in 1994 from 987 elderly persons (70+) by structured interviews. Most of respondents wanted open communication and wished to be involved in medical decisions regarding life-sustaining treatment. However, only a minority tell their physicians and/or family members of their wishes. This suggests that most of the elderly expect physicians to be the first to initiate discussions of these issues. The results also indicate that among the elderly, those more educated, less religious, and those living in Israel longer, are more likely to want open communication with their physicians. This is explained by the relationship of these characteristics with the dominant cultural values of this group, and its acceptable models of relations in other areas of life. PMID:9451885

  9. 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

  10. 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

  11. Medication errors in oral dosage form preparation for neonates: The importance of preparation technique

    PubMed Central

    Valizadeh, Sousan; Rasekhi, Mehri; Hamishehkar, Hamed; Asadollahi, Malihe; Hamishehkar, Hadi

    2015-01-01

    Objective: Considering the inability of neonates to swallow oral drugs in the form of solid tablets, the lack of appropriate dosage forms for infants, and the necessity to prepare some pills for neonates, the current study investigated dosage accuracy in drugs for neonates prepared from tablets by analyzing the concentrations of final products. Methods: Captopril and spironolactone, oral dosage forms that are not suitable for infants, were chosen as the drug model for this study. Demographic characteristics of nurses providing medications and tablet preparation methods were documented in a random observational method. To determine concentrations of final solutions, 120 drug samples (60 captopril and 60 spironolactone samples) prepared by Neonatal Intensive Care Unit nurses of the Children Cure and Health Hospital of Tabriz University of Medical Sciences were analyzed using high performance liquid chromatography (HPLC) and spectrophotometry. Findings: There was a significant error rate in the concentration of captopril in prepared solutions compared with the ordered dosage. No differences were observed in the demographic characteristics of the nurses and the method of preparation between the two drugs. The only difference related to the preparation technique was that in most cases (70.8%), one whole spironolactone tablet was used, whereas in around 50% of samples in captopril group, half or a quarter of one captopril tablet was utilized for the intended dosage (P = 0.009). Conclusion: This research suggests that the use of a whole tablet instead of a divided tablet in the manual preparation of medication dosage forms for neonates is the most appropriate approach. PMID:26312254

  12. 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

  13. 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

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

    PubMed Central

    PONNAMPALAM, Louisa Shobhini

    2014-01-01

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

  15. 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

  16. Brand names of Portuguese medication: understanding the importance of their linguistic structure and regulatory issues.

    PubMed

    Pires, Carla; Vigário, Marina; Cavaco, Afonso

    2015-08-01

    Among other regulatory requirements, medicine brands should be composed of single names without abbreviations to prevent errors in prescription of medication. The purposes of the study were to investigate the compliance of a sam ple of Portuguese medicine brand names with Portuguese pharmaceutical regulations. This includes identifying their basic linguistic characteristics and comparing these features and their frequency of occurrence with benchmark values of the colloquial or informal language. A sample of 474 brand names was selected. Names were analyzed using manual (visual analyses) and computer methods (FreP - Frequency Patterns of Phonological Objects in Portuguese and MS word). A significant number of names (61.3%) failed to comply with the Portuguese phonologic system (related to the sound of words) and/or the spelling system (related to the written form of words) contained more than one word, comprised a high proportion of infrequent syllable types or stress patterns and included abbreviations. The results suggest that some of the brand names of Portuguese medication should be reevaluated, and that regulation on this issue should be enforced and updated, taking into consideration specific linguistic and spelling codes. PMID:26221822

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

    PubMed

    Fischer, A F; Stevenson, D K

    1987-10-01

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

  18. Medical decision support using machine learning for early detection of late-onset neonatal sepsis

    PubMed Central

    Mani, Subramani; Ozdas, Asli; Aliferis, Constantin; Varol, Huseyin Atakan; Chen, Qingxia; Carnevale, Randy; Chen, Yukun; Romano-Keeler, Joann; Nian, Hui; Weitkamp, Jörn-Hendrik

    2014-01-01

    Objective The objective was to develop non-invasive predictive models for late-onset neonatal sepsis from off-the-shelf medical data and electronic medical records (EMR). Design The data used in this study are from 299 infants admitted to the neonatal intensive care unit in the Monroe Carell Jr. Children’s Hospital at Vanderbilt and evaluated for late-onset sepsis. Gold standard diagnostic labels (sepsis negative, culture positive sepsis, culture negative/clinical sepsis) were assigned based on all the laboratory, clinical and microbiology data available in EMR. Only data that were available up to 12?h after phlebotomy for blood culture testing were used to build predictive models using machine learning (ML) algorithms. Measurement We compared sensitivity, specificity, positive predictive value and negative predictive value of sepsis treatment of physicians with the predictions of models generated by ML algorithms. Results The treatment sensitivity of all the nine ML algorithms and specificity of eight out of the nine ML algorithms tested exceeded that of the physician when culture-negative sepsis was included. When culture-negative sepsis was excluded both sensitivity and specificity exceeded that of the physician for all the ML algorithms. The top three predictive variables were the hematocrit or packed cell volume, chorioamnionitis and respiratory rate. Conclusions Predictive models developed from off-the-shelf and EMR data using ML algorithms exceeded the treatment sensitivity and treatment specificity of clinicians. A prospective study is warranted to assess the clinical utility of the ML algorithms in improving the accuracy of antibiotic use in the management of neonatal sepsis. PMID:24043317

  19. Resuscitation decisions.

    PubMed

    Petty, T L

    1986-08-01

    Some of the considerations that go into resuscitation decision making and the withdrawal of life support are discussed. These considerations include: ethical principles (benevolence, autonomy, and informed consent); surrogate decision making (the principles of substituted judgment, patients' best interests, and reason); medical decisions concerning resuscitation; and guiding principles for the individual care giver. PMID:3461871

  20. "Desktop knowledge": a new focus for medical education and decision support.

    PubMed

    Greenes, R A

    1989-11-01

    Physicians today are faced with "data overload" and, paradoxically, "information underload"--the inability to locate pertinent, needed knowledge in a sea of data with which they are inundated. Increasingly, the professional functions of the physician are becoming focused on the desktop workstation, in terms of its ability to provide "windows" into local databases and knowledge resources, and to serve as an access port to other networked resources. A challenge we now face is to develop means for structuring the vast potentially available knowledge resources in such a manner that access to pertinent knowledge can be facilitated, and to develop acceptable interfaces to the knowledge resources so that a user can effectively navigate through them. The complexity of this task is due to the nature of the knowledge resources--knowledge can be in a variety of forms, ranging from textual and pictorial material, to structured representations, to more dynamic embodiments in the form of procedures. In the Decision Systems Group we have focused on the development of a prototype desktop knowledge management environment known as Explorer-2, with the objective of providing a consistent interface for access to a wide variety of knowledge. Our accomplishments to date encompass the incorporation into the Explorer-2 environment of adaptations of textbook chapters and books, image data bases, simulations, and expert systems. Navigational aids are provided by a semantic net browser using both MeSH and augmented taxonomies and by a graphical overview map.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2622385

  1. Snake Venomics and Antivenomics of Bothrops diporus, a Medically Important Pitviper in Northeastern Argentina

    PubMed Central

    Gay, Carolina; Sanz, Libia; Calvete, Juan J.; Pla, Davinia

    2015-01-01

    Snake species within genus Bothrops are responsible for more than 80% of the snakebites occurring in South America. The species that cause most envenomings in Argentina, B. diporus, is widely distributed throughout the country, but principally found in the Northeast, the region with the highest rates of snakebites. The venom proteome of this medically relevant snake was unveiled using a venomic approach. It comprises toxins belonging to fourteen protein families, being dominated by PI- and PIII-SVMPs, PLA2 molecules, BPP-like peptides, L-amino acid oxidase and serine proteinases. This toxin profile largely explains the characteristic pathophysiological effects of bothropic snakebites observed in patients envenomed by B. diporus. Antivenomic analysis of the SAB antivenom (Instituto Vital Brazil) against the venom of B. diporus showed that this pentabothropic antivenom efficiently recognized all the venom proteins and exhibited poor affinity towards the small peptide (BPPs and tripeptide inhibitors of PIII-SVMPs) components of the venom. PMID:26712790

  2. Snake Venomics and Antivenomics of Bothrops diporus, a Medically Important Pitviper in Northeastern Argentina.

    PubMed

    Gay, Carolina; Sanz, Libia; Calvete, Juan J; Pla, Davinia

    2015-01-01

    Snake species within genus Bothrops are responsible for more than 80% of the snakebites occurring in South America. The species that cause most envenomings in Argentina, B. diporus, is widely distributed throughout the country, but principally found in the Northeast, the region with the highest rates of snakebites. The venom proteome of this medically relevant snake was unveiled using a venomic approach. It comprises toxins belonging to fourteen protein families, being dominated by PI- and PIII-SVMPs, PLA₂ molecules, BPP-like peptides, L-amino acid oxidase and serine proteinases. This toxin profile largely explains the characteristic pathophysiological effects of bothropic snakebites observed in patients envenomed by B. diporus. Antivenomic analysis of the SAB antivenom (Instituto Vital Brazil) against the venom of B. diporus showed that this pentabothropic antivenom efficiently recognized all the venom proteins and exhibited poor affinity towards the small peptide (BPPs and tripeptide inhibitors of PIII-SVMPs) components of the venom. PMID:26712790

  3. Sexual assault centres and police reporting--an important arena for medical/legal interaction.

    PubMed

    Nesvold, Helle; Ormstad, Kari; Friis, Svein

    2011-09-01

    This study explores the usefulness of forensic medical examination (FME) irrespective of police request and police-reporting practices at a self-referral Sexual Assault Centre (SAC). The study is retrospective, descriptive: a 2-year series of cases from a Scandinavian SAC and corresponding police files. Among 354 SAC cases, 180 were reported to the police, comprising 103 of 197 total rapes registered in this police district. Of 278 complainants presenting in time for FME, 55% reported to the police. FME was performed in 238 cases, 142 of these registered by the police. In 24% of the latter, examination preceded reporting by ≄ 2 days. Thus, substantial amounts of SAC casework remain unavailable to the police owing to nonreporting. However, performing FME regardless of reporting considerably increases the amount of information available to the police in late-reported cases. Although several factors predict reporting, the predictive power is insufficient for performing FME selectively. PMID:21827470

  4. [New report of insects of medical importance for the northeastern island chain of CamagĂŒey. Preliminary report].

    PubMed

    Diéguez Fernåndez, L; Rodríguez Gonzålez, L; Sånchez Alonso, C

    1997-01-01

    The existence of a group of insect of medical importance belonging to the families Culicidae, Blattide, Muscidae, Tabanidae, Ceratopogonidae and Chloropidae was reported in the northwestern keys of CamagĂŒey (keys MĂ©gano Grande, Cruz, Romano and GĂŒajaba). Key Romano seems to have the best ecological conditions for the establishment of such vectors according to the number of species reported. PMID:9685978

  5. 77 FR 19716 - Importer of Controlled Substances; Notice of Application Meridian Medical Technologies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ... Register on September 23, 1975, 40 FR 43745-46, all applicants for registration to import a basic class of... United States. The company exports this product to customers around the world, including in Europe....

  6. Maternal medication, drug use, and breastfeeding.

    PubMed

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

    2013-02-01

    This article reviews the necessary skills required for clinicians to make informed decisions about the use of medications in women who are breastfeeding. Even without specific data on certain medications, this review of kinetic principles, mechanisms of medication entry into breast milk, and important infant factors can aid in clinical decision making. In addition, common medical conditions and suitable treatments of depression, hypertension, infections and so forth for women who are breastfeeding are also reviewed. PMID:23178070

  7. “The Ultimate Decision Is Yours”: Exploring Patients’ Attitudes about the Overuse of Medical Interventions

    PubMed Central

    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

  8. Medical Decision Support System for Diagnosis of Heart Arrhythmia using DWT and Random Forests Classifier.

    PubMed

    Alickovic, Emina; Subasi, Abdulhamit

    2016-04-01

    In this study, Random Forests (RF) classifier is proposed for ECG heartbeat signal classification in diagnosis of heart arrhythmia. Discrete wavelet transform (DWT) is used to decompose ECG signals into different successive frequency bands. A set of different statistical features were extracted from the obtained frequency bands to denote the distribution of wavelet coefficients. This study shows that RF classifier achieves superior performances compared to other decision tree methods using 10-fold cross-validation for the ECG datasets and the obtained results suggest that further significant improvements in terms of classification accuracy can be accomplished by the proposed classification system. Accurate ECG signal classification is the major requirement for detection of all arrhythmia types. Performances of the proposed system have been evaluated on two different databases, namely MIT-BIH database and St. -Petersburg Institute of Cardiological Technics 12-lead Arrhythmia Database. For MIT-BIH database, RF classifier yielded an overall accuracy 99.33 % against 98.44 and 98.67 % for the C4.5 and CART classifiers, respectively. For St. -Petersburg Institute of Cardiological Technics 12-lead Arrhythmia Database, RF classifier yielded an overall accuracy 99.95 % against 99.80 % for both C4.5 and CART classifiers, respectively. The combined model with multiscale principal component analysis (MSPCA) de-noising, discrete wavelet transform (DWT) and RF classifier also achieves better performance with the area under the receiver operating characteristic (ROC) curve (AUC) and F-measure equal to 0.999 and 0.993 for MIT-BIH database and 1 and 0.999 for and St. -Petersburg Institute of Cardiological Technics 12-lead Arrhythmia Database, respectively. Obtained results demonstrate that the proposed system has capacity for reliable classification of ECG signals, and to assist the clinicians for making an accurate diagnosis of cardiovascular disorders (CVDs). PMID:26922592

  9. Best-fit model of exploratory and confirmatory factor analysis of the 2010 Medical Council of Canada Qualifying Examination Part I clinical decision-making cases

    PubMed Central

    Champlain, André F. De

    2015-01-01

    Purpose: This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1) clinical decision-making (CDM) cases. The outcomes of this study have important implications for a range of domains, including scoring and test development. Methods: The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses. Results: Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit. Conclusion: The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age. PMID:25961675

  10. The importance of distinguishing Hispanic subpopulations in the use of medical care.

    PubMed

    Schur, C L; Bernstein, A B; Berk, M L

    1987-07-01

    Rather than analyzing Hispanics as a homogeneous population, this paper uses the 1977 National Medical Care Expenditure Survey in order to make separate national estimates for Cubans, Puerto Ricans, and Mexicans. Utilization of various health services by these three groups is discussed, as well as their insurance coverage, mean annual expenses by source of payment, and health status indicators. The analysis has a descriptive as well as multivariate component and focuses specifically on the use of physician and hospital services and prescribed medicines. It is found that Puerto Ricans are almost twice as likely as Mexicans, and over four times as likely as Cubans, to be covered by Medicaid; Cubans, on the other hand, are most often privately insured. Of the three groups, Puerto Ricans have the highest annual expenses and are most likely to have at least one physician visit. The number of visits for those with a visit, however, is identical across the groups. The paper discusses the policy implications of these findings, as well as the methodologic implications of classifying various Hispanic subgroups into one all-encompassing category. PMID:3121952

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

    PubMed Central

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

    2012-01-01

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

  12. Memory for Medication Side Effects in Younger and Older Adults: The Role of Subjective and Objective Importance

    PubMed Central

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

    2014-01-01

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

  13. 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

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Disclosures Without Patient Consent § 1.484 Disclosure of...

  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

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Disclosures Without Patient Consent § 1.484 Disclosure of...

  15. 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

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Disclosures Without Patient Consent § 1.484 Disclosure of...

  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

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Disclosures Without Patient Consent § 1.484 Disclosure of...

  17. Insights into the development of Ixodes scapularis: a resource for research on a medically important tick species.

    PubMed

    Kocan, Katherine M; de la Fuente, José; Coburn, Lisa A

    2015-01-01

    Ticks (Acari: Ixodida) are arthropod ectoparasites dependent on a bloodmeal from a vertebrate host at each developmental stage for completion of their life cycle. This tick feeding cycle impacts animal health by causing damage to hides, secondary infections, immune reactions and diseases caused by transmission of pathogens. The genus Ixodes includes several medically important species that vector diseases, including granulocytic anaplasmosis and Lyme disease. I. scapularis, commonly called the black-legged or deer tick, is a medically-important tick species in North America and therefore was the first tick genome to be sequenced, thus serving as an important resource for tick research. This Primer focuses on the normal developmental cycle and laboratory rearing of I. scapularis. Definition of normal morphology, along with a consistent source of laboratory-reared I. scapularis, are fundamental for all aspects of future research, especially the effects of genetic manipulation and the evaluation of tick vaccine efficacy. Recent research important for the advancement of tick research, namely the development of tick cell culture systems for study of ticks and tick-borne pathogens, RNA interference for genetic manipulation of ticks and discovery of candidate antigens for development of tick vaccines, are briefly presented along with areas to target for future research. PMID:26576940

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

    PubMed Central

    BAZRAFCAN, LEILA; HAGHANI, FARIBA; SHOKRPOUR, NASRIN

    2014-01-01

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

  19. [Importance and Implementation of Prevention in Germany--A Nationwide Survey of Decision-makers in the GKV-Spitzenverband and Political Decision-makers].

    PubMed

    Pawils, S; Boettcher, A; Metzner, F; Plaumann, M; Walter, U

    2015-09-01

    Representatives of the statutory health insurance (n=46) and policy makers at the local, federal and state level (n=136) were interviewed in 2 nationwide online surveys about the significance and degree of implementation of prevention. The group comparison between the decision-makers shows significant differences in terms of attitudes towards health prevention. The political leaders are demanding an improvement of the GKV-benefit package and the obstacles require the cooperation of urgent attention. PMID:26406532

  20. Medical end-of-life decisions: does its use differ in vulnerable patient groups? A systematic review and meta-analysis.

    PubMed

    Rietjens, Judith A C; Deschepper, Reginald; Pasman, Roeline; Deliens, Luc

    2012-04-01

    Medical end-of-life decisions, defined as end-of-life practices with a potential or certain life-shortening effect, precede almost 50% of deaths in Western countries, and receive ample medical-ethical attention. This systematic review aims to detect whether there are differences in the prevalence of medical end-of-life decisions in 'vulnerable' patient groups. In 2009, five major databases were scrutinized for publications containing original data on the prevalence of euthanasia/physician-assisted suicide, life-ending without explicit patient request, intensified symptom alleviation, non-treatment decisions and palliative sedation by social factors (eg age, gender and SES). Heterogeneous findings were pooled using a random effects model. We identified 6377 papers of which 51 papers were selected, involving over 1.09 million patients. Most publications reported the prevalence of non-treatment decisions. The most studied social factors were age and gender. Among patients older than eighty years, non-treatment decisions occurred more frequently compared with younger patients, while intensified symptom alleviation, palliative sedation, euthanasia/physician-assisted suicide and life-ending without explicit request were practiced less often. Similar patterns of association, although less strong, were found for female patients compared with males and those with lower levels of education versus more highly-educated patients. We conclude that the administration of medication with a potential or certain life-shortening effect seemed generally to be practiced less often among the elderly, females and less well-educated patients compared with younger, male or more educated patients, while decisions that include the withdrawal or withholding of treatments seem to be more common in these groups. Further studies should focus on investigating whether these differences reflect less than optimal end-of-life care for specific patient groups. PMID:22401644

  1. The importance of shunt valve position in flow characteristics of the Medtronic PS Medical Delta valve.

    PubMed

    Francel, P C; Stevens, F A; Tompkins, P; Pollay, M

    1999-11-15

    This study was conducted to document the extent to which flow depends on valve position in relation to head-pressure reference. Medtronic PS Medical Delta valves (contour model, performance levels 0.5, 1.0, 1.5, and 2.0) were studied in a bench test designed to evaluate flow rates with respect to valve position in relation to the head-pressure reference postion. The valves were connected to an "infinite" reservoir by the standard inlet catheter. An initial head (proximal) pressure was selected for each valve based on package insert data. The position of the inlet catheter tip was fixed at this starting head pressure, thus making the inlet catheter tip position the reference for relative head pressures on the valve assembly. When the valve body is positioned above this level, the effective head pressure is lowered, and when the valve body is positioned below this level, the effective head pressure is raised. Flow was established with the siphon control portion of the valve body located on the same horizontal level as the inlet catheter tip (the reference head pressure or "0" position). A standard silastic catheter was attached to the outlet of the valve, and its length was fixed at 50 cm for all valves (-50 cm H(2)0). The distal end of the outlet catheter was connected to a fraction collector, and 1-minute samples (five replicates) were collected for gravimetric determination of flow rate. The valve assembly was then moved in 1-cm increments through the range of 4 cm above to 8 cm below the head-pressure reference position. Samples were collected from each position (4 cm to -8 cm) relative to the inlet catheter tip. Flow rate, in milliliters/hour, was plotted against both relative position (4 cm to -8 cm) and absolute head pressure (in centimeters of water). Each of the valves tested was shown to have a linear relationship between flow and position relative to the inlet catheter tip (or absolute head pressure). The average increase in flow per centimeter of displacement of valve from catheter tip was 16.5 ml/hr/cm (range 14.4-17.6 ml/hr/cm). Once the inlet catheter tip is fixed in position, it serves as a pressure reference. Movement of the valve above this level results in a net decrease in effective head pressure, and movement below this position results in a net increase in effective head pressure. Thus, the positioning of shunt valves in locations different from this pressure reference position should be performed only with the knowledge that significant increases in outflow rate may occur when the valve body is positioned lower than the inlet catheter tip. This increase in outflow rate is not the result of siphoning or a defect in the antisiphon device but instead the result of a net increase in effective head pressure. PMID:16918214

  2. Enhancing Medical Decision-Making Evaluations: Introduction of Normative Data for the Capacity to Consent to Treatment Instrument.

    PubMed

    Gerstenecker, Adam; Niccolai, Lindsay; Marson, Daniel; Triebel, Kristen L

    2016-04-01

    A number of measures have been developed to assess medical decision-making capacity (MDC) in adults. However, their clinical utility is limited by a lack of available normative data. In the current study, we introduce age-independent and age-adjusted normative data for a measure of MDC: the Capacity to Consent to Treatment Instrument. The sample consisted of 308 cognitively normal, community-dwelling adults ranging in age from 19 to 86 years. For age-adjusted norms, individual raw scores were first converted to age-corrected scaled scores based on position within a cumulative frequency distribution and then grouped according to empirically supported age ranges. For age-independent norms, the same method was utilized but without age-corrections being applied or participants being grouped into age ranges. This study has the potential to enhance MDC evaluations by allowing clinicians to compare a patient's performance on the Capacity to Consent to Treatment Instrument with that of adults regardless of age as well as to same age peers. Tables containing normative corrections are supplementary material available online at http://asm.sagepub.com/supplemental. PMID:26282778

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

    PubMed Central

    Heinrichs, Guido; de Hoog, G. Sybren

    2012-01-01

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

  4. The Evolving Medical and Veterinary Importance of the Gulf Coast tick (Acari: Ixodidae).

    PubMed

    Paddock, Christopher D; Goddard, Jerome

    2015-03-01

    Amblyomma maculatum Koch (the Gulf Coast tick) is a three-host, ixodid tick that is distributed throughout much of the southeastern and south-central United States, as well as several countries throughout Central and South America. A considerable amount of scientific literature followed the original description of A. maculatum in 1844; nonetheless, the Gulf Coast tick was not recognized as a vector of any known pathogen of animals or humans for >150 years. It is now identified as the principal vector of Hepatozoon americanum, the agent responsible for American canine hepatozoonosis, and Rickettsia parkeri, the cause of an emerging, eschar-associated spotted fever group rickettsiosis identified throughout much of the Western Hemisphere. Coincident with these discoveries has been recognition that the geographical distribution of A. maculatum in the United States is far more extensive than described 70 yr ago, supporting the idea that range and abundance of certain tick species, particularly those with diverse host preferences, are not fixed in time or space, and may change over relatively short intervals. Renewed interest in the Gulf Coast tick reinforces the notion that the perceived importance of a particular tick species to human or animal health can be relatively fluid, and may shift dramatically with changes in the distribution and abundance of the arthropod, its vertebrate hosts, or the microbial agents that transit among these organisms. PMID:26336308

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

    Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates¼, PDF Expert¼, VisualDx¼, and Micromedex¼. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions. PMID:25317266

  7. 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

  8. Plant-borne ovicides in the fight against mosquito vectors of medical and veterinary importance: a systematic review.

    PubMed

    Benelli, Giovanni

    2015-09-01

    Mosquitoes (Diptera: Culicidae) are a huge threat for millions of people worldwide, since they act as vectors for devastating parasites and pathogens. Culicidae control is of crucial importance. Mosquito eggs, larvae, and pupae are usually targeted using organophosphates, insect growth regulators, and microbial agents. Indoor residual spraying and insecticide-treated bed nets are also employed. However, these chemicals have negative effects on human health and the environment, and induce resistance in a number of species. Eco-friendly tools have been recently implemented against mosquito vectors, including botanical insecticides. The majority of researches focused on larvicides (745 SCOPUS results, July 2015) and adult repellents (434 SCOPUS results), while limited efforts were conducted to identify effective ovicides of botanical origin (59 SCOPUS results). Here, I review current knowledge on the effectiveness of plant-borne ovicides against major mosquito vectors of medical and veterinary importance. The majority of researches focused on the toxicity of crude extracts, their fractions, or essential oils against three important mosquito vectors, Anopheles stephensi, Aedes aegypti, and Culex quinquefasciatus. As a general trend, C. quinquefasciatus eggs were the most resistant to botanical ovicides. Five studies proposed selected compounds from plant extracts and essential oils as ovicides effective at few parts per million. However, no efforts were conducted to shed light on possible mechanisms underlying the toxicity of plant-borne ovicides. In the final section, a number of hot issues needing further research and cooperation among parasitologists, entomologists, and researchers working in natural product chemistry are outlined. PMID:26239801

  9. Leaving home at an early age: parents' decisions about out-of-home placement for young children with complex medical needs.

    PubMed

    Bruns, D A

    2000-02-01

    Qualitative methodology was used to examine the circumstances leading to the realization of the need for out-of-home placement. A series of indepth, semi-structured interviews were conducted with 5 parents who had made the decision for out-of-home placement. Results indicated that these parents went through a similar process: initial feelings of excitement turn to weariness, first thoughts about the need for additional assistance in caring for their child, realization of the need for out-of-home placement based on minimal social supports, difficulties with services, overwhelming medical care, and mounting financial concerns ("triggering events"); need for approval for the decision; and reflections on the decision. Conclusions and implications for practice, policy, and future research are provided. PMID:10703218

  10. In Favour of Medical Dissensus: Why We Should Agree to Disagree About End-of-Life Decisions.

    PubMed

    Wilkinson, Dominic; Truog, Robert; Savulescu, Julian

    2016-02-01

    End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions - that of 'professional dissensus'. In the final part of the article we address the role of agreement in end-of-life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing. PMID:25908398

  11. The relative importance of perceived doctor’s attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study

    PubMed Central

    Coxon, Domenica; Frisher, Martin; Jinks, Clare; Jordan, Kelvin; Paskins, Zoe; Peat, George

    2015-01-01

    Objectives Some patients spend years with painful osteoarthritis without consulting for it, including times when they are experiencing persistent severe pain and disability. Beliefs about osteoarthritis and what primary care has to offer may influence the decision to consult but their relative importance has seldom been quantified. We sought to investigate the relative importance of perceived service-related and clinical need attributes in the decision to consult a primary care physician for painful osteoarthritis. Design Partial-profile choice-based conjoint analysis study, using a self-complete questionnaire containing 10 choice tasks, each presenting two scenarios based on a combination of three out of six selected attributes. Setting General population. Participants Adults aged 50?years and over with hip, knee or hand pain registered with four UK general practices. Outcome measures Relative importance of pain characteristics, level of disruption to everyday life, extent of comorbidity, assessment, management, perceived general practitioner (GP) attitude. Results 863 (74%) people responded (55% female; mean age 70?years, range: 58–93). The most important determinants of the patient's decision to consult the GP for joint pain were the extent to which pain disrupted everyday life (‘most’ vs ‘none’: relative importance 31%) and perceived GP attitude (‘legitimate problem, requires treatment’ vs ‘part of the normal ageing process that one just has to accept’: 24%). Thoroughness of assessment (14%), management options offered (13%), comorbidity (13%) and pain characteristics (5%) were less strongly associated with the decision to consult. Conclusions Anticipating that the GP will regard joint pain as ‘part of the normal ageing process that one just has to accept’ is a strong disincentive to seeking help, potentially outweighing other aspects of quality of care. Alongside the recognition and management of disrupted function, an important goal of each primary care consultation for osteoarthritis should be to avoid imparting or reinforcing this perception. PMID:26503396

  12. WHAT ROLE SHOULD PUBLIC OPINION PLAY IN ETHICO-LEGAL DECISION MAKING? THE EXAMPLE OF SELECTING SEX FOR NON-MEDICAL REASONS USING PREIMPLANTATION GENETIC DIAGNOSIS.

    PubMed

    Fovargue, Sara; Bennett, Rebecca

    2016-01-01

    In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice. PMID:26811500

  13. 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

  14. Unveiling the complexities of Daboia russelii venom, a medically important snake of India, by tandem mass spectrometry.

    PubMed

    Sharma, Maitreyee; Das, Diganta; Iyer, Janaki Krishnamoorthy; Kini, R Manjunatha; Doley, Robin

    2015-12-01

    Composition of Indian Russell's viper (Daboia russelii russelii) venom, a medically important snake and member of "Big Four" snakes of India was done by gel filtration chromatography followed by tandem mass spectrometry. The MS/MS analyses of tryptic digested gel filtration peaks divulged the presence of 63 different proteins belonging to 12 families. Phospholipase A2 (PLA2), serine proteases, metalloproteases, cysteine-rich secretory proteins, l-amino acid oxidase, C-type lectin-like proteins, kunitz-type serine protease inhibitor, disintegrin, nucleotidase, phosphodiesterase, vascular endothelial growth factor and vascular nerve growth factor families were identified. PLA2 enzymes with isoforms of N-, S- and H-type based on their first N-terminal amino acid residue were observed. The venom is also found to be rich in RVV-X, RVV-V and thrombin-like enzymes. Homologues of disintegrins with RGD and RTS motifs were also observed. The high percentage of PLA2 and proteases in the venom proteome could be responsible for the observed coagulopathy, haemorrhage and edema which can be correlated with the clinical manifestations of Russell's viper envenomation. This is the first proteomic analysis of Indian D. russelii venom which might assist in understanding the pathophysiological effects of viper envenomation. Such study will also be important for developing more effective antivenom for viper bite management. PMID:26160495

  15. Work-home interface stress: an important predictor of emotional exhaustion 15 years into a medical career.

    PubMed

    Hertzberg, Tuva Kolstad; RÞ, Karin Isaksson; Vaglum, Per JÞrgen Wiggen; Moum, TorbjÞrn; RÞvik, Jan Ole; Gude, Tore; Ekeberg, Øivind; Tyssen, Reidar

    2016-03-28

    The importance of work-home interface stress can vary throughout a medical career and between genders. We studied changes in work-home interface stress over 5 yr, and their prediction of emotional exhaustion (main dimension of burn-out), controlled for other variables. A nationwide doctor cohort (NORDOC; n=293) completed questionnaires at 10 and 15 yr after graduation. Changes over the period were examined and predictors of emotional exhaustion analyzed using linear regression. Levels of work-home interface stress declined, whereas emotional exhaustion stayed on the same level. Lack of reduction in work-home interface stress was an independent predictor of emotional exhaustion in year 15 (ÎČ=-0.21, p=0.001). Additional independent predictors were reduction in support from colleagues (ÎČ=0.11, p=0.04) and emotional exhaustion at baseline (ÎČ=0.62, p<0.001). Collegial support was a more important predictor for men than for women. In separate analyses, significant adjusted predictors were lack of reduction in work-home interface stress among women, and reduction of collegial support and lack of reduction in working hours among men. Thus, change in work-home interface stress is a key independent predictor of emotional exhaustion among doctors 15 yr after graduation. Some gender differences in predictors of emotional exhaustion were found. PMID:26538002

  16. 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

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

    PubMed

    Otto, W?odzimierz; Tulczy?ski, Aleksander

    2002-01-01

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

  18. Medical rare book provenance.

    PubMed Central

    Overmier, J A; Sentz, L

    1987-01-01

    Provenance is defined as the record of a book's ownership history. Its value and uses are explored. A survey of provenance practices in medical school rare book libraries found that only 21% of the reporting libraries maintain this important file. Examples of the uses and value of a provenance file in a medical rare book collection are presented. Decisions necessary to institute and maintain such a file are outlined and discussed. PMID:3828606

  19. Rapid extraction of genomic DNA from medically important yeasts and filamentous fungi by high-speed cell disruption.

    PubMed

    Müller, F M; Werner, K E; Kasai, M; Francesconi, A; Chanock, S J; Walsh, T J

    1998-06-01

    Current methods of DNA extraction from different fungal pathogens are often time-consuming and require the use of toxic chemicals. DNA isolation from some fungal organisms is difficult due to cell walls or capsules that are not readily susceptible to lysis. We therefore investigated a new and rapid DNA isolation method using high-speed cell disruption (HSCD) incorporating chaotropic reagents and lysing matrices in comparison to standard phenol-chloroform (PC) extraction protocols for isolation of DNA from three medically important yeasts (Candida albicans, Cryptococcus neoformans, and Trichosporon beigelii) and two filamentous fungi (Aspergillus fumigatus and Fusarium solani). Additional extractions by HSCD were performed on Saccharomyces cerevisiae, Pseudallescheria boydii, and Rhizopus arrhizus. Two different inocula (10(8) and 10(7) CFU) were compared for optimization of obtained yields. The entire extraction procedure was performed on as many as 12 samples within 1 h compared to 6 h for PC extraction. In comparison to the PC procedure, HSCD DNA extraction demonstrated significantly greater yields for 10(8) CFU of C. albicans, T. beigelii, A. fumigatus, and F. solani (P < or = 0.005), 10(7) CFU of C. neoformans (P < or = 0.05), and 10(7) CFU of A. fumigatus (P < or = 0.01). Yields were within the same range for 10(8) CFU of C. neoformans and l0(7) CFU of C. albicans for both HSCD extraction and PC extraction. For 10(7) CFU of T. beigelii, PC extraction resulted in a greater yield than did HSCD (P < or = 0.05). Yields obtained from 10(8) and 10(7) CFU were significantly greater for filamentous fungi than for yeasts by the HSCD extraction procedure (P < 0.0001). By the PC extraction procedure, differences were not significant. For all eight organisms, the rapid extraction procedure resulted in good yield, integrity, and quality of DNA as demonstrated by restriction fragment length polymorphism, PCR, and random amplified polymorphic DNA. We conclude that mechanical disruption of fungal cells by HSCD is a safe, rapid, and efficient procedure for extracting genomic DNA from medically important yeasts and especially from filamentous fungi. PMID:9620390

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2015-01-01

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

  2. 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

  3. Development of a Mobile System Decision-support for Medical Diagnosis of Asthma in Primary Healthcare--InteliMED.

    PubMed

    Menezes, Júlio; Gusmăo, Cristine

    2015-01-01

    The structure of public and primary healthcare in Brazil is organized in a way to provide decentralized services. In theory, this scenario could enable the usage of mobile devices integrated with information systems of several purposes. In addition, there is a need of decision-support tools that are based on collected evidences, once the professional of primary healthcare, which essentially has general knowledge (non-specialist). Therefore there is a need of information that support the decision-making process on more specific contexts. This paper presents the proposal, experience of development and application of the InteliMED, a decision-support system to asthma diagnosis of children and adolescents through decision-trees and mobile devices (smartphones and tablets). PMID:26262261

  4. 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

    ... published a notice \\1\\ in the Federal Register on February 2, 2011 (76 FR 5779-5780, Docket No. APHIS-2010... weeds via the importation of litchi from the Republic of South Africa. DATES: Effective Date: December... mitigate the risks of introducing or disseminating plant pests or noxious weeds via the importation...

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

    PubMed Central

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

    2007-01-01

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

  6. Identification and antifungal activity of novel organic compounds found in cuticular and internal lipids of medically important flies.

    PubMed

    Go??biowski, Marek; Cerkowniak, Magdalena; Urbanek, Aleksandra; Dawgul, Ma?gorzata; Kamysz, Wojciech; Bogu?, Mieczys?awa I; Stepnowski, Piotr

    2015-01-01

    Novel organic compounds found in the cuticular and internal lipids of medically important flies were identified. Uracil, 9-tricosene, 1-oleoyl glycerol, dimethyl suberate and butyl stearate were tested for their potential antifungal activity. Minimal inhibitory concentrations of the compounds against reference strains of fungi were determined. Uracil and dimethyl suberate slightly inhibited the growth of entomopathogenic fungi. The cuticular and internal lipids of Calliphora vicina, Calliphora vomitoria, Sarcophaga carnaria and Musca domestica were studied by gas chromatography (GC) combined with mass spectrometry (GC/MS). A comparison of the lipid extracts between the preimaginal and mature stages showed adults flies contained a higher total content of the identified components. Furthermore, their amounts distinctly predominated in the internal lipids of all the species. The amount of 9-tricosene was the highest in adults of C. vicina, while the larvae and pupae had a definitively lower amount of this compound. Uracil was found to be the most abundant component in extracts obtained from C. vomitoria especially in the internal lipids of adults. 1-oleoyl glycerol was detected in all of the examined species of flies. It was most abundant in the internal extracts isolated from the larvae of C. vicina and the pupae of C. vomitoria. Suberic acid dimethyl ester was found in the larval and pupal internal lipids of C. vicina and S. carnaria in low amounts. Butyl stearate was identified only in the internal lipids of the larvae and adults of houseflies. PMID:25026883

  7. 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

    ... published a notice \\1\\ in the Federal Register on March 6, 2012 (77 FR 13260-13261, Docket No. APHIS- 2012... or disseminating plant pests or noxious weeds via the importation of fresh fruit of litchi,...

  8. 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

    ... accordance with that process, we published a notice \\1\\ in the Federal Register on August 11, 2011 (76 FR... weeds via the importation of fresh Cape gooseberry fruit from Chile. DATES: Effective Date: December...

  9. 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

    ..., 2011 (76 FR 13972, Docket No. APHIS-2011- 0013), in which we announced the availability, for review and... weeds via the importation of fresh papaya fruit from Malaysia. DATES: Effective Date: August 11,...

  10. 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

    ... notice \\1\\ in the Federal Register on July 8, 2010 (75 FR 39203-39204, Docket No. APHIS- 2010-0027), in... plant pests or noxious weeds via the importation of wall rocket leaves from the United Kingdom....

  11. 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

    ... accordance with that process, we published a notice \\1\\ in the Federal Register on June 30, 2011 (76 FR 38349... noxious weeds via the importation of dragon fruit from Thailand. DATES: Effective Date: October 4,...

  12. 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

    ... August 2, 2011 (76 FR 46268-46269, Docket No. APHIS-2011-0031), in which we announced the availability... weeds via the importation of fresh pitayas and pomegranates from Mexico. DATES: As of August 13,...

  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

    ... published a notice \\1\\ in the Federal Register on October 12, 2010 (75 FR 62500-62501, Docket No. APHIS-2010... weeds via the importation of fresh strawberries from Jordan. DATES: Effective Date: February 16,...

  14. 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

    ..., 2011 (76 FR 31577-31578, Docket No. APHIS- 2011-0039), in which we announced the availability, for... introducing or disseminating plant pests or noxious weeds via the importation of fresh apricot, sweet...

  15. Medication reviews in primary care in Sweden: importance of clinical pharmacists' recommendations on drug-related problems.

    PubMed

    Modig, Sara; Holmdahl, Lydia; Bondesson, Ćsa

    2016-02-01

    Background One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews. Objective To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists. Setting A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ?65 years and lived in ordinary housing with medication-related community help. Method Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher. Conclusion The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients. PMID:26582483

  16. Plant-mediated biosynthesis of nanoparticles as an emerging tool against mosquitoes of medical and veterinary importance: a review.

    PubMed

    Benelli, Giovanni

    2016-01-01

    Mosquitoes (Diptera: Culicidae) are a key threat for millions of people worldwide, since they act as vectors for devastating parasites and pathogens. Mosquito young instars are usually targeted with organophosphates, insect growth regulators and microbial control agents. Indoors residual spraying and insecticide-treated bed nets are also employed. However, these chemicals have strong negative effects on human health and the environment. Newer and safer tools have been recently implemented to enhance control of mosquitoes. In this review, I focus on characterization, effectiveness, and non-target effects of mosquitocidal nanoparticles synthesized using botanical products (mosquitocidal nanoparticles, MNP). The majority of plant-fabricated MNP are silver ones. The synthesis of MNP is usually confirmed by UV-visualization spectroscopy, followed by scanning electron microscopy or transmission electron microscopy, energy-dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, and X-ray diffraction studies. Interestingly, plant-synthesized metal nanoparticles have been reported as effective ovicides, larvicides, pupicides, adulticides, and oviposition deterrents against different mosquito species of medical and veterinary importance. Few parts per million of different MNP are highly toxic against the malaria vector Anopheles stephensi, the dengue vector Aedes aegypti, and the filariasis mosquito Culex quiquefasciatus. However, despite the growing number of evidences about the effectiveness of MNP, moderate efforts have been carried out to shed light on their possible non-target effects against mosquito's natural enemies and other aquatic organisms. In the final section, particular attention was dedicated to this issue. A number of hot areas that need further research and cooperation among parasitologists and entomologists are highlighted. PMID:26541154

  17. 77 FR 29588 - Notice of Decision To Issue Permits for the Importation of Fresh Celery, Arugula, and Spinach...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-18

    ... notice \\1\\ in the Federal Register on August 25, 2010 (75 FR 52302-52303, Docket No. APHIS-2010-0074), in... the Importation of Fresh Celery, Arugula, and Spinach From Colombia into the Continental United States... fresh celery, arugula, and spinach from Colombia. Based on the findings of three pest risk...

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-20

    ... published a notice\\1\\ in the Federal Register on July 8, 2013 (78 FR 40688-40689, Docket No. APHIS- 2013... From Colombia Into the Continental United States AGENCY: Animal and Plant Health Inspection Service... importation into the continental United States of Swiss chard from Colombia. Based on the findings of a...

  19. 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

    ... notice\\1\\ in the Federal Register on February 9, 2010 (75 FR 6344-6345, Docket No. APHIS-2009-0097), in..., 2010, we published a notice in the Federal Register (75 FR 5034-5035, Docket No. APHIS-2009-0082) in... plant pests or noxious weeds via the importation of fresh pomegranates and fresh baby kiwi from...

  20. Decision technology.

    PubMed

    Edwards, W; Fasolo, B

    2001-01-01

    This review is about decision technology-the rules and tools that help us make wiser decisions. First, we review the three rules that are at the heart of most traditional decision technology-multi-attribute utility, Bayes' theorem, and subjective expected utility maximization. Since the inception of decision research, these rules have prescribed how we should infer values and probabilities and how we should combine them to make better decisions. We suggest how to make best use of all three rules in a comprehensive 19-step model. The remainder of the review explores recently developed tools of decision technology. It examines the characteristics and problems of decision-facilitating sites on the World Wide Web. Such sites now provide anyone who can use a personal computer with access to very sophisticated decision-aiding tools structured mainly to facilitate consumer decision making. It seems likely that the Web will be the mode by means of which decision tools will be distributed to lay users. But methods for doing such apparently simple things as winnowing 3000 options down to a more reasonable number, like 10, contain traps for unwary decision technologists. The review briefly examines Bayes nets and influence diagrams-judgment and decision-making tools that are available as computer programs. It very briefly summarizes the state of the art of eliciting probabilities from experts. It concludes that decision tools will be as important in the 21st century as spreadsheets were in the 20th. PMID:11148318

  1. Ixodes (Ixodes) scapularis (Acari:Ixodidae): redescription of all active stages, distribution, hosts, geographical variation, and medical and veterinary importance.

    PubMed

    Keirans, J E; Hutcheson, H J; Durden, L A; Klompen, J S

    1996-05-01

    The blacklegged tick, Ixodes (Ixodes) scapularis Say, 1821, is redescribed, based on laboratory reared specimens originating in Bulloch County, Georgia. Information on distribution, host associations, morphological variation, and medical/veterinary importance is also presented. A great deal of recent work has focused on this species because it is the principal vector of the agent of Lyme disease (Borrelia burgdorferi Johnson, Schmidt, Hyde, Steigerwaldt & Brenner) in eastern North America. Its distribution appears to be expanding, and includes the state of Florida in the southeastern United States north to the provinces of Nova Scotia and Prince Edward Island, Canada, west to North and South Dakota, United States, and south to the state of Coahuila, Mexico. Although I. scapularis feeds on at least 125 species of North American vertebrates (54 mammalian, 57 avian, and 14 lizard species), analysis of the U.S. National Tick Collection holdings show that white-tailed deer, Odocoileus virginianus (Zimmermann), cattle, Bos taurus L., dogs, Canis lupus L., and other medium-to-large sized mammals are important hosts for adults as are native mice and other small mammals, certain ground-frequenting birds, skinks, and glass lizards for nymphs and larvae. This tick is a polytypic species exhibiting north-south and east-west morphological clines. Analysis of variance and Student-Newman-Keuls multiple comparisons revealed significant interpopulational variation that is expressed most significantly in the nymphal stage. Nymphs from northern (Minnesota, Massachusetts, Maryland) populations had relatively larger basis capituli with shorter cornua (except Maryland) than southern (North Carolina, Georgia) populations. Midwestern populations (Minnesota, Missouri) differed from eastern populations (Massachusetts, Maryland, North Carolina, Georgia) in idiosomal characters (broader scuta, larger coxae III, and IV). In addition to Lyme disease, this tick is also a primary vector of the agent of human and rodent babesiosis, Babesia microti Franca. Under laboratory conditions it has transmitted the agents of deer babesiosis, Babesia odocoilei Emerson & Wright, tularemia, Francisella tularensis McCoy & Chapin, and anaplasmosis, Anaplasma marginale Theiler. Moreover, I. scapularis can reach pest proportions on livestock, and females can cause tick paralysis in dogs. PMID:8667375

  2. A decision support system to improve medical diagnosis using a combination of k-medoids clustering based attribute weighting and SVM.

    PubMed

    Peker, Musa

    2016-05-01

    The use of machine learning tools has become widespread in medical diagnosis. The main reason for this is the effective results obtained from classification and diagnosis systems developed to help medical professionals in the diagnosis phase of diseases. The primary objective of this study is to improve the accuracy of classification in medical diagnosis problems. To this end, studies were carried out on 3 different datasets. These datasets are heart disease, Parkinson's disease (PD) and BUPA liver disorders. Key feature of these datasets is that they have a linearly non-separable distribution. A new method entitled k-medoids clustering-based attribute weighting (kmAW) has been proposed as a data preprocessing method. The support vector machine (SVM) was preferred in the classification phase. In the performance evaluation stage, classification accuracy, specificity, sensitivity analysis, f-measure, kappa statistics value and ROC analysis were used. Experimental results showed that the developed hybrid system entitled kmAW + SVM gave better results compared to other methods described in the literature. Consequently, this hybrid intelligent system can be used as a useful medical decision support tool. PMID:27000777

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    1996-01-01

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

  5. 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

  6. Clinical Decision Analysis Using Microcomputers

    PubMed Central

    Wong, John B.; Moskowitz, Alan J.; Pauker, Stephen G.

    1986-01-01

    Many difficult medical decisions involve uncertainty. Decision analysis—an explicit, normative and analytic approach to making decisions under uncertainty—provides a probabilistic framework for exploring difficult problems in nondeterministic domains. As the methodology has advanced, clinical decision analysis has been applied to increasingly complex medical problems and disseminated widely in the medical literature. Unfortunately, this approach imposes a heavy computational burden on analysts. Microcomputer-based decision-support software can ease this burden. PMID:3027993

  7. 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

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

    PubMed Central

    Lamy, J.-B.

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  11. 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

  12. 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.

  13. A survey of decision tree classifier methodology

    NASA Technical Reports Server (NTRS)

    Safavian, S. Rasoul; Landgrebe, David

    1990-01-01

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

  14. 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

  15. Recent Iowa trends in sudden unexpected infant deaths: the importance of public health collaboration with medical examiners' offices.

    PubMed

    Harris, Meghan L; Massaquoi, David; Soyemi, Kenneth; Brend, Sarah M; Klein, Dennis; Pentella, Michael; Kraemer, John; Nashelsky, Marcus; Schmunk, Gregory; Smith, Tara; Pleva, Ariel

    2012-06-01

    During the winter in 2008, Iowa experienced an increase in sudden unexplained infant deaths (SUIDs). SUIDs and infectious causes of infant deaths generally average 3 monthly (SD = 1.0) in Iowa. However, in January 2008, 9 infant deaths were reported to the Iowa Department of Public Health and the Iowa Office of the State Medical Examiner. Between January and March of 2008, joint investigation of 22 SUIDs was conducted. The investigations required the involvement of multiple medical examiners from various jurisdictions, testing for pathogens at the University Hygienic Laboratory, epidemiologic support from the Iowa Department of Public Health, and consultation with the Centers for Disease Control and Prevention. The preliminary hypotheses for the increase in the infant mortality included viral respiratory disease and/or possible novel respiratory viral infections being the cause. Collaboration between public health and the medical examiner offices resulted in timely assessment of the cases. While no single causative agent was responsible for the increase seen in the number of infant deaths, respiratory pathogens played a role in the deaths of 15 of 22 children. PMID:20938328

  16. The clinical decision analysis using decision tree

    PubMed Central

    Bae, Jong-Myon

    2014-01-01

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

  17. [Computerized decision support in drug prescribing I: Better survey of patients' medications yields better quality of care].

    PubMed

    Gustafsson, Lars L; Widäng, Kenneth; Hoffmann, Mikael; Andersén-Karlsson, Eva; Elfman, Karin; Johansson, Björn; Johansson, Eva; Larson, Mats

    2003-04-10

    New drugs and new discoveries--such as those concerning the use of individual genetic profiles to help customize dosages--have refined drug treatment. Drug companies' marketing efforts as well as patients' views and wishes influence physicians in their choice of treatment. Drug-drug interactions continue to be a common cause of admissions to hospitals. Instantaneous access to a patient's complete drug list and to reliable medical information in a computer-based drug-prescribing system will help ensure patient safety. It will also contribute to evidence-based choice of pharmacological principle, drug, method of administration and dosage and to better agreement between patient and doctor. PMID:12739403

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2012-01-01

    Background: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. Methods: In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Results: Of 332 patients in a development cohort, expert reviewers (?, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio2 ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). Conclusions: A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use. PMID:22030803

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

    PubMed Central

    Xie, Ningxin; Wen, Guoqiu; Li, Zhaowen

    2014-01-01

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

  1. A method for fuzzy soft sets in decision making based on grey relational analysis and d-s theory of evidence: application to medical diagnosis.

    PubMed

    Xie, Ningxin; Wen, Guoqiu; Li, Zhaowen

    2014-01-01

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

  2. Integrated approach for designing medical decision support systems with knowledge extracted from clinical databases by statistical methods.

    PubMed Central

    Krusinska, E.; Babic, A.; Chowdhury, S.; Wigertz, O.; Bodemar, G.; Mathiesen, U.

    1991-01-01

    In clinical research data is often studied by a particular method without previous analysis of quality or semantic contents which could link clinical database and data analytical (e.g. statistical) procedures. In order to avoid bias caused by this situation, we propose that the analysis of medical data should be divided into two main steps. In the first one we concentrate on conducting the quality, semantic and structure analyses. In the second step our aim is to build an appropriate dictionary of data analysis methods for further knowledge extraction. Methods like robust statistical techniques, procedures for mixed continuous and discrete data, fuzzy linguistic approach, machine learning and neural networks can be included. The results may be evaluated both using test samples and applying other relevant data-analytical techniques to the particular problem under the study. PMID:1807621

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

    PubMed Central

    Tan, Jacinta; Salloch, Sabine; Vollmann, Jochen

    2013-01-01

    Background. Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment. Methods. Qualitative in-depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed. Results. Physicians reported that a number of nonmedical factors influence professional decisions about the offering or limiting of cancer treatment in advanced cancer in addition to medical criteria. Physicians' individual judgments about the benefit of treatment, as well as the amount of their clinical experience, were cited as such factors. In addition, the physicians' perceptions of the patient's age and life circumstances were reported to influence their treatment decisions. Multiprofessional team discussions and the systematic collection of relevant clinical data regarding the outcomes of different treatment approaches in advanced cancer were suggested as strategies to improve the quality of treatment decisions. Conclusion. The findings of this study provide explanations for the variation in treatment in advanced cancer. Making value judgments explicit and gathering more appropriate clinical data on the outcomes of treatment near the end of life are prerequisites for improved ethical and evidence-based treatment decisions in advanced cancer. PMID:23287883

  4. Differences by race/ethnicity in older adults’ beliefs about the relative importance of dietary supplements versus prescription medications: Results from the SURE study

    PubMed Central

    Albright, Cheryl L.; Schembre, Susan M.; Steffen, Alana D.; Wilkens, Lynne R.; Monroe, Kristine R.; Yonemori, Kim M.; Murphy, Suzanne P.

    2012-01-01

    Dietary supplement use is widespread among adults across races/ethnicities, yet reasons for use may vary across these groups. The SUpplement REporting (SURE) study quantified dietary supplement use and reasons for taking supplements in a multiethnic sample of adults who took at least one supplement. This study explored socio-demographic differences, including by race/ethnicity, associated with specific reasons/motivations for taking dietary supplements, including perceived importance of taking supplements relative to prescription medications. The study time period was March 2005 to August 2006. Participants (n=397) were older adults (age = 52–88 y) recruited from the Multiethnic Cohort Study in Hawaii and Los Angeles, with equal representation of males and females from six ethnic groups (white, Japanese-American, Native Hawaiian, African-American, US-born Latino, and foreign-born Latino). Subgroups of participants were compared by chi-square tests and logistic regression. The most common reasons for taking supplements were to maintain a healthy life, recommended by a health professional, and to prevent a disease/medical problem. A majority (76%) of participants reported that their dietary supplements were as important as prescription medications, with foreign-born Latinos and Japanese-Americans being most likely to state this belief. The relative importance of supplements was not associated with excessive use, but 27% of participants exceeded the upper limit for a nutrient. It is crucial for health professionals to better understand why individuals take supplements and the importance that they attach to their use. This information could lead to better monitoring and education efforts in order to prevent overuse of supplements and possible interactions with medications. PMID:22818730

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

    PubMed Central

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

    2013-01-01

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

  6. 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

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

    PubMed Central

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

    2014-01-01

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

  8. 75 FR 37450 - Draft Guidance: The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-29

    ... and animal health. The development of resistance to this important class of drugs, and the resulting... judiciously in both animal and human medicine to slow the development of resistance. Using these drugs... public health communities that a significant contributing factor to antimicrobial resistance is the...

  9. Implementation of "social and communicative competencies" in medical education. The importance of curriculum, organisational and human resource development

    PubMed Central

    Pruskil, Susanne; Deis, Nicole; Druener, Susanne; Kiessling, Claudia; Philipp, Swetlana; Rockenbauch, Katrin

    2015-01-01

    Objective: With this article we want to support teachers and curriculum planners to be aware of and apply knowledge and recommendations of organisational (OD), curriculums (CD) and human resource development (HRD) ideas already in the planning phase of a project. Taking these into account can influence the process of change successfully and controlled during the introduction and establishment of curricula in the field of communication and social skills in medical education. Approach and Results: In the context of a multi-stage developmental process, a recommendation on CD for "Communicative and social competencies" was developed. The basis for it was made during two workshops of the GMA-committee "Communicative and social competencies" and supplemented by the available literature and the experience of communication experts. The "Undeloher Recommendation" (see attachment ) includes a compilation of recommendations and guiding questions, which is geared to the various phases of CD. Additionally, general approaches and recommendations of organisational and human resource development were integrated, which turned out to be particularly relevant in the process of CD. Thus, the "Undeloher recommendation" includes an orientation for each phase of the curriculum development process, the organisation and the staff in order to successfully implement a longitudinal curriculum. In addition to theoretical models the long-term discussion process and the personal experiences of a variety of curriculum planners and teachers have been integrated. Conclusion: The "Undeloher recommendation" can support the implementation processes of curricula in communication and social skills during development and realisation. Its application was reviewed in the context of workshops based on concrete examples. The participating teachers and curriculum planners assessed it to be very helpful. The recommendation goes beyond of what has been described in terms of content models in the CD so fare. In particular, the organisational and human resource development related aspects such as the formation of a steering committee and recommendations for the phase of sustainability. PMID:26604992

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

    PubMed

    Farajollahi, Ary; Price, Dana C

    2013-09-01

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

  11. "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

  12. 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

  13. Comparative analysis of instance selection algorithms for instance-based classifiers in the context of medical decision support

    NASA Astrophysics Data System (ADS)

    Mazurowski, Maciej A.; Malof, Jordan M.; Tourassi, Georgia D.

    2011-01-01

    When constructing a pattern classifier, it is important to make best use of the instances (a.k.a. cases, examples, patterns or prototypes) available for its development. In this paper we present an extensive comparative analysis of algorithms that, given a pool of previously acquired instances, attempt to select those that will be the most effective to construct an instance-based classifier in terms of classification performance, time efficiency and storage requirements. We evaluate seven previously proposed instance selection algorithms and compare their performance to simple random selection of instances. We perform the evaluation using k-nearest neighbor classifier and three classification problems: one with simulated Gaussian data and two based on clinical databases for breast cancer detection and diagnosis, respectively. Finally, we evaluate the impact of the number of instances available for selection on the performance of the selection algorithms and conduct initial analysis of the selected instances. The experiments show that for all investigated classification problems, it was possible to reduce the size of the original development dataset to less than 3% of its initial size while maintaining or improving the classification performance. Random mutation hill climbing emerges as the superior selection algorithm. Furthermore, we show that some previously proposed algorithms perform worse than random selection. Regarding the impact of the number of instances available for the classifier development on the performance of the selection algorithms, we confirm that the selection algorithms are generally more effective as the pool of available instances increases. In conclusion, instance selection is generally beneficial for instance-based classifiers as it can improve their performance, reduce their storage requirements and improve their response time. However, choosing the right selection algorithm is crucial.

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

    PubMed Central

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

    2013-01-01

    Objective To determine the repellent and pupicidal activities of Pogostemon cablin (P. cablin) chemical compositions were assayed for their toxicity against selected important vector mosquitoes, viz., Aedes aegypti (Ae. aegypti), Anopheles stephensi (An. stephensi) and Culex quinquefasciatus (Cx. quinquefasciatus) (Diptera: Culicidae). Methods The plants dry aerial parts were subjected to hydrodistillation using a modified Clevenger-type apparatus. The composition of the essential oil was analyzed by Gas Chromatography (GC) and GC mass spectrophotometry. Evaluation was carried out in a net cage (45 cmŚ30 cmŚ45 cm) containing 100 blood starved female mosquitoes and were assayed in the laboratory condition by using the protocol of WHO 2010. The repellent activity of P. cablin chemical compositions at concentration of 2mg/cm2were applied on skin of fore arm in man and exposed against adult female mosquitoes. The pupicidal activity was determined against selected important vector mosquitoes to concentration of 100 mg/L and mortality of each pupa was recorded after 24 h of exposure to the compounds. Results Chemical constituents of 15 compounds were identified in the oil of P.cablin compounds representing to 98.96%. The major components in essential oil were â-patchoulene, á-guaiene, ă-patchoulene, á-bulnesene and patchouli alcohol. The repellent activity of patchouli alcohol compound was found to be most effective for repellent activity and 2 mg/cm2 concentration provided 100% protection up to 280 min against Ae. aegypti, An. stephensi and Cx. quinquefasciatus, respectively. Similarly, pupae exposed to 100 mg/L concentrations of P. cablin chemical compositions. Among five compounds tested patchouli alcoholwas found to be most effective for pupicidal activity provided 28.44, 26.28 and 25.36 against Ae.aegypti, An.stephensi and Cx. quinquefasciatus, respectively. The percent adult emergence was inversely proportional to the concentration of compounds and directly proportional to the pupal mortality. Conclusion These results suggest that the P. cablin chemical compositions have the potential to be used as an ideal eco-friendly approach for the control of mosquitoes. This is the first report on the mosquito repellent and pupicidal activities of the reported P. cablin chemical compositions.

  15. Development of multiplex loop-mediated isothermal amplification assays to detect medically important yeasts in dairy products.

    PubMed

    Kasahara, Kohei; Ishikawa, Hiroshi; Sato, Sumie; Shimakawa, Yasuhisa; Watanabe, Koichi

    2014-08-01

    Rapid detection of yeast contamination is important in the food industry. We have developed loop-mediated isothermal amplification (LAMP) assays to detect the emerging opportunistic pathogenic yeasts: Candida albicans, Candida glabrata, Candida tropicalis, the Candida parapsilosis group, Trichosporon asahii, and Trichosporon mucoides. These yeasts may cause deep-seated candidiasis or trichosporonosis. Four LAMP primer sets specific for Candida were designed to target the internal transcribed spacer 2 (ITS2) region between the 5.8S and 26S rRNA genes, and two LAMP primer sets specific for Trichosporon were designed to target the intergenic spacer 1 (IGS1) region between the 26S and 5S rRNA genes. The LAMP assays could detect these yeasts in a range between 10(0) and 10(3)  cells mL(-1) in a contaminated dairy product within 1 h. We also developed multiplex LAMP assays to detect these Candida or Trichosporon species in a single reaction. Multiplex LAMP assays can detect contamination if at least one of the target species is present; they are more time- and cost-efficient than conventional methods and could detect target yeasts with sensitivity close to that of the LAMP assays. Multiplex LAMP assays established in this study can be used as a primary screening method for yeast contamination in food products. PMID:24965944

  16. Importance of in-hospital initiation of evidence-based medical therapies for heart failure-a review.

    PubMed

    Fonarow, Gregg C; Gheorghiade, Mihai; Abraham, William T

    2004-11-01

    Patients who have had heart failure (HF) face very high risks of hospitalization and mortality. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors, aldosterone antagonists, and beta blockers decrease rates of hospitalization and mortality in patients who have had HF, these life-prolonging therapies continue to be underused. Many studies in a variety of clinical settings have documented that important numbers of patients who have had HF are not receiving treatment with these evidence-based therapies, which are recommended by national guidelines, when guided by conventional care. This HF treatment gap results from a variety of complex issues, including lack of systems and disease management programs. This gap in beta-blocker therapy may be due in part to persisting perceptions, despite recent evidence to the contrary, that it should be delayed until patients who developed HF have been stable for 2 to 4 weeks after hospital discharge and that its initiation results in a substantial risk of worsening HF. Conversely, recent clinical trial evidence has substantiated that beta blockers can be safely initiated for patients with HF in the hospital and that there are early benefits, including decreased risks of mortality and hospitalization for worsening HF. It has become increasingly evident that in-hospital initiation of evidence-based cardiovascular therapies and patient education have a positive effect on long-term patient compliance and clinical outcomes. Adopting in-hospital initiation of these therapies as the standard of care (in the absence of contraindications or intolerance) in patients who have HF and stabilized systolic dysfunction could substantially improve treatment rates, decrease the risk of future hospitalizations, and prolong life in the large number of patients who are hospitalized each year for HF. PMID:15518610

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

    PubMed

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

    2005-11-01

    We describe a new method, Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) for the rapid and sensitive real-time detection and quantification of volatile organic compounds from medically important fungi, grown on a range of laboratory media. SIFT-MS utilises the chemical ionisation reactions of mass-selected ions to characterise volatile organic compounds (VOCs) that are produced as metabolites from fungi. This technique has the distinct advantage over others in that it readily detects low molecular weight, reactive volatiles, and allows for real-time, quantitative monitoring. The fungi examined in this study were Aspergillus flavus, Aspergillus fumigatus, Candida albicans, Mucor racemosus, Fusarium solani, and Cryptococcus neoformans grown on or in malt extract agar, Columbia agar, Sabouraud's dextrose agar, blood agar, and brain-heart infusion broth. Common metabolites (ethanol, methanol, acetone, acetaldehyde, methanethiol, and crotonaldehyde) were detected and quantified. We found the fingerprint of volatiles, in terms of presence and quantity of volatiles to be strongly dependent on the culture medium, both in terms of variety and quantity of volatiles produced, but may form the basis for species specific identification of medically important fungi. PMID:15893831

  18. Multimodal medical information retrieval with unsupervised rank fusion.

    PubMed

    Mourão, André; Martins, Flåvio; Magalhães, João

    2015-01-01

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

  19. 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

  20. [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

  1. Clinical decision support foundations.

    PubMed

    Pradhan, Malcolm; Liaw, Siaw Teng

    2010-01-01

    This chapter gives an educational overview of: * The elements of a clinical decision; * The elements of decision making: prior probability, evidence (likelihood), posterior probability, actions, utility (value); * A framework for decision making, and support, encompassing validity, utility, importance and certainty; and * The required elements of a clinical decision support system. * The role of knowledge management in the construction and maintenance of clinical decision support. PMID:20407168

  2. The Gulf Coast tick: a review of the life history, ecology, distribution, and emergence as an arthropod of medical and veterinary importance.

    PubMed

    Teel, P D; Ketchum, H R; Mock, D E; Wright, R E; Strey, O F

    2010-09-01

    The Gulf Coast tick, Amblyomma maculatum Koch (Acari: Ixodidae), is a unique univoltine ectoparasite of seven vertebrate host classes in the Western Hemisphere that is increasingly recognized as a pest of livestock and wildlife, a vector of pathogens to humans and canines, and a putative vector of Ehrlichia ruminantium, the causal agent of heartwater, a fatal foreign animal disease of ruminants resident in the Caribbean. This review assembles current and historical literature encompassing the biology, ecology, and zoogeography of this tick and provides new assessments of changes in cyclical population distribution, habitat associations, host utilization, seasonal phenology, and life history. These assessments are pertinent to the emergence of A. maculatum as a vector of veterinary and medical importance, and its pest management on livestock and other animals. PMID:20939363

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

    ERIC Educational Resources Information Center

    Wilson, Sharise Mavis

    2010-01-01

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

  4. 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…

  5. Molecular Detection and Species-Specific Identification of Medically Important Aspergillus Species by Real-Time PCR in Experimental Invasive Pulmonary Aspergillosis ▿

    PubMed Central

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

    2011-01-01

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

  6. 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


  7. 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…

  8. 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


  9. 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…

  10. Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians

    PubMed Central

    Sugano, Koji; Okuyama, Toru; Iida, Shinsuke; Komatsu, Hirokazu; Ishida, Takashi; Kusumoto, Shigeru; Uchida, Megumi; Nakaguchi, Tomohiro; Kubota, Yosuke; Ito, Yoshinori; Takahashi, Kazuhisa; Akechi, Tatsuo

    2015-01-01

    Background Decision-making capacity to provide informed consent regarding treatment is essential among cancer patients. The purpose of this study was to identify the frequency of decision-making incapacity among newly diagnosed older patients with hematological malignancy receiving first-line chemotherapy, to examine factors associated with incapacity and assess physicians’ perceptions of patients’ decision-making incapacity. Methods Consecutive patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Decision-making capacity was assessed using the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory-Revised (SICIATRI-R). Cognitive impairment, depressive condition and other possible associated factors were also evaluated. Results Among 139 eligible patients registered for this study, 114 completed the survey. Of these, 28 (25%, 95% confidence interval [CI]: 17%-32%) were judged as having some extent of decision-making incompetency according to SICIATRI-R. Higher levels of cognitive impairment and increasing age were significantly associated with decision-making incapacity. Physicians experienced difficulty performing competency assessment (Cohen’s kappa -0.54). Conclusions Decision-making incapacity was found to be a common and under-recognized problem in older patients with cancer. Age and assessment of cognitive impairment may provide the opportunity to find patients that are at a high risk of showing decision-making incapacity. PMID:26296202

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

    PubMed

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

    2014-09-01

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

  12. Nurses' involvement in end-of-life decisions.

    PubMed

    de Veer, Anke J E; Francke, Anneke L; Poortvliet, Ernst-Paul

    2008-01-01

    In Dutch healthcare, patients and physicians are responsible for medical end-of-life decisions. These include nontreatment decisions, withholding or withdrawing parenteral hydration and nutrition where the patient can no longer drink or eat, relieving pain and other symptoms with drugs that might shorten life, euthanasia, and physician-assisted suicide. The objective of this study is to investigate the views of nurses on their role with regard to discussing these kinds of decisions, as well as their actual role in the decision-making process. Nurses (n = 489) involved in palliative terminal care answered questions about their preferred and actual role in end-of-life decision-making processes. Nurses want to be involved in making end-of-life decisions, but this depends partly on the kind of decision that has to be taken. When caring for terminal patients, 62% of the nurses usually talk about such decisions with patients or their families. Three-quarters of the nurses had been involved in an end-of-life decision-making process in the previous 2 years, mostly by talking with the physician and the patient's family. It is concluded that physicians should discuss these decisions with nurses more often. The finding that characteristics of the nurses influence their role in end-of-life decision-making processes emphasizes the importance of developing mechanisms to ensure that end-of-life decisions are made in a consistent manner and do not depend on the demographic characteristics of nurses. PMID:18453879

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

    PubMed

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

    2015-05-01

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

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

    NASA Astrophysics Data System (ADS)

    Baarsen, Bernadette van

    2013-06-01

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

  15. Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-Health tools versus print materials: A randomized controlled trial

    PubMed Central

    Heisler, Michele; Choi, Hwajung; Palmisano, Gloria; Mase, Rebecca; Richardson, Caroline; Fagerlin, Angela; Montori, Victor M.; Spencer, Michael; An, Laurence C.

    2015-01-01

    Background Health care centers serving low-income communities have scarce resources to support medication decision-making among patients with poorly controlled diabetes. Objective We compared outcomes between community health worker (CHW) use of a tailored, interactive web-based tablet-delivered tool (iDecide) versus use of print educational materials. Design A randomized two-arm trial from 2011-2013. Trial Registration NCT01427660. Setting Community health center in Detroit serving a Latino and African American low-income population. Participants 188 adults with a hemoglobinA1c >7.5% (55%) or who reported questions, concerns, or difficulty taking diabetes medications Primary Funding Sources Agency for Health Care Quality and Research (1R18HS019256-01) and P30DK092926 (MCDTR) Measurements Primary outcomes were changes in knowledge about anti-hyperglycemic medications, patient-reported medication decisional conflict, and satisfaction with anti-hyperglycemic medication information. We also examined changes in diabetes distress, self-efficacy, medication adherence, and A1c. Intervention Participants were randomized to receive a 1-2 hour session with a CHW using either iDecide or printed educational materials and two follow-up calls. Results 94% of participants completed three-month follow-up. Both groups improved across most measures. iDecide participants reported greater improvements in satisfaction with medication information (helpfulness, p=.007; clarity, p=.03) and in diabetes distress compared to the print materials group (p<0.001). There were no differences between groups in other outcomes. Limitations The study was conducted at one health center over a short period, and the CHWs were experienced in behavioral counseling, thus possibly mitigating the need for additional support tools. Conclusions Most outcomes were similarly improved among participants receiving both types of diabetes medication decision-making support. Longer-term evaluations are necessary to determine whether the greater improvements in satisfaction with medication information and diabetes distress achieved in the iDecide group at three months translate into better longer-term diabetes outcomes. PMID:25402398

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

    PubMed

    Nulty, Dorothy

    2011-01-01

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

  17. The use of amplified fragment length polymorphism in determining species trees at fine taxonomic levels: analysis of a medically important snake, Trimeresurus albolabris.

    PubMed

    Giannasi, N; Thorpe, R S; Malhotra, A

    2001-02-01

    There are a huge number of phylogenetic studies based on mitochondrial DNA (mtDNA); however, these may represent gene trees that may not be congruent with the species tree. A solution to this problem is to include additional, independent, loci from the nuclear genome. At fine taxonomic levels, i.e. between populations and closely related species, previously suggested nuclear markers such as intron sequence data may not be appropriate. In this study we investigate the use of amplified fragment length polymorphisms (AFLP) to aid determination of the species tree for 24 specimens of a medically important snake, Trimeresurus albolabris. This is of particular importance for many venomous snakes as venom often varies intraspecifically. Five different primer combinations produced 434 bands and were analysed by constructing a phylogenetic tree using neighbour joining and principal component analysis. Results were similar across all methods and found distinct groupings. The results were compared with mtDNA data and a reconciled tree was constructed in order to determine the species tree for T. albolabris. We found that T. albolabris (sensu lato) is not monophyletic. Specimens from the Indonesian islands (except West Java) form a distinct clade and we propose elevation to species level. A specimen from Nepal is also distinct and suggests that this population also deserves specific status. We suggest that AFLPs may prove a valuable aid in determining species trees as opposed to gene trees at fine taxonomic levels and this should facilitate the incorporation of molecular data into such activities as antivenom production and conservation management. PMID:11298956

  18. Economic Evaluation Enhances Public Health Decision Making.

    PubMed

    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. PMID:26157792

  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. PMID:26157792

  20. [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

  1. The Integrated Medical Model

    NASA Technical Reports Server (NTRS)

    Butler, Douglas J.; Kerstman, Eric

    2010-01-01

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

  2. 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.

  3. Use of the medical Ethics Consultation Service in a busy Level I trauma center: impact on decision-making and patient care.

    PubMed

    Johnson, Laura S; Lesandrini, Jason; Rozycki, Grace S

    2012-07-01

    The purposes of this study were to assess reasons for consultation of the Ethics Consultation Service for trauma patients and how consultations impacted care. We conducted a review of ethics consultations at a Level I trauma center from 2001 to 2010. Data included patient demographics, etiology of injury, and timing/type of the consult, categorized as: shared decision-making, end-of-life, privacy and confidentiality, resource allocation, and professionalism. Consultations were requested on 108 patients (age mean, 46.5 ± 20 years; Injury Severity Score mean, 23 ± 14; length of stay [LOS] mean, 44 ± 44 days), 0.50 per cent of all trauma admissions. Seventy-seven per cent of consultations occurred in the intensive care unit. End of life was the most common consultation (44%) followed by shared decision-making (41%). Average time to consultation was 25 days. Shared decision-making consults occurred much earlier than end-of-life consults as evidenced by a lower consult day/LOS ratio (consult day/LOS = 0.36 ± 0.3 vs 0.77 ± 0.3, P = 0.0001). Conclusions consisted of: 1) ethics consultation on trauma patients are most commonly for end-of-life and shared decision-making issues; 2) most ethics consultations occur while patients are in the intensive care unit; and 3) earlier ethics consultations are likely to be for shared decision-making issues. PMID:22748529

  4. End-of-life decisions: Christian perspectives.

    PubMed

    Stempsey, William E

    1997-12-01

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

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

    PubMed Central

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

    2011-01-01

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

  6. 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.

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    Archer, Benjamin R; Gray, Joel E

    2005-12-01

    The recently published Report No. 147 of The National Council on Radiation Protection and Measurements entitled "Structural shielding design for medical x-ray imaging facilities" provides an update of shielding recommendations for x rays used for medical imaging. The goal of this report is to ensure that the shielding in these facilities limits radiation exposures to employees and members of the public to acceptable levels. Board certified medical and health physicists, as defined in this report, are the "qualified experts" who are competent to design radiation shielding for these facilities. As such, physicists must be aware of the new technical information and the changes from previous reports that Report No. 147 supersedes. In this article we summarize the new data, models and recommendations for the design of radiation barriers in medical imaging facilities that are presented in Report No. 147. PMID:16475758

  9. Parental Decision Making in Male Circumcision

    PubMed Central

    Sardi, Lauren; Livingston, Kathy

    2015-01-01

    Abstract Purpose: To study which healthcare professionals (HCPs) firstasked parents about their decision regarding circumcision; whether parents felt they were given enough information by their HCP; and what reasons parents cited for their decision. Study Design and Methods: Bilingual questionnaires were administered to parents and expecting parents of boys (N = 60). Close-ended survey responses were analyzed through factor analysis to ascertain what types of beliefs parents used in their decision making, whether they felt they had enough information, and who first asked them about their decision. Results: Nurses were most likely to be the first HCPs to ask parents about circumcision. Parental personal and cultural beliefs played an equal or more important role in influencing decision making than medical information received. However, some parents noted that there was a lack of access to accurate information regarding risks and benefits of male circumcision. Clinical Nursing Implications: Nurses continue to play a critical role in acquisition of knowledge surrounding male circumcision and serve as important liaisons between parents and the proxy consent process. Nurses, as well as other HCPs, should discuss circumcision early in pregnancy so parents have ample time to ask questions, gather information, and make an appropriate decision. PMID:25504039

  10. 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

  11. Medication communication through documentation in medical wards: knowledge and power relations.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-09-01

    Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. PMID:23822212

  12. 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

  13. 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…

  14. 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

  15. 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


  16. 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

  17. Medical Issues: Nutrition

    MedlinePLUS

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

  18. Personal portable devices as enablers for advanced pHealth decision support and decision making services.

    PubMed

    Pharow, Peter; Lhotska, Lenka; Cheshire, Paul

    2013-01-01

    Mobile devices are becoming more and more important for services offered either directly to individuals, or indirectly as part of a therapeutic or rehabilitation procedure. Representing the work of the EFMI WG "Personal Portable Devices", this paper offers an introduction to some of the most important technical and privacy-related challenges that arise when introducing mobile sensor or actuator devices (and networks) into health care, wellness, and fitness processes in order to exploit their capability to collect, record and process personal health data. Data processing can be viewed in three classes of application, namely processes for recommendations, decision support and decision making in personalized health and wellbeing service provision. This paper therefore briefly addresses aspects such as the Medical Device Directive for certifying devices in that respect. But regardless whether being MDD-compliant or not, each class of devices may have its own benefits and weaknesses in terms of enabling health-related personalized decisions. PMID:23739352

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

    PubMed

    Lemmens, Christophe

    2010-12-01

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

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

    PubMed

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

    2013-05-01

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

  1. Intergenerational Differences and Similarities in Life-Sustaining Treatment Attitudes and Decision Factors.

    ERIC Educational Resources Information Center

    Mills, Terry L.; Wilmoth, Janet M.

    2002-01-01

    A cross-sectional sample of three-generation families was used to evaluate life-sustaining medical treatment attitudes and decision factors. Results show that the older generation perceived mental capacity, family burden, and pain as most important considerations. Among the middle generation the type of life-sustaining treatment was important. The…

  2. [Medical ethics and responsibility].

    PubMed

    Labram, Claude; Dusehu, Etienne

    2002-04-20

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

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

    PubMed

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

    2013-12-01

    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

  4. 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.; Alvord, Lori Arviso; Flum, David R.

    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

  5. Shared decision-making in epilepsy management.

    PubMed

    Pickrell, W O; Elwyn, G; Smith, P E M

    2015-06-01

    Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance. PMID:25862468

  6. [The Importance of Medication History Management by Hospital and Community Pharmacists for Oral Anticancer Drug S-1(Tegafur/Gimeracil/Oteracil Potassium) - A Retrospective Study].

    PubMed

    Maeda, Makoto; Saito, Yoshimasa; Makino, Yoshinori; Iwase, Haruo; Hayashi, Yoshikazu

    2016-01-01

    S-1(tegafur/gimeracil/oteracil potassium)is an effective oral anticancer drug for treatment of a wide spectrum of cancers. However, it may incur serious adverse effects through factors such as interactions with other drugs, renal dysfunction, or an insufficient washout period. In view of this, pharmacists should play an increasingly significant role in managing the medication history of patients treated with S-1. As there seems to be no standardized management tool for patients receiving S-1, we conducted a retrospective study to evaluate medication history management methods, which are commonly available in community pharmacies as well as hospitals. We identified 128 outpatients who were prescribed S-1 for the first time at the National Cancer Center Hospital from July to December of 2011. These patients were divided into in-hospital(n=48)and out-of-hospital(n=80)groups. The percentage of patients, who dropped out during the first course of S-1 treatment, was 16.7% for the in-hospital group, and 10% for the out-of-hospital group. Examining renal dysfunction, non-elderly patients with low creatinine clearance(Ccr)were found. These results suggest that there is the possibility of side effect occurrence in both the in-hospital and out-of-hospital prescription groups. Community pharmacists should check prescriptions with particular attention to the Ccr. It is necessary to develop mechanisms for cooperation between hospital and community pharmacists, with clear role sharing between them, allowing the community pharmacists to exercise medication history management for patients prescribed S-1 to the same degree as hospital pharmacists based on available information including laboratory test values. PMID:26809530

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

    PubMed Central

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

    2012-01-01

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

  8. Designing for Decision Making

    ERIC Educational Resources Information Center

    Jonassen, David H.

    2012-01-01

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


  9. Improving Decision Making.

    ERIC Educational Resources Information Center

    Mehallis, Mantha, Ed.

    1981-01-01

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

  10. Designing for Decision Making

    ERIC Educational Resources Information Center

    Jonassen, David H.

    2012-01-01

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

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

    PubMed Central

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

    2013-01-01

    Introduction: Health care systems in the United States are transitioning from volume-based purchasing models to value-based purchasing models that demand both delivery of personalized care for each patient and cost-effective population health management. The enhanced medical record for aging brain care (eMR-ABC) software is an electronic decision support system that facilitates the management of a high-risk population suffering from aging brain disorders such as dementia. Methods: Using the lenses of the Complex Adaptive System and the Reflective Adaptive Process, we assembled an interdisciplinary team of clinicians, health services researchers, and software developers who designed, implemented, evaluated, and continuously modified the eMR-ABC to meet the needs of care coordinators who manage the health of a targeted high-risk population. Results: The eMR-ABC captures and monitors the cognitive, functional, behavioral, and psychological symptoms of a registry of patients suffering from dementia or depression as well as the burden of patients’ family caregivers. It provides decision support to care coordinators to create a personalized care plan that includes evidence-based nonpharmacological protocols, self-management handouts, and alerts of medications with potentially adverse cognitive effects. The software’s built-in engine tracks patient visits and on-demand functionality to generate population reports for specified indicators. Discussion: Population health programs depend on data collection and information systems with the ability to provide valuable and timely feedback on an ongoing basis. Following these guidelines, the eMR-ABC was designed specifically to meet the management needs of a high-risk population. PMID:25848560

  12. 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

  13. [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

  14. [The decision-making process of abortion high committees].

    PubMed

    Cohen-Almagor, R; Snir, Y

    2000-06-15

    Factors influencing the decision-making process of the Abortions High Committees (after the 23rd week of pregnancy), and whether there are differences between decisions of different Committees were examined. A questionnaire was sent to the 45 members of these committees of whom 24 responded (53%). Some hospitals refused to cooperate because they did not want to evoke discussion about the practices of the Committees. The significant factors that play a part in the decision as to whether or not to allow an abortion are the medical condition of the fetus, the medical and psychological state of the mother, and the week of pregnancy. The data also show that women committee members are more inclined to authorize abortion than men, and that the more religious members are less inclined to authorize abortions. No differences were found between hospitals, and the age of committee members had no influence. Members did not accord any importance to fear of litigation in their considerations. PMID:10979420

  15. Can Medical Decision-making at the Scene by EMS Staff Reduce the Number of Unnecessary Ambulance Transportations, but Still Be Safe?

    PubMed Central

    Peyravi, Mahmoudreza; Örtenwall, Per; Khorram-Manesh, Amir

    2015-01-01

    Objectives: The aim of this study was to evaluate the procedures adopted by the staff of the Shiraz Emergency Medical Services (EMS) and the outcome of the patients discharged from the scene over a one-year period.   Background: Unnecessary use of ambulances results in the overloading of EMS and the over-crowding of emergency departments. Medical assessment at the scene by EMS staff may reduce these issues. In an earlier study in Shiraz, 36% of the patients were left at home/discharged directly from the scene with or without treatment by EMS staff after consulting a physician at the dispatch center. However, there has been no evaluation of this system with regard to mortality and morbidity.   Materials and Methods: Retrospective data on all missions performed by the Shiraz EMS (2012-2013) were reviewed. All the patients discharged from the scene by the EMS staff on the 5th, 15th, and 25th days of each month were included. A questionnaire with nine questions was designed, and available patients/relatives were interviewed prospectively (2014; follow-up period 4-12 months).   Results: Out of 3019 cases contacted, 994 (almost 33%) replied. There were 26%-93% reductions in the complaints in all disease categories. A group of the patients left the scene at their own will. Of those who were discharged by the EMS staff at the scene, over 60% were without any complaints. Twelve out of 253 patients died after they were sent home by the EMS staff.   Conclusions: Patients may be discharged at the scene by EMS staff and after consulting a physician. However, there is a need for a solid protocol to ensure total patient safety. This calls for a prospective study.  PMID:26203394

  16. 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

  17. The importance of a medical chaperone: a quality improvement study exploring the use of a note stamp in a tertiary breast surgery unit

    PubMed Central

    Rose, K; Eshelby, S; Thiruchelvam, P; Khoo, A; Hogben, K

    2015-01-01

    Objectives The project aim was to determine current use and documentation of medical chaperones within a major breast service unit. It explored ways of improving adherence to professional guidelines concerning chaperones. Setting The single centre quality improvement project was completed in a tertiary breast service unit in North West London. It was a three-stage project with initial audit in October 2013, 1st postintervention cycle in November 2013 and 2nd postintervention cycle in October 2014. Participants In each study cycle, data were collected from entries in clinic notes until at least 155 encounters with documented clinical examination were analysed. All notes were of female patients. Interventions (1) Intervention 1st cycle: presentation and discussion of chaperone guidelines alongside reminder posters and introduction of note stamp. (2) Intervention 2nd cycle: note stamp alone. Primary and secondary outcome measures Documentation of chaperone offer, documentation of patient preference regarding chaperone, identifier (name or signature) of chaperone present and gender of examining clinician. Results In the 1st postintervention cycle, 69.95% documentation of chaperone offer was recorded, p<0.001, CI (59.04% to 80.76%). This result was replicated in the 2nd postintervention cycle a year later with 74.86% documentation of chaperone offer recorded, p<0.001, CI (66.41% to 83.31%). The 4.91% difference was insignificant; p=0.294, CI (14.03% to 4.21%). Conclusions The authors suggest that a proforma approach to medical chaperones is an effective means of ensuring adherence to best practice guidelines. A stamp, or similar, that can be embedded into documentation structure is an effective example of such an approach. Improved documentation allows any problems with adherence to guidelines to be more easily identified, helping to ensure the safeguarding of patients and staff involved in intimate examinations. PMID:26179645

  18. Program eases decision making.

    PubMed

    Turri, J J

    1988-10-01

    A useful tool to assist management with complex multiple-criteria decision making is the analytic hierarchy process (AHP) microcomputer program. The AHP requires the user to judge the relative importance of each criterion, then specify a preference for each alternative relative to each criterion. The result is a prioritized overall ranking of the decision alternatives. Providence Ventures, Inc., used the AHP to assist a recent hospital client in selecting a magnetic resonance imaging vendor. A committee was appointed to narrow the decision alternatives down to three vendors, using the following criteria: price, technology, sitting, service, service contract, cryogen contract, and patient comfort. A key factor in the AHP is establishing priorities and preferences through the pairwise comparison procedure. The program asks the user, for example, if price and technology are equally important. If the response is no, the user tells the program which is more important and by how much, assigning a weight to each criterion. Similarly the user enters pairwise preferences for the vendors in regard to each criterion. The program then computes the overall decision. The entire process takes 10 to 15 minutes. A tool such as the AHP enables the manager and hospital to gain control of resources by saving time in reaching a decision, double checking other decisions for validity, using the model to audit department head decisions, and standardizing the decision-making process. PMID:10290384

  19. Time as a dimension of medical law.

    PubMed

    Harrington, John

    2012-01-01

    This paper considers the importance of temporal categories in medical law argumentation. Proceeding from a view of time as plural, rhetorical, and socially produced, it argues that decision making in areas such as the access of minors to contraception, abortion law, end of life care, and emergency caesarian sections can be usefully read as struggles over appropriate time frames. Judges, legislators, and commentators seek to establish the plausibility of a given legal development with reference to the common sense understanding of time which it embodies. Such understandings may be plausible because of their resonance with the diverse temporalities of the law itself. Alternatively, they may reproduce the temporal frames proper to medical science. Not only is time represented in medical law rhetoric, but deliberation in such cases is also subject to temporal pressures which may significantly affect their outcome. The paper concludes by considering the broader political stakes of intertemporal struggles in medical law. PMID:22474099

  20. 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

  1. 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

  2. Three innovative curricula for addressing medical students' career development.

    PubMed

    Navarro, Anita M; Taylor, Anita D; Pokorny, Anita P

    2011-01-01

    Medical students make specialty decisions that are critically important to their long-term career satisfaction and overall well-being. The dynamic of larger class sizes set against stagnant numbers of residency positions creates an imperative for students to make and test specialty decisions earlier in medical school. Ideally, formal career advising begins in medical school. Medical schools typically offer career development programs as extracurricular offerings. The authors describe three curricular approaches and the innovative courses developed to address medical students' career development needs. The models differ in complexity and cost, but they share the goals of assisting students to form career identities and to use resources effectively in their specialty decision processes. The first model is a student-organized specialties elective. To earn course credit, students must complete questionnaires for the sessions, submit results from two self-assessments, and report on two physician informational interviews. The second model comprises two second-year career development courses that have evolved into a longitudinal career development program. The third model integrates career topics through a doctoring course and advising teams. The authors discuss challenges and lessons learned from implementing each of the programs, including marshaling resources, achieving student buy-in, and obtaining time in the curriculum. Invoking a curricular approach seems to normalize the tasks associated with career development and puts them on par in importance with other medical school endeavors. PMID:21099397

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

    PubMed Central

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

    2014-01-01

    Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived. PMID:24804212

  4. 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.; Rodrigues, George; Palma, David A.; Cao, Jeffrey Q.; Yaremko, Brian P.; Malthaner, Richard; Mocanu, Joseph D.

    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.

  5. Information resources to aid parental decision-making on when to seek medical care for their acutely sick child: a narrative systematic review

    PubMed Central

    Neill, Sarah; Roland, Damian; Jones, Caroline HD; Thompson, Matthew; Lakhanpaul, Monica

    2015-01-01

    Objective To identify the effectiveness of information resources to help parents decide when to seek medical care for an acutely sick child under 5 years of age, including the identification of factors influencing effectiveness, by systematically reviewing the literature. Methods 5 databases and 5 websites were systematically searched using a combination of terms on children, parents, education, acute childhood illness. A narrative approach, assessing quality via the Mixed Methods Appraisal Tool, was used due to non-comparable research designs. Results 22 studies met the inclusion criteria: 9 randomised control trials, 8 non-randomised intervention studies, 2 qualitative descriptive studies, 2 qualitative studies and 1 mixed method study. Consultation frequency (15 studies), knowledge (9 studies), anxiety/reassurance (7 studies), confidence (4 studies) satisfaction (4 studies) and antibiotic prescription (4 studies) were used as measures of effectiveness. Quality of the studies was variable but themes supported information needing to be relevant and comprehensive to enable parents to manage an episode of minor illness Interventions addressing a range of symptoms along with assessment and management of childhood illness, appeared to have the greatest impact on the reported measures. The majority of interventions had limited impact on consultation frequencies, No conclusive evidence can be drawn from studies measuring other outcomes. Conclusions Findings confirm that information needs to be relevant and comprehensive to enable parents to manage an episode of minor illness. Incomplete information leaves parents still needing to seek help and irrelevant information appears to reduce parents’ trust in the intervention. Interventions are more likely to be effective if they are also delivered in non-stressful environments such as the home and are coproduced with parents. PMID:26674495

  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. Comprehensive framework for preventive maintenance priority of medical equipment.

    PubMed

    Saleh, Neven; Balestra, Gabriella

    2015-08-01

    Throughout the medical equipment life cycle, preventive maintenance is considered one of the most important stages that should be managed properly. However, the need for better management and control by giving a reasonable prioritization for preventive maintenance becomes essential. The purpose of this study is to develop a comprehensive framework for preventive maintenance priority of medical equipment using Quality Function Deployment (QFD) and Fuzzy Logic (FL). The quality function deployment is proposed in order to identify the most important criteria that could impact preventive maintenance priority decision; meanwhile the role of the fuzzy logic is to generate a priority index of the list of equipment considering those criteria. The model validation was carried out on 140 pieces of medical equipment belonging to two hospitals. In application, we propose to classify the priority index into five classes. The results indicate that the strong correlation existence between risk-based criteria and preventive maintenance priority decision. PMID:26736488

  8. Civilian medical qualification determinations.

    PubMed

    Gibson, Brent Randall; Fox-Samson, Connie L; Rowe, John R

    2007-01-01

    Much like their counterparts in private industry, federal medical officers, particularly preventive and occupational medicine physicians, must ensure a workforce fit to perform their duties. Meeting this objective often requires balancing competing interests between employers and employees. The medical examination is the method for protecting the government's interests in identifying federal civilian applicants and workers who are medically unqualified to perform their duties while also preventing discrimination against qualified individuals with disabilities. Scant published guidance on performing authorized medical examinations and analyzing the resultant information is available for federal medical officers. This is needed to foster an equitable, compliant decision for both federal employers and employees. Using the Department of Defense as an example, this article provides a legal road map for the practitioner by defining medical standards and physical requirements, discussing medical examinations, and examining disability determinations. PMID:17274268

  9. Medical Care during Pregnancy

    MedlinePLUS

    ... Emergency Cerebral Palsy: Caring for Your Child Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During ... médica durante el embarazo The Importance of Prenatal Care Millions of American women give birth every year, ...

  10. Medical Care during Pregnancy

    MedlinePLUS

    ... for Your Child All About Food Allergies Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During ... médica durante el embarazo The Importance of Prenatal Care Millions of American women give birth every year, ...

  11. HIV Medication Adherence

    MedlinePLUS

    HIV Treatment HIV Medication Adherence (Last updated 3/1/2016; last reviewed 3/1/2016) Key Points Medication adherence means sticking ... exactly as prescribed. Why is adherence to an HIV regimen important? Adherence to an HIV regimen gives ...

  12. Decision Making in Action

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

  13. Guarding against discriminatory treatment decisions.

    PubMed

    Griffith, Richard

    2013-10-01

    This article studies a case in which a 52-year-old male patient has early onset dementia, Down's syndrome and an associated heart condition, for which he is prescribed warfarin and digoxin. A district nurse, who is an independent prescriber, monitors and adjusts his medication and takes the required blood sample. The staff at the care home where the patient lives report that the patient is spitting out his medication and they have not been able to persuade him to swallow his tablets for a week. Despite the patient being assessed as lacking capacity to decide treatment decisions, the care home staff argue that his refusal to take medication should be respected and the medication discontinued. Although withdrawing the medication would make caring for the patient less challenging, the district nurse assesses the legal obligations that must be considered before this decision can be considered lawful. PMID:24471220

  14. Medical leasing.

    PubMed

    Holden, Elizabeth A

    2012-01-01

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

  15. Medical database security policies.

    PubMed

    Pangalos, G J

    1993-11-01

    Database security plays an important role in the overall security of medical information systems. Security does not only involve fundamental ethical principles such as privacy and confidentiality, but is also an essential prerequisite for effective medical care. The general framework and the requirements for medical database security are presented. The three prominent proposals for medical database security are discussed in some detail, together with specific proposals for medical database security. A number of parameters for a secure medical database development are presented and discussed, and guidelines are given for the development of secure medical database systems. PMID:8295541

  16. Cognitive processes in anesthesiology decision making.

    PubMed

    Stiegler, Marjorie Podraza; Tung, Avery

    2014-01-01

    The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making. PMID:24212195

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

    PubMed Central

    Petrocelli, John V.

    2013-01-01

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

  18. Medication Adherence Behavior and Priorities Among Older Adults With CKD: A Semistructured Interview Study

    PubMed Central

    Rifkin, Dena E.; Laws, M. Barton; Rao, Madhumathi; Balakrishnan, V. S.; Sarnak, Mark J.; Wilson, Ira B.

    2010-01-01

    Background Older adults with chronic kidney disease (CKD) typically take more than five medications and have multiple prescribing physicians. Little however is known about how they prioritize their medical conditions or decide which medications to take. Methods Semistructured interviews (average length 40 minutes) with twenty community-dwelling adults with CKD stages 3-5D, receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients’ decisions regarding medication prioritization, understanding, and adherence decisions. Results Participants (age range, 55–84 years; mean, 72) took 5–14 prescribed medications, had 2–9 physicians, and 5–11 comorbid conditions. All had assigned implicit priorities to their medications. While the majority expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there was often substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and on the barriers (physical, logistic, or financial) to taking the prescribed drug. Side effects of medications were common and anxiety-provoking, but discussions with the prescribing physician were often delayed or unfulfilling for the patient. Conclusions Polypharmacy in CKD patients leads to complex medication choices and adherence behaviors in this population. Most of the patients we interviewed had beliefs or priorities that were non-concordant with conventional medical opinion, but patients rarely discussed these beliefs and priorities, or the resultant poor medication adherence, with their physicians. Further study is needed to provide quantitative data on the magnitude of adherence barriers. It is likely that more effective communication about medication taking could improve patients’ health outcomes and reduce potential adverse drug events. PMID:20674113

  19. High-throughput multiplexed xMAP Luminex array panel for detection of twenty two medically important mosquito-borne arboviruses based on innovations in synthetic biology.

    PubMed

    Glushakova, Lyudmyla G; Bradley, Andrea; Bradley, Kevin M; Alto, Barry W; Hoshika, Shuichi; Hutter, Daniel; Sharma, Nidhi; Yang, Zunyi; Kim, Myong-Jung; Benner, Steven A

    2015-03-01

    Mosquito-borne arboviruses are emerging world-wide as important human and animal pathogens. This makes assays for their accurate and rapid identification essential for public health, epidemiological, ecological studies. Over the past decade, many mono- and multiplexed assays targeting arboviruses nucleic acids have been reported. None has become established for the routine identification of multiple viruses in a "single tube" setting. With increasing multiplexing, the detection of viral RNAs is complicated by noise, false positives and negatives. In this study, an assay was developed that avoids these problems by combining two new kinds of nucleic acids emerging from the field of synthetic biology. The first is a "self-avoiding molecular recognition system" (SAMRS), which enables high levels of multiplexing. The second is an "artificially expanded genetic information system" (AEGIS), which enables clean PCR amplification in nested PCR formats. A conversion technology was used to place AEGIS component into amplicon, improving their efficiency of hybridization on Luminex beads. When Luminex "liquid microarrays" are exploited for downstream detection, this combination supports single-tube PCR amplification assays that can identify 22 mosquito-borne RNA viruses from the genera Flavivirus, Alphavirus, Orthobunyavirus. The assay differentiates between closely-related viruses, as dengue, West Nile, Japanese encephalitis, and the California serological group. The performance and the sensitivity of the assay were evaluated with dengue viruses and infected mosquitoes; as few as 6-10 dengue virions can be detected in a single mosquito. PMID:25680538

  20. High-throughput Multiplexed xMAP Luminex Array Panel for Detection of Twenty TWO Medically Important Mosquito-borne Arboviruses based on Innovations in Synthetic Biology

    PubMed Central

    Glushakova, Lyudmyla G.; Bradley, Andrea; Bradley, Kevin M.; Alto, Barry W.; Hoshika, Shuichi; Hutter, Daniel; Sharma, Nidhi; Yang, Zunyi; Kim, Myong-Jung; Benner, Steven A.

    2015-01-01

    Mosquito-borne arboviruses are emerging world-wide as important human and animal pathogens. This makes assays for their accurate and rapid identification essential for public health, epidemiological, ecological studies. Over the past decade, many mono- and multiplexed assays targeting arboviruses nucleic acids have been reported. None has become established for the routine identification of multiple viruses in a “single tube” setting. With increasing multiplexing, the detection of viral RNAs is complicated by noise, false positives and negatives. In this study, an assay was developed that avoids these problems by combining two new kinds of nucleic acids emerging from the field of synthetic biology. The first is a “self-avoiding molecular recognition system” (SAMRS), which enables high levels of multiplexing. The second is an “artificially expanded genetic information system” (AEGIS), which enables clean PCR amplification in nested PCR formats. A conversion technology was used to place AEGIS component into amplicon, improving their efficiency of hybridization on Luminex beads. When Luminex “liquid microarrays” are exploited for downstream detection, this combination supports single-tube PCR amplification assays that can identify 22 mosquito-borne RNA viruses from the genera Flavivirus, Alphavirus, Orthobunyavirus. The assay differentiates between closely-related viruses, as dengue, West Nile, Japanese encephalitis, and the California serological group. The performance and the sensitivity of the assay were evaluated with dengue viruses and infected mosquitoes; as few as 6–10 dengue virions can be detected in a single mosquito. PMID:25680538