CONTEXT: Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences. PURPOSE: To review the extant literature regarding the role of uncertainty and intuition and associated ...

For many years, efficacy and safety have been key parameters for decision-making in healthcare policy. However, the current situation is rather different as resources are scarce, so it is necessary to take efficiency into account when allocating limited resources. Efficiency-based pharmacotherapy is a new discipline that combines the principles of ...

BACKGROUND: This study was conducted to determine the influence of patient perceptions of absolute risk on choices for cancer screening and use of medications to prevent heart attack, stroke, and hip fracture. METHODS: At the end of routine office visits, we surveyed all eligible consecutive patients who visited four geriatricians ...

OBJECTIVE: This paper studies the differences between controlled medical vocabularies that are designed as external artifacts and the mental concepts that are inside users' heads and used by users for reasoning, decision making, diagnosis, and treatment. DESIGN: The major theories of concept representations developed in cognitive science were reviewed, analyzed, ...

As science progresses, new issues in bioethics grab the headlines, but in neonatal medicine communication and decision making for sick and premature infants is as important today as it was thirty years ago. Decisions have to be made and made well, despite suboptimal time, data, or knowledge. To this end, ...

The purpose of this review is to assess the evidence of healthcare benefits involving the application of artificial neural networks to the clinical functions of diagnosis, prognosis and survival analysis, in the medical domains of oncology, critical care and cardiovascular medicine. The primary source of publications is PUBMED listings under ...

Considering the patient's right to autonomy and the trend towards more involvement of the patient in the decision making, it is our belief that obstetricians should consider the woman's request for cesarean section without medical indication. The procedure can only be carried out after obtaining proper consent of the patient ...

Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an ...

Age-related macular degeneration (AMD) is a major public health issue, but little is known about the economics of the disease. This contribution describes the epidemiology and the economics of AMD in four European countries: France, Germany, Italy and the United Kingdom (UK). We reviewed published information on AMD, including guidelines, ...

OBJECTIVES: To explore the views and experiences of pre-registration house officers (PRHOs) in general practice and hospital settings regarding the concept of patient partnership and their experience of involving patients in management decisions. DESIGN: The 12 PRHOs who had graduated from British universities and who were working within the Yorkshire ...

BACKGROUND: In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. OBJECTIVES: (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning ...

Physicians make their decisions based upon scientific evidence with their first consideration being the Hippocratic axiom 'not to do harm'. In practice, a number of non-medical issues influence this process and generate conflicting judgments. We analyze these issues that form the context of medical ethics which is perceived as a ...

Growing evidence indicates that the integration of clinical decision support (CDS) into the computer-based patient record (CPR) can decrease medical errors, enhance patient safety, decrease unwanted practice variation, and improve patient outcomes. Two case studies are presented of advanced CDS systems that go beyond basic integration with the CPR to ...

Diagnostic and therapeutic decisions in the domain of medicine usually depend on observed or measured data, such as observations made during an examination, or laboratory data. Furthermore, such decisions are often based on abstract domain knowledge. For decision-making, it is necessary to establish relationships between concrete data and abstract knowledge. ...

BACKGROUND: Medical school admission committees differ in their decision-making procedures. Some assign ratings to groups of application materials to devise rank order acceptance lists, whereas others deliberate and vote on each separate application. PURPOSE: This study examined what the screening review and deliberative processes contribute to decision making in a ...

This study examines the practical side of communicating about patients' thoughts, feelings, and physical health. A study of 53 medical visits suggests that biopsychosocial communication need not be as difficult or as time consuming as many practitioners believe. Biopsychosocial medical visits can be conducted in roughly the same amount of ...

We address the problem of filtering medical news articles for targeted audiences. The approach is based on terms and one of the difficulties is extracting a feature set appropriate for the domain. This paper addresses the medical news-filtering problem using a machine learning approach. We describe the application of two ...

This Article cautions practitioners to be careful when advising clients about living wills in advance of disease or illness because changed circumstances and future medical advances may render medical directive decisions no longer desirable. The Article opens by providing a general history of medical advances then analyzes the decision to ...

The British Parliament stated that health services would be covered by the Disability Discrimination Act 1995 (the act). However, when people with disabilities are at their most vulnerable, for example when in hospital or subject to medical procedures, the antidiscrimination law fails them. A review of cases indicates that when ...

Beta-thalassaemia major and sickle-cell disease (SCD) reduce lifespan and quality of life for >300000 children and young adults worldwide. The only cure for both disorders is allogeneic stem cell transplantation (SCT). The decision-making processes in recommending SCT for patients with thalassaemia and SCD are different. For thalassaemia, where transfusion-related iron ...

The importance of clinical research for the practice of clinical medicine is immense and undeniable. Yet the type of knowledge gained from clinical research, referred to here as "empirical evidence," is itself insufficient to provide for optimal clinical care. A gap exists between empirical evidence and clinical practice. Proponents of ...

Over the past 30 years, euthanasia has been under continuous debate in The Netherlands. This contribution aims to provide a moral assessment of this debate. It is argued that euthanasia should be understood within a historical context, as a protest against medical power and as a way to bring about ...

During medical practice, doctors use different aspects of reasoning for diagnosis and treatment. There is a particular process when several doctors are involved in taking a medical decision. In this paper we present an overview of different constraints in the process of conventional decision making and collaborative medical reasoning. General ...

To perform a medical procedure on a competent patient who is refusing it may constitute battery; but to fail to perform a medical procedure on an incompetent patient who is refusing it may constitute negligence. Competence involves being able to understand the consequences of receiving medical treatment, and not receiving ...

OBJECTIVES: To explore older people's experiences of health care in relation to their medical condition (ischaemic heart disease), their understanding of health risks, treatment preferences, and the impact of different treatments on their quality of life. DESIGN: Qualitative study based on five focus groups. SETTING: Five local heart support groups ...

The medical profession generally is uncertain both as to the circumstances in which the guidance of the courts can be sought in relation to ethical decisions regarding individual patients and the way to go about requesting such guidance. The machinery is under used although the courts encourage its use in ...

Guidelines can be regarded as special forms of algorithms and have been shown to be useful tools for supporting medical decision making. With the Council Directive 97/43/Euratom recommendations concerning referral criteria for medical exposure have to be implemented into national law of all EU member states. The time- and cost-consuming ...

The progress of medical informatics has been characterized by the development of a wide range of reasoning methods. These reasoning methods are based on organizing principles that make use of the various relations existing in medical domains: associations, probabilities, causality, functional relationships, temporal relations, locality, similarity, and clinical practice. Some, ...

The aim of this study was to increase the knowledge of the final phase in acute myeloid leukaemia (AML), a period which entails many complex medical and psychosocial decisions. Data on cause and place of death were gathered through a retrospective review of medical and nursing records of 106 patients ...

The primary purpose of a Consensus Conference is to provide informed guidance on treatment decisions, assisting clinicians to make the optimal therapeutic choice for the patient, and providing protection against unjustified malpractice actions. The First American College of Chest Physicians (ACCP) Consensus Conference took place in 1985 and, using a ...

Medical decision support systems (MDSS) play an increasingly important role in medical practice. By assisting physicians with making clinical decisions, MDSS are expected to improve the quality of medical care. However, there are also concerns that malfunctioning or inappropriate use of MDSS could jeopardize the well-being of the patient. While ...

Dysphagia, or difficulty swallowing, is a relatively common consequence following stroke, with most sources quoting rates of around 40%. The percentage of stroke patients who require tube feeding for nutritional support varies quite widely, with studies quoting rates in the acute phase from 8.5% to 29%. Since stroke patients are ...

The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which ...

The decision of whether to initiate antiarrhythmic medications in or out of the hospital for patients with atrial fibrillation remains an issue of significant controversy. The current review analyzes the available data pertaining to the safety of antiarrhythmic agent initiation in patients with atrial fibrillation and provides a practice guideline.

This study examined whether special jury instructions or the bifurcation of liability and compensation decisions would counter the tendency for evidence concerning the defendant's liability to affect damages awards. Mock jurors made liability and award decisions in response to a case description in which the level of defendant responsibility for ...

As the population ages, greater numbers of elderly patients will be considered for spinal surgery for spinal stenosis and complex primary and revision reconstructions. The age-related medical comorbidities impact not only on the decision to undertake a procedure but also impact the magnitude of the procedure. The surgeon must understand ...

In 1998, the Italian Ministry of Health urged the Italian Society of Nephrology (SIN) to draft recommendations for uniform decision-making procedures in the field of dialysis. In accordance with the Ministry's specifications, at the time the Society approved diagnostic protocols regarding clinical questions, but without fully recognizing the multiple issues ...

Until recently, the most significant issue facing a family physician regarding the diagnosis and treatment of dementia was ruling out delirium and potentially treatable etiologies. However, as more treatment options become available, it will become increasingly important to diagnose dementia early. Dementia may be suspected if memory deficits are exhibited ...

The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of ...

Decision analysis is increasingly used to address difficult medical problems. Case-by-case models designed for individual patients facing complex trade-offs in their medical care often help individual clinical decision making, but are expensive and time consuming. On the other hand, generic models addressing broad clinical questions that can be adapted from ...

Proceedings of the 10th World Congress on Medical Informatics (MEDINFO 2001). London, 2 - 5 Sept. 2001, 503 - 507

The dream is a unique psychodynamically informative instrument for evaluating the subjective correlates of brain activity during REM sleep. These include feelings, percepts, memories, wishes, fantasies, impulses, conflicts, and defenses, as well as images of self and others. Dream analysis can be used in a variety of clinical settings to ...

Mr. Roest argues in favor of the Third Circuit's decision in University Medical Center v. Sullivan to advance the proposition that the Doctrine of Recoupment should be applied narrowly in health care bankruptcy cases. The article begins by introducing key provisions of the Medicare Act and Bankruptcy Code, and by ...

At present in the UK, when there is conflict of opinion between relatives and health care professionals regarding the treatment of incompetent patients, the courts generally support the latter over the former. This article examines the potential impact of the Human Rights Act 1998, which incorporates the European Convention on ...

The author first summarizes historical tensions surrounding the use of medication in psychoanalytic treatments. Next he examines the now-popular viewpoint that clinicians should consider only descriptive criteria in deciding whether to medicate. He then describes how medication use can potentially undermine patients' full integration of psychic experiences. Finally, he presents ...

This decade will see great strides in the acceptance of methadone treatment for heroin addiction, as a result of clear scientific and clinical evidence of its efficacy, and strong methadone advocacy. The new proposal for rule making (NPRM) will help the medical profession accept methadone treatment as beneficial for opiate ...

Pharmaceutical companies have greatly increased their level of "direct-to-consumer" (DTC) advertising in recent years. For 1998, estimates are that over $1.1 billion was spent on this form of advertising, increased from $850 million in 1997 and $600 million in 1996. In 1998, 84 separate drugs were advertised to consumers. The ...

BACKGROUND: Medical diagnosis may be thought of as a categorization task. Research and theory in psychology as well as medical decision making indicate at least 2 processes by which this categorization task may be accomplished: (a) analytic processing, in which one makes explicit use of clinical features to reach a ...

The paper explains the application of an artificial intelligence tool for the purpose of medical decision-making. The first product of this application is a triage engine, available on the Internet, to help laypersons make a decision about the urgency of their situation by providing tailored and accurate information. The expansion ...

The aim of this paper is to provide a concise portrayal of medical applications of a new fuzzy classification method called PROAFTN, which uses a multicriteria decision aid approach. The review summarises and discusses medical applications of the proposed method in acute leukemia, astrocytic and bladder tumours. Although still an ...