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Crisis decision making

T Speer, T Mühlbradt, C Fastner, O Schöffski, S Schröder
Working in anesthesiology is characterized by a complex environment in which effective teamwork with different disciplines as well as other professions (e. g. nursing staff and surgical assistants) is crucial. Clinical risk management includes all steps to prevent incidents and patient harm. An example for this is simulation training based on crisis resource management (CRM). This training course focuses on teaching non-medical skills using simulation manikins in order to enable employees to maintain patient safety under the adverse, ever-changing and unfamiliar conditions of a medical emergency...
February 7, 2019: Der Anaesthesist
Günter Polt, Dietmar Weixler, Norbert Bauer
In palliative medicine planning in advance is important for critical care situations. It is highly significant to make useful and by the patient and his relatives desired decisions. These concern transport in a situation of crisis and the venue of death (either death at home or transfer to a hospital).In this study the effect of a new Emergency Information Form about the place of death was examined. The used Emergency Information Form enabled the patient to express a wish on transfer in the case of crisis in advance and communicate this wish to the Emergency system...
February 6, 2019: Wiener Medizinische Wochenschrift
Kurt Kroenke, Daniel P Alford, Charles Argoff, Bernard Canlas, Edward Covington, Joseph W Frank, Karl J Haake, Steven Hanling, W Michael Hooten, Stefan G Kertesz, Richard L Kravitz, Erin E Krebs, Steven P Stanos, Mark Sullivan
Background: A national crisis of opioid-related morbidity, mortality, and misuse has led to initiatives to address the appropriate role of opioids to treat pain. Deployment of a guideline from the Centers for Disease Control and Prevention to reduce the risks of opioid therapy has raised substantial clinical and public policy challenges. The agency anticipated implementation challenges and committed to reevaluating the guideline for intended and unintended effects on clinician and patient outcomes...
January 25, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
R Gotlieb, J Abitbol, J A How, I Ben-Brith, H A Abenhaim, S K Lau, M Basik, Z Rosberger, N Geva, W H Gotlieb, A Mintz
There is an absence of information on how physicians make surgical decisions, and on the effect of gender on the processing of information. A novel web based decision-matrix software was designed to trace experimentally the process of decision making in medical situations. The scenarios included a crisis and non-crisis simulation for endometrial cancer surgery. Gynecologic oncologists, fellows, and residents (42 male and 42 female) in Canada participated in this experiment. Overall, male physicians used more heuristics, whereas female physicians were more comprehensive in accessing clinical information (p < 0...
February 2019: Gynecologic Oncology Reports
Angela Branche, Olivia Neeser, Beat Mueller, Philipp Schuetz
PURPOSE OF REVIEW: There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data...
January 14, 2019: Current Opinion in Infectious Diseases
Nur-Ain Nadir, Danielle Hart, Michael Cassara, Joan Noelker, Tiffany Moadel, Miriam Kulkarni, Christopher S Sampson, Suzanne Bentley, Neel K Naik, Jessica Hernandez, Sara M Krzyzaniak, Steven Lai, Gregory Podolej, Christopher Strother
Introduction: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR). Methods: We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation...
January 2019: Western Journal of Emergency Medicine
Jesse Schnall, Dean Hayden, Dominic Wilkinson
Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions...
December 26, 2018: Developing World Bioethics
Yingying Yao, Chunmiao Zheng, Charles Andrews, Xin He, Aijing Zhang, Jie Liu
Groundwater supplies fresh water for drinking and irrigation and sustains the health of ecosystems. Although the serious consequences caused by unsustainable depletion of groundwater have been widely reported, restricting pumping in exhausted aquifers requires identifying alternative water sources, determining how much water can be made accessible to avert the groundwater crisis and formulating water allocation regulations to achieve regional water sustainability. It is perceived that groundwater management needs integrated action considering environmental and socioeconomic systems; however, how a coupled socio-environmental system can be captured and quantified, and how this scientific evaluation is elicited and structured in policy making and implementation processes are still unclear...
December 14, 2018: Science of the Total Environment
R Hammarlund, K A Crapanzano, L Luce, L Mulligan, K M Ward
Substance-use disorders are a public health crisis globally and carry with them significant morbidity and mortality. Stigma toward people who abuse these substances, as well as the internalization of that stigma by substance users, is widespread. In this review, we synthesized the available evidence for the role of perceived social stigma and self-stigma in people's willingness to seek treatment. While stigma may be frequently cited as a barrier to treatment in some samples, the degree of its impact on decision-making regarding treatment varied widely...
2018: Substance Abuse and Rehabilitation
Marilaeta Cindryani, I Made Gede Widnyana, I Gusti Ngurah Mahaalit Aribawa, Tjokorda Ga Senapathi
Background: Anesthesia crisis management (ACM) simulation would expose anesthesiology residents and trainees to dynamic emergencies that need quick yet effective responses to gain their core strength and capabilities as anesthesiologists. Our department had already employed ACM simulation into modules and practiced in examinations. The aim is to enhance professional working ethics and human responsibility in residents, which would be accomplished in semi-realistic simulation. This would be a useful tool for lecturers to evaluate current teaching methods and measure protégés in daily emergencies, which should be done better in continuous pattern...
2018: Advances in Medical Education and Practice
Joseph Arthur, Eduardo Bruera
The current opioid crisis has brought renewed attention and scrutiny to opioid prescriptions. When patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, untoward consequences can occur. New evidence suggests that patients with cancer might be at a higher risk of NMOU than was previously thought, but clinical evidence still supports the use of opioid analgesics as the gold standard to treat cancer-related pain, creating a dilemma in patient management. Clinicians are encouraged to adopt a universal precautions approach to patients with cancer receiving opioids, which includes screening all patients; discussing the risks, benefits, adverse effects and alternatives of opioid therapy; and providing education on safe use, storage and disposal...
December 4, 2018: Nature Reviews. Clinical Oncology
Perri Zeitz Ruckart, Adrienne S Ettinger, Mona Hanna-Attisha, Nicole Jones, Stephanie I Davis, Patrick N Breysse
CONTEXT: The City of Flint was already distressed because of decades of financial decline when an estimated 140 000 individuals were exposed to lead and other contaminants in drinking water. In April 2014, Flint's drinking water source was changed from Great Lakes' Lake Huron (which was provided by the Detroit Water and Sewerage Department) to the Flint River without necessary corrosion control treatment to prevent lead release from pipes and plumbing. Lead exposure can damage children's brains and nervous systems, lead to slow growth and development, and result in learning, behavior, hearing, and speech problems...
January 2019: Journal of Public Health Management and Practice: JPHMP
Alexandre Y Dombrovski, Michael N Hallquist, Vanessa M Brown, Jonathan Wilson, Katalin Szanto
BACKGROUND: Suicidal behavior is associated with impaired decision making in contexts of uncertainty. Existing studies, however, do not definitively address whether suidice attempers have 1) impairment in learning from experience or 2) impairment in choice based on comparison of estimated option values. Our reinforcement learning model-based behavioral study tested these hypotheses directly in middle-aged and older suicide attempters representative of those who die by suicide. METHODS: Two samples (sample 1, n = 135; sample 2, n = 125) of suicide attempters with depression (nattempters  = 54 and 39, respectively), suicide ideators, nonsuicidal patients with depression, and healthy control participants completed a probabilistic three-choice decision-making task...
October 18, 2018: Biological Psychiatry
David M Powell
The "sustainability crisis" in zoos and aquariums has been a sobering reminder of how limited our resources are for maintaining viable populations of species threatened with extinction. This, combined with increasing concern among the public about the value of zoos and aquariums, suggests that the zoological profession should engage in a thorough re-examination of our guiding principles, philosophies, and practices with regard to collection planning at global, regional, and institutional scales. An analysis of AZA cooperative breeding programs reveals that in order to make these populations viable, many more founders and tens of thousands more spaces for animals, either in existing facilities or new ones, are necessary if we want to maintain all of the species that are covered by cooperative breeding programs currently...
November 22, 2018: Zoo Biology
Chiara Lombardo, Mónica Santos, Tine Van Bortel, Robert Croos, Ella Arensman, Manaan Kar Ray
Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach. RESULTS: Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics...
November 19, 2018: BJPsych Bulletin
Aymo Brunetti
This paper analyses the role of economists in advising political agents. Based on the experience in the recent financial crisis, it starts with the important role of expectations management. Economists should make clear that precise forecasts are not possible but that application of economic principles and careful analysis of data and historical events can substantially improve political decisions. In order to be effective, economic advisors have to be aware of the first best as well as of the political feasibility of proposals...
2018: Swiss journal of economics and statistics
Marinus H Van Ijzendoorn, Miriam Steele, Pehr Granqvist
In the service of children's best interests, we argue for a sharpening of the evidentiary standards used in family court decision making, from preponderance of (occasionally substandard) evidence to "beyond a reasonable doubt." Second, we call for a move in child protection cases from static diagnoses (e.g., attachment classifications) to assessments of the potential for enhanced parenting. Finally, informed by the implications of the replication crisis in the biomedical and psychological sciences, we applaud the move of the attachment field forward to large-scale, collective research agendas and goals...
November 2018: Infant Mental Health Journal
Xiao-Tian Wang
Food, money, and time are exchangeable resources essential for survival and reproduction. Individuals live within finite budgets of these resources and make tradeoffs between money and time when making intertemporal choices between an immediate smaller reward and a delayed lager reward. In this paper, I examine signaling functions of blood glucose in regulating behaviors related to resource regulations beyond caloric metabolisms. These behavioral regulations include choices between energy expenditure and energy conservation, monetary intertemporal choices, and self-control in overcoming temptations...
2018: Frontiers in Psychology
Matthew K Laing, Kenneth W Tupper, Nadia Fairbairn
Adulteration of illicit drug supplies with synthetic opioids such as fentanyl has contributed to a dramatic rise in overdose morbidity and mortality in North America. One promising response to this crisis is the implementation of "drug checking" services. Drug checking encompasses a range of interventions used to assess the constituents of illicit drug samples, such as colour-spot testing, gas or liquid chromatography, and various methods of spectroscopy. Testing may be performed on-site at events or harm reduction service locales, performed independently by consumers, or sent to a centralized lab for analysis...
October 22, 2018: International Journal on Drug Policy
Stéphane Duhem, Sofian Berrouiguet, Christophe Debien, François Ducrocq, Anne Laure Demarty, Antoine Messiah, Philippe Courtet, Louis Jehel, Pierre Thomas, Dominique Deplanque, Thierry Danel, Michel Walter, Charles-Edouard Notredame, Guillaume Vaiva
INTRODUCTION: The early postattempt period is considered to be one of the most at-risk time windows for suicide reattempt or completion. Among the postcrisis prevention programmes developed to compensate for this risk, brief contact interventions (BCIs) have been proven to be efficient but not equally for each subpopulation of attempters. VigilanS is a region-wide programme that relies on an algorithmic system to tailor surveillance and BCI provisions to individuals discharged from the hospital after a suicide attempt...
October 23, 2018: BMJ Open
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