scholarly journals Hyperprolactinaemia: A guide for psychiatrists

2017 ◽  
Vol 23 (3) ◽  
pp. 158-166 ◽  
Author(s):  
Ovais Wadoo ◽  
Aadil Jan Shah ◽  
Rachael Hall ◽  
Yaasir Mamoojee
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Adverse Effects ◽  
Elevated Serum ◽  
Learning Objectives ◽  
Flow Diagram ◽  
Serum Prolactin ◽  
Elevate Serum ◽  
Adverse Health Outcomes ◽  
And Function

SummaryMedications prescribed by psychiatrists are known to elevate serum prolactin levels, but hyperprolactinaemia remains underrecognised, as the adverse effects of an elevated prolactin are mostly not visible. Hyperprolactinaemia can lead to adverse health outcomes, so clinicians need not only to be alert to its symptoms, but to manage the consequences as well. In this article we provide a brief overview of prolactin physiology, regulation and function. We list various factors that can lead to elevated serum prolactin. We discuss the interpretation of blood results and the management of psychotropic-induced hyperprolactinaemia. We include a flow diagram to assist clinicians in decision-making in the clinical management of hyperprolactinaemia.Learning Objectives• Understand prolactin physiology and regulation• Understand hyperprolactinaemia and its causes• Know the consequences of hyperprolactinaemia and appropriately manage it in clinical practice

scholarly journals High-dose antipsychotics: addressing patients' resistance to physical health monitoring

2015 ◽  
Vol 21 (2) ◽  
pp. 88-97
Author(s):  
Paula Marie Murphy ◽  
Andrew Iles ◽  
Suja Sreedharan
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Physical Health ◽  
Health Monitoring ◽  
Flow Diagram ◽  
High Dose ◽  
Strict Adherence ◽  
Legal Implications ◽  
Case Vignettes

SummaryHigh-dose antipsychotics are sometimes used in clinical practice when patients fail to respond to treatment at standard doses. Owing to the potential physical complications associated with this, strict adherence to physical health monitoring is essential. Challenges arise for clinicians when patients refuse to cooperate with this monitoring. We discuss different interventions to overcome this problem, many of which are coercive in nature, and consider their professional, ethical and legal implications. We include a flow diagram to assist clinicians in their documentation and decision-making in these circumstances as well as case vignettes showing when monitoring under restraint is and is not justifiable.

El debriefing, aprendizaje reflexivo en la simulación interprofesional

2019 ◽  
Vol 62 (0) ◽  
pp. 45-53
Author(s):  
Hugo E. Olvera ◽  
Argimira Vianey Barona Nuñez ◽  
Laura S. Hernández Gutiérrez ◽  
Erick López León
Keyword(s):  
Clinical Practice ◽  
Communication Skills ◽  
Learning Objectives ◽  
Complex Activity ◽  
Learning Space ◽  
Daily Lives ◽  
Reaction Phase ◽  
Analysis Phase ◽  
Simulation Scenario ◽  
Basic Standards

In the field of interprofessional simulation, an important element for achieving the stated objectives of the simulation scenario is the debriefing. The debriefing is a complex activity that requires certain skills, experience and knowledge from the facilitator or facilitators, who are known as debriefer/s. Their function is to make the participants reflect on the reasons for their actions, their decisions, and how they acted as a team or individually. Its purpose is the acquisition of a significant learning (achieving the learning objectives) that can subsequently be applied in their daily lives. The interprofessional debriefing styles are varied, but basically its structure integrates: a reaction phase, an analysis phase and an application phase; keeping in mind that the basic standards must be maintained when carrying out a debriefing: time, the construction of a safe learning space, identification, and the closure of knowledge gaps. The advantages of performing an interprofessional debriefing goes beyond the objectives of the simulation, since it favors the acquisition of effective communication skills, teamwork, leadership, the notion of error, etc., which can later be applied in the daily clinical practice.

An introduction to advance care planning: practice at the frontline

2018 ◽  
Author(s):  
Anjali Mullick ◽  
Jonathan Martin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Communication Skills ◽  
Advance Care Planning ◽  
Use Case ◽  
Care Planning ◽  
Practical Advice ◽  
Future Care ◽  
Case Vignettes ◽  
Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

Anatomy for Dental Students

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Clinical Practice ◽  
Dental Students ◽  
Multiple Choice Questions ◽  
Developmental Anatomy ◽  
Form And Function ◽  
Full Color ◽  
Online Resource ◽  
The Central Nervous System ◽  
And Function ◽  
Key Resources

Anatomy for Dental Students, Fourth Edition, demonstrates and explains all the anatomy needed for a modern dentistry undergraduate course. This text covers developmental anatomy, the thorax, the central nervous system, and the head and neck with an emphasis on the practical application of anatomical knowledge. This new edition has been extensively revised and updated in line with contemporary teaching and dental practice. Over 300 new full color diagrams map all the anatomical regions that dental students need to know, while the lively and accesible text guides the reader's learning. Throughout Clinical Application Boxes demonstrate how the form and function of anatomy have consequences for clinical practice. Sidelines boxes contain additional descriptions for key anatomical structures. This text is supported by an Online Resource Centre with multiple choice questions, drag and drop figure exercises, and links to key resources to help readers to consolidate and extend their knowledge of anatomy. Anatomy for Dental Students brings together anatomical structure, function, and their relationship to clinical practice, making it ideal for dental students.

scholarly journals Text Classification in Clinical Practice Guidelines Using Machine-Learning Assisted Pattern-Based Approach

2021 ◽  
Vol 11 (8) ◽  
pp. 3296
Author(s):  
Musarrat Hussain ◽  
Jamil Hussain ◽  
Taqdir Ali ◽  
Syed Imran Ali ◽  
Hafiz Syed Muhammad Bilal ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Machine Learning Algorithms ◽  
Nominal Group ◽  
Specific Information ◽  
Matching Techniques ◽  
Disease Specific

Clinical Practice Guidelines (CPGs) aim to optimize patient care by assisting physicians during the decision-making process. However, guideline adherence is highly affected by its unstructured format and aggregation of background information with disease-specific information. The objective of our study is to extract disease-specific information from CPG for enhancing its adherence ratio. In this research, we propose a semi-automatic mechanism for extracting disease-specific information from CPGs using pattern-matching techniques. We apply supervised and unsupervised machine-learning algorithms on CPG to extract a list of salient terms contributing to distinguishing recommendation sentences (RS) from non-recommendation sentences (NRS). Simultaneously, a group of experts also analyzes the same CPG and extract the initial patterns “Heuristic Patterns” using a group decision-making method, nominal group technique (NGT). We provide the list of salient terms to the experts and ask them to refine their extracted patterns. The experts refine patterns considering the provided salient terms. The extracted heuristic patterns depend on specific terms and suffer from the specialization problem due to synonymy and polysemy. Therefore, we generalize the heuristic patterns to part-of-speech (POS) patterns and unified medical language system (UMLS) patterns, which make the proposed method generalize for all types of CPGs. We evaluated the initial extracted patterns on asthma, rhinosinusitis, and hypertension guidelines with the accuracy of 76.92%, 84.63%, and 89.16%, respectively. The accuracy increased to 78.89%, 85.32%, and 92.07% with refined machine-learning assistive patterns, respectively. Our system assists physicians by locating disease-specific information in the CPGs, which enhances the physicians’ performance and reduces CPG processing time. Additionally, it is beneficial in CPGs content annotation.

scholarly journals Applicability of somatic monitoring instructions in clinical practice guidelines on antipsychotic drug use

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jurriaan M. J. L. Brouwer ◽  
Erien Olde Hengel ◽  
Arne J. Risselada ◽  
Eric N. van Roon ◽  
Hans Mulder
Keyword(s):  
Clinical Practice ◽  
Drug Use ◽  
Adverse Effects ◽  
Antipsychotic Drug ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Frail Elderly ◽  
Antipsychotic Drugs ◽  
Electronic Database ◽  
Elderly Populations

Abstract Background Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use. Methods A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached. Results In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0–47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations. Conclusions We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.

scholarly journals Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

2021 ◽  
pp. 112972982198990
Author(s):  
Kulli Kuningas ◽  
Nicholas Inston
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Vascular Access ◽  
Clinical Condition ◽  
The Elderly ◽  
Dialysis Access ◽  
Adverse Health Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

Comparative study on e-bikes’ decision-making behaviors under flashing green and green countdown

2021 ◽  
pp. 1-8
Author(s):  
Haoyang Meng ◽  
Sheng Dong ◽  
Jibiao Zhou ◽  
Shuichao Zhang ◽  
Zhenjiang Li
Keyword(s):  
Decision Making ◽  
Critical Issue ◽  
Trajectory Data ◽  
Decision Points ◽  
Binary Logit ◽  
The One ◽  
Common Signal ◽  
And Function ◽  
Decision Behaviors ◽  
Stop Line

Green flash light (FG) and green countdown (GC) are the two most common signal formats applied in green-red transition that provides drivers additional alert before termination of green phase. Due to their importance and function in stop-pass decision-making process, proper use of them has become a critical issue to greatly improve the safety and efficiency of signalized intersections. Gradually e-bike riders have become more important commuters in China, however, the influence of FG or GC on them is not clear yet and need pay more attention to it. This study chooses two almost identical intersections to obtain highly accurate trajectory data of e-bike riders to study their decision-making behaviors under FG or GC. The e-bike riders’ behavior is classified into four categories and is to identify their stop-pass decision points using the acceleration trend. Two binary-logit models were built to predict the stop–pass decision behaviors for the different e-bike rider groups, explaining that the potential time to the stop-line is the dominant independent factor of the different behaviors of GC and FG. Furthermore empirical analysis of decision points indicated that GC provides the earlier stop-pass decision point and longer decision making duration on the one side while results in more complexity of decision making and greater risk of stop-line crossing than FG on the other side.

scholarly journals The use of multiple-criteria decision-making theory to measure students’ perceptions of high-fidelity simulation

2017 ◽  
Vol 3 (3) ◽  
pp. 88-93 ◽  
Author(s):  
Maureen Anne Jersby ◽  
Paul Van-Schaik ◽  
Stephen Green ◽  
Lili Nacheva-Skopalik
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Learning Experience ◽  
Clinical Decision ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Initial Exposure ◽  
Repeated Measures Design

BackgroundHigh-Fidelity Simulation (HFS) has great potential to improve decision-making in clinical practice. Previous studies have found HFS promotes self-confidence, but its effectiveness in clinical practice has not been established. The aim of this research is to establish if HFS facilitates learning that informs decision-making skills in clinical practice using MultipleCriteria DecisionMaking Theory (MCDMT).MethodsThe sample was 2nd year undergraduate pre-registration adult nursing students.MCDMT was used to measure the students’ experience of HFS and how it developed their clinical decision-making skills. MCDMT requires characteristic measurements which for the learning experience were based on five factors that underpin successful learning, and for clinical decision-making, an analytical framework was used. The study used a repeated-measures design to take two measurements: the first one after the first simulation experience and the second one after clinical placement. Baseline measurements were obtained from academics. Data were analysed using the MCDMT tool.ResultsAfter their initial exposure to simulation learning, students reported that HFS provides a high-quality learning experience (87%) and supports all aspects of clinical decision-making (85%). Following clinical practice, the level of support for clinical decision-making remained at 85%, suggesting that students believe HFS promotes transferability of knowledge to the practice setting.ConclusionOverall, students report a high level of support for learning and developing clinical decision-making skills from HFS. However, there are no comparative data available from classroom teaching of similar content so it cannot be established if these results are due to HFS alone.

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