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Sample records for readera medical decision

  1. Automated modeling of medical decisions.

    PubMed Central

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

    1993-01-01

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

  2. [Medical decision making: some aspects].

    PubMed

    Steurer, J

    2004-09-22

    Three main aspects of medical decision making will be shortly described in this article. Comprehensible information is required to make decisions. The question is, how much information is needed to make decisions, and a third aspect in this article concerns the decision maker. Research in the field of information transfer has shown that medical information, as presented in most journals, is difficult to understand. According to the classic decision theory, decisions are taken after collecting all available information. More recent research in decision making proves the hypothesis that human beings are able to decide correctly with much less information than presumed earlier. In medicine the patient is the decision maker, and the primary task of physicians is to inform the patient about his health status and enable him to reach a conclusion. PMID:15500244

  3. 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. PMID:27034630

  4. 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…

  5. Hormone therapy, dilemmas, medical decisions.

    PubMed

    Schulkin, Jay

    2008-01-01

    The decision for women to go on hormone therapy (HT) remains controversial. An historical oscillation of beliefs exists related in part to expectations of the medicinal value of HT over longer-term use beyond the initial peri-menonpausal period. Studies thought to resolve issues surrounding the efficacy of HT were perhaps overstated as confusion still permeates the decision making with regard to HT. Overzealous advertising and exaggerated understanding of the results (negative or positive) undermine patient and physician decision making. There remains no magic bullet with regard to HT. What remains is still the possibility of HT longer-term efficacy on diverse end organ systems with pockets of clinical and scientific ambiguity while working to engender reasonable expectations. PMID:18315763

  6. Acceptable regret in medical decision making.

    PubMed

    Djulbegovic, B; Hozo, I; Schwartz, A; McMasters, K M

    1999-09-01

    When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another course of action would have been preferable. This realization may bring a sense of loss, or regret. When anticipated regret is compelling, a decision maker may choose to violate expected utility theory to avoid regret. We formulate a concept of acceptable regret in medical decision making that explicitly introduces the patient's attitude toward loss of health due to a mistaken decision into decision making. In most cases, minimizing expected regret results in the same decision as maximizing expected utility. However, when acceptable regret is taken into consideration, the threshold probability below which we can comfortably withhold treatment is a function only of the net benefit of the treatment, and the threshold probability above which we can comfortably administer the treatment depends only on the magnitude of the risks associated with the therapy. By considering acceptable regret, we develop new conceptual relations that can help decide whether treatment should be withheld or administered, especially when the diagnosis is uncertain. This may be particularly beneficial in deciding what constitutes futile medical care. PMID:10580533

  7. 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

  8. [Kairos. Decision-making in medical ethics].

    PubMed

    Jousset, David

    2014-06-01

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

  9. Medical decision making for the incompetent patient.

    PubMed

    Drane, J F; Roth, R B

    1987-12-01

    In America competent adult patients have a right to refuse unwanted medical treatments. For incompetent patients who have made no advance directive, the family ordinarily makes decisions about medical treatments. But in many healthcare facilities, problems arise in choosing a surrogate to make decisions for an incompetent patient and in working with that surrogate. Concrete, step-by-step procedures for resolving conflict are needed. Every effort should be made to have competent patients fill out advance directives or indicate their treatment preferences in the event of loss of competence. Family members may not override decisions made by competent patients, but anyone closely involved with the patients' care may question their competence. The physician generally assesses the patients' competence, but sometimes the courts are involved. The physician may be the appropriate person to choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government. Treatment decisions are made within the surrogate-patient-physician triad. When different value judgments about the proper treatment conflict, the surrogate may have to mediate to restore physician-patient communication, or institutional proceedings through the ethics committee may be needed to resolve disputes quickly, amicably, and at low cost. As a last resort, the case may be referred to the courts. PMID:10285412

  10. Anomalies in medical decision making: the preception of risk

    SciTech Connect

    Travis, C.; Tonn, B.

    1985-03-28

    This paper discusses risk perception in medical decision making. Biases in risk perception by physicians and patients could result in undue loss of life and unwarranted medical expenses. Possible biases include availability of information, framing of choices, and the fundamental attribution error. An example of an anomaly in medical decision making possibly related to biased decision making is elective hysterectomy. 25 refs.

  11. Surgical decisions regarding medically intractable epilepsy.

    PubMed

    Spencer, D D; Pappas, C T

    1992-01-01

    The neurosurgeon's primary intention in epilepsy care is to cure patients with medically intractable seizures. If cure cannot be achieved, reduction of the frequency and intensity of the seizures may be worthwhile. With these goals, work-up of the patients must be thoroughly carried out to localize the seizure focus and to demarcate surrounding functional brain. Once the seizure focus and pattern are well understood, the surgical decision can be based on a logical and flexible decision tree. Potential complications and past statistics must also enter into the decision process. With these factors combined, the routine and special needs for each patient can be accommodated. The advancing modalities of AVEEG monitoring and imaging, coupled with more sophisticated surgical techniques resulting in predictably good outcomes, have moved surgery for medically intractable epilepsy from a few dedicated centers to universal component of our health care. Increasing numbers of young patients afflicted with this chronic debilitating disease can expect freedom from social and employer ostracism, a chance to drive, and an opportunity for freedom from family or other caretaker dependence. Advancement in this will continue as neurosurgeons blend their knowledge of basic neurobiology and the clinical sciences. PMID:1537203

  12. Advance directive decision making among medical inpatients.

    PubMed

    Rein, A J; Harshman, D L; Frick, T; Phillips, J M; Lewis, S; Nolan, M T

    1996-01-01

    Per the Patient Self-Determination Act of 1991, hospitals are required to ascertain whether patients have an advance directive (AD). At this point, factors prompting patients to issue ADs have not been studied. The purpose of this study was to describe patients' understanding of ADs as well as the process patients used to arrive at their decisions to implement an AD. A stratified random sample of 26 patients from two intensive care units, one general medical unit, one general cardiac unit, and one acquired immunodeficiency unit were selected for participation. Patients were asked a series of open-ended questions to determine their knowledge and understanding of ADs. The constant comparative method was used to review the transcripts. It was found that only 31 per cent of patients had issued an AD, and 20% had learned of ADs for the first time during their hospitalization. Response analysis showed four phases of AD decision making: evaluation of illness, establishment of priorities, consideration of implications of the directives, and selection or rejection of directives. In conclusion, patients continue to have limited understanding of ADs and their implications. Continued investigation will elucidate the best strategies to educate patients about this topic. PMID:8583031

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

    ERIC Educational Resources Information Center

    Gibson, Denise D.; Borges, Nicole J.

    2004-01-01

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

  14. Portrayal of medical decision making around medical interventions life-saving encounters on three medical television shows

    PubMed Central

    Schwei, Rebecca J; Jacobs, Elizabeth A.; Wingert, Katherine; Montague, Enid

    2015-01-01

    Introduction Previous literature has shown that patients obtain information about the medical system from television shows. Additionally, shared decision making is regularly cited as the ideal way to make decisions during a medical encounter. Little information exists surrounding the characteristics of medical decision-making, such as who makes the decision, on medical television shows. We evaluate the characteristics of medical decisions in lifesaving encounters on medical television shows and evaluate if these characteristics were different on staged and reality television shows. Methods We coded type of medical intervention, patient’s ability to participate in decision, presence of patient advocate during decision, final decision maker, decision to use intervention, and controversy surrounding decision on three television shows. Frequencies by show were calculated and differences across the three television shows and between staged (ER) and reality (BostonMed and Hopkins) television shows were assessed with chi-square tests. Results The final data set included 37 episodes, 137 patients and 593 interventions. On ER, providers were significantly more likely to make the decision about the medical intervention without informing the patient when a patient was capable of making a decision compared to BostonMed or Hopkins (p<0.001). Across all shows, 99% of all decisions on whether to use a medical intervention resulted in the use of that intervention. Discussion Medical interventions are widely portrayed in the medical television shows we analyzed. It is possible that what patients see on television influences their expectations surrounding the decision making process and the use of medical interventions in everyday healthcare encounters. PMID:26478829

  15. The precautionary principle and medical decision making.

    PubMed

    Resnik, David B

    2004-06-01

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

  16. Incorporating patients' preferences into medical decision making.

    PubMed

    Fraenkel, Liana

    2013-02-01

    Current models of care emphasize the importance of including patients' values in the decision-making process. This is particularly important for decisions for which there are few data supporting a clear strategy or treatment choice. Constructing preferences for complex decisions requires that patients be able to consider multiple trade-offs between specific risks and benefits. Several marketing research techniques have been recently applied to heath care settings to facilitate this process. Most can be programmed to generate patients' preferences or priorities, which can then be used to improve patient-physician communication. In this article, we will describe some of the currently available approaches that have been successfully used in the health care setting. We provide case examples to illustrate the potential value of adopting each of these approaches in clinical practice. PMID:23132890

  17. The Attitude-Behavior Discrepancy in Medical Decision Making

    PubMed Central

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

    2014-01-01

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

  18. 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

  19. 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.

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

    PubMed

    Tomaszewski, Wiesław

    2012-01-01

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

  1. General practitioners' decisions about discontinuation of medication: an explorative study.

    PubMed

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-06-20

    Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience. PMID:27296879

  2. 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

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

    PubMed Central

    Manigault, Andrew Wilhelm; Whillock, Summer Rain

    2015-01-01

    Background To improve patient health, recent research urges for medical decision aids that are designed to enhance the effectiveness of specific medically related decisions. Many such decisions involve complex information, and decision aids that independently use deliberative (analytical and slower) or intuitive (more affective and automatic) cognitive processes for such decisions result in suboptimal decisions. Unconscious thought can arguably use both intuitive and deliberative (slow and analytic) processes, and this combination may further benefit complex patient (or practitioner) decisions as medical decision aids. Indeed, mounting research demonstrates that individuals render better decisions generally if they are distracted from thinking consciously about complex information after it is presented (but can think unconsciously), relative to thinking about that information consciously or not at all. Objective The current research tested whether the benefits of unconscious thought processes can be replicated using an Internet platform for a patient medical decision involving complex information. This research also explored the possibility that judgments reported after a period of unconscious thought are actually the result of a short period of conscious deliberation occurring during the decision report phase. Methods A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while

  4. Overcoming barriers to development of cooperative medical decision support models.

    PubMed

    Hudson, Donna L; Cohen, Maurice E

    2012-01-01

    Attempts to automate the medical decision making process have been underway for the at least fifty years, beginning with data-based approaches that relied chiefly on statistically-based methods. Approaches expanded to include knowledge-based systems, both linear and non-linear neural networks, agent-based systems, and hybrid methods. While some of these models produced excellent results none have been used extensively in medical practice. In order to move these methods forward into practical use, a number of obstacles must be overcome, including validation of existing systems on large data sets, development of methods for including new knowledge as it becomes available, construction of a broad range of decision models, and development of non-intrusive methods that allow the physician to use these decision aids in conjunction with, not instead of, his or her own medical knowledge. None of these four requirements will come easily. A cooperative effort among researchers, including practicing MDs, is vital, particularly as more information on diseases and their contributing factors continues to expand resulting in more parameters than the human decision maker can process effectively. In this article some of the basic structures that are necessary to facilitate the use of an automated decision support system are discussed, along with potential methods for overcoming existing barriers. PMID:23366358

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

    PubMed

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

    2015-03-01

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

  6. 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

  7. On the heuristic nature of medical decision-support systems.

    PubMed

    Aliferis, C F; Miller, R A

    1995-03-01

    In the realm of medical decision-support systems, the term "heuristic systems" is often considered to be synonymous with "medical artificial intelligence systems" or with "systems employing informal model(s) of problem solving". Such a view may be inaccurate and possibly impede the conceptual development of future systems. This article examines the nature of heuristics and the levels at which heuristic solutions are introduced during system design and implementation. The authors discuss why heuristics are ubiquitous in all medical decision-support systems operating at non-trivial domains, and propose a unifying definition of heuristics that encompasses formal and ad hoc systems. System developers should be aware of the heuristic nature of all problem solving done in complex real world domains, and characterize their own use of heuristics in describing system development and implementation. PMID:9082138

  8. The liability of medical directors for utilization review decisions.

    PubMed

    Trueman, David L

    2002-01-01

    Managed Care Organizations (MCOs) have turned to numerous cost-containment measures to combat rising healthcare costs. One of the most common is the use of utilization review to ascertain whether a recommended mode of treatment is "medically necessary." When the medical director of an MCO determines that care recommended by a patient's treating physician is not medically necessary and not eligible for coverage (and, as a result, potentially unattainable due to cost), the stage is set for litigation. In such situations, medical directors may become potentially liable for disciplinary action by their state medical licensing board as well as lawsuits for malpractice or negligence. However, plaintiffs wishing to recover damages for improper determinations of this nature or state boards trying to discipline these physicians, face the hurdles of the preemptive force of ERISA, and state doctrines to the effect that corporations (and, derivatively, their medical directors) cannot practice medicine and therefore cannot be liable for malpractice. Conflicting decisions and opinions make it impossible at the present time to have a settled expectation regarding the potential liability of medical directors in this context, although the law appears to be moving toward the treatment of utilization review as medical decisionmaking; therefore, it appears likely that the activities of medical directors increasingly will face state oversight--including the imposition of common law liability in appropriate situations. PMID:11974520

  9. 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.

  10. 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

  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. MIDAS intelligent platform for medical services, support for decision optimization in virtual medical communities.

    PubMed

    Arotăriţei, D; Toma, C M; Turnea, M; Toma, Vasilica

    2008-01-01

    The paper describes the implementation of a open multifunctional platform--MIDAS--for heterogeneous medical data management--support for optimization of clinical decision in virtual medical communities. The objectives of this intelligent environment are: diagnostic easier by access to heterogeneous medical data, a virtual support for medical personal in order to reduce medical errors, fast access to resources for education and improvement of medical education for physicians and students. The structure of the platform is based on a core module and a number of dedicated modules that give an important advantage as re-configurable platform depending on necessities. The core module tries to be as general is possible in order to be used in the future as core model in a platform focused on dentistry cases. PMID:19295034

  13. 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

  14. Why decision support systems are important for medical education.

    PubMed

    Konstantinidis, Stathis Th; Bamidis, Panagiotis D

    2016-03-01

    During the last decades, the inclusion of digital tools in health education has rapidly lead to a continuously enlarging digital era. All the online interactions between learners and tutors, the description, creation, reuse and sharing of educational digital resources and the interlinkage between them in conjunction with cheap storage technology has led to an enormous amount of educational data. Medical education is a unique type of education due to accuracy of information needed, continuous changing competences required and alternative methods of education used. Nowadays medical education standards provide the ground for organising the educational data and the paradata. Analysis of such education data through education data mining techniques is in its infancy, but decision support systems (DSSs) for medical education need further research. To the best of our knowledge, there is a gap and a clear need for identifying the challenges for DSSs in medical education in the era of medical education standards. Thus, in this Letter the role and the attributes of such a DSS for medical education are delineated and the challenges and vision for future actions are identified. PMID:27222734

  15. 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

  16. 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

  17. Decision support in medical practice: a physician's perspective

    NASA Astrophysics Data System (ADS)

    Shieh, Yao-Yang; Roberson, Glenn H.

    1998-03-01

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

  18. Evaluation of RxNorm for Medication Clinical Decision Support.

    PubMed

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

    2014-01-01

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

  19. 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

  20. 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

  1. Hospital Information System Support for the Medical Decision Maker

    PubMed Central

    Mishelevich, David J.; Atkinson, Jack B.; Noland, Robert L.; Eisenberg, Jerry R.

    1981-01-01

    This paper describes the early stages in migration toward a comprehensive, on-line Hospital Information System with emphasis placed on the needs of the physician and other Medical Decision Makers. Such systems will properly put the computing power where it belongs: in the hands of the user, to the decision being made, to enhance health professional productivity and cost effectiveness. Thus we are evolving to such feedback to the physician in multiple dimensions, whether previous orders and/or results, patient profiles, cost of item ordered, potential drug-drug and drug-laboratory test interactions, potential duplicate examinations, or other information are involved. Considerations for systems which can potentially meet these needs are outlined. Specific examples of characteristics of the IBM Patient Care System {PCS} are presented as a prototypical model. Critical components are the presence of relevant data and the human-engineered, user-cordial access to that data. Coverage is given to multiple existing and potential sources of clinically-significant data whether manual or automated instrument input are involved.

  2. 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

  3. 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

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

    PubMed Central

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

    2007-01-01

    BACKGROUND A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES To better understand the challenges of decision-making from the surrogate’s perspective. DESIGN Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS Fifty designated surrogates with previous decision-making experience. APPROACH We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates’ social networks (such as intrafamily discord about the “right” decision), (3) surrogate–patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate–clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient’s condition, prognosis, and treatment options. PMID:17619223

  5. 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.

  6. Not a Humbug: the evolution of patient-centred medical decision-making.

    PubMed

    Trump, Benjamin D; Linkov, Faina; Edwards, Robert P; Linkov, Igor

    2015-12-01

    This 'Christmas Issue'-type paper uses the framework of 'A Christmas Carol' to tell about the evolution of decision-making in evidence-based medicine (EBM). The Ghost of the Past represents paternalistic medicine, the Ghost of the Present symbolises EBM, while the Ghost of the Future serves as a patient-centred system where research data and tools of decision science are jointly used to make optimal medical decisions for individual patients. We argue that this shift towards a patient-centred approach to EBM and medical care is the next step in the evolution of medical decision-making, which would help to empower patients with the capability to make educated decisions throughout the course of their medical treatment. PMID:26475717

  7. The Appleton Consensus: suggested international guidelines for decisions to forgo medical treatment.

    PubMed

    1989-03-13

    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 Forgo Medical Treatment. The guidelines deal with four specific decision-making circumstances. 1. Five guidelines were created for decisions involving competent patients or patients who 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 judgment" 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. PMID:2929046

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

    PubMed

    Karnieli-Miller, Orit; Zisman-Ilani, Yaara; Meitar, Dafna; Mekori, Yoseph

    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

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

    PubMed Central

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

    1988-01-01

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

  11. Projection in surrogate decisions about life-sustaining medical treatments.

    PubMed

    Fagerlin, A; Ditto, P H; Danks, J H; Houts, R M; Smucker, W D

    2001-05-01

    To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed. PMID:11403214

  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. 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…

  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. 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

  16. Patients’ Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings

    PubMed Central

    Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

    2016-01-01

    Background The contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions. Design Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. Results In the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. Limitations The design of the study made it difficult to draw definite cause-and-effect conclusions. Conclusion The Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians

  17. 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)

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

    PubMed

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

    2013-01-01

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

  19. Clinical Recommendations in Medical Practice: A Proposed Framework to Reduce Bias and Improve the Quality of Medical Decisions.

    PubMed

    Alfandre, David

    2016-01-01

    Patients rely on, benefit from, and are strongly influenced by physicians' recommendations. In spite of the centrality and importance of physicians' recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of those processes or how patients' preferences ought to be considered and how much weight they should hold. Moreover, physicians' bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients' trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions-that is, clinical decisions when patients' values and preferences are relevant-the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients' values and preferences. When patients' preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. PMID:27045301

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

    PubMed Central

    Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

    2011-01-01

    There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice. PMID:21647328

  3. 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)

  4. 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…

  5. 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

  6. The Role of the Message Convergence Framework in Medical Decision Making.

    PubMed

    Anthony, Kathryn E; Sellnow, Timothy L

    2016-01-01

    This study investigated numerous complexities in medical decision making among obstetricians treating high-risk or complex pregnancies. Obstetricians in a southeastern state (N = 28) were interviewed using a guide based on the framework of message convergence. The study assessed how the physicians manage uncertainty surrounding patient care and engage in medical decision making in the midst of either unclear evidence or competing messages. As a result, the study found that message convergence plays a notable role in the obstetricians' clinical decision making. Conclusions and practical recommendations are provided, and theoretical extensions to the message convergence framework in the clinical and communicative practices of the physicians are also advanced. PMID:26192458

  7. Medical decision-making system of ultrasound carotid artery intima-media thickness using neural networks.

    PubMed

    Santhiyakumari, N; Rajendran, P; Madheswaran, M

    2011-12-01

    The objective of this work is to develop and implement a medical decision-making system for an automated diagnosis and classification of ultrasound carotid artery images. The proposed method categorizes the subjects into normal, cerebrovascular, and cardiovascular diseases. Two contours are extracted for each and every preprocessed ultrasound carotid artery image. Two types of contour extraction techniques and multilayer back propagation network (MBPN) system have been developed for classifying carotid artery categories. The results obtained show that MBPN system provides higher classification efficiency, with minimum training and testing time. The outputs of decision support system are validated with medical expert to measure the actual efficiency. MBPN system with contour extraction algorithms and preprocessing scheme helps in developing medical decision-making system for ultrasound carotid artery images. It can be used as secondary observer in clinical decision making. PMID:21181487

  8. Visual analytics in medical education: impacting analytical reasoning and decision making for quality improvement.

    PubMed

    Vaitsis, Christos; Nilsson, Gunnar; Zary, Nabil

    2015-01-01

    The medical curriculum is the main tool representing the entire undergraduate medical education. Due to its complexity and multilayered structure it is of limited use to teachers in medical education for quality improvement purposes. In this study we evaluated three visualizations of curriculum data from a pilot course, using teachers from an undergraduate medical program and applying visual analytics methods. We found that visual analytics can be used to positively impacting analytical reasoning and decision making in medical education through the realization of variables capable to enhance human perception and cognition on complex curriculum data. The positive results derived from our evaluation of a medical curriculum and in a small scale, signify the need to expand this method to an entire medical curriculum. As our approach sustains low levels of complexity it opens a new promising direction in medical education informatics research. PMID:25991109

  9. 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…

  10. 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…

  11. Teaching Advance Care Planning to Medical Students with a Computer-Based Decision Aid

    PubMed Central

    Levi, Benjamin H.

    2013-01-01

    Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n=60) outperformed the Standard Group (n=61) in terms of students´ knowledge (p<0.01), confidence in helping patients with advance care planning (p<0.01), knowledge of what matters to patients (p=0.05), and satisfaction with their learning experience (p<0.01). Likewise, patients in the Decision Aid Group were more satisfied with the advance care planning method (p<0.01) and with several aspects of student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients. PMID:20632222

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

    PubMed

    Stanley, J M

    1989-09-01

    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. Telemonitoring in heart failure patients with clinical decision support to optimize medication doses based on guidelines.

    PubMed

    Kropf, Martin; Modre-Osprian, Robert; Hayn, Dieter; Fruhwald, Friedrich; Schreier, Günter

    2014-01-01

    The European Society of Cardiology guidelines for heart failure management are based on strong evidence that adherence to optimal medication is beneficial for heart failure patients. Telemonitoring with integrated clinical decision support enables physicians to adapt medication dose based on up to date vital parameters and reduces the number of hospital visits needed solely for up-titration of heart failure medication. Although keeping track of weight and blood pressure changes is recommended during unstable phases, e.g. post-discharge and during up-titration of medication, guidelines are rather vague regarding telehealth aspects. In this paper, we focus on the evaluation of a clinical decision support system for adaption of heart failure medication and for detecting early deteriorations through monitoring of blood pressure, heart rate and weight changes. This clinical decision support system is currently used in INTENSE-HF, a large scale telemonitoring trial with heart failure patients. The aim of this paper was to apply the decision support algorithm to an existing telemonitoring dataset, to assess the ability of the decision support concept to adhere to the guidelines and to discuss its limitations and potential improvements. PMID:25570663

  14. Electronic medication ordering with integrated drug database and clinical decision support system.

    PubMed

    Cufar, Andreja; Droljc, Anže; Orel, Andrej

    2012-01-01

    Medication errors have been identified as one of the most important causes of adverse drug events. Computerized physician order-entry (CPOE) systems, coupled with decision support (Medication allergy checking, drug interactions, and dose calculations), are considered to be appropriate solutions for reducing medication errors and standardizing care. It is quite useful if clinical information system (CIS) supports order sets, which help with standardizing care, preventing omission errors, and expediting the ordering process. Order sets are predefined groups of orders pertinent to one or more specific clinical conditions or diagnoses. The article describes how a clinical information system can be used to support medication process (prescribing, ordering, dispensing, administration and monitoring) and offer participating medical teams real time warnings and key information regarding medications and patient status, thus reducing medication errors. Integrated electronic prescribing support system benefits for total parenteral nutrition (TPN) are discussed at the end. PMID:22874280

  15. A concept-based medication vocabulary: an essential requirement for pharmacy decision support.

    PubMed

    Broverman, C; Kapusnik-Uner, J; Shalaby, J; Sperzel, D

    1998-04-01

    The impact of adverse drug events (ADEs) on the cost and quality of health care today is indisputable. A significant portion of these events can be detected and prevented with computerized pharmacy decision support systems. Challenges to the successful implementation of decision support systems include availability and quality of patient data and the accessibility of drug information that can be integrated programmatically on a patient-specific basis. An additional related challenge is establishing the vocabulary (i.e., codes, terms, and meanings) to be used for the representation, exchange, and automation of drug information and clinical functions. A central argument of this article is that a concept-based medication vocabulary needs to be created in order to facilitate the development of pharmacy decision support. We address the medication vocabulary challenge by defining a specific concept-based model of drugs as the basis for a standardized medication terminology. PMID:10184876

  16. The medical visit context of treatment decision-making and the therapeutic relationship.

    PubMed

    Roter, Debra

    2000-03-01

    The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals. Failures of this kind, have been largely attributed to the psychological dynamics of the patients, physicians, illnesses, and contexts that characterize the medical decision. There has been little attempt to provide a framework for accommodating or understanding the larger social context and social influences that contribute to this variation. Applying Paulo Freire's participatory social orientation model to the context of the medical visit suggests a framework for viewing the impact of physicians' communication behaviours on patients' capacity for treatment decision-making. Physicians' use of communication strategies can act to reinforce an experience of patient dependence or self-reliance in regard to the patient-physician relationship generally and treatment decision-making, in particular. Certain communications enhance patient participation in the medical visit's dialogue, contribute to patient engagement in problem posing and problem-solving, and finally, facilitate patient confidence and competence to undertake autonomous action. The purpose of this essay is to place treatment decision-making within the broader context of the therapeutic relationship, and to describe ways in which routine medical visit communication can accommodate individual patient preferences and help develop and further patient capacity for autonomous decision-making. PMID:11281908

  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. Individualized Medical Decision Making: Necessary, Achievable, but Not Yet Attainable

    PubMed Central

    Fraenkel, Liana; Fried, Terri R.

    2010-01-01

    There is an urgent need to provide older persons with individualized information regarding the benefits and harms of different diagnostic and treatment strategies. This need results from the growing recognition of the heterogeneity in outcomes among older persons with differing comorbidity profiles. The importance of heterogeneity in outcomes has been most thoroughly described in cancer screening. The heterogeneity of benefits and harms resulting from treatment is not yet as well appreciated. Warfarin versus aspirin for the reduction of stroke risk in nonvalvular atrial fibrillation (NVAF) provides an example of a treatment for which the benefit to harm ratio may actually reverse according to an older person’s comorbidities, thus highlighting the importance of basing this treatment decision on individualized outcome data Despite the wealth of studies in NVAF, many assumptions are necessary to calculate patient-specific outcomes, and these assumptions may lead to substantial over- or under-estimation of benefits and harms. Improving care for patients with co-morbidities will require substantive increases in the efforts and resources allocated towards the collection and dissemination of outcome data for patients with varying comorbidities. PMID:20308644

  19. "Patient informatics": creating new partnerships in medical decision making.

    PubMed

    Bader, S A; Braude, R M

    1998-04-01

    The amassing of health information on the Internet and World Wide Web continues unabated. Patients anxious to participate in decisions about their own treatment have turned to the Internet to confirm diagnoses, validate physician-recommended treatment, or seek alternative therapies. While increased information for patients has been linked to improved outcomes, there are inherent dangers associated with the kind of unauthenticated information available on the Web. The authors discuss the nature of these dangers as well as review the advantages for patients of "information therapy" (improved access to health information). They also examine how the Internet has begun to affect the physician-patient relationship, and describe how the Internet and information technology can be effectively used by physicians in patient care. They recommend that the academic health sciences community seize the opportunity to take the lead in ensuring that patients have access to reliable health information, and suggest that "patient informatics" be integrated by academic physicians and educators into the teaching of clinical skills. PMID:9580718

  20. 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

  1. Decision making on the adoption of advanced medical technology in Taiwan.

    PubMed

    Lan, C F

    1987-01-01

    This paper discusses both the current interest in and approaches to the employment of advanced medical technology in Taiwan. It describes the formation of the national policy, including funding, reimbursement, and regulatory processes, on adopting innovative and expensive medical technologies. Using the case of extracorporeal shockwave lithotripsy (ESWL), the key players who affect organizational decision making on the adoption and diffusion of medical technology have also been analyzed. Finally, it examines some of the salient features of medical technology adoption and assessment in Taiwan, and in other countries which depend heavily upon imported advanced medical technology. It is hoped that an understanding of Taiwan's attempts to use innovative medical technology wisely while incorporating the practice of technology assessment and appropriate policies, will assist other countries with similar conditions to gain maximal benefit from technological advancement. PMID:10284927

  2. 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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  4. 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…

  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. 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…

  8. Medical ethics: four principles, two decisions, two roles and no reasons.

    PubMed

    Kennelly, John

    2011-06-01

    The 'four principle' view of medical ethics has a strong international pedigree. Despite wide acceptance, there is controversy about the meaning and use of the principles in clinical practice as a checklist for moral behaviour. Recent attempts by medical regulatory authorities to use the four principles to judge medical practitioner behaviour have not met with success in clarifying how these principles can be incorporated into a legal framework. This may reflect the philosophical debate about the relationship between law and morals. In this paper, legal decisions from two cases in which general practitioners have been charged with professional shortcomings are discussed. Difficulties with the application of the four principles (autonomy, beneficence, nonmaleficence and justice) to judge medical practitioner behaviour are highlighted. The four principles are relevant to medical practitioner behaviour, but if applied as justifications for disciplinary decisions without explanation, perverse results may ensue. Solutions are suggested to minimise ambiguities in the application of the four principles: adjudicators should acknowledge the difference between professional and common morality and the statutory requirement to give decisions with reasons. PMID:21625670

  9. 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

  10. Collective intelligence meets medical decision-making: the collective outperforms the best radiologist.

    PubMed

    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

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

    PubMed

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

    2004-02-01

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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Pediatric obstetrical ethics: Medical decision-making by, with, and for pregnant early adolescents.

    PubMed

    Mercurio, Mark R

    2016-06-01

    Pregnancy in an early adolescent carries with it specific ethical considerations, in some ways different from pregnancy in an adult and from medical care of a non-pregnant adolescent. Obstetrical ethics emphasizes the right of the patient to autonomy and bodily integrity, including the right to refuse medical intervention. Pediatric ethics recognizes the right of parents, within limits, to make medical decisions for their children, and the right of a child to receive medical or surgical interventions likely to be of benefit to her, sometimes over her own objections. As the child gets older, and particularly during the years of adolescence, there is also a recognition of the right to an increasingly prominent role in decisions about her own healthcare. Pediatric obstetrical ethics, referring to ethical decisions made by, with, and for pregnant early adolescents, represents the intersection of these different cultures. Principles and approaches from both obstetrical and pediatric ethics, as well as a unified understanding of rights, obligations, and practical considerations, will be needed. PMID:26916394

  17. 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

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

    PubMed

    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

  19. 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

  20. Older Adults’ Preferences for Independent or Delegated End-of-Life Medical Decision-Making

    PubMed Central

    Moorman, Sara M.

    2011-01-01

    Objectives This study assesses the proportions of participants who prefer independent or delegated medical decision-making at end-of-life, and examines the relationships of personal beliefs, affiliative beliefs, and end-of-life planning behaviors to decision-making preference. Methods Data are drawn from the Wisconsin Longitudinal Study, a sample of nearly 4,500 healthy white Midwestern high school graduates in their mid-60s. Results Four-fifths of participants wanted to make decisions independently. Valuing independence, being less avoidant of thoughts of death, and valuing quality of life over length of life had strong associations with a preference for independent decision-making. Those concerned about burdening a caregiver wanted to make independent decisions. Persons who both executed a living will and appointed a durable power of attorney for health care preferred independent decision-making. Discussion Older adults cite personal and affiliative beliefs, not lack of autonomy, as reasons for their choice to decide independently or delegate. PMID:20947875

  1. Medical alert management: a real-time adaptive decision support tool to reduce alert fatigue.

    PubMed

    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

  2. A mobile decision support system for red eye diseases diagnosis: experience with medical students.

    PubMed

    López, Marta Manovel; López, Miguel Maldonado; de la Torre Díez, Isabel; Jimeno, José Carlos Pastor; López-Coronado, Miguel

    2016-06-01

    A good primary health care is the base for a better healthcare system. Taking a good decision on time by the primary health care physician could have a huge repercussion. In order to ease the diagnosis task arise the Decision Support Systems (DSS), which offer counselling instead of refresh the medical knowledge, in a profession where it is still learning every day. The implementation of these systems in diseases which are a frequent cause of visit to the doctor like ophthalmologic pathologies are, which affect directly to our quality of life, takes more importance. This paper aims to develop OphthalDSS, a totally new mobile DSS for red eye diseases diagnosis. The main utilities that OphthalDSS offers will be a study guide for medical students and a clinical decision support system for primary care professionals. Other important goal of this paper is to show the user experience results after OphthalDSS being used by medical students of the University of Valladolid. For achieving the main purpose of this research work, a decision algorithm will be developed and implemented by an Android mobile application. Moreover, the Quality of Experience (QoE) has been evaluated by the students through the questions of a short inquiry. The app developed which implements the algorithm OphthalDSS is capable of diagnose more than 30 eye's anterior segment diseases. A total of 67 medical students have evaluated the QoE. The students find the diseases' information presented very valuable, the appearance is adequate, it is always available and they have ever found what they were looking for. Furthermore, the students think that their quality of life has not been improved using the app and they can do the same without using the OphthalDSS app. OphthalDSS is easy to use, which is capable of diagnose more than 30 ocular diseases in addition to be used as a DSS tool as an educational tool at the same time. PMID:27142275

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

    PubMed Central

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

    1996-01-01

    We demonstrated the use of the World Wide Web for the presentation and explanation of a medical decision model. We put on the web a treatment model developed as part of the Cardiac Arrhythmia and Risk of Death Patient Outcomes Research Team (CARD PORT). To demonstrate the advantages of our web-based presentation, we critiqued both the conventional paper-based and the web-based formats of this decision-model presentation with reference to an accepted published guide to understanding clinical decision models. A web-based presentation provides a useful supplement to paper-based publications by allowing authors to present their model in greater detail, to link model inputs to the primary evidence, and to disseminate the model to peer investigators for critique and collaborative modeling. PMID:8947628

  4. 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

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

    PubMed

    Goulionis, John E; Vozikis, Athanassios

    2009-01-01

    Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels. PMID:19549341

  6. The law and its interaction with medical ethics in end-of-life decision making.

    PubMed

    Cerminara, Kathy L

    2011-09-01

    The previous two articles in this series explored the historical and theoretical development of medical decision making from initial reliance on medical beneficence to a more recent emphasis on patient autonomy. The law of withholding and withdrawal of treatment has much in common with medical ethics. It is based on concerns about patient autonomy expressed by courts, legislatures, and the executive branch of the government. Legally, the patient's right of self-determination has been based on a variety of sources ranging from state and federal constitutions to the common law of torts and from cases to statutes and regulations. Understanding the various sources of the law, the distinctions among those sources, and the interaction of the branches of government in this context assists in understanding the law itself. In our federalist system of government, significant legal variations can exist among the states, but although technically valid, excessive concern about compliance with the precise contours of each state's statute when surrogate decision makers are engaging in bedside deliberations is unnecessary. Regardless of source or precise legal contours, the overall goal, which neither the physician nor the patient's surrogate or proxy decision makers should forget, is to honor what the patient would want to have done. Physicians and attorneys will agree on that as a matter of both ethics and the law. PMID:21896521

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

    PubMed Central

    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

  8. 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

  9. 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.

  10. Overriding parents' medical decisions for their children: a systematic review of normative literature.

    PubMed

    McDougall, Rosalind J; Notini, Lauren

    2014-07-01

    This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question 'when health professionals and parents disagree about the appropriate course of medical treatment for a child,under what circumstances is the health professional ethically justified in overriding the parents' wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. Each of these frameworks centred on a different key moral concept including harm,constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. PMID:23824967

  11. 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

  12. What Do Physicians Believe About the Way Decisions Are Made? A Pilot Study on Metacognitive Knowledge in the Medical Context.

    PubMed

    Iannello, Paola; Perucca, Valeria; Riva, Silvia; Antonietti, Alessandro; Pravettoni, Gabriella

    2015-11-01

    Metacognition relative to medical decision making has been poorly investigated to date. However, beliefs about methods of decision making (metacognition) play a fundamental role in determining the efficiency of the decision itself. In the present study, we investigated a set of beliefs that physicians develop in relation to the modes of making decisions in a professional environment. The Solomon Questionnaire, designed to assess metacognitive knowledge about behaviors and mental processes involved in decision making, was administered to a sample of 18 emergency physicians, 18 surgeons, and 18 internists. Significant differences in metacognitive knowledge emerged among these three medical areas. Physicians' self-reports about the decision process mirrored the peculiarities of the context in which they operate. Their metacognitive knowledge demonstrated a reflective attitude that is an effective tool during the decision making process. PMID:27247686

  13. What Do Physicians Believe About the Way Decisions Are Made? A Pilot Study on Metacognitive Knowledge in the Medical Context

    PubMed Central

    Iannello, Paola; Perucca, Valeria; Riva, Silvia; Antonietti, Alessandro; Pravettoni, Gabriella

    2015-01-01

    Metacognition relative to medical decision making has been poorly investigated to date. However, beliefs about methods of decision making (metacognition) play a fundamental role in determining the efficiency of the decision itself. In the present study, we investigated a set of beliefs that physicians develop in relation to the modes of making decisions in a professional environment. The Solomon Questionnaire, designed to assess metacognitive knowledge about behaviors and mental processes involved in decision making, was administered to a sample of 18 emergency physicians, 18 surgeons, and 18 internists. Significant differences in metacognitive knowledge emerged among these three medical areas. Physicians’ self-reports about the decision process mirrored the peculiarities of the context in which they operate. Their metacognitive knowledge demonstrated a reflective attitude that is an effective tool during the decision making process. PMID:27247686

  14. Investigating medical decision-making capacity in patients with cognitive impairment using a protocol based on linguistic features.

    PubMed

    Tallberg, Ing-Mari; Stormoen, Sara; Almkvist, Ove; Eriksdotter, Maria; Sundström, Erik

    2013-10-01

    A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision-making capacity by use of a Swedish linguistic instrument for medical decision-making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision-making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision-making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one-dimensional instrument of medical decision-making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment. PMID:23841467

  15. 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

  16. Medical Waste Disposal Method Selection Based on a Hierarchical Decision Model with Intuitionistic Fuzzy Relations.

    PubMed

    Qian, Wuyong; Wang, Zhou-Jing; Li, Kevin W

    2016-01-01

    Although medical waste usually accounts for a small fraction of urban municipal waste, its proper disposal has been a challenging issue as it often contains infectious, radioactive, or hazardous waste. This article proposes a two-level hierarchical multicriteria decision model to address medical waste disposal method selection (MWDMS), where disposal methods are assessed against different criteria as intuitionistic fuzzy preference relations and criteria weights are furnished as real values. This paper first introduces new operations for a special class of intuitionistic fuzzy values, whose membership and non-membership information is cross ratio based ]0, 1[-values. New score and accuracy functions are defined in order to develop a comparison approach for ]0, 1[-valued intuitionistic fuzzy numbers. A weighted geometric operator is then put forward to aggregate a collection of ]0, 1[-valued intuitionistic fuzzy values. Similar to Saaty's 1-9 scale, this paper proposes a cross-ratio-based bipolar 0.1-0.9 scale to characterize pairwise comparison results. Subsequently, a two-level hierarchical structure is formulated to handle multicriteria decision problems with intuitionistic preference relations. Finally, the proposed decision framework is applied to MWDMS to illustrate its feasibility and effectiveness. PMID:27618082

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

    PubMed Central

    Coman, Dora; Coman, Alin; Hirst, William

    2013-01-01

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

  18. 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.

  19. Collection of Medical Original Data with Search Engine for Decision Support.

    PubMed

    Orthuber, Wolfgang

    2016-01-01

    Medicine is becoming more and more complex and humans can capture total medical knowledge only partially. For specific access a high resolution search engine is demonstrated, which allows besides conventional text search also search of precise quantitative data of medical findings, therapies and results. Users can define metric spaces ("Domain Spaces", DSs) with all searchable quantitative data ("Domain Vectors", DSs). An implementation of the search engine is online in http://numericsearch.com. In future medicine the doctor could make first a rough diagnosis and check which fine diagnostics (quantitative data) colleagues had collected in such a case. Then the doctor decides about fine diagnostics and results are sent (half automatically) to the search engine which filters a group of patients which best fits to these data. In this specific group variable therapies can be checked with associated therapeutic results, like in an individual scientific study for the current patient. The statistical (anonymous) results could be used for specific decision support. Reversely the therapeutic decision (in the best case with later results) could be used to enhance the collection of precise pseudonymous medical original data which is used for better and better statistical (anonymous) search results. PMID:27577383

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

    PubMed Central

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

    2012-01-01

    Abstract Objectives Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. Methods Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. Results Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and

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

    PubMed

    Zieba, Maciej

    2014-09-01

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

  2. 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

  3. 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

  4. 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

  5. Planning for medical decision making: living wills and durable powers of attorney.

    PubMed

    Hoffman, D E

    1989-02-01

    The enactment of living will and durable power of attorney statutes in most states, including Maryland, provide individuals with a mechanism for setting forth their preferences for medical treatment in the event of their inability to make treatment decisions on their own behalf. Although still under used, these mechanisms are becoming more common, and physicians will be confronting them more frequently. The following overview of the Maryland Life Sustaining Procedures Act and the Durable Power of Attorney Act and discussion of their advantages and limitations is from the perspective of patients and their physicians. PMID:2915622

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

    PubMed

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

    2008-01-01

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

  7. The family and harmonious medical decision making: cherishing an appropriate Confucian moral balance.

    PubMed

    Chen, Xiaoyang; Fan, Ruiping

    2010-10-01

    This essay illustrates what the Chinese family-based and harmony-oriented model of medical decision making is like as well as how it differs from the modern Western individual-based and autonomy-oriented model in health care practice. The essay discloses the roots of the Chinese model in the Confucian account of the family and the Confucian view of harmony. By responding to a series of questions posed to the Chinese model by modern Western scholars in terms of the basic individualist concerns and values embedded in the modern Western model, we conclude that the Chinese people have justifiable reasons to continue to apply the Chinese model to their contemporary health care and medical practice. PMID:20855426

  8. Medical equipment classification: method and decision-making support based on paraconsistent annotated logic.

    PubMed

    Oshiyama, Natália F; Bassani, Rosana A; D'Ottaviano, Itala M L; Bassani, José W M

    2012-04-01

    As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification. PMID:22407498

  9. Critical decision points in the management of impaired doctors: the New South Wales Medical Board program.

    PubMed

    Wilhelm, Kay A; Reid, Alison M

    2004-10-01

    The New South Wales Medical Board has developed the Impaired Registrants Program to deal with impaired registrants (doctors and medical students) in a constructive and non-disciplinary manner; the program is now well established. The Program enables the Board to protect the public, while maintaining doctors in practice whenever possible. Disorders that commonly lead to referral of impaired doctors include alcohol and drug misuse, major depression, bipolar disorder, cognitive impairment and, less commonly, psychotic and personality disorders and anorexia nervosa. Pathways in the program are individualised according to the impact of the specific disorder, the registrant's career stage, stage of involvement in the program, insight and motivation. Critical points in the program include entry, easing of conditions, breach of conditions, return to work after suspension, and exit from the program. Decision-making at these points takes into account the nature of the impairment, compliance, professional and personal support available and the registrant's insight and motivation. PMID:15462656

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

    PubMed Central

    Müller-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

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

    PubMed Central

    2013-01-01

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

  12. CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.

    PubMed

    Chow, Grant V; Czarny, Matthew J; Hughes, Mark T; Carrese, Joseph A

    2010-02-01

    The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event. PMID:20133288

  13. 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

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

    PubMed

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

    2009-01-01

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

  15. 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

  16. Decisions by Finnish Medical Research Ethics Committees: A Nationwide Study of Process and Outcomes.

    PubMed

    Hemminki, Elina; Virtanen, Jorma I; Regushevskaya, Elena

    2015-10-01

    Review by research ethics committees (RECs) is the key in medical research regulation. Data from meeting notes and project summaries were abstracted from all projects submitted in 2002 (n = 1,004) and 2007 (n = 1,045) to the official medical RECs in Finland. Data from consecutive submissions were combined per project. When comparing RECs, logistic regression was used to adjust for application characteristics. The number of projects handled varied notably by REC. In the first handling, 85% of applications in 2002 and 77% in 2007 were approved, while 13% and 20% were tabled. For 61% of the projects, the review time was <30 days, 16% had >89 days, and 6% had 6 months or longer. The variation by REC in approval rates, number of handlings, or long review times was not explained by project characteristics. In the last handling, 94% of the projects in both years were approved or concluded not to need a statement from that REC. The most common reason for tabling or not approving an application was patient autonomy, usually centered on the patient leaflet. The next most common reasons were requests for further information and dissatisfaction with the scientific aspects of the project. The reasons classified as "ethics" in the narrow sense were rare. The REC focus was to assure that researchers follow the various rules on medical research and to improve the quality of research and project documents. REC considerations could be divided into decisions based on ethics and recommendations covering other aspects. PMID:26333684

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

    PubMed

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

    2012-01-01

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

  18. From complex questionnaire and interviewing data to intelligent Bayesian Network models for medical decision support

    PubMed Central

    Constantinou, Anthony Costa; Fenton, Norman; Marsh, William; Radlinski, Lukasz

    2016-01-01

    Objectives 1) To develop a rigorous and repeatable method for building effective Bayesian network (BN) models for medical decision support from complex, unstructured and incomplete patient questionnaires and interviews that inevitably contain examples of repetitive, redundant and contradictory responses; 2) To exploit expert knowledge in the BN development since further data acquisition is usually not possible; 3) To ensure the BN model can be used for interventional analysis; 4) To demonstrate why using data alone to learn the model structure and parameters is often unsatisfactory even when extensive data is available. Method The method is based on applying a range of recent BN developments targeted at helping experts build BNs given limited data. While most of the components of the method are based on established work, its novelty is that it provides a rigorous consolidated and generalised framework that addresses the whole life-cycle of BN model development. The method is based on two original and recent validated BN models in forensic psychiatry, known as DSVM-MSS and DSVM-P. Results When employed with the same datasets, the DSVM-MSS demonstrated competitive to superior predictive performance (AUC scores 0.708 and 0.797) against the state-of-the-art (AUC scores ranging from 0.527 to 0.705), and the DSVM-P demonstrated superior predictive performance (cross-validated AUC score of 0.78) against the state-of-the-art (AUC scores ranging from 0.665 to 0.717). More importantly, the resulting models go beyond improving predictive accuracy and into usefulness for risk management purposes through intervention, and enhanced decision support in terms of answering complex clinical questions that are based on unobserved evidence. Conclusions This development process is applicable to any application domain which involves large-scale decision analysis based on such complex information, rather than based on data with hard facts, and in conjunction with the incorporation of

  19. 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, Pål

    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

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

    PubMed Central

    2011-01-01

    Background Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. Methods We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. Results The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. Conclusions These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics. PMID:21510880

  1. 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

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

    PubMed Central

    Gibert, Karina

    2009-01-01

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

  3. The combined analysis of uncertainty and patient heterogeneity in medical decision models.

    PubMed

    Groot Koerkamp, Bas; Stijnen, Theo; Weinstein, Milton C; Hunink, M G Myriam

    2011-01-01

    The analysis of both patient heterogeneity and parameter uncertainty in decision models is increasingly recommended. In addition, the complexity of current medical decision models commonly requires simulating individual subjects, which introduces stochastic uncertainty. The combined analysis of uncertainty and heterogeneity often involves complex nested Monte Carlo simulations to obtain the model outcomes of interest. In this article, the authors distinguish eight model types, each dealing with a different combination of patient heterogeneity, parameter uncertainty, and stochastic uncertainty. The analyses that are required to obtain the model outcomes are expressed in equations, explained in stepwise algorithms, and demonstrated in examples. Patient heterogeneity is represented by frequency distributions and analyzed with Monte Carlo simulation. Parameter uncertainty is represented by probability distributions and analyzed with 2nd-order Monte Carlo simulation (aka probabilistic sensitivity analysis). Stochastic uncertainty is analyzed with 1st-order Monte Carlo simulation (i.e., trials or random walks). This article can be used as a reference for analyzing complex models with more than one type of uncertainty and patient heterogeneity. PMID:20974904

  4. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    PubMed

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana. PMID:26754167

  5. 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

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

    PubMed Central

    Wilhelms, Evan A.

    2013-01-01

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

  7. Emergency medical triage decisions are swayed by computer-manipulated cues of physical dominance in caller’s voice

    PubMed Central

    Boidron, Laurent; Boudenia, Karim; Avena, Christophe; Boucheix, Jean-Michel; Aucouturier, Jean-Julien

    2016-01-01

    In humans as well as other animals, displays of body strength such as power postures or deep masculine voices are associated with prevalence in conflicts of interest and facilitated access to resources. We conduct here an ecological and highly critical test of this hypothesis in a domain that, on first thought, would appear to be shielded from such influences: access to emergency medical care. Using acoustic manipulations of vocal masculinity, we systematically varied the perceived level of physical dominance of mock patients calling a medical call center simulator. Callers whose voice were perceived as indicative of physical dominance (i.e. those with low fundamental and formant frequency voices) obtained a higher grade of response, a higher evaluation of medical emergency and longer attention from physicians than callers with strictly identical medical needs whose voice signaled lower physical dominance. Strikingly, while the effect was important for physician participants, it was virtually non-existent when calls were processed by non-medically-trained phone operators. This finding demonstrates an unprecedented degree of vulnerability of telephone-based medical decisions to extra-medical factors carried by vocal cues, and shows that it may not simply be assumed that more medical training will shield decisions from such influences. PMID:27456205

  8. Emergency medical triage decisions are swayed by computer-manipulated cues of physical dominance in caller's voice.

    PubMed

    Boidron, Laurent; Boudenia, Karim; Avena, Christophe; Boucheix, Jean-Michel; Aucouturier, Jean-Julien

    2016-01-01

    In humans as well as other animals, displays of body strength such as power postures or deep masculine voices are associated with prevalence in conflicts of interest and facilitated access to resources. We conduct here an ecological and highly critical test of this hypothesis in a domain that, on first thought, would appear to be shielded from such influences: access to emergency medical care. Using acoustic manipulations of vocal masculinity, we systematically varied the perceived level of physical dominance of mock patients calling a medical call center simulator. Callers whose voice were perceived as indicative of physical dominance (i.e. those with low fundamental and formant frequency voices) obtained a higher grade of response, a higher evaluation of medical emergency and longer attention from physicians than callers with strictly identical medical needs whose voice signaled lower physical dominance. Strikingly, while the effect was important for physician participants, it was virtually non-existent when calls were processed by non-medically-trained phone operators. This finding demonstrates an unprecedented degree of vulnerability of telephone-based medical decisions to extra-medical factors carried by vocal cues, and shows that it may not simply be assumed that more medical training will shield decisions from such influences. PMID:27456205

  9. 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

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

    PubMed

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

    2005-01-01

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

  11. SNR and noise measurements for medical imaging: I. A practical approach based on statistical decision theory.

    PubMed

    Tapiovaara, M J; Wagner, R F

    1993-01-01

    A method of measuring the image quality of medical imaging equipment is considered within the framework of statistical decision theory. In this approach, images are regarded as random vectors and image quality is defined in the context of the image information available for performing a specified detection or discrimination task. The approach provides a means of measuring image quality, as related to the detection of an image detail of interest, without reference to the actual physical mechanisms involved in image formation and without separate measurements of signal transfer characteristics or image noise. The measurement does not, however, consider deterministic errors in the image; they need a separate evaluation for imaging modalities where they are of concern. The detectability of an image detail can be expressed in terms of the ideal observer's signal-to-noise ratio (SNR) at the decision level. Often a good approximation to this SNR can be obtained by employing sub-optimal observers, whose performance correlates well with the performance of human observers as well. In this paper the measurement of SNR is based on implementing algorithmic realizations of specified observers and analysing their responses while actually performing a specified detection task of interest. Three observers are considered: the ideal prewhitening matched filter, the non-prewhitening matched filter, and the DC-suppressing non-prewhitening matched filter. The construction of the ideal observer requires an impractical amount of data and computing, except for the most simple imaging situations. Therefore, the utilization of sub-optimal observers is advised and their performance in detecting a specified signal is discussed. Measurement of noise and SNR has been extended to include temporally varying images and dynamic imaging systems. PMID:8426870

  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

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

    PubMed

    Cherry, Mark J

    2015-08-01

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

  14. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  17. 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

  18. Attitudes towards informed consent, confidentiality, and substitute treatment decisions in southern African medical students: a case study from Zimbabwe.

    PubMed

    Hipshman, L

    1999-08-01

    This study explored the attitudes of biomedical science students (medical students) in a non-Western setting towards three medical ethics concepts that are based on fundamental Western culture ethical principles. A dichotomous (agree/disagree) response questionnaire was constructed using Western ethnocentric culture (WEC) based perspectives of informed consent, confidentiality, and substitute decision-making. Hypothesized WEC-Biased responses were assigned to the questionnaire's questions or propositions. A number of useful responses (169) were obtained from a large, cross-sectional, convenience sample of the MBChB students at the University of Zimbabwe Medical School. Statistical analysis described the differences in response patterns between the student's responses compared to the hypothesized WEC-Biased response. The effect of the nine independent variables on selected dependent variables (responses to certain questionnaire questions) was analyzed by stepwise logistic regression. Students concurred with the hypothesized WEC-Biased responses for two-thirds of the questionnaire items. This agreement included support for the role of legal advocacy in the substitute decision-making process. The students disagreed with the hypothesized WEC-Biased responses in several important medical ethics aspects. Most notably, the students indicated that persons with mental dysfunctions, as a class, were properly considered incompetent to make treatment decisions. None of the studied independent variables was often associated with students' responses, but training year was more frequently implicated than either ethnicity or gender. In order to develop internationally and culturally relevant medical ethics standards, non-Western perspectives ought to be acknowledged and incorporated. Two main areas for further efforts include: curriculum development in ethics reasoning and related clinical (medico-legal) decision-making processes that would be relevant to medical students from

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

    PubMed

    West, D; West, V

    2000-11-01

    There are a number of different quantitative models that can be used in a medical diagnostic decision support system (MDSS) including parametric methods (linear discriminant analysis or logistic regression), non-parametric models (K nearest neighbor, or kernel density) and several neural network models. The complexity of the diagnostic task is thought to be one of the prime determinants of model selection. Unfortunately, there is no theory available to guide model selection. Practitioners are left to either choose a favorite model or to test a small subset using cross validation methods. This paper illustrates the use of a self-organizing map (SOM) to guide model selection for a breast cancer MDSS. The topological ordering properties of the SOM are used to define targets for an ideal accuracy level similar to a Bayes optimal level. These targets can then be used in model selection, variable reduction, parameter determination, and to assess the adequacy of the clinical measurement system. These ideas are applied to a successful model selection for a real-world breast cancer database. Diagnostic accuracy results are reported for individual models, for ensembles of neural networks, and for stacked predictors. PMID:10998586

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

    PubMed

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

    2016-06-01

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

  1. Selection of diagnostic tests for clinical decision making and translation to a problem oriented medical record.

    PubMed

    Realdi, Giuseppe; Previato, Lorenzo; Vitturi, Nicola

    2008-07-01

    The leading function of the physician is the clinical reasoning, which involves appropriate investigation of the problems of the patient, formulation of a diagnostic suspect based on the patient's symptoms and signs, gathering of additional relevant information, to select necessary tests and administration of the most suitable therapy. The problems of the patient are expressed by symptoms or signs or abnormal test results, requested for a variety of reasons. The entire scientific, as well as diagnostic approach, is based on three steps: to stumble in a problem; to try a solution through a hypothesis; to disprove or to prove the hypothesis by a process of criticism. Clinicians use the information obtained from the history and physical examination to estimate initial (or pre-test) probability and then use the results from tests and other diagnostic procedures to modify this probability until the post-test probability is such that the suspected diagnosis is either confirmed or ruled out. When the pre-test probability of disease is high, tests characterized by high specificity will be preferred, in order to confirm the diagnostic suspect. When the pre-test probability of disease is low, a test with high sensitivity is advisable to exclude the hypothetical disease. The above mentioned process of decision making has been transferred to a problem oriented medical record that is currently employed in our Clinic. PMID:18420030

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

    PubMed Central

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

    2012-01-01

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

  3. 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

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

    PubMed

    Papageorgiou, Elpiniki; Stylios, Chrysostomos; Groumpos, Peter

    2007-01-01

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

  5. 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

  6. 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

  7. 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

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

    PubMed

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

    2012-06-01

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

  9. 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

  10. 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

  11. Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

    PubMed

    Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

    2016-06-01

    Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital

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

    PubMed Central

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

    1989-01-01

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

  13. 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

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

    PubMed Central

    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

  15. 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.

  16. 20 CFR 702.417 - Fees for medical services; disputes; effect of adverse decision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AND PROCEDURE Medical Care and Supervision § 702.417 Fees for medical services; disputes; effect of... services rendered if such services were rendered in an emergency (see § 702.435(b)). At the termination of... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Fees for medical services; disputes;...

  17. 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

  18. Beyond Bioethics: A Child Rights-Based Approach to Complex Medical Decision-Making.

    PubMed

    Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

    2016-01-01

    This analysis adopts a child rights approach-based on the principles, standards, and norms of child rights and the U.N. Convention on the Rights of the Child (CRC)-to explore how decisions could be made with regard to treatment of a severely impaired infant (Baby G). While a child rights approach does not provide neat answers to ethically complex issues, it does provide a framework for decision-making in which the infant is viewed as an independent rights-holder. The state has obligations to develop the capacity of those who make decisions for infants in such situations to meet their obligations to respect, protect, and fulfill their rights as delineated in the CRC. Furthermore, a child rights approach requires procedural clarity and transparency in decision-making processes. As all rights in the CRC are interdependent and indivisible, all must be considered in the process of ethical decision-making, and the reasons for decisions must be delineated by reference to how these rights were considered. It is also important that decisions that are made in this context be monitored and reviewed to ensure consistency. A rights-based framework ensures decision-making is child-centered and that there are transparent criteria and legitimate procedures for making decisions regarding the child's most basic human right: the right to life, survival, and development. PMID:27157351

  19. 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

  20. 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…

  1. Improving medical diagnosis reliability using Boosted C5.0 decision tree empowered by Particle Swarm Optimization.

    PubMed

    Pashaei, Elnaz; Ozen, Mustafa; Aydin, Nizamettin

    2015-08-01

    Improving accuracy of supervised classification algorithms in biomedical applications is one of active area of research. In this study, we improve the performance of Particle Swarm Optimization (PSO) combined with C4.5 decision tree (PSO+C4.5) classifier by applying Boosted C5.0 decision tree as the fitness function. To evaluate the effectiveness of our proposed method, it is implemented on 1 microarray dataset and 5 different medical data sets obtained from UCI machine learning databases. Moreover, the results of PSO + Boosted C5.0 implementation are compared to eight well-known benchmark classification methods (PSO+C4.5, support vector machine under the kernel of Radial Basis Function, Classification And Regression Tree (CART), C4.5 decision tree, C5.0 decision tree, Boosted C5.0 decision tree, Naive Bayes and Weighted K-Nearest neighbor). Repeated five-fold cross-validation method was used to justify the performance of classifiers. Experimental results show that our proposed method not only improve the performance of PSO+C4.5 but also obtains higher classification accuracy compared to the other classification methods. PMID:26737960

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

    PubMed Central

    2014-01-01

    Background Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. Methods We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase “shared decision making” or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. Results We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). Conclusion This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the

  3. 78 FR 55244 - Notice of Availability of Record of Decision for Medical Facilities Development and University...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ... standards for military medicine at the Walter Reed National Military Medical Center (WRNMMC) by providing... provide adequate education and research space to meet Military Health System commitments to...

  4. 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.

  5. Differential medical and surgical house staff involvement in end-of-life decisions: A retrospective chart review.

    PubMed

    Kelley, Amy S; Gold, Heather T; Roach, Keith W; Fins, Joseph J

    2006-08-01

    To quantify the house officer's role in end-of-life decisions, the authors abstracted charts for documentation of end-of-life discussions for 100 patients withdrawn from life-sustaining treatment. They assessed the proportion of end-of-life care notes written by house officers, controlling for service, length of stay, outpatient physician involvement, race, and diagnostic category. Patients on the medical service were 22 times more likely to have house officer end-of-life notes than patients on the surgical service (P < 0.00001). Sixty-one percent of medical patients and 10% of surgical patients had a do-not-resuscitate note written by a house officer (P < 0.00001). House officers on the medical service wrote a significantly greater proportion of notes regarding withdrawal of care than surgical house officers (41% vs. 10%, P < 0.00001). This study reveals extensive involvement of medical house officers in primary end-of-life discussions with a complex patient population undergoing withdrawal of life-sustaining therapy. Team structure and professional culture may account for some of the observed differences between the medical and surgical services. These findings have significant implications for the education of house officers on end-of-life communication. PMID:16877178

  6. Simulation studies of data classification by artificial neural networks: potential applications in medical imaging and decision making.

    PubMed

    Wu, Y; Doi, K; Metz, C E; Asada, N; Giger, M L

    1993-05-01

    Artificial neural networks are being investigated in the field of medical imaging as a means to facilitate pattern recognition and patient classification. In the work reported here, the effects of internal structure and the nature of input data on the performance of neural networks were investigated systematically using computer-simulated data. Network performance was evaluated quantitatively by means of receiver operating characteristic analysis and compared with the performance of an ideal statistical decision maker. We found that the relatively simple neural networks investigated in this study can perform at the level of an ideal decision maker. These simple networks were also found to learn accurately even when the training data are extremely unbalanced with respect to the prevalence of actually positive cases and to differentiate input data patterns by recognizing their unique characteristics. PMID:8334172

  7. Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments.

    PubMed

    Hermann, Helena; Trachsel, Manuel; Elger, Bernice S; Biller-Andorno, Nikola

    2016-01-01

    Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria. PMID:27303329

  8. Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments

    PubMed Central

    Hermann, Helena; Trachsel, Manuel; Elger, Bernice S.; Biller-Andorno, Nikola

    2016-01-01

    Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria. PMID:27303329

  9. 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

    ... information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions...: (a) The patient lacks decision-making capacity; and (b) The practitioner deems the content of the... Patient Consent § 1.484 Disclosure of medical information to the surrogate of a patient who lacks...

  10. 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

    ... information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions...: (a) The patient lacks decision-making capacity; and (b) The practitioner deems the content of the... Patient Consent § 1.484 Disclosure of medical information to the surrogate of a patient who lacks...

  11. 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

    ... information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions...: (a) The patient lacks decision-making capacity; and (b) The practitioner deems the content of the... Patient Consent § 1.484 Disclosure of medical information to the surrogate of a patient who lacks...

  12. 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

    ... information to the surrogate of a patient who lacks decision-making capacity. 1.484 Section 1.484 Pensions...: (a) The patient lacks decision-making capacity; and (b) The practitioner deems the content of the... Patient Consent § 1.484 Disclosure of medical information to the surrogate of a patient who lacks...

  13. 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.…

  14. Assessment of providers' referral decisions in Rural Burkina Faso: a retrospective analysis of medical records

    PubMed Central

    2012-01-01

    Background A well-functioning referral system is fundamental to primary health care delivery. Understanding the providers' referral decision-making process becomes critical. This study's aim was to assess the correctness of diagnoses and appropriateness of the providers' referral decisions from health centers (HCs) to district hospitals (DHs) among patients with severe malaria and pneumonia. Methods A record review of twelve months of consultations was conducted covering eight randomly selected HCs to identify severe malaria (SM) cases among children under five and pneumonia cases among adults. The correctness of the diagnosis and appropriateness of providers' referral decisions were determined using the National Clinical Guidebook as a 'gold standard'. Results Among the 457 SM cases affecting children under five, only 66 cases (14.4%) were correctly diagnosed and of those 66 correctly diagnosed cases, 40 cases (60.6%) received an appropriate referral decision from their providers. Within these 66 correctly diagnosed SM cases, only 60.6% were appropriately referred. Among the adult pneumonia cases, 5.9% (79/1331) of the diagnoses were correctly diagnosed; however, the appropriateness rate of the provider's referral decision was 98.7% (78/79). There was only one case that should not have been referred but was referred. Conclusions The adherence to the National Guidelines among the health center providers when making a diagnosis was low for both severe malaria cases and pneumonia cases. The appropriateness of the referral decisions was particularly poor for children with severe malaria. Health center providers need to be better trained in the diagnostic process and in disease management in order to improve the performance of the referral system in rural Burkina Faso. PMID:22397326

  15. The Columbia-Presbyterian Medical Center decision-support system as a model for implementing the Arden Syntax.

    PubMed Central

    Hripcsak, G.; Cimino, J. J.; Johnson, S. B.; Clayton, P. D.

    1991-01-01

    Columbia-Presbyterian Medical Center is implementing a decision-support system based on the Arden Syntax for Medical Logic Modules (MLM's). The system uses a compiler-interpreter pair. MLM's are first compiled into pseudo-codes, which are instructions for a virtual machine. The MLM's are then executed using an interpreter that emulates the virtual machine. This design has resulted in increased portability, easier debugging and verification, and more compact compiled MLM's. The time spent interpreting the MLM pseudo-codes has been found to be insignificant compared to database accesses. The compiler, which is written using the tools "lex" and "yacc," optimizes MLM's by minimizing the number of database accesses. The interpreter emulates a stack-oriented machine. A phased implementation of the syntax was used to speed the development of the system. PMID:1807598

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

    PubMed

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

    2010-01-01

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

  17. 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.

  18. 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…

  19. 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

  20. Resident Attitudes on Ethical and Medical Decision-Making for Neonates at the Limit of Viability.

    PubMed

    Kukora, Stephanie; Laventhal, Naomi

    2016-04-01

    Objective This study aims to identify pediatric resident knowledge and attitudes on current practices and ideal gestational age (GA) thresholds for offering and mandating resuscitation, and the role of influencing factors in decision-making. Study Design Pediatric residents were assessed via electronic survey at a large academic institution. Result A total of 62% of the residents identified 23 weeks as the lower threshold for resuscitation, despite 84 and 89% reporting that practices are inconsistent and unclear, respectively. Only 21% identified 24 weeks as the latest GA that parents may decline. The majority disagreed with our current practices, identifying older GA as appropriate for all thresholds. They reported scientific evidence as undervalued, and attending physicians' personal beliefs as overvalued in decision-making. Conclusion Our residents recognize decision-making for extremely preterm infants consistent with general guidelines for management based on population outcomes, but attribute these decisions to physicians' personal beliefs. Preferences for higher GA thresholds for resuscitation may reflect disproportionate pessimism about these patients or diverse values regarding autonomy. PMID:26485248

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

    PubMed

    Tomaszewski, Wiesław; Bliźniuk, Grzegorz; Czamara, Andrzej; Ameljańczyk, Andrzej; Widuchowski, Wojciech; Klukowski, Krzysztof

    2011-01-01

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

  2. 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

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

    PubMed

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

    2015-01-01

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

  4. Older adults use of online and offline sources of health information and constructs of reliance and self-efficacy for medical decision making

    PubMed Central

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

    2016-01-01

    Background Little is known about older adults’ use of online and offline health information sources for medical decision-making despite increasing numbers of older adults who report using the Internet for health information to aid in patient/provider communication and medical decision-making. Objective To investigate older adult users and nonusers of online and offline sources of health information and factors related to medical decision-making. Methods Survey research was conducted using random-digit-dialing of Florida residents’ landline telephones. The Decision Self-Efficacy Scale and the Reliance Scale were used to measure relationships between users and nonusers of online health information. Results Study respondents were 225 older adults (age range 50–92, M = 68.9, SD = 10.4), which included users (n = 105, 46.7%) and nonusers (n = 119, 52.9%) of online health information. Users and nonusers differed in frequency and types of health sources sought. Users of online health information preferred a self-reliant approach and nonusers of online health information preferred a physician-reliant approach to involvement in medical decisions on the Reliance Scale. Conclusion This study found significant differences between older adult users and nonusers of online and offline sources of health information and examined factors related to online health information engagement for medical decision-making. PMID:26054777

  5. [The reliable and plausible conclusions in the decisions of the forensic medical experts].

    PubMed

    Kovalev, A V; Shmarov, L A; Ten'kov, A A

    2016-01-01

    The authors characterize in brief the conclusions drawn by the forensic medical experts in the course of their professional activities with special reference to their reliability and plausibility. The most common errors creeping into the conclusions are discussed together with the approaches to their prevention and/or correction. This article continues a series of publications of the same authors concerning the main logical errors encountered in the conclusions of the forensic medical experts. The results of a deeper analysis of such errors will be published elsewhere. PMID:27030098

  6. [Applications of a simple system of aid to medical decision-making with various patients in internal medicine: SELF].

    PubMed

    Kohler, F; Monchovet, S; Patris, A; Vervin, D; Kagan-Meyer, L; Groussin-Weyland, M; Anthoine, D; Guerci, O; Legras, B

    1988-01-01

    Many medical decision helping systems are very complex and require expensive computers, which restricts their diffusion and limits their use to specialized people. The idea was to find a simplified system that any practitioner--even unaccustomed to microcomputing--would be able to use. Moreover, this system had to work on widely available and inexpensive microcomputers. SELF (system in fuzzy set) is this kind of system. It has been devised as a complete interactive system of medical decision help. It is entirely parameterized, allows any kind of application and works according to such rules as "if there is premise, then there is conclusion", tempered by a coefficient. The bases of knowledge are represented on a correspondence chart where columns materialize the premises (clinical signs, laboratory results, etc.) and horizontal lines all the diagnoses and therapeutic conclusions. The system includes proceedings that create, modify and update basic knowledge. It uses the fuzzy set rules to draw conclusions. SELF was first applied to the prescription of contraceptive methods, but it has now been tested in other specialties, such as gynaecology, pneumology, haematology and so forth. In every case, the reliability of the results obtained depends on the bases chosen by the creator himself. Owing to the general character of the system, one may regard it as being open to any user who would like to create his own applications. PMID:3420333

  7. Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students

    PubMed Central

    Leung, Gabriel M; Johnston, Janice M; Tin, Keith Y K; Wong, Irene O L; Ho, Lai-Ming; Lam, Wendy W T; Lam, Tai-Hing

    2003-01-01

    Objective To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. Design Randomised controlled trial. Setting University of Hong Kong, 2001. Participants 169 fourth year medical students. Main outcome measures Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. Results The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. Conclusions Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making. PMID:14604933

  8. [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

  9. 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

  10. 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

  11. 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

  12. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage: A Case Study for Medical Decision-Making Heuristics.

    PubMed

    Dredla, Brynn; Freeman, William D

    2016-04-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient's medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis. PMID:27053985

  13. Court Decisions on Medical Malpractice in China After the New Tort Liability Law.

    PubMed

    Zhang, Kui; Li, Yuan; Fan, Fei; Liu, Xin; Deng, Zhen-Hua

    2016-09-01

    A new Tort Law of the People's Republic of China became effective on July 1, 2010. We undertook an analysis of medical malpractice lawsuits brought before regional courts in Beijing districts after this new Tort Liability Law went into effect. In total, 726 cases eventuating in a final verdict were collected from the Beijing district courts from 2011 to 2013 in this retrospective study; 83.7% of the 726 alleged instances of medical malpractice were confirmed to be malpractice by the final verdict. The disciplines most frequently involved with claims of medical malpractice were obstetrics and gynecology, the most frequent outcomes was death, and the most common types of case associated with malpractice was surgery related. The average length of time between the occurrence of the injury and closure of the claim was 9.2 months, and the average payment was ¥163,000. Since the introduction of the new Tort Liability Law, the average time to complete a litigation was shortened, but it has made little apparent difference otherwise. PMID:27281443

  14. Review article: Medical decision models of Helicobacter pylori therapy to prevent gastric cancer.

    PubMed

    Sonnenberg, A; Inadomi, J M

    1998-02-01

    The aim of the present article is to study the utility of Helicobacter pylori eradication programmes in decreasing the incidence of gastric cancer. Three types of decision models are employed to pursue this aim, i.e. decision tree, present value, and declining exponential approximation of life expectancy (DEALE). 1) A decision tree allows one to model the interaction of multiple variables in great detail and to calculate the marginal cost, as well as the marginal cost-benefit ratio, of a preventive strategy. The cost of gastric cancer, the efficacy of H. pylori therapy in preventing cancer, and the cumulative probability of developing gastric cancer exert the largest influence on the marginal cost of cancer prevention. The high cost of future gastric cancer and a high efficacy of therapy make screening for H. pylori and its eradication the preferred strategy. 2) The present value is an economic method to adjust future costs or benefits to their current value using a discount rate and the length of time between now and a given time point in the future. It accounts for the depreciation of money and all material values over time. During childhood, the present value of future gastric cancer is very low. Vaccination of children to prevent gastric cancer would need to be very inexpensive to be practicable. Cancer prevention becomes a feasible option, only if the time period between the preventive measures and the occurrence of gastric cancer can be made relatively short. 3) The DEALE provides a means to calculate the increase in life expectancy that would occur, if death from a particular disease became preventable. Life expectancy of the general population is hardly affected by gastric cancer. For life expectancy to increase appreciably by vaccination or antibiotic therapy directed against H. pylori infection, these interventions would need to be focused towards a sub-population with an a priori high risk for gastric cancer. PMID:9701008

  15. 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

  16. 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

  17. 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

  18. 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

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

    PubMed

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

    2015-07-01

    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

  20. End‐of‐life decisions in medical practice: a survey of doctors in Victoria (Australia)

    PubMed Central

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

    2007-01-01

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

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

    PubMed Central

    Moore, G. William; Hutchins, Grover M.

    1982-01-01

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

  2. 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

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

    PubMed Central

    Manalo, Maria Fidelis C

    2013-01-01

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

  4. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    PubMed

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession. PMID:18447864

  5. Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

    PubMed Central

    Fiks, Alexander G; Zhang, Peixin; Localio, A Russell; Khan, Saira; Grundmeier, Robert W; Karavite, Dean J; Bailey, Charles; Alessandrini, Evaline A; Forrest, Christopher B

    2015-01-01

    Objective Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. Study Setting A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010. Study Design Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary. Data Collection Extraction from a common EHR. Principal Findings Clinicians and practices used the CDS system for a mean of 21 percent (range: 0–85 percent) and 17 percent (0–51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study. Conclusions Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows. PMID:25287670

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

    PubMed

    Schleifer, David; Rothman, David J

    2012-01-01

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

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

    PubMed

    Robson, Barry

    2014-08-01

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

  8. “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

  9. 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

  10. Helping smokers make decisions: the enhancement of brief intervention for general medical practice.

    PubMed

    Rollnick, S; Butler, C C; Stott, N

    1997-07-01

    Primary care clinicians are often encouraged by government agencies to intervene systematically with all smokers. Pressure of time and pessimism about their own efficacy and patients' capacity to change are some of the reasons why clinicians do not feel it is appropriate to always advise every patient about unhealthy behaviours. Developments in patient centred approaches to the consultation and progress in the addictions field suggest that new consulting methods could be constructed which are more satisfying than giving brief advice to change. The aim of this study was to develop a structured, teachable and acceptable intervention for clinicians to help patients consider their smoking during general medical consultations. Patient centred strategies derived from the stages of change model and motivational interviewing and its adaptations were explored in experimental consultations with 20 volunteer smokers. Feedback from them and from general practice registrars trained in the use of the method informed its development. Acceptability to clinicians was assessed by semi structured telephone interviews with 24 general practice registrars who participated in a randomised controlled trial assessing the effectiveness of the method. Anonymous, written questionnaires were also completed by 20 of the registrars who recruited ten or more patients into the trial. The method is described. Key components are: establishing rapport, assessing motivation and confidence, and then depending on the response, asking standard scaling questions, asking about pros and cons of smoking, non-judgmental information sharing, brainstorming solutions and negotiating attainable goals and follow-up. The clinicians used the method with a total of 270 smokers, taking an average of 9.69 min with each patient. Evaluation reveals that it is acceptable to the group of general practice registrars. Longer consultation time was seen as the main drawback. We conclude that acceptable methods for

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

    PubMed Central

    2011-01-01

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

  12. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    De Jesus, Maria

    2013-01-01

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

  15. Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0

    PubMed Central

    Kripke, Katharine; Opuni, Marjorie; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason; Stover, John

    2016-01-01

    Background Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President’s Plan for AIDS Relief (PEPFAR) supported the development and application of a model to inform national planning in five countries from 2013–2014. Methods and Findings The Decision Makers’ Program Planning Toolkit (DMPPT) 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15–34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20–29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10–19 in Uganda, 15–24 in Malawi and South Africa, 10–24 in Tanzania, and 15–29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15–34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds. Conclusions The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly. PMID:27410966

  16. “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

  17. Health Economic Data in Reimbursement of New Medical Technologies: Importance of the Socio-Economic Burden as a Decision-Making Criterion

    PubMed Central

    Iskrov, Georgi; Dermendzhiev, Svetlan; Miteva-Katrandzhieva, Tsonka; Stefanov, Rumen

    2016-01-01

    Background: Assessment and appraisal of new medical technologies require a balance between the interests of different stakeholders. Final decision should take into account the societal value of new therapies. Objective: This perspective paper discusses the socio-economic burden of disease as a specific reimbursement decision-making criterion and calls for the inclusion of it as a counterbalance to the cost-effectiveness and budget impact criteria. Results/Conclusions: Socio-economic burden is a decision-making criterion, accounting for diseases, for which the assessed medical technology is indicated. This indicator is usually researched through cost-of-illness studies that systematically quantify the socio-economic burden of diseases on the individual and on the society. This is a very important consideration as it illustrates direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. By measuring and comparing the socio-economic burden of different diseases to society, health authorities and payers could benefit in optimizing priority setting and resource allocation. New medical technologies, especially innovative therapies, present an excellent case study for the inclusion of socio-economic burden in reimbursement decision-making. Assessment and appraisal have been greatly concentrated so far on cost-effectiveness and budget impact, marginalizing all other considerations. In this context, data on disease burden and inclusion of explicit criterion of socio-economic burden in reimbursement decision-making may be highly beneficial. Realizing the magnitude of the lost socio-economic contribution resulting from diseases in question could be a reasonable way for policy makers to accept a higher valuation of innovative therapies. PMID:27582707

  18. 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

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

    PubMed

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

    2011-02-01

    Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations. PMID:20703588

  20. 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

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

    PubMed Central

    Truog, Robert; Savulescu, Julian

    2015-01-01

    Abstract 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

  2. Core and comprehensive health care services: 1. Introduction to the Canadian Medical Association's decision-making framework.

    PubMed

    Wilson, R; Rowan, M S; Henderson, J

    1995-04-01

    The CMA's decision-making framework on core (i.e., publicly funded) and comprehensive health care services emphasizes flexibility and recognizes three levels at which decisions can be made: between patients and physicians (micro), in the community or by society (meso) and by governments (macro). Three major content dimensions are considered quality of care (e.g., effectiveness, appropriateness and efficiency of health care services), ethics (e.g., decisions that reflect fairness and acceptability to patients and physicians) and economics (e.g., measurement of service costs against economic benefits in a time of severe economic restraint). There are challenges in applying the framework; however, by providing decision-makers with the knowledge and tools needed to assist in the process, it is hoped that the first and foremost concern will continue to be the quality of patient care so highly valued by Canadians. PMID:7712418

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  4. 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

  5. Data-mining to build a knowledge representation store for clinical decision support. Studies on curation and validation based on machine performance in multiple choice medical licensing examinations.

    PubMed

    Robson, Barry; Boray, Srinidhi

    2016-06-01

    Extracting medical knowledge by structured data mining of many medical records and from unstructured data mining of natural language source text on the Internet will become increasingly important for clinical decision support. Output from these sources can be transformed into large numbers of elements of knowledge in a Knowledge Representation Store (KRS), here using the notation and to some extent the algebraic principles of the Q-UEL Web-based universal exchange and inference language described previously, rooted in Dirac notation from quantum mechanics and linguistic theory. In a KRS, semantic structures or statements about the world of interest to medicine are analogous to natural language sentences seen as formed from noun phrases separated by verbs, prepositions and other descriptions of relationships. A convenient method of testing and better curating these elements of knowledge is by having the computer use them to take the test of a multiple choice medical licensing examination. It is a venture which perhaps tells us almost as much about the reasoning of students and examiners as it does about the requirements for Artificial Intelligence as employed in clinical decision making. It emphasizes the role of context and of contextual probabilities as opposed to the more familiar intrinsic probabilities, and of a preliminary form of logic that we call presyllogistic reasoning. PMID:27089305

  6. 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

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

    PubMed Central

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

    2004-01-01

    Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with electronic patient data to present real-time, patient-specific recommendations. However, technical success in implementing decision support systems may not translate directly into system use by clinicians. Successful technology integration into clinical work settings requires explicit attention to the organizational context. We describe the application of a “sociotechnical” approach to integration of ATHENA DSS, a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics. We applied an iterative technical design in response to organizational input and obtained ongoing endorsements of the project by the organization's administrative and clinical leadership. Conscious attention to organizational context at the time of development, deployment, and maintenance of the system was associated with extensive clinician use of the system. PMID:15187064

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

    PubMed Central

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

    2010-01-01

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

  9. Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes.

    PubMed

    Sorita, Atsushi; Bos, J Martijn; Morlan, Bruce W; Tarrell, Robert F; Ackerman, Michael J; Caraballo, Pedro J

    2015-04-01

    We developed and implemented a 'CPOE-QT Alert' system, that is, clinical decision support integrated in the computerized physician order entry system (CPOE), in 2011. The system identifies any attempts to order medications with risk of torsade de pointes (TdP) for patients with a history of significant QT prolongation (QTc ≥500 ms) and alerts the provider entering the order. We assessed its impact by comparing orders and subsequent medication administration before and after activation of the system. We found a significant decrease in the proportion of completed order per ordering attempt after system activation (94% (1293/1379) vs 77% (1888/2453), difference 16.8%; p<0.001). This resulted in a 13.9% reduction in the administration of those medications to patients. A significant decrease was observed across all provider types, educational levels, and specialties. The CPOE-QT Alert system successfully reduced exposure to QT-prolonging medications in high risk patients. PMID:25324555

  10. 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