Discounting and clinical decision making: Physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms

2002 ◽  
Vol 11 (4) ◽  
pp. 355-370 ◽  
Author(s):  
S. Höjgård ◽  
U. Enemark ◽  
C. H. Lyttkens ◽  
A. Lindgren ◽  
T. Troëng ◽  
...  
2013 ◽  
Vol 22 (01) ◽  
pp. 009-012 ◽  
Author(s):  
Ilias Dalainas ◽  
John Kakisis ◽  
Spyridon Mylonas ◽  
Christos Liapis ◽  
Konstnatinos Moulakakis

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 120-123 ◽  
Author(s):  
Anıl Özen ◽  
Ertekin Utku Unal ◽  
Serkan Mola ◽  
Ibrahim Erkengel ◽  
Erman Kiris ◽  
...  

Objective To assess the ability of Glasgow Aneurysm Score in predicting postoperative mortality for ruptured aortic aneurysm which may assist in decision making regarding the open surgical repair of an individual patient. Methods A total of 121 patients diagnosed of ruptured abdominal aortic aneurysm who underwent open surgery in our hospital between 1999 and 2013 were included. The Glasgow Aneurysm Score for each patient was graded according to the Glasgow Aneurysm Score (Glasgow Aneurysm Score = age in years + 17 for shock + 7 for myocardial disease + 10 for cerebrovascular disease + 14 for renal disease). The groups were divided as Group 1 (containing the patients who died) and Group 2 (the patients who were discharged). The Glasgow Aneurysm Scores amongst the groups were compared. Results Out of 121 patients, 108 (89.3%) were males and 13 (10.7%) were females. The in-hospital mortality was 48 patients (39.7%). The Glasgow Aneurysm Score was 84.15 ± 15.94 in Group 1 and 75.14 ± 14.67 in Group 2 which revealed significance ( p = 0.002). The most appropriate cut-off value for Glasgow Aneurysm Score was determined as 78.5 (AUC = 0.669, p = 0.002, sensitivity: 64.6%, specificity: 60.3%). Glasgow Aneurysm Score value above 78.5 is associated with almost threefold increase in mortality ( p = 0.007, OR:2.76, 95% CI 1.30–5.89). In further logistic regression models, Glasgow Aneurysm Score value and preoperative hematocrit values were found to be independent predictors for mortality ( p = 0.023 and p = 0.007, respectively). Conclusion Glasgow Aneurysm Score may have a predictive value for outcome of patients with ruptured abdominal aortic aneurysm undergoing open surgical procedure and it appears to be a useful tool in clinical decision-making of an individual patient when integrated with clinical experience.


2021 ◽  
pp. emermed-2020-209961
Author(s):  
Nicola Jane Credland ◽  
Clare Whitfield

BackgroundIncivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered ‘part of the job’.MethodsQualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.ResultsFour themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.ConclusionsThis study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.


2007 ◽  
Vol 14 (4) ◽  
pp. 536-540 ◽  
Author(s):  
Annette F. Baas ◽  
Diederick E. Grobbee ◽  
Jan D. Blankensteijn

Purpose: To report a retrospective study into the effects of trials on clinical decision-making regarding abdominal aortic aneurysm (AAA) patients suitable for both conventional open (OR) and endovascular aneurysm repair (EVAR). Methods: A questionnaire was sent to 1400 Dutch surgeons and trainees. Interviewees had to choose between OR and EVAR for AAA patients with and without comorbidity. Specifically, their preferences before and after the publication of 2 randomized trials (EVAR-1 and DREAM) were polled. Results: Of the 524 (37%) questionnaires returned, 223 (43%) respondents treated AAA patients. Before publication of the trials, 160 (72%) preferred OR for the patient without comorbidity and 169 (76%) preferred EVAR for the patient with comorbidity. In total, 72 (32%) respondents changed their preference after the trials were published; however, there was no overall major shift. Focusing on the different cases revealed that the OR preference was significantly enhanced for the patient without comorbidity (p<0.01), while the EVAR preference was significantly enhanced for the patient with comorbidity (p<0.05). Conclusion: The randomized trials have not induced major overall changes in surgical decision-making for AAA patients suitable for both EVAR and OR.


Circulation ◽  
2004 ◽  
Vol 110 (23) ◽  
Author(s):  
Mohammed Al-Omran ◽  
Subodh Verma ◽  
Thomas F. Lindsay ◽  
Richard D. Weisel ◽  
Yaron Sternbach

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