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https://read.qxmd.com/read/30773745/harm-reduction-philosophical-drivers-of-conceptual-tensions-and-ways-forward
#1
Sunny Jiao
Of the various debates surrounding harm reduction, a conceptual tension that perhaps has the most relevance for the provision of services is that of harm reduction as a technical solution versus a contextualized social practice. The aim of this paper was to examine this conceptual tension. First, the two perspectives will be presented through the use of examples. Second, philosophical drivers that serve to underpin and justify each perspective will be explicated at the level of the knowledge that we privilege; the ideologies that we subscribe to; and the interests that we stand to serve...
February 17, 2019: Nursing Inquiry
https://read.qxmd.com/read/30773608/birth-choices-for-women-in-a-positive-birth-after-caesarean-clinic-randomised-trial-of-alternative-shared-decision-support-strategies
#2
Michelle R Wise, Lynn Sadler, Brett Shorten, Kelly van der Westhuizen, Allison Shorten
BACKGROUND: Systematic approaches to information giving and decision support for women with previous caesarean sections are needed. AIM: To evaluate decision support within a 'real-world' shared decision-making model. METHODS: A pragmatic comparative effectiveness randomised trial in the Positive Birth After Caesarean Clinic. Women with one previous caesarean and singleton pregnancy <25 weeks were randomly allocated to standard Positive Birth After Caesarean care, or standard Positive Birth After Caesarean care plus a decision aid booklet...
February 18, 2019: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://read.qxmd.com/read/30771226/deprescribing-cholinesterase-inhibitors-and-memantine-in-dementia-guideline-summary
#3
Emily Reeve, Barbara Farrell, Wade Thompson, Nathan Herrmann, Ingrid Sketris, Parker J Magin, Lynn Chenoweth, Mary Gorman, Lyntara Quirke, Graeme Bethune, Sarah N Hilmer
INTRODUCTION: Cholinesterase inhibitors (ChEIs) and memantine are medications used to treat the symptoms of specific types of dementia. Their benefits and harms can change over time, particularly during long term use. Therefore, appropriate use of ChEIs and memantine involves both prescribing these medications to individuals who are likely to benefit, and deprescribing (withdrawing) them from individuals when the risks outweigh the benefits. We recently developed an evidence-based clinical practice guideline for deprescribing ChEIs and memantine, using robust international guideline development processes...
February 16, 2019: Medical Journal of Australia
https://read.qxmd.com/read/30768467/on-trust-and-shared-decision-making
#4
Alyse Wheelock
No abstract text is available yet for this article.
February 12, 2019: Academic Medicine: Journal of the Association of American Medical Colleges
https://read.qxmd.com/read/30768429/using-electronic-clinical-decision-support-in-patient-centered-medical-homes-to-improve-management-of-diabetes-in-primary-care-the-decide-study
#5
James Gill, Kathrin Kucharski, Barbara Turk, Chunshen Pan, Wenhui Wei
This prospective, randomized, real-world study aimed to examine the impact of electronic health record-based clinical decision support (CDS) tools on the management of diabetes in small- to medium-sized primary care practices participating in Delaware's patient-centered medical home project. Overall, use of CDS systems was associated with greater reductions from baseline in hemoglobin A1c and low-density lipoprotein cholesterol, and more patients achieving treatment goals. Physicians and staff reported that the CDS toolkit empowered them to be more involved in clinical decision-making, thereby helping to improve diabetes care...
February 13, 2019: Journal of Ambulatory Care Management
https://read.qxmd.com/read/30765491/glossary-of-health-equity-concepts-for-public-health-action-in-the-canadian-context
#6
Dianne Oickle, Connie Clement
Despite increased interest in addressing health equity through public health initiatives, practitioner and decision maker comprehension of core concepts is limited and inconsistent. Absence of a shared understanding of equity and related terminology contributes to lack of coordinated solutions as practitioners focus on individual level issues, unrelated to social justice. Taking action to decrease population health inequities requires a comprehension of where inequities are rooted, who is affected and interventions that consider the complexity of inequities being addressed...
February 14, 2019: Journal of Epidemiology and Community Health
https://read.qxmd.com/read/30765371/how-often-do-both-core-competencies-of-shared-decision-making-occur-in-family-medicine-teaching-clinics
#7
Gisèle Diendéré, Selma Chipenda Dansokho, Rhéa Rocque, Anne-Sophie Julien, France Légaré, Luc Côté, Sonia Mahmoudi, Philippe Jacob, Natalia Arias Casais, Laurie Pilote, Roland Grad, Anik M C Giguère, Holly O Witteman
OBJECTIVE: To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence. DESIGN: Qualitative and quantitative cross-sectional study. SETTING: Five university-affiliated family medicine teaching clinics across Quebec. PARTICIPANTS: Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old)...
February 2019: Canadian Family Physician Médecin de Famille Canadien
https://read.qxmd.com/read/30764810/cultural-safety-strategies-for-rural-indigenous-palliative-care-a-scoping-review
#8
Kaela Schill, Susana Caxaj
BACKGROUND: There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. METHODS: We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia...
February 14, 2019: BMC Palliative Care
https://read.qxmd.com/read/30764654/developing-and-testing-a-personalized-evidence-based-shared-decision-making-tool-for-stent-selection-in-percutaneous-coronary-intervention-using-a-pre-post-study-design
#9
Adnan K Chhatriwalla, Carole Decker, Elizabeth Gialde, Delwyn Catley, Kathy Goggin, Katie Jaschke, Philip Jones, Dave deBronkart, Tony Sun, John A Spertus
Background Drug-eluting stents reduce the risk of restenosis in patients undergoing percutaneous coronary intervention, but their use necessitates prolonged dual antiplatelet therapy, which increases costs and bleeding risk, and which may delay elective surgeries. While >80% of patients in the United States receive drug-eluting stents, less than a third report that their physicians discussed options with them. Methods and Results An individualized shared decision-making (SDM) tool for stent selection was designed and implemented at 2 US hospitals...
February 2019: Circulation. Cardiovascular Quality and Outcomes
https://read.qxmd.com/read/30764653/shared-decision-making-in-revascularization-decisions
#10
EDITORIAL
Laura D Scherer, Angela Fagerlin
No abstract text is available yet for this article.
February 2019: Circulation. Cardiovascular Quality and Outcomes
https://read.qxmd.com/read/30764651/prepared-study-a-study-of-shared-decision-making-for-coronary-artery-disease
#11
Jacob A Doll, W Schuyler Jones, Yuliya Lokhnygina, Sara Culpepper, Robin L Parks, Christy Calhoun, David H Au, Manesh R Patel
Background Guidelines recommend patient engagement in shared decision-making regarding coronary revascularization, but studies demonstrate poor patient understanding of risks, benefits, and alternatives. Effective strategies are needed to integrate informed patient preferences into clinical care, particularly for patients undergoing diagnostic coronary angiography. Methods and Results We developed a web-based decision aid to educate patients and survey their treatment preferences before angiography. We compared knowledge, attitudes, and preferences of 203 patients with and without use of the decision aid...
February 2019: Circulation. Cardiovascular Quality and Outcomes
https://read.qxmd.com/read/30764578/source-a-registry-based-prediction-model-for-overall-survival-in-patients-with-metastatic-oesophageal-or-gastric-cancer
#12
Héctor G van den Boorn, Ameen Abu-Hanna, Emil Ter Veer, Jessy Joy van Kleef, Florian Lordick, Michael Stahl, Jaffer A Ajani, Rosine Guimbaud, Se Hoon Park, Susan J Dutton, Yung-Jue Bang, Narikazu Boku, Nadia Haj Mohammad, Mirjam A G Sprangers, Rob H A Verhoeven, Aeilko H Zwinderman, Martijn G H van Oijen, Hanneke W M van Laarhoven
Prediction models are only sparsely available for metastatic oesophagogastric cancer. Because treatment in this setting is often preference-based, decision-making with the aid of a prediction model is wanted. The aim of this study is to construct a prediction model, called SOURCE, for the overall survival in patients with metastatic oesophagogastric cancer. Data from patients with metastatic oesophageal ( n = 8010) or gastric ( n = 4763) cancer diagnosed during 2005⁻2015 were retrieved from the nationwide Netherlands cancer registry...
February 5, 2019: Cancers
https://read.qxmd.com/read/30759696/hypofractionated-radiation-therapy-for-localized-prostate-cancer-executive-summary-of-an-astro-asco-and-aua-evidence-based-guideline
#13
Scott C Morgan, Karen Hoffman, D Andrew Loblaw, Mark K Buyyounouski, Caroline Patton, Daniel Barocas, Soren Bentzen, Michael Chang, Jason Efstathiou, Patrick Greany, Per Halvorsen, Bridget F Koontz, Colleen Lawton, C Marc Leyrer, Daniel Lin, Michael Ray, Howard Sandler
PURPOSE: The aim of this guideline is to present recommendations regarding moderately hypofractionated (240-340 cGy per fraction) and ultrahypofractionated (500 cGy or more per fraction) radiation therapy for localized prostate cancer. METHODS AND MATERIALS: The American Society for Radiation Oncology convened a task force to address 8 key questions on appropriate indications and dose-fractionation for moderately and ultrahypofractionated radiation therapy, as well as technical issues, including normal tissue dose constraints, treatment volumes, and use of image guided and intensity modulated radiation therapy...
March 2019: Journal of Urology
https://read.qxmd.com/read/30759067/pediatric-faculty-knowledge-and-comfort-discussing-diagnostic-errors-a-pilot-survey-to-understand-barriers-to-an-educational-program
#14
Joseph A Grubenhoff, Sonja I Ziniel, Lalit Bajaj, Daniel Hyman
Background Improving Diagnosis in Healthcare calls for improved training in diagnostic reasoning and establishing non-judgmental forums to learn from diagnostic errors arising from heuristic-driven reasoning. Little is known about pediatric providers' familiarity with heuristics or the culture surrounding forums where diagnostic errors are discussed. This study aimed to describe pediatric providers' familiarity with common heuristics and perceptions surrounding public discussions of diagnostic errors. Methods We surveyed pediatric providers at a university-affiliated children's hospital...
February 13, 2019: Diagnosis
https://read.qxmd.com/read/30758855/systematic-review-of-clinical-prediction-models-for-survival-after-surgery-for-resectable-pancreatic-cancer
#15
REVIEW
M Strijker, J W Chen, T H Mungroop, N B Jamieson, C H van Eijck, E W Steyerberg, J W Wilmink, B Groot Koerkamp, H W van Laarhoven, M G Besselink
BACKGROUND: As more therapeutic options for pancreatic cancer are becoming available, there is a need to improve outcome prediction to support shared decision-making. A systematic evaluation of prediction models in resectable pancreatic cancer is lacking. METHODS: This systematic review followed the CHARMS and PRISMA guidelines. PubMed, Embase and Cochrane Library databases were searched up to 11 October 2017. Studies reporting development or validation of models predicting survival in resectable pancreatic cancer were included...
February 13, 2019: British Journal of Surgery
https://read.qxmd.com/read/30758784/the-role-of-pre-peri-and-postnatal-risk-factors-in-bipolar-disorder-and-adult-adhd
#16
Franziska Tole, Juliane Kopf, Katrin Schröter, Viola Stella Palladino, Christian P Jacob, Andreas Reif, Sarah Kittel-Schneider
Gene-environment-development interactions are suggested to play a crucial role in psychiatric disorders. However, it is not clear if there are specific risk gene interactions with particular pre-, peri-, and postnatal risk factors for distinct disorders, such as adult attention-deficit-/hyperactivity disorder (aADHD) and bipolar disorder (BD). In this pilot study, the first aim was to investigate retrospective self-reports of pre-, peri-, and postnatal complications and risk factors from 126 participants (aADHD, BD, and healthy controls) and their mothers...
February 13, 2019: Journal of Neural Transmission
https://read.qxmd.com/read/30758489/cost-and-outcomes-information-should-be-part-of-shared-decision-making-reply
#17
Margaret L Schwarze, David Urbach, Kimberly E Kopecky
No abstract text is available yet for this article.
February 13, 2019: JAMA Surgery
https://read.qxmd.com/read/30758484/cost-and-outcomes-information-should-be-part-of-shared-decision-making
#18
William B Weeks, James N Weinstein
No abstract text is available yet for this article.
February 13, 2019: JAMA Surgery
https://read.qxmd.com/read/30757949/patient-s-decisional-control-preferences-of-a-cohort-of-patients-with-advanced-cancer-receiving-palliative-care-in-india
#19
Arunangshu Ghoshal, Anuja Damani, M A Muckaden, Sriram Yennurajalingam, Naveen Salins, Jayita Deodhar
CONTEXT: Frequency of passive decisional control preferences (DCPs) has been variably reported but is generally higher among patients living in developing countries. OBJECTIVES: This prospective cross-sectional study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center in India and to identify its association with their sociodemographic and clinical characteristics. METHODS: Patients with advanced cancer referred to palliative care (between March and August 2016) underwent assessment of DCP using validated tools including Control Preference Scale, Satisfaction with Decision Scale, and understanding of illness questionnaire...
February 13, 2019: Journal of Palliative Care
https://read.qxmd.com/read/30755689/deepsofa-a-continuous-acuity-score-for-critically-ill-patients-using-clinically-interpretable-deep-learning
#20
Benjamin Shickel, Tyler J Loftus, Lasith Adhikari, Tezcan Ozrazgat-Baslanti, Azra Bihorac, Parisa Rashidi
Traditional methods for assessing illness severity and predicting in-hospital mortality among critically ill patients require time-consuming, error-prone calculations using static variable thresholds. These methods do not capitalize on the emerging availability of streaming electronic health record data or capture time-sensitive individual physiological patterns, a critical task in the intensive care unit. We propose a novel acuity score framework (DeepSOFA) that leverages temporal measurements and interpretable deep learning models to assess illness severity at any point during an ICU stay...
February 12, 2019: Scientific Reports
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