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[PMID]:29233854
[Au] Autor:Mohan D; Farris C; Fischhoff B; Rosengart MR; Angus DC; Yealy DM; Wallace DJ; Barnato AE
[Ad] Endereço:Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA.
[Ti] Título:Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
[So] Source:BMJ;359:j5416, 2017 12 12.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. DESIGN: Randomized clinical trial. SETTING: Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. PARTICIPANTS: 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. INTERVENTIONS: Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. MAIN OUTCOME MEASURES: Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. RESULTS: 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) 155/288 (0.54) in the game arm; 197/300 (0.66) 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. CONCLUSIONS: Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. TRIAL REGISTRATION: clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
[Mh] Termos MeSH primário: Aplicativos Móveis/utilização
Médicos/estatística & dados numéricos
Triagem/métodos
Jogos de Vídeo/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões
Tomada de Decisões Assistida por Computador
Medicina de Emergência/normas
Serviço Hospitalar de Emergência/normas
Feminino
Heurística
Seres Humanos
Masculino
Meia-Idade
Aplicativos Móveis/estatística & dados numéricos
Avaliação de Resultados (Cuidados de Saúde)
Centros de Traumatologia/normas
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5416


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[PMID]:29240330
[Au] Autor:Price WN
[Ad] Endereço:University of Michigan Law School.
[Ti] Título:Regulating Black-Box Medicine.
[So] Source:Mich Law Rev;116(3):421-74, 2017.
[Is] ISSN:0026-2234
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Data drive modern medicine. And our tools to analyze those data are growing ever more powerful. As health data are collected in greater and greater amounts, sophisticated algorithms based on those data can drive medical innovation, improve the process of care, and increase efficiency. Those algorithms, however, vary widely in quality. Some are accurate and powerful, while others may be riddled with errors or based on faulty science. When an opaque algorithm recommends an insulin dose to a diabetic patient, how do we know that dose is correct? Patients, providers, and insurers face substantial difficulties in identifying high-quality algorithms; they lack both expertise and proprietary information. How should we ensure that medical algorithms are safe and effective? Medical algorithms need regulatory oversight, but that oversight must be appropriately tailored. Unfortunately, the Food and Drug Administration (FDA) has suggested that it will regulate algorithms under its traditional framework, a relatively rigid system that is likely to stifle innovation and to block the development of more flexible, current algorithms. This Article draws upon ideas from the new governance movement to suggest a different path. FDA should pursue a more adaptive regulatory approach with requirements that developers disclose information underlying their algorithms. Disclosure would allow FDA oversight to be supplemented with evaluation by providers, hospitals, and insurers. This collaborative approach would supplement the agency's review with ongoing real-world feedback from sophisticated market actors. Medical algorithms have tremendous potential, but ensuring that such potential is developed in high-quality ways demands a careful balancing between public and private oversight, and a role for FDA that mediates--but does not dominate--the rapidly developing industry.
[Mh] Termos MeSH primário: Algoritmos
Tomada de Decisões Assistida por Computador
Diagnóstico por Computador
Regulamentação Governamental
[Mh] Termos MeSH secundário: Técnicas de Apoio para a Decisão
Seres Humanos
Colaboração Intersetorial
Segurança do Paciente
Vigilância de Produtos Comercializados
Kit de Reagentes para Diagnóstico/normas
Software
Telemedicina
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Reagent Kits, Diagnostic)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE


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[PMID]:29089403
[Au] Autor:Sharifi M; Franz C; Horan CM; Giles CM; Long MW; Ward ZJ; Resch SC; Marshall R; Gortmaker SL; Taveras EM
[Ad] Endereço:Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut; mona.sharifi@yale.edu.
[Ti] Título:Cost-Effectiveness of a Clinical Childhood Obesity Intervention.
[So] Source:Pediatrics;140(5), 2017 Nov.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS: In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS: The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. CONCLUSIONS: A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.
[Mh] Termos MeSH primário: Índice de Massa Corporal
Análise Custo-Benefício
Tomada de Decisões Assistida por Computador
Intervenção Médica Precoce/economia
Registros Eletrônicos de Saúde/economia
Obesidade Pediátrica/economia
Obesidade Pediátrica/terapia
[Mh] Termos MeSH secundário: Criança
Análise Custo-Benefício/métodos
Análise Custo-Benefício/tendências
Intervenção Médica Precoce/métodos
Intervenção Médica Precoce/tendências
Registros Eletrônicos de Saúde/tendências
Feminino
Seres Humanos
Masculino
Obesidade Pediátrica/epidemiologia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171102
[St] Status:MEDLINE


  4 / 2609 MEDLINE  
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[PMID]:28938004
[Au] Autor:Choi JH; Lee JY; Cha J; Kim K; Hong SN; Lee SH
[Ad] Endereço:Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.
[Ti] Título:Predictive models of objective oropharyngeal OSA surgery outcomes: Success rate and AHI reduction ratio.
[So] Source:PLoS One;12(9):e0185201, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study was to develop a predictive model of objective oropharyngeal obstructive sleep apnea (OSA) surgery outcomes including success rate and apnea-hypopnea index (AHI) reduction ratio in adult OSA patients. STUDY DESIGN: Retrospective outcome research. METHODS: All subjects with OSA who underwent oropharyngeal and/or nasal surgery and were followed for at least 3 months were enrolled in this study. Demographic, anatomical [tonsil size (TS) and palate-tongue position (PTP) grade (Gr)], and polysomnographic parameters were analyzed. The AHI reduction ratio (%) was defined as [(postoperative AHI-preoperative AHI) x 100 / postoperative AHI], and surgical success was defined as a ≥ 50% reduction in preoperative AHI with a postoperative AHI < 20. RESULTS: A total of 156 consecutive OSAS adult patients (mean age ± SD = 38.9 ± 9.6, M / F = 149 / 7) were included in this study. The best predictive equation by Forward Selection likelihood ratio (LR) logistic regression analysis was: [Formula: see text]The best predictive equation according to stepwise multiple linear regression analysis was: [Formula: see text] (TS/PTP Gr = 1 if TS/PTP Gr 3 or 4, TS/PTP Gr = 0 if TS/PTP Gr 1 or 2). CONCLUSION: The predictive models for oropharyngeal surgery described in this study may be useful for planning surgical treatments and improving objective outcomes in adult OSA patients.
[Mh] Termos MeSH primário: Apneia Obstrutiva do Sono/diagnóstico
Apneia Obstrutiva do Sono/cirurgia
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões Assistida por Computador
Estudos de Viabilidade
Feminino
Seres Humanos
Funções Verossimilhança
Modelos Lineares
Modelos Logísticos
Masculino
Nariz/cirurgia
Orofaringe/cirurgia
Polissonografia
Prognóstico
Estudos Retrospectivos
Apneia Obstrutiva do Sono/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185201


  5 / 2609 MEDLINE  
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[PMID]:28496266
[Au] Autor:Muratov E; Lewis M; Fourches D; Tropsha A; Cox WC
[Ad] Endereço:UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
[Ti] Título:Computer-Assisted Decision Support for Student Admissions Based on Their Predicted Academic Performance.
[So] Source:Am J Pharm Educ;81(3):46, 2017 Apr.
[Is] ISSN:1553-6467
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To develop predictive computational models forecasting the academic performance of students in the didactic-rich portion of a doctor of pharmacy (PharmD) curriculum as admission-assisting tools. All PharmD candidates over three admission cycles were divided into two groups: those who completed the PharmD program with a GPA ≥ 3; and the remaining candidates. Random Forest machine learning technique was used to develop a binary classification model based on 11 pre-admission parameters. Robust and externally predictive models were developed that had particularly high overall accuracy of 77% for candidates with high or low academic performance. These multivariate models were highly accurate in predicting these groups to those obtained using undergraduate GPA and composite PCAT scores only. The models developed in this study can be used to improve the admission process as preliminary filters and thus quickly identify candidates who are likely to be successful in the PharmD curriculum.
[Mh] Termos MeSH primário: Logro
Tomada de Decisões Assistida por Computador
Técnicas de Apoio para a Decisão
Educação de Pós-Graduação em Farmácia
Aprendizado de Máquina
Critérios de Admissão Escolar
[Mh] Termos MeSH secundário: Avaliação Educacional
Escolaridade
Previsões/métodos
Seres Humanos
Faculdades de Farmácia/normas
Estudantes de Farmácia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE
[do] DOI:10.5688/ajpe81346


  6 / 2609 MEDLINE  
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[PMID]:28476975
[Au] Autor:Wu JX; Li CM; Chen GC; Ho YR; Lin CH
[Ad] Endereço:National Synchrotron Radiation Research Center, Hsinchu Science Park, Hsinchu 30076, Taiwan.
[Ti] Título:Peripheral arterial disease screening for hemodialysis patients using a fractional-order integrator and transition probability decision-making model.
[So] Source:IET Syst Biol;11(2):69-76, 2017 04.
[Is] ISSN:1751-8849
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Atherosclerosis and resultant peripheral arterial disease (PAD) are common complications in patients with type 2 diabetes mellitus or end-stage renal disease and in elderly patients. The prevalence of PAD is higher in patients receiving haemodialysis therapy. For early assessment of arterial occlusion using bilateral photoplethysmography (PPG), such as changes in pulse transit time and pulse shape, bilateral timing differences could be used to identify the risk level of PAD. Hence, the authors propose a discrete fractional-order integrator to calculate the bilateral area under the systolic peak (AUSP). These indices indicated the differences in both rise-timing and amplitudes of PPG signals. The dexter and sinister AUSP ratios were preliminarily used to separate the normal condition from low/high risk of PAD. Then, transition probability-based decision-making model was employed to evaluate the risk levels. The joint probability could be specified as a critical threshold, < 0.81, to identify the true positive for screening low or high risk level of PAD, referring to the patients' health records. In contrast to the bilateral timing differences and traditional methods, the proposed model showed better efficiency in PAD assessments and provided a promising strategy to be implemented in an embedded system.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Técnicas de Diagnóstico Cardiovascular
Modelos Estatísticos
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/etiologia
Fotopletismografia
Diálise Renal/efeitos adversos
[Mh] Termos MeSH secundário: Algoritmos
Simulação por Computador
Tomada de Decisões Assistida por Computador
Técnicas de Diagnóstico Cardiovascular/instrumentação
Estudos de Viabilidade
Seres Humanos
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170507
[St] Status:MEDLINE
[do] DOI:10.1049/iet-syb.2016.0046


  7 / 2609 MEDLINE  
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[PMID]:28380196
[Au] Autor:Yousefi M; Ferreira RP
[Ad] Endereço:Departamento de Engenharia Mecânica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
[Ti] Título:An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department.
[So] Source:Braz J Med Biol Res;50(5):e5955, 2017 Mar 30.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager) allocates the resources (receptionist, nurses, doctors, etc.) to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.
[Mh] Termos MeSH primário: Simulação por Computador
Tomada de Decisões Assistida por Computador
Técnicas de Apoio para a Decisão
Serviço Hospitalar de Emergência/organização & administração
[Mh] Termos MeSH secundário: APACHE
Eficiência Organizacional
Seres Humanos
Modelos Organizacionais
Pacientes
Admissão e Escalonamento de Pessoal
Reprodutibilidade dos Testes
Fatores de Tempo
Estudos de Tempo e Movimento
Triagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE


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[PMID]:28353386
[Au] Autor:Delvaux N; Van Thienen K; Heselmans A; de Velde SV; Ramaekers D; Aertgeerts B
[Ti] Título:The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review.
[So] Source:Arch Pathol Lab Med;141(4):585-595, 2017 Apr.
[Is] ISSN:1543-2165
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CONTEXT: - Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays. OBJECTIVE: - To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering. DATA SOURCES: - We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patient-specific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics. CONCLUSIONS: - Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.
[Mh] Termos MeSH primário: Sistemas de Informação em Laboratório Clínico/estatística & dados numéricos
Técnicas de Laboratório Clínico/estatística & dados numéricos
Tomada de Decisões Assistida por Computador
Sistemas de Apoio a Decisões Clínicas
[Mh] Termos MeSH secundário: Sistemas de Informação em Laboratório Clínico/economia
Sistemas de Informação em Laboratório Clínico/normas
Serviços de Laboratório Clínico/economia
Serviços de Laboratório Clínico/normas
Serviços de Laboratório Clínico/estatística & dados numéricos
Análise Custo-Benefício
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170418
[Lr] Data última revisão:
170418
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.5858/arpa.2016-0115-RA


  9 / 2609 MEDLINE  
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[PMID]:28333785
[Au] Autor:McIlvennan CK
[Ad] Endereço:Author Affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, and Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora.
[Ti] Título:Improving Decision Making for Advanced Heart Failure Patients and Caregivers.
[So] Source:J Nurs Adm;47(4):190-191, 2017 Apr.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In this month's Magnet® Perspectives column, Colleen K. McIlvennan, DNP, ANP, lead nurse practitioner, Advanced Heart Failure and Transplantation at the University of Colorado, discusses her groundbreaking research encompassing patients' and caregivers' emotional, rational, and fundamental beliefs when considering a left ventricular assist device (LVAD). Results have led to the development of 2 innovative decision aids that are currently in use by LVAD programs across the United States and Canada. Dr McIlvennan's efforts led to a $2 million grant from the Patient-Centered Outcomes Research Institute, as well as national recognition from the American Heart Association and the Heart Failure Society of America. Last year, she received the 2016 National Magnet Nurse of the Year® Award in the Empirical Outcomes category. In addition to sharing her findings, Dr McIlvennan examines the value of performing research in a Magnet-recognized organization.
[Mh] Termos MeSH primário: Cuidadores/psicologia
Tomada de Decisão Clínica
Tomada de Decisões Assistida por Computador
Insuficiência Cardíaca/terapia
Coração Auxiliar/psicologia
Pacientes/psicologia
[Mh] Termos MeSH secundário: Canadá
Feminino
Seres Humanos
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170410
[Lr] Data última revisão:
170410
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:170324
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000463


  10 / 2609 MEDLINE  
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[PMID]:28225495
[Au] Autor:Gassmann D; Cheetham M; Siebenhuener K; Holzer BM; Meindl-Fridez C; Hildenbrand FF; Virgini V; Martin M; Battegay E
[Ad] Endereço:aDepartment of Internal Medicine, University Hospital Zurich bCenter of Competence Multimorbidity cUniversity Research Priority Program "Dynamics of Healthy Aging," University of Zurich dDepartment of Dermatology, University Hospital Zurich eDivision of Gerontopsychology and Gerontology, Department of Psychology, University of Zurich, Zurich, Switzerland.
[Ti] Título:The multimorbidity interaction severity index (MISI): A proof of concept study.
[So] Source:Medicine (Baltimore);96(8):e6144, 2017 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Therapeutic decision-making for patients with multimorbidity (MM) is challenging. Clinical practice guidelines inadequately address harmful interactions and resulting therapeutic conflicts within and among diseases. A patient-specific measure of MM severity that takes account of this conflict is needed.As a proof of concept, we evaluated whether the new Multimorbidity Interaction Severity Index (MISI) could be used to reliably differentiate patients in terms of lower versus higher potential for harmful interactions.Two hypothetical patient cases were generated, each with 6 concurrent morbidities. One case had a low (i.e., low conflict case) and the other a high (i.e., high conflict case) potential for harmful interactions. All possible interactions between conditions and treatments were extracted from each case's record into a multimorbidity interaction matrix. Experienced general internists (N = 18) judged each interaction in the matrix in terms of likely resource utilization needed to manage the interaction. Based on these judgements, a composite index of MM interaction severity, that is, the MISI, was generated for each physician and case.The difference between each physician's MISI score for the 2 cases (MISIdiff) was computed. Based on MISIdiff, the high conflict case was judged to be of significantly greater MM severity than was the low conflict case. The positive values of the inter-quartile range, a measure of variation (or disagreement) between the 2 cases, indicated general consistency of individual physicians in judging MM severity.The data indicate that the MISI can be used to reliably differentiate hypothetical multimorbid patients in terms of lesser versus greater severity of potentially harmful interactive effects. On this basis, the MISI will be further developed for use in patient-specific assessment and management of MM. The clinical relevance of the MISI as an alternative approach to defining MM severity is discussed.
[Mh] Termos MeSH primário: Comorbidade
Tomada de Decisões Assistida por Computador
Sistemas de Apoio a Decisões Clínicas
Índice de Gravidade de Doença
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Medicina Interna/métodos
Masculino
Médicos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006144



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