scholarly journals Invited Commentary: Opportunities That Come With Studying the Co-Occurrence of Multiple Outcomes

2020 ◽  
Vol 189 (9) ◽  
pp. 982-984 ◽  
Author(s):  
Sebastien Haneuse ◽  
Deborah Schrag ◽  
Daniel Nevo
Keyword(s):  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Settings ◽  
Care Providers ◽  
Additional Information ◽  
Potential Benefits ◽  
Almost All

Abstract In almost all clinical settings, patients are at risk for multiple potential events and, in consultation with health-care providers, must weigh the potential benefits and harms across these events when making decisions. As researchers seek to build an evidence base to inform these decisions, they must contend with a choice as to how they will handle the different events. One approach, arguably the standard approach in the literature, is to consider the events individually by conducting analyses and publishing results for each one at a time. Doing so, however, fails to acknowledge or exploit the inherent multivariate nature of the data, represents a lost opportunity, and results in an evidence base that is not aligned with how clinical decision-making is actually performed. The article by Prentice et al. (Am J Epidemiol. 2020;189(9):972–981) in this issue of the Journal moves beyond this standard by illustrating recently developed methods that directly take advantage of information on the co-occurrence of multiple events. Moreover, their article highlights the role of modern methods in deriving additional information and insight from studies of multiple clinical outcomes by making full use of multivariate data, with the goal being to complement, not replace, existing methods.

mHealth in clinical decision-making: A systematic literature review (Preprint)

2019 ◽  
Author(s):  
Amandeep Dhir
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Future Research ◽  
Care Providers ◽  
Rigorous Approach ◽  
Almost All ◽  
Mhealth Apps

UNSTRUCTURED A large number of mHealth apps are available nowadays for patients and health care providers. Many of those apps are designed specifically for clinical decision making (CDM). Despite their proliferation, limited studies have examined the utilization and effectiveness of these apps. The current study undertakes a systematic review to organize and synthesize the extant literature on mHealth for CDM in all resource settings. A thorough search of databases resulted in a preliminary list of 1,313 titles and abstracts, of which 1,107 were excluded as they were either duplicates or irrelevant to the scope of the study. Thereafter, full-text screening of the remaining 206 articles was performed, and 175 were excluded on the basis of pre-specified inclusion/exclusion criteria. This rigorous approach resulted in the identification of 31 studies for inclusion in the review. The utilization of mHealth for CDM appears to have pervaded almost all health care settings, as demonstrated by the insights gleaned from the review of the prior studies in the domain. However, the evidence of effectiveness is still limited and unreliable, which underscores the existence of a paucity of accumulated knowledge that, in turn, invites interesting opportunities for future research.

Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs

2019 ◽  
Vol 25 (1) ◽  
pp. 3-6 ◽  
Author(s):  
Manas A. Rane ◽  
Alexander Gitin ◽  
Benjamin Fiedler ◽  
Lawrence Fiedler ◽  
Charles H. Hennekens
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Relieve Pain ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, diclofenac, and ibuprofen, as well as selective cyclooxygenase 2 inhibitors such as celecoxib. Their use is common, as well as their side effects which cause 100 000 hospitalizations and 17 000 deaths annually. Recently, the US Food and Drug Administration strengthened its warning about the risks of cardiovascular disease (CVD) attributed to nonaspirin NSAIDs. Methods: When the sample size is large, randomization provides control of confounding not possible to achieve with any observational study. Further, observational studies and, especially, claims data have inherent confounding by indication larger than the small to moderate effects being sought. Results: While trials are necessary, they must be of sufficient size and duration and achieve high compliance and follow-up. Until then, clinicians should remain uncertain about benefits and risks of these drugs. Conclusions: Since the totality of evidence remains incomplete, health-care providers should consider all these aforementioned benefits and risks, both CVD and beyond, in deciding whether and, if so, which, NSAID to prescribe. The factors in the decision of whether and, if so, which NSAID to prescribe for relief of pain from inflammatory arthritis should not be limited to risks of CVD or gastrointestinal side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.

Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice

2016 ◽  
Vol 25 (4) ◽  
pp. 453-469 ◽  
Author(s):  
Jennifer Horner ◽  
Maria Modayil ◽  
Laura Roche Chapman ◽  
An Dinh
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Legal Advice ◽  
Medical Context

PurposeWhen patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice.MethodThe authors use a hypothetical case of a “noncompliant” individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient–practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy.ConclusionsSpeech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

Affect and Clinical Decision-Making

2018 ◽  
Author(s):  
Jane Heyhoe ◽  
Rebecca Lawton
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Clinical Decision ◽  
Evidence Base ◽  
Empirical Literature ◽  
Affective States ◽  
Psychological Models ◽  
The Individual

In the chapter “Affect and Clinical Decision-Making,” theoretical and empirical literature from within and outside healthcare are drawn on to understand the role of affect in clinical decision-making at the individual and team level. Theories of individual decision-making are summarized and psychological models of decision-making and current knowledge of thought processes are presented to explain the role of affect in judgment and behavior in healthcare settings. Three types of affect: anticipatory affect, incidental affect, and anticipated affect are discussed in detail and used to illustrate how affective states may play a role in different clinical contexts and settings. Gaps in the existing evidence base are identified, and suggestions are made for interventions that might support health professionals to make better decisions.

scholarly journals The difference between a clinical technician and clinical practitioner is in the scope of practice: the need for a bioscience understanding in paramedicine

2019 ◽  
Vol 43 (4) ◽  
pp. 541-545
Author(s):  
Joseph A. Rathner ◽  
Christine Kettle
Keyword(s):  
Health Care Providers ◽  
Allied Health ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Complex Case ◽  
Care Providers ◽  
Anatomy And Physiology ◽  
Coronary Syndrome ◽  
The Difference

“Only teach me what I need to know!” This commonly heard refrain is often spoken by allied health students while studying preclinical sciences (physiology, anatomy, pharmacology). Here we use a clinical scenario undertaken by second-year Bachelor of Paramedic Practice students of acute coronary syndrome to demonstrate the difference in clinical decision making when using a clinical reasoning approach to treatment rather than relying exclusively on a practice guidelines approach. We hope to demonstrate that understanding basic bioscience concepts, such as the Frank-Starling mechanism and the anatomy and physiology of the autonomic nervous system, are key to providing good clinical care in response to ambiguous patient symptoms. Students who understand these concepts underlying their patient care guideline will make better clinical decisions and better provide quality of care than students who follow the guideline exclusively. We aim this as a practical demonstration of the value of detailed understanding of human bioscience in allied health education. As health care providers transition from “technician” to “practitioner,” the key distinguishing feature of the role is the ability to practice independently, using “best judgment” rather than clinical guidelines (alone). Evidence suggests that complex case management requires detailed bioscience understanding.

The role of MRI and CT for diagnosis and work-up in suspected ACS

Diagnosis ◽  
2016 ◽  
Vol 3 (4) ◽  
pp. 143-154 ◽  
Author(s):  
Florian André ◽  
Sebastian J. Buss ◽  
Matthias G. Friedrich
Keyword(s):  
Clinical Utility ◽  
Clinical Decision Making ◽  
Cardiac Computed Tomography ◽  
Clinical Decision ◽  
Clinical Settings ◽  
Coronary Syndrome ◽  
Current State ◽  
Diagnostic Work ◽  
Work Up

AbstractThis article describes the role of cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) in the diagnostic work-up of patients with suspected acute coronary syndrome (ACS). Recent studies on the principles, diagnostic targets, clinical utility, accuracy, prognostic relevance and implications for clinical decision-making are discussed and current state-of-the-art and novel approaches are presented. The authors recognize that in ACS, time is of the essence and therefore put a special emphasis on the feasibility of tomographic cardiac imaging in realistic clinical settings.

Supporting the transition from pre-dialysis to end-stage renal failure

2020 ◽  
Vol 5 (5) ◽  
pp. 206-210
Author(s):  
Eoghan McDermott ◽  
Roseline Agyekum
Keyword(s):  
Renal Failure ◽  
Clinical Decision Making ◽  
Research Question ◽  
Clinical Decision ◽  
Evidence Base ◽  
End Stage Renal Failure ◽  
Additional Information ◽  
Ckd Stage ◽  
The Individual ◽  
End Stage

Renal replacement therapy (RRT) is a life-saving therapy for those with chronic kidney disease (CKD) stage 5 or end-stage renal failure (ESRF)—defined as an estimated Glomerular Filtration Rate of less than 15 ml/min/1.73 m2. RRT has a profound impact on quality of life (QoL), dependent on the preparation for and timing of therapy initiation; the mode of RRT selected; and the individual's age, health, and priorities. This article explores the transition to RRT, directed by the research question, ‘How does the evidence base inform clinical decision-making when supporting CKD patients’ transition from pre-dialysis to management of ESRF?'. The discussion of these critical decisions, including timing, modality and potential of dialysis to benefit the individual, is framed by their effect on QoL as dialysis is established. There are many other aspects concerning the transition to RRT, which are not discussed, but the reader is signposted to additional information sources.

Pitfalls Associated With Antibiograms

2008 ◽  
Vol 21 (5) ◽  
pp. 319-323 ◽  
Author(s):  
Edward H. Eiland ◽  
Christopher Ryan Dunne ◽  
William Lindgren
Keyword(s):  
Patient Outcomes ◽  
Health Care Providers ◽  
Bacterial Resistance ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Systems ◽  
Care Providers ◽  
Antimicrobial Susceptibility Test ◽  
Critical Care Units ◽  
Correct Analysis

An accurate, appropriately collated antibiogram represents an integral resource for health care providers when assessing bacterial resistance and guiding antimicrobial selection and formulary decisions. Interpretation of bacterial susceptibility statistics is problematic yet frequent and unrecognized pitfalls may be avoided by following the M39-A2 guidelines to ensure correct analysis and presentation of cumulative antimicrobial susceptibility test data. This review addresses guideline recommendations related to antibiogram development, CLSI breakpoint interpretation, antimicrobial inclusion decisions, and the avoidance of duplicate and surveillance isolates. Unit-specific antibiograms in critical care units is encouraged for differentiation between hospital-wide ecology and these specific areas harboring more resistant pathogens. Antibiograms cannot track the emergence of microbial resistance during therapy and discrepancies exist between automated microbiology surveillance systems and their agreement with manual surveillance methods. When striving to improve overall patient outcomes, the use of a well-produced and disseminated antibiogram helps guide clinical decision making for patients requiring antimicrobial therapy.

scholarly journals Clinical decision-making approaches by health caregivers of patients with COVID-19

2020 ◽  
Vol 7 (10) ◽  
pp. 4056-4057
Author(s):  
Mohsen Taghadosi ◽  
Neda Mirbagher Ajorpaz ◽  
Mohammad Aghajani
Keyword(s):  
Decision Making ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Quality Care ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
World Health ◽  
Care Providers ◽  
Health Crisis ◽  
The World

The Coronavirus disease of 2019 COVID-19) is the current health crisis in the world- a new, complex phenomenon that has affected and hospitalized many people around the world. Health care providers deal with COVID-19 patients daily and care for the patients while there is no definitive cure for it. Clinical decision-making is an important task of health professionals that plays an essential role in preserving the patient's life and providing quality care. Therefore, understanding clinical decision-making approaches by healthcare providers, such as nurses and physicians, especially in crises such as COVID-19, is essential.

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