WorldWideScience

Sample records for grid-based medical decision

  1. Grid-enabled SEE++, A Grid-Based Medical Decision Support System for Eye Muscle Surgery Conference

    CERN Document Server

    Schreiner, W.; Buchberger, M.; Kaltofen, T.

    2006-01-01

    JKU/RISC currently develops in cooperation with Upper Austrian Research (UAR) the SEE-GRID software system. SEE-GRID is based on the SEE++ software for the biomechanical 3D simulation of the human eye and its muscles. SEE++ simulates the common eye muscle surgery techniques in a graphic interactive way that is familiar to an experienced surgeon. SEE++ is world-wide the most advanced software for this purpose; it is used by various hospitals and medical doctors for surgery training and planning, SEE++ deals with the support of diagnosis and treatment of strabismus, which is the common name given to usually persistent or regularly occuring misalignment of the eyes. Strabismus is a visual defect in which eyes point in different directions. A person suffering from it may see double images due to misaligned eyes. SEE++ is able to simulate the result of the Hess-Lancaster test, from which the pathological reason of strabismus can be estimated. The outcome of such an examination is two gaze patterns of blue points a...

  2. Grid-based virtual clinic for medical diagnosis tutoring | Yatchou ...

    African Journals Online (AJOL)

    La réalisation visée est un outil collaboratif d\\'enseignement pour les médecins du terrain et les étudiants en médecine au sein d\\'une organisation virtuelle. The emerging grid-based technologies are increasingly adopted to enhance education and provide better learning services. This is characterized all over the world, ...

  3. Real-Time Pricing Decision Making for Retailer-Wholesaler in Smart Grid Based on Game Theory

    Directory of Open Access Journals (Sweden)

    Yeming Dai

    2014-01-01

    Full Text Available Real-time pricing DSM (demand side management is widely used to dynamically change or shift the electricity consumption in the smart grid. In this paper, a game decision making scheme is proposed in the smart grid with DSM. The interaction between two retailers and their wholesaler is modeled as a two-stage game model. Considering the competition between two retailers, two different game models are developed in terms of the different action order between retailers and their wholesaler. Through analyzing the equilibrium revenues of the retailers for different situations we find that although the wholesaler expects to decentralize certain management powers to the retailers, it has retained the right to change the rules of the game and frequently reneged on the promises. More specifically, the law should ensure that any change of the revenue-sharing formula must go through certain legal procedures. Imposing legal restrictions on the wholesaler’s discretionary policy suggests that the time-inconsistency problem is mitigated. Numerical simulation shows the effectiveness of proposed scheme.

  4. The Structure of Medical Decisions

    DEFF Research Database (Denmark)

    Austin, Laurel C.; Reventlow, Susanne; Sandøe, Peter

    2013-01-01

    Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible......, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which......) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical...

  5. Decisions, decisions: why the quality of medical decisions matters.

    Science.gov (United States)

    Blumenthal, David

    2004-01-01

    Questions about the process leading to particular medical decisions are seldom addressed in discussions of health care quality. In some cases, strict adherence to treatment protocols may overlook important elements in the clinical decision-making process, such as physicians' judgment and patients' preferences. Papers by Annette O'Connor and colleagues and Karen Sepucha and colleagues are welcome additions to this debate because they highlight the importance of the medical decision-making process; they suggest that the quality of this process should be considered when evaluating health care quality. I explore some key limitations and uncertainties that must be addressed before work in this area can become broadly applicable.

  6. Framework of Uncertainty in Medical Decision Making

    DEFF Research Database (Denmark)

    Austin, L; Brodersen, John; Reventlow, Susanne

    Historically, medical decisions have primarily involved diagnosis and treatment of symptomatic patients. Increasingly, medical decisions concern uncertain future health states in asymptomatic people. We construct a taxonomy of five medical decision situations that encompasses these wider possibil......Historically, medical decisions have primarily involved diagnosis and treatment of symptomatic patients. Increasingly, medical decisions concern uncertain future health states in asymptomatic people. We construct a taxonomy of five medical decision situations that encompasses these wider...... the symptomatic patient; 2) assessing someone for an asymptomatic condition; 3) assessing someone for increased risk of a future condition; 4) simultaneously assessing multiple risks factors for one person; and 5) assessing the individual based only on population membership....

  7. Medical decision making and medical education: challenges and opportunities.

    Science.gov (United States)

    Schwartz, Alan

    2011-01-01

    The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.

  8. Court decisions on medical malpractice.

    Science.gov (United States)

    Knaak, Jan-Paul; Parzeller, Markus

    2014-11-01

    Recent studies on court cases dealing with medical malpractice are few and far between. This retrospective study, therefore, undertakes an analysis of medical malpractice lawsuits brought before regional courts in two judicial districts of the federal state of Hesse. Over a 5-year period (2006-2010), 232 court decisions on medical malpractice taken by the regional courts (Landgericht) of Kassel and Marburg were evaluated according to medical discipline, diagnosis, therapy, relevant level of care, charge of neglect of duty by the claimant party, outcome of the lawsuit, and further criteria. With certain overlaps, the disciplines most frequently confronted with claims of medical malpractice were accident surgery and orthopedics (30.2%; n = 70), dentistry (16.4%; n = 38), surgery (12.1%; n = 28), and gynecology and obstetrics (7.8%; n = 18), followed by the remaining medical disciplines (38.8%; n = 90). Malpractice allegations were brought against the practice-based sector in 35.8 % (n = 83) of cases, the hospital-based sector in 63.3% (n = 147) of cases, and other sectors in 0.9% (n = 2) of cases. The allegation grounds included false administration of treatment (67.2%; n = 156), false indication of treatment (37.1%; n = 86), false diagnosis (31.5%; n = 73), and/or organizational negligence (13.8%; n = 32). A breach of duty to inform was given as grounds for the claim in 38.8% (n = 90) of cases. A significant majority of 65.6% (n = 152) of cases ended in a court settlement. Of the cases, 18.9% (n = 44) were concluded by claim withdrawal, 11.2% (n = 26) by claim dismissal and 2.6% (n = 6) by criminal sentence. Of the cases, 1.7% (n = 4) were for purposes of securing evidence. Although there was no conclusive evidence of malpractice, two thirds of the cases ended in a court settlement. On the one hand, this outcome reduces the burden on the courts, but on the other, it can in the long term give

  9. Influence of framing on medical decision making

    OpenAIRE

    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.

  10. Influence of framing on medical decision making

    Science.gov (United States)

    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

  11. MINDS - Medical Information Network Decision Support System

    National Research Council Canada - National Science Library

    Armenian, H. K

    2008-01-01

    .... The increase in and complexity of medical data at various levels of resolution has increased the need for system level advancements in clinical decision support systems that provide computer-aided...

  12. Family interests and medical decisions for children.

    Science.gov (United States)

    Baines, Paul

    2017-10-01

    Medical decisions for children are usually justified by the claim that they are in a child's best interests. More recently, following criticisms of the best interests standard, some advocate that the family's interests should influence medical decisions for children, although what is meant by family interests is often not made clear. I argue that at least two senses of family interests may be discerned. There is a 'weak' sense (as the amalgamated interests of family members) of family interests and a 'strong' sense (that the family itself has interests over and above the interests of individuals). I contend that there are problems with both approaches in making medical decisions for children but that the weak sense is more plausible. Despite this, I argue that claims for family interests are not helpful in making medical decisions for children. © 2017 John Wiley & Sons Ltd.

  13. Doctor's dilemma (medical decision making)

    International Nuclear Information System (INIS)

    Ganatra, R.D.

    2003-01-01

    Disagreement between experts is presumed to be uncommon in medical diagnosis. Radiology is considered to be a particularly objective means of diagnosis and expert radiographic interpretation is expected to be infallible. Five military radiologists were made to review independently chest radiographs of 1256 patients recorded in four image formats and interpret each as positive or negative for tuberculosis. The results were unexpected. Ability to detect tuberculosis varied little between various image formats but the extent of disagreement between doctors was remarkable. The number of cases judged positive varied from 56 to 100 among the five readers. Of cases judged positive at least once, the mean rate of disagreement between pairs of readers was 19%. The validity of these findings have been confirmed repeatedly in several subsequent trials. Other diagnostic modalities show equally surprising rates of diagnostic dissonance. Extensive observer disagreement was found to be a universal problem in medical diagnosis, giving credence to the proverbial adage that 'no two doctors agree'. The magnitude of disagreement between experts is the principal theoretic problem of diagnosis. Even a stochastic theory of diagnosis is devised which accounts for the disagreement between experts, where the disagreement approaches a theoretic maximum even for ideal diagnosticians

  14. Grid-based Visualization Framework

    Science.gov (United States)

    Thiebaux, M.; Tangmunarunkit, H.; Kesselman, C.

    2003-12-01

    Advances in science and engineering have put high demands on tools for high-performance large-scale visual data exploration and analysis. For example, earthquake scientists can now study earthquake phenomena from first principle physics-based simulations. These simulations can generate large amounts of data, possibly high spatial resolution, and long time series. Single-system visualization software running on commodity machines cannot scale up to the large amounts of data generated by these simulations. To address this problem, we propose a flexible and extensible Grid-based visualization framework for time-critical, interactively controlled visual browsing of spatially and temporally large datasets in a Grid environment. Our framework leverages Grid resources for scalable computation and data storage to maintain performance and interactivity with large visualization jobs. Our framework utilizes Globus Toolkit 2.4 components for security (i.e., GSI), resource allocation and management (i.e., DUROC, GRAM) and communication (i.e., Globus-IO) to couple commodity desktops with remote, scalable storage and computational resources in a Grid for interactive data exploration. There are two major components in this framework---Grid Data Transport (GDT) and the Grid Visualization Utility (GVU). GDT provides libraries for performing parallel data filtering and parallel data exchange among Grid resources. GDT allows arbitrary data filtering to be integrated into the system. It also facilitates multi-tiered pipeline topology construction of compute resources and displays. In addition to scientific visualization applications, GDT can be used to support other applications that require parallel processing and parallel transfer of partial ordered independent files, such as file-set transfer. On top of GDT, we have developed the Grid Visualization Utility (GVU), which is designed to assist visualization dataset management, including file formatting, data transport and automatic

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

    Science.gov (United States)

    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.

  16. General practitioners’ decisions about discontinuation of medication

    DEFF Research Database (Denmark)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-01-01

    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...

  17. Multimedia medical case retrieval using decision trees.

    Science.gov (United States)

    Quellec, Gwénolé; Lamard, Mathieu; Bekri, Lynda; Cazuguel, Guy; Cochener, Béatrice; Roux, Christian

    2007-01-01

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

  18. Multimedia medical case retrieval using decision trees

    Science.gov (United States)

    Quellec, Gwénolé; Lamard, Mathieu; Bekri, Lynda; Cazuguel, Guy; Cochener, Béatrice; Roux, Christian

    2007-01-01

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

  19. Ethics and medical decision-making.

    Science.gov (United States)

    Burke, G

    1980-12-01

    There is a tendency for physicians to approach ethical problems in a manner similar to that in which they approach medical problems. Instead of disease categories (such as congestive heart failure or diarrhea), the physician substitutes moral quandaries (such as euthanasia or abortion). The goal is to learn what the "right" rules are for this particular problem at this particular moment. Although this method has important practical and instructive value, it can produce an empirical attitude toward ethics akin to that found in students who strive to learn medicine solely by algorithms. Using theoretical models as a center for discussion, this article has attempted to approach medical ethics as a decision-making process derived from the physician-patient relationship model in use. What is the type of physician-patient relationship that forms the soundest base for making ethical decisions? It must be realized that the contractual relationship cannot be ignored, for in our consumer-oriented society it will surely remain as a protection for the patient against the incompetent or immoral physician. It should not become the sole guide of physician behavior, however, lest we be satisfied with mediocre behavior as the maximal standard. Likewise, although technical competence is required for one to make the right and good decision, it is insufficient alone as a guide for moral behavior. Given the medically correct facts, a multitude of responses are available which necessitate a moral choice. Physicians need a guiding principle that goes beyond any aesthetic code of behavior, or protection of self-interest, and which enables them to deal with all the unexpected ethical questions faced in providing care to patients. Moral principles such as truth-telling, promise-keeping, and protecting the patient when he is vulnerable, help the physician to act in a moral manner, but lack the encompassing nature of the covenantal promise. The covenantal model includes a donative element

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

    Science.gov (United States)

    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.…

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

    Science.gov (United States)

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

    2015-07-01

    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. 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. 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 (ptelevision 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.

  2. Incorporating patients' preferences into medical decision making.

    Science.gov (United States)

    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.

  3. Heuristics: foundations for a novel approach to medical decision making.

    Science.gov (United States)

    Bodemer, Nicolai; Hanoch, Yaniv; Katsikopoulos, Konstantinos V

    2015-03-01

    Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics-simple rules of thumb-and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accurate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.

  4. Medical Operations Decision Support System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Determining the probability of specific medical events on a given space mission is difficult. Yet, it is important to have reasonable estimates of these...

  5. Medical Operations Decision Support System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Determining the probability of specific medical events on a given space mission is difficult. Yet, it is important to have reasonable estimates of these...

  6. Medical Operations Decision Support System, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Risks associated with possible medical events during space missions are challenging to identify and manage. Resources must be applied judiciously and risk must not...

  7. Medical decision making tools: Bayesian analysis and ROC analysis

    International Nuclear Information System (INIS)

    Lee, Byung Do

    2006-01-01

    During the diagnostic process of the various oral and maxillofacial lesions, we should consider the following: 'When should we order diagnostic tests? What tests should be ordered? How should we interpret the results clinically? And how should we use this frequently imperfect information to make optimal medical decision?' For the clinicians to make proper judgement, several decision making tools are suggested. This article discusses the concept of the diagnostic accuracy (sensitivity and specificity values) with several decision making tools such as decision matrix, ROC analysis and Bayesian analysis. The article also explain the introductory concept of ORAD program

  8. Patients' participation in decision-making in the medical field

    DEFF Research Database (Denmark)

    Glasdam, Stinne; Oeye, Christine; Thrysøe, Lars

    2015-01-01

    is going to happen in his life. Both professionals and patients have an underlying, tacit preconception that every medical treatment is better than no treatment. 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 the 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 frame and medical logic. The decision-making competence in relation to the choice of treatment is placed away...

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

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

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

  10. Connectionist expert systems as medical decision aid.

    Science.gov (United States)

    Barreto, J M; de Azevedo, F M

    1993-12-01

    In this paper neural networks are used as associative memories to build an expert system for aiding medical diagnosis. As in expert systems using symbolic manipulation, the knowledge is introduced by a knowledge engineer using a collection of known cases. The system has an object-oriented approach to knowledge organization and the resulting network topology. Fuzzy sets are used to interpret connection values and/or excitation state of the units. The main result is that the proposed neural network allows not only finding a solution in some cases, but also suggests obtaining more clinical data if the data available is insufficient to reach a conclusion. This approach is illustrated by examples.

  11. Grid based calibration of SWAT hydrological models

    Directory of Open Access Journals (Sweden)

    D. Gorgan

    2012-07-01

    Full Text Available The calibration and execution of large hydrological models, such as SWAT (soil and water assessment tool, developed for large areas, high resolution, and huge input data, need not only quite a long execution time but also high computation resources. SWAT hydrological model supports studies and predictions of the impact of land management practices on water, sediment, and agricultural chemical yields in complex watersheds. The paper presents the gSWAT application as a web practical solution for environmental specialists to calibrate extensive hydrological models and to run scenarios, by hiding the complex control of processes and heterogeneous resources across the grid based high computation infrastructure. The paper highlights the basic functionalities of the gSWAT platform, and the features of the graphical user interface. The presentation is concerned with the development of working sessions, interactive control of calibration, direct and basic editing of parameters, process monitoring, and graphical and interactive visualization of the results. The experiments performed on different SWAT models and the obtained results argue the benefits brought by the grid parallel and distributed environment as a solution for the processing platform. All the instances of SWAT models used in the reported experiments have been developed through the enviroGRIDS project, targeting the Black Sea catchment area.

  12. Assessment of unconscious decision aids applied to complex patient-centered medical decisions.

    Science.gov (United States)

    Manigault, Andrew Wilhelm; Handley, Ian Michael; Whillock, Summer Rain

    2015-02-05

    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. 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. A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while reporting judgments. Cognitive load

  13. Women's experience of decision-making with medication abortion.

    Science.gov (United States)

    Cappiello, Joyce; Merrell, Joy; Rentschler, Dorothy

    2014-01-01

    Medication abortion received regulatory approval in 2001 in the United States with healthcare providers increasingly offering this method. However, most studies in the United States have only explored acceptability and decision-making with women who participated in clinical trials. Overall, the literature on women's experience with a method that it is now widely available is under research in the United States. To describe and analyze the women's experience as they choose the option of and experienced the process of medication abortion. A constructivist grounded theory study. Outpatient clinical offices in a three-state area in the northeast region of the United States. A purposive sample of 22 women aged 16 to 45 who experienced a medication abortion. Data were collected by in-depth, open-ended, face-to-face interviews. The constant comparative method was used for analysis. Five interwoven categories emerged regarding women's initial decision to have a medication abortion: choosing a natural process, avoiding "surgery," respecting the "baby," scheduling to meet needs, and appreciating the home setting. The enhanced sense of personal control associated with the medication abortion option was the overriding reason given for choosing this method. This study contributes to the paucity of literature on the reasons why women choose medication abortion. It is important for nurses to understand the complexity of medication abortion decision-making so that they can effectively support women through this process.

  14. Factors influencing US medical students' decision to pursue surgery.

    Science.gov (United States)

    Schmidt, Lauren E; Cooper, Clairice A; Guo, Weidun Alan

    2016-06-01

    Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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. © 2014 International Union of Psychological Science.

  17. XForms and XML Events to Support Decisions about Medication Management

    OpenAIRE

    Calabretto, Jean-Pierre; Banerjee, Debdeep; Warren, Jim; Bird, Linda

    2005-01-01

    Representation and presentation of information in healthcare is problematic, including issues related to common formats and accessibility. XML technology infrastructure (particularly XForms and XML events) appears promising in addressing some of these issues. These technologies were investigated in the context of decision support for medication management. XForms allows rapid prototyping of information models and interfaces. XML events are useful to model simple alerts altho...

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

    Science.gov (United States)

    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.

  19. Medical case retrieval from a committee of decision trees.

    Science.gov (United States)

    Quellec, Gwénolé; Lamard, Mathieu; Bekri, Lynda; Cazuguel, Guy; Roux, Christian; Cochener, Béatrice

    2010-09-01

    A novel content-based information retrieval framework, designed to cover several medical applications, is presented in this paper. The presented framework allows the retrieval of possibly incomplete medical cases consisting of several images together with semantic information. It relies on a committee of decision trees, decision support tools well suited to process this type of information. In our proposed framework, images are characterized by their digital content. It was applied to two heterogeneous medical datasets for computer-aided diagnoses: a diabetic retinopathy follow-up dataset (DRD) and a mammography-screening dataset (DDSM). Measure of precision among the top five retrieved results of 0.788 + or - 0.137 and 0.869 + or - 0.161 was obtained on DRD and DDSM, respectively. On DRD, for instance, it increases by half the retrieval of single images.

  20. Dual processing model of medical decision-making.

    Science.gov (United States)

    Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

    2012-09-03

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

  1. Dual processing model of medical decision-making

    Science.gov (United States)

    2012-01-01

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

  2. Decision conflict and regret among surrogate decision makers in the medical intensive care unit.

    Science.gov (United States)

    Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael

    2016-04-01

    Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier

  3. Human-Computer Interaction with Medical Decisions Support Systems

    Science.gov (United States)

    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.

  4. Factors influencing judicial decisions on medical disputes in plastic surgery.

    Science.gov (United States)

    Vila-Nova da Silva, Dione Batista; Nahas, Fábio Xerfan; Ferreira, Lydia Masako

    2015-05-01

    Recently, more lawsuits have been filed by patients against their plastic surgeons, often leading to social and financial losses for the physicians involved. The authors sought to determine the factors that influence judicial decisions against plastic surgeons. Data from 98 malpractice claims filed between January 1 2000 and December 31 2008 were obtained from a state court of justice in Brazil. The authors selected 39 closed cases for this study. The following parameters were reviewed for each case: date of decision, complaint(s), conclusions of expert report, presence/absence of informed consent, medical records, and judicial decision. The chi-square test, Cramer's V coefficient, Fisher's exact test, and Cochran-Armitage test were utilized to compare data. Significance was defined as P ≤ .05. Most lawsuits pertained to breast surgery (32%), abdominoplasty (24%), rhinoplasty (22%), and liposuction (22%). The most common complaints were scars and resulting contour (48.9%), general dissatisfaction (25.6%), and complications (25.2%). In all cases with medical records considered of "good quality" by the judge (n = 17), the surgeon was acquitted. There was a significant correlation between decisions favoring the surgeon and the presence of written informed consent documentation. "Not guilty" verdicts also were associated with expert report conclusions favoring the physician. Surgeons were found guilty of malpractice in cases that failed to meet at least 2 of these 3 conditions (good-quality medical record, informed consent, expert report favoring the surgeon). Factors that heavily influenced judicial decisions were the quality of medical records, informed consent, and expert report conclusions. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  5. Grid-based modeling for land use planning and environmental resource mapping.

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J. A.

    1999-08-04

    Geographic Information System (GIS) technology is used by land managers and natural resource planners for examining resource distribution and conducting project planning, often by visually interpreting spatial data representing environmental or regulatory variables. Frequently, many variables influence the decision-making process, and modeling can improve results with even a small investment of time and effort. Presented are several grid-based GIS modeling projects, including: (1) land use optimization under environmental and regulatory constraints; (2) identification of suitable wetland mitigation sites; and (3) predictive mapping of prehistoric cultural resource sites. As different as the applications are, each follows a similar process of problem conceptualization, implementation of a practical grid-based GIS model, and evaluation of results.

  6. [A model of shared decision-making in medical rehabilitation].

    Science.gov (United States)

    Körner, M

    2009-06-01

    In this article, an adjusted model of shared decision-making is presented for the sector of medical rehabilitation. This model of interaction describes shared decision-making as a process between physician and patient on the basis of shared information and with both parties equally and actively involved. The typical elements of this interaction model can be transferred to other professionals in the health care sector (i. e. therapists, nurses, social workers, etc.) as well as to the interaction between these different groups of health professionals working as a team. The idea of patient orientation is supplemented with the aspect of relations between the different groups of health professionals, hence establishing patient-oriented interaction inside the organization. In order to strengthen internal patient orientation through a process of shared decision-making between different health professionals (providers), a co-operative leadership style is required in the rehabilitation clinic. Creating the internal conditions for shared decision-making (internal patient orientation) is a prerequisite for considering needs and expectations of the patient within the treatment process (external patient orientation). Health professionals need to display the ability to create these internal conditions to allow for improvement of patient orientated treatment in terms of an integrated patient orientation. Training of the providers is a prerequisite for implementation of an integrated patient orientation in medical rehabilitation. Once a higher level of patient orientation is achieved, through participation in the provider-patient-relationship and communication between the providers within the team, an improved quality of decision-making, a higher level of patient and employee satisfaction and more positive treatment outcomes can be assumed.

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

    Science.gov (United States)

    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.

  8. IMPRESS: medical location-aware decision making during emergencies

    Science.gov (United States)

    Gkotsis, I.; Eftychidis, G.; Leventakis, G.; Mountzouris, M.; Diagourtas, D.; Kostaridis, A.; Hedel, R.; Olunczek, A.; Hahmann, S.

    2017-09-01

    Emergency situations and mass casualties involve several agencies and public authorities, which need to gather data from the incident scene and exchange geo-referenced information to provide fast and accurate first aid to the people in need. Tracking patients on their way to the hospitals can prove critical in taking lifesaving decisions. Increased and continuous flow of information combined by vital signs and geographic location of emergency victims can greatly reduce the response time of the medical emergency chain and improve the efficiency of disaster medicine activity. Recent advances in mobile positioning systems and telecommunications are providing the technology needed for the development of location-aware medical applications. IMPRESS is an advanced ICT platform based on adequate technologies for developing location-aware medical response during emergencies. The system incorporates mobile and fixed components that collect field data from diverse sources, support medical location and situation-based services and share information on the patient's transport from the field to the hospitals. In IMPRESS platform tracking of victims, ambulances and emergency services vehicles is integrated with medical, traffic and crisis management information into a common operational picture. The Incident Management component of the system manages operational resources together with patient tracking data that contain vital sign values and patient's status evolution. Thus, it can prioritize emergency transport decisions, based on medical and location-aware information. The solution combines positioning and information gathered and owned by various public services involved in MCIs or large-scale disasters. IMPRESS solution, were validated in field and table top exercises in cooperation with emergency services and hospitals.

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

    Science.gov (United States)

    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

  10. [The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

    Science.gov (United States)

    Su, Szu-Huei; Wu, Li-Min

    2018-04-01

    The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p < .01), and whether the patient had signed a currently valid advance healthcare directive (Eta = .223, p = .002). Furthermore, a significantly negative correlation was found between these intentions and length of stay in the ICU (r = -.263, p < .01). Patient age, whether the patient had signed a currently valid advance healthcare directive, and length of stay in the ICU were all predictive factors for the behavioral intentions underlying the medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

  11. Medical students, clinical preventive services, and shared decision-making.

    Science.gov (United States)

    Keefe, Carole W; Thompson, Margaret E; Noel, Mary Margaret

    2002-11-01

    Improving access to preventive care requires addressing patient, provider, and systems barriers. Patients often lack knowledge or are skeptical about the importance of prevention. Physicians feel that they have too little time, are not trained to deliver preventive services, and are concerned about the effectiveness of prevention. We have implemented an educational module in the required family practice clerkship (1) to enhance medical student learning about common clinical preventive services and (2) to teach students how to inform and involve patients in shared decision making about those services. Students are asked to examine available evidence-based information for preventive screening services. They are encouraged to look at the recommendations of various organizations and use such resources as reports from the U.S. Preventive Services Task Force to determine recommendations they want to be knowledgeable about in talking with their patients. For learning shared decision making, students are trained to use a model adapted from Braddock and colleagues(1) to discuss specific screening services and to engage patients in the process of making informed decisions about what is best for their own health. The shared decision making is presented and modeled by faculty, discussed in small groups, and students practice using Web-based cases and simulations. The students are evaluated using formative and summative performance-based assessments as they interact with simulated patients about (1) screening for high blood cholesterol and other lipid abnormalities, (2) screening for colorectal cancer, (3) screening for prostate cancer, and (4) screening for breast cancer. The final student evaluation is a ten-minute, videotaped discussion with a simulated patient about screening for colorectal cancer that is graded against a checklist that focuses primarily on the elements of shared decision making. Our medical students appear quite willing to accept shared decision making as

  12. Decision theory on the quality evaluation of medical images

    International Nuclear Information System (INIS)

    Lessa, Patricia Silva

    2001-10-01

    The problem of quality has been a constant issue in every organization.One is always seeking to produce more, to do it at a lower cost, and to do it with better quality. However, in this country, there is no radiographic film quality control system for radiographic services. The tittle that actually gets done is essentially ad hoc and superficial. The implications of this gap, along with some other shortcomings that exist in process as a whole (the state of the x-ray equipment, the adequate to use in order to obtain a radiography, the quality of the film, the processing of the film, the brightness and homogeneity of the viewing boxes, the ability of the radiologist), have a very negative impact on the quality of the medical image, and, as result, to the quality of the medical diagnosis and therapy. It frequently happens that many radiographs have to be repeated, which leads to an increase of the patient's exposure to radiation, as well as of the cost of the procedure for the patient. Low quality radiographs that are not repeated greatly increase the probability of a wrong diagnosis, and consequently, of inadequate therapeutical procedures, thus producing increased incidence of bad outcomes and higher costs. The paradigm proposed in order to establish a system for the measurement of the image's quality is Decision Theory. The problem of the assessment of the image is studied by proposing a Decision Theory approach. The review of the literature reveals a great concern with the quality of the image, along with an absence of an adequate paradigm and several essentially empirical procedures. Image parameters are developed in order to formalize the problem in terms of Decision Theory, and various aspects of image digitalisation are exposed. Finally, a solution is presented, including a protocol for quality control. (author)

  13. SHOP: scaffold hopping by GRID-based similarity searches

    DEFF Research Database (Denmark)

    Bergmann, Rikke; Linusson, Anna; Zamora, Ismael

    2007-01-01

    A new GRID-based method for scaffold hopping (SHOP) is presented. In a fully automatic manner, scaffolds were identified in a database based on three types of 3D-descriptors. SHOP's ability to recover scaffolds was assessed and validated by searching a database spiked with fragments of known...

  14. Medication-related clinical decision support alert overrides in inpatients.

    Science.gov (United States)

    Nanji, Karen C; Seger, Diane L; Slight, Sarah P; Amato, Mary G; Beeler, Patrick E; Her, Qoua L; Dalleur, Olivia; Eguale, Tewodros; Wong, Adrian; Silvers, Elizabeth R; Swerdloff, Michael; Hussain, Salman T; Maniam, Nivethietha; Fiskio, Julie M; Dykes, Patricia C; Bates, David W

    2018-05-01

    To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons. We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P 75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.

  15. Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

    Science.gov (United States)

    Kim, Hyejin; Song, Mi-Kyung

    2018-01-01

    Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

  16. Exploration Clinical Decision Support System: Medical Data Architecture

    Science.gov (United States)

    Lindsey, Tony; Shetye, Sandeep; Shaw, Tianna (Editor)

    2016-01-01

    The Exploration Clinical Decision Support (ECDS) System project is intended to enhance the Exploration Medical Capability (ExMC) Element for extended duration, deep-space mission planning in HRP. A major development guideline is the Risk of "Adverse Health Outcomes & Decrements in Performance due to Limitations of In-flight Medical Conditions". ECDS attempts to mitigate that Risk by providing crew-specific health information, actionable insight, crew guidance and advice based on computational algorithmic analysis. The availability of inflight health diagnostic computational methods has been identified as an essential capability for human exploration missions. Inflight electronic health data sources are often heterogeneous, and thus may be isolated or not examined as an aggregate whole. The ECDS System objective provides both a data architecture that collects and manages disparate health data, and an active knowledge system that analyzes health evidence to deliver case-specific advice. A single, cohesive space-ready decision support capability that considers all exploration clinical measurements is not commercially available at present. Hence, this Task is a newly coordinated development effort by which ECDS and its supporting data infrastructure will demonstrate the feasibility of intelligent data mining and predictive modeling as a biomedical diagnostic support mechanism on manned exploration missions. The initial step towards ground and flight demonstrations has been the research and development of both image and clinical text-based computer-aided patient diagnosis. Human anatomical images displaying abnormal/pathological features have been annotated using controlled terminology templates, marked-up, and then stored in compliance with the AIM standard. These images have been filtered and disease characterized based on machine learning of semantic and quantitative feature vectors. The next phase will evaluate disease treatment response via quantitative linear

  17. The professional medical ethics model of decision making under conditions of clinical uncertainty.

    Science.gov (United States)

    McCullough, Laurence B

    2013-02-01

    The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.

  18. The analytic hierarchy process in medical decision making: a tutorial.

    Science.gov (United States)

    Dolan, J G; Isselhardt, B J; Cappuccio, J D

    1989-01-01

    The analytic hierarchy process (AHP) is a quantitative decision making technique created especially for complicated, multicriteria decision problems. This report reviews the theoretical foundations of the AHP and shows how to use it in a step-by-step fashion.

  19. Decision forests for computer vision and medical image analysis

    CERN Document Server

    Criminisi, A

    2013-01-01

    This practical and easy-to-follow text explores the theoretical underpinnings of decision forests, organizing the vast existing literature on the field within a new, general-purpose forest model. Topics and features: with a foreword by Prof. Y. Amit and Prof. D. Geman, recounting their participation in the development of decision forests; introduces a flexible decision forest model, capable of addressing a large and diverse set of image and video analysis tasks; investigates both the theoretical foundations and the practical implementation of decision forests; discusses the use of decision for

  20. Culture and medical decision making : Patient perspectives in Japan and the U.S

    NARCIS (Netherlands)

    Alden, D.; Friend, J.; Lee, A.Y.; de Vries, Marieke; Osawa, R.; Chen, Q.

    2015-01-01

    Objective: Two studies identified core value influences on medical decision-making processes across and within cultures. Methods: In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents

  1. Neighboring Structure Visualization on a Grid-based Layout.

    Science.gov (United States)

    Marcou, G; Horvath, D; Varnek, A

    2017-10-01

    Here, we describe an algorithm to visualize chemical structures on a grid-based layout in such a way that similar structures are neighboring. It is based on structure reordering with the help of the Hilbert Schmidt Independence Criterion, representing an empirical estimate of the Hilbert-Schmidt norm of the cross-covariance operator. The method can be applied to any layout of bi- or three-dimensional shape. The approach is demonstrated on a set of dopamine D5 ligands visualized on squared, disk and spherical layouts. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

    Science.gov (United States)

    Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

    2015-12-01

    Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

  3. Looking for a more participative healthcare: sharing medical decision making

    OpenAIRE

    Bravo, Paulina; Escuela de Enfermería, Pontificia Universidad Católica de Chile, Chile. School of Medicine, Cardiff University. Reino Unido. Enfermera, doctora en Salud Pública.; Contreras, Aixa; Escuela de Enfermería, Pontificia Universidad Católica de Chile, Chile. enfermera matrona, magister en Psicología Social Comunitaria.; Perestelo-Pérez, Lilisbeth; Servicio de Evaluación del Servicio Canario de la Salud, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). España. psicóloga, doctora en Psicología Clínica y de la Salud.; Pérez-Ramos, Jeanette; Fundación Canaria de Investigación y Salud (FUNCIS). España. psicóloga.; Málaga, Germán; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. médico internista, magister en Medicina.

    2014-01-01

    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 kno...

  4. Health Care Professional Factors Influencing Shared Medical Decision Making in Korea

    Directory of Open Access Journals (Sweden)

    Kae-Hwa Jo

    2015-11-01

    Full Text Available Till date, the medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians. However, in recent years, shared decision making at the end-of-life between physicians and nurses is now emphasized in Korea. The purpose of this study was conducted to explore how health care professionals’ characteristics, attitude toward dignified dying, and moral sensitivity affect their shared medical decision making. The design was descriptive survey. This study was undertaken in two university hospitals in two metropolitan cities, South Korea. The participants were 344 nurses and 80 physicians who work at university hospitals selected by convenience sampling method. Data were collected from January 10 through March 20, 2014 using the Dignified Dying Scale, Moral Sensitivity Scale, and Shared Medical Decision-Making Scale. Shared medical decision making, attitude toward dignified dying, moral sensitivity, age, and working experience had a significant correlation with each other. The factors affecting shared medical decision making of Korean health care professionals were moral sensitivity and attitude toward dignified dying. These variables explained 22.4% of the shared medical decision making. Moral sensitivity and a positive attitude toward dignified dying should be promoted among health care professionals as a part of an educational program for shared medical decision making.

  5. Teaching advance care planning to medical students with a computer-based decision aid.

    Science.gov (United States)

    Green, Michael J; Levi, Benjamin H

    2011-03-01

    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 satisfaction with their learning experience (p 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.

  6. Medical decision-making and healthcare disparities: The physician's role.

    Science.gov (United States)

    Aberegg, Scott K; Terry, Peter B

    2004-07-01

    Widespread disparities in US healthcare have been documented with attendant speculation about their causes, including the potential role of the physician as a healthcare decision-maker. However, the current evidence on physician decision-making is inadequate to draw firm conclusions on how it relates to healthcare inequalities. In this article, we review the available evidence on physician decision-making as it relates to healthcare disparities, with an emphasis on its shortcomings, discuss potential sources of bias, including interpersonal factors and physician preferences, and make suggestions for further research in this area.

  7. Grid-Based Hybrid Network Deployment Approach for Energy Efficient Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Haleem Farman

    2016-01-01

    Full Text Available Wireless sensor networks (WSN empower applications for critical decision-making through collaborative computing, communications, and distributed sensing. However, they face several challenges due to their peculiar use in a wide variety of applications. One of the inherent challenges with any battery operated sensor is the efficient consumption of energy and its effect on network lifetime. In this paper, we introduce a novel grid-based hybrid network deployment (GHND framework which ensures energy efficiency and load balancing in wireless sensor networks. This research is particularly focused on the merge and split technique to achieve even distribution of sensor nodes across the grid. Low density neighboring zones are merged together whereas high density zones are strategically split to achieve optimum balance. Extensive simulations reveal that the proposed method outperforms state-of-the-art techniques in terms of load balancing, network lifetime, and total energy consumption.

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

    Science.gov (United States)

    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.

  9. [Design and user-testing of a decision aid comparing medications for smoking cessation].

    Science.gov (United States)

    Jakob, Julian; Cornuz, Jacques; Auer, Reto; Jacot Sadowski, Isabelle; Cardinaux, Regula; Selby, Kevin

    2017-06-07

    Medications for smoking cessation, such as nicotine replacement, bupropion and varenicline have comparable efficacy, but present different advantages and drawbacks, making patient-specific preferences important when choosing a medication for smoking cessation. Through 3 PDCA cycles (Plan-Do-Check-Act), we developed and user-tested a decision aid for use during consultations. It contains the most relevant information for choosing a smoking cessation medication and is freely available online. The methodology used for its development could be employed for other decision aids for preference-sensitive decisions.

  10. Medical decision support and medical informatics education: roots, methods and applications in czechoslovakia and the czech republic.

    Science.gov (United States)

    Zvárová, Jana

    2013-01-01

    The paper describes the history of medical informatics in Czechoslovakia and the Czech Republic. It focuses on the topics of medical informatics education and decision support methods and systems. Several conferences held in Czechoslovakia and in the Czech Republic organized in cooperation with IMIA or EFMI are described. Support of European Union and Czech agencies in several European and national projects focused on medical informatics topics highly contributed to medical informatics development in Czechoslovakia and the Czech Republic and to the establishment of the European Center for Medical Informatics, Statistics and Epidemiology as the joint workplace of Charles University in Prague and Academy of Sciences of the Czech Republic in 1994.

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

    International Nuclear Information System (INIS)

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

    2007-01-01

    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

  12. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy.

    Science.gov (United States)

    Blumenthal-Barby, J S; Krieger, Heather

    2015-05-01

    The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients. © The Author(s) 2014.

  13. Assessment of dual selection in grid based selectivity systems

    DEFF Research Database (Denmark)

    Sistiaga, Manu; Herrmann, Bent; Grimaldo, Eduardo

    2010-01-01

    Herein we propose a method to assess dual selection in grid based selectivity systems. This method takes into account the parameter “grid contact likelihood” (Cgrid), which can be interpreted as the proportion of fish that actually makes an attempt to escape through the grid. In a case study...... of the Barents Sea cod and haddock trawl fishery, we demonstrate that our model describes the experimental data better than the models previously used to fit similar data. For both cod and haddock, Cgrid was significantly smaller than 1.0, which demonstrated the relevance of the proposed model. Cgrid was higher......-compartment setup to avoid imprecise estimates of Cgrid, L50grid, SRgrid, L50codend, and SRcodend. In general, only the combined selectivity of the grid and the codend could be estimated with acceptable precision using a standard two-compartment sampling approach....

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

    Science.gov (United States)

    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…

  15. Logistic regression in medical decision making and epidemiology

    NARCIS (Netherlands)

    P.I.M. Schmitz (Paul)

    1986-01-01

    textabstractIn his recent textbook "Primer of Biostatistics", S, A, Glantz refers to the nowadays growing pressure on clinicians for more effective use of medical resources. He asserts that clinicians should be able to make better informed judgements about claims of medical efficacy. They can

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

    Science.gov (United States)

    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.

  17. Shared decision-making in medication management: development of a training intervention.

    Science.gov (United States)

    Stead, Ute; Morant, Nicola; Ramon, Shulamit

    2017-08-01

    Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

  18. Ethical decisions in endof- life care | Norval | Continuing Medical ...

    African Journals Online (AJOL)

    Ethical decisions in endof- life care. D Norval, E Gwyther. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  19. Prediction of Screening Decisions in a Medical School Admission Process

    Science.gov (United States)

    Milstein, Robert M.; And Others

    1976-01-01

    As the first stage of a comprehensive study of admissions, a tree model and a linear model were compared in the prediction of admission process screening decisions for a single year's applicants to the Yale University School of Medicine. Cross-validation of the results was also performed on a sample taken from the following year's applicant class.…

  20. Impact of Medical Library Services on Clinical Decision-Making ...

    African Journals Online (AJOL)

    Relationship does not, however, exist between use of library “AND” service delivery. Generally, the library impacted on the Doctors' clinical decision-making despite its huge limitations enumerated by the Doctors. Recommendations were made towards a balanced collection development of both print and non-print materials ...

  1. Education for Medical Decision Support at EuroMISE Centre

    Czech Academy of Sciences Publication Activity Database

    Martinková, Patrícia; Zvára Jr., Karel; Dostálová, T.; Zvárová, Jana

    2013-01-01

    Roč. 1, č. 1 (2013), s. 40-40 ISSN 1805-8698. [EFMI 2013 Special Topic Conference. 17.04.2013-19.04.2013, Prague] Institutional support: RVO:67985807 Keywords : education * decision support * knowledge evaluation * e- learning Subject RIV: IN - Informatics, Computer Science

  2. Family involvement in medical decision-making: Perceptions of nursing and psychology students.

    Science.gov (United States)

    Itzhaki, Michal; Hildesheimer, Galya; Barnoy, Sivia; Katz, Michael

    2016-05-01

    Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. A descriptive cross-sectional design was used. First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Living Wills and Advance Directives for Medical Decisions

    Science.gov (United States)

    ... wishes, think about your values, such as the importance to you of being independent and self-sufficient, ... added to medical charts in a hospital or nursing home. Also, talk to your health care agent, ...

  4. Do social norms play a role in explaining involvement in medical decision-making?

    Science.gov (United States)

    Brabers, Anne E M; van Dijk, Liset; Groenewegen, Peter P; de Jong, Judith D

    2016-12-01

    Patients' involvement in medical decision-making is crucial to provide good quality of care that is respectful of, and responsive to, patients' preferences, needs and values. Whether people want to be involved in medical decision-making is associated with individual patient characteristics, and health status. However, the observation of differences in whether people want to be involved does not in itself provide an explanation. Insight is necessary into mechanisms that explain people's involvement. This study aims to examine one mechanism, namely social norms. We make a distinction between subjective norms, that is doing what others think one ought to do, and descriptive norms, doing what others do. We focus on self-reported involvement in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%; N = 974). A regression model was used to estimate the relationship between socio-demographics, social norms and involvement in medical decision-making. In line with our hypotheses, we observed that the more conservative social norms are, the less people are involved in medical decision-making. The effects for both types of norms were comparable. This study indicates that social norms play a role as a mechanism to explain involvement in medical decision-making. Our study offers a first insight into the possibility that the decision to be involved in medical decision-making is not as individual as it at first seems; someone's social context also plays a role. Strategies aimed at emphasizing patient involvement have to address this social context. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  5. The Role of Medical Expenditure Risk in Portfolio Allocation Decisions.

    Science.gov (United States)

    Ayyagari, Padmaja; He, Daifeng

    2017-11-01

    Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk because of the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  6. A Randomized Controlled Trial on Teaching Geriatric Medical Decision Making and Cost Consciousness With the Serious Game GeriatriX

    NARCIS (Netherlands)

    Lagro, J.; Pol, M.H.J. van de; Laan, A. van der; Huijbregts-Verheyden, F.J.; Fluit, L.; Olde Rikkert, M.G.M.

    2014-01-01

    OBJECTIVE: Medical students often lack training in complex geriatric medical decision making. We therefore developed the serious game, GeriatriX, for training medical decision making with weighing patient preferences, and appropriateness and costs of medical care. We hypothesized that education with

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

    Science.gov (United States)

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

    2016-01-01

    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. 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. 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. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients

  8. Institutional constraints on strategic maneuvering in shared decision medical decision making

    NARCIS (Netherlands)

    Snoeck Henkemans, A.F.; Mohammed, D.

    2012-01-01

    In this paper it is first investigated to what extent the institutional goal and basic principles of shared decision making are compatible with the aim and rules for critical discussion. Next, some techniques that doctors may use to present their own treatment preferences strategically in a shared

  9. A novel medical information management and decision model for uncertain demand optimization.

    Science.gov (United States)

    Bi, Ya

    2015-01-01

    Accurately planning the procurement volume is an effective measure for controlling the medicine inventory cost. Due to uncertain demand it is difficult to make accurate decision on procurement volume. As to the biomedicine sensitive to time and season demand, the uncertain demand fitted by the fuzzy mathematics method is obviously better than general random distribution functions. To establish a novel medical information management and decision model for uncertain demand optimization. A novel optimal management and decision model under uncertain demand has been presented based on fuzzy mathematics and a new comprehensive improved particle swarm algorithm. The optimal management and decision model can effectively reduce the medicine inventory cost. The proposed improved particle swarm optimization is a simple and effective algorithm to improve the Fuzzy interference and hence effectively reduce the calculation complexity of the optimal management and decision model. Therefore the new model can be used for accurate decision on procurement volume under uncertain demand.

  10. Understanding behavioral intent to participate in shared decision-making in medically uncertain situations.

    Science.gov (United States)

    Maffei, Roxana M; Dunn, K; Zhang, J; Hsu, C E; Holmes, J H

    2012-01-01

    This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations. Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents' experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty. Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual's behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual's Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual's Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations. The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the

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

    Science.gov (United States)

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

    2014-10-01

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

  12. Object-oriented design and programming in medical decision support.

    Science.gov (United States)

    Heathfield, H; Armstrong, J; Kirkham, N

    1991-12-01

    The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.

  13. The Effect of Algorithm-Based Learning on Clinical Decision Making Abilities of Medical Emergency Students

    Directory of Open Access Journals (Sweden)

    H Asayesh

    2015-12-01

    Full Text Available Introduction: Improvement of students’ clinical decision making is one of the main challenges in medical education. There are numerous ways to improve these skills. The aim of this study was to examine the effect of algorithm-based learning on clinical decision making abilities of medical emergency students. Method: in this experimental study, twenty five medical emergency students were randomly assigned to algorithm based learning group  (n=13 and control group  (n=12. Student in algorithm-based learning group were educated the diagnosis and treatment of selected medical emergency situation with algorithmic approach. Education in the control group was conducted by a routine lecture, along with copies of educational content. Three-hour training period was held for both groups  (two separate sessions with an interval day. After intervention, clinical decision making of the students in both group were measured by clinical scenarios and clinical decision making self-efficacy scale. Results: The mean of acquired scores from clinical scenarios among students in algorithm-based learning group was 17.50  (±1.67 and in the control group was 14.50 (±2.63. The differences was statistically significant  (t=0.006, P=0.006. The students in algorithm-based learning group had better scores in the clinical decision making in terms of self-efficacy scale and it was 13.30 (1.57 and in the control group this mean was 10.32  (3.05. In this case, the differences was statistically significant (t=3.01, P=0.009. Conclusion: algorithm-based learning is effective in improvement of clinical decision making and applying of this method along with other educational methods could promote students’ clinical decision making especially in medical emergency situations.

  14. Computerized clinical decision support for medication prescribing and utilization in pediatrics.

    Science.gov (United States)

    Stultz, Jeremy S; Nahata, Milap C

    2012-01-01

    Accurate and informed prescribing is essential to ensure the safe and effective use of medications in pediatric patients. Computerized clinical decision support (CCDS) functionalities have been embedded into computerized physician order entry systems with the aim of ensuring accurate and informed medication prescribing. Owing to a lack of comprehensive analysis of the existing literature, this review was undertaken to analyze the effect of CCDS implementation on medication prescribing and use in pediatrics. A literature search was performed using keywords in PubMed to identify research studies with outcomes related to the implementation of medication-related CCDS functionalities. Various CCDS functionalities have been implemented in pediatric patients leading to different results. Medication dosing calculators have decreased calculation errors. Alert-based CCDS functionalities, such as duplicate therapy and medication allergy checking, may generate excessive alerts. Medication interaction CCDS has been minimally studied in pediatrics. Medication dosing support has decreased adverse drug events, but has also been associated with high override rates. Use of medication order sets have improved guideline adherence. Guideline-based treatment recommendations generated by CCDS functionalities have had variable influence on appropriate medication use, with few studies available demonstrating improved patient outcomes due to CCDS use. Although certain medication-related CCDS functionalities have shown benefit in medication prescribing for pediatric patients, others have resulted in high override rates and inconsistent or unknown impact on patient care. Further studies analyzing the effect of individual CCDS functionalities on safe and effective prescribing and medication use are required.

  15. The framing effect in medical decision-making: a review of the literature.

    Science.gov (United States)

    Gong, Jingjing; Zhang, Yan; Yang, Zheng; Huang, Yonghua; Feng, Jun; Zhang, Weiwei

    2013-01-01

    The framing effect, identified by Tversky and Kahneman, is one of the most striking cognitive biases, in which people react differently to a particular choice depending whether it is presented as a loss or as a gain. Numerous studies have subsequently demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision-making. Compared to daily decisions, medical decisions are of low frequency but of paramount importance. The framing effect is a well-documented bias in a variety of studies, but research is inconsistent regarding whether and how variables influence framing effects in medical decision-making. To clarify the discrepancy in the previous literature, published literature in the English language concerning the framing effect was retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion and evaluated the articles' methodological quality. The framing effect in medical decision-making was reviewed in these papers. No studies identified an influence of framing information upon compliance with health recommendations, and different studies demonstrate different orientations of the framing effect. Because so many variables influence the presence or absence of the framing effect, the unexplained heterogeneity between studies suggests the possibility of a framing effect under specific conditions. Further research is needed to determine why the framing effect is induced and how it can be precluded.

  16. Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

    Science.gov (United States)

    Nantha, Yogarabindranath Swarna

    2017-11-01

    A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

  17. Adolescent and parental perceptions of medical decision-making in Hong Kong.

    Science.gov (United States)

    Hui, Edwin

    2011-11-01

    To investigate whether Chinese adolescents in Hong Kong share similar perceptions with their Western counterparts regarding their capacity for autonomous decision-making, and secondarily whether Chinese parents underestimate their adolescent children's desire and capacity for autonomous decision-making. 'Healthy Adolescents' and their parents were recruited from four local secondary schools, and 'Sick Adolescents' and their parents from the pediatric wards and outpatient clinics. Their perceptions of adolescents' understanding of illnesses and treatments, maturity in judgment, risk-taking, openness to divergent opinions, pressure from parents and doctors, submission to parental authority and preference for autonomy in medical decision-making are surveyed by a 50-item questionnaire on a five-point Likert scale. Findings indicate that Chinese adolescents aged 14-16 perceive themselves to possess the necessary cognitive abilities and maturity in judgment to be autonomous decision-makers like their Western counterparts. Paradoxically, although they hesitate to assert their autonomy, they are also unwilling to surrender that autonomy to their parents even under coercion or intimidation. Parents tend to underestimate their adolescents' preferences for making autonomous decisions and overestimate the importance of parental authority in decision-making. '14-and-above' Chinese adolescents in Hong Kong perceive themselves as capable of autonomous decision-making in medically-related matters, but hesitate to assert their autonomy, probably because of the Confucian values of parental authority and filial piety that are deeply embedded in the local culture. © 2010 Blackwell Publishing Ltd.

  18. Soil Erosion Estimation Using Grid-based Computation

    Directory of Open Access Journals (Sweden)

    Josef Vlasák

    2005-06-01

    Full Text Available Soil erosion estimation is an important part of a land consolidation process. Universal soil loss equation (USLE was presented by Wischmeier and Smith. USLE computation uses several factors, namely R – rainfall factor, K – soil erodability, L – slope length factor, S – slope gradient factor, C – cropping management factor, and P – erosion control management factor. L and S factors are usually combined to one LS factor – Topographic factor. The single factors are determined from several sources, such as DTM (Digital Terrain Model, BPEJ – soil type map, aerial and satellite images, etc. A conventional approach to the USLE computation, which is widely used in the Czech Republic, is based on the selection of characteristic profiles for which all above-mentioned factors must be determined. The result (G – annual soil loss of such computation is then applied for a whole area (slope of interest. Another approach to the USLE computation uses grids as a main data-structure. A prerequisite for a grid-based USLE computation is that each of the above-mentioned factors exists as a separate grid layer. The crucial step in this computation is a selection of appropriate grid resolution (grid cell size. A large cell size can cause an undesirable precision degradation. Too small cell size can noticeably slow down the whole computation. Provided that the cell size is derived from the source’s precision, the appropriate cell size for the Czech Republic varies from 30m to 50m. In some cases, especially when new surveying was done, grid computations can be performed with higher accuracy, i.e. with a smaller grid cell size. In such case, we have proposed a new method using the two-step computation. The first step computation uses a bigger cell size and is designed to identify higher erosion spots. The second step then uses a smaller cell size but it make the computation only the area identified in the previous step. This decomposition allows a

  19. What role does health literacy play in patients' involvement in medical decision-making?

    Science.gov (United States)

    Brabers, Anne E M; Rademakers, Jany J D J M; Groenewegen, Peter P; van Dijk, Liset; de Jong, Judith D

    2017-01-01

    Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social resources needed for people to access, understand and use information to make decisions about their health. This study aimed to examine the relationship between health literacy and self-reported patient involvement. With respect to health literacy, we focused on those competences relevant for medical decision-making. We hypothesized that people with higher health literacy report that they are more involved in medical decision-making. A structured questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%, N = 974). Health literacy was measured using five scales of the Health Literacy Questionnaire. A regression model was used to estimate the relationship between health literacy and self-reported involvement. In general, our results did not show a relationship between health literacy and self-reported involvement. We did find a positive significant association between the health literacy scale appraisal of health information and self-reported involvement. Our hypothesis was partly confirmed. The results from this study suggest that higher order competences, that is to say critical health literacy, in particular, are important in reporting involvement in medical decision-making. Future research is recommended to unravel further the relationship between health literacy and patient involvement in order to gain insight into whether health literacy might be an asset to enhance patient participation in medical decision-making.

  20. Advances in intelligent analysis of medical data and decision support systems

    CERN Document Server

    Iantovics, Barna

    2013-01-01

    This volume is a result of the fruitful and vivid discussions during the MedDecSup'2012 International Workshop bringing together a relevant body of knowledge, and new developments in the increasingly important field of medical informatics. This carefully edited book presents new ideas aimed at the development of intelligent processing of various kinds of medical information and the perfection of the contemporary computer systems for medical decision support. The book presents advances of the medical information systems for intelligent archiving, processing, analysis and search-by-content which will improve the quality of the medical services for every patient and of the global healthcare system. The book combines in a synergistic way theoretical developments with the practicability of the approaches developed and presents the last developments and achievements in  medical informatics to a broad range of readers: engineers, mathematicians, physicians, and PhD students.

  1. Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

    Science.gov (United States)

    Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

    2017-05-08

    Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors

  2. Disrupted latent decision processes in medication-free pediatric OCD patients.

    Science.gov (United States)

    Erhan, Ceyla; Bulut, Gresa Çarkaxhiu; Gökçe, Sebla; Ozbas, Duru; Turkakin, Esin; Dursun, Onur Burak; Yazgan, Yanki; Balcı, Fuat

    2017-01-01

    Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. The small sample size limited the power of the study. Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Bloembergen Peter

    2011-03-01

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

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

    Science.gov (United States)

    Bruins, Marjan J; Ruijs, Gijs J H M; Wolfhagen, Maurice J H M; Bloembergen, Peter; Aarts, Jos E C M

    2011-03-30

    Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making. © 2011 Bruins et al; licensee BioMed Central Ltd.

  5. Development and validation of a musculoskeletal physical examination decision-making test for medical students.

    Science.gov (United States)

    Bishop, Julie Y; Awan, Hisham M; Rowley, David M; Nagel, Rollin W

    2013-01-01

    Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees. We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate. Academic medical center in the Midwestern United States. Orthopedic residents, chairmen, and medical students. Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, pphysical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, pphysical examination decision-making test

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

    Science.gov (United States)

    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…

  7. Higher preference for participation in treatment decisions is associated with lower medication adherence in asthma patients.

    NARCIS (Netherlands)

    Schneider, A.; Wensing, M.J.P.; Quinzler, R.; Bieber, C.; Szecsenyi, J.

    2007-01-01

    OBJECTIVE: To investigate the interrelations between medication adherence, self-management, preference for involvement in treatment decisions and preference for information in asthma patients in primary care. METHODS: One hundred and eighty-five patients from 43 practices completed a series of

  8. Value of multi-criteria decision analysis in early assessment of medical diagnostic devices

    NARCIS (Netherlands)

    IJzerman, Maarten Joost; Hummel, J. Marjan

    2010-01-01

    OBJECTIVES: Multicriteria decision analytic (MCDA) techniques are a powerful tool in evaluating health care interventions where multiple, often competing, factors need to be considered. The analytic hierarchy process (AHP) is one such technique. We have applied AHP to evaluate medical diagnostic

  9. What role does health literacy play in patients' involvement in medical decision-making?

    NARCIS (Netherlands)

    Brabers, A.E.M.; Rademakers, J.J.D.J.M.; Groenewegen, P.P.; Dijk, L. van; Jong, J.D. de

    2017-01-01

    Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social

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

    Science.gov (United States)

    Lambert, Heather

    2012-01-01

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

  11. Can shared decision-making reduce medical malpractice litigation? A systematic review

    NARCIS (Netherlands)

    Durand, M.A.; Moulton, B.; Cockle, E.; Mann, M.; Elwyn, G.

    2015-01-01

    BACKGROUND: To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation. METHODS: We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or

  12. Reasoning in the capacity to make medical decisions: the consideration of values.

    Science.gov (United States)

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

    2010-01-01

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

  13. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

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

    Science.gov (United States)

    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.

  15. Grid-based platform for training in Earth Observation

    Science.gov (United States)

    Petcu, Dana; Zaharie, Daniela; Panica, Silviu; Frincu, Marc; Neagul, Marian; Gorgan, Dorian; Stefanut, Teodor

    2010-05-01

    GiSHEO platform [1] providing on-demand services for training and high education in Earth Observation is developed, in the frame of an ESA funded project through its PECS programme, to respond to the needs of powerful education resources in remote sensing field. It intends to be a Grid-based platform of which potential for experimentation and extensibility are the key benefits compared with a desktop software solution. Near-real time applications requiring simultaneous multiple short-time-response data-intensive tasks, as in the case of a short time training event, are the ones that are proved to be ideal for this platform. The platform is based on Globus Toolkit 4 facilities for security and process management, and on the clusters of four academic institutions involved in the project. The authorization uses a VOMS service. The main public services are the followings: the EO processing services (represented through special WSRF-type services); the workflow service exposing a particular workflow engine; the data indexing and discovery service for accessing the data management mechanisms; the processing services, a collection allowing easy access to the processing platform. The WSRF-type services for basic satellite image processing are reusing free image processing tools, OpenCV and GDAL. New algorithms and workflows were develop to tackle with challenging problems like detecting the underground remains of old fortifications, walls or houses. More details can be found in [2]. Composed services can be specified through workflows and are easy to be deployed. The workflow engine, OSyRIS (Orchestration System using a Rule based Inference Solution), is based on DROOLS, and a new rule-based workflow language, SILK (SImple Language for worKflow), has been built. Workflow creation in SILK can be done with or without a visual designing tools. The basics of SILK are the tasks and relations (rules) between them. It is similar with the SCUFL language, but not relying on XML in

  16. Global Population Projection Grids Based on Shared Socioeconomic Pathways (SSPs), 2010-2100

    Data.gov (United States)

    National Aeronautics and Space Administration — The Global Population Projection Grids Based on Shared Socioeconomic Pathways (SSPs), 2010-2100 consists of global spatial population projections at a resolution of...

  17. Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.

    Science.gov (United States)

    Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron

    2018-01-23

    Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making. All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression. Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses. NZ medical students demonstrated ethnic bias, although

  18. Medical Decision Making for Patients Without Proxies: The Effect of Personal Experience in the Deliberative Process.

    Science.gov (United States)

    Robichaud, Allyson L

    2015-01-01

    The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent--or informed refusal--is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  19. Using T3, an improved decision tree classifier, for mining stroke-related medical data.

    Science.gov (United States)

    Tjortjis, C; Saraee, M; Theodoulidis, B; Keane, J A

    2007-01-01

    Medical data are a valuable resource from which novel and potentially useful knowledge can be discovered by using data mining. Data mining can assist and support medical decision making and enhance clinical management and investigative research. The objective of this work is to propose a method for building accurate descriptive and predictive models based on classification of past medical data. We also aim to compare this method with other well established data mining methods and identify strengths and weaknesses. We propose T3, a decision tree classifier which builds predictive models based on known classes, by allowing for a certain amount of misclassification error in training in order to achieve better descriptive and predictive accuracy. We then experiment with a real medical data set on stroke, and various subsets, in order to identify strengths and weaknesses. We also compare performance with a very successful and well established decision tree classifier. T3 demonstrated impressive performance when predicting unseen cases of stroke resulting in as little as 0.4% classification error while the state of the art decision tree classifier resulted in 33.6% classification error respectively. This paper presents and evaluates T3, a classification algorithm that builds decision trees of depth at most three, and results in high accuracy whilst keeping the tree size reasonably small. T3 demonstrates strong descriptive and predictive power without compromising simplicity and clarity. We evaluate T3 based on real stroke register data and compare it with C4.5, a well-known classification algorithm, showing that T3 produces significantly more accurate and readable classifiers.

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

    Directory of Open Access Journals (Sweden)

    Athanasios Tsalatsanis

    Full Text Available 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.

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

    Science.gov (United States)

    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.

  2. The potential for intelligent decision support systems to improve the quality and consistency of medication reviews.

    Science.gov (United States)

    Bindoff, I; Stafford, A; Peterson, G; Kang, B H; Tenni, P

    2012-08-01

    Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems. Two prototype multiple-classification ripple-down rules medication review systems were built, the second being a refinement of the first. Each of the systems was trained incrementally using a human medication review expert. The resultant knowledge bases were analysed and compared, showing factors such as accuracy, time taken to train, and potential errors avoided. The two systems performed well, achieving accuracies of approximately 80% and 90%, after being trained on only a small number of cases (126 and 244 cases, respectively). Through analysis of the available data, it was estimated that without the system intervening, the expert training the first prototype would have missed approximately 36% of potentially relevant DRPs, and the second 43%. However, the system appeared to prevent the majority of these potential expert errors by correctly identifying the DRPs for them, leaving only an estimated 8% error rate for the first expert and 4% for the second. These intelligent decision support systems have shown a clear potential to substantially improve the quality and consistency of medication reviews, which should in turn translate into

  3. Physicians' anxiety due to uncertainty and use of race in medical decision making.

    Science.gov (United States)

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

    2014-08-01

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

  4. [Subjectivity, decision and neurodegenerative diseases: reflexions on the role of the clinical psychologist in medical decision making].

    Science.gov (United States)

    Brocq, H; Liarte, A; Soriani, M-H; Desnuelle, C

    2013-01-01

    Should a patient be forced to accept a treatment, especially when suffering from a neurodegenerative disease? We argue that physicians, nurses and care givers should instead accept his or her choice in accordance with the principle that every patient is an autonomous person able to make a choice, even in case of declined cognition. Beside the legal obligation, we suggest a theoretical approach and focus on the practical impacts of the patient's decision. Our objective is to promote the value of ethical doubt and attentive listening to individual opinions, so as to improve the quality of the medical staff's work and reduce patients' distress when affected by fatal diseases. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

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

    2015-07-01

    The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available. © 2014 John Wiley & Sons Ltd.

  6. [Cost-conscious medical decisions. Normative guidance within the conflicting demands of ethics and economics].

    Science.gov (United States)

    Marckmann, G; In der Schmitten, J

    2014-05-01

    Under the current conditions in the health care system, physicians inevitably have to take responsibility for the cost dimension of their decisions on the level of single cases. This article, therefore, discusses the question how physicians can integrate cost considerations into their clinical decisions at the microlevel in a medically rational and ethically justified way. We propose a four-step model for "ethical cost-consciousness": (1) forego ineffective interventions as required by good evidence-based medicine, (2) respect individual patient preferences, (3) minimize the diagnostic and therapeutic effort to achieve a certain treatment goal, and (4) forego expensive interventions that have only a small or unlikely (net) benefit for the patient. Steps 1-3 are ethically justified by the principles of beneficence, nonmaleficence, and respect for autonomy, step 4 by the principles of justice. For decisions on step 4, explicit cost-conscious guidelines should be developed locally or regionally. Following the four-step model can contribute to ethically defensible, cost-conscious decision-making at the microlevel. In addition, physicians' rationing decisions should meet basic standards of procedural fairness. Regular cost-case discussions and clinical ethics consultation should be available as decision support. Implementing step 4, however, requires first of all a clear political legitimation with the corresponding legal framework.

  7. Exploring medical student decisions regarding attending live lectures and using recorded lectures.

    Science.gov (United States)

    Gupta, Anmol; Saks, Norma Susswein

    2013-09-01

    Student decisions about lecture attendance are based on anticipated effect on learning. Factors involved in decision-making, the use of recorded lectures and their effect on lecture attendance, all warrant investigation. This study was designed to identify factors in student decisions to attend live lectures, ways in which students use recorded lectures, and if their use affects live lecture attendance. A total of 213 first (M1) and second year (M2) medical students completed a survey about lecture attendance, and rated factors related to decisions to attend live lectures and to utilize recorded lectures. Responses were analyzed overall and by class year and gender. M1 attended a higher percentage of live lectures than M2, while both classes used the same percentage of recorded lectures. Females attended more live lectures, and used a smaller percentage of recorded lectures. The lecturer was a key in attendance decisions. Also considered were the subject and availability of other learning materials. Students use recorded lectures as replacement for live lectures and as supplement to them. Lectures, both live and recorded, are important for student learning. Decisions about lecture placement in the curriculum need to be based on course content and lecturer quality.

  8. Application of visually based, computerised diagnostic decision support system in dermatological medical education: a pilot study.

    Science.gov (United States)

    Chou, Wan-Yi; Tien, Peng-Tai; Lin, Fang-Yu; Chiu, Pin-Chi

    2017-05-01

    Medical education has shifted from memory-based practice to evidence-based decisions. The question arises: how can we ensure that all students get correct and systematic information? Visually based, computerised diagnostic decision support system (VCDDSS, VisualDx) may just fit our needs. A pilot study was conducted to investigate its role in medical education and clinical practice. This was a prospective study, including one consultant dermatologist, 51 medical students and 13 dermatology residents, conducted in the dermatology teaching clinic at China Medical University Hospital from 30 December 2014 to 21 April 2015. Clinical diagnoses of 13 patients were made before and after using VCDDSS. Questionnaires were filled out at the end. The consultant dermatologist's diagnosis was defined as the standard answer; the Sign test was used to analyse diagnostic accuracy and the Fisher exact test to analyse questionnaires. There was an 18.75% increase in diagnostic accuracy after use of VCDDSS (62.5-81.25%; p value system in clinical practice, medical education, residency training, and patient education in the future. Further large-scale studies should be planned to confirm its application. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    OpenAIRE

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

    2011-01-01

    Objectives To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. Methods Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to ...

  10. An experimental comparison of fuzzy logic and analytic hierarchy process for medical decision support systems.

    Science.gov (United States)

    Uzoka, Faith-Michael Emeka; Obot, Okure; Barker, Ken; Osuji, J

    2011-07-01

    The task of medical diagnosis is a complex one, considering the level vagueness and uncertainty management, especially when the disease has multiple symptoms. A number of researchers have utilized the fuzzy-analytic hierarchy process (fuzzy-AHP) methodology in handling imprecise data in medical diagnosis and therapy. The fuzzy logic is able to handle vagueness and unstructuredness in decision making, while the AHP has the ability to carry out pairwise comparison of decision elements in order to determine their importance in the decision process. This study attempts to do a case comparison of the fuzzy and AHP methods in the development of medical diagnosis system, which involves basic symptoms elicitation and analysis. The results of the study indicate a non-statistically significant relative superiority of the fuzzy technology over the AHP technology. Data collected from 30 malaria patients were used to diagnose using AHP and fuzzy logic independent of one another. The results were compared and found to covary strongly. It was also discovered from the results of fuzzy logic diagnosis covary a little bit more strongly to the conventional diagnosis results than that of AHP. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2016-02-01

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

  12. Can shared decision-making reduce medical malpractice litigation? A systematic review.

    Science.gov (United States)

    Durand, Marie-Anne; Moulton, Benjamin; Cockle, Elizabeth; Mann, Mala; Elwyn, Glyn

    2015-04-18

    To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation. We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or likely influence of shared decision-making or shared decision-making interventions on medical malpractice litigation or on patients' intentions to litigate. The following databases were searched from inception until January 2014: CINAHL, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, HMIC, Lexis library, MEDLINE, NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge. We also hand searched reference lists of included studies and contacted experts in the field. Downs & Black quality assessment checklist, the Critical Appraisal Skill Programme qualitative tool, and the Critical Appraisal Guidelines for single case study research were used to assess the quality of included studies. 6562 records were screened and 19 articles were retrieved for full-text review. Five studies wee included in the review. Due to the number and heterogeneity of included studies, we conducted a narrative synthesis adapted from the ESRC guidance for narrative synthesis. Four themes emerged. The analysis confirms the absence of empirical data necessary to determine whether or not shared decision-making promoted in the clinical encounter can reduce litigation. Three out of five included studies provide retrospective and simulated data suggesting that ignoring or failing to diagnose patient preferences, particularly when no effort has been made to inform and support understanding of possible harms and benefits, puts clinicians at a higher risk of litigation. Simulated scenarios suggest that documenting the use of decision support interventions in patients' notes could offer some level of medico-legal protection. Our analysis also indicated that a sizeable

  13. Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol

    Directory of Open Access Journals (Sweden)

    Gagnon Marie-Pierre

    2011-01-01

    Full Text Available Abstract Background In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale. Methods/design This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+. Discussion Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared

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

    Science.gov (United States)

    Ho, Anita

    2008-03-01

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

  15. Arogyasree: An Enhanced Grid-Based Approach to Mobile Telemedicine

    Directory of Open Access Journals (Sweden)

    Sriram Kailasam

    2010-01-01

    Full Text Available A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends.

  16. Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries.

    Science.gov (United States)

    Alden, Dana L; Friend, John; Lee, Ping Yein; Lee, Yew Kong; Trevena, Lyndal; Ng, Chirk Jenn; Kiatpongsan, Sorapop; Lim Abdullah, Khatijah; Tanaka, Miho; Limpongsanurak, Supanida

    2018-01-01

    Research suggests that desired family involvement (FI) in medical decision making may depend on cultural values. Unfortunately, the field lacks cross-cultural studies that test this assumption. As a result, providers may be guided by incomplete information or cultural biases rather than patient preferences. Researchers developed 6 culturally relevant disease scenarios varying from low to high medical seriousness. Quota samples of approximately 290 middle-aged urban residents in Australia, China, Malaysia, India, South Korea, Thailand, and the USA completed an online survey that examined desired levels of FI and identified individual difference predictors in each country. All reliability coefficients were acceptable. Regression models met standard assumptions. The strongest finding across all 7 countries was that those who desired higher self-involvement (SI) in medical decision making also wanted lower FI. On the other hand, respondents who valued relational-interdependence tended to want their families involved - a key finding in 5 of 7 countries. In addition, in 4 of 7 countries, respondents who valued social hierarchy desired higher FI. Other antecedents were less consistent. These results suggest that it is important for health providers to avoid East-West cultural stereotypes. There are meaningful numbers of patients in all 7 countries who want to be individually involved and those individuals tend to prefer lower FI. On the other hand, more interdependent patients are likely to want families involved in many of the countries studied. Thus, individual differences within culture appear to be important in predicting whether a patient desires FI. For this reason, avoiding culture-based assumptions about desired FI during medical decision making is central to providing more effective patient centered care.

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

    Science.gov (United States)

    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. © 2013 The Scandinavian Psychological Associations.

  18. Community decision-making about critical access hospitals: lessons learned from Montana's Medical Assistance Facility Program.

    Science.gov (United States)

    Shreffler, M J; Capalbo, S M; Flaherty, R J; Heggem, C

    1999-01-01

    Limited-service hospitals have been used as a means of maintaining health care services in rural communities with full-service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited-service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full-service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision-making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision-making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for nonphysician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policy-makers, researchers, and regional and national health care decision makers.

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

    Science.gov (United States)

    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.

  20. Judicial Decision-Making and Juvenile Offenders: Effects of Medical Evidence and Victim Age.

    Science.gov (United States)

    Falligant, John Michael; Fix, Rebecca L; Alexander, Apryl A

    2017-01-01

    A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse. A sample of 636 participants read vignettes and answered questions pertaining to the vignette. Participants also provided demographic information and responded to a series of items assessing participants' judicial decision-making strategies and outcomes. Broadly, the presence of medical evidence significantly influenced participants' decision-making across a variety of variables, including verdict outcome, verdict confidence, confidence that the victim was truthful, and determinations involving sex offender registration and notification requirements. The influence of medical evidence and victim age on perceptions and sentencing of juvenile sex offenders across these and additional outcome variables will be discussed.

  1. The Influence of Attitudes, Beliefs, and Social Factors on Caregivers' Decisions on the Use of OTC Medications in Preschool Children

    National Research Council Canada - National Science Library

    Ecklund, Connie

    1998-01-01

    The purpose of this descriptive correlational study was to determine the extent that social factors, health beliefs, and attitudes influenced caregiver's decisions in home management with over-the-counter (OTC) medications...

  2. Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

    Science.gov (United States)

    Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

    2016-02-01

    At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

  4. Quantitative Analysis of Uncertainty in Medical Reporting: Part 3: Customizable Education, Decision Support, and Automated Alerts.

    Science.gov (United States)

    Reiner, Bruce I

    2017-12-18

    In order to better elucidate and understand the causative factors and clinical implications of uncertainty in medical reporting, one must first create a referenceable database which records a number of standardized metrics related to uncertainty language, clinical context, technology, and provider and patient data. The resulting analytics can in turn be used to create context and user-specific reporting guidelines, real-time decision support, educational resources, and quality assurance measures. If this technology can be directly integrated into reporting technology and workflow, the goal is to proactively improve clinical outcomes at the point of care.

  5. A Mainframe Medical Records and Decision Support System for Application in Hand Surgery

    Science.gov (United States)

    Thomas, Melissa S.; Wyllie, F.J.; Dent, J.A.; Lister, G.D.

    1987-01-01

    This document provides a discussion of the development of a mainframe medical record keeping and decision support system for use in a busy hand surgery practice. Navigation through the system is accomplished via a light pen and a series of menu screens which place little reliance on fluent English usage or typing ability. This system is designed to provide multiple paths of data entry which accommodate the individual user, as well as guard against omission of important clinical details. Initial efforts have been directed in the areas of office and emergency room examination, operative procedures, nursing procedures and vascular laboratory investigations.

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

    Science.gov (United States)

    Wilhelm, Kay A; Reid, Alison M

    2004-10-04

    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.

  7. Medical Decision-Making Processes and Online Behaviors Among Cannabis Dispensary Staff

    Directory of Open Access Journals (Sweden)

    Nicholas C Peiper

    2017-08-01

    Full Text Available Background: Most cannabis patients engage with dispensary staff, like budtenders, for medical advice on cannabis. Yet, little is known about these interactions and how the characteristics of budtenders affect these interactions. This study investigated demographics, workplace characteristics, medical decision-making, and online behaviors among a sample of budtenders. Methods: Between June and September 2016, a cross-sectional Internet survey was administered to budtenders in the San Francisco Bay Area and Greater Los Angeles. A total of 158 budtenders fully responded to the survey. A series of comparisons were conducted to determine differences between trained and untrained budtenders. Results: Among the 158 budtenders, 56% had received formal training to become a budtender. Several demographic differences were found between trained and untrained budtenders. For workplace characteristics, trained budtenders were more likely to report budtender as their primary job (74% vs 53%, practice more than 5 years (34% vs 11%, and receive sales commission (57% vs 16%. Trained budtenders were significantly less likely to perceive medical decision-making as very important (47% vs 68% and have a patient-centered philosophy (77% vs 89%. Although trained budtenders had significantly lower Internet usage, they were significantly more likely to exchange information with patients through e-mail (58% vs 39%, text message (46% vs 30%, mobile app (33% vs 11%, video call (26% vs 3%, and social media (51% vs 23%. Conclusions: Budtenders who are formally trained exhibit significantly different patterns of interaction with medical cannabis patients. Future studies will use multivariate methods to better determine which factors independently influence interactions and how budtenders operate after the introduction of regulations under the newly passed Proposition 64 that permits recreational cannabis use in California.

  8. Bringing the patient back in: behavioral decision-making and choice in medical economics.

    Science.gov (United States)

    Mendoza, Roger Lee

    2018-04-01

    We explore the behavioral methodology and "revolution" in economics through the lens of medical economics. We address two questions: (1) Are mainstream economic assumptions of utility-maximization realistic approximations of people's actual behavior? (2) Do people maximize subjective expected utility, particularly in choosing from among the available options? In doing so, we illustrate-in terms of a hypothetical experimental sample of patients with dry eye diagnosis-why and how utility in pharmacoeconomic assessments might be valued differently by patients when subjective psychological, social, cognitive, and emotional factors are considered. While experimentally-observed or surveyed behavior yields stated (rather than revealed) preferences, behaviorism offers a robust toolset in understanding drug, medical device, and treatment-related decisions compared to the optimizing calculus assumed by mainstream economists. It might also do so more perilously than economists have previously understood, in light of the intractable uncertainties, information asymmetries, insulated third-party agents, entry barriers, and externalities that characterize healthcare. Behavioral work has been carried out in many sub-fields of economics. Only recently has it been extended to healthcare. This offers medical economists both the challenge and opportunity of balancing efficiency presumptions with relatively autonomous patient choices, notwithstanding their predictable, yet seemingly consistent, irrationality. Despite its comparative youth and limitations, the scientific contributions of behaviorism are secure and its future in medical economics appears to be promising.

  9. Fostering Entrepreneurial Investment Decision in Medical Technology Ventures in a Changing Business Environment

    Directory of Open Access Journals (Sweden)

    Sonja Bettina Keppler

    2015-02-01

    Full Text Available This paper presents the results obtained from a survey among public and private venture capitalists from countries which attract a large amount of venture capital investment: Germany, Switzerland, Austria and Israel. The objective is to investigate venture capitalists’ investment criteria for medical technology ventures in the start-up or expansion phase. Since existing research evaluated venture capitalists’ general investment criteria, the aim of this study is to provide specific results on entrepreneurial investment decisions for the medical technology sector, which constantly attracted a significant share of European venture capital. The research used semi-structured interviews with 39 venture capitalists and experts. The results show that venture capitalists prefer to invest in companies which develop products for treating and diagnosing diseases showing a high prevalence and large market volumes, such as cardiovascular, metabolic and neurological diseases, and orthopaedic disorders. The study confirms that venture capitalists use a number of industry-specific criteria highly relevant in a changing business environment. These include a high medical need for the product, availability of clinical data, stage of European Conformity approval, high probability of receiving reimbursement from health insurances, medical key opinion leaders supporting technology, management’s regulatory experience and their communication ability with doctors and key opinion leaders.

  10. Adoption Decisions for Medical Devices in the Field of Cardiology: Results from a European Survey.

    Science.gov (United States)

    Hatz, Maximilian H M; Schreyögg, Jonas; Torbica, Aleksandra; Boriani, Giuseppe; Blankart, Carl R B

    2017-02-01

    Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

  11. Efficient management of diarrhea in the acquired immunodeficiency syndrome (AIDS). A medical decision analysis.

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    Johanson, J F; Sonnenberg, A

    1990-06-15

    To compare the efficacy and cost effectiveness of alternative strategies for the evaluation and medical management of diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). Medical decision analysis using a decision tree. Three management strategies were compared: full evaluation, which included stool culture, ova and parasite examination, stain for protozoa, blood cultures, esophagogastroduodenoscopy with biopsy, and colonoscopy with biopsy; limited evaluation, which included stool culture, ova and parasite examination, stool stain for protozoa, and blood cultures; and minimal evaluation, which included only a stool culture. Treatment was based on the outcome of the diagnostic workup. Patients without a specific diagnosis were treated symptomatically with diphenoxylate hydrochloride. Nonrespondents to initial symptomatic treatment and patients with recurrent diarrhea after specific therapy were given the full evaluation. Average probabilities of diagnostic and therapeutic success were calculated from previous reports. Costs were compiled based on diagnostic and therapeutic expenditures. Under baseline assumptions, the remission rates for diarrhea were 75.2%, 74.8%, and 74.8% in patients undergoing the full, limited, and minimal evaluations, respectively. The respective costs of the three strategies were $5419, $1997, and $1700 per patient in remission. A sensitivity analysis showed that the differences in efficacy and cost among the full, limited, and minimal strategies remained unchanged over a broad range of possible rates of diagnostic or therapeutic success. The minimal evaluation in all patients, with the full evaluation reserved only for nonrespondents to symptomatic treatment, is efficacious and is the most cost-effective strategy for managing AIDS-related diarrhea.

  12. A randomized controlled trial on teaching geriatric medical decision making and cost consciousness with the serious game GeriatriX.

    Science.gov (United States)

    Lagro, Joep; van de Pol, Marjolein H J; Laan, Annalies; Huijbregts-Verheyden, Fanny J; Fluit, Lia C R; Olde Rikkert, Marcel G M

    2014-12-01

    Medical students often lack training in complex geriatric medical decision making. We therefore developed the serious game, GeriatriX, for training medical decision making with weighing patient preferences, and appropriateness and costs of medical care. We hypothesized that education with GeriatriX would improve the ability to deal with geriatric decision making and also increase cost consciousness. A randomized, controlled pre-post measurement design. Fifth-year medical students. Playing the serious game GeriatriX as an additive to usual geriatric education. We evaluated the effects of playing GeriatriX on self-perceived knowledge of geriatric themes and the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in geriatric decision making. Cost consciousness was evaluated with a postmeasurement to estimate costs of different diagnostic tests. There was a large positive increase in the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in the intervention group (n = 71) (effect sizes of 0.7, 1.0, and 1.2, respectively), which was significantly better for the last 2 aspects than in the control group (n = 63). The intervention group performed better on cost consciousness. Although the self-perceived knowledge increased substantially on some geriatric topics, this improvement was not different between the intervention and control groups. After playing the serious game, GeriatriX, medical students have a higher self-perceived competence in weighing patient preferences, appropriateness, and costs of medical care in complex geriatric medical decision making. Playing GeriatriX also resulted in better cost consciousness. We therefore encourage wider use of GeriatriX to teach geriatrics in medical curricula and its further research on educational and health care outcomes. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier

  13. 'That's the doctor's job': Overcoming patient reluctance to be involved in medical decision making.

    Science.gov (United States)

    Blumenthal-Barby, J S

    2017-01-01

    To review the barriers to patient engagement and techniques to increase patients' engagement in their medical decision-making and care. Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients' interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere. Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. [Oncological patients' decision making processes concerning their pain medication at home: a qualitative secondary analysis].

    Science.gov (United States)

    Lüscher-Buffet, C; Koller, A; Schaefer, I; Spichiger, E

    2012-10-01

    Unrelieved pain affects up to 75 % of cancer patients. Possible reasons for the undertreatment of pain are, amongst others, patient-related barriers towards cancer pain management. However the way patients decide on the use of analgesics remains unclear. The purpose of this qualitative study was to explore decision-making processes of four women and four men with diverse cancers concerning their pain medications. Audiotaped protocols of the 10-week-intervention and interviews of the PEINCA-pilot study provided data for a secondary analysis. This pilot study was conducted at a comprehensive cancer centre in Germany to test the German version of a cancer pain self-management intervention to enhance oncology patients' pain self-management for the first time. The data of purposively selected patients were analysed using content analysis. The results showed that these patients were very ambivalent about their analgesic use. The need to relieve severe pain conflicted with the desire to avoid opioids at any price. Decisions were reconsidered and overturned even after good experiences with analgesics. This study seems to provide a first look into decision-making processes over 10 weeks during a self-management education. Individually tailored counselling by a professional within the education programme helped the patients adopt new attitudes towards analgesics and gradually reduce their pain levels. Previous experiences of the patients and their possible ambivalence towards analgesics should be considered in a pain therapy, and patients should be coached by professionals.

  15. Medical expertise and patient involvement: a multiperspective qualitative observation study of the patient's role in oncological decision making.

    Science.gov (United States)

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

    2014-06-01

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

  16. "It Was the Best Decision of My Life": a thematic content analysis of former medical tourists' patient testimonials.

    Science.gov (United States)

    Hohm, Carly; Snyder, Jeremy

    2015-01-22

    Medical tourism is international travel with the intention of receiving medical care. Medical tourists travel for many reasons, including cost savings, limited domestic access to specific treatments, and interest in accessing unproven interventions. Medical tourism poses new health and safety risks to patients, including dangers associated with travel following surgery, difficulty assessing the quality of care abroad, and complications in continuity of care. Online resources are important to the decision-making of potential medical tourists and the websites of medical tourism facilitation companies (companies that may or may not be affiliated with a clinic abroad and help patients plan their travel) are an important source of online information for these individuals. These websites fail to address the risks associated with medical tourism, which can undermine the informed decision-making of potential medical tourists. Less is known about patient testimonials on these websites, which can be a particularly powerful influence on decision-making. A thematic content analysis was conducted of patient testimonials hosted on the YouTube channels of four medical tourism facilitation companies. Five videos per company were viewed. The content of these videos was analyzed and themes identified and counted for each video. Ten main themes were identified. These themes were then grouped into three main categories: facilitator characteristics (e.g., mentions of the facilitator by name, reference to the price of the treatment or to cost savings); service characteristics (e.g., the quality and availability of the surgeon, the quality and friendliness of the support staff); and referrals (e.g., referrals to other potential medical tourists). These testimonials were found either not to mention risks associated with medical tourism or to claim that these risks can be effectively managed through the use of the facilitation company. The failure fully to address the risks of medical

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

    Science.gov (United States)

    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 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. © The Author(s) 2015.

  18. MEDICAL AND LEGAL ISSUES OF THE DECISIONS RENDERED BY THE EUROPEAN COURT OF HUMAN RIGHTS.

    Science.gov (United States)

    Chakhvadze, B; Chakhvadze, G

    2017-01-01

    The European Convention on Human rights is a document that protects human rights and fundamental freedoms of individuals, and the European Court of Human Rights and its case-law makes a convention a powerful instrument to meet the new challenges of modernity and protect the principles of rule of law and democracy. This is important, particularly for young democracies, including Georgia. The more that Georgia is a party to this convention. Article 3 of the convention deals with torture, inhuman and degrading treatment, while article 8 deals with private life, home and correspondence. At the same time, the international practice of the European court of human rights shows that these articles are often used with regard to medical rights. The paper highlights the most recent and interesting cases from the case-law of the ECHR, in which the courts conclusions are based solely on the European Convention on Human Rights. In most instances, the European Court of Human Rights uses the principle of democracy with regard to medical rights. The European court of human rights considers medical rights as moral underpinning rights. Particularly in every occasion, the European Court of Human Rights acknowledges an ethical dimension of these rights. In most instances, it does not matter whether a plaintiff is a free person or prisoner, the European court of human rights make decisions based on fundamental human rights and freedoms of individuals.

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

    Directory of Open Access Journals (Sweden)

    Emrani Parastu

    2011-04-01

    Full Text Available Abstract 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.

  20. Biomedical visual data analysis to build an intelligent diagnostic decision support system in medical genetics.

    Science.gov (United States)

    Kuru, Kaya; Niranjan, Mahesan; Tunca, Yusuf; Osvank, Erhan; Azim, Tayyaba

    2014-10-01

    In general, medical geneticists aim to pre-diagnose underlying syndromes based on facial features before performing cytological or molecular analyses where a genotype-phenotype interrelation is possible. However, determining correct genotype-phenotype interrelationships among many syndromes is tedious and labor-intensive, especially for extremely rare syndromes. Thus, a computer-aided system for pre-diagnosis can facilitate effective and efficient decision support, particularly when few similar cases are available, or in remote rural districts where diagnostic knowledge of syndromes is not readily available. The proposed methodology, visual diagnostic decision support system (visual diagnostic DSS), employs machine learning (ML) algorithms and digital image processing techniques in a hybrid approach for automated diagnosis in medical genetics. This approach uses facial features in reference images of disorders to identify visual genotype-phenotype interrelationships. Our statistical method describes facial image data as principal component features and diagnoses syndromes using these features. The proposed system was trained using a real dataset of previously published face images of subjects with syndromes, which provided accurate diagnostic information. The method was tested using a leave-one-out cross-validation scheme with 15 different syndromes, each of comprised 5-9 cases, i.e., 92 cases in total. An accuracy rate of 83% was achieved using this automated diagnosis technique, which was statistically significant (p<0.01). Furthermore, the sensitivity and specificity values were 0.857 and 0.870, respectively. Our results show that the accurate classification of syndromes is feasible using ML techniques. Thus, a large number of syndromes with characteristic facial anomaly patterns could be diagnosed with similar diagnostic DSSs to that described in the present study, i.e., visual diagnostic DSS, thereby demonstrating the benefits of using hybrid image processing

  1. Empiric Antibiotic Prescribing Decisions Among Medical Residents: The Role of the Antibiogram.

    Science.gov (United States)

    Tallman, Gregory B; Vilches-Tran, Rowena A; Elman, Miriam R; Bearden, David T; Taylor, Jerusha E; Gorman, Paul N; McGregor, Jessina C

    2018-03-01

    OBJECTIVE To assess general medical residents' familiarity with antibiograms using a self-administered survey DESIGN Cross-sectional, single-center survey PARTICIPANTS Residents in internal medicine, family medicine, and pediatrics at an academic medical center METHODS Participants were administered an anonymous survey at our institution during regularly scheduled educational conferences between January and May 2012. Questions collected data regarding demographics, professional training; further open-ended questions assessed knowledge and use of antibiograms regarding possible pathogens, antibiotic regimens, and prescribing resources for 2 clinical vignettes; a series of directed, closed-ended questions followed. Bivariate analyses to compare responses between residency programs were performed. RESULTS Of 122 surveys distributed, 106 residents (87%) responded; internal medicine residents accounted for 69% of responses. More than 20% of residents could not accurately identify pathogens to target with empiric therapy or select therapy with an appropriate spectrum of activity in response to the clinical vignettes; correct identification of potential pathogens was not associated with selecting appropriate therapy. Only 12% of respondents identified antibiograms as a resource when prescribing empiric antibiotic therapy for scenarios in the vignettes, with most selecting the UpToDate online clinical decision support resource or The Sanford Guide. When directly questioned, 89% reported awareness of institutional antibiograms, but only 70% felt comfortable using them and only 44% knew how to access them. CONCLUSIONS When selecting empiric antibiotics, many residents are not comfortable using antibiograms as part of treatment decisions. Efforts to improve antibiotic use may benefit from residents being given additional education on both infectious diseases pharmacotherapy and antibiogram utilization. Infect Control Hosp Epidemiol 2018;1-6.

  2. Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents.

    Science.gov (United States)

    Russ, Alissa L; Militello, Laura G; Glassman, Peter A; Arthur, Karen J; Zillich, Alan J; Weiner, Michael

    2017-05-03

    Cognitive task analysis (CTA) can yield valuable insights into healthcare professionals' cognition and inform system design to promote safe, quality care. Our objective was to adapt CTA-the critical decision method, specifically-to investigate patient safety incidents, overcome barriers to implementing this method, and facilitate more widespread use of cognitive task analysis in healthcare. We adapted CTA to facilitate recruitment of healthcare professionals and developed a data collection tool to capture incidents as they occurred. We also leveraged the electronic health record (EHR) to expand data capture and used EHR-stimulated recall to aid reconstruction of safety incidents. We investigated 3 categories of medication-related incidents: adverse drug reactions, drug-drug interactions, and drug-disease interactions. Healthcare professionals submitted incidents, and a subset of incidents was selected for CTA. We analyzed several outcomes to characterize incident capture and completed CTA interviews. We captured 101 incidents. Eighty incidents (79%) met eligibility criteria. We completed 60 CTA interviews, 20 for each incident category. Capturing incidents before interviews allowed us to shorten the interview duration and reduced reliance on healthcare professionals' recall. Incorporating the EHR into CTA enriched data collection. The adapted CTA technique was successful in capturing specific categories of safety incidents. Our approach may be especially useful for investigating safety incidents that healthcare professionals "fix and forget." Our innovations to CTA are expected to expand the application of this method in healthcare and inform a wide range of studies on clinical decision making and patient safety.

  3. Menopause and the virtuous woman: the importance of the moral order in accounting for medical decision making.

    Science.gov (United States)

    Stephens, Christine; Breheny, Mary

    2008-01-01

    Whether or not to use hormone replacement therapy (HRT) around the time of menopause is seen as an important decision for many mid-aged women. Recent studies of information provided to women to assist them in making a medical decision about the use of HRT have highlighted the importance of understanding the broader social context of the decision. In this article we examine one important aspect of western mid-aged women's social world: the moral order and the imperative of virtue. Qualitative data from a survey, focus group discussions, and interviews with mid-aged women about HRT use are used to provide examples of the importance of the local moral order in women's talk about menopause and HRT use. The implications of these data will be discussed in terms of the different narrative resources available to construct menopause and HRT, the role of morality, and the demonstration of virtue in daily social life, including medical decision making.

  4. Design and implementation of GRID-based PACS in a hospital with multiple imaging departments

    Science.gov (United States)

    Yang, Yuanyuan; Jin, Jin; Sun, Jianyong; Zhang, Jianguo

    2008-03-01

    Usually, there were multiple clinical departments providing imaging-enabled healthcare services in enterprise healthcare environment, such as radiology, oncology, pathology, and cardiology, the picture archiving and communication system (PACS) is now required to support not only radiology-based image display, workflow and data flow management, but also to have more specific expertise imaging processing and management tools for other departments providing imaging-guided diagnosis and therapy, and there were urgent demand to integrate the multiple PACSs together to provide patient-oriented imaging services for enterprise collaborative healthcare. In this paper, we give the design method and implementation strategy of developing grid-based PACS (Grid-PACS) for a hospital with multiple imaging departments or centers. The Grid-PACS functions as a middleware between the traditional PACS archiving servers and workstations or image viewing clients and provide DICOM image communication and WADO services to the end users. The images can be stored in distributed multiple archiving servers, but can be managed with central mode. The grid-based PACS has auto image backup and disaster recovery services and can provide best image retrieval path to the image requesters based on the optimal algorithms. The designed grid-based PACS has been implemented in Shanghai Huadong Hospital and been running for two years smoothly.

  5. Fuzzy trace theory and medical decisions by minors: differences in reasoning between adolescents and adults.

    Science.gov (United States)

    Wilhelms, Evan A; Reyna, Valerie F

    2013-06-01

    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.

  6. The effect object paradigm--a means to support medication safety with clinical decision support.

    Science.gov (United States)

    Patapovas, Andrius; Pfistermeister, Barbara; Tarkhov, Aleksey; Terfloth, Lothar; Maas, Renke; Fromm, Martin F; Kornhuber, Johannes; Prokosch, Hans-Ulrich; Bürkle, Thomas

    2014-01-01

    In many countries, officially approved drug information known as summary of product characteristics (SPC) is mostly available in text form, which cannot be used for Clinical Decision Support Systems (CDSS). It may be essential however to substantiate CDSS advice with such legally binding text snippets. In an attempt to link various drug data sources including SPC towards a CDSS to support medication safety in psychiatric patients we arrived at the notion of an effect object. A requirements analysis revealed data items and data structure which are needed from the patient and from the drug information source for the CDSS functionality. Published drug data modelling approaches were analyzed and found unsuitable. A conceptional database modeling approach using top down and bottom up modeling was performed. The schema based data model implemented within the django framework centered on SPC "effect objects" which comprise all SPC data required for the respective CDSS function such as search for contraindications in the proposed medication. Today six effect objects have been defined for contraindications and warnings, missing indications, adverse effects, drug-drug interactions, dosing and pharmacokinetics. The transformation of SPC data to a database-driven "effect objects" structure permits decoupling between the CDSS functions and different underlying data sources and supports the design of reusable, stable and verified CDSS functions.

  7. A qualitative study of women's decision to view or not view an ultrasound image before early medication abortion.

    Science.gov (United States)

    Cappiello, Joyce; Merrell, Joy; Rentschler, Dorothy

    2014-01-01

    Transvaginal ultrasounds are commonly performed for gestational dating of pregnancy before a medication abortion. This paper presents findings regarding women's perspectives on viewing the gestational dating ultrasound image, which arose from a study exploring women's medication abortion experience. By providing women the opportunity to talk about their medication abortion experience through open-ended interviews, women reported their experience of viewing or not viewing the ultrasound in detail, which to date has been underexplored. A constructivist, grounded theory approach was used. The purposive sample consisted of 18 women in the United States who experienced a medication abortion in the preceding 4 months. Not all women wanted to view the ultrasound; however, they all wanted a choice. Women wanted to view the image to confirm health and fertility, satisfy curiosity, and process their decision regarding the pregnancy. None of the women stated that they wanted to view the image as a prerequisite to making their decision to terminate the pregnancy; rather, viewing was a way to process their decision. Women wanted a choice of whether to view the ultrasound image because they felt it was their right to decide whether to access this aspect of their personal health information. They wanted providers to engage in a dialogue about viewing the image or not and to respect their decision. Providers need to be appropriately prepared to offer women the choice to view and to support women in their decision. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Marasinghe, Keshini Madara

    2015-05-12

    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. 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. 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. CCDSS have received little attention in LTC, as attested by the limited published literature. With an increasing ageing population, greater use of LTC by the ageing population and increased workload for health professionals, merely relying on physicians' judgement on medication safety would not be sufficient. CCDSS to improve medication safety and enhance the quality of prescribing decisions are essential. Analysis of review findings indicates that CCDSS are beneficial, effective and have potential to improve medication safety in LTC; however, the use of CCDSS in LTC is scarce. Careful assessment on the impact of CCDSS on medication safety and further modifications to existing CCDSS are recommended for wider acceptance. Due to scant evidence in the current literature, further research on implementation and

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

    Science.gov (United States)

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

    2009-05-19

    Computerized physician order entry (CPOE) systems are software to electronically enter medication orders. They can be equipped with tools for decision support (CDS). In Germany, various vendors offer such systems for hospitals and physicians' offices. These systems have mostly been developed during the last five to ten years. CPOE-systems exist since the 1970's. Usually, clinical decision support is integrated into the CPOE to avoid errors. This HTA-report aims to evaluate the effectiveness and efficiency of CPOE-/CDS-systems and their ethical, social and legal aspects. The systematic literature search (27 international data bases) yielded 791 abstracts. Following a two-part selection process, twelve publications were included in the assessment. All reviews and studies included in the present report show that the use of CPOE-/CDS-systems can lead to a reduction of medication errors. Minor errors can be eliminated almost completely. The effect of CPOE-/CDS-systems on the rate of adverse drug events (ADE) is evaluated in only two primary studies with conflicting results. It is difficult to compare the results of economical studies because they evaluate different settings, interventions and time frames. In addition, the documentation often is not fully transparent. All four studies included measure costs and effects from the perspective of a hospital or hospital affiliation. Concerning social aspects, the literature points at changes regard competing interests of technology and humans that result from the implementation of CPOE-systems. The experience of institutions in which the implementation of CPOE-systems leads to problems showed that the importance of considering the socio-organisational context had partly been underestimated. CPOE-/CDS-systems are able to reduce the rate of medication errors when ordering medications. The adherence to guidelines, communication, patient care and personnel satisfaction can also be affected positively. However, the literature also

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

    Directory of Open Access Journals (Sweden)

    Traurig, Peter

    2009-05-01

    Full Text Available Health political background: Computerized physician order entry (CPOE systems are software to electronically enter medication orders. They can be equipped with tools for decision support (CDS. In Germany, various vendors offer such systems for hospitals and physicians’ offices. These systems have mostly been developed during the last five to ten years. Scientific background: CPOE-systems exist since the 1970’s. Usually, clinical decision support is integrated into the CPOE to avoid errors. Research questions: This HTA-report aims to evaluate the effectiveness and efficiency of CPOE-/CDS-systems and their ethical, social and legal aspects. Methods: The systematic literature search (27 international data bases yielded 791 abstracts. Following a two-part selection process, twelve publications were included in the assessment. Results: All reviews and studies included in the present report show that the use of CPOE-/CDS-systems can lead to a reduction of medication errors. Minor errors can be eliminated almost completely. The effect of CPOE-/CDS-systems on the rate of adverse drug events (ADE is evaluated in only two primary studies with conflicting results. It is difficult to compare the results of economical studies because they evaluate different settings, interventions and time frames. In addition, the documentation often is not fully transparent. All four studies included measure costs and effects from the perspective of a hospital or hospital affiliation. Concerning social aspects, the literature points at changes regard competing interests of technology and humans that result from the implementation of CPOE-systems. The experience of institutions in which the implementation of CPOE-systems leads to problems showed that the importance of considering the socio-organisational context had partly been underestimated. Discussion: CPOE-/CDS-systems are able to reduce the rate of medication errors when ordering medications. The adherence to

  11. Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-Maker Following a Large Scale Nuclear or Radiation Incident

    International Nuclear Information System (INIS)

    Coleman, C. Norman; Koerner, John F.

    2016-01-01

    The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by health-care professionals with biodosimetry assays providing critical supporting data. (authors)

  12. Development of traditional Chinese medicine clinical data warehouse for medical knowledge discovery and decision support.

    Science.gov (United States)

    Zhou, Xuezhong; Chen, Shibo; Liu, Baoyan; Zhang, Runsun; Wang, Yinghui; Li, Ping; Guo, Yufeng; Zhang, Hua; Gao, Zhuye; Yan, Xiufeng

    2010-01-01

    Traditional Chinese medicine (TCM) is a scientific discipline, which develops the related theories from the long-term clinical practices. The large-scale clinical data are the core empirical knowledge source for TCM research. This paper introduces a clinical data warehouse (CDW) system, which incorporates the structured electronic medical record (SEMR) data for medical knowledge discovery and TCM clinical decision support (CDS). We have developed the clinical reference information model (RIM) and physical data model to manage the various information entities and their relationships in TCM clinical data. An extraction-transformation-loading (ETL) tool is implemented to integrate and normalize the clinical data from different operational data sources. The CDW includes online analytical processing (OLAP) and complex network analysis (CNA) components to explore the various clinical relationships. Furthermore, the data mining and CNA methods are used to discover the valuable clinical knowledge from the data. The CDW has integrated 20,000 TCM inpatient data and 20,000 outpatient data, which contains manifestations (e.g. symptoms, physical examinations and laboratory test results), diagnoses and prescriptions as the main information components. We propose a practical solution to accomplish the large-scale clinical data integration and preprocessing tasks. Meanwhile, we have developed over 400 OLAP reports to enable the multidimensional analysis of clinical data and the case-based CDS. We have successfully conducted several interesting data mining applications. Particularly, we use various classification methods, namely support vector machine, decision tree and Bayesian network, to discover the knowledge of syndrome differentiation. Furthermore, we have applied association rule and CNA to extract the useful acupuncture point and herb combination patterns from the clinical prescriptions. A CDW system consisting of TCM clinical RIM, ETL, OLAP and data mining as the core

  13. Title: A study of the relationship between managers\\' decision making styles and organizational health in Isfahan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    S Bahrami

    2012-12-01

    Full Text Available   Background and Aims: Managers decision making style can function effectively correct departments in universities and its positive impact on organizational health group will increase efficiency. The present study aims to examine the relationship between the decision-making styles and organizational health departments in Isfahan University of Medical Sciences.   Methods: A descriptive and survey research method was utilized. The statistical population included all 594 members of Isfahan Medical Science University Colleges from which a sample of 201 was selected though a classified random sampling   The data gathering instruments included, a researcher – made decision making questionnaire and the Ho & Feldmn (1990, organizational health questionnaire. The reliability of the instruments was estimated 0.86 and 0.92 respectively, though Cronbach Alpha coefficient. Utilizing SPSS (15 statistical software, both descriptive and inferential statistics were applied to analyze the data.   Results: Consultative decision making scored the highest average among the chairpersons, while the authoritative style scored the lowest average. The departments' organizational health was more than mean level in all dimensions except chairperson's influence. Moreover, a significant relationship was observed between decision making style and organizational health indices. Also a direct relationship was not observed between authoritarian decision makings and institutional integration, chairperson influence, consideration, initiating structure, and academic emphasis. A direct relationship was observed between Consultative decision making and chairperson influence, consideration, initiating structure, resource support, morale, and academic emphasis. A direct relationship was observed between Participative decision making and chairperson Influence, consideration, initiating structure.   Conclusion: Consultative and participative decision making can lead to enhancement

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

    Science.gov (United States)

    Donnelly, Kyla Z; Thompson, Rachel

    2015-07-14

    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). 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. 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. This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Do people intend to have an active role in medical decision-making? The role of social resources.

    NARCIS (Netherlands)

    Brabers, A.; Jong, J. de; Groenewegen, P.; Dijk, L. van

    2015-01-01

    Introduction: There is growing emphasis to include patients in medical decision-making (MDM). Still, not all patients are actively involved in MDM. It depends upon circumstances whether they are actively involved. Until now, research mainly focused on the influence of characteristics of the patient

  16. Individual and work-unit measures of psychological demands and decision latitude and the use of antihypertensive medication

    DEFF Research Database (Denmark)

    Daugaard, S; Andersen, J H; Grynderup, Matias Brødsgaard

    2015-01-01

    National Prescription Registry. Odds ratios (OR) comparing the highest and lowest third of the population at individual and work-unit level, respectively, were estimated by multilevel logistic regression adjusted for confounders. Psychological demands and decision latitude were tested for interaction......PURPOSE: To analyse whether psychological demands and decision latitude measured on individual and work-unit level were related to prescription of antihypertensive medication. METHODS: A total of 3,421 women and 897 men within 388 small work units completed a questionnaire concerning psychological...... working conditions according to the job strain model. Mean levels of psychological demands and decision latitude were computed for each work unit to obtain exposure measures that were less influenced by reporting bias. Dispensed antihypertensive medication prescriptions were identified in The Danish...

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

    Science.gov (United States)

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

    2009-02-01

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

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

    Science.gov (United States)

    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.

  19. Modelling security properties in a grid-based operating system with anti-goals

    OpenAIRE

    Arenas, A.; Aziz, Benjamin; Bicarregui, J.; Matthews, B.; Yang, E.

    2008-01-01

    In this paper, we discuss the use of formal requirements-engineering techniques in capturing security requirements for a Grid-based operating system. We use KAOS goal model to represent two security goals for Grid systems, namely authorisation and single-sign on authentication. We apply goal-refinement to derive security requirements for these two security goals and we develop a model of antigoals and show how system vulnerabilities and threats to the security goals can arise from such anti-m...

  20. The any particle molecular orbital grid-based Hartree-Fock (APMO-GBHF) approach.

    Science.gov (United States)

    Posada, Edwin; Moncada, Félix; Reyes, Andrés

    2018-02-28

    The any particle molecular orbital grid-based Hartree-Fock approach (APMO-GBHF) is proposed as an initial step to perform multi-component post-Hartree-Fock, explicitly correlated, and density functional theory methods without basis set errors. The method has been applied to a number of electronic and multi-species molecular systems. Results of these calculations show that the APMO-GBHF total energies are comparable with those obtained at the APMO-HF complete basis set limit. In addition, results reveal a considerable improvement in the description of the nuclear cusps of electronic and non-electronic densities.

  1. Operation of an InGrid based X-ray detector at the CAST experiment

    Directory of Open Access Journals (Sweden)

    Krieger Christoph

    2018-01-01

    During operation at the experiment, background rates in the order of 10−5 keV−1 cm−2 s−1 have been achieved by application of a likelihood based method discriminating the non-photon background originating mostly from cosmic rays. For continued operation in 2016, an upgraded InGrid based detector is to be installed among other improvements including decoupling and sampling of the signal induced on the grid as well as a veto scintillator to further lower the observed background rates and improving sensitivity.

  2. Medical end-of-life decisions in Switzerland 2001 and 2013: Who is involved and how does the decision-making capacity of the patient impact?

    Science.gov (United States)

    Schmid, Margareta; Zellweger, Ueli; Bosshard, Georg; Bopp, Matthias

    2016-01-01

    In Switzerland, the prevalence of medical end-of-life practices had been assessed on a population level only once - in 2001 - until in 2013/14 an identical study was conducted. We aimed to compare the results of the 2001 and 2013 studies with a special focus on shared decision-making and patients' decision-making capacity. Our study encompassed a 21.3% sample of deaths among residents of the German-speaking part of Switzerland aged 1 year or older. From 4998 mailed questionnaires, 3173 (63.5%) were returned. All data were weighted to adjust for age- and sex-specific differences in response rates. Cases with at least one reported end-of-life practice significantly increased from 74.5% (2001) to 82.3% (2013) of all deaths eligible for an end-of-life decision (p Switzerland, there remains potential for further improvement in shared decision-making. Efforts to motivate physicians to involve patients and relatives may be a win-win situation.

  3. Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making.

    Science.gov (United States)

    Kamara, Daniella; Weil, Jon; Youngblom, Janey; Guerra, Claudia; Joseph, Galen

    2018-02-01

    In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.

  4. gLibrary/DRI: A grid-based platform to host multiple repositories for digital content

    International Nuclear Information System (INIS)

    Calanducci, A.; Gonzalez Martin, J. M.; Ramos Pollan, R.; Rubio del Solar, M.; Tcaci, S.

    2007-01-01

    In this work we present the gLibrary/DRI (Digital Repositories Infrastructure) platform. gLibrary/DRI extends gLibrary, a system with a easy-to-use web front-end designed to save and organize multimedia assets on Grid-based storage resources. The main goal of the extended platform is to reduce the cost in terms of time and effort that a repository provider spends to get its repository deployed. This is achieved by providing a common infrastructure and a set of mechanisms (APIs and specifications) that the repository providers use to define the data model, the access to the content (by navigation trees and filters) and the storage model. DRI offers a generic way to provide all this functionality; nevertheless the providers can add specific behaviours to the default functions for their repositories. The architecture is Grid based (VO system, data federation and distribution, computing power, etc). A working example based on a mammograms repository is also presented. (Author)

  5. [Patient participation in medical decision making among breast cancer patients--a comparison of breast centre care units and non-centre hospitals].

    Science.gov (United States)

    Ernst, Jochen; Weissflog, Gregor; Hohlfeld, Sylvia; Wittekind, Christian; Brähler, Elmar

    2011-08-01

    This study investigated the extent of involvement of breast cancer patients in medical decisions in comparison between certified breast cancer centres vs. non-centres. Data on the participation in medical decision making were collected in a retrospective cross-sectional design from 652 breast cancer patients. 9 different dimensions of participation were analysed. In the descriptive analysis, there is only one significant difference in participation between breast centres and non-centres (dimension: time of treatment). In multivariate analysis, the treatment in a breast cancer centre was a predictor for increased patient participation in 3 dimensions of participation in medical decisions (p younger age and good health are of statistical significance for participation in medical decision making. There is a higher participation of patients in breast centres in only few subdimensions of medical decision making, but not in general. Georg Thieme Verlag KG Stuttgart · New York.

  6. How primary health care physicians make sick listing decisions: The impact of medical factors and functioning

    Directory of Open Access Journals (Sweden)

    Svärdsudd Kurt

    2008-01-01

    Full Text Available Abstract Background The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Örebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.

  7. Incentives, expertise, and medical decisions: testing the robustness of natural frequency framing.

    Science.gov (United States)

    Ferguson, Eamonn; Starmer, Chris

    2013-09-01

    The natural frequency effect (NF effect)-whereby framing health risks using information presented as natural frequencies (NFs), instead of conditional probabilities (CPs), results in improved diagnostic problem solving-has led to the recommended use of NFs in clinical practice. This experiment tests, via incentivization of a lab-based decision, the hypothesis that the NF effect reflects differential motivation applied to solving problems that differ in complexity. The study examines if incentive effects are moderated by task complexity and expertise and also explores the extent to which NF frames improve diagnostic understanding. Three-hundred and 25 participants (235 novices and 90 medical experts) were randomly allocated to a frame (NF vs. CP) by task difficulty (short vs. standard menus) by incentive (present vs. absent) between-subjects design. The task was to calculate the positive predictive value (PPV) of the hemoccult test for colorectal cancer. Effort, self-efficacy, and diagnostic understanding were assessed. Incentives increased correct problem solving and the NF effect was replicated. The NF effect did not vary as a function of incentivization, but was slightly attenuated by task complexity and expertise. There was no evidence that effort mediated the incentive effect. The correct PPV (which is low) was associated with reduced trust in the test's diagnostic accuracy. For those who committed errors, NF frames increased the likelihood of underestimating the PPV, with underestimation associated with greater trust in the test. The NF effect is robust to incentives supporting the use of NF frames in clinical settings. When errors occur, however, NF frames are linked to underestimation. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  8. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation.

    Science.gov (United States)

    Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade; Liu, Chien-Tsai

    2018-01-19

    A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan. This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. A CDS engine was developed that can download patients' up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians' responses to handling the alerts for each encounter. The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Alagiakrishnan K

    2016-01-01

    Full Text Available Kannayiram Alagiakrishnan,1 Patricia Wilson,2 Cheryl A Sadowski,3 Darryl Rolfson,1 Mark Ballermann,4,5 Allen Ausford,6,7 Karla Vermeer,7 Kunal Mohindra,8 Jacques Romney,9 Robert S Hayward10 1Department of Medicine, Division of Geriatric Medicine, 2Department of Medicine, 3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 4Chief Medical Information Office, Alberta Health Services, 5Division of Critical Care, Department of Medicine, University of Alberta, 6Department of Family Medicine, University of Alberta, 7Lynwood Family Physician, 8eClinician EMR, Alberta Health Services-Information Systems, 9Department of Medicine, Division of Endocrinology, 10Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada 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

  11. The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.

    Directory of Open Access Journals (Sweden)

    Cheryl L L Carling

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

  12. Ontology-based Medical Decision Support System to Enhance Chronic Patients' Lifestyle within E-care Telemonitoring Platform.

    Science.gov (United States)

    Benmimoune, Lamine; Hajjam, Amir; Ghodous, Parisa; Andres, Emmanuel; Talha, Samy; Hajjam, Mohamed

    2015-01-01

    The aim of this paper is to describe an original approach which consists of designing ontology based Medical Decision Support System (MDSS) to enhance the patients' lifestyle. This system is composed of two main parts: data collector which collects relevant lifestyle-related patent data by prompting the only significant questions in connection with the patient's medical background, and advices provider which provides personalized lifestyle advices to the patients regarding their lifestyle changes. The proposed MDSS is integrated within E-care home health monitoring platform in order to: (i) improve the patient's healthy lifestyle; (ii) educate the patients towards their disease; (iii) increase the early detection of risky situation.

  13. Everyday and medical life choices: decision-making among 8- to 15-year-old school students.

    Science.gov (United States)

    Alderson, P

    1992-01-01

    How much do young patients expect to be involved in medical decisions affecting them? We are investigating this question during interviews with 8- to 15-year-olds having orthopaedic surgery. Many youngsters taking part in our research project on consent to surgery are more than usually dependent on their parents. We wondered how their views would compare with those of their peers at school. This paper reports a schools survey carried out as a background to the research with young people in hospital. Students in seven schools answered questionnaires on choices about late-night television viewing, new friends, timing homework, seeing their family doctor and consenting to surgery. They were asked about agreement with their parents, how they negotiate disagreement, and when they think they were/will be old enough to make everyday and medical decisions without their parents' help.

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

    Science.gov (United States)

    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…

  15. Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication : an Agenda for Science and Practice

    OpenAIRE

    Betsch, Cornelia; Böhm, Robert; Airhihenbuwa, Collins O.; Butler, Robb; Chapman, Gretchen B.; Haase, Niels; Herrmann, Benedikt; Igarashi, Tasuku; Kitayama, Shinobu; Korn, Lars; Nurm, Ülla-Karin; Rohrmann, Bernd; Rothman, Alexander J.; Shavitt, Sharon; Updegraff, John A.

    2016-01-01

    This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making ...

  16. Operation of an InGrid based X-ray detector at the CAST experiment

    Science.gov (United States)

    Krieger, Christoph; Desch, Klaus; Kaminski, Jochen; Lupberger, Michael

    2018-02-01

    The CERN Axion Solar Telescope (CAST) is searching for axions and other particles which could be candidates for DarkMatter and even Dark Energy. These particles could be produced in the Sun and detected by a conversion into soft X-ray photons inside a strong magnetic field. In order to increase the sensitivity for physics beyond the Standard Model, detectors with a threshold below 1 keV as well as efficient background rejection methods are required to compensate for low energies and weak couplings resulting in very low detection rates. Those criteria are fulfilled by a detector utilizing the combination of a pixelized readout chip with an integrated Micromegas stage. These InGrid (Integrated Grid) devices can be build by photolithographic postprocessing techniques, resulting in a close to perfect match of grid and pixels facilitating the detection of single electrons on the chip surface. The high spatial resolution allows for energy determination by simple electron counting as well as for an event-shape based analysis as background rejection method. Tests at an X-ray generator revealed the energy threshold of an InGrid based X-ray detector to be well below the carbon Kα line at 277 eV. After the successful demonstration of the detectors key features, the detector was mounted at one of CAST's four detector stations behind an X-ray telescope in 2014. After several months of successful operation without any detector related interruptions, the InGrid based X-ray detector continues data taking at CAST in 2015. During operation at the experiment, background rates in the order of 10-5 keV-1 cm-2 s-1 have been achieved by application of a likelihood based method discriminating the non-photon background originating mostly from cosmic rays. For continued operation in 2016, an upgraded InGrid based detector is to be installed among other improvements including decoupling and sampling of the signal induced on the grid as well as a veto scintillator to further lower the

  17. OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

    Science.gov (United States)

    Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

    2016-03-01

    To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.

  18. Physicians' use of computerized clinical decision supports to improve medication management in the elderly - the Seniors Medication Alert and Review Technology intervention.

    Science.gov (United States)

    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

    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. 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. 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. While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers' Criteria in ambulatory care EMRs.

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

    Science.gov (United States)

    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

  20. Semantics-based plausible reasoning to extend the knowledge coverage of medical knowledge bases for improved clinical decision support.

    Science.gov (United States)

    Mohammadhassanzadeh, Hossein; Van Woensel, William; Abidi, Samina Raza; Abidi, Syed Sibte Raza

    2017-01-01

    Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians' experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mechanisms apply patterns from human thought processes, such as generalization, similarity and interpolation, based on attributional, hierarchical, and relational knowledge. Plausible reasoning mechanisms include inductive reasoning , which generalizes the commonalities among the data to induce new rules, and analogical reasoning , which is guided by data similarities to infer new facts. By further leveraging rich, biomedical Semantic Web ontologies to represent medical knowledge, both known and tentative, we increase the accuracy and expressivity of plausible reasoning, and cope with issues such as data heterogeneity, inconsistency and interoperability. In this paper, we present a Semantic Web-based, multi-strategy reasoning approach, which integrates deductive and plausible reasoning and exploits Semantic Web technology to solve complex clinical decision support queries. We evaluated our system using a real-world medical dataset of patients with hepatitis, from which we randomly removed different percentages of data (5%, 10%, 15%, and 20%) to reflect scenarios with increasing amounts of incomplete medical knowledge. To increase the reliability of the results, we generated 5 independent datasets for each percentage of missing values, which resulted in 20 experimental datasets (in addition to the original dataset). The results show that plausibly inferred knowledge extends the coverage of the knowledge base by, on average, 2%, 7%, 12%, and 16% for datasets with, respectively, 5%, 10%, 15

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-05-01

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

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

    Science.gov (United States)

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

    2016-02-18

    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. To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. 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. 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. 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.

  3. Coordinated control of micro-grid based on distributed moving horizon control.

    Science.gov (United States)

    Ma, Miaomiao; Shao, Liyang; Liu, Xiangjie

    2018-03-20

    This paper proposed the distributed moving horizon coordinated control scheme for the power balance and economic dispatch problems of micro-grid based on distributed generation. We design the power coordinated controller for each subsystem via moving horizon control by minimizing a suitable objective function. The objective function of distributed moving horizon coordinated controller is chosen based on the principle that wind power subsystem has the priority to generate electricity while photovoltaic power generation coordinates with wind power subsystem and the battery is only activated to meet the load demand when necessary. The simulation results illustrate that the proposed distributed moving horizon coordinated controller can allocate the output power of two generation subsystems reasonably under varying environment conditions, which not only can satisfy the load demand but also limit excessive fluctuations of output power to protect the power generation equipment. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

  4. Hybrid method based on embedded coupled simulation of vortex particles in grid based solution

    Science.gov (United States)

    Kornev, Nikolai

    2017-09-01

    The paper presents a novel hybrid approach developed to improve the resolution of concentrated vortices in computational fluid mechanics. The method is based on combination of a grid based and the grid free computational vortex (CVM) methods. The large scale flow structures are simulated on the grid whereas the concentrated structures are modeled using CVM. Due to this combination the advantages of both methods are strengthened whereas the disadvantages are diminished. The procedure of the separation of small concentrated vortices from the large scale ones is based on LES filtering idea. The flow dynamics is governed by two coupled transport equations taking two-way interaction between large and fine structures into account. The fine structures are mapped back to the grid if their size grows due to diffusion. Algorithmic aspects of the hybrid method are discussed. Advantages of the new approach are illustrated on some simple two dimensional canonical flows containing concentrated vortices.

  5. Project GRACE A grid based search tool for the global digital library

    CERN Document Server

    Scholze, Frank; Vigen, Jens; Prazak, Petra; The Seventh International Conference on Electronic Theses and Dissertations

    2004-01-01

    The paper will report on the progress of an ongoing EU project called GRACE - Grid Search and Categorization Engine (http://www.grace-ist.org). The project participants are CERN, Sheffield Hallam University, Stockholm University, Stuttgart University, GL 2006 and Telecom Italia. The project started in 2002 and will finish in 2005, resulting in a Grid based search engine that will search across a variety of content sources including a number of electronic thesis and dissertation repositories. The Open Archives Initiative (OAI) is expanding and is clearly an interesting movement for a community advocating open access to ETD. However, the OAI approach alone may not be sufficiently scalable to achieve a truly global ETD Digital Library. Many universities simply offer their collections to the world via their local web services without being part of any federated system for archiving and even those dissertations that are provided with OAI compliant metadata will not necessarily be picked up by a centralized OAI Ser...

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

    Science.gov (United States)

    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.

  7. Simulation of single grid-based phase-contrast x-ray imaging (g-PCXI)

    Energy Technology Data Exchange (ETDEWEB)

    Lim, H.W.; Lee, H.W. [Department of Radiation Convergence Engineering, iTOMO Group, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do 26493 (Korea, Republic of); Cho, H.S., E-mail: hscho1@yonsei.ac.kr [Department of Radiation Convergence Engineering, iTOMO Group, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do 26493 (Korea, Republic of); Je, U.K.; Park, C.K.; Kim, K.S.; Kim, G.A.; Park, S.Y.; Lee, D.Y.; Park, Y.O.; Woo, T.H. [Department of Radiation Convergence Engineering, iTOMO Group, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do 26493 (Korea, Republic of); Lee, S.H.; Chung, W.H.; Kim, J.W.; Kim, J.G. [R& D Center, JPI Healthcare Co., Ltd., Ansan 425-833 (Korea, Republic of)

    2017-04-01

    Single grid-based phase-contrast x-ray imaging (g-PCXI) technique, which was recently proposed by Wen et al. to retrieve absorption, scattering, and phase-gradient images from the raw image of the examined object, seems a practical method for phase-contrast imaging with great simplicity and minimal requirements on the setup alignment. In this work, we developed a useful simulation platform for g-PCXI and performed a simulation to demonstrate its viability. We also established a table-top setup for g-PCXI which consists of a focused-linear grid (200-lines/in strip density), an x-ray tube (100-μm focal spot size), and a flat-panel detector (48-μm pixel size) and performed a preliminary experiment with some samples to show the performance of the simulation platform. We successfully obtained phase-contrast x-ray images of much enhanced contrast from both the simulation and experiment and the simulated contract seemed similar to the experimental contrast, which shows the performance of the developed simulation platform. We expect that the simulation platform will be useful for designing an optimal g-PCXI system. - Highlights: • It is proposed for the single grid-based phase-contrast x-ray imaging (g-PCXI) technique. • We implemented for a numerical simulation code. • The preliminary experiment with several samples to compare is performed. • It is expected to be useful to design an optimal g-PCXI system.

  8. Putting cognitive psychology to work: Improving decision-making in the medical encounter.

    Science.gov (United States)

    Schwab, Abraham P

    2008-12-01

    Empirical research in social psychology has provided robust support for the accuracy of the heuristics and biases approach to human judgment. This research, however, has not been systematically investigated regarding its potential applications for specific health care decision-makers. This paper makes the case for investigating the heuristics and biases approach in the patient-physician relationship and recommends strategic empirical research. It is argued that research will be valuable for particular decisions in the clinic and for examining and altering the background conditions of patient and physician decision-making.

  9. Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey.

    Science.gov (United States)

    Williams, Robert L; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina M; Sussman, Andrew L; Zyzanski, Stephen J

    2015-06-01

    Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. The study included senior medical students. We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations.

  10. Existential decision-making in a fatal progressive disease: how much do legal and medical frameworks matter?

    Science.gov (United States)

    Weber, Christian; Fijalkowska, Barbara; Ciecwierska, Katarzyna; Lindblad, Anna; Badura-Lotter, Gisela; Andersen, Peter M; Kuźma-Kozakiewicz, Magdalena; Ludolph, Albert C; Lulé, Dorothée; Pasierski, Tomasz; Lynöe, Niels

    2017-12-28

    Healthcare legislation in European countries is similar in many respects. Most importantly, the framework of informed consent determines that physicians have the duty to provide detailed information about available therapeutic options and that patients have the right to refuse measures that contradict their personal values. However, when it comes to end-of-life decision-making a number of differences exist in the more specific regulations of individual countries. These differences and how they might nevertheless impact patient's choices will be addressed in the current debate. In this article we show how the legal and medical frameworks of Germany, Poland and Sweden differ with regard to end-of-life decisions for patients with a fatal progressive disease. Taking Amyotrophic Lateral Sclerosis (ALS) as an example, we systematically compare clinical guidelines and healthcare law, pointing out the country-specific differences most relevant for existential decision-making. A fictional case report discusses the implications of these differences for a patient with ALS living in either of the three countries. Patients with ALS in Germany, Poland and Sweden are confronted with a similar spectrum of treatment options. However, the analysis of the normative frameworks shows that the conditions for making existential decisions differ considerably in Germany, Poland and Sweden. Specifically, these differences concern (1) the legal status of advance directives, (2) the conditions under which life-sustaining therapies are started or withheld, and (3) the legal regulations on assisted dying. According to the presented data, regulations of terminating life-sustaining treatments and the framework of "informed consent" are quite differently understood and implemented in the legal setting of the three countries. It is possible, and even likely, that these differences in the legal and medical frameworks have a considerable influence on existential decisions of patients with ALS.

  11. Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making

    Science.gov (United States)

    Beam, Andrew L.; Kartoun, Uri; Pai, Jennifer K.; Chatterjee, Arnaub K.; Fitzgerald, Timothy P.; Shaw, Stanley Y.; Kohane, Isaac S.

    2017-02-01

    Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received (OR = 3.13 p = 3 × 10-37). In addition to the dominant effect of empirically determined physician preference, discussion of depression in a patient’s note was found to have a statistically significant association with receiving a prescription for trazodone (OR = 1.38, p = 0.04). EMR data can yield insights into physician prescribing behavior based on real-world physician-patient interactions.

  12. Decisions, Decisions!

    Science.gov (United States)

    McFadden, F. Lee

    1975-01-01

    A self-instructional program on decision making was used in conjunction with workshops to introduce the staff of an instructional materials company to the decision tree process as they used it to study their own film production problem. (Author/MS)

  13. Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

    Science.gov (United States)

    Brabers, Anne E M; de Jong, Judith D; Groenewegen, Peter P; van Dijk, Liset

    2016-09-21

    There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.

  14. Health Information Obtained From the Internet and Changes in Medical Decision Making: Questionnaire Development and Cross-Sectional Survey

    Science.gov (United States)

    Chen, Yen-Yuan; Li, Chia-Ming; Tsai, Chin-Chung

    2018-01-01

    Background The increasing utilization of the internet has provided a better opportunity for people to search online for health information, which was not easily available to them in the past. Studies reported that searching on the internet for health information may potentially influence an individual’s decision making to change her health-seeking behaviors. Objective The objectives of this study were to (1) develop and validate 2 questionnaires to estimate the strategies of problem-solving in medicine and utilization of online health information, (2) determine the association between searching online for health information and utilization of online health information, and (3) determine the association between online medical help-seeking and utilization of online health information. Methods The Problem Solving in Medicine and Online Health Information Utilization questionnaires were developed and implemented in this study. We conducted confirmatory factor analysis to examine the structure of the factor loadings and intercorrelations for all the items and dimensions. We employed Pearson correlation coefficients for examining the correlations between each dimension of the Problem Solving in Medicine questionnaire and each dimension of the Online Health Information Utilization questionnaire. Furthermore, we conducted structure equation modeling for examining the possible linkage between each of the 6 dimensions of the Problem Solving in Medicine questionnaire and each of the 3 dimensions of the Online Health Information Utilization questionnaire. Results A total of 457 patients participated in this study. Pearson correlation coefficients ranged from .12 to .41, all with statistical significance, implying that each dimension of the Problem Solving in Medicine questionnaire was significantly associated with each dimension of the Online Health Information Utilization questionnaire. Patients with the strategy of online health information search for solving medical

  15. [Knowledge, trust, and the decision to donate organs : A comparison of medical students and students of other disciplines in Germany].

    Science.gov (United States)

    Terbonssen, T; Settmacher, U; Dirsch, O; Dahmen, U

    2018-02-01

    Following the organ transplant scandal in Germany in 2011, the willingness to donate organs postmortem decreased dramatically. This was explained by a loss of confidence in the German organ donation system. The aim of this study was to evaluate the relationship between knowledge, trust, and fear in respect to organ donation and the explicit willingness to potentially act as an organ donor by comparing medical students to students of other disciplines. We conducted a Facebook-based online survey (June-July 2013). The participating students were divided into two groups according to their discipline: medical students and other students. Based on questions covering different aspects of organ donation, a knowledge, trust, and fear score was established and calculated. The answers were related to an explicitly expressed decision to donate organs as expressed in a signed organ donor card. In total, 2484 participants took part in our survey. Of these, 1637 were students, 83.7% (N = 1370) of which were medical students and 16.3% (N = 267) other students. As expected, medical students reached a higher knowledge score regarding organ donation compared with other students (knowledge score 4.13 vs. 3.38; p organ donation, resulting in a higher confidence score (3.94 vs. 3.33; p organ donation as indicated by the lower fear score (1.76 vs. 2.04; p donate organs more often than did other students (78.2% vs. 55.2%; p organ donation cards did not differ significantly between medical students and other students. Medical students possessing an organ donor card showed a higher knowledge and a higher trust score than did medical students without an organ donor card. In contrast, other students possessing an organ donor card showed a higher trust score but did not show a higher knowledge score. The higher level of knowledge and trust demonstrated by the medical students was associated with a higher rate of written decisions to donate organs. In contrast, the lower level

  16. How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making.

    Science.gov (United States)

    Schapira, Marilyn M; Aggarwal, Charu; Akers, Scott; Aysola, Jaya; Imbert, Diana; Langer, Corey; Simone, Charlie B; Strittmatter, Emily; Vachani, Anil; Fraenkel, Liana

    2016-11-01

    Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct shared decision making effectively. A useful organizing theme should include consideration of a patient's response to and tolerance of uncertainty associated with lung cancer screening. The objectives of this study are to: (1) describe how patients respond to specific categories of uncertainty in the context of lung cancer screening, and (2) inform strategies for addressing concerns about uncertainty as part of the shared decision making. We performed two series of structured interviews on participants in a convenience sample of current or former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia. An interview guide included prompts related to benefits, harms, and responses to general and specific types of uncertainty (stochastic, statistical, and evidentiary) associated with lung cancer screening. Interviews were audio-recorded, transcribed, and independently coded by two investigators. An inductive analysis was conducted, and major themes were identified. Twenty-two adults participated in the study. Sixty-eight percent were men, 72% were black or African American, and 50% met U.S. Preventive Services Task Force criteria for lung cancer screening. The primary themes to emerge from our study were: (1) the desire to decrease uncertainty may motivate lung cancer screening decisions; (2) uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening; (3) patient understanding and tolerance of uncertainty varies across stochastic, statistical, and evidentiary uncertainty; and (4) provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening. A systematic approach to understanding and addressing patients' concerns about uncertainty in the context of lung cancer screening can

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

    Directory of Open Access Journals (Sweden)

    Ilboudo Tegawende

    2012-03-01

    Full Text Available Abstract 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.

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

    Science.gov (United States)

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

    2008-02-19

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

  19. Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan.

    Science.gov (United States)

    Thatte, Urmila; Hussain, Samsinah; de Rosas-Valera, Madeleine; Malik, Muhammad Ashar

    2009-01-01

    This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices. In all countries, the Ministries of Health are generally responsible for approval of health technologies through various agencies like the Central Drugs Standard Control Organisation in India, Bureau of Food and Drugs for medicines and Bureau of Health Devices and Technology for medical devices in the Philippines, the National Pharmaceutical Control Bureau, Health Technology Assessment Unit and Medical Device Bureau in Malaysia, and the Drug Control Organization in Pakistan. Product dossiers are evaluated while taking decisions. India has a strong price control mechanism through the National Pharmaceutical Pricing Authority. In the Philippines, the Essential Drug Price Monitoring System monitors prices of 37 essential drugs monthly from all drugstore outlets nationwide. In Malaysia and Pakistan registration pricing of new drugs is negotiated/fixed by the government with the vendor. A mix of social, voluntary private and community-based health insurance plans are available in India while the Philippine Health Insurance Corporation is responsible for reimbursement of drugs and medical devices in the Philippines. In Malaysia no formal reimbursement system is being practiced, and in Pakistan the government reimburses medical claims of its employees. In both India and the Philippines the bulk of health expenditure is out of pocket while the government pays for 20% and 28% respectively in both countries. The public health care services in Malaysia are heavily subsidized by the government with minimum fee being charged to the public. The government of Pakistan gives free medicines to its citizens at the public health facilities. In the region under discussion, one of the priority areas that the different

  20. Impact of a computerized provider radiography order entry system without clinical decision support on emergency department medical imaging requests.

    Science.gov (United States)

    Claret, Pierre-Géraud; Bobbia, Xavier; Macri, Francesco; Stowell, Andrew; Motté, Antony; Landais, Paul; Beregi, Jean-Paul; de La Coussaye, Jean-Emmanuel

    2016-06-01

    The adoption of computerized physician order entry is an important cornerstone of using health information technology (HIT) in health care. The transition from paper to computer forms presents a change in physicians' practices. The main objective of this study was to investigate the impact of implementing a computer-based order entry (CPOE) system without clinical decision support on the number of radiographs ordered for patients admitted in the emergency department. This single-center pre-/post-intervention study was conducted in January, 2013 (before CPOE period) and January, 2014 (after CPOE period) at the emergency department at Nîmes University Hospital. All patients admitted in the emergency department who had undergone medical imaging were included in the study. Emergency department admissions have increased since the implementation of CPOE (5388 in the period before CPOE implementation vs. 5808 patients after CPOE implementation, p=.008). In the period before CPOE implementation, 2345 patients (44%) had undergone medical imaging; in the period after CPOE implementation, 2306 patients (40%) had undergone medical imaging (p=.008). In the period before CPOE, 2916 medical imaging procedures were ordered; in the period after CPOE, 2876 medical imaging procedures were ordered (p=.006). In the period before CPOE, 1885 radiographs were ordered; in the period after CPOE, 1776 radiographs were ordered (pmedical imaging did not vary between the two periods. Our results show a decrease in the number of radiograph requests after a CPOE system without clinical decision support was implemented in our emergency department. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Grid-based Continual Analysis of Molecular Interior for Drug Discovery, QSAR and QSPR.

    Science.gov (United States)

    Potemkin, Andrey V; Grishina, Maria A; Potemkin, Vladimir A

    2017-01-01

    In 1979, R.D.Cramer and M.Milne made a first realization of 3D comparison of molecules by aligning them in space and by mapping their molecular fields to a 3D grid. Further, this approach was developed as the DYLOMMS (Dynamic Lattice- Oriented Molecular Modelling System) approach. In 1984, H.Wold and S.Wold proposed the use of partial least squares (PLS) analysis, instead of principal component analysis, to correlate the field values with biological activities. Then, in 1988, the method which was called CoMFA (Comparative Molecular Field Analysis) was introduced and the appropriate software became commercially available. Since 1988, a lot of 3D QSAR methods, algorithms and their modifications are introduced for solving of virtual drug discovery problems (e.g., CoMSIA, CoMMA, HINT, HASL, GOLPE, GRID, PARM, Raptor, BiS, CiS, ConGO,). All the methods can be divided into two groups (classes):1. Methods studying the exterior of molecules; 2) Methods studying the interior of molecules. A series of grid-based computational technologies for Continual Molecular Interior analysis (CoMIn) are invented in the current paper. The grid-based analysis is fulfilled by means of a lattice construction analogously to many other grid-based methods. The further continual elucidation of molecular structure is performed in various ways. (i) In terms of intermolecular interactions potentials. This can be represented as a superposition of Coulomb, Van der Waals interactions and hydrogen bonds. All the potentials are well known continual functions and their values can be determined in all lattice points for a molecule. (ii) In the terms of quantum functions such as electron density distribution, Laplacian and Hamiltonian of electron density distribution, potential energy distribution, the highest occupied and the lowest unoccupied molecular orbitals distribution and their superposition. To reduce time of calculations using quantum methods based on the first principles, an original quantum

  2. Selecting Relevant Information for Medical Decision Support with Application in Cardiology

    Czech Academy of Sciences Publication Activity Database

    Kalina, Jan; Seidl, L.; Grünfeldová, H.; Slovák, Dalibor; Zvárová, Jana

    2013-01-01

    Roč. 9, č. 1 (2013), s. 2-6 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional support: RVO:67985807 Keywords : decision support system * web -service * information extraction * high dimension * gene expressions Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/img/ejbi/2013/1/Kalina_en.pdf

  3. Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

    NARCIS (Netherlands)

    Brabers, A.E.M.; Jong, J.D. de; Groenewegen, P.P.; Dijk, L. van

    2016-01-01

    Background: There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be

  4. Social support plays a role in the attitude that people have towards taking an active role in medical decision-making

    NARCIS (Netherlands)

    Brabers, Anne E M; De Jong, Judith D.; Groenewegen, Peter P.; Van Dijk, Liset

    2016-01-01

    Background: There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be

  5. Computerized Decision Support Improves Medication Review Effectiveness : An Experiment Evaluating the STRIP Assistant's Usability

    NARCIS (Netherlands)

    Meulendijk, Michiel C; Spruit, Marco R; Drenth-van Maanen, A Clara; Numans, Mattijs E; Brinkkemper, Sjaak; Jansen, Paul A F; Knol, Wilma

    BACKGROUND: Polypharmacy poses threats to patients' health. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is a drug optimization process for conducting medication reviews in primary care. To effectively and efficiently incorporate this method into daily practice, the STRIP

  6. Computerized decision support improves medication review effectiveness: an experiment evaluating the STRIP Assistant’s usability

    NARCIS (Netherlands)

    Meulendijk, M.; Spruit, M.; Drenth-van Maanen, C.; Numans, M.; Brinkkemper, S.; Jansen, P.; Knol, W

    2015-01-01

    Background Polypharmacy poses threats to patients’ health. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is a drug optimization process for conducting medication reviews in primary care. To effectively and efficiently incorporate this method into daily practice, the STRIP

  7. Wikipedia as informal self-education for clinical decision-making in medical practice

    OpenAIRE

    Matheson-Monnet, Catherine; Matheson, David J.

    2017-01-01

    Background For almost any topic, a Wikipedia page will appear among the first ten items of a search online. Wikipedia is also a site whose quality and reliability has been called into question. Methods In this paper, we aim to discuss medical practitioners’ use of Wikipedia, what this consists of and what it might be. We consider the context and history of Wikipedia before discussing the relationship between Wikipedia and the medical profession. In so doing, we will consider Wikipedia as a me...

  8. The Pink Underside: The Commercialization of Medical Risk Assessment and Decision-Making Tools for Hereditary Breast Cancer Risk.

    Science.gov (United States)

    Hesse-Biber, Sharlene; Flynn, Bailey; Farrelly, Keeva

    2018-04-01

    The growth of the Internet since the millennium has opened up a myriad of opportunities for education, particularly in medicine. Although those looking for health care information used to have to turn to a face-to-face doctor's visit, an immense library of medical advice is now available at their fingertips. The BRCA genetic predispositions (mutations of the BRCA1 and BRCA2 breast cancer genes) which expose men and women to greater risk of breast, ovarian, and other cancers can be researched extensively online. Several nonprofit organizations now offer online risk assessment and decision-making tools meant to supplement conversation with medical professionals, which in actuality are quickly replacing it. We argue here through a critical qualitative template analysis of several such tools that the discursive frameworks utilized are prone to fearmongering, commercialization, and questionable validity. Left unchecked, these assessment tools could do more harm than good in driving young women especially to take unnecessary extreme surgical action.

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

    Science.gov (United States)

    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.

  10. Evaluation of the decision support system for antimicrobial treatment, TREAT, in an acute medical ward of a university hospital

    DEFF Research Database (Denmark)

    Arboe, Bente; Laub, Rasmus Rude; Kronborg, Gitte

    2014-01-01

    .247). The coverage of TREAT advice for the bacteraemia patients was non-inferior to the physicians (p=1.00). CONCLUSIONS: TREAT can potentially improve the ecological costs of empirical antimicrobial therapy for patients in acute medical wards, but provided lower coverage than local guidelines.......OBJECTIVES: TREAT, a decision support system for antimicrobial therapy, was implemented in an acute medical ward. METHODS: Patients admitted on suspicion of infection were included in the study. The evaluation of TREAT was done both retrospectively and prospectively. Coverage of empirical...... of hospital stay, or hospital or 30-day mortality. Direct costs were significantly higher for TREAT advice than for local guidelines or the physician prescriptions (padvice than for both local guidelines (p

  11. A sparse grid based method for generative dimensionality reduction of high-dimensional data

    Science.gov (United States)

    Bohn, Bastian; Garcke, Jochen; Griebel, Michael

    2016-03-01

    Generative dimensionality reduction methods play an important role in machine learning applications because they construct an explicit mapping from a low-dimensional space to the high-dimensional data space. We discuss a general framework to describe generative dimensionality reduction methods, where the main focus lies on a regularized principal manifold learning variant. Since most generative dimensionality reduction algorithms exploit the representer theorem for reproducing kernel Hilbert spaces, their computational costs grow at least quadratically in the number n of data. Instead, we introduce a grid-based discretization approach which automatically scales just linearly in n. To circumvent the curse of dimensionality of full tensor product grids, we use the concept of sparse grids. Furthermore, in real-world applications, some embedding directions are usually more important than others and it is reasonable to refine the underlying discretization space only in these directions. To this end, we employ a dimension-adaptive algorithm which is based on the ANOVA (analysis of variance) decomposition of a function. In particular, the reconstruction error is used to measure the quality of an embedding. As an application, the study of large simulation data from an engineering application in the automotive industry (car crash simulation) is performed.

  12. Location-Aware Dynamic Session-Key Management for Grid-Based Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    I-Hsien Lin

    2010-08-01

    Full Text Available Security is a critical issue for sensor networks used in hostile environments. When wireless sensor nodes in a wireless sensor network are distributed in an insecure hostile environment, the sensor nodes must be protected: a secret key must be used to protect the nodes transmitting messages. If the nodes are not protected and become compromised, many types of attacks against the network may result. Such is the case with existing schemes, which are vulnerable to attacks because they mostly provide a hop-by-hop paradigm, which is insufficient to defend against known attacks. We propose a location-aware dynamic session-key management protocol for grid-based wireless sensor networks. The proposed protocol improves the security of a secret key. The proposed scheme also includes a key that is dynamically updated. This dynamic update can lower the probability of the key being guessed correctly. Thus currently known attacks can be defended. By utilizing the local information, the proposed scheme can also limit the flooding region in order to reduce the energy that is consumed in discovering routing paths.

  13. Automatic building extraction from LiDAR data fusion of point and grid-based features

    Science.gov (United States)

    Du, Shouji; Zhang, Yunsheng; Zou, Zhengrong; Xu, Shenghua; He, Xue; Chen, Siyang

    2017-08-01

    This paper proposes a method for extracting buildings from LiDAR point cloud data by combining point-based and grid-based features. To accurately discriminate buildings from vegetation, a point feature based on the variance of normal vectors is proposed. For a robust building extraction, a graph cuts algorithm is employed to combine the used features and consider the neighbor contexture information. As grid feature computing and a graph cuts algorithm are performed on a grid structure, a feature-retained DSM interpolation method is proposed in this paper. The proposed method is validated by the benchmark ISPRS Test Project on Urban Classification and 3D Building Reconstruction and compared to the state-art-of-the methods. The evaluation shows that the proposed method can obtain a promising result both at area-level and at object-level. The method is further applied to the entire ISPRS dataset and to a real dataset of the Wuhan City. The results show a completeness of 94.9% and a correctness of 92.2% at the per-area level for the former dataset and a completeness of 94.4% and a correctness of 95.8% for the latter one. The proposed method has a good potential for large-size LiDAR data.

  14. Potential Odor Intensity Grid Based UAV Path Planning Algorithm with Particle Swarm Optimization Approach

    Directory of Open Access Journals (Sweden)

    Yang Liu

    2016-01-01

    Full Text Available This paper proposes a potential odor intensity grid based optimization approach for unmanned aerial vehicle (UAV path planning with particle swarm optimization (PSO technique. Odor intensity is created to color the area in the searching space with highest probability where candidate particles may locate. A potential grid construction operator is designed for standard PSO based on different levels of odor intensity. The potential grid construction operator generates two potential location grids with highest odor intensity. Then the middle point will be seen as the final position in current particle dimension. The global optimum solution will be solved as the average. In addition, solution boundaries of searching space in each particle dimension are restricted based on properties of threats in the flying field to avoid prematurity. Objective function is redesigned by taking minimum direction angle to destination into account and a sampling method is introduced. A paired samples t-test is made and an index called straight line rate (SLR is used to evaluate the length of planned path. Experiments are made with other three heuristic evolutionary algorithms. The results demonstrate that the proposed method is capable of generating higher quality paths efficiently for UAV than any other tested optimization techniques.

  15. Evolutionary states of red-giant stars from grid-based modelling

    Science.gov (United States)

    Hekker, Saskia; Elsworth, Yvonne; Basu, Sarbani; Bellinger, Earl

    2017-10-01

    From its surface properties it can be difficult to determine whether a red-giant star is in its heliumcore-burning phase or only burning hydrogen in a shell around an inert helium core. Stars in either of these stages can have similar effective temperatures, radii and hence luminosities, i.e. they can be located at the same position in the Hertzsprung-Russell diagram. Asteroseismology - the study of the internal structure of stars through their global oscillations - can provide the necessary additional constraints to determine the evolutionary states of red-giant stars. Here, we present a method that uses grid-based modelling based on global asteroseismic properties (vmax, frequency of maximum oscillation power; and Δv, frequency spacing between modes of the same degree and consecutive radial orders) as well as effective temperature and metallicity to determine the evolutionary phases. This method is applicable even to timeseries data of limited length, although with a small fraction of miss-classifications.

  16. A new service-oriented grid-based method for AIoT application and implementation

    Science.gov (United States)

    Zou, Yiqin; Quan, Li

    2017-07-01

    The traditional three-layer Internet of things (IoT) model, which includes physical perception layer, information transferring layer and service application layer, cannot express complexity and diversity in agricultural engineering area completely. It is hard to categorize, organize and manage the agricultural things with these three layers. Based on the above requirements, we propose a new service-oriented grid-based method to set up and build the agricultural IoT. Considering the heterogeneous, limitation, transparency and leveling attributes of agricultural things, we propose an abstract model for all agricultural resources. This model is service-oriented and expressed with Open Grid Services Architecture (OGSA). Information and data of agricultural things were described and encapsulated by using XML in this model. Every agricultural engineering application will provide service by enabling one application node in this service-oriented grid. Description of Web Service Resource Framework (WSRF)-based Agricultural Internet of Things (AIoT) and the encapsulation method were also discussed in this paper for resource management in this model.

  17. GENECODIS-Grid: An online grid-based tool to predict functional information in gene lists

    International Nuclear Information System (INIS)

    Nogales, R.; Mejia, E.; Vicente, C.; Montes, E.; Delgado, A.; Perez Griffo, F. J.; Tirado, F.; Pascual-Montano, A.

    2007-01-01

    In this work we introduce GeneCodis-Grid, a grid-based alternative to a bioinformatics tool named Genecodis that integrates different sources of biological information to search for biological features (annotations) that frequently co-occur in a set of genes and rank them by statistical significance. GeneCodis-Grid is a web-based application that takes advantage of two independent grid networks and a computer cluster managed by a meta-scheduler and a web server that host the application. The mining of concurrent biological annotations provides significant information for the functional analysis of gene list obtained by high throughput experiments in biology. Due to the large popularity of this tool, that has registered more than 13000 visits since its publication in January 2007, there is a strong need to facilitate users from different sites to access the system simultaneously. In addition, the complexity of some of the statistical tests used in this approach has made this technique a good candidate for its implementation in a Grid opportunistic environment. (Author)

  18. All that wheezes is not asthma: cognitive bias in pediatric emergency medical decision making.

    Science.gov (United States)

    Park, Daniel B; Dobson, Joseph V; Losek, Joseph D

    2014-02-01

    The objectives of this study were to highlight the intimate role that cognitive biases play in clinical decision making in the pediatric emergency department and to recommend strategies to limit their negative impact on patient care outcomes. This was a descriptive study of 3 cases of presumed asthma exacerbation evolving into alternate diagnoses. The role cognitive biases played in either delay to diagnosis or missed diagnosis contributing to patient morbidity are illustrated in each case. Common cognitive biases play a role in the unique milieu of the pediatric emergency department. A case series of presumed patients with asthma illustrates how mental shortcuts (heuristics) taken in times of high decision density and uncertainty may lead to diagnostic errors and patient harm. Suggestions to address and prevent cognitive biases are presented.

  19. [Medical and administrative neglect of high blood glucose levels; comments on a decision by a medical disciplinary tribunal].

    Science.gov (United States)

    Erkelens, D W

    1997-04-26

    A 41-year-old man died in 1995 during ketoacidotic coma. He suffered from chronic manic depression, used lithium carbonate, and consulted the psychiatrist and the general practitioner (GP) frequently. Diabetes had not been diagnosed. Late in 1994 the situation worsened, the patient complaining of general illness, fatigue, nausea, vomiting, diarrhoea, thirst and excessive drinking of soft drinks. The GP referred the patient to a neurologist who found no neurological disorder but who asked for determination of blood glucose and lithium levels, and of thyroid function. The day afterwards the neurologist went on holiday. The blood glucose level proved to be elevated (16.9 mmol/1) but nobody took any action and the GP was not informed. Six days after returning from his holiday, the neurologist who had an administration backlog, found the laboratory findings only after he had been informed that the patient had just died. The court gave the neurologist a warning. Lessons are that somatic problems should be treated as such, even in a psychiatric patient, and that a good administrative signalling system is a prerequisite for quality in medical practice.

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

    Science.gov (United States)

    Henderson, W; Corke, C

    2015-09-01

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

  1. Improving medication management in multimorbidity: development of the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention using the Behaviour Change Wheel.

    Science.gov (United States)

    Sinnott, Carol; Mercer, Stewart W; Payne, Rupert A; Duerden, Martin; Bradley, Colin P; Byrne, Molly

    2015-09-24

    Multimorbidity, the presence of two or more chronic conditions, affects over 60 % of patients in primary care. Due to its association with polypharmacy, the development of interventions to optimise medication management in patients with multimorbidity is a priority. The Behaviour Change Wheel is a new approach for applying behavioural theory to intervention development. Here, we describe how we have used results from a review of previous research, original research of our own and the Behaviour Change Wheel to develop an intervention to improve medication management in multimorbidity by general practitioners (GPs), within the overarching UK Medical Research Council guidance on complex interventions. Following the steps of the Behaviour Change Wheel, we sought behaviours associated with medication management in multimorbidity by conducting a systematic review and qualitative study with GPs. From the modifiable GP behaviours identified, we selected one and conducted a focused behavioural analysis to explain why GPs were or were not engaging in this behaviour. We used the behavioural analysis to determine the intervention functions, behavioural change techniques and implementation plan most likely to effect behavioural change. We identified numerous modifiable GP behaviours in the systematic review and qualitative study, from which active medication review (rather than passive maintaining the status quo) was chosen as the target behaviour. Behavioural analysis revealed GPs' capabilities, opportunities and motivations relating to active medication review. We combined the three intervention functions deemed most likely to effect behavioural change (enablement, environmental restructuring and incentivisation) to form the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention. MY COMRADE primarily involves the technique of social support: two GPs review the medications prescribed to a complex multimorbid patient together. Four other

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

    Science.gov (United States)

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

    2017-01-01

    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. Using ultrasonography as a teaching support tool in undergraduate medical education - time to reach a decision.

    Science.gov (United States)

    Mircea, Petru-Adrian; Badea, Radu; Fodor, Daniela; Buzoianu, Anca Dana

    2012-09-01

    Medical education and the process of teaching and learning, respectively, are constantly changing. This is induced by the pace at which knowledge, teaching methodology and its related tools are updated, the use of simulation, virtual depiction and the use of static and/or dynamic images. In this respect, X-ray images have been used in the understanding of macroanatomy ever since the beginning of the last century. Starting with the 1990s, when high-performing and relatively less costly equipment started to emerge, several experts in the field of education anticipated the huge resource that ultrasound could become in the field of medicine. The method is easy to understand, intuitive and available to anyone studying human anatomy and, subsequently, the major pathological issues during undergraduate medical studies. The present paper reviews the attempts made at using ultrasound as an educational support tool, from the first experiences in teaching anatomy (Hannover Medical School, 1996) until the recent development of an entire medical university curriculum integrating ultrasound (University of South Carolina, School of Medicine, 2006-2011). It is an exciting journey proving beyond any doubt that the method should be learned, understood and developed in medical schools from the undergraduate stage, together with the other clinical skills.

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

    Science.gov (United States)

    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. © The Author(s) 2015.

  5. End- of- life decisions and minors: do minors have the right to refuse life preserving medical treatment? A comparative study.

    Science.gov (United States)

    Lemmens, Christophe

    2009-09-01

    The principles of the right to informed consent and informed refusal are quite clear for competent adult patients. The right of a competent adult patient to give his informed consent before medical treatment can be started, is a patients' right that is recognised all over the world. The logical corollary of the right to informed consent is the right to informed refusal. A competent adult patient also has the right to refuse medical treatment by simply withholding or withdrawing his consent. A physician who starts medical treatment without the informed consent of his patient will be held liable for battery. Can these same principles be applied to minors? In other words: do minors also have the right to refuse medical treatment? Can a minor refuse even life preserving care? The interests of the involved parties (minor, parents and state) have to be weighed against each other case by case. A thorough examination of the available case law shows that the best interests of the minor are paramount. This "best interests" standard guides judges in their making of a decision. However, this is certainly not always in accordance with reality. In fact, minors can be mature enough to refuse treatment at a much earlier time than the age of legal majority, whatever the consequences of that refusal may be.

  6. The Process of Parents' Decision-Making to Discharge Their Child against Medical Advice (DAMA: A grounded theory study

    Directory of Open Access Journals (Sweden)

    Nikbakht Nasrabadi Alireza

    2016-05-01

    Full Text Available Discharge against medical advice (DAMA refers to the phenomenon that patient or the patient’s surrogate decides to leave the hospital before the attending physician confirms the patient is discharged. Children are much more vulnerable to such discharges. This process occurs with different mechanisms that identifying them can be helpful in reducing this phenomenon. We aimed to explore the process of parents' decision-making to discharge their child against medical advice. In-depth, semi-structured interviews were conducted with 10 fathers, 10 mothers, 6 nurses and 3 physician assistants and the data were collected to the point of saturation. Grounded theory methodology was adopted for data collection and analysis. The results of qualitative analysis in the field of the parents' decisionmaking on the DAMA revealed 4 main themes: "lack of family-centered care", "disruption of the parenting process", "distrust to the medical team and center" and "psychological strategy of shirk responsibility for child care and treatment ". By providing family-centered care, adopting measures to empowering the families, developing the trust of parents to the health care team and developing a discharge plan from the beginning of children hospitalization with the cooperation of health care team and parents and considering all factors such as child's special health condition and parent's health related perceptions and beliefs, children will not be discharged against medical advice and will experience better outcomes.

  7. The role of the autopsy in medical malpractice cases, I: a review of 99 appeals court decisions.

    Science.gov (United States)

    Bove, Kevin E; Iery, Clare

    2002-09-01

    Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. To determine how autopsy information influences the outcome of medical malpractice litigation. We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

  8. A Realistic Digital Deteriorating Patient to Foster Emergency Decision-Making Skills in Medical Students

    DEFF Research Database (Denmark)

    Blanchard, Emmanuel G.; Wiseman, Jeffrey; Naismith, Laura

    2012-01-01

    The Deteriorating Patient Activity (DPA) is a real-life educational simulation that prepares medical students to effectively approach emergency situations through a role play where their instructor plays the role of a patient whose state is rapidly deteriorating. Although proven engaging and effe......The Deteriorating Patient Activity (DPA) is a real-life educational simulation that prepares medical students to effectively approach emergency situations through a role play where their instructor plays the role of a patient whose state is rapidly deteriorating. Although proven engaging...

  9. [Coping with complex medical emergency situations : Competent and successful decision-making, communication and leadership].

    Science.gov (United States)

    Vetter, B; Gasch, B; Padosch, S A

    2015-04-01

    Stress is an integral part of the daily routine among healthcare workers in anesthesiology and emergency medicine. This article describes negative stress effects in complex emergency situations and presents helpful tools for coping with them. Evaluation and discussion of selected medical and psychological publications and the inclusion of expert opinions are presented. Negative stress of healthcare providers in medical emergencies severely affects their reasoning and communication and is inadequately taken into account during routine care. Research in aviation and psychology has provided various tools to improve performance during stressful events and should be taken into consideration for routine daily use.

  10. Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service.

    Science.gov (United States)

    Sharma, Rupali; Jayathissa, Sisira; Weatherall, Mark

    2016-01-08

    To determine the knowledge in cardiopulmonary resuscitation (CPR) process, preference for CPR, and desire to participate in end-of-life decision making amongst older hospitalised patients. We prospectively interviewed 100 participants above 65 years of age awaiting discharge from acute medical ward and collected demographics, knowledge of CPR and opinion on CPR in various clinical scenarios. Amongst the participants, 58% had good understanding of all components of CPR and 91% overestimated its success. Fifty-eight percent wished to have CPR in current health status, but this declined if they were presented a hypothetical scenario of critical illness (46%), functional impairment (17%), terminal illness (13%) and dementia (13%). Tertiary education, male gender and not living alone were associated with accepting CPR. Ninety-three percent were comfortable discussing CPR and 84% felt comfortable documenting their wishes in the medical notes. Seventy percent wished such discussion to include themselves and their family. Older inpatients have a reasonable understanding of the components of CPR and wish to be involved in CPR decision-making. Clinical scenarios with poor prognosis may lead to patients declining CPR. Discussion and documentation of resuscitation wishes is useful in routine assessment process among elderly hospitalised patients.

  11. Medical decision making and risky choices: psychological and medicolegal consequences of HIV and HCV contamination of blood products

    Directory of Open Access Journals (Sweden)

    Riva S

    2017-08-01

    Full Text Available S Riva,1 S Del Sordo,2,3 U Genovese,1,3 G Pravettoni1 1Department of Oncology and Hemato-oncology, University of Milan, Italy; 2FOLSATEC (Foundations & Ethics of the Life Sciences PhD School, University of Milan, Milan, Italy; 3Healthcare Accountability Lab, University of Milan, Milan, Italy Aims: The overall goal of this article is to make a scientific comment about the psycho-social consequences of hemophilia patients affected by human immunodeficiency virus (HIV and/or hepatitis C virus (HCV and to point out the related medicolegal issues. Methods: This commentary takes into account some published evidences about the current scenario of hemophilia patients infected by HIV and/or HCV who received contaminated blood products in the late 1970s through 1985. Results: Several psychological and medicolegal consequences are related with HIV and HCV contamination of blood products. A multidisciplinary approach is needed to treat all the difficulties experienced by these patients and to ensure good clinical decisions in medical practice. Conclusion: The literature on the psychosocial functioning of hemophilia patients with human HIV and HCV infection offers a number of implications, including medicolegal issues, that can be discussed for guaranteeing a good level of care and safeguard of this group of patients. Keywords: hemophilia, viral contaminated blood products, monetary compensation, medico-legal issues, medical decision making

  12. A Stackelberg Game Approach for Energy Outage-Aware Power Distribution of an Off-Grid Base Station over Multiple Retailers

    Directory of Open Access Journals (Sweden)

    Seung Hyun Jeon

    2018-03-01

    Full Text Available This paper investigates the problem of power distribution for an off-grid base station (BS that operates sustainably without an electrical grid. We consider that multiple retailers with heterogeneous renewable energy sources (RESs compete to maximize their revenues by individually setting the unit power price. Energy outages (EOs, which cause the power supply to fall below that which is sufficient for ensuring the traffic arrival rate required for the off-grid BS, critically affect the users’ service quality. To minimize EOs and operational expenditure (OPEX, the off-grid BS manages the power supply by reacting to the retailers’ pricing decisions. We analyze the economic benefits of power distribution to the off-grid BS from the perspective of the retailers’ pricing competition, by designing a hierarchical decision-making scheme as a multi-leader single-follower Stackelberg game. We derive a closed form expression for the optimal behavior of the off-grid BS and retailers, based on well-designed utility functions. Finally, numerical results demonstrate the proposed solution with its practical convergence time.

  13. "Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

    Science.gov (United States)

    Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

    2008-01-01

    Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

  14. Dignity and cost-effectiveness: analysing the responsibility for decisions in medical ethics.

    Science.gov (United States)

    Robertson, G S

    1984-01-01

    In the operation of a health care system, defining the limits of medical care is the joint responsibility of many parties including clinicians, patients, philosophers and politicians. It is suggested that changes in the potential for prolonging life make it necessary to give doctors guidance which may have to incorporate certain features of utilitarianism, individualism and patient-autonomy. PMID:6502644

  15. A decision framework to evaluate intellectual property strategies in the medical nutrition market

    NARCIS (Netherlands)

    Weenen, T.C.; Jentink, A.; Commandeur, H.R.; Pronker, E.S.; Claassen, E.

    2013-01-01

    In the medical nutrition (MN) market, insights into the motives driving intellectual property (IP) protection strategies remain unclear. This emerging market has expressed the pressing need for clarity on the subject of applicable IP methods. The aim of this study is therefore to evaluate the role

  16. A decision framework to evaluate intellectual property strategies in the medical nutrition market.

    NARCIS (Netherlands)

    Weenen, T.C.; Jentink, A.W.; Pronker, E.S.; Commandeur, H.R.; Claassen, E.

    2013-01-01

    In the medical nutrition (MN) market, insights into the motives driving intellectual property (IP) protection strategies remain unclear. This emerging market has expressed the pressing need for clarity on the subject of applicable IP methods. The aim of this study is therefore to evaluate the role

  17. Decision theory on the quality evaluation of medical images; A teoria da decisao na avaliacao da qualidade da imagem medica

    Energy Technology Data Exchange (ETDEWEB)

    Lessa, Patricia Silva

    2001-10-01

    The problem of quality has been a constant issue in every organization.One is always seeking to produce more, to do it at a lower cost, and to do it with better quality. However, in this country, there is no radiographic film quality control system for radiographic services. The tittle that actually gets done is essentially ad hoc and superficial. The implications of this gap, along with some other shortcomings that exist in process as a whole (the state of the x-ray equipment, the adequate to use in order to obtain a radiography, the quality of the film, the processing of the film, the brightness and homogeneity of the viewing boxes, the ability of the radiologist), have a very negative impact on the quality of the medical image, and, as result, to the quality of the medical diagnosis and therapy. It frequently happens that many radiographs have to be repeated, which leads to an increase of the patient's exposure to radiation, as well as of the cost of the procedure for the patient. Low quality radiographs that are not repeated greatly increase the probability of a wrong diagnosis, and consequently, of inadequate therapeutical procedures, thus producing increased incidence of bad outcomes and higher costs. The paradigm proposed in order to establish a system for the measurement of the image's quality is Decision Theory. The problem of the assessment of the image is studied by proposing a Decision Theory approach. The review of the literature reveals a great concern with the quality of the image, along with an absence of an adequate paradigm and several essentially empirical procedures. Image parameters are developed in order to formalize the problem in terms of Decision Theory, and various aspects of image digitalisation are exposed. Finally, a solution is presented, including a protocol for quality control. (author)

  18. Feature engineering and a proposed decision-support system for systematic reviewers of medical evidence.

    Directory of Open Access Journals (Sweden)

    Tanja Bekhuis

    Full Text Available 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.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.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.A computer-assisted, decision support system based on our methods could substantially reduce the burden of screening citations for systematic review teams and solo reviewers. Additionally, such a system could deliver quality assurance both by confirming concordant decisions and by naming

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

    Science.gov (United States)

    Feldstein, Josh; Brooks, Elizabeth

    2010-05-01

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

  20. Connecting Education to Quality: Engaging Medical Students in the Development of Evidence-Based Clinical Decision Support Tools.

    Science.gov (United States)

    Crabtree, Elizabeth A; Brennan, Emily; Davis, Amanda; Squires, Jerry E

    2017-01-01

    Evidence-based practice (EBP) skills are crucial for delivering high-quality patient care. It is essential that medical students learn EBP concepts through a practical, in-depth research project. To date, literature on preparing students in this manner is limited. In academic year 2014-2015, the Medical University of South Carolina's (MUSC's) Center for Evidence-Based Practice (now known as the Value Institute) partnered with College of Medicine faculty to revitalize the undergraduate medical student EBP curriculum. Without adding to the number of the lecture hours, the curriculum was restructured to be more process driven, project based, and clinically relevant. The resulting yearlong EBP course partnered small teams of medical students with interprofessional clinical teams to engage the students in developing evidence-based clinical decision support tools. The content developed during the EBP projects is currently being used to develop evidence-based clinical practice guidelines and accompanying order sets. It is likely that this model will serve as a new framework for guideline development and will greatly expand the breadth of evidence-based content currently produced and available for clinicians at the MUSC. It would be feasible to offer a similar course within the MUSC to other disciplines and colleges, or at other institutions, if there were support from administration, interest on the part of clinicians and medical faculty, and individuals with the required expertise available to develop the curriculum and facilitate the course. It is worth considering how to improve the course and evaluating opportunities to implement it within other settings.

  1. Training neural network classifiers for medical decision making: the effects of imbalanced datasets on classification performance.

    Science.gov (United States)

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

    2008-01-01

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

  2. Energy flow modeling and optimal operation analysis of the micro energy grid based on energy hub

    International Nuclear Information System (INIS)

    Ma, Tengfei; Wu, Junyong; Hao, Liangliang

    2017-01-01

    Highlights: • Design a novel architecture for energy hub integrating power hub, cooling hub and heating hub. • The micro energy grid based on energy hub is introduced and its advantages are discussed. • Propose a generic modeling method for the energy flow of micro energy grid. • Propose an optimal operation model for micro energy grid with considering demand response. • The roles of renewable energy, energy storage devices and demand response are discussed separately. - Abstract: The energy security and environmental problems impel people to explore a more efficient, environment friendly and economical energy utilization pattern. In this paper, the coordinated operation and optimal dispatch strategies for multiple energy system are studied at the whole Micro Energy Grid level. To augment the operation flexibility of energy hub, the innovation sub-energy hub structure including power hub, heating hub and cooling hub is put forward. Basing on it, a generic energy hub architecture integrating renewable energy, combined cooling heating and power, and energy storage devices is developed. Moreover, a generic modeling method for the energy flow of micro energy grid is proposed. To minimize the daily operation cost, a day-ahead dynamic optimal operation model is formulated as a mixed integer linear programming optimization problem with considering the demand response. Case studies are undertaken on a community Micro Energy Grid in four different scenarios on a typical summer day and the roles of renewable energy, energy storage devices and demand response are discussed separately. Numerical simulation results indicate that the proposed energy flow modeling and optimal operation method are universal and effective over the entire energy dispatching horizon.

  3. ENERGY CONSUMPTION MONITORING OF SMART GRID BASED ON SEMANTIC STREAM DATA ANALYSIS

    Directory of Open Access Journals (Sweden)

    M. A. Kolchin

    2015-03-01

    Full Text Available Problem statement. Currently, the task of improving energy efficiency are addressed mainly through the creation of more efficient devices and appliances, the use of alternative energy sources, application of special additional equipment for power consumption control and other technological methods. All these solutions are quite expensive and often economically difficult to payback. At the same time, the issues of automated integrated analysis of existing data measuring equipment have been poorly known. But just these data contain all the necessary information for finding bottlenecks and failures in the equipment, leading to increased energy consumption. Methods. Methods of web services creation are considered for current state monitoring of electrical networks using CQELS for static and streaming data integration of smart meters. RDF data model is used as the main way of data representation. Results. The architecture of the energy monitoring system (Smart grid based on semantic analysis of the streaming data is proposed. Ontology has been worked out, aimed at information domain model creation, which describes the measurement data and the possible situations for tracking by the system using semantic queries. An example of system operation is shown, and description of the visualization interfaces for streaming data and log of messages is given. Practical relevance. Industrial application of the proposed approach will give the possibility to achieve significant energy efficiency through integrated analysis of smart meters data based on existing infrastructure of test and measurement equipment. An additional effect lies in the ability to create flexible Smart grid monitoring system and visualization of their states by an ontological approach to the domain modeling.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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 house officer (P 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 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.

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

    Science.gov (United States)

    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

  8. Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection

    DEFF Research Database (Denmark)

    Sørensen, T M; Bjørnvad, C R; Cordoba, G

    2018-01-01

    dipstick (99%), microscopic examination of urine (80%) and bacterial culture (56%). Fifty-one percent of dogs had urinary tract infection (UTI) based on reference QBC. Appropriate DTT was made for 62% of the dogs, while 36% were over-prescribed and 2% under-prescribed. Inappropriate use of second......BACKGROUND: Clinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work-up could optimize treatment and reduce the risk of inappropriate use of antibiotics. HYPOTHESIS/OBJECTIVES: To describe and evaluate the impact of diagnostic work......-up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease. ANIMALS: One hundred and fifty-one dogs presenting to 52 Danish veterinary practices. METHODS: Prospective, observational study. Clinical signs, diagnostic work...

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

    Science.gov (United States)

    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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

    Science.gov (United States)

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

    2013-07-22

    of future adherence on a clinician-facing Web interface. The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the "MPR Monitor", where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality.

  11. Long Range Debye-Hückel Correction for Computation of Grid-based Electrostatic Forces Between Biomacromolecules

    Energy Technology Data Exchange (ETDEWEB)

    Mereghetti, Paolo; Martinez, M.; Wade, Rebecca C.

    2014-06-17

    Brownian dynamics (BD) simulations can be used to study very large molecular systems, such as models of the intracellular environment, using atomic-detail structures. Such simulations require strategies to contain the computational costs, especially for the computation of interaction forces and energies. A common approach is to compute interaction forces between macromolecules by precomputing their interaction potentials on three-dimensional discretized grids. For long-range interactions, such as electrostatics, grid-based methods are subject to finite size errors. We describe here the implementation of a Debye-Hückel correction to the grid-based electrostatic potential used in the SDA BD simulation software that was applied to simulate solutions of bovine serum albumin and of hen egg white lysozyme.

  12. The medical folder as an active tool in defining the clinical decision-making process.

    Science.gov (United States)

    Ferri, F

    1995-01-01

    Whenever the user of a consultation system needs to know a large amount of information items that are possibly inter-related, a system that is able to cooperate with the user can simplify the interaction and increase its speed. In fact, these systems can recognize the goals of the user, individuate the information related to his goals, and finally focus their attention on this information [1]. This paper describes research work on the design and creation of a medical folder management system capable of establishing cooperative dialogue with users who have access to the information contained therein. Particular attention has thus been paid to the problems of man-computer dialogue and user models. The research work has addressed the problem of integrating into the system knowledge about the medical domain and users (physicians are only used for the time being), which are both necessary to activate a cooperative dialogue. After analysing the literature on the problems of user models, this paper presents and formalizes a study performed at the IVth Surgical Clinic of the Rome University Umberto I General Hospital to identify and represent how, when, and with what goals the physician consults the medical folder, as well as the dialogue procedures he normally adopts. The paper also illustrates important characteristics of the CADMIO prototype, which has been developed since the study was made. CADMIO stores information about users for use in recognizing and interpreting their behaviour, providing help, and in acquiring and returning further information. Whilst always bearing in mind the physician's pre-established goals, it structures information to facilitate his consultation activity, offering him options for the retrieval of further information semantically linked to that already obtained.

  13. A Markov Decision Process Model for the Optimal Dispatch of Military Medical Evacuation Assets

    Science.gov (United States)

    2014-03-27

    took it upon themselves to walk unaided back to friendly territory, a solution was conceived. Jonathan Letterman, the Medical Director of the Army of the...Rij + T s. (3.2) In order to provide a solution to the problem described in this section, we outline a general model in section 4 that will prove...service systems to improve patient survival. IIE Transactions on Healthcare Systems Engineering, 3(1), 39–56. [27] McLay, Laura A, & Mayorga, Maria E

  14. Elderly arrestees in police custody cells: implementation of detention and medical decision on fitness to be detained.

    Science.gov (United States)

    Beaufrère, Aurélie; Belmenouar, Otmane; Chariot, Patrick

    2014-08-01

    Most individuals detained in police custody are male adolescents or young adults. Demeaning custody conditions, which are common in French police cells, bring to light legitimate questions about the detention of elderly people. We aimed to determine the proportion of detainees over age 60, their health characteristics and conditions of detention, and the factors included in medical decisions on fitness to be detained. We studied all arrestees over age 60 examined in one year (January 1st-December 31st, 2009) by forensic physicians from our department. We collected data concerning their medical histories, their experiences in police custody, and their reported assaults. Individuals over 60 accounted for 180 of 15,481 detainees (1%) and were predominantly male (92%). Some arrestees were examined several times during one or more detentions such that a total of 265 medical examinations were performed. Most individuals (133 of 172, 77%) reported one or more chronic somatic disorders and 115 of 160 (72%) were currently receiving treatment for a condition. Less half of two detainees (78 of 170, 46%) expressed some complaints during examination, commonly including pain (54 of 170, 32%), and 115 of 160 arrestees (72%) received medication while in custody. Detainees were considered to be completely fit for police custody in 119 of 259 cases (46%), and 25 of 259 cases (10%) were considered to be unfit to be detained. The harsh conditions of police custody are particularly inappropriate for elderly individuals. Guidelines for custody officers and attending physicians that take the specific health needs of older detainees into account should be implemented. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik

    2013-09-22

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

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

    Directory of Open Access Journals (Sweden)

    Karpa Kelly

    2011-10-01

    Full Text Available Abstract 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 Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources.

  17. Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication: An Agenda for Science and Practice.

    Science.gov (United States)

    Betsch, Cornelia; Böhm, Robert; Airhihenbuwa, Collins O; Butler, Robb; Chapman, Gretchen B; Haase, Niels; Herrmann, Benedikt; Igarashi, Tasuku; Kitayama, Shinobu; Korn, Lars; Nurm, Ülla-Karin; Rohrmann, Bernd; Rothman, Alexander J; Shavitt, Sharon; Updegraff, John A; Uskul, Ayse K

    2016-10-01

    This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research. © The Author(s) 2015.

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

    Science.gov (United States)

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

    2013-01-01

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

  19. The impact of information on clinical decision making by General Medical Practitioners

    Directory of Open Access Journals (Sweden)

    Frances Wood

    1996-01-01

    Full Text Available Summarises some of the principal findings of a recent study investigation of information usage by general medical practitioners (GPs. The work was based on previous studies of the value and impact of information, these studies being undertaken in the corporate sector in Canada, the USA and the UK. The study used a critical incident technique similar to that employed in the Canadian and USA studies. Twenty seven in-depth interviews were conducted with general practitioners (GPs in the Trent Health Region (only one from each practice. The sample, selected from two health districts, included large, medium and small practices, fund-holding and non-fund-holding practices, and training and non-training practices, with some representation of those located in deprived and non-deprived (socio-economic areas.

  20. Non-conscious bias in medical decision making: what can be done to reduce it?

    Science.gov (United States)

    Stone, Jeff; Moskowitz, Gordon B

    2011-08-01

    Non-conscious stereotyping and prejudice contribute to racial and ethnic disparities in health care. Contemporary training in cultural competence is insufficient to reduce these problems because even educated, culturally sensitive, egalitarian individuals can activate and use their biases without being aware they are doing so. However, these problems can be reduced by workshops and learning modules that focus on the psychology of non-conscious bias. THE PSYCHOLOGY OF NON-CONSCIOUS BIAS: Research in social psychology shows that over time stereotypes and prejudices become invisible to those who rely on them. Automatic categorisation of an individual as a member of a social group can unconsciously trigger the thoughts (stereotypes) and feelings (prejudices) associated with that group, even if these reactions are explicitly denied and rejected. This implies that, when activated, implicit negative attitudes and stereotypes shape how medical professionals evaluate and interact with minority group patients. This creates differential diagnosis and treatment, makes minority group patients uncomfortable and discourages them from seeking or complying with treatment. Cultural competence training involves teaching students to use race and ethnicity to diagnose and treat minority group patients, but to avoid stereotyping them by over-generalising cultural knowledge to individuals. However, the Culturally and Linguistically Appropriate Services (CLAS) standards do not specify how these goals should be accomplished and psychological research shows that common approaches like stereotype suppression are ineffective for reducing non-conscious bias. To effectively address bias in health care, training in cultural competence should incorporate research on the psychology of non-conscious stereotyping and prejudice. Workshops or other learning modules that help medical professionals learn about non-conscious processes can provide them with skills that reduce bias when they interact with

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

    Science.gov (United States)

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

    2014-01-01

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

  2. A grid-based tropospheric product for China using a GNSS network

    Science.gov (United States)

    Zhang, Hongxing; Yuan, Yunbin; Li, Wei; Zhang, Baocheng; Ou, Jikun

    2017-11-01

    Tropospheric delay accounts for one source of error in global navigation satellite systems (GNSS). To better characterize the tropospheric delays in the temporal and spatial domain and facilitate the safety-critical use of GNSS across China, a method is proposed to generate a grid-based tropospheric product (GTP) using the GNSS network with an empirical tropospheric model, known as IGGtrop. The prototype system generates the GTPs in post-processing and real-time modes and is based on the undifferenced and uncombined precise point positioning (UU-PPP) technique. GTPs are constructed for a grid form (2.0{°}× 2.5{°} latitude-longitude) over China with a time resolution of 5 min. The real-time GTP messages are encoded in a self-defined RTCM3 format and broadcast to users using NTRIP (networked transport of RTCM via internet protocol), which enables efficient and safe transmission to real-time users. Our approach for GTP generation consists of three sequential steps. In the first step, GNSS-derived zenith tropospheric delays (ZTDs) for a network of GNSS stations are estimated using UU-PPP. In the second step, vertical adjustments for the GNSS-derived ZTDs are applied to address the height differences between the GNSS stations and grid points. The ZTD height corrections are provided by the IGGtrop model. Finally, an inverse distance weighting method is used to interpolate the GNSS-derived ZTDs from the surrounding GNSS stations to the location of the grid point. A total of 210 global positioning system (GPS) stations from the crustal movement observation network of China are used to generate the GTPs in both post-processing and real-time modes. The accuracies of the GTPs are assessed against with ERA-Interim-derived ZTDs and the GPS-derived ZTDs at 12 test GPS stations, respectively. The results show that the post-processing and real-time GTPs can provide the ZTDs with accuracies of 1.4 and 1.8 cm, respectively. We also apply the GTPs in real-time kinematic GPS PPP

  3. Improving the anesthetic process by a fuzzy rule based medical decision system.

    Science.gov (United States)

    Mendez, Juan Albino; Leon, Ana; Marrero, Ayoze; Gonzalez-Cava, Jose M; Reboso, Jose Antonio; Estevez, Jose Ignacio; Gomez-Gonzalez, José F

    2018-01-01

    The main objective of this research is the design and implementation of a new fuzzy logic tool for automatic drug delivery in patients undergoing general anesthesia. The aim is to adjust the drug dose to the real patient needs using heuristic knowledge provided by clinicians. A two-level computer decision system is proposed. The idea is to release the clinician from routine tasks so that he can focus on other variables of the patient. The controller uses the Bispectral Index (BIS) to assess the hypnotic state of the patient. Fuzzy controller was included in a closed-loop system to reach the BIS target and reject disturbances. BIS was measured using a BIS VISTA monitor, a device capable of calculating the hypnosis level of the patient through EEG information. An infusion pump with propofol 1% is used to supply the drug to the patient. The inputs to the fuzzy inference system are BIS error and BIS rate. The output is infusion rate increment. The mapping of the input information and the appropriate output is given by a rule-base based on knowledge of clinicians. To evaluate the performance of the fuzzy closed-loop system proposed, an observational study was carried out. Eighty one patients scheduled for ambulatory surgery were randomly distributed in 2 groups: one group using a fuzzy logic based closed-loop system (FCL) to automate the administration of propofol (42 cases); the second group using manual delivering of the drug (39 cases). In both groups, the BIS target was 50. The FCL, designed with intuitive logic rules based on the clinician experience, performed satisfactorily and outperformed the manual administration in patients in terms of accuracy through the maintenance stage. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Mapping very low level occupational exposure in medical imaging: A useful tool in risk communication and decision making

    International Nuclear Information System (INIS)

    Covens, P.; Berus, D.; Mey, J. de; Buls, N.

    2012-01-01

    Objectives: The use of ionising radiation in medical imaging is accompanied with occupational exposure which should be limited by optimised room design and safety instructions. These measures can however not prevent that workers are exposed to instantaneous dose rates, e.g. the residual exposure through shielding or the exposure of discharged nuclear medicine patients. The latter elements are often questioned by workers and detailed assessment should give more information about the impact on the individual radiation dose. Methods: Cumulated radiation exposure was measured in a university hospital during a period of 6 months by means of thermoluminescent dosimeters. Radiation exposure was measured at background locations and at locations where enhanced exposure levels are expected but where the impact on the individual exposure is unclear. Results: The results show a normal distribution of the cumulated background radiation level. No enhanced cumulated radiation exposure which significantly differs from this background level could be found during the operation of intra-oral apparatus, during ultrasonography procedures among nuclear medicine patients and at operator consoles of most CT-rooms. Conclusions: This 6 months survey offers useful information about occupational low level exposure in medical imaging and the findings can be useful in both risk communication and decision making

  5. Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff.

    NARCIS (Netherlands)

    Bekkema, N.; Veer, A.J.E. de; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2014-01-01

    Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

  6. Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs, ID physicians and care staff

    NARCIS (Netherlands)

    Bekkema, N.; de Veer, A.J.E.; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2014-01-01

    Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

  7. The increased cost of medical services for people diagnosed with primary open-angle glaucoma: a decision analytic approach.

    Science.gov (United States)

    Kymes, Steven M; Plotzke, Michael R; Li, Jim Z; Nichol, Michael B; Wu, Joanne; Fain, Joel

    2010-07-01

    Glaucoma accounts for more than 11% of all cases of blindness in the United States, but there have been few studies of economic impact. We examine incremental cost of primary open-angle glaucoma considering both visual and nonvisual medical costs over a lifetime of glaucoma. A decision analytic approach taking the payor's perspective with microsimulation estimation. We constructed a Markov model to replicate health events over the remaining lifetime of someone newly diagnosed with glaucoma. Costs of this group were compared with those estimated for a control group without glaucoma. The cost of management of glaucoma (including medications) before the onset of visual impairment was not considered. The model was populated with probability data estimated from Medicare claims data (1999 through 2005). Cost of nonocular medications and nursing home use was estimated from California Medicare claims, and all other costs were estimated from Medicare claims data. We found modest differences in the incidence of comorbid conditions and health service use between people with glaucoma and the control group. Over their expected lifetime, the cost of care for people with primary open-angle glaucoma was higher than that of people without primary open-angle glaucoma by $1688 or approximately $137 per year. Among Medicare beneficiaries, glaucoma diagnosis not found to be associated with significant risk of comorbidities before development of visual impairment. Further study is necessary to consider the impact of glaucoma on quality of life, as well as aspects of physical and visual function not captured in this claims-based analysis. 2010 Elsevier Inc. All rights reserved.

  8. Impact on process results of clinical decision support systems (CDSSs) applied to medication use: overview of systematic reviews.

    Science.gov (United States)

    Reis, Wálleri C; Bonetti, Aline F; Bottacin, Wallace E; Reis, Alcindo S; Souza, Thaís T; Pontarolo, Roberto; Correr, Cassyano J; Fernandez-Llimos, Fernando

    2017-01-01

    The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process. A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy. There was no limitation of date or language for inclusion. We included revisions that investigated, as a main or secondary objective, changes in process outcomes. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) score was used to evaluate the quality of the studies. The search retrieved 954 articles. Five articles were added through manual search, totaling an initial sample of 959 articles. After screening and reading in full, 44 systematic reviews met the inclusion criteria. In the medication-use processes where CDSS was used, the most common stages were prescribing (n=38 (86.36%) and administering (n=12 (27.27%)). Most of the systematic reviews demonstrated improvement in the health care process (30/44 - 68.2%). The main positive results were related to improvement of the quality of prescription by the physicians (14/30 - 46.6%) and reduction of errors in prescribing (5/30 - 16.6%). However, the quality of the studies was poor, according to the score used. CDSSs represent a promising technology to optimize the medication-use process, especially related to improvement in the quality of prescriptions and reduction of prescribing errors, although higher quality studies are needed to establish the predictors of success in these systems.

  9. Grid-based water quality simulation at catchment scale: Nitrogen model development and evaluation

    Science.gov (United States)

    Yang, Xiaoqiang; Jomaa, Seifeddine; Rode, Michael

    2017-04-01

    Stream water quality has been changed significantly during last few decades due to changes in human impacts. Accurate and flexible water quality models, which can properly reflect the heterogeneity and long term temporal dynamic of catchment functioning, are still needed. To this end, a new grid-based catchment water quality model was developed based on the mesoscale Hydrological Model (mHM) and the HYdrological Prediction of Environment (HYPE) model. The model structure and parameterization scheme were flexibly designed depending on the spatial heterogeneity of study sites and their specific requirements. Based on that, more detailed spatial information can be provided. Moreover, three main improvements on Nitrate sub-model were implemented: i) nitrate transport processes were conducted in physically connected river networks, allowing time-series point-source inputs added in the exact location of sewage treatment plants; ii) additional retention storage of deep groundwater was included for long term nitrate-N simulation; iii) special design for better taking into account crop rotation was implemented. Those new features can extend the model capability and facilitate the understanding of catchment mechanisms and analysis of future scenarios and measures. The newly developed model was fully verified in the Selke catchment (456 km2), central Germany. Long term discharge and water quality data have been collected at three nested gauging stations (1997-2015). The station Meisdorf, above where 72% of area is occupied by forest, represents the discharge and nutrient exports from forest area. Agricultural land dominates the lower part of the catchment (almost 96% of in-between area of the Meisdorf and the outlet station Hausneindorf) with considerable urban areas. Due to the relatively large number of model parameters, sensitivity analysis was firstly conducted. Subsequently, sensitive parameters were calibrated using stepwise and multi-variable approaches, respectively

  10. The survey of Zahedan medical sciences university training hospitals’ nurses’ ethical sensitivity in decision making in 2016

    Directory of Open Access Journals (Sweden)

    Ali Reza Salar

    2016-05-01

    Full Text Available The nursing occupation is considered among those sciences which have had and will also have numerous ethical and exemplary aspects. The results of the studies performed regarding ethics indicate the weak nature of the nurses’ ethical decision making. Therefore, it was felt that there is a need to perform a study aiming at the ethical sensitivity level in decision making of the nurses working in training hospitals belonging to Zahedan medical sciences universities. The current study is a descriptive-analytical research performed on 140 nurses who were selected based on a randomized clustering method. To collect the information there was made use of a questionnaire comprising of two parts, the first part of which is related to the demographic characteristics and the second part pertains to a standard questionnaire of nurses’ ethical sensitivity in decision making. Finally after the questionnaires were collected they were analyzed by the use of SPSS 19 and descriptive statistics, Pierson correlation test, variance analysis and independent t-test. Nurses’ average age was 28.56 ± 6.48 and of the total population 123 individuals were women of whom 68 people had participated in ethics seminars and 53 of them were single. The overall ethical sensitivity mean among the nurses was 59.82 ± 17.50 which was ranked as intermediate according to the classification of the questionnaire, and in each of the dimensions of the ethical sensitivity the following scores were obtained respectively, in respect for the help-seeker independence the score was 10.71 ± 4.00, in the dimension if ethical problems and challenges the score obtained was 11.35 ± 4.21, in the dimension of application of the ethical concepts in decision making the score was 12.49 ± 3.82 and in the dimension of honesty and benevolence the obtained score was 4.73 ± 1.70, the professional knowledge dimension scored 13.49 ± 4.50 and the dimension of awareness of the nurses’ treating style

  11. Grid-based mapping: A method for rapidly determining the spatial distributions of small features over very large areas

    Science.gov (United States)

    Ramsdale, Jason D.; Balme, Matthew R.; Conway, Susan J.; Gallagher, Colman; van Gasselt, Stephan A.; Hauber, Ernst; Orgel, Csilla; Séjourné, Antoine; Skinner, James A.; Costard, Francois; Johnsson, Andreas; Losiak, Anna; Reiss, Dennis; Swirad, Zuzanna M.; Kereszturi, Akos; Smith, Isaac B.; Platz, Thomas

    2017-06-01

    The increased volume, spatial resolution, and areal coverage of high-resolution images of Mars over the past 15 years have led to an increased quantity and variety of small-scale landform identifications. Though many such landforms are too small to represent individually on regional-scale maps, determining their presence or absence across large areas helps form the observational basis for developing hypotheses on the geological nature and environmental history of a study area. The combination of improved spatial resolution and near-continuous coverage significantly increases the time required to analyse the data. This becomes problematic when attempting regional or global-scale studies of metre and decametre-scale landforms. Here, we describe an approach for mapping small features (from decimetre to kilometre scale) across large areas, formulated for a project to study the northern plains of Mars, and provide context on how this method was developed and how it can be implemented. Rather than ;mapping; with points and polygons, grid-based mapping uses a ;tick box; approach to efficiently record the locations of specific landforms (we use an example suite of glacial landforms; including viscous flow features, the latitude dependant mantle and polygonised ground). A grid of squares (e.g. 20 km by 20 km) is created over the mapping area. Then the basemap data are systematically examined, grid-square by grid-square at full resolution, in order to identify the landforms while recording the presence or absence of selected landforms in each grid-square to determine spatial distributions. The result is a series of grids recording the distribution of all the mapped landforms across the study area. In some ways, these are equivalent to raster images, as they show a continuous distribution-field of the various landforms across a defined (rectangular, in most cases) area. When overlain on context maps, these form a coarse, digital landform map. We find that grid-based mapping

  12. "I didn't even know what I was looking for": A qualitative study of the decision-making processes of Canadian medical tourists.

    Science.gov (United States)

    Johnston, Rory; Crooks, Valorie A; Snyder, Jeremy

    2012-07-07

    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. 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. 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. While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the

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

    Science.gov (United States)

    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. © The Author(s) 2015.

  14. Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making.

    Science.gov (United States)

    van der Horst, Nick; Backx, Fjg; Goedhart, Edwin A; Huisstede, Bionka Ma

    2017-11-01

    There are three major questions about return to play (RTP) after hamstring injuries: How should RTP be defined? Which medical criteria should support the RTP decision? And who should make the RTP decision? The study aimed to provide a clear RTP definition and medical criteria for RTP and to clarify RTP consultation and responsibilities after hamstring injury. The study used the Delphi procedure. The results of a systematic review were used as a starting point for the Delphi procedure. Fifty-eight experts in the field of hamstring injury management selected by 28 FIFA Medical Centres of Excellence worldwide participated. Each Delphi round consisted of a questionnaire, an analysis and an anonymised feedback report. After four Delphi rounds, with more than 83% response for each round, consensus was achieved that RTP should be defined as 'the moment a player has received criteria-based medical clearance and is mentally ready for full availability for match selection and/or full training'. The experts reached consensus on the following criteria to support the RTP decision: medical staff clearance, absence of pain on palpation, absence of pain during strength and flexibility testing, absence of pain during/after functional testing, similar hamstring flexibility, performance on field testing, and psychological readiness. It was also agreed that RTP decisions should be based on shared decision-making, primarily via consultation with the athlete, sports physician, physiotherapist, fitness trainer and team coach. The consensus regarding aspects of RTP should provide clarity and facilitate the assessment of when RTP is appropriate after hamstring injury, so as to avoid or reduce the risk of injury recurrence because of a premature RTP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Grid-based molecular footprint comparison method for docking and de novo design: application to HIVgp41.

    Science.gov (United States)

    Balius, Trent E; Allen, William J; Mukherjee, Sudipto; Rizzo, Robert C

    2013-05-30

    Scoring functions are a critically important component of computer-aided screening methods for the identification of lead compounds during early stages of drug discovery. Here, we present a new multigrid implementation of the footprint similarity (FPS) scoring function that was recently developed in our laboratory which has proven useful for identification of compounds which bind to a protein on a per-residue basis in a way that resembles a known reference. The grid-based FPS method is much faster than its Cartesian-space counterpart, which makes it computationally tractable for on-the-fly docking, virtual screening, or de novo design. In this work, we establish that: (i) relatively few grids can be used to accurately approximate Cartesian space footprint similarity, (ii) the method yields improved success over the standard DOCK energy function for pose identification across a large test set of experimental co-crystal structures, for crossdocking, and for database enrichment, and (iii) grid-based FPS scoring can be used to tailor construction of new molecules to have specific properties, as demonstrated in a series of test cases targeting the viral protein HIVgp41. The method is available in the program DOCK6. Copyright © 2013 Wiley Periodicals, Inc.

  16. 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.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  19. Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

    Science.gov (United States)

    Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

    2017-01-01

    New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  20. [Survey and analysis on sources of reference intervals and distribution of medical decision levels in NT-proBNP, BNP and homocysteine].

    Science.gov (United States)

    Zhang, Lu; Wang, Wei; Zhong, Kun; He, Falin; Wang, Zhiguo

    2015-11-01

    To analyze the sources of reference intervals and distribution of medical decision levels in NT-proBNP, BNP and homocysteine (Hcy) based on the feedback of laboratories which participated in the 2014 External Quality Assessment (EQA) program in China. Information of reference intervals and medical decision levels was collected from the 2014 EQA programs in NT-proBNP, BNP and Hcy.All the abnormal values and errors were eliminated.Data were analyzed by SPSS 13.0 and Microsoft Excel 2007 in terms of referring to sources of reference intervals and distribution of medical decision levels.Values were further grouped based on instrument system for NT-proBNP and BNP, reagent manufacturers for Hcy. There were 330, 119 and 339 laboratories submitting the data on the reference intervals of NT-proBNP, BNP and Hcy. Only 133, 54 and 102 laboratories provided information about medical decision levels.Most reference sources were derived from reagent manufactures (NT-proBNP 76.97%(254/330), BNP 89.08%(106/119), Hcy 83.19%(282/339)). Approximately, 36.53%(122/334), 45.38%(54/119) and 47.95%(164/342) of the laboratories validated the reference intervals of NT-proBNP, BNP and Hcy.According to the surveys, the mean and median values were not close to each other (NT-proBNP 507.99 ng/L and 300.00 ng/L, BNP 342.72 ng/L and 100.00 ng/L, Hcy 17.34 µmol/L and 15.00 µmol/L). Variation of P2.5 and P97.5 was as follows: (NT-proBNP 125.00-1 800.00 ng/L, BNP 87.50-4562.50 ng/L, Hcy 4.15-50.00 µmol/L). The ranges were NT-proBNP 60.00-7 000.00 ng/L, and BNP 80.00-7 000.00 ng/L, and Hcy 1.5-52.00 µmol/L.P values of rank sum test for NT-proBNP, BNP and Hcy were 0.449, 0.208 and 0.754. Medical decision levels of NT-proBNP, Hcy and BNP showed large variation among laboratories and the sources of reference interval were not unified.Thus, urgent efforts should be made to establish appropriate reference intervals for Chinese people and promote harmonization and standardization of reference intervals

  1. Counselling and medical decision-making in the era of personalised medicine a practice-oriented guide

    CERN Document Server

    Sanchini, Virginia

    2016-01-01

    This book offers an overview of the main questions arising when biomedical decision-making intersects ethical decision-making. It reports on two ethical decision-making methodologies, one addressing the patients, the other physicians. It shows how patients’ autonomous choices can be empowered by increasing awareness of ethical deliberation, and at the same time it supports healthcare professionals in developing an ethical sensitivity, which they can apply in their daily practice. The book highlights the importance and relevance of practicing bioethics in the age of personalized medicine. It presents concrete cases studies dealing with cancer and genetic diseases, where difficult decisions need to be made by all the parties involved: patients, physicians and families. Decisions concern not only diagnostic procedures and treatments, but also moral values, religious beliefs and ways of seeing life and death, thus adding further layers of complexity to biomedical decision-making. This book, which is strongly ro...

  2. A novel approach to optimize workflow in grid-based teleradiology applications.

    Science.gov (United States)

    Yılmaz, Ayhan Ozan; Baykal, Nazife

    2016-01-01

    This study proposes an infrastructure with a reporting workflow optimization algorithm (RWOA) in order to interconnect facilities, reporting units and radiologists on a single access interface, to increase the efficiency of the reporting process by decreasing the medical report turnaround time and to increase the quality of medical reports by determining the optimum match between the inspection and radiologist in terms of subspecialty, workload and response time. Workflow centric network architecture with an enhanced caching, querying and retrieving mechanism is implemented by seamlessly integrating Grid Agent and Grid Manager to conventional digital radiology systems. The inspection and radiologist attributes are modelled using a hierarchical ontology structure. Attribute preferences rated by radiologists and technical experts are formed into reciprocal matrixes and weights for entities are calculated utilizing Analytic Hierarchy Process (AHP). The assignment alternatives are processed by relation-based semantic matching (RBSM) and Integer Linear Programming (ILP). The results are evaluated based on both real case applications and simulated process data in terms of subspecialty, response time and workload success rates. Results obtained using simulated data are compared with the outcomes obtained by applying Round Robin, Shortest Queue and Random distribution policies. The proposed algorithm is also applied to a real case teleradiology application process data where medical reporting workflow was performed based on manual assignments by the chief radiologist for 6225 inspections. RBSM gives the highest subspecialty success rate and integrating ILP with RBSM ratings as RWOA provides a better response time and workload distribution success rate. RWOA based image delivery also prevents bandwidth, storage or hardware related stuck and latencies. When compared with a real case teleradiology application where inspection assignments were performed manually, the proposed

  3. Small-mammal density estimation: A field comparison of grid-based vs. web-based density estimators

    Science.gov (United States)

    Parmenter, R.R.; Yates, Terry L.; Anderson, D.R.; Burnham, K.P.; Dunnum, J.L.; Franklin, A.B.; Friggens, M.T.; Lubow, B.C.; Miller, M.; Olson, G.S.; Parmenter, Cheryl A.; Pollard, J.; Rexstad, E.; Shenk, T.M.; Stanley, T.R.; White, Gary C.

    2003-01-01

    blind” test allowed us to evaluate the influence of expertise and experience in calculating density estimates in comparison to simply using default values in programs CAPTURE and DISTANCE. While the rodent sample sizes were considerably smaller than the recommended minimum for good model results, we found that several models performed well empirically, including the web-based uniform and half-normal models in program DISTANCE, and the grid-based models Mb and Mbh in program CAPTURE (with AÌ‚ adjusted by species-specific full mean maximum distance moved (MMDM) values). These models produced accurate DÌ‚ values (with 95% confidence intervals that included the true D values) and exhibited acceptable bias but poor precision. However, in linear regression analyses comparing each model's DÌ‚ values to the true D values over the range of observed test densities, only the web-based uniform model exhibited a regression slope near 1.0; all other models showed substantial slope deviations, indicating biased estimates at higher or lower density values. In addition, the grid-based DÌ‚ analyses using full MMDM values for WÌ‚ area adjustments required a number of theoretical assumptions of uncertain validity, and we therefore viewed their empirical successes with caution. Finally, density estimates from the independent analysts were highly variable, but estimates from web-based approaches had smaller mean square errors and better achieved confidence-interval coverage of D than did grid-based approaches. Our results support the contention that web-based approaches for density estimation of small-mammal populations are both theoretically and empirically superior to grid-based approaches, even when sample size is far less than often recommended. In view of the increasing need for standardized environmental measures for comparisons among ecosystems and through time, analytical models based on distance sampling appear to offer accurate density estimation approaches for research

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

    NARCIS (Netherlands)

    Brom, L.; Hopmans, W.; Pasman, H.R.W.; Timmermans, D.R.M.; Widdershoven, G.A.M.; Onwuteaka-Philipsen, B.D.

    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'

  5. [The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making].

    Science.gov (United States)

    Moraleda Barba, Sandra; Ballesta Rodríguez, M Isabel; Delgado Quero, Antonio Luis; Lietor Villajos, Norberto; Moreno Corredor, Andrés; Delgado Rodríguez, Miguel

    2015-03-01

    To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. Observational study of prospective validation. Primary and hospital care of the basic health area of Jaen. One hundred twenty-nine patients. Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

    Science.gov (United States)

    Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie

    2016-03-01

    A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Johnston Rory

    2012-07-01

    Full Text Available Abstract 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

  9. Impact of effectiveness information format on patient choice of therapy and satisfaction with decisions about chronic disease medication

    DEFF Research Database (Denmark)

    Harmsen, Charlotte Gry; Jarbøl, Dorte Ejg; Nexøe, Jørgen

    2013-01-01

    Decision Making Effectiveness (COMRADE) questionnaire will be used to measure patients' confidence and satisfaction with the risk communication immediately after the conversation with their GPs. DISCUSSION: This randomised clinical trial compares the impact of two effectiveness formats on real-life risk...... and effectiveness of a cholesterol-lowering drug, we posed the research question: how does the format of risk information influence patients' decisions concerning therapy, patients' satisfaction with the communication as well as confidence in the decision. We hypothesise that patients are less prone to accept...... therapy when the benefits of long-term intervention are presented in terms of prolongation of life (POL) in months compared to the absolute risk reduction (ARR). We hypothesise that patients presented with POL will be more satisfied with the communication and confident in their decision, suggesting...

  10. Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J.E. de; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELD) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  11. Attitudes of nursing staff towards involvement in medical end-of-life decisions: A national survey study

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; de Veer, A.J.E.; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELDs) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  12. Artificial intelligence: Neural network model as the multidisciplinary team member in clinical decision support to avoid medical mistakes

    OpenAIRE

    Igor Vyacheslavovich Buzaev; Vladimir Vyacheslavovich Plechev; Irina Evgenievna Nikolaeva; Rezida Maratovna Galimova

    2016-01-01

    Objective: The continuous uninterrupted feedback system is the essential part of any well-organized system. We propose aLYNX concept that is a possibility to use an artificial intelligence algorithm or a neural network model in decision-making system so as to avoid possible mistakes and to remind the doctors to review tactics once more in selected cases. Method: aLYNX system includes: registry with significant factors, decisions and results; machine learning process based on this registry dat...

  13. Would caregivers of Alzheimer disease patients involve their relative in a decision to use an AD-slowing medication?

    Science.gov (United States)

    Hirschman, Karen B; Joyce, Colette M; James, Bryan D; Xie, Sharon X; Casarett, David J; Karlawish, Jason H T

    2005-11-01

    The authors examined the factors associated with 1) caregivers' willingness to involve a relative with Alzheimer disease (AD) in a decision to use an AD-slowing treatment; and 2) how caregivers would resolve a disagreement over this decision with the their relative. This was a cross-sectional interview study of 102 caregivers of patients with mild-to-severe-stage AD, enrolled in a University Memory Disorders Clinic. Forty-four percent of caregivers (45/102) said that his or her relative would participate in a decision to use an AD-slowing treatment. Logistic regression showed that having less dementia severity, being a female caregiver, and a spousal relationship were all associated with caregivers' involving their relative in this decision. Among the caregivers who said they would involve their relative, the majority said they would resolve disagreements over whether to use the treatment in favor of what the patient wanted, versus what the family wanted for the patient. Male caregivers were less likely to resolve disagreements in favor of the patients' preferences. Although most caregivers of patients in mild-to-moderate stages would include these patients in an AD treatment decision, certain caregiver characteristics, such as gender and relationship, are associated with not involving patients in this decision. Physicians working with dementia patients and their family members should take these characteristics into account when discussing treatment options and work with patient-caregiver dyads to improve the communication of preferences.

  14. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre.

    Science.gov (United States)

    Hing Wong, Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. The ACP educational brochure clinically impacts patients' preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  15. A Randomised Controlled Experimental Study on the Influence of Patient Age on Medical Decisions in Respect to the Diagnosis and Treatment of Depression in the Elderly

    Directory of Open Access Journals (Sweden)

    Michael Linden

    2009-01-01

    Full Text Available Background. Elderly patients are often treated differently than younger patients, even when suffering from the same disorder. Objective. The study examines the influence of “patient age” on the perception of symptoms and conclusions of physicians in respect to diagnosis and treatment. Methods. In a randomised controlled experimental study on medical decision-making, 121 general practitioners were given two case vignettes which contained all the criteria for major depression according to ICD-10, but differed in respect to the age of the patient (39 or 81. Reaction time, diagnostic conclusions and therapeutic recommendations were assessed by computer. Results. Depression and anxiety were significantly seen as more probable in the young cases and dementia and physical illness in the old. In young age, psychotherapy, pharmacotherapy and referral to a specialist or inpatient treatment were significantly more recommended than in old age, for whom supportive counselling was significantly more recommended. The time needed for a decision was significantly longer in the older patients. Conclusion. Ageing stereotypes can also form medical illness concepts and have a significant influence on diagnostic and therapeutic decisions.

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

    International Nuclear Information System (INIS)

    Esik, O.; Seitz, W.; Loevey, J.; Knocke, T.H.; Gaudi, I.; Nemeth, G.; Poetter, R.

    1999-01-01

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E, Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993;29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects

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

    Directory of Open Access Journals (Sweden)

    Enevoldsen Carsten

    2009-08-01

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

  18. 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.

    Science.gov (United States)

    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. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Shared decision-making for psychiatric medication: A mixed-methods evaluation of a UK training programme for service users and clinicians.

    Science.gov (United States)

    Ramon, Shulamit; Morant, Nicola; Stead, Ute; Perry, Ben

    2017-12-01

    Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health. Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators. The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews. Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users' decisional conflict and perceptions of practitioners' interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users' and care co-ordinators confidence to explore medication experience, and group-based training was valued. The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions.

  20. Physician medical decision-making at the end of life in newborns : Insight into implementation at 2 Dutch centers

    NARCIS (Netherlands)

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

    OBJECTIVE. Decisions regarding end-of-life care in critically ill newborns in the Netherlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and

  1. 77 FR 76457 - Howard Hughes Medical Institute, et al.; Notice of Consolidated Decision on Applications for Duty...

    Science.gov (United States)

    2012-12-28

    ... suitable technologies for producing moldable biomass based materials for applications presently occupied by....; Notice of Consolidated Decision on Applications for Duty-Free Entry of Scientific Instruments This is a... Ambient Pressure Scanning Probe Microscope. Manufacturer: SPECS Surface Nano Analysis, GmbH, Germany...

  2. Application of an Unstructured Grid-Based Water Quality Model to Chesapeake Bay and Its Adjacent Coastal Ocean

    Directory of Open Access Journals (Sweden)

    Meng Xia

    2016-09-01

    Full Text Available To provide insightful information on water quality management, it is crucial to improve the understanding of the complex biogeochemical cycles of Chesapeake Bay (CB, so a three-dimensional unstructured grid-based water quality model (ICM based on the finite-volume coastal ocean model (FVCOM was configured for CB. To fully accommodate the CB study, the water quality simulations were evaluated by using different horizontal and vertical model resolutions, various wind sources and other hydrodynamic and boundary settings. It was found that sufficient horizontal and vertical resolution favored simulating material transport efficiently and that winds from North American Regional Reanalysis (NARR generated stronger mixing and higher model skill for dissolved oxygen simulation relative to observed winds. Additionally, simulated turbulent mixing was more influential on water quality dynamics than that of bottom friction: the former considerably influenced the summer oxygen ventilation and new primary production, while the latter was found to have little effect on the vertical oxygen exchange. Finally, uncertainties in riverine loading led to larger deviation in nutrient and phytoplankton simulation than that of benthic flux, open boundary loading and predation. Considering these factors, the model showed reasonable skill in simulating water quality dynamics in a 10-year (2003–2012 period and captured the seasonal chlorophyll-a distribution patterns. Overall, this coupled modeling system could be utilized to analyze the spatiotemporal variation of water quality dynamics and to predict their key biophysical drivers in the future.

  3. Direct Quantum Dynamics Using Grid-Based Wave Function Propagation and Machine-Learned Potential Energy Surfaces.

    Science.gov (United States)

    Richings, Gareth W; Habershon, Scott

    2017-09-12

    We describe a method for performing nuclear quantum dynamics calculations using standard, grid-based algorithms, including the multiconfiguration time-dependent Hartree (MCTDH) method, where the potential energy surface (PES) is calculated "on-the-fly". The method of Gaussian process regression (GPR) is used to construct a global representation of the PES using values of the energy at points distributed in molecular configuration space during the course of the wavepacket propagation. We demonstrate this direct dynamics approach for both an analytical PES function describing 3-dimensional proton transfer dynamics in malonaldehyde and for 2- and 6-dimensional quantum dynamics simulations of proton transfer in salicylaldimine. In the case of salicylaldimine we also perform calculations in which the PES is constructed using Hartree-Fock calculations through an interface to an ab initio electronic structure code. In all cases, the results of the quantum dynamics simulations are in excellent agreement with previous simulations of both systems yet do not require prior fitting of a PES at any stage. Our approach (implemented in a development version of the Quantics package) opens a route to performing accurate quantum dynamics simulations via wave function propagation of many-dimensional molecular systems in a direct and efficient manner.

  4. The grid-based fast multipole method--a massively parallel numerical scheme for calculating two-electron interaction energies.

    Science.gov (United States)

    Toivanen, Elias A; Losilla, Sergio A; Sundholm, Dage

    2015-12-21

    Algorithms and working expressions for a grid-based fast multipole method (GB-FMM) have been developed and implemented. The computational domain is divided into cubic subdomains, organized in a hierarchical tree. The contribution to the electrostatic interaction energies from pairs of neighboring subdomains is computed using numerical integration, whereas the contributions from further apart subdomains are obtained using multipole expansions. The multipole moments of the subdomains are obtained by numerical integration. Linear scaling is achieved by translating and summing the multipoles according to the tree structure, such that each subdomain interacts with a number of subdomains that are almost independent of the size of the system. To compute electrostatic interaction energies of neighboring subdomains, we employ an algorithm which performs efficiently on general purpose graphics processing units (GPGPU). Calculations using one CPU for the FMM part and 20 GPGPUs consisting of tens of thousands of execution threads for the numerical integration algorithm show the scalability and parallel performance of the scheme. For calculations on systems consisting of Gaussian functions (α = 1) distributed as fullerenes from C20 to C720, the total computation time and relative accuracy (ppb) are independent of the system size.

  5. CRT--Cascade Routing Tool to define and visualize flow paths for grid-based watershed models

    Science.gov (United States)

    Henson, Wesley R.; Medina, Rose L.; Mayers, C. Justin; Niswonger, Richard G.; Regan, R.S.

    2013-01-01

    The U.S. Geological Survey Cascade Routing Tool (CRT) is a computer application for watershed models that include the coupled Groundwater and Surface-water FLOW model, GSFLOW, and the Precipitation-Runoff Modeling System (PRMS). CRT generates output to define cascading surface and shallow subsurface flow paths for grid-based model domains. CRT requires a land-surface elevation for each hydrologic response unit (HRU) of the model grid; these elevations can be derived from a Digital Elevation Model raster data set of the area containing the model domain. Additionally, a list is required of the HRUs containing streams, swales, lakes, and other cascade termination features along with indices that uniquely define these features. Cascade flow paths are determined from the altitudes of each HRU. Cascade paths can cross any of the four faces of an HRU to a stream or to a lake within or adjacent to an HRU. Cascades can terminate at a stream, lake, or HRU that has been designated as a watershed outflow location.

  6. Mini-grid based off-grid electrification to enhance electricity access in developing countries: What policies may be required?

    International Nuclear Information System (INIS)

    Bhattacharyya, Subhes C.; Palit, Debajit

    2016-01-01

    With 1.2 billion people still lacking electricity access by 2013, electricity access remains a major global challenge. Although mini-grid based electrification has received attention in recent times, their full exploitation requires policy support covering a range of areas. Distilling the experience from a five year research project, OASYS South Asia, this paper presents the summary of research findings and shares the experience from four demonstration activities. It suggests that cost-effective universal electricity service remains a challenge and reaching the universal electrification target by 2030 will remain a challenge for the less developed countries. The financial, organisational and governance weaknesses hinder successful implementation of projects in many countries. The paper then provides 10 policy recommendations to promote mini-grids as a complementary route to grid extension to promote electricity access for successful outcomes. - Highlights: •The academic and action research activities undertaken through OASYS South Asia Project are reported. •Evidence produced through a multi-dimensional participatory framework supplemented by four demonstration projects. •Funding and regulatory challenges militate against universal electrification objectives by 2030. •Innovative business approaches linking local mini-grids and livelihood opportunities exist. •Enabling policies are suggested to exploit such options.

  7. Improving Medical Students' Application of Knowledge and Clinical Decision-Making Through a Porcine-Based Integrated Cardiac Basic Science Program.

    Science.gov (United States)

    Stott, Martyn Charles; Gooseman, Michael Richard; Briffa, Norman Paul

    2016-01-01

    Despite the concerted effort of modern undergraduate curriculum designers, the ability to integrate basic sciences in clinical rotations is an ongoing problem in medical education. Students and newly qualified doctors themselves report worry about the effect this has on their clinical performance. There are examples in the literature to support development of attempts at integrating such aspects, but this "vertical integration" has proven to be difficult. We designed an expert-led integrated program using dissection of porcine hearts to improve the use of cardiac basic sciences in clinical medical students' decision-making processes. To our knowledge, this is the first time in the United Kingdom that an animal model has been used to teach undergraduate clinical anatomy to medical students to direct wider application of knowledge. Action research methodology was used to evaluate the local curriculum and assess learners needs, and the agreed teaching outcomes, methods, and delivery outline were established. A total of 18 students in the clinical years of their degree program attended, completing precourse and postcourse multichoice questions examinations and questionnaires to assess learners' development. Student's knowledge scores improved by 17.5% (p = 0.01; students t-test). Students also felt more confident at applying underlying knowledge to decision-making and diagnosis in clinical medicine. An expert teacher (consultant surgeon) was seen as beneficial to students' understanding and appreciation. This study outlines how the development of a teaching intervention using porcine-based methods successfully improved both student's knowledge and application of cardiac basic sciences. We recommend that clinicians fully engage with integrating previously learnt underlying sciences to aid students in developing decision-making and diagnostic skills as well as a deeper approach to learning. Copyright © 2016 Association of Program Directors in Surgery. Published by

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

    Science.gov (United States)

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

    2010-01-01

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

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

    International Nuclear Information System (INIS)

    Shakespeare, Thomas P.; Back, Michael F.; Lu, Jiade J.; Lee, Khai Mun; Mukherjee, Rahul K.

    2006-01-01

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

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

    Science.gov (United States)

    Fovargue, Sara; Bennett, Rebecca

    2016-01-01

    In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice. © The Author 2016. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Balancing costs and benefits at different stages of medical innovation: a systematic review of Multi-criteria decision analysis (MCDA).

    Science.gov (United States)

    Wahlster, Philip; Goetghebeur, Mireille; Kriza, Christine; Niederländer, Charlotte; Kolominsky-Rabas, Peter

    2015-07-09

    The diffusion of health technologies from translational research to reimbursement depends on several factors included the results of health economic analysis. Recent research identified several flaws in health economic concepts. Additionally, the heterogeneous viewpoints of participating stakeholders are rarely systematically addressed in current decision-making. Multi-criteria Decision Analysis (MCDA) provides an opportunity to tackle these issues. The objective of this study was to review applications of MCDA methods in decisions addressing the trade-off between costs and benefits. Using basic steps of the PRISMA guidelines, a systematic review of the healthcare literature was performed to identify original research articles from January 1990 to April 2014. Medline, PubMed, Springer Link and specific journals were searched. Using predefined categories, bibliographic records were systematically extracted regarding the type of policy applications, MCDA methodology, criteria used and their definitions. 22 studies were included in the analysis. 15 studies (68 %) used direct MCDA approaches and seven studies (32 %) used preference elicitation approaches. Four studies (19 %) focused on technologies in the early innovation process. The majority (18 studies - 81 %) examined reimbursement decisions. Decision criteria used in studies were obtained from the literature research and context-specific studies, expert opinions, and group discussions. The number of criteria ranged between three up to 15. The most frequently used criteria were health outcomes (73 %), disease impact (59 %), and implementation of the intervention (40 %). Economic criteria included cost-effectiveness criteria (14 studies, 64 %), and total costs/budget impact of an intervention (eight studies, 36 %). The process of including economic aspects is very different among studies. Some studies directly compare costs with other criteria while some include economic consideration in a second step. In early

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

    Directory of Open Access Journals (Sweden)

    Laurier Claudine

    2011-01-01

    Full Text Available Abstract Background The misuse and limited effectiveness of antibiotics for acute respiratory infections (ARIs are well documented, and current approaches targeting physicians or patients to improve appropriate use have had limited effect. Shared decision-making could be a promising strategy to improve appropriate antibiotic use for ARIs, but very little is known about its implementation processes and outcomes in clinical settings. In this matter, pilot studies have played a key role in health science research over the past years in providing information for the planning, justification, and/or refinement of larger studies. The objective of our study was to assess the feasibility and acceptability of the study design, procedures, and intervention of the DECISION+ program, a continuing medical education program in shared decision-making among family physicians and their patients on the optimal use of antibiotics for treating ARIs in primary care. Methods A pilot clustered randomised trial was conducted. Family medicine groups (FMGs were randomly assigned, to either the DECISION+ program, which included three 3-hour workshops over a four- to six-month period, or a control group that had a delayed exposure to the program. Results Among 21 FMGs contacted, 5 (24% agreed to participate in the pilot study. A total of 39 family physicians (18 in the two experimental and 21 in the three control FMGs and their 544 patients consulting for an ARI were recruited. The proportion of recruited family physicians who participated in all three workshops was 46% (50% for the experimental group and 43% for the control group, and the overall mean level of satisfaction regarding the workshops was 94%. Conclusions This trial, while aiming to demonstrate the feasibility and acceptability of conducting a larger study, has identified important opportunities for improving the design of a definitive trial. This pilot trial is informative for researchers and clinicians

  13. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality.

    Science.gov (United States)

    Price, Morgan; Davies, Iryna; Rusk, Raymond; Lesperance, Mary; Weber, Jens

    2017-06-15

    Potentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly. We sought to understand how the Screening Tool of Older People's Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non-academic) primary care practices. We conducted a mixed-method, pragmatic, cluster, randomized control trial in research naïve primary care practices. Phase 1: In the randomized controlled trial, 40 fully automated STOPP rules were implemented as EMR alerts during a 16-week intervention period. The control group did not receive the 40 STOPP rules (but received other alerts). Participants were recruited through the OSCAR EMR user group mailing list and in person at user group meetings. Results were assessed by querying EMR data PIPs. EMR data quality probes were included. Phase 2: physicians were invited to participate in 1-hour semi-structured interviews to discuss the results. In the EMR, 40 STOPP rules were successfully implemented. Phase 1: A total of 28 physicians from 8 practices were recruited (16 in intervention and 12 in control groups). The calculated PIP rate was 2.6% (138/5308) (control) and 4.11% (768/18,668) (intervention) at baseline. No change in PIPs was observed through the intervention (P=.80). Data quality probes generally showed low use of problem list and medication list. Phase 2: A total of 5 physicians participated. All the participants felt that they were aware of the alerts but commented on workflow and presentation challenges. The calculated PIP rate was markedly less than the expected rate found in literature (2.6% and 4.0% vs 20% in literature). Data quality probes highlighted issues related to completeness of data in areas of the EMR used for PIP reporting and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with

  14. Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring.

    Science.gov (United States)

    Centeno, Carlos; Robinson, Carole; Noguera-Tejedor, Antonio; Arantzamendi, María; Echarri, Fernando; Pereira, José

    2017-12-16

    Medical Schools are challenged to improve palliative care education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on palliative care decision-making but aimed at introducing these other important competencies as well. The 20 h-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group. Twenty students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispelled. They came to appreciate the multifaceted nature of decision-making in the palliative care setting and the need to individualize care plans. Moreover, the course resulted in a re-conceptualization of relationships with patients and families, as well as their role as future physicians. Palliative care decision-making therefore, augmented by the visual arts, can serve as a vehicle to address several competencies, including the introduction of competencies related to being patient-centred and empathic.

  15. Adaptive grid based multi-objective Cauchy differential evolution for stochastic dynamic economic emission dispatch with wind power uncertainty.

    Science.gov (United States)

    Zhang, Huifeng; Lei, Xiaohui; Wang, Chao; Yue, Dong; Xie, Xiangpeng

    2017-01-01

    Since wind power is integrated into the thermal power operation system, dynamic economic emission dispatch (DEED) has become a new challenge due to its uncertain characteristics. This paper proposes an adaptive grid based multi-objective Cauchy differential evolution (AGB-MOCDE) for solving stochastic DEED with wind power uncertainty. To properly deal with wind power uncertainty, some scenarios are generated to simulate those possible situations by dividing the uncertainty domain into different intervals, the probability of each interval can be calculated using the cumulative distribution function, and a stochastic DEED model can be formulated under different scenarios. For enhancing the optimization efficiency, Cauchy mutation operation is utilized to improve differential evolution by adjusting the population diversity during the population evolution process, and an adaptive grid is constructed for retaining diversity distribution of Pareto front. With consideration of large number of generated scenarios, the reduction mechanism is carried out to decrease the scenarios number with covariance relationships, which can greatly decrease the computational complexity. Moreover, the constraint-handling technique is also utilized to deal with the system load balance while considering transmission loss among thermal units and wind farms, all the constraint limits can be satisfied under the permitted accuracy. After the proposed method is simulated on three test systems, the obtained results reveal that in comparison with other alternatives, the proposed AGB-MOCDE can optimize the DEED problem while handling all constraint limits, and the optimal scheme of stochastic DEED can decrease the conservation of interval optimization, which can provide a more valuable optimal scheme for real-world applications.

  16. Artificial intelligence: Neural network model as the multidisciplinary team member in clinical decision support to avoid medical mistakes

    Directory of Open Access Journals (Sweden)

    Igor Vyacheslavovich Buzaev

    2016-09-01

    Full Text Available Objective: The continuous uninterrupted feedback system is the essential part of any well-organized system. We propose aLYNX concept that is a possibility to use an artificial intelligence algorithm or a neural network model in decision-making system so as to avoid possible mistakes and to remind the doctors to review tactics once more in selected cases. Method: aLYNX system includes: registry with significant factors, decisions and results; machine learning process based on this registry data; the use of the machine learning results as the adviser. We show a possibility to build a computer adviser with a neural network model for making a choice between coronary aortic bypass surgery (CABG and percutaneous coronary intervention (PCI in order to achieve a higher 5-year survival rate in patients with angina based on the experience of 5107 patients. Results: The neural network was trained by 4679 patients who achieved 5-year survival. Among them, 2390 patients underwent PCI and 2289 CABG. After training, the correlation coefficient (r of the network was 0.74 for training, 0.67 for validation, 0.71 for test and 0.73 for total. Simulation of the neural network function has been performed after training in the two groups of patients with known 5-year outcome. The disagreement rate was significantly higher in the dead patient group than that in the survivor group between neural network model and heart team [16.8% (787/4679 vs. 20.3% (87/428, P = 0.065]. Conclusion: The study shows the possibility to build a computer adviser with a neural network model for making a choice between CABG and PCI in order to achieve a higher 5-year survival rate in patients with angina. Keywords: Coronary artery bypass grafting, Percutaneous coronary intervention, Artificial intelligence, Decision making

  17. A comparison of graphical and textual presentations of time series data to support medical decision making in the neonatal intensive care unit.

    Science.gov (United States)

    Law, Anna S; Freer, Yvonne; Hunter, Jim; Logie, Robert H; McIntosh, Neil; Quinn, John

    2005-06-01

    To compare expert-generated textual summaries of physiological data with trend graphs, in terms of their ability to support neonatal Intensive Care Unit (ICU) staff in making decisions when presented with medical scenarios. Forty neonatal ICU staff were recruited for the experiment, eight from each of five groups--junior, intermediate and senior nurses, junior and senior doctors. The participants were presented with medical scenarios on a computer screen, and asked to choose from a list of 18 possible actions those they thought were appropriate. Half of the scenarios were presented as trend graphs, while the other half were presented as passages of text. The textual summaries had been generated by two human experts and were intended to describe the physiological state of the patient over a short period of time (around 40 minutes) but not to interpret it. In terms of the content of responses there was a clear advantage for the Text condition, with participants tending to choose more of the appropriate actions when the information was presented as text rather than as graphs. In terms of the speed of response there was no difference between the Graphs and Text conditions. There was no significant difference between the staff groups in terms of speed or content of responses. In contrast to the objective measures of performance, the majority of participants reported a subjective preference for the Graphs condition. In this experimental task, participants performed better when presented with a textual summary of the medical scenario than when it was presented as a set of trend graphs. If the necessary algorithms could be developed that would allow computers automatically to generate descriptive summaries of physiological data, this could potentially be a useful feature of decision support tools in the intensive care unit.

  18. Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes

    Directory of Open Access Journals (Sweden)

    Marzorati C

    2017-03-01

    Full Text Available Chiara Marzorati,1,2 Gabriella Pravettoni2,3 1Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM, 2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Abstract: In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of “value” is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on “value” and new paradigms such as patient-centered system (PCS, patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care. Keywords: health care system, value, value-based medicine, patient empowerment, clinical decision

  19. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis.

    Science.gov (United States)

    Durand, Marie-Anne; Yen, Renata; Barr, Paul J; Cochran, Nan; Aarts, Johanna; Légaré, France; Reed, Malcolm; James O'Malley, A; Scalia, Peter; Painchaud Guérard, Geneviève; Elwyn, Glyn

    2017-06-23

    Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article

  20. Postgraduates' perceptions of preparedness for work as a doctor and making future career decisions: support for rural, non-traditional medical schools.

    Science.gov (United States)

    Eley, D S

    2010-08-01

    The intern year is a critical time for making career decisions and gaining confidence in clinical skills, communication and teamwork practices; this justifies an interest in junior doctors' perceptions of their level of preparedness for hospital work. This study explored Australian junior doctors' perspectives regarding the transition from student to doctor roles, their preparation as medical undergraduates within either traditional metropolitan schools or smaller, outer metropolitan-based (rural) programs such as Rural Clinical Schools (RCS), and the educational environment they experienced in their internship. A qualitative cross-sectional design used semi-structured interviews with postgraduate year one and two junior doctors (9 females and 11 males) within teaching hospitals in Queensland Australia. Interview questions focussed on four major content areas: preparedness for hospital work, undergraduate training, building confidence and career advice. Data were analyzed using a framework method to identify and explore major themes. Junior doctors who spent undergraduate years training at smaller, non-traditional medical schools felt more confident and better prepared at internship. More hands-on experience as students, more patient contact and a better grounding in basic sciences were felt by interns to be ideal for building confidence. Junior doctors perceived a general lack of career guidance in both undergraduate and postgraduate teaching environments to help them with the transition from the student to junior doctor roles. Findings are congruent with studies that have confirmed student opinion on the higher quality of undergraduate medical training outside a traditional metropolitan-based program, such as a RCS. The serious shortage of doctors in rural and remote Australia makes these findings particularly relevant. It will be important to gain a better understanding of how smaller non-traditional medical programs build confidence and feelings of work

  1. Medic - Abdominal Pain: A Decision Support Program for the Management of Acute Abdominal Pain. (User’s Manual)

    Science.gov (United States)

    1989-10-11

    Diagnosis Entry Page Your Gynecological Diagnosis APPENDICITIS NON-SPECIFIC ABDOMINAL PAIN PELVIC INFLAMMATORY DISEASE URINARY TRACT INFECTION OVARIAN...presence of diverticular disease does not preclude development of acute appendicitis concxitantly. The initial medical treatment is the same as for...for those patients whose symptoms are non-specific and resolve spontaneously without a diagnosis being made. Peptic ulcer disease (FUD) is included in

  2. Influence of income, hours worked, and loan repayment on medical students' decision to pursue a primary care career.

    Science.gov (United States)

    Rosenthal, M P; Diamond, J J; Rabinowitz, H K; Bauer, L C; Jones, R L; Kearl, G W; Kelly, R B; Sheets, K J; Jaffe, A; Jonas, A P

    To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care. A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools. Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers. Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50,000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n = 313) of the students indicated either they were planning to enter primary care (n = 188) or they would change to a primary care specialty (n = 125) with appropriate adjustments in income, hours worked, or loan repayment. Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.

  3. The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes.

    Science.gov (United States)

    Baker, Elizabeth A; Ledford, Cynthia H; Fogg, Louis; Way, David P; Park, Yoon Soo

    2015-01-01

    Construct: Clinical skills are used in the care of patients, including reporting, diagnostic reasoning, and decision-making skills. Written comprehensive new patient admission notes (H&Ps) are a ubiquitous part of student education but are underutilized in the assessment of clinical skills. The interpretive summary, differential diagnosis, explanation of reasoning, and alternatives (IDEA) assessment tool was developed to assess students' clinical skills using written comprehensive new patient admission notes. The validity evidence for assessment of clinical skills using clinical documentation following authentic patient encounters has not been well documented. Diagnostic justification tools and postencounter notes are described in the literature (1,2) but are based on standardized patient encounters. To our knowledge, the IDEA assessment tool is the first published tool that uses medical students' H&Ps to rate students' clinical skills. The IDEA assessment tool is a 15-item instrument that asks evaluators to rate students' reporting, diagnostic reasoning, and decision-making skills based on medical students' new patient admission notes. This study presents validity evidence in support of the IDEA assessment tool using Messick's unified framework, including content (theoretical framework), response process (interrater reliability), internal structure (factor analysis and internal-consistency reliability), and relationship to other variables. Validity evidence is based on results from four studies conducted between 2010 and 2013. First, the factor analysis (2010, n = 216) yielded a three-factor solution, measuring patient story, IDEA, and completeness, with reliabilities of .79, .88, and .79, respectively. Second, an initial interrater reliability study (2010) involving two raters demonstrated fair to moderate consensus (κ = .21-.56, ρ =.42-.79). Third, a second interrater reliability study (2011) with 22 trained raters also demonstrated fair to moderate agreement

  4. Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records.

    Science.gov (United States)

    O'Reilly, Daria; Holbrook, Anne; Blackhouse, Gordon; Troyan, Sue; Goeree, Ron

    2012-01-01

    Computerized decision support systems (CDSSs) are believed to enhance patient care and reduce healthcare costs; however the current evidence is limited and the cost-effectiveness remains unknown. To estimate the long-term cost-effectiveness of a CDSS linked to evidence-based treatment recommendations for type 2 diabetes. Using the Ontario Diabetes Economic Model, changes in factors (eg, HbA1c) from a randomized controlled trial were used to estimate cost-effectiveness. The cost of implementation, development, and maintenance of the core dataset, and projected diabetes-related complications were included. The base case assumed a 1-year treatment effect, 5% discount rate, and 40-year time horizon. Univariate, one-way sensitivity analyses were carried out by altering different parameter values. The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars. The cost of implementing the intervention was $483,699. The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg, but increased body mass index by 0.02 kg/m², resulting in a relative risk reduction of 14% in the occurrence of amputation. The model estimated that the intervention resulted in an additional 0.0117 quality-adjusted life year; the incremental cost-effectiveness ratio was $160,845 per quality-adjusted life-year. The web-based prototype decision support system slightly improved short-term risk factors. The model predicted moderate improvements in long-term health outcomes. This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes.

  5. Decision support tool for early differential diagnosis of acute lung injury and cardiogenic pulmonary edema in medical critically ill patients.

    Science.gov (United States)

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

    2012-01-01

    At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.

  6. Artificial intelligence: Neural network model as the multidisciplinary team member in clinical decision support to avoid medical mistakes.

    Science.gov (United States)

    Buzaev, Igor Vyacheslavovich; Plechev, Vladimir Vyacheslavovich; Nikolaeva, Irina Evgenievna; Galimova, Rezida Maratovna

    2016-09-01

    The continuous uninterrupted feedback system is the essential part of any well-organized system. We propose aLYNX concept that is a possibility to use an artificial intelligence algorithm or a neural network model in decision-making system so as to avoid possible mistakes and to remind the doctors to review tactics once more in selected cases. aLYNX system includes: registry with significant factors, decisions and results; machine learning process based on this registry data; the use of the machine learning results as the adviser. We show a possibility to build a computer adviser with a neural network model for making a choice between coronary aortic bypass surgery (CABG) and percutaneous coronary intervention (PCI) in order to achieve a higher 5-year survival rate in patients with angina based on the experience of 5107 patients. The neural network was trained by 4679 patients who achieved 5-year survival. Among them, 2390 patients underwent PCI and 2289 CABG. After training, the correlation coefficient ( r ) of the network was 0.74 for training, 0.67 for validation, 0.71 for test and 0.73 for total. Simulation of the neural network function has been performed after training in the two groups of patients with known 5-year outcome. The disagreement rate was significantly higher in the dead patient group than that in the survivor group between neural network model and heart team [16.8% (787/4679) vs. 20.3% (87/428), P  = 0.065)]. The study shows the possibility to build a computer adviser with a neural network model for making a choice between CABG and PCI in order to achieve a higher 5-year survival rate in patients with angina.

  7. A grid-based Model for Backwasting at supraglacial Ice Cliffs on a debris-covered Glacier

    Science.gov (United States)

    Buri, P.; Steiner, J. F.; Pellicciotti, F.; Miles, E. S.; Immerzeel, W.

    2014-12-01

    In the Himalaya, debris-covered glaciers cover significant portions of the glacierised area. Their behaviour is not entirely understood, but they seem to experience strong mass losses in direct contradiction with the insulating effect of debris. A characteristic most debris-covered glaciers share is the appearance of cliffs and lakes on their surface. These supraglacial features play a role in surface evolution, dynamics and downwasting of debris-covered glaciers but their actual effects have not been quantified at the glacier scale. Numerous measurements of radiative fluxes at the cliff surface, detailed survey of cliffs geometry and ablation have been conducted on the debris-covered Lirung Glacier, Nepalese Himalayas. We used four 20cm-resolution DEMs obtained from UAV flights to represent the glacier surface to a very detailed degree. As the debris remains stable on slopes up to 30°, ice cliffs show inclinations above this threshold and were clearly represented in the DEMs. Direct measurements and a point-scale cliff-backwasting model have showed that melt patterns over a single cliff are highly variable across and along the ice surface due to non-uniform geometry, varying inclination, aspect and terrain view factors. Variability in observed ablation was large also among cliffs. We therefore developed an energy balance model with a gridded representation of the cliff to understand the melt behaviour at the cliff scale. Previous models assumed the cliff to be a plane with a constant slope and aspect, and extrapolation of melt rates to the glacier scale based on this assumption might be erroneous. Using a grid-based approach allows representation of real inclined areas of the cliff. The detailed surface from the UAV-DEM was taken as initial condition for the model. The model was in close agreement with ablation measurements at numerous stakes located on 3 cliffs. Results show very high variability both along the cliffs' elevation and extension. These cannot be

  8. Evaluation of a deterministic grid-based Boltzmann solver (GBBS) for voxel-level absorbed dose calculations in nuclear medicine

    Science.gov (United States)

    Mikell, Justin; Cheenu Kappadath, S.; Wareing, Todd; Erwin, William D.; Titt, Uwe; Mourtada, Firas

    2016-06-01

    To evaluate the 3D Grid-based Boltzmann Solver (GBBS) code ATTILA ® for coupled electron and photon transport in the nuclear medicine energy regime for electron (beta, Auger and internal conversion electrons) and photon (gamma, x-ray) sources. Codes rewritten based on ATTILA are used clinically for both high-energy photon teletherapy and 192Ir sealed source brachytherapy; little information exists for using the GBBS to calculate voxel-level absorbed doses in nuclear medicine. We compared DOSXYZnrc Monte Carlo (MC) with published voxel-S-values to establish MC as truth. GBBS was investigated for mono-energetic 1.0, 0.1, and 0.01 MeV electron and photon sources as well as 131I and 90Y radionuclides. We investigated convergence of GBBS by analyzing different meshes ({{M}0},{{M}1},{{M}2} ), energy group structures ({{E}0},{{E}1},{{E}2} ) for each radionuclide component, angular quadrature orders (≤ft. {{S}4},{{S}8},{{S}16}\\right) , and scattering order expansions ({{P}0} -{{P}6} ); higher indices imply finer discretization. We compared GBBS to MC in (1) voxel-S-value geometry for soft tissue, lung, and bone, and (2) a source at the interface between combinations of lung, soft tissue, and bone. Excluding Auger and conversion electrons, MC agreed within  ≈5% of published source voxel absorbed doses. For the finest discretization, most GBBS absorbed doses in the source voxel changed by less than 1% compared to the next finest discretization along each phase space variable indicating sufficient convergence. For the finest discretization, agreement with MC in the source voxel ranged from  -3% to  -20% with larger differences at lower energies (-3% for 1 MeV electron in lung to  -20% for 0.01 MeV photon in bone); similar agreement was found for the interface geometries. Differences between GBBS and MC in the source voxel for 90Y and 131I were  -6%. The GBBS ATTILA was benchmarked against MC in the nuclear medicine regime. GBBS can be a viable

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

    Directory of Open Access Journals (Sweden)

    Ningxin Xie

    2014-01-01

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

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

    Science.gov (United States)

    2013-01-01

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

  11. The impact of medical institutions on the treatment decisions and outcome of root-resected molars: A retrospective claims analysis from a representative database

    Directory of Open Access Journals (Sweden)

    Da-Yo Yuh

    2014-01-01

    Full Text Available Background: This study analyzes the prognostic factors affecting the survival rate of root-resected molars by using a representative population-based dataset. Materials and Methods: A total of 635,216 eligible patients were enrolled from a representative cohort composed of one million of Taiwan′s population. The tooth-related factors influencing the survival rates of root-resected teeth were examined on 516 molars, in 492 patients. Cox regression was performed to statistically analyze the factors. Results: The overall survival rate for the root-resected molars was 91.7%. Of the analyzed factors with respect to root-resection procedures, whether or not concomitant flap surgery was performed in the medical institutions, the dental arch and tooth location demonstrated a considerable influence on the treatment and decision-making. The main reasons and results of root-resected molars receiving root-resection therapy in hospitals were the periodontal-compromised conditions, whereas, the root-resected molars that received root-resection therapy in private practice clinics were caused by caries/endodontic reasons. After adjusting for other factors, in the outcome of root-resected molars, a higher risk of extraction occurrence was seen in hospitals than in private practice clinics (hazard ratio = 2.03; 95% CI = 1.04 to 3.98; P = 0.039. Conclusions: Of the analyzed prognostic factors, medical institutions significantly affect the treatment decision and survival of root-resected molars. Therefore, a comprehensive evaluation, risk assessment, and treatment plan should be executed before the root-resection procedure is performed.

  12. Anticonvulsant medications attenuate amphetamine-induced deficits in behavioral inhibition but not decision making under risk on a rat gambling task.

    Science.gov (United States)

    Tremblay, Melanie; Winstanley, Catharine A

    2016-11-01

    Impulsivity is a major component of mania in bipolar disorder (BD), and patients also show impairments in decision-making involving risk on the Iowa Gambling Task (IGT). Similar deficits are observed in some patients with temporal lobe epilepsy (TLE), and incidence of problem gambling is higher in both these populations. Anticonvulsant drugs are widely used in the treatment of epilepsy, but also as mood stabilizers and prophylaxis for the management of BD. Unfortunately, little is still known about the precise mechanisms of action underlying their efficacy, and the specific behavioral aspect targeted by these drugs. This project explored the effect of the three anticonvulsant drugs currently also used as mood stabilizers- carbamazepine, valproate and lamotrigine on aspects of decision-making using a rat analogue of the IGT, the rat Gambling Task (rGT). In this task, rats choose between four distinct, probabilistic reinforcement schedules. Sugar pellet profits are maximized by adopting a conservative strategy, avoiding tempting high-risk, high-reward options. Effects of the anticonvulsant agents were assessed on baseline performance and also in conjunction with amphetamine administration, in order to approximate a "mania-like" state. Carbamazepine appeared to slow processing speed, decreasing premature responses and increasing choice latency, whereas valproate and lamotrigine had no effect. When administered prior to amphetamine, lamotrigine was the only drug that failed to attenuate the pro-impulsive effect of the psychostimulant. Further studies looking at chronic administration of anticonvulsants may help us understand the impact of this medication class on decision-making and impulsivity in healthy rats and disease models. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    Science.gov (United States)

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

  14. Allometric considerations when assessing aortic aneurysms in Turner syndrome: Implications for activity recommendations and medical decision-making.

    Science.gov (United States)

    Corbitt, Holly; Maslen, Cheryl; Prakash, Siddharth; Morris, Shaine A; Silberbach, Michael

    2018-02-01

    In Turner syndrome, the potential to form thoracic aortic aneurysms requires routine patient monitoring. However, the short stature that typically occurs complicates the assessment of severity and risk because the relationship of body size to aortic dimensions is different in Turner syndrome compared to the general population. Three allometric formula have been proposed to adjust aortic dimensions, all employing body surface area: aortic size index, Turner syndrome-specific Z-scores, and Z-scores based on a general pediatric and young adult population. In order to understand the differences between these formula we evaluated the relationship between age and aortic size index and compared Turner syndrome-specific Z-scores and pediatric/young adult based Z-scores in a group of girls and women with Turner syndrome. Our results suggest that the aortic size index is highly age-dependent for those under 15 years; and that Turner-specific Z-scores are significantly lower than Z-scores referenced to the general population. Higher Z-scores derived from the general reference population could result in stigmatization, inappropriate restriction from sports, and increasing the risk of unneeded medical or operative treatments. We propose that when estimating aortic dissection risk clinicians use Turner syndrome-specific Z-score for those under fifteen years of age. © 2017 Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    André F. De Champlain

    2015-04-01

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

  16. Assessment of Service Quality in Teaching Hospitals of Yazd University of Medical Sciences: Using Multi-criteria Decision Making Techniques.

    Science.gov (United States)

    Shafii, Milad; Rafiei, Sima; Abooee, Fatemeh; Bahrami, Mohammad Amin; Nouhi, Mojtaba; Lotfi, Farhad; Khanjankhani, Khatere

    2016-08-01

    Hospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). A literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards. Six dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851). Findings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients' security and plan effectively for its promotion.

  17. Interpretation of 'Unnatural death' in coronial law: A review of the English legal process of decision making, statutory interpretation, and case law: The implications for medical cases and coronial consistency.

    Science.gov (United States)

    Harris, Andrew; Walker, Andrew

    2018-04-23

    The article examines the decision-making process for medical reporting of deaths to a coroner and the statutory basis for coronial decisions whether to investigate. It analyses what is published about the consistency of decision making of coroners and discusses what should be the legal basis for determining whether a particular death is natural or unnatural in English law. There is a review of English case law, including the significance of Touche and Benton and the development of 'unnatural' as a term of art, which informs what the courts have held to be an unnatural death. What case law indicates about multiple causes and the significance of the wording in the Coroners & Justice Act 2009 that triggers an investigation are considered. It highlights the importance of considering the medical cause of death and to what extent information other than the initial death report is required, before making the decision that the coroner's duty to open an investigation is triggered. The article concludes that a two-stage test is required. Firstly, is the cause of death medically unnatural? Secondly, whether the circumstances themselves are unnatural or such as to make a medically natural cause of death unnatural. If the coroner has reason to suspect the medical cause of death is unnatural per se the statutory duty to investigate will be engaged, regardless of the circumstances.

  18. Grid-Based Projector Augmented Wave (GPAW) Implementation of Quantum Mechanics/Molecular Mechanics (QM/MM) Electrostatic Embedding and Application to a Solvated Diplatinum Complex

    DEFF Research Database (Denmark)

    Dohn, A. O.; Jónsson, E. Ö.; Levi, Gianluca

    2017-01-01

    A multiscale density functional theory-quantum mechanics/molecular mechanics (DFT-QM/MM) scheme is presented, based on an efficient electrostatic coupling between the electronic density obtained from a grid-based projector augmented wave (GPAW) implementation of density functional theory...... and a classical potential energy function. The scheme is implemented in a general fashion and can be used with various choices for the descriptions of the QM or MM regions. Tests on H2O clusters, ranging from dimer to decamer show that no systematic energy errors are introduced by the coupling that exceeds...

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

    Science.gov (United States)

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

    2013-08-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  1. Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative.

    Science.gov (United States)

    Ahluwalia, Vandana; Rampakakis, Emmanouil; Movahedi, Mohammad; Cesta, Angela; Li, Xiuying; Sampalis, John S; Bombardier, Claire

    2017-11-01

    Despite the availability of treatment guidelines and effective treatments, real-world effectiveness remains suboptimal partly due to poor patient medication adherence. We evaluated a comprehensive set of sociodemographic, health insurance, and disease-related factors for association with patient decision to discontinue anti-rheumatic medications (ARMs) in a large observational RA cohort in Ontario, Canada. Patients from the Ontario Best Practices Research Initiative registry were included. The following predictors of ARM discontinuation were evaluated with cox-regression: patient age, gender, education, income, smoking, health insurance type/coverage, RA duration, erosion presence, RF positivity, DAS28-ESR, physician global, HAQ-DI, comorbidity number, ARM types, and physician characteristics (gender, academic position, urban vs. rural, distance from patient's residence). Patients (1762) were included with a mean (SD) age of 57.4 years (13.0). Approximately 80% were female, 29% had early (≤ 1 year) RA, and 70% were RF-positive. Mean (SD) baseline DAS28-ESR and HAQ-DI were 4.5 (1.5) and 1.2 (0.76), respectively. In multivariate analysis, married status (HR [95%CI] 0.73 [0.56-0.96]), RF positivity (0.73 [0.56-0.96]), and higher comorbidity number (0.92 [0.85-0.99]) were significant predictors of ARMs continuation while higher physician global (1.10 [1.04-1.15]), NSAID use (1.75 [1.29-2.38]), and number of ARMs (1.23 [1.07-1.40]) were associated with ARMs discontinuation. In a subset analysis assessing conventional or biologic DMARD discontinuation, higher HAQ-DI and biologic use over time were associated with lower hazard for discontinuation. Several sociodemographic, disease, and treatment parameters were identified as independent predictors of patient discontinuation of ARMs. These results should be considered when developing patient adherence support programs and in the choice of treatment regimens.

  2. Decision and decision makers

    Directory of Open Access Journals (Sweden)

    Anuta Porutiu

    2010-12-01

    Full Text Available In the current economic context, decision making requires complex and multiple actions on the part of the policy makers, who are more challenged than in previous situations, due to the crisis that we are facing. Decision problems cannot be solved by focusing on manager’s own experience or intuition, but require constant adaptation of the methods used effectively in the past to new challenges. Thus, a systemic analysis and modeling of arising issues is required, resulting in the stringent use of Decision Support Systems (DSS, as a necessity in a competitive environment. DSS optimize the situation by getting a timely decision because the decision making process must acquire, process and interpret an even larger amount of data in the shortest possible time. A solution for this purpose is the artificial intelligence systems, in this case Decision Support Systems (DSS, used in a wider area due to expansion of all the new information technologies in decisionmaking processes. These substantial cyber innovations have led to a radical shift in the relationship between enterprise success and quality of decisions made by managers.

  3. Grid-Based Moment Tensor Inversion Technique by Using 3-D Green's Functions Database: A Demonstration of the 23 October 2004 Taipei Earthquake

    Directory of Open Access Journals (Sweden)

    Shiann-Jong Lee

    2010-01-01

    Full Text Available Moment tensor inversion is a routine procedure to obtain information on an earthquake source for moment magnitude and focal mechanism. However, the inversion quality is usually controlled by factors such as knowledge of an earthquake location and the suitability of a 1-D velocity model used. Here we present an improved method to invert the moment tensor solution for local earthquakes. The proposed method differs from routine centroid-moment-tensor inversion of the Broadband Array in Taiwan for Seismology in three aspects. First, the inversion is repeated in the neighborhood of an earthquake_?s hypocenter on a grid basis. Second, it utilizes Green_?s functions based on a true three-dimensional velocity model. And third, it incorporates most of the input waveforms from strong-motion records. The proposed grid-based moment tensor inversion is applied to a local earthquake that occurred near the Taipei basin on 23 October 2004 to demonstrate its effectiveness and superiority over methods used in previous studies. By using the grid-based moment tensor inversion technique and 3-D Green_?s functions, the earthquake source parameters, including earthquake location, moment magnitude and focal mechanism, are accurately found that are sufficiently consistent with regional ground motion observations up to a frequency of 1.0 Hz. This approach can obtain more precise source parameters for other earthquakes in or near a well-modeled basin and crustal structure.

  4. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department

    Directory of Open Access Journals (Sweden)

    Amalia Leceta

    2017-02-01

    Full Text Available Background: Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs. Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. Data sources and methods: Queries received by the Medical Information Department and the responses provided to senders of these queries. Results: The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants, antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in

  5. NICeSim: an open-source simulator based on machine learning techniques to support medical research on prenatal and perinatal care decision making.

    Science.gov (United States)

    Cerqueira, Fabio Ribeiro; Ferreira, Tiago Geraldo; de Paiva Oliveira, Alcione; Augusto, Douglas Adriano; Krempser, Eduardo; Corrêa Barbosa, Helio José; do Carmo Castro Franceschini, Sylvia; de Freitas, Brunnella Alcantara Chagas; Gomes, Andreia Patricia; Siqueira-Batista, Rodrigo

    2014-11-01

    This paper describes NICeSim, an open-source simulator that uses machine learning (ML) techniques to aid health professionals to better understand the treatment and prognosis of premature newborns. The application was developed and tested using data collected in a Brazilian hospital. The available data were used to feed an ML pipeline that was designed to create a simulator capable of predicting the outcome (death probability) for newborns admitted to neonatal intensive care units. However, unlike previous scoring systems, our computational tool is not intended to be used at the patients bedside, although it is possible. Our primary goal is to deliver a computational system to aid medical research in understanding the correlation of key variables with the studied outcome so that new standards can be established for future clinical decisions. In the implemented simulation environment, the values of key attributes can be changed using a user-friendly interface, where the impact of each change on the outcome is immediately reported, allowing a quantitative analysis, in addition to a qualitative investigation, and delivering a totally interactive computational tool that facilitates hypothesis construction and testing. Our statistical experiments showed that the resulting model for death prediction could achieve an accuracy of 86.7% and an area under the receiver operating characteristic curve of 0.84 for the positive class. Using this model, three physicians and a neonatal nutritionist performed simulations with key variables correlated with chance of death. The results indicated important tendencies for the effect of each variable and the combination of variables on prognosis. We could also observe values of gestational age and birth weight for which a low Apgar score and the occurrence of respiratory distress syndrome (RDS) could be less or more severe. For instance, we have noticed that for a newborn with 2000 g or more the occurrence of RDS is far less problematic

  6. The decision evaluation scales

    NARCIS (Netherlands)

    Stalmeier, PFM; Roosmalen, MS; Verhoef, LCG; Hoekstra-Weebers, JEHM; Oosterwijk, JC; Moog, U; Hoogerbrugge, N; van Daal, WAJ

    There are several instruments to assess how patients evaluate their medical treatment choice. These are used to evaluate decision aids. Our objective is to investigate which psychological factors play a role when patients evaluate their medical treatment choices. A pool of 36 items was constructed,

  7. Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System.

    Science.gov (United States)

    Wong, Adrian; Wright, Adam; Seger, Diane L; Amato, Mary G; Fiskio, Julie M; Bates, David

    2017-08-23

    Electronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement. To compare the two systems and identify areas for potential improvement with the new commercial system at a single institution. Overridden medication-related CDS alerts were included from October to December of the systems' respective years (legacy, 2011; commercial, 2015), restricted to three intensive care units. The two systems were compared with regards to CDS presentation and override rates for four types of CDS: drug-allergy, drug-drug interaction (DDI), geriatric and renal alerts. A post hoc analysis to evaluate for adverse drug events (ADEs) potentially resulting from overridden alerts was performed for 'contraindicated' DDIs via chart review. There was a significant increase in provider exposure to alerts and alert overrides in the commercial system (commercial: n=5,535; legacy: n=1,030). Rates of overrides were higher for the allergy and DDI alerts (pcommercial system. Geriatric and renal alerts were significantly different in incidence and presentation between the two systems. No ADEs were identified in an analysis of 43 overridden contraindicated DDI alerts. The vendor system had much higher rates of both alerts and overrides, although we did not find evidence of harm in a review of DDIs which were overridden. We propose recommendations for improving our current system which may be helpful to other similar institutions; improving both alert presentation and the underlying knowledge base appear important.

  8. ANNOTATION TAKEN, IN THE PERSPECTIVE OF CRIMINAL AND CONSTITUTIONAL LAW, AS WELL AS IN CRIMINOLOGY, TO THE DECISION OF THE PORTUGUESE CONSTITUTIONAL COURT, OF JANUARY 13, 2011--WITH RESPECT TO THE PROBLEMS OF "CONSENT" AND "MEDICAL ACT".

    Science.gov (United States)

    Bandeira, Gonçalo S de Melo

    2014-07-01

    1--Summary of the decision taken by the Portuguese Constitutional Court, of January 13, 2011; 2--Complete text of the decision of the Portuguese Constitutional Court, of January 13, 2011, Judge Maria João ANTUNES (Reporter), Judge Carlos Pamplona de OLIVEIRA, Judge José Borges SOEIRO, Judge Gil GALVÃO, Judge Rui Manuel Moura RAMOS (President)--in terms of the appositive declaration to the sentence n. 487/2010: t.c.http://www. tribunalconstitucional.pt, August 1, 2011; 3--Brief annotation to the problem of the "medical act"; 3.1--Plus some conclusions on the brief annotation to the problem of the "medical act"; 3.2--Brief annotation to the problem of "consent"--continuation of the previous comments; 4--Conclusions. It must never be forgotten that "consent" does not stand as the only cause of exclusion of unlawfulness.

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

    Directory of Open Access Journals (Sweden)

    Koji Sugano

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

  10. Split Decisions, Split Decisions

    Directory of Open Access Journals (Sweden)

    2000-01-01

    Full Text Available The lead stories in Nature and Science went in opposite directions this week. Science chose outer space, launching into NASA’s hotly disputed decision to shelve a planned mission to Pluto. Nature plunged into inner space with a story about a report to the European Commission advising against granting “premature” approval to create human embryos for stem-cell research.

  11. Grid-Based Projector Augmented Wave (GPAW) Implementation of Quantum Mechanics/Molecular Mechanics (QM/MM) Electrostatic Embedding and Application to a Solvated Diplatinum Complex.

    Science.gov (United States)

    Dohn, A O; Jónsson, E Ö; Levi, G; Mortensen, J J; Lopez-Acevedo, O; Thygesen, K S; Jacobsen, K W; Ulstrup, J; Henriksen, N E; Møller, K B; Jónsson, H

    2017-12-12

    A multiscale density functional theory-quantum mechanics/molecular mechanics (DFT-QM/MM) scheme is presented, based on an efficient electrostatic coupling between the electronic density obtained from a grid-based projector augmented wave (GPAW) implementation of density functional theory and a classical potential energy function. The scheme is implemented in a general fashion and can be used with various choices for the descriptions of the QM or MM regions. Tests on H 2 O clusters, ranging from dimer to decamer show that no systematic energy errors are introduced by the coupling that exceeds the differences in the QM and MM descriptions. Over 1 ns of liquid water, Born-Oppenheimer QM/MM molecular dynamics (MD) are sampled combining 10 parallel simulations, showing consistent liquid water structure over the QM/MM border. The method is applied in extensive parallel MD simulations of an aqueous solution of the diplatinum [Pt 2 (P 2 O 5 H 2 ) 4 ] 4- complex (PtPOP), spanning a total time period of roughly half a nanosecond. An average Pt-Pt distance deviating only 0.01 Å from experimental results, and a ground-state Pt-Pt oscillation frequency deviating by <2% from experimental results were obtained. The simulations highlight a remarkable harmonicity of the Pt-Pt oscillation, while also showing clear signs of Pt-H hydrogen bonding and directional coordination of water molecules along the Pt-Pt axis of the complex.

  12. DC Voltage Control and Power-Sharing of Multi-Terminal DC Grids Based on Optimal DC Power Flow and Flexible Voltage Droop Strategy

    Directory of Open Access Journals (Sweden)

    F. Azma

    2015-06-01

    Full Text Available This paper develops an effective control framework for DC voltage control and power-sharing of multi-terminal DC (MTDC grids based on an optimal power flow (OPF procedure and the voltage-droop control. In the proposed approach, an OPF algorithm is executed at the secondary level to find optimal reference of DC voltages and active powers of all voltage-regulating converters. Then, the voltage droop characteristics of voltage-regulating converters, at the primary level, are tuned based on the OPF results such that the operating point of the MTDC grid lies on the voltage droop characteristics. Consequently, the optimally-tuned voltage droop controller leads to the optimal operation of the MTDC grid. In case of variation in load or generation of the grid, a new stable operating point is achieved based on the voltage droop characteristics. By execution of a new OPF, the voltage droop characteristics are re-tuned for optimal operation of the MTDC grid after the occurrence of the load or generation variations. The results of simulation on a grid inspired by CIGRE B4 DC grid test system demonstrate efficient grid performance under the proposed control strategy.

  13. Cellular scanning strategy for selective laser melting: evolution of optimal grid-based scanning path and parametric approach to thermal homogeneity

    Science.gov (United States)

    Mohanty, Sankhya; Tutum, Cem Celal; Hattel, Jesper Henri

    2013-03-01

    Selective laser melting, as a rapid manufacturing technology, is uniquely poised to enforce a paradigm shift in the manufacturing industry by eliminating the gap between job- and batch-production techniques. Products from this process, however, tend to show an increased amount of defects such as distortions, residual stresses and cracks; primarily attributed to the high temperatures and temperature gradients occurring during the process. A unit cell approach towards the building of a standard sample, based on literature, has been investigated in the present work. A pseudo-analytical model has been developed and validated using thermal distributions obtained using different existing scanning strategies. Several existing standard and non-standard scanning methods have been evaluated and compared using the empirical model as well as a 3D-thermal finite element model. Finally, a new grid-based scan strategy has been developed for processing the standard sample, one unit cell at a time, using genetic algorithms, with an objective of reducing thermal asymmetries.

  14. Effects of Simulated Pathophysiology on the Performance of a Decision Support Medical Monitoring System for Early Detection of Hemodynamic Decompensation in Humans

    Science.gov (United States)

    2017-02-01

    in both animals (Frey, 1914) and humans (Loeper & Crouzon, 1904). Additionally, experimentally induced psychological stress (Dhabhar et al., 2012...neurologic, or metabolic disease. Subjects were non- obese (BMI < 30 kg/m2), non-smokers, and 104 were not taking any medication. Prior to the...explained. Subjects were non- obese (BMI < 30), non- 100 smokers, did not take any medications and all subjects reported to be free of cardiovascular

  15. Rational decisions

    CERN Document Server

    Binmore, Ken

    2008-01-01

    It is widely held that Bayesian decision theory is the final word on how a rational person should make decisions. However, Leonard Savage--the inventor of Bayesian decision theory--argued that it would be ridiculous to use his theory outside the kind of small world in which it is always possible to ""look before you leap."" If taken seriously, this view makes Bayesian decision theory inappropriate for the large worlds of scientific discovery and macroeconomic enterprise. When is it correct to use Bayesian decision theory--and when does it need to be modified? Using a minimum of mathematics,

  16. Theoretical investigation on the mass loss impact on asteroseismic grid-based estimates of mass, radius, and age for RGB stars

    Science.gov (United States)

    Valle, G.; Dell'Omodarme, M.; Prada Moroni, P. G.; Degl'Innocenti, S.

    2018-01-01

    Aims: We aim to perform a theoretical evaluation of the impact of the mass loss indetermination on asteroseismic grid based estimates of masses, radii, and ages of stars in the red giant branch (RGB) phase. Methods: We adopted the SCEPtER pipeline on a grid spanning the mass range [0.8; 1.8] M⊙. As observational constraints, we adopted the star effective temperatures, the metallicity [Fe/H], the average large frequency spacing Δν, and the frequency of maximum oscillation power νmax. The mass loss was modelled following a Reimers parametrization with the two different efficiencies η = 0.4 and η = 0.8. Results: In the RGB phase, the average random relative error (owing only to observational uncertainty) on mass and age estimates is about 8% and 30% respectively. The bias in mass and age estimates caused by the adoption of a wrong mass loss parameter in the recovery is minor for the vast majority of the RGB evolution. The biases get larger only after the RGB bump. In the last 2.5% of the RGB lifetime the error on the mass determination reaches 6.5% becoming larger than the random error component in this evolutionary phase. The error on the age estimate amounts to 9%, that is, equal to the random error uncertainty. These results are independent of the stellar metallicity [Fe/H] in the explored range. Conclusions: Asteroseismic-based estimates of stellar mass, radius, and age in the RGB phase can be considered mass loss independent within the range (η ∈ [0.0,0.8]) as long as the target is in an evolutionary phase preceding the RGB bump.

  17. Analysis of aggregation and disaggregation effects for grid-based hydrological models and the development of improved precipitation disaggregation procedures for GCMs

    Directory of Open Access Journals (Sweden)

    H. S. Wheater

    1999-01-01

    Full Text Available Appropriate representation of hydrological processes within atmospheric General Circulation Models (GCMs is important with respect to internal model dynamics (e.g. surface feedback effects on atmospheric fluxes, continental runoff production and to simulation of terrestrial impacts of climate change. However, at the scale of a GCM grid-square, several methodological problems arise. Spatial disaggregation of grid-square average climatological parameters is required in particular to produce appropriate point intensities from average precipitation. Conversely, aggregation of land surface heterogeneity is necessary for grid-scale or catchment scale application. The performance of grid-based hydrological models is evaluated for two large (104km2 UK catchments. Simple schemes, using sub-grid average of individual land use at 40 km scale and with no calibration, perform well at the annual time-scale and, with the addition of a (calibrated routing component, at the daily and monthly time-scale. Decoupling of hillslope and channel routing does not necessarily improve performance or identifiability. Scale dependence is investigated through application of distribution functions for rainfall and soil moisture at 100 km scale. The results depend on climate, but show interdependence of the representation of sub-grid rainfall and soil moisture distribution. Rainfall distribution is analysed directly using radar rainfall data from the UK and the Arkansas Red River, USA. Among other properties, the scale dependence of spatial coverage upon radar pixel resolution and GCM grid-scale, as well as the serial correlation of coverages are investigated. This leads to a revised methodology for GCM application, as a simple extension of current procedures. A new location-based approach using an image processing technique is then presented, to allow for the preservation of the spatial memory of the process.

  18. A method of decision analysis quantifying the effects of age and comorbidities on the probability of deriving significant benefit from medical treatments

    OpenAIRE

    Fitzgerald, Stephen P.; Bean, Nigel G.; Ruberu, Ravi P.

    2017-01-01

    Background: The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study. Objective: To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit. Design: We developed a method to calculate prob...

  19. A method of decision analysis quantifying the effects of age and comorbidities on the probability of deriving significant benefit from medical treatments

    OpenAIRE

    Fitzgerald, Stephen P.; Bean, Nigel G.; Ruberu, Ravi P.

    2017-01-01

    Background The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study. Objective To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit. Design We developed a method to calculate probabi...

  20. How many Medical specialists do Ministry of Health- Sri Lanka need by 2025: Use of system dynamics modelling for policy decisions

    Science.gov (United States)

    De Silva, M D

    2017-09-30

    The Ministry of Health is the largest health care provider in Sri Lanka in terms of funding, coverage and human resources. Long duration and high training cost of a medical specialist highlights the importance of health human resource planning. Ministry of Health, Sri Lanka has no scientific cadre planning for medical specialists. System dynamics, an analytical modelling approach and a methodology for studying complex feedback systems was used. Two sub models of “need” and “supply” were developed and simulated over a period of 10 years from 2016 to 2025. By December 2015 there were 1860 clinician medical specialists with an average age of 46.8 years, in the government hospitals in Sri Lanka. In the surgical group of specialties the Proposed Training Rate is more than Current Training Rate while in Medical and Paediatric groups and in Radiology, Anaesthesiology, Psychiatry, Dermatology and Hematology Proposed Training Rate is less than the Current Training Rate. In Surgical specilities the number of trainees enrolled in the Pre-MD programme should be increased from 55 to 71 and while in Medical specilaities the number of trainees enrolled in Pre- MD programmes should be reduced from 107 to 68 and in the Paediatric specialities from 47 to 39. During the 2016-2025 period, 765 specialists will be lost to the Ministry of Health costing nearly Rs 7.6 billion and there will be 4050 consultants by 2025, which is a 120% increase.

  1. A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education.

    Science.gov (United States)

    Calabrese, Sarah K; Earnshaw, Valerie A; Krakower, Douglas S; Underhill, Kristen; Vincent, Wilson; Magnus, Manya; Hansen, Nathan B; Kershaw, Trace S; Mayer, Kenneth H; Betancourt, Joseph R; Dovidio, John F

    2018-04-01

    Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

  2. Intelligent Decision-Making System with Green Pervasive Computing for Renewable Energy Business in Electricity Markets on Smart Grid

    Directory of Open Access Journals (Sweden)

    Dong-Joo Kang

    2009-01-01

    Full Text Available This paper is about the intelligent decision-making system for the smart grid based electricity market which requires distributed decision making on the competitive environments composed of many players and components. It is very important to consider the renewable energy and emission problem which are expected to be monitored by wireless communication networks. It is very difficult to predict renewable energy outputs and emission prices over time horizon, so it could be helpful to catch up those data on real time basis using many different kinds of communication infrastructures. On this backgrounds this paper provides an algorithm to make an optimal decision considering above factors.

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

    Science.gov (United States)

    Santana Arroyo, Sonia; del Carmen Gonzalez Rivero, Maria

    2012-01-01

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

  4. End of life decisions and pregnant women: do pregnant women have the right to refuse life preserving medical treatment? A comparative study

    OpenAIRE

    Lemmens, C.

    2010-01-01

    Abstract: In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is re...

  5. End of life decisions and pregnant women: do pregnant women have the right to refuse life preserving medical treatment? A comparative study.

    Science.gov (United States)

    Lemmens, Christophe

    2010-12-01

    In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is repeated in the situation where the woman is found to be incompetent or brain dead.

  6. Consultant choice across decision contexts: are abortion decisions different?

    Science.gov (United States)

    Finken, L L; Jacobs, J E

    1996-04-01

    A survey conducted among college students in the midwestern US indicated that abortion decision-making consultation patterns differ substantially from those associated with other types of decisions. Surveyed were 169 predominantly White, middle-income students (68 males and 101 females) 18-20 years of age recruited from an introductory psychology class. Participants were presented with vignettes that pertained to four types of decisions: abortion (unplanned pregnancy), medical (cancer treatment type), future (career move), and interpersonal (crisis with a friend). For each decision, students were asked who they would consult (specific family members, significant others, friends, various professionals) and the order in which they would consult them. The mean number of consultants selected was 3.72 for abortion, 5.54 for medical, 4.90 for future-oriented, and 2.41 for interpersonal decisions. Significant others were selected most often for all decision scenarios; however, the highest frequency of consultation and lowest mean rank order for the significant other was on the abortion decision. The next most important consultant for abortion decisions was friends, then family members, and, finally, professionals. The only gender difference was a greater tendency for females to consult their mothers. For every category of consultant (except best friend), the pattern differed depending on the type of decision. These findings underscore the importance of considering context and multifaceted approaches in the design of programs aimed at enhancing adolescents' decision-making skills.

  7. Old Dog New Tricks: Use of Point-based Crop Models in Grid-based Regional Assessment of Crop Management Technologies Impact on Future Food Security

    Science.gov (United States)

    Koo, J.; Wood, S.; Cenacchi, N.; Fisher, M.; Cox, C.

    2012-12-01

    HarvestChoice (harvestchoice.org) generates knowledge products to guide strategic investments to improve the productivity and profitability of smallholder farming systems in sub-Saharan Africa (SSA). A keynote component of the HarvestChoice analytical framework is a grid-based overlay of SSA - a cropping simulation platform powered by process-based, crop models. Calibrated around the best available representation of cropping production systems in SSA, the simulation platform engages the DSSAT Crop Systems Model with the CENTURY Soil Organic Matter model (DSSAT-CENTURY) and provides a virtual experimentation module with which to explore the impact of a range of technological, managerial and environmental metrics on future crop productivity and profitability, as well as input use. For each of 5 (or 30) arc-minute grid cells in SSA, a stack of model input underlies it: datasets that cover soil properties and fertility, historic and future climate scenarios and farmers' management practices; all compiled from analyses of existing global and regional databases and consultations with other CGIAR centers. Running a simulation model is not always straightforward, especially when certain cropping systems or management practices are not even practiced by resource-poor farmers yet (e.g., precision agriculture) or they were never included in the existing simulation framework (e.g., water harvesting). In such cases, we used DSSAT-CENTURY as a function to iteratively estimate relative responses of cropping systems to technology-driven changes in water and nutrient balances compared to zero-adoption by farmers, while adjusting model input parameters to best mimic farmers' implementation of technologies in the field. We then fed the results of the simulation into to the economic and food trade model framework, IMPACT, to assess the potential implications on future food security. The outputs of the overall simulation analyses are packaged as a web-accessible database and published

  8. A New Intelligent Medical Decision Support System Based on Enhanced Hierarchical Clustering and Random Decision Forest for the Classification of Alcoholic Liver Damage, Primary Hepatoma, Liver Cirrhosis, and Cholelithiasis.

    Science.gov (United States)

    Singh, Aman; Pandey, Babita

    2018-01-01

    Diagnosis of liver disease principally depends on physician's subjective knowledge. Automatic prediction of the disease is a critical real-world medical problem. This work presents an EHC-ERF-based intelligence-integrated model purposive to predict different types of liver disease including alcoholic liver damage, primary hepatoma, liver cirrhosis, and cholelithiasis. These diseases cause many clinical complications, and their accurate assessment is the only way for providing efficient treatment facilities to patients. EHC is deployed to divide the data into a hierarchy structure that is more informative for the disease predictions carried out by ERF. The occurrence of ERF error rate was dependent on correlation and strength of each individual tree where correlation is directly proportional to forest error rate and strength is inversely proportional to the forest rate. In total, two individual and three integrated classification models are developed to achieve enhanced predictions for the liver disease types. Analysis of results showed that the proposed framework achieved better outcomes in terms of accuracy, true positive rate, precision, F -measure, kappa statistic, mean absolute error, and root mean squared error. Furthermore, it achieved the highest accuracy rates when compared with the state-of-the-art techniques. Results also indicated that the weighted distance function employed in EHC has improved the efficiency of proposed system and has shown the capability to be used by physicians for diagnostic advice.

  9. A New Intelligent Medical Decision Support System Based on Enhanced Hierarchical Clustering and Random Decision Forest for the Classification of Alcoholic Liver Damage, Primary Hepatoma, Liver Cirrhosis, and Cholelithiasis

    Directory of Open Access Journals (Sweden)

    Aman Singh

    2018-01-01

    Full Text Available Diagnosis of liver disease principally depends on physician’s subjective knowledge. Automatic prediction of the disease is a critical real-world medical problem. This work presents an EHC-ERF-based intelligence-integrated model purposive to predict different types of liver disease including alcoholic liver damage, primary hepatoma, liver cirrhosis, and cholelithiasis. These diseases cause many clinical complications, and their accurate assessment is the only way for providing efficient treatment facilities to patients. EHC is deployed to divide the data into a hierarchy structure that is more informative for the disease predictions carried out by ERF. The occurrence of ERF error rate was dependent on correlation and strength of each individual tree where correlation is directly proportional to forest error rate and strength is inversely proportional to the forest rate. In total, two individual and three integrated classification models are developed to achieve enhanced predictions for the liver disease types. Analysis of results showed that the proposed framework achieved better outcomes in terms of accuracy, true positive rate, precision, F-measure, kappa statistic, mean absolute error, and root mean squared error. Furthermore, it achieved the highest accuracy rates when compared with the state-of-the-art techniques. Results also indicated that the weighted distance function employed in EHC has improved the efficiency of proposed system and has shown the capability to be used by physicians for diagnostic advice.

  10. Reliability of cervical radiculopathy, its congruence between patient history and medical imaging evidence of disc herniation and its role in surgical decision.

    Science.gov (United States)

    Mostofi, Keyvan; Khouzani, Reza Karimi

    2016-10-01

    The incidence of cervical disc herniation is estimated about 5.5/100,000, and they lead to surgical intervention in 26 %. Cervical disc herniation causes radiculopathy, which defines by radicular pain and sensory deficit and maybe weakness following the path of the affected nerves. Classically, cervical radiculopathy is expected to follow its specific dermatome-C4, C5, C6, C7 and C8. We investigate patients who present with discrepancy between classical radiculopathy and imaging findings in the daily practice of our profession. We reviewed the medical records of 102 patients with cervical radiculopathy, caused by cervical disc herniation. All patients had surgery. We found an apparent discrepancy between clinical and radiological findings, patients complained of radiculopathy on one side, and magnetic resonance imaging (MRI) scan or CT scan finding on the other side in ten patients (10.2 %). We did not found any other abnormalities in preoperative and post-operative period. All patients underwent cervical diskectomy via anterior approach. Six weeks after surgery eight patients (80 %) recovered completely, and 3 months after all ten patients (100 %) had been relieved totally. The aim of this paper is review of this medical concept and management of radiculopathy in patients with this discrepancy. As far as we know, the subject has not yet been touched in this light in medical literature. The discrepancy between clinical radiculopathy and disc herniation level on MRI or on CT scan is not rare. Management of this discrepancy requires further investigation to avoid missing diagnosis and treatment failure.

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

    Science.gov (United States)

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

    2014-09-01

    The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors' Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists' opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most-metformin, SUs, insulin, and perhaps now also TZDs-are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients' clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  12. Medical Computational Thinking

    DEFF Research Database (Denmark)

    Musaeus, Peter; Tatar, Deborah Gail; Rosen, Michael A.

    2017-01-01

    Computational thinking (CT) in medicine means deliberating when to pursue computer-mediated solutions to medical problems and evaluating when such solutions are worth pursuing in order to assist in medical decision making. Teaching computational thinking (CT) at medical school should be aligned...... with learning objectives, teaching and assessment methods, and overall pedagogical mission of the individual medical school in relation to society. Medical CT as part of the medical curriculum could help educate novices (medical students and physicians in training) in the analysis and design of complex...

  13. Avaliação das decisões médicas durante o processo do morrer Evaluation of medical decisions at the end-of-life process

    Directory of Open Access Journals (Sweden)

    Rachel Duarte Moritz

    2009-06-01

    Full Text Available OBJETIVOS: Avaliar as condutas médicas adotadas durante o morrer de pacientes que foram a óbito no HU/UFSC. Comparar essas condutas e o perfil epidemiológico dos que morreram na unidade de terapia intensiva (UTI com o dos que morreram nas enfermarias de clínica médica (ECM ou cirúrgicas (ECC. MÉTODOS: Estudo retrospectivo e observacional, onde foram anotados os dados demográficos, clínicos e terapêuticos dos pacientes adultos que morreram nas enfermarias e na unidade de terapia intensiva do HU/UFSC, no período de julho/2004 a dezembro/2008. Para análise estatística foram utilizados os testes: t Student, χ2 e ANOVA (significante pOBJECTIVES: To evaluate the medical decisions at end-of-life of patients admitted at HU/UFSC and to compare these decisions and the profile of patients who died in the intensive care unit (ICU to those who died in medical (MW and surgical wards (SW. METHODS: This is a retrospective and observational study. Demographic data, clinical features, treatment and the end-of-life care decisions of adult patients who died in wards and the intensive care unit of HU/UFSC from July/2004 to December/2008 were analyzed . For statistical analysis the Student's t, χ2 and ANOVA tests were used: (significance p <0.05. RESULTS: An analysis was made of 1124 deaths: 404 occurred in ICU, 607 in MW and 113 in SW. The overall hospital mortality rate was 5.9% (ICU=24.49%, MW=7.2%, SW=1.69%. Mean ages of patients were: ICU=56.7, MW=69.3 and SW=70.4 years (p <0.01. Withholding/withdrawing life support was performed prior to 30.7% of deaths in the intensive care unit and 10% in the wards (p <0.01. Cardiopulmonary resuscitation was not carried out in 65% of cases in ICU, 79% in MW and 62% in SW. Besides cardiopulmonary resuscitation, the more frequent withholding/withdrawing life support in the intensive care unit were vasoactive drugs and in the wards refusal of admission to intensive care unit . Do-not-resuscitate order was

  14. Design of an electronic medical record (EMR-based clinical decision support system to alert clinicians to the onset of severe sepsis

    Directory of Open Access Journals (Sweden)

    Fountain S

    2016-04-01

    Full Text Available Background: The aim of our study was to design an electronic medical record ­based alert system to detect the onset of severe sepsis with sensitivity and positive predictive value (PPV above 50%. Methods: The PPV for each of seven potential criteria for suspected infection (white blood cell count (WBCC >12 or 0.1 K/uL or immature granulocyte % >1%, temperature >38 C. or 50%, the charts of sixty consecutive patients who met CMS criteria for severe sepsis were reviewed to calculate the sensitivity of organ dysfunction plus any one of the suspected infection criteria. Results: Four proposed criteria for suspected infection had PPV >50%: WBCC >12 x 10 9 /L (69%; 95%CI:53­84%, Temperature >38C. (84%; 95%CI:68­100%, Temperature <36C. (57% 95%CI:36­78%, and initiation of antibiotics (70% 95%CI:56­84%. These four criteria were present in 53/60 of the patients with severe sepsis by CMS criteria, yielding a sensitivity of 88.3% (95%CI: 80.2­96.4%. Alert criteria were satisfied before the onset of severe sepsis in 25/53 cases, and within 90 minutes afterwards in 28/53 cases. Conclusions: Our criteria for suspected infection plus organ dysfunction yields reasonable sensitivity and PPV for the detection of severe sepsis in real­time.

  15. PDA Use by Clinicians has a Positive Impact on Clinical Decision Making. A review of: Dee, Cheryl R., Marilyn Teolis, and Andrew D. Todd. “Physicians’ use of the personal digital assistant (PDA in clinical decision making.” Journal of the Medical Library Association 93.4 (October 2005: 480-6.

    Directory of Open Access Journals (Sweden)

    Suzanne P. Lewis

    2006-06-01

    Full Text Available Objective – To examine how frequently attending physicians and physicians in training (medical students, interns and residents used PDAs for patient care and to explore physicians’ perceptions of the impact of PDA use on several aspects of clinical care. Design – User study via a questionnaire. Setting – Teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania in the United States. Subjects – A convenience sample of fifty nine attending physicians and forty-nine physicians in training (108 total, spread unevenly across the five states. Methods – Subjects were recruited by librarians at teaching hospitals to answer a questionnaire which was distributed and collected at medical meetings, as well as by email, mail, and fax. The subjects were required to have and use a PDA, but prior training on PDA use was not a requirement, nor was it offered to the subjects before the study. Most of the questions required the respondent to choose from five Likert scale answers regarding frequency of PDA use: almost always, often, a few times, rarely, or never. In the reporting of results, the options ‘almost always’ and ‘often’ were combined and reported as ‘frequent’, and the options ‘a few times’ and ‘rarely’, were combined and reported as ‘occasional’. Subjects could also record comments for each question, but only for affirmative responses. Subjects were asked about their frequency of PDA use before, during, or after a patient encounter. They were also asked if PDA use had influenced one or more of five aspects of clinical care – decision making, diagnosis, treatment, test ordering, and in-patient hospital length of stay. Data analysis included chi square tests to assess differences between attending physicians and physicians in training regarding frequency of PDA use and the influence of PDA use on the five aspects of clinical care. The subject population was also divided into frequent and occasional

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

    International Nuclear Information System (INIS)

    Louie, Alexander V.; Rodrigues, George; Hannouf, Malek; Zaric, Gregory S.; Palma, David A.; Cao, Jeffrey Q.; Yaremko, Brian P.; Malthaner, Richard; Mocanu, Joseph D.

    2011-01-01

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

  17. Failing Decision

    DEFF Research Database (Denmark)

    Knudsen, Morten

    2014-01-01

    Recently the Danish subway trains have begun to announce “on time” when they arrive at a station on time. This action reflects a worrying acceptance of the normality of failure. If trains were generally expected to be on time, there would be no reason to – triumphantly – announce it. This chapter...... as a controlled cost for achieving organizational goals. Decisions must fail so the organization can succeed. This chapter uses two cases to elaborate on these ideas. By way of introduction, I will reflect on the notion of ‘failing decisions’ within organization and decision theory. This chapter is also propelled...

  18. Heuristic decision making in medicine

    Science.gov (United States)

    Marewski, Julian N.; Gigerenzer, Gerd

    2012-01-01

    Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care. PMID:22577307

  19. Medical Issues: Nutrition

    Science.gov (United States)

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

  20. Driver fitness medical guidelines.

    Science.gov (United States)

    2009-09-01

    This guide provides guidance to assist licensing agencies in making decisions about an individuals fitness for driving. This is the first attempt to produce a consolidated document covering medical conditions included in the task agreement between...

  1. Organizational Decision

    DEFF Research Database (Denmark)

    Kreiner, Kristian

    2012-01-01

    in architectural competitions and claim that they reflect necessity more than vice. They are ways around the fundamental incommensurability of the alternative design proposals. The garbage can model is used as a framework for making sense of the observed counterintuitive ways of decision making. Its attempt...

  2. Organizational Decisions.

    Science.gov (United States)

    1982-03-01

    traders reach diametrically opposite decisions, to buy what thousands of others are offering to sell. The traders, differ in objectives, differ in...differentiation among them is sought to make the final choise easier. This differentiation effort "leads to a search for new information, not...of the organization. Sales promotions to stimulate purchases during off-seasons are illustrations often used to stimulate buying . Utilities provide

  3. Nuclear decisions

    International Nuclear Information System (INIS)

    Fischhoff, B.

    1991-01-01

    This attempts to identify the role of judgmental processes in various nuclear arms/war decisions. That task analysis is done with some confidence. The next two steps, diagnosing potential weaknesses in those judgments and suggesting ameliorative procedures, are done with increasing timidity. The empirical research base is not (ever) as large as one would like. It is particularly weak with regard to studies of experts forced to go beyond hard data and rely on intuitive judgments within their field of expertise. further evidence is needed to substantiate the claim that experts think like everyone else unless they have had the opportunity to master a particular kind of judgment as a learned skill. Although there is both theoretical and empirical reason to believe that various forms of decision aiding are possible, the high stakes involved mandate caution before proposing any intervention. Ineffective steps may make matters worse if they raise confidence without improving performance, or if they disrupt the cognitive ecology within which decision makers are accustomed to functioning, so that they lose touch with their own imperfect intuitions without acquiring viable alternatives

  4. Decision analysis using decision trees for a simple clinical decision.

    Science.gov (United States)

    Blakley, Brian

    2012-10-01

    To illustrate the use of decision trees with a utility index in clinical decision making. A decision tree was created related to whether or not to perform a tonsillectomy. Data from the literature were applied to a common hypothetical clinical scenario. A decision tree graphically represents the typical decision-making process that many clinicians use. The addition of utility functions permitted consideration of the adverse or beneficial effects of outcomes, altering the treatment decision. Quantitative tools such as decision trees may quantify outcome preferences and aid in clinical decision making, but the proper tool and background data are essential.

  5. Decision rules for decision tables with many-valued decisions

    KAUST Repository

    Chikalov, Igor

    2011-01-01

    In the paper, authors presents a greedy algorithm for construction of exact and partial decision rules for decision tables with many-valued decisions. Exact decision rules can be \\'over-fitted\\', so instead of exact decision rules with many attributes, it is more appropriate to work with partial decision rules with smaller number of attributes. Based on results for set cover problem authors study bounds on accuracy of greedy algorithm for exact and partial decision rule construction, and complexity of the problem of minimization of decision rule length. © 2011 Springer-Verlag.

  6. Medical Models and Bayesian Networks

    DEFF Research Database (Denmark)

    Olesen, Kristian Grønborg

    1999-01-01

    Proc. of a Workshop Held during the Joint European Conf. on Artificial Intelligence in Medicine and Medical Decision Making : AIMDM'99, Aalborg, Denmark, June 1999......Proc. of a Workshop Held during the Joint European Conf. on Artificial Intelligence in Medicine and Medical Decision Making : AIMDM'99, Aalborg, Denmark, June 1999...

  7. Decision Strategy Research

    International Nuclear Information System (INIS)

    Hardeman, F.

    2001-01-01

    The objective of SCK-CEN's R and D programme on decision strategies is: (1) to study the decision-making process in a nuclear context with particular emphasis on emergency preparedness; (2) to disseminate knowledge on nuclear emergency preparedness including courses in the field of off-site emergency response to nuclear accidents; (3) to co-ordinate efforts within SCK-CEN in the field of medical applications of radiation; (4) to support projects and reflexion groups related to interdisciplinary research on the no-technical aspects of radiation protection or nuclear apllications; (5) to give advice and support to authorities and the industry on any topic related to radiation protection and to make expertise and infrastructure available. Main focus of the programme is on the surveillance of the territory and emergency preparedness. Principal achievements in 2000 are described

  8. Decision Strategy Research

    Energy Technology Data Exchange (ETDEWEB)

    Hardeman, F

    2001-04-01

    The objective of SCK-CEN's R and D programme on decision strategies is: (1) to study the decision-making process in a nuclear context with particular emphasis on emergency preparedness; (2) to disseminate knowledge on nuclear emergency preparedness including courses in the field of off-site emergency response to nuclear accidents; (3) to co-ordinate efforts within SCK-CEN in the field of medical applications of radiation; (4) to support projects and reflexion groups related to interdisciplinary research on the no-technical aspects of radiation protection or nuclear apllications; (5) to give advice and support to authorities and the industry on any topic related to radiation protection and to make expertise and infrastructure available. Main focus of the programme is on the surveillance of the territory and emergency preparedness. Principal achievements in 2000 are described.

  9. Social networks and vaccination decisions

    OpenAIRE

    Rao, Neel; Möbius, Markus M.; Rosenblat, Tanya

    2007-01-01

    We combine information on social networks with medical records and survey data in order to examine how friends affect one’s decision to get vaccinated against the flu. The random assignment of undergraduates to residential halls at a large private university allows us to estimate how peer effects influence health beliefs and vaccination choices. Our results indicate that social exposure to medical information raises people’s perceptions of the benefits of immunization. The average student’s b...

  10. Diseases Diagnosis Using Medical Palmistry Fuzzy Model

    OpenAIRE

    Othman Zainab; Saleem Sarmad

    2016-01-01

    The design n, implementation, and use of biomedical information systems in the form of computer – aided decision support have become essential and widely used over the last two decades. Medical decision support systems play an increasingly important role in medical practice by assisting physicians who make clinical decisions. Medical scientists discovered that the hand can be used as an indicator for medical problems and the palm is the reflection of activities going on brain. The purpose of ...

  11. Organising medication discontinuation

    DEFF Research Database (Denmark)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-01-01

    Background: Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a m...

  12. Refusal to medical interventions.

    Science.gov (United States)

    Palacios, G; Herreros, B; Pacho, E

    2014-10-01

    Refusal to medical interventions is the not acceptance, voluntary and free, of an indicated medical intervention. What the physician should do in case of refusal? It is understandable that the rejection of a validated medical intervention is difficult to accept by the responsible physician when raises the conflict protection of life versus freedom of choice. Therefore it is important to follow some steps to incorporate the most relevant aspects of the conflict. These steps include: 1) Give complete information to patients, informing on possible alternatives, 2) determine whether the patient can decide (age, competency and level of capacity), 3) to ascertain whether the decision is free, 4) analyze the decision with the patient, 5) to persuade, 6) if the patient kept in the rejection decision, consider conscientious objection, 7) take the decision based on the named criteria, 8) finally, if the rejection is accepted, offer available alternatives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  13. Genomic Testing and Resulting Medical Decisions

    Science.gov (United States)

    2017-10-03

    Cancer of Unknown Origin; Cancer Refractory; Cancer of Stomach; Cancer Head Neck; Cancer of Skin; Cancer, Lung; Cancer Colorectal; Cancer of Esophagus; Cancer, Bladder; Cancer, Uterus; Cancer Cervix; Cancer Liver; Cancer, Kidney; Cancer, Breast; Hematologic Neoplasms

  14. Shared clinical decision making

    Science.gov (United States)

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  15. Reprocessing decision

    International Nuclear Information System (INIS)

    Heising, C.D.

    1978-01-01

    The United States must decide whether to permit, delay, or prohibit the reprocessing and recycling of nuclear spent fuel. To permit reprocessing would allow recycle as early as 1985; to delay the decision for a later administration to deal with means spent fuel would mount up at nuclear reactor sites; to prohibit would eliminate recycling and mandate permanent storage. Bayesian decision analysis was used to examine reprocessing costs associated with risks and economic benefits. Three distinct categories of risk that are important in the nuclear fuel cycle are discussed. These are: health, environment, and safety risks; nuclear theft and sabotage; and nuclear weapons proliferation risks. Results are discussed from comparing nine routes to weapons-usuable mterial available to nonweapons states that desire a nuclear capability. These are: production reactor and military reporcessor; research reacotr and military reprocessor; power plant plus military reprocessor or commercial reprocessor; enrichment (centrifuge, gaseous diffusion, electromagnetic separation, or aerodynamic jet cascade); and accelerator. It was found that the commercial power reactor-commercial reprocessor route is comparatively unattractive to a nonweapons state. In summary, allowing nuclear fuel reprocessing to go forward in the United States can be expected to increase the costs to society by a maximum $360 million a year. This is approximately one-seventh of the expected benefit (reduced electricity bills) to be dderived by society from closing the fuel cycle. It appears that the permitting reprocessing now is logically preferable to delaying or prohibiting the technology, the author concludes

  16. An examination of binding motifs associated with inter-particle interactions between facetted nano-crystals of acetylsalicylic acid and ascorbic acid through the application of molecular grid-based search methods.

    Science.gov (United States)

    Hammond, R B; Jeck, S; Ma, C Y; Pencheva, K; Roberts, K J; Auffret, T

    2009-12-01

    Grid-based intermolecular search methods using atom-atom force fields are used to assess the structural nature of potential crystal-crystal interfacial binding associated with the examination of representative pharmaceutical formulation components, viz acetylsalicylic acid (aspirin) and ascorbic acid (vitamin C). Molecular models of nano-sized molecular clusters for these two compounds, shaped in accordance with an attachment energy model of the respective particle morphologies, are constructed and used together with a grid-based search method to model the likely inter-particle interactions. The most-stable, mutual alignments of the respective nano-clusters based on their interaction energies are identified in the expectation that these are indicative of the most likely inter-particle binding configurations. The stable inter-particle binding configurations identified reveal that the number of interfacial hydrogen bonds formed between the binding particles is, potentially, an important factor in terms of the stability of inter-particle cohesion. All preferred inter-particle alignments are found to involve either the (1 0 0) or the (1 1 0) face of aspirin crystals interacting with a number of the growth forms of ascorbic acid. Four main types of interfacial hydrogen bonds are found to be associated with inter-particle binding and involve acceptor-donor interactions between hydroxyl, carbonyl, ester and lactone acceptor groups and hydroxyl donor groups. This hydrogen bonding network is found to be consistent with the surface chemistry of the interacting habit faces with, in general, the number of hydrogen bonds increasing for the more stable alignments. The likely usefulness of this approach for predicting solid-state formulation properties is reviewed. 2009 Wiley-Liss, Inc. and the American Pharmacists Association

  17. Social Influences in Sequential Decision Making.

    Directory of Open Access Journals (Sweden)

    Markus Schöbel

    Full Text Available People often make decisions in a social environment. The present work examines social influence on people's decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others' authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions.

  18. Social Influences in Sequential Decision Making

    Science.gov (United States)

    Schöbel, Markus; Rieskamp, Jörg; Huber, Rafael

    2016-01-01

    People often make decisions in a social environment. The present work examines social influence on people’s decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others’ authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions. PMID:26784448

  19. Group Decision Process Support

    DEFF Research Database (Denmark)

    Gøtze, John; Hijikata, Masao

    1997-01-01

    Introducing the notion of Group Decision Process Support Systems (GDPSS) to traditional decision-support theorists.......Introducing the notion of Group Decision Process Support Systems (GDPSS) to traditional decision-support theorists....

  20. The Systematic Medical Appraisal, Referral and Treatment (SMART Mental Health Project: Development and Testing of Electronic Decision Support System and Formative Research to Understand Perceptions about Mental Health in Rural India.

    Directory of Open Access Journals (Sweden)

    Pallab K Maulik

    Full Text Available Common mental disorders (CMD such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign.The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre.The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers.A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen's behavioural model of health services use.The findings assisted with refining the intervention prior to large-scale implementation and evaluation.

  1. Patient participation in decisions about disease modifying anti-rheumatic drugs: a cross-sectional survey

    NARCIS (Netherlands)

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

    2014-01-01

    Background Involvement of patients in decision-making about medication is currently being advocated. This study examined (the concordance between) inflammatory arthritis patients’ preferred and perceived involvement in decision-making in general, and in four specific decisions about

  2. Synergistic Effect Evaluation of Main and Auxiliary Industry of Power Grid Based on the Information Fusion Technology from the Perspective of Sustainable Development of Enterprises

    Directory of Open Access Journals (Sweden)

    Xiaomin Xu

    2018-02-01

    Full Text Available With the development of the diversified economic union, the power grid enterprises’ auxiliary industries are continuing to grow and develop faster. However, in the process of development, power grid enterprises are still faced with the problem of low efficiency of the management of main and auxiliary and resource allocation and utilization. Thus, the synergistic development evaluation for power grid enterprises’ main and auxiliary industries has a strong practical significance. It can help the managers to find the short board of each industry and search for the exploration direction for improvement to promote the sustainable development of the main and auxiliary industries comprehensively. It can also provide the reference for improving the management level of power grid enterprises. Information fusion technology, as a process of information processing for decision making, can make use of multi-source information synergistically to get a more objective and more essential understanding of the same thing or the same goal. It has been applied to many fields in a mature way. Based on the characteristics of each industry, this paper constructs a synergistic effect evaluation index system of the main and auxiliary industries from the aspects of management foundation, resource integration, operational efficiency and effectiveness. The variable precision fuzzy rough set (VPFRS is introduced to screen the index system, eliminate redundant indexes, retain key indexes and improve the efficiency and accuracy of evaluation effectively. Meanwhile, based on the characteristic of dealing with the imprecise problem of the vague set, this paper establishes the evaluation model based on information fusion technology of the variable precision fuzzy rough set and vague set (VPFRS-Vague. In order to verify the validity of the model, five typical companies belonging to power grid enterprises are selected as examples for analysis to prove the validity and

  3. caTIES: a grid based system for coding and retrieval of surgical pathology reports and tissue specimens in support of translational research.

    Science.gov (United States)

    Crowley, Rebecca S; Castine, Melissa; Mitchell, Kevin; Chavan, Girish; McSherry, Tara; Feldman, Michael

    2010-01-01

    The authors report on the development of the Cancer Tissue Information Extraction System (caTIES)--an application that supports collaborative tissue banking and text mining by leveraging existing natural language processing methods and algorithms, grid communication and security frameworks, and query visualization methods. The system fills an important need for text-derived clinical data in translational research such as tissue-banking and clinical trials. The design of caTIES addresses three critical issues for informatics support of translational research: (1) federation of research data sources derived from clinical systems; (2) expressive graphical interfaces for concept-based text mining; and (3) regulatory and security model for supporting multi-center collaborative research. Implementation of the system at several Cancer Centers across the country is creating a potential network of caTIES repositories that could provide millions of de-identified clinical reports to users. The system provides an end-to-end application of medical natural language processing to support multi-institutional translational research programs.

  4. caTIES: a grid based system for coding and retrieval of surgical pathology reports and tissue specimens in support of translational research

    Science.gov (United States)

    Castine, Melissa; Mitchell, Kevin; Chavan, Girish; McSherry, Tara; Feldman, Michael

    2010-01-01

    The authors report on the development of the Cancer Tissue Information Extraction System (caTIES)—an application that supports collaborative tissue banking and text mining by leveraging existing natural language processing methods and algorithms, grid communication and security frameworks, and query visualization methods. The system fills an important need for text-derived clinical data in translational research such as tissue-banking and clinical trials. The design of caTIES addresses three critical issues for informatics support of translational research: (1) federation of research data sources derived from clinical systems; (2) expressive graphical interfaces for concept-based text mining; and (3) regulatory and security model for supporting multi-center collaborative research. Implementation of the system at several Cancer Centers across the country is creating a potential network of caTIES repositories that could provide millions of de-identified clinical reports to users. The system provides an end-to-end application of medical natural language processing to support multi-institutional translational research programs. PMID:20442142

  5. Decision Making with Imperfect Decision Makers

    CERN Document Server

    Guy, Tatiana Valentine; Wolpert, David H

    2012-01-01

    Prescriptive Bayesian decision making has reached a high level of maturity and is well-supported algorithmically. However, experimental data shows that real decision makers choose such Bayes-optimal decisions surprisingly infrequently, often making decisions that are badly sub-optimal. So prevalent is such imperfect decision-making that it should be accepted as an inherent feature of real decision makers living within interacting societies. To date such societies have been investigated from an economic and gametheoretic perspective, and even to a degree from a physics perspective. However, lit

  6. A survey of decision tree classifier methodology

    Science.gov (United States)

    Safavian, S. R.; Landgrebe, David

    1991-01-01

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

  7. Decision, 29 February 1988.

    Science.gov (United States)

    1988-01-01

    This document contains the text of a 1988 Decision of the Chairman of the Council of Ministers of Viet Nam authorizing Vietnamese citizens to travel abroad to attend to personal business. Such business may include visiting immediate relatives, needing medical treatment, meeting and accompanying returning handicapped persons, resolving the question of marriage with foreigners or with overseas Vietnamese resident, pursuing education abroad, accompanying relatives who are old or weak or who are children, bringing home the remains of a dead relative, and tourism in foreign countries. Those who will not receive permission to travel abroad include criminals and those who oppose the socialist order. The normal period of travel abroad will not exceed three months, but extensions will be possible.

  8. Capturing Design Decision Rationale with Decision Cards

    OpenAIRE

    Gutierrez Lopez , Marisela; Rovelo , Gustavo; Haesen , Mieke; Luyten , Kris; Coninx , Karin

    2017-01-01

    In the design process, designers make a wide variety of decisions that are essential to transform a design from a conceptual idea into a concrete solution. Recording and tracking design decisions, a first step to capturing the rationale of the design process, are tasks that until now are considered as cumbersome and too constraining. We used a holistic approach to design, deploy, and verify decision cards; a low threshold tool to capture, externalize, and contextualize design decisions during...

  9. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

    Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

    of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

  10. Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

    Science.gov (United States)

    Rennie, Sarah C; van Rij, Andre M; Jaye, Chrystal; Hall, Katherine H

    2011-06-01

    Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

  11. Shared decision making

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000877.htm Shared decision making To use the sharing features on this page, ... treatment you both support. When to use Shared Decision Making Shared decision making is often used when you ...

  12. Breakout Session: Empowering Fair Use Decisions in Higher Education: Developing Copyright Instruction for 90 Minutes or Less. Presented by Ben Harnke, Education & Reference Librarian, the University of Colorado Anschutz Medical Campus Health Sciences Library, John Jones, Instruction & Curriculum Librarian, the University of Colorado Anschutz Medical Campus Health Sciences Library, and Meghan Damour, Reference Intern, the University of Colorado Anschutz Medical Campus Health Sciences Library.

    Directory of Open Access Journals (Sweden)

    Jennifer Mayer

    2018-02-01

    Full Text Available The presenters shared their experiences and strategies for effective fair use instruction for researchers and faculty members at the University of Colorado Anschutz Medical Campus. The session featured multiple discussion prompts, in order to allow for audience participation. Specific themes and practical tips about fair use instruction included obstacles and challenges, developing the fair use class session, and planning and logistics. Links to supplementary presentation material and tools are provided.

  13. Decision Dissonance: Evaluating an Approach to Measuring the Quality of Surgical Decision Making

    Science.gov (United States)

    Fowler, Floyd J.; Gallagher, Patricia M.; Drake, Keith M.; Sepucha, Karen R.

    2013-01-01

    Background Good decision making has been increasingly cited as a core component of good medical care, and shared decision making is one means of achieving high decision quality. If it is to be a standard, good measures and protocols are needed for assessing the quality of decisions. Consistency with patient goals and concerns is one defining characteristic of a good decision. A new method for evaluating decision quality for major surgical decisions was examined, and a methodology for collecting the needed data was developed. Methods For a national probability sample of fee-for-service Medicare beneficiaries who had a coronary artery bypass graft (CABG), a lumpectomy or a mastectomy for breast cancer, or surgery for prostate cancer during the last half of 2008, a mail survey of selected patients was carried out about one year after the procedures. Patients’ goals and concerns, knowledge, key aspects of interactions with clinicians, and feelings about the decisions were assessed. A Decision Dissonance Score was created that measured the extent to which patient ratings of goals ran counter to the treatment received. The construct and predictive validity of the Decision Dissonance Score was then assessed. Results When data were averaged across all four procedures, patients with more knowledge and those who reported more involvement reported significantly lower Decision Dissonance Scores. Patients with lower Decision Dissonance Scores also reported more confidence in their decisions and feeling more positively about how the treatment turned out, and they were more likely to say that they would make the same decision again. Conclusions Surveying discharged surgery patients is a feasible way to evaluate decision making, and Decision Dissonance appears to be a promising approach to validly measuring decision quality. PMID:23516764

  14. How to make the best decision. Philosophical aspects of clinical decision theory.

    Science.gov (United States)

    Wulff, H R

    1981-01-01

    An attempt is made to discuss some of the philosophical implications of the use of decision-analytic techniques. The probabilities of a decision analysis are subjective measures of belief, and it is concluded that clinicians base their subjective beliefs on both recorded observations and theoretical knowledge. The clinical decision maker also evaluates the consequences of his actions, and therefore clinical decision theory transcends medical science. A number of different schools of normative ethics are mentioned to illustrate the complexity of everyday decision making. The philosophical terminology is useful for the analysis of clinical problems, and it is argued that clinical decision making has both a teleological and a deontological component. The results of decision-analytic studies depend on such factors as the wealth of the country, the organization of the health service, and cultural norms.

  15. Intelligent Decision Technologies : Proceedings of the 4th International Conference on Intelligent Decision Technologies

    CERN Document Server

    Watanabe, Toyohide; Phillips-Wren, Gloria; Howlett, Robert; Jain, Lakhmi

    2012-01-01

    The Intelligent Decision Technologies (IDT) International Conference encourages an interchange of research on intelligent systems and intelligent technologies that enhance or improve decision making. The focus of IDT is interdisciplinary and includes research on all aspects of intelligent decision technologies, from fundamental development to real applications. IDT has the potential to expand their support of decision making in such areas as finance, accounting, marketing, healthcare, medical and diagnostic systems, military decisions, production and operation, networks, traffic management, crisis response, human-machine interfaces, financial and stock market monitoring and prediction, and robotics. Intelligent decision systems implement advances in intelligent agents, fuzzy logic, multi-agent systems, artificial neural networks, and genetic algorithms, among others.  Emerging areas of active research include virtual decision environments, social networking, 3D human-machine interfaces, cognitive interfaces,...

  16. Risky Decision Making in Juvenile Myoclonic Epilepsy

    Directory of Open Access Journals (Sweden)

    Iris Unterberger

    2018-03-01

    Full Text Available It is not known whether patients with juvenile myoclonic epilepsy (JME differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years and a group of 38 healthy controls (mean age 26.03/SD 4.84 years. Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

  17. Grid-based Meteorological and Crisis Applications

    Science.gov (United States)

    Hluchy, Ladislav; Bartok, Juraj; Tran, Viet; Lucny, Andrej; Gazak, Martin

    2010-05-01

    We present several applications from domain of meteorology and crisis management we developed and/or plan to develop. Particularly, we present IMS Model Suite - a complex software system designed to address the needs of accurate forecast of weather and hazardous weather phenomena, environmental pollution assessment, prediction of consequences of nuclear accident and radiological emergency. We discuss requirements on computational means and our experiences how to meet them by grid computing. The process of a pollution assessment and prediction of the consequences in case of radiological emergence results in complex data-flows and work-flows among databases, models and simulation tools (geographical databases, meteorological and dispersion models, etc.). A pollution assessment and prediction requires running of 3D meteorological model (4 nests with resolution from 50 km to 1.8 km centered on nuclear power plant site, 38 vertical levels) as well as running of the dispersion model performing the simulation of the release transport and deposition of the pollutant with respect to the numeric weather prediction data, released material description, topography, land use description and user defined simulation scenario. Several post-processing options can be selected according to particular situation (e.g. doses calculation). Another example is a forecasting of fog as one of the meteorological phenomena hazardous to the aviation as well as road traffic. It requires complicated physical model and high resolution meteorological modeling due to its dependence on local conditions (precise topography, shorelines and land use classes). An installed fog modeling system requires a 4 time nested parallelized 3D meteorological model with 1.8 km horizontal resolution and 42 levels vertically (approx. 1 million points in 3D space) to be run four times daily. The 3D model outputs and multitude of local measurements are utilized by SPMD-parallelized 1D fog model run every hour. The fog forecast model is a subject of the parameterization and parameter optimization before its real deployment. The parameter optimization requires tens of evaluations of the parameterized model accuracy and each evaluation of the model parameters requires re-running of the hundreds of meteorological situations collected over the years and comparison of the model output with the observed data. The architecture and inherent heterogeneity of both examples and their computational complexity and their interfaces to other systems and services make them well suited for decomposition into a set of web and grid services. Such decomposition has been performed within several projects we participated or participate in cooperation with academic sphere, namely int.eu.grid (dispersion model deployed as a pilot application to an interactive grid), SEMCO-WS (semantic composition of the web and grid services), DMM (development of a significant meteorological phenomena prediction system based on the data mining), VEGA 2009-2011 and EGEE III. We present useful and practical applications of technologies of high performance computing. The use of grid technology provides access to much higher computation power not only for modeling and simulation, but also for the model parameterization and validation. This results in the model parameters optimization and more accurate simulation outputs. Having taken into account that the simulations are used for the aviation, road traffic and crisis management, even small improvement in accuracy of predictions may result in significant improvement of safety as well as cost reduction. We found grid computing useful for our applications. We are satisfied with this technology and our experience encourages us to extend its use. Within an ongoing project (DMM) we plan to include processing of satellite images which extends our requirement on computation very rapidly. We believe that thanks to grid computing we are able to handle the job almost in real time.

  18. Project Decision Chain

    DEFF Research Database (Denmark)

    Rolstadås, Asbjørn; Pinto, Jeffrey K.; Falster, Peter

    2015-01-01

    To add value to project performance and help obtain project success, a new framework for decision making in projects is defined. It introduces the project decision chain inspired by the supply chain thinking in the manufacturing sector and uses three types of decisions: authorization, selection......, and plan decision. A primitive decision element is defined where all the three decision types can be accommodated. Each task in the primitive element can in itself contain subtasks that in turn will comprise new primitive elements. The primitive elements are nested together in a project decision chain....

  19. Informatics perspectives on decision taking

    OpenAIRE

    Bergstra, J.A.

    2011-01-01

    A decision is an act or event of decision taking. Decision making always includes decision taking, the latter not involving significant exchanges with non-deciding agents. A decision outcome is a piece of storable information constituting the result of a decision. Decision outcomes are typed, for instance: plan, command, assertion, or boolean reply to a question. A decision effect is any consequence of putting a decision outcome into effect. Decision outcomes must be expected by the decider t...

  20. An ABC for decision making

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Luiz Henrique Costa, E-mail: luiz_mogi@yahoo.com.br [Associacao de Medicina Intensiva Brasileira (AMIB), Sao Paulo, SP (Brazil); Irmandade da Santa Casa de Misericordia de Sao Paulo, SP (Brazil); Ferreira, Bruna Cortez [Hospital de Base de Sao Jose do Rio Preto, SP (Brazil)

    2015-03-15

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw-Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. (author)

  1. An ABC for decision making

    International Nuclear Information System (INIS)

    Garcia, Luiz Henrique Costa; Ferreira, Bruna Cortez

    2015-01-01

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw-Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. (author)

  2. An ABC for decision making

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Costa Garcia

    2015-04-01

    Full Text Available The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education; British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters; Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.

  3. Political and medical views on medical marijuana and its future.

    Science.gov (United States)

    Rubens, Muni

    2014-01-01

    The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of marijuana has always been political, rather than scientific. Federal law has barred the use of medical marijuana though 18 state governments and Washington, DC, support the medical use of marijuana. Unfortunately, not many studies exist on medical marijuana to back these laws and policies. The judiciary, on the other hand, has elicited a diverse response to medical marijuana through its rulings over several decades. Some rulings favored the federal government's opinion, and others supported the larger public view and many state governments with legalized medical marijuana. Public opinion on legalizing medical marijuana has always favored the use of medical marijuana. The movement of scientific knowledge of medical marijuana follows an erratic, discontinuous pathway. The future place of medical marijuana in U.S. society remains unknown. The three forces-scientific knowledge, social-political acceptance, and laws-play a role in the direction that medical marijuana takes in society. Overcoming political-social forces requires a concerted effort from the scientific community and political leaders. The results of scientific research must guide the decisions for laws and medical use of marijuana. This article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana by tracing the past history of medical marijuana with its bumpy pathway in the social-political arena.

  4. Learning Probabilistic Decision Graphs

    DEFF Research Database (Denmark)

    Jaeger, Manfred; Dalgaard, Jens; Silander, Tomi

    2004-01-01

    Probabilistic decision graphs (PDGs) are a representation language for probability distributions based on binary decision diagrams. PDGs can encode (context-specific) independence relations that cannot be captured in a Bayesian network structure, and can sometimes provide computationally more...

  5. Decision support systems

    OpenAIRE

    Georgiana MARIN

    2008-01-01

    Decision Support Systems (DSS) are a specific class of computerized information system that supports business and organizational decision-making activities. A properly-designed DSS is an interactive software-based system intended to help decision makers compile useful information from raw data, documents, personal knowledge, and/or business models to identify and solve problems and make decisions. DSS belong to an environment with multidisciplinary foundations, including database reasearch, a...

  6. Marketing Decisions and Strategies

    DEFF Research Database (Denmark)

    Kuada, John Ernest

    The marketing literature generally assumes that managers and customers always make rational (reasonable and logical) decisions. In real life, however, decision making process is hardly rational and straight forward. Managers and customers normally make decisions “in-action” – i.e. as they grapple...

  7. Decision Support Tool

    NARCIS (Netherlands)

    Ritsema van Eck, Gerard; Ceross, Aaron

    The decision support tool is part of the toolkit for policy makers which came out of the FP7 RESPECT project, which dealt with privacy and surveillance. It's aim is to support decision makers at all levels of government who face difficult decisions regarding the implementation of surveillance

  8. Measurement Decision Theory.

    Science.gov (United States)

    Rudner, Lawrence M.

    This paper describes and evaluates the use of decision theory as a tool for classifying examinees based on their item response patterns. Decision theory, developed by A. Wald (1947) and now widely used in engineering, agriculture, and computing, provides a simple model for the analysis of categorical data. Measurement decision theory requires only…

  9. Decision-making in nursing practice: An integrative literature review.

    Science.gov (United States)

    Nibbelink, Christine W; Brewer, Barbara B

    2018-03-01

    To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient

  10. Sensitivity Analysis in Sequential Decision Models.

    Science.gov (United States)

    Chen, Qiushi; Ayer, Turgay; Chhatwal, Jagpreet

    2017-02-01

    Sequential decision problems are frequently encountered in medical decision making, which are commonly solved using Markov decision processes (MDPs). Modeling guidelines recommend conducting sensitivity analyses in decision-analytic models to assess the robustness of the model results against the uncertainty in model parameters. However, standard methods of conducting sensitivity analyses cannot be directly applied to sequential decision problems because this would require evaluating all possible decision sequences, typically in the order of trillions, which is not practically feasible. As a result, most MDP-based modeling studies do not examine confidence in their recommended policies. In this study, we provide an approach to estimate uncertainty and confidence in the results of sequential decision models. First, we provide a probabilistic univariate method to identify the most sensitive parameters in MDPs. Second, we present a probabilistic multivariate approach to estimate the overall confidence in the recommended optimal policy considering joint uncertainty in the model parameters. We provide a graphical representation, which we call a policy acceptability curve, to summarize the confidence in the optimal policy by incorporating stakeholders' willingness to accept the base case policy. For a cost-effectiveness analysis, we provide an approach to construct a cost-effectiveness acceptability frontier, which shows the most cost-effective policy as well as the confidence in that for a given willingness to pay threshold. We demonstrate our approach using a simple MDP case study. We developed a method to conduct sensitivity analysis in sequential decision models, which could increase the credibility of these models among stakeholders.

  11. Evaluation of TRIGRS (transient rainfall infiltration and grid-based regional slope-stability analysis)'s predictive skill for hurricane-triggered landslides: A case study in Macon County, North Carolina

    Science.gov (United States)

    Liao, Z.; Hong, Y.; Kirschbaum, D.; Adler, R.F.; Gourley, J.J.; Wooten, R.

    2011-01-01

    The key to advancing the predictability of rainfall-triggered landslides is to use physically based slope-stability models that simulate the transient dynamical response of the subsurface moisture to spatiotemporal variability of rainfall in complex terrains. TRIGRS (transient rainfall infiltration and grid-based regional slope-stability analysis) is a USGS landslide prediction model, coded in Fortran, that accounts for the influences of hydrology, topography, and soil physics on slope stability. In this study, we quantitatively evaluate the spatiotemporal predictability of a Matlab version of TRIGRS (MaTRIGRS) in the Blue Ridge Mountains of Macon County, North Carolina where Hurricanes Ivan triggered widespread landslides in the 2004 hurricane season. High resolution digital elevation model (DEM) data (6-m LiDAR), USGS STATSGO soil database, and NOAA/NWS combined radar and gauge precipitation are used as inputs to the model. A local landslide inventory database from North Carolina Geological Survey is used to evaluate the MaTRIGRS' predictive skill for the landslide locations and timing, identifying predictions within a 120-m radius of observed landslides over the 30-h period of Hurricane Ivan's passage in September 2004. Results show that within a radius of 24 m from the landslide location about 67% of the landslide, observations could be successfully predicted but with a high false alarm ratio (90%). If the radius of observation is extended to 120 m, 98% of the landslides are detected with an 18% false alarm ratio. This study shows that MaTRIGRS demonstrates acceptable spatiotemporal predictive skill for landslide occurrences within a 120-m radius in space and a hurricane-event-duration (h) in time, offering the potential to serve as a landslide warning system in areas where accurate rainfall forecasts and detailed field data are available. The validation can be further improved with additional landslide information including the exact time of failure for each

  12. Markov decision processes: a tool for sequential decision making under uncertainty.

    Science.gov (United States)

    Alagoz, Oguzhan; Hsu, Heather; Schaefer, Andrew J; Roberts, Mark S

    2010-01-01

    We provide a tutorial on the construction and evaluation of Markov decision processes (MDPs), which are powerful analytical tools used for sequential decision making under uncertainty that have been widely used in many industrial and manufacturing applications but are underutilized in medical decision making (MDM). We demonstrate the use of an MDP to solve a sequential clinical treatment problem under uncertainty. Markov decision processes generalize standard Markov models in that a decision process is embedded in the model and multiple decisions are made over time. Furthermore, they have significant advantages over standard decision analysis. We compare MDPs to standard Markov-based simulation models by solving the problem of the optimal timing of living-donor liver transplantation using both methods. Both models result in the same optimal transplantation policy and the same total life expectancies for the same patient and living donor. The computation time for solving the MDP model is significantly smaller than that for solving the Markov model. We briefly describe the growing literature of MDPs applied to medical decisions.

  13. Decisions, Decisions: The Neurobiology of the effects of Dopamine Replacement Therapy on Decision-Making in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Julie Lee

    2015-05-01

    Full Text Available Dopamine replacement therapy (DRT alleviates motor symptoms in Parkinson’s disease but induces neuropsychiatric side-effects. This review evaluates recent research into the decision-making deficits caused by DRT arising because dopamine ‘overdoses’ a relatively-intact ventral striatum while replenishing the dorsal striatum. Consequently, patients on medication are worse at learning from losses but better at learning from wins than healthy controls. Additionally, due to greater disruption of medication on limbic than cognitive neural circuits, patients are poorer at decision-making under risk than decision-making under ambiguity. Particularly, task components related to ventral fronto-striatal and orbitofrontal regions are affected more than those related to dorsal and prefrontal regions. Selective deficits in feedback processing and outcome evaluation due to limbic overdose likely drive this effect.

  14. Informatics perspectives on decision taking

    NARCIS (Netherlands)

    Bergstra, J.A.

    2011-01-01

    A decision is an act or event of decision taking. Decision making always includes decision taking, the latter not involving significant exchanges with non-deciding agents. A decision outcome is a piece of storable information constituting the result of a decision. Decision outcomes are typed, for

  15. Shared decision-making as an existential journey: Aiming for restored autonomous capacity

    NARCIS (Netherlands)

    Gulbrandsen, P.; Clayman, M.L.; Beach, M.C.; Han, P.K.; Boss, E.F.; Ofstad, E.H.; Elwyn, G.

    2016-01-01

    OBJECTIVE: We describe the different ways in which illness represents an existential problem, and its implications for shared decision-making. METHODS: We explore core concepts of shared decision-making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust,

  16. Making Sustainable Decisions Using the KONVERGENCE Framework

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-02-01

    possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases.

  17. Making Sustainable Decisions Using The KONVERGENCE Framework

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-02-25

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

  18. Making Sustainable Decisions Using The KONVERGENCE Framework

    International Nuclear Information System (INIS)

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

    2003-01-01

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

  19. Marketing Decisions and Strategies

    DEFF Research Database (Denmark)

    Kuada, John Ernest

    The marketing literature generally assumes that managers and customers always make rational (reasonable and logical) decisions. In real life, however, decision making process is hardly rational and straight forward. Managers and customers normally make decisions “in-action” – i.e. as they grapple...... students a variety of decision making skills as they prepare themselves to work in international companies. This is the task initiated in this book. It discusses how managers combine both rational and non-rational approaches and tools in their decision making processes, especially in international business...

  20. Marketing Decisions and Strategies

    DEFF Research Database (Denmark)

    Kuada, John Ernest

    The marketing literature generally assumes that managers and customers always make rational (reasonable and logical) decisions. In real life, however, decision making process is hardly rational and straight forward. Managers and customers normally make decisions “in-action” – i.e. as they grapple...... with critical problems on daily basis. As such, they tend to combine experience-based knowledge with intuition and analysis to inform their decisions. Their decision making processes become even more complex when their companies operate within international contexts. It is therefore appropriate to teach...

  1. Computerized operator decision aids

    International Nuclear Information System (INIS)

    Long, A.B.

    1984-01-01

    This article explores the potential benefits associated with the use of computers in nuclear plants by the operating crew as an aid in making decisions. Pertinent findings are presented from recently completed projects to establish the context in which operating decisions have to be made. Key factors influencing the decision-making process itself are also identified. Safety parameter display systems, which are being implemented in various forms by the nuclear industry, are described within the context of decision making. In addition, relevant worldwide research and development activities are examined as potential enhancements to computerized operator decision aids to further improve plant safety and availability

  2. Deregulating mandatory medical prescription.

    Science.gov (United States)

    Mitchell, C N

    1986-01-01

    This Article links the legal evolution of mandatory medical prescription since 1900 to the police-power's prohibition of alcohol and the opiates as well as to the self-interested monopolization of new drugs by physicians. The Article advances a theory of professionalization consistent with the evidence that mandatory prescription is not in the public interest. The Article suggests that the supremacy of self-medication is consistent with competition policy, the medical profession's fiduciary duty to clients, reduced medical costs and improved health. The author analyzes the consequences of regulating drug production, testing, marketing and consumtion by granting decision-making authority to the lowest-cost risk avoider, suggesting this as a plausible basis for legal reform.

  3. Make better decisions.

    Science.gov (United States)

    Davenport, Thomas H

    2009-11-01

    Traditionally, decision making in organizations has rarely been the focus of systematic analysis. That may account for the astounding number of recent poor calls, such as decisions to invest in and securitize subprime mortgage loans or to hedge risk with credit default swaps. Business books are rich with insights about the decision process, but organizations have been slow to adopt their recommendations. It's time to focus on decision making, Davenport says, and he proposes four steps: (1) List and prioritize the decisions that must be made; (2) assess the factors that go into each, such as who plays what role, how often the decision must be made, and what information is available to support it; (3) design the roles, processes, systems, and behaviors your organization needs; and (4) institutionalize decision tools and assistance. The Educational Testing Service and The Stanley Works, among others, have succeeded in improving their decisions. ETS established a centralized deliberative body to make evidence-based decisions about new-product offerings, and Stanley has a Pricing Center of Excellence with internal consultants dedicated to its various business units. Leaders should bring multiple perspectives to their decision making, beware of analytical models that managers don't understand, be clear about their assumptions, practice "model management," and--because only people can revise decision criteria over time--cultivate human backups.

  4. Business making decisions

    Directory of Open Access Journals (Sweden)

    Enrique Benjamín Franklin Fincowsky

    2011-06-01

    Full Text Available People and organizations make better or get wrong as consequence of making decisions. Sometimes making decisions is just a trial and error process. Some others, decisions are good and the results profitable with a few of mistakes, most of the time because it’s considered the experience and the control of a specific field or the good intention of who makes them. Actually, all kinds of decisions bring learning. What is important is the intention, the attitude and the values considered in this process. People from different scenes face many facts and circumstances—almost always out of control—that affect the making decisions process. There is not a unique way to make decisions for all companies in many settings. The person who makes a decision should identify the problem, to solve it later using alternatives and solutions. Even though, follow all the steps it’s not easy as it seems. Looking back the conditions related to the decisions, we can mention the followings: uncertainty, risk and certainty. When people identify circumstances and facts, as well as its effects in a possible situation, they will make decisions with certainty. As long as the information decreases and it becomes ambiguous the risk becomes an important factor in the making decisions process because they are connected to probable objectives (clear or subjective (opinion judgment or intuition. To finish, uncertainty, involves people that make a decision with no or little information about circumstances or criteria with basis

  5. Medical Identity

    DEFF Research Database (Denmark)

    Musaeus, Peter

    2015-01-01

    Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...

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

    Science.gov (United States)

    Blau, Gary; Chapman, Susan

    2011-01-01

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

  7. Decision Aids: The Effect of Labeling Options on Patient Choices and Decision Making.

    Science.gov (United States)

    Dolan, James G; Cherkasky, Olena A; Chin, Nancy; Veazie, Peter J

    2015-11-01

    Conscious and unconscious biases can influence how people interpret new information and make decisions. Current standards for creating decision aids, however, do not address this issue. Using a 2×2 factorial design, we developed surveys that contained a decision scenario (involving a choice between aspirin or a statin drug to lower risk of heart attack) and a decision aid. Each aid presented identical information about reduction in heart attack risk and likelihood of a major side effect. They differed in whether the options were labeled and the amount of decisional guidance: information only (a balance sheet) versus information plus values clarification (a multicriteria decision analysis). We sent the surveys to members of 2 Internet survey panels. After using the decision aid, participants indicated their preferred medication. Those using a multicriteria decision aid also judged differences in the comparative outcome data provided for the 2 options and the relative importance of achieving benefits versus avoiding risks in making the decision. The study sample size was 536. Participants using decision aids with unlabeled options were more likely to choose a statin: 56% versus 25% (P < 0.001). The type of decision aid made no difference. This effect persisted after adjustment for differences in survey company, age, gender, education level, health literacy, and numeracy. Participants using unlabeled decision aids were also more likely to interpret the data presented as favoring a statin with regard to both treatment benefits and risk of side effects (P ≤ 0.01). There were no significant differences in decision priorities (P = 0.21). Identifying the options in patient decision aids can influence patient preferences and change how they interpret comparative outcome data. © The Author(s) 2015.

  8. Regulatory decision making by decision analyses

    International Nuclear Information System (INIS)

    Holmberg, J.; Pulkkinen, U.

    1993-11-01

    The Technical Research Centre of Finland (VTT) has studied with the Finnish Centre for Radiation and Nuclear Safety (STUK) the applicability of decision analytic approach to the treatment of nuclear safety related problems at the regulatory body. The role of probabilistic safety assessment (PSA) in decision making has also been discussed. In the study, inspectors from STUK exercised with a decision analytic approach by reoperationalizing two occurred and solved problems. The research scientist from VTT acted as systems analysts guiding the analysis process. The first case was related to a common cause failure phenomenon in solenoid valves controlling pneumatic valves important to safety of the plant. The problem of the regulatory body was to judge whether to allow continued operation or to require more detailed inspections and in which time chedule the inspections should be done. The latter problem was to evaluate design changes of external electrical grid connections after a fire incident had revealed weakness in the separation of electrical system. In both cases, the decision analysis was carried out several sessions in which decision makers, technical experts as well as experts of decision analysis participated. A multi-attribute value function was applied as a decision model so that attributes had to be defined to quantify the levels of achievements of the objectives. The attributes included both indicators related to the level of operational safety of the plant such as core damage frequency given by PSA, and indicators related to the safety culture, i.e., how well the chosen option fits on the regulatory policy. (24 refs., 6 figs., 9 tabs.)

  9. Deferred Personal Life Decisions of Women Physicians.

    Science.gov (United States)

    Bering, Jamie; Pflibsen, Lacey; Eno, Cassie; Radhakrishnan, Priya

    2018-03-12

    Inadequate work-life balance can have significant implications regarding individual performance, retention, and on the future of the workforce in medicine. The purpose of this study was to determine whether women physicians defer personal life decisions in pursuit of their medical career. We conducted a survey study of women physicians ages 20-80 from various medical specialties using a combination of social media platforms and women physicians' professional listservs with 801 survey responses collected from May through November 2015. The primary endpoint was whether women physicians deferred personal life decisions in pursuit of their medical career. Secondary outcomes include types of decisions deferred and correlations with age, hours worked per week, specialty, number of children, and career satisfaction. Respondents were categorized into deferred and nondeferred groups. Personal decision deferments were reported by 64% of respondents. Of these, 86% reported waiting to have children and 22% reported waiting to get married. Finally, while 85% of women in the nondeferment group would choose medicine again as a career, only 71% of women in the deferment group would do so (p work-life balance, decreasing job satisfaction, and insurance/administrative burden. The results of this survey have significant implications on the future of the workforce in medicine. Overall, our analysis shows that 64% of women physicians defer important life decisions in pursuit of their medical career. With an increase in the number of women physicians entering the workforce, lack of support and deferred personal decisions have a potential negative impact on individual performance and retention. Employers must consider the economic impact and potential workforce shortages that may develop if these issues are not addressed.

  10. Risk communication in practice: the contribution of decision aids

    OpenAIRE

    O'Connor, Annette M; Légaré, France; Stacey, Dawn

    2003-01-01

    As patients want to participate more in decision making, and as the range of medical options expands, clinicians are challenged to improve their communication of risk and supportive skills. Are practitioners' counselling skills up to the job?

  11. Info-gap decision theory decisions under severe uncertainty

    CERN Document Server

    Ben-Haim, Yakov

    2006-01-01

    Everyone makes decisions, but not everyone is a decision analyst. A decision analyst uses quantitative models and computational methods to formulate decision algorithms, assess decision performance, identify and evaluate options, determine trade-offs and risks, evaluate strategies for investigation, and so on. This book is written for decision analysts. The term ""decision analyst"" covers an extremely broad range of practitioners. Virtually all engineers involved in design (of buildings, machines, processes, etc.) or analysis (of safety, reliability, feasibility, etc.) are decision analysts,

  12. Learning decision making through serious games.

    Science.gov (United States)

    Kaczmarczyk, Joseph; Davidson, Richard; Bryden, Daniele; Haselden, Stephen; Vivekananda-Schmidt, Pirashanthie

    2016-08-01

    In Serious Games (SGs), educational content is integrated into a game so that learning is intrinsic to play, thereby motivating players and improving engagement. SGs enable learning by developing situated understanding in users and by enabling players to practise safe clinical decision making; however, the use of SGs in medical education is not well established. We aimed to design a game-based resource to teach clinical decision making to medical students, and to assess user perceptions of educational value, usability and the role for SGs in undergraduate training. An SG focusing on the acute management of tachyarrhythmias was developed. Third- and fourth-year medical students at the medical school were invited to use and evaluate the game using questionnaires and focus groups. We invited 479 students, and 281 accessed the game. Only 47 students completed the questionnaire and 31 students participated in the focus groups. The data suggest that SGs: (1) can allow students to rehearse taking responsibility for decision making; (2) are fun and motivational; (3) have a role in revising and consolidating knowledge; and (4) could be formative assessment tools. Serious Games enable learning by developing situated understanding in users SGs could be employed as adjuvant learning resources to develop students' skills and knowledge. Further empirical research is required to assess the added value of games in medical education. © 2015 John Wiley & Sons Ltd.

  13. Shared decision-making in Israel: status, barriers, and recommendations

    OpenAIRE

    Miron-Shatz, Talya; Golan, Ofra; Brezis, Mayer; Siegal, Gil; Doniger, Glen M

    2012-01-01

    Abstract Shared decision making (SDM) - involving patients in decisions relevant to their health - has been increasingly influential in medical thought and practice around the world. This paper reviews the current status of SDM in Israel, including efforts to promote SDM in the legislation and healthcare system, its influence in medical training and the national health plans, and funding for SDM-related research. Published studies of SDM in Israel are also reviewed. Although informed consent ...

  14. Feasibility of web-based decision aids in neurological patients

    NARCIS (Netherlands)

    van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

    2010-01-01

    Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

  15. Evaluating Ethical Responsibility in Inverse Decision Support

    Directory of Open Access Journals (Sweden)

    Ahmad M. Kabil

    2012-01-01

    Full Text Available Decision makers have considerable autonomy on how they make decisions and what type of support they receive. This situation places the DSS analyst in a different relationship with the client than his colleagues who support regular MIS applications. This paper addresses an ethical dilemma in “Inverse Decision Support,” when the analyst supports a decision maker who requires justification for a preconceived selection that does not correspond to the best option that resulted from the professional resolution of the problem. An extended application of the AHP model is proposed for evaluating the ethical responsibility in selecting a suboptimal alternative. The extended application is consistent with the Inverse Decision Theory that is used extensively in medical decision making. A survey of decision analysts is used to assess their perspective of using the proposed extended application. The results show that 80% of the respondents felt that the proposed extended application is useful in business practices. 14% of them expanded the usability of the extended application to academic teaching of the ethics theory. The extended application is considered more usable in a country with a higher Transparency International Corruption Perceptions Index (TICPI than in a country with a lower one.

  16. Handbook on Decision Making

    CERN Document Server

    Jain, Lakhmi C

    2010-01-01

    The present "Volume 1: Techniques and Applications" of the "Handbook on Decision Making" presents a useful collection of AI techniques, as well as other complementary methodologies, that are useful for the design and development of intelligent decision support systems. Application examples of how these intelligent decision support systems can be utilized to help tackle a variety of real-world problems in different domains, such as business, management, manufacturing, transportation and food industries, and biomedicine, are presented. The handbook includes twenty condensed c

  17. Continuous Decision Support

    Science.gov (United States)

    2015-12-24

    The International Journal of Multicriteria Decision Making describing the Triage Method • Chapter 4 contains a paper published in 2014 in The...International Journal of Multicriteria Decision Making describing extensions to the Triage Method to consider resource constraints • Chapter 5 contains a...was under review by The International Journal of Multicriteria Decision Making 7 • Chapter 6 contains a paper describing methods for eliciting

  18. Decision analysis multicriteria analysis

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    The ALARA procedure covers a wide range of decisions from the simplest to the most complex one. For the simplest one the engineering judgement is generally enough and the use of a decision aiding technique is therefore not necessary. For some decisions the comparison of the available protection option may be performed from two or a few criteria (or attributes) (protection cost, collective dose,...) and the use of rather simple decision aiding techniques, like the Cost Effectiveness Analysis or the Cost Benefit Analysis, is quite enough. For the more complex decisions, involving numerous criteria or for decisions involving large uncertainties or qualitative judgement the use of these techniques, even the extended cost benefit analysis, is not recommended and appropriate techniques like multi-attribute decision aiding techniques are more relevant. There is a lot of such particular techniques and it is not possible to present all of them. Therefore only two broad categories of multi-attribute decision aiding techniques will b