Search results for "decision"
showing 10 items of 2091 documents
A systematic approach to medical decision-making of uncommon clinical pictures: A case of ulcerative skin lesions by palm tree thorn injury and a one…
2005
In clinical practice, the clinician is challenged with symptoms and/or signs at times apparently insoluble by diagnostic and/ or therapeutic means. We propose that in these cases, we have to use an EBM approach in which evidence may be looked up in every available clinical report and bibliographic databases are used for searching that evidence. We report on a case of ulcerative skin lesions apparently insoluble by expert dermatologists following a conventional diagnostic and therapeutic process. We use this case report for illustrating a systematic approach to resolve diagnostic and therapeutic questions using a bibliographic database search (like MEDLINE and EMBASE). Both a systematic appr…
Nurses' decision-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting.
2019
To describe nurses' decision-making, practices and perceptions of patient involvement in medication administration in acute hospital settings.Medication errors cause unintended harm to patients. Nurses have a major role in ensuring patient safety in medication administration practices in hospital settings. Investigating nurses' medication administration decision-making and practices and their perceptions of patient involvement, may assist in developing interventions by revealing how and when to involve patients during medication administration in hospital.A descriptive exploratory study design.Twenty nurses were recruited from two surgical and two medical wards of a major metropolitan hospi…
Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: interim analysis of a multicentric pro…
2012
Purpose: To study the accuracy of different cutoffs for an involved circumferential resection margin (CRM) compared with T and N categories measured by MRI as basis for selective application of neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma. Materials and Methods: In a prospective multicenter observational study involving 153 primarily operated patients, the preoperative results of MRI with pathohistological findings of resected specimens were compared. Results: For a cutoff of ≤1 mm for involvement of the CRM, the accuracy of preoperative MRI was 90.9% (139/153). The negative predictive value was 98.5% (134/136). The four participating departments did not differ significantly. Fo…
Evaluation of surgical decision making and resulting outcome in patients with highly eloquent glioblastoma: Results of a multicenter assessment.
2017
Treatment of glioblastoma(GB) patients amenable only for a subtotal resection(STR) is controversial. Since outcome of patients is affected by surgical management, our aim was to assess surgical decision making and resulting outcome in patients with highly eloquent GBs.We retrospectively assessed GB patients with intended sub-total resection (STR) or stereotactic biopsy (STX) of 3 neurooncological centers operated between 2008 and 2013. A volumetric assessment of overall extent of resection(oEoR), presence of complications, new permanent neurological deficits(nPNDs) was performed. A central reviewer reassessed all cases blinded and gave recommendation on surgical management and on a potentia…
Focal breast lesion characterization according to the BI-RADS US lexicon: role of a computer-aided decision-making support
2018
Objectives: to assess the diagnostic performance of a computer-guided decision- making software (S-Detect) in the US characterization of focal breast lesions (FBLs), according to the radiologist's experience. Materials and Methods: 300 FBLs (size: 2.6-47.2 mm; mean: 13.2 mm) in 255 patients (mean age: 51 years) were prospectively assessed in consensus according to BIRADS US lexicon by two experienced radiologists without and with S-Detect; to evaluate intra and inter-observer agreement, the same 300 FBLs were independently evaluated by two residents at baseline and after 3 months. Results: 120/300 (40%) FBLs were malignant, 2/300 (0.7%) high-risk and 178/300 (59.3%) benign. Experts review s…
Characteristics and determinants of patient burden and needs in the treatment of chronic spontaneous urticaria
2019
Objectives: Treatment of chronic spontaneous urticaria (CSU) is based on evidence-based guidelines. However, specific patient needs and benefits from therapy have not been differentiated on the guideline level. The current study was designed to use the first part of the PBI, the PNQ, to characterize[for full text, please go to the a.m. URL]
Defer or treat? Reasons for treatment decisions in patients with chronic hepatitis C genotype 1 in the early era of directly acting antiviral agents
2013
Abstract Background In chronic genotype 1 hepatitis C, telaprevir or boceprevir plus peginterferon and ribavirin have become the new standard of care. Aim of this study was to identify factors contributing to the decision whether to defer or treat with the current triple regimens. Methods Prospective assessment of eight parameters on 0-4-point scales by the attending physician at a German tertiary referral centre between 1st September 2011 and 31st December 2012. Results 307 patients were evaluated at least once by one of the 11 hepatologists involved; 267 patients were considered, but only 163 were recommended to receive triple therapy. Multivariate regression analysis revealed that a high…
A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.
2011
SUMMARYOptimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3without experiencing AIDS or death. For patients with a baseline HIV viral load ⩾5 log10copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ⩾500/mm3than…
Poor estimates of motor variability are associated with longer grooved pegboard times for middle-aged and older adults
2018
Goal-directed movements that involve greater motor variability are performed with an increased risk that the intended goal will not be achieved. The ability to estimate motor variability during such actions varies across individuals and influences how people decide to move about their environment. The purpose of our study was to identify the decision-making strategies used by middle-aged and older adults when performing two goal-directed motor tasks and to determine if these strategies were associated with the time to complete the grooved pegboard test. Twenty-one middle-aged (48 ± 6 yr; range 40–59 yr, 15 women) and 20 older adults (73 ± 4 yr; range 65–79 yr, 8 women) performed two target…
Personalized Goal for Dyspnea and Clinical Response in Advanced Cancer Patients
2018
Abstract Background The clinical response after comprehensive symptom management is difficult to determine in terms of a clinically important difference. Moreover, therapies should try to reach the threshold perceived by the individual patient for the determination of a favorable response to a treatment. Measures The Edmonton Symptom Assessment Score (ESAS) was measured at admission (T0), and seven days after starting palliative care (T7). Patient Global Impression and Goal Response after one week of palliative care and its relation with the Personalized Dyspnea Goal were measured at T7. Intervention Patients admitted to palliative care units underwent a comprehensive symptom assessment by …