There is currently a vast armamentarium of biomarkers for evaluating human exposures to environmental carcinogens, the effects of such exposures and/or susceptibility to disease outcome. Before application, however, these biomarkers require validation in terms of truly reflecting what is claimed. Transitional epidemiological studies bridge the gap between laboratory and field. ...

The extradition proceedings relating to Senator Pinochet were ultimately resolved by the decision of the Secretary of State on the basis of medical evidence as to the Senator's competence to participate in a criminal trial. In considering the decision-making of the Secretary of State the court considered whether a confidential ...

Friends of Alan Berkman, M.D., who helped organize the movement to make AIDS and other medications available in developing countries, are seeking a genetically matched stem-cell donor. Persons of Eastern European Jewish ancestry can help Dr. Berkman and others by being tested and joining the registry of potential donors.

In a recent survey of women with HIV, prayer was mentioned as a very important source in decision making about HIV antiretroviral therapy. As a follow-up to this finding, we conducted in-depth interviews with 51 women attending a comprehensive HIV care center to better understand the role of prayer in ...

BACKGROUND: Our study is a repeat of the Dutch death-certificate study on end-of-life decisions (ELDs). The main objective was to estimate the frequency of euthanasia (the administration of lethal drugs with the explicit intention of shortening the patient's life at the patient's explicit request), physician-assisted suicide (PAS), and other ELDs ...

The modern day treatment of UPJO with retrograde endopyelotomy continues to evolve as experience and knowledge progress. Use of the straight lateral incision and selective use of spiral CT angiogram has refined treatment decisions with retrograde endopyelotomy further. The authors' decision-oriented approach offers guidelines for the practicing urologist. Ultimately, it ...

We investigated the ability of honeybees to learn mazes of four types: constant-turn mazes, in which the appropriate turn is always in the same direction in each decision chamber; zig-zag mazes, in which the appropriate turn is alternately left and right in successive decision chambers; irregular mazes, in which there ...

The majority of Australia's general practitioners are now believed to be using a computer to support clinical practice. This technology has the potential to deliver evidence-based clinical practice guidelines to the GP during consultations. If clinical practice guidelines are to be incorporated into electronic medical record systems, to assist clinical ...

The present review addresses recent literature on advances in regional anaesthesia and medical diseases, and focuses on expert guidelines and decision-making processes. Attention is also given to risk-benefit ratios in the management of patients with chronic illnesses, difficulties in treatment of the elderly, and associated morbidity and mortality.

Withholding or withdrawing life-sustaining therapies is ethical and medically appropriate in some circumstances. This article summarizes the American Medical Association's Education for Physicians on End-of-life Care (EPEC) curriculum module on withholding or withdrawing therapy. Before reviewing specific treatment preferences, it is useful to ask patients about their understanding of the ...

Computer networks are constantly and radically changing the way in which the medical professions thinks and works. This article briefly explores some of these innovations.

For the clinician who works in a behavioral-medicine or primary-care setting, this article presents the association between medical illness and suicide. Specific illnesses such as HIV/AIDS, cancers of the brain and nervous system, and multiple sclerosis all are associated with an increased risk of suicide. Rates of major depression rise ...

In this article, the authors discuss the rationale for the use of computerized medication algorithms and decision support systems in the treatment of major psychiatric disorders. The field of psychopharmacology has advanced tremendously in the last two decades, with the resulting vast array of new information yielding a marked disparity ...

A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, ...

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Among the issues with which they have ...

OBJECTIVE: In 1993, Children's Healthcare of Atlanta at Scottish Rite (formery Scottish Rite Children's Medical Center, Atlanta, GA) added facilities to perform inpatient covert video surveillance (CVS) of suspected cases of Munchausen syndrome by proxy (MSBP). Forty-one patients were monitored from 1993 to 1997. This study was performed to review ...

The conclusions from a profile analysis to identify performance extremes can be affected substantially by the standards and statistical methods used and by the adequacy of risk adjustment. Medically meaningful standards are proposed to replace common statistical standards. Hierarchical regression methods can handle several levels of random variation, make risk ...

Symptoms of sinusitis are among the most common reasons for patients presenting to primary care physicians. There is considerable controversy regarding appropriate management of both acute and chronic sinus disease. This article reviews etiologic mechanisms in these conditions and presents recent evidence to provide a logical basis on which to ...

Japanese national sentiment has been described as paternalistic, which has potentially wide-ranging implications for the manner in which psychiatric patients should participate in medical decision-making. To examine the extent and possible determinants of the desire to participate in medical decision-making among Japanese people, we distributed a packet of questionnaires to ...

Most religious traditions hold that what makes one a person is the possession of a soul and that this gives one moral status. This status in turn gives persons interests and rights that delimit the set of actions that are permitted to be done to them. In this paper, I ...

Caregivers and family members are forced to deal with questions about tube feeding at the end of life for hundreds of thousands of patients suffering from severe dementia every year. But decisions about accepting or forgoing artificial nutrition and hydration (ANH) tend to be made in haste, late in the ...

The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from ...

This paper develops a framework to compare clinical decision making in relation to chronic and acute medical conditions. Much of the literature on patient-physician decision making has focused on acute and often life-threatening medical situations in which the patient is highly dependent upon the expertise of the physician in providing ...

PURPOSE: To compare four standard-setting procedures for an objective structure clinical examination (OSCE). METHODS: A 12-station OSCE was administered to 84 students in each of the final (fourth-) year medical classes of 1996 and 1997 at Dalhousie University Faculty of Medicine. Four standard-setting procedures (Angoff, borderline, relative, and holistic) were ...

PTA is a decision-theoretic expert system that aims to assist clinicians in diagnosing and treating patients with pneumonia at the intensive care unit. The underlying probabilistic network model includes knowledge for diagnosing pneumonia on the basis of the likelihood of tracheobronchial-tree colonisation by pathogens, and symptoms and signs actually present ...

Until recently, much of the medical and psychological literature has examined and conceptualized the taking of medication from the viewpoint of adherence to or compliance with recommendations from health professionals. However, some authors have argued that medication taking is mostly determined by patient decision making. In order to investigate the ...

The advent of accountability and evidence-based medicine set a new standard, suggesting that new medical technologies should require validation of their safety and effectiveness through controlled studies prior to their broad dissemination. Certainly, the concept of evidence-based medicine appears to be rational, objective, and consistent. However, the process can become ...

WizOrder, Vanderbilt University Medical Center's (VUMC) clinician order entry system, is an excellent platform for delivering high-quality decision support to clinical end-users. A scripting language designed to make it easy for non-programmer domain experts to enter rules helps distribute the generation and maintenance of the knowledge-base necessary to drive effective ...

There is much in the literature concerning conflicts between clinicians and the law over who should make decisions in a legal context, such as involuntary hospitalization or patients' competency to make treatment decisions. There is little, however, about judges' trying to impose specific treatment decisions on clinicians. This article addresses ...

Comparison of transplantation medicine in Sweden, Denmark, Germany, Spain and Portugal reveals many and important differences with respect to frequency of transplantations, frequency of life donations, legal regulations and influence of the family on organ donation. The differences observed are at least partly related to cultural and value differences between ...

In our previous work, we proposed a domain-independent language to describe clinical guidelines and a graphical tool to acquire them. In this paper, we describe an approach to execute clinical guidelines. We propose a flexible execution engine that can be used in clinical decision support applications, and also for medical ...

Of growing concern over Jehovah's Witnesses' (JWs) refusal of blood is the intrusion of the religious organisation into its members' personal decision making about medical care. The organisation currently may apply severe religious sanctions to JWs who opt for certain forms of blood-based treatment. While the doctrine may be maintained ...

When healthcare coverage entails medical necessity review, patients, providers, payers, and government agencies must confront issues of fairness and rationing. To explore the ethical ramifications of medical necessity decisions, we provide 2 illustrative case. In the first case, we discuss the implications of rule-based rationing and in the second we ...

Inter-observer agreement in the interpretation according to the FIGO guidelines of 33 cardiotocographic tracings by experts and subsequent clinical decision was evaluated, using the kappa statistic (K) and the proportions of agreement (Pa). Overall agreement in the classification of tracings was fair (K = 0.48) and was better for normal ...

Improved understanding of neurobehavior in normal aging, Alzheimer's disease, and late-life depression makes early detection of neurodegenerative conditions possible. Primary care physicians can screen patients' mental status and mood states with simple in-office tests. When screening results or the clinical picture is ambiguous or complex, neuropsychological evaluation is useful in ...

Introduction: Three challenges that physicians and decision makers in the health care systems have to meet are a remarkable proportion of medical decisions without a sufficient base of scientific evidence, a slow and opaque process of integrating scientific knowledge into medical practice and a steadily decreasing half-life period of the ...

PURPOSE: To describe the Patient Findings Questionnaire (PFQ) and compare its scores and pass/fail decisions with those obtained from standardized patient (SP) examination checklists. METHOD: Checklists and PFQs were used to assess data acquisition by 790 second-year medical students. PFQs were composed of multiple-choice items designed to determine whether examines ...

The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Problem Knowledge Couplers are a clinical decision support software tool that offer a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, ...

Evidence-based medicine (EBM) combines clinical experience with the best available patient-centred medical knowledge. EBM is not restricted to randomised trials and meta-analyses. It involves finding the best studies (the best "external evidence") to answer the clinical questions we face in everyday clinical practice. This is a challenging framework where medical ...

When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another ...

In this paper we revisit and add elements to our earlier conceptual framework on shared treatment decision-making within the context of different decision-making approaches in the medical encounter (Charles, C., Gafni, A., Whelan, T., 1997. Shared decision-making in the medical encounter: what does it mean? (or, it takes at least ...

Catheter occlusions are a common occurrence in pediatric patients with central venous catheters. These occlusions are attributable to many factors, such as mechanical problems caused by catheter and patient size, clot formation caused by blood product administration and laboratory sampling, drug precipitation, and lipid residues. Because of the significant patient ...

While many have voiced the need for increased humanism in the practice of medicine, few approaches exist for explicitly and systematically permeating the medical culture with humanistic thinking and behavior. This article describes the central importance of developing a "habit" of humanistic communication, decision making, and behavior. The habit comprises ...

Consumer choice research has shown that, contrary to normative theory, the introduction of an inferior alternative to an existing choice set can increase the likelihood that one of the original alternatives will be chosen. This phenomenon, the attraction effect, is relevant to physician decision making, particularly when the physician is ...

OBJECTIVE: To assess residents' propensity to display the sunk-cost effect, an irrational decision-making bias, in medical treatment decisions; and to compare residents' and undergraduates' susceptibility to the bias in non-medical, everyday behaviors. DESIGN: Cross-sectional, in-person survey. SETTING: Louisiana State University, two locations: Medical Center-Baton Rouge and Main Campus-Psychology Department. PARTICIPANTS: ...

The response of Barbara Pfeffer Billauer to my article "If I Am Only My Genes, What Am I? Genetic Essentialism and a Jewish Response" highlights the conflict between a sociological understanding of religion and the resistance to such analysis from within a faith tradition. Ms. Billauer makes three main points; ...

In this paper we explore the possible reasons why medical papers reporting clinical trials sponsored by the pharmaceutical industry often analyse repeated measures data at certain key time-points instead of employing sophisticated models of repeated measures proposed by many statisticians. A survey indicated that the priority reason in the industry ...

BACKGROUND: Health plans commonly face the conflicting demands of trying to provide access to novel technologies, including new classes of medications, while trying to contain costs. These demands are particularly acute for California's Medicaid program, known as Medi-Cal, which is responsible for delivery of medical care to an unusually large ...

International criteria for bariatric surgery and bariatric surgeons have been well-defined in terms of the current state of the art and are presented together with weight tables and a list of co-morbidities of morbid obesity. The bariatric surgeon should make the primary judgement concerning bariatric surgery using these criteria as ...

In general terms, medical-decision-making "capacity" is the ability to give informed consent to accept a medical intervention or to make an informed refusal of the intervention. This article presents a method to guide physicians who assess and care for patients whose medical decision-making capacities are in question. The guide relies ...