The role of meta-analysis in medical decision making

2003 ◽  
Vol 3 (5) ◽  
pp. 329-330 ◽  
Author(s):  
Michael Von Korff
2019 ◽  
pp. bmjebm-2019-111247
Author(s):  
David Slawson ◽  
Allen F Shaughnessy

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.


2016 ◽  
Vol 13 (11) ◽  
pp. 1969-1976 ◽  
Author(s):  
Marilyn M. Schapira ◽  
Charu Aggarwal ◽  
Scott Akers ◽  
Jaya Aysola ◽  
Diana Imbert ◽  
...  

1997 ◽  
Vol 47 (1-2) ◽  
pp. 43-49 ◽  
Author(s):  
M.F. Anderson ◽  
H. Moazamipour ◽  
D.L. Hudson ◽  
M.E. Cohen

2021 ◽  
Vol 2 ◽  
Author(s):  
Robin Andrews ◽  
Gabrielle Hale ◽  
Bev John ◽  
Deborah Lancastle

Evidence suggests that monitoring and appraising symptoms can result in increased engagement in medical help-seeking, improved patient-doctor communication, and reductions in symptom prevalence and severity. To date, no systematic reviews have investigated whether symptom monitoring could be a useful intervention for menopausal women. This review explored whether symptom monitoring could improve menopausal symptoms and facilitate health-related behaviours. Results suggested that symptom monitoring was related to improvements in menopausal symptoms, patient-doctor communication and medical decision-making, heightened health awareness, and stronger engagement in setting treatment goals. Meta-analyses indicated large effects for the prolonged use of symptom diaries on hot flush frequencies. Between April 2019 and April 2021, PsychInfo, EMBASE, MEDLINE, CINAHL, Cochrane, ProQuest, PsychArticles, Scopus, and Web of Science were searched. Eighteen studies met the eligibility criteria and contributed data from 1,718 participants. Included studies quantitatively or qualitatively measured the impact of symptom monitoring on menopausal populations and symptoms. Research was narratively synthesised using thematic methods, 3 studies were examined via meta-analysis. Key themes suggest that symptom monitoring is related to improvements in menopausal symptoms, improved patient-doctor communication and medical decision-making, increased health awareness, and stronger engagement in goal-setting behaviours. Meta-analysis results indicated large effects for the prolonged use of symptom diaries on hot flush frequency: 0.73 [0.57, 0.90]. This review is limited due to the low number of studies eligible for inclusion, many of which lacked methodological quality. These results indicate that symptom monitoring has potential as an effective health intervention for women with menopausal symptoms. This intervention may be beneficial within healthcare settings, in order to improve patient-doctor relations and adherence to treatment regimes. However, findings are preliminary and quality assessments suggest high risk of bias. Thus, further research is needed to support these promising outcomes.Systematic Review Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?, PROSPERO, identifier: CRD42019146270.


2019 ◽  
Vol 26 (2) ◽  
pp. 1152-1176 ◽  
Author(s):  
Motti Haimi ◽  
Shuli Brammli-Greenberg ◽  
Yehezkel Waisman ◽  
Nili Stein ◽  
Orna Baron-Epel

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.


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