When a patient is hospitalized with acute, severe ulcerative colitis, the primary decision is whether or not to proceed directly to surgery. Absolute indications for an immediate colectomy include exsanguinating hemorrhage, perforation and cancer. If medical therapy is undertaken, however, the decision for urgent surgery or non-operative salvage therapy will ...

Medical practitioners owe much of the significant progress made in the diagnosis and treatment of disease to industrial research. Hence, co-operation between providers of medical services, most notably medical practitioners, and the pharmaceutical industry is in the best interest of patients. Yet, empirical evidence shows how well-directed influence exerted by ...

ABSTRACT: Psychiatric nosology is widely criticized, but solutions are proving elusive. Planned revisions of diagnostic criteria will not resolve heterogeneity, comorbidity, fuzzy boundaries between normal and pathological, and lack of specific biomarkers. Concern about these difficulties reflects a narrow model that assumes most mental disorders should be defined by their ...

Introduction.  The history of treatments for erectile dysfunction (ED) has involved a repeated pattern of uptake, followed by abandonment of the various therapies in the medium term. Even effective and simple to use medications are not necessarily continued; discontinuation rates range between 15% and 60%. Despite the association between partner ...

Translational informatics (TI) is extremely important for the pharmaceutical industry, especially as the bar for regulatory approval of new medications is set higher and higher. This paper will explore three specific areas in the drug development lifecycle, from tools developed by precompetitive consortia to standardized clinical data collection to the ...

BACKGROUND: The requirement of obtaining informed consent before medical procedures is well established. With patients having greater access to information through information technology and owing to other factors, disclosure that goes beyond the traditional elements of the risks, benefits, and alternatives to an intervention is demanded from physicians. QUESTIONS/PURPOSES: We ...

The electronic medical record (EMR) is commonly thought to improve the safety and quality of care; however, there is scant information on the impact the EMR has on graduate medical education (GME). A review of English language literature was performed using MEDLINE and OVID databases using or combining the terms, ...

Introduction: Use of electronic prescribing (e-prescribing) can improve safety and reduce costs of care by alerting prescribers to drug-drug interactions, patient nonadherence to therapies, and insurance coverage information. Deriving these benefits will require clinical decision support based on presentation of accurate and complete formulary and benefit (F&B) and medication history ...

To undertake a questionnaire-based study to evaluate attitudes towards the use of unlicensed medicines among prescribing doctors and members of the general public (ie, patients). The study also aimed to explore the factors that influence physicians' prescribing decisions and priorities, and to understand the knowledge of the medicines licensing system ...

Empirical research has proven the influence exerted by the medical industry on physicians' decision-making. Physicians are the gatekeepers who determine how money is spent within the healthcare system. Hence, they are the target group of powerful lobbies in the field, i.e. the manufacturers of medical devices and the pharmaceutical industry. ...

OBJECTIVES: 1) To review and summarize what is known about the health risks of radiation. 2) To compare risks from medical imaging to background radiation and to exposure from nuclear accidents. METHODS: Literature review and summative critical analysis. RESULTS: Over the past several years, physicians and patients have become increasingly ...

This article explores the question of how scientific uncertainty can be managed in medical decision making using the Advisory Committee on Immunization Practices as a case study. It concludes that where a high degree of technical consensus exists about the evidence and data, decision makers act according to a clear ...

OBJECTIVE: To explore why it is permissible for surgeons to "unilaterally withhold" surgery, whereas it is not commonplace (in the United States) to unilaterally withhold cardiopulmonary resuscitation (CPR) for clinical situations with similar degrees of uncertainty and prognosis. DATA SOURCES: The medical literature was sampled using PubMed and Google search ...

PURPOSE: To assess medical students' and residents' experiences with defensive medicine, which is any deviation from sound medical practice due to a perceived threat of liability through either assurance or avoidance behaviors. Assurance behaviors include providing additional services of minimal clinical value. Avoidance behaviors include withholding services that are, or ...

What is known and Objective:  Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of ...

The hazy world of "medical marijuana" continues to cry out for clear data on which to base medical decision making and rational policy design. In this issue of Clinical Pharmacology & Therapeutics, Abrams and colleagues report that vaporized cannabis does not meaningfully affect opioid plasma levels and may even augment ...

To evaluate the impact of computerized physician order entry (CPOE) with decision support on the frequency of antithrombotic medication errors in patients with chronic kidney disease (CKD) admitted with acute coronary syndrome (ACS) and to measure what effect it would have on in-hospital bleeding. We evaluated 80 patients with CKD ...

John Keown has constructed a logical slippery slope argument from voluntary euthanasia (VAE) to nonvoluntary euthanasia (NVAE). VAE if justified implies that death can be of overall benefit, in which case it should also be facilitated in those who cannot consent (NVAE). Hallvard Lillehammer asserts that Keown's argument rests on ...

Background  Many decisions can be understood in terms of actors' valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the ...

A cornerstone of American medical ethics is the right to say, "Keep your hands off of me," to decline medical treatment. A central problem is how to decide about individuals who have become incapacitated and can no longer request or refuse potentially life-sustaining treatment. An advance directive is a formal ...

The past decade has witnessed the advent of the smartphone, a device armed with computing power, mobility and downloadable "apps," that has become commonplace within the medical field as both a personal and professional tool. The popularity of medically-related apps suggests that physicians use mobile technology to assist with clinical ...

E-prescribing systems enable electronic transmissions of prescriptions to pharmacies from the provider's office. The promise of e-prescribing in regard to patient safety is reduction in the time gap between point of care and point of service, reduction in medication errors, and improved quality of care. This article will give a ...

BACKGROUND AND OBJECTIVES: Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced ...

A foundation of care within a Patient-centered Medical Home (PCMH) is respect for patients' values and preferences. Shared decision making (SDM) involves a set of principles and approaches to working with patients that integrates medical information and data with the preferences, values, and support systems of individual patients facing medical ...

Essays by Seigler and Emmanuel define some criteria and requirements when doing an innovative procedure such as hand transplantation to determine whether it is possible to conduct clinical research.These criteria and requirements take into account the patient, the medical team, and society. However, we think that there are still other ...

The objective of this study is to understand psychiatrist's decisions to prescribe psychiatric medications. A survey questionnaire was prepared consisting of 15 factors. Each factor had a five-point Likert scale, rating the importance of each factor in making decisions to prescribe medications. Twenty-six psychiatrists at a state psychiatric hospital completed ...

Uncomplicated urinary tract infection (uUTI) is a bacterial infection that affects individuals with normal urinary tracts from both structural and functional perspective. The appropriate antibiotics and treatment suggestions to individuals suffer of uUTI is an important and complex task that demands a special attention. How to decrease the unsafely use ...

This study explored the informational needs of individuals attending genetic counseling for hereditary cancer, using a free-choice and a forced choice method. Prior to the consultation the informational needs of 334 counselees from Sweden and Norway were assessed by the QUOTE-gene (ca) questionnaire and by a study specific forced choice ...

Medical decision-making involves choices, which can lead to benefits or to harms. Most benefits and harms may or may not occur, and can be minor or major when they do. Medical research, especially randomized controlled trials, provides estimates of chance of occurrence and magnitude of event. Because there is no ...

To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; ...

Inadequate supervision is a significant contributing factor to medical errors involving trainees, but supervision in high-risk settings such as the intensive care unit (ICU) is not well studied. We explored how residents in the ICU experienced supervision related to medication safety, not only from supervising physicians but also from other ...

This study aims to measure the frequency of medication error (ME) in rheumatology outpatients of the Social Security System (SS) in Mexico and to measure the costs by comparing the days lost at work as direct consequence of the medication error against the theoretical cost of no error in the ...

Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks ...

A community pharmacist is frequently the first healthcare professional who is asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she ...

This paper provides a brief overview and critique of the dominant objectivist understanding and use of illness narrative in Enlightenment (scientific) medicine and ethics, as well as several revisionist accounts, which reflect the evolution of this approach. In light of certain limitations and difficulties endemic in the objectivist understanding of ...

In America's freewheeling economy, the nation's supply of physicians has fluctuated widely over decades, driven by countless decisions of individuals, private organizations, and governments. In this complicated mix, the federal government has remained a strong supporter of graduate medical education (GME), the pathway through which medical students must pass to ...

ObjectiveTo compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS).DesignA prospective observational study.Materials and methodsWe collected 4023 medication orders in a hospital for independent evaluation in two pharmacotherapy-related decision support systems. Only the more advanced system considered patient characteristics and ...

Worldwide, billions of dollars are invested in medical product development and there is an increasing pressure to maximize the revenues of these investments. That is, governments need to be informed about the benefits of spending public resources, companies need more information to manage their product development portfolios and even universities ...

Relationships between physicians and their industry partners have ranged from spectacular collaborations that produce extraordinary advances in patient care, such as endovascular aneurysm repair, to humiliating scandals such as extravagant trips and bogus "consulting" agreements resulting in legal actions. It is the latter which have led many to call for ...

Objectives:To establish consensus on the most important clinical decisions paramedics make during high-acuity emergency calls and to visualize these decisions on a process map of an emergency call. A secondary objective was to measure agreement among paramedics and medical director panel members.Methods:A multiround online survey of Canadian paramedics and medical ...

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National ...

The previous two articles in this series explored the historical and theoretical development of medical decision making from initial reliance on medical beneficence to a more recent emphasis on patient autonomy. The law of withholding and withdrawal of treatment has much in common with medical ethics. It is based on ...

Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the ...

International humanitarian law requires medical practitioners to be given "respect and protection" when serving as medical practitioners in the military. A component of this legal assurance is that when military medical personnel base their decisions on their medical code of ethics, that decision will be respected and protected. Although the ...

Menopause is understood, portrayed, and experienced in diverse ways. The dominant biomedical perspective medicalizes menopause as a biological 'hormone deficiency' requiring 'treatment' with hormone replacement therapy (HRT). Alternative perspectives view menopause as discursively located within particular socio-historical times and places, or privilege women's embodied experiences of menopause. We argue that ...

This paper investigates the case of Italians travelling abroad for fertility treatments as a reaction to the restrictive Italian law regulating medically assisted procreation. The acknowledgement of legal limitations provokes special feelings of abandonment while the decision to leave the country represents intentions that oppose institutional positions and results in ...

Nearly 90% of terminally ill patients who have used Oregon's distinctive death with dignity law to receive a medication to end their lives are enrolled in hospice care programs. In 2009-2010, we conducted a study of the policies developed by Oregon hospices to address patient inquiries and requests for death ...

ABSTRACT: BACKGROUND: Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the ...

Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors ...

ABSTRACT: BACKGROUND: Withdrawing and withholding life-support therapy (WH/WD) are undeniably integrated parts of medical activity. However, Emergency Department (ED) might not be the most appropriate place to give end-of life (EOL) care; the legal aspects and practices of the EOL care in emergency rooms are rarely mentioned in the medical ...