scholarly journals Irremediable psychiatric suffering in the context of physician assisted death: a Delphi-study

2021 ◽  
Author(s):  
Sisco M.P. van Veen ◽  
Natalie Evans ◽  
Andrea M. Ruissen ◽  
Joris Vandenberghe ◽  
Aartjan T.F. Beekman ◽  
...  
Keyword(s):  
Decision Making ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Treatment Refusal ◽  
Expert Group ◽  
Assisted Death ◽  
Delphi Procedure ◽  
Narrative Description

Background Patients with a psychiatric disorder (PPD) are eligible to request physician assisted death (PAD) in a small but growing number of jurisdictions, including the Netherlands and Belgium. For this request to be granted, most of these jurisdictions demand that the patient is competent in her request, and that the suffering experienced is unbearable and irremediable. Especially the criterion of irremediability is challenging to establish in patients with psychiatric disorders. Aims To establish what criteria Dutch and Belgian experts agree to be essential in characterising irremediable psychiatric suffering (IPS) in the context of PAD. Method A two round Delphi procedure among psychiatrists with relevant experience. Results Thirteen consensus-criteria were established: five diagnostic and eight treatment-related criteria. Diagnostically, the participants deem a narrative description and attention to contextual and systemic elements necessary. Also, a mandatory second opinion is required. The criteria concerning treatment show that extensive biopsychosocial treatment is needed, and the suffering must be present for several years. Finally, in the case of treatment refusal, the participants agree that there are limits to the number of diagnostic procedures or treatments a patient must undergo. Conclusions Consensus was found among a Dutch and Belgian expert group on essential criteria for establishing IPS in the context of PAD. These criteria can be used in clinical decision making and can inform future procedural demands and research.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

scholarly journals Operationalization of the learned non-use phenomenon - A Delphi study

2020 ◽  
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Negative Reinforcement ◽  
Brain Lesion ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

AbstractThe discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms such as negative reinforcement. Despite the generally accepted existence of the LNU phenomenon among clinicians and researchers, no unequivocal and transdisciplinary definition exists to date. Furthermore, although therapeutic approaches are implemented in clinical practice to explicitly target LNU, no standardized diagnostic routine is described in the current literature.Based on a structured group communication following the Delphi method among clinical and scientific experts in the field of LNU, knowledge from both, the work with patient populations and with animal models, was synthesized and integrated to reach consensus regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Building on these results, the need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

scholarly journals CHANGES UN CARDIOVASCULAR SYSTEM OF DOGS DUE TO AGEING

2010 ◽  
Vol 3 (2) ◽  
pp. 35-46
Author(s):  
Ljubica Spasojević Kosić ◽  
Dragiša R. Trailović
Keyword(s):  
Decision Making ◽  
Cardiovascular System ◽  
Clinical Decision Making ◽  
Preventive Measures ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Therapeutic Procedures ◽  
Points Of View

The characteristics of aging and the changes of cardiovascular system with aging are important in clinical decision making and in designing preventive measures. Studies of aging in dogs represent paradigm in biomedical researches. Aging leads to numerous changes of cardiovascular system, which could be looked from morphological, functional, endocrinological, genetic and biochemical points of view. These aspects of aging enable many diagnostic procedures, therapeutic procedures and preventive measures as well. In this paper special emphasis was put on changes of cardiovascular system, caused by aging, which are clinically free to registered or may be affected by therapy or prophylaxis.

scholarly journals Developing a Physiotherapy-Specific Preliminary Clinical Decision-Making Tool for Oxygen Titration: A Modified Delphi Study

2014 ◽  
Vol 66 (3) ◽  
pp. 286-295 ◽  
Author(s):  
Michelle Duong ◽  
Kendra Bertin ◽  
Renee Henry ◽  
Deepti Singh ◽  
Nolla Timmins ◽  
...  
Keyword(s):  
Decision Making ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Modified Delphi ◽  
Decision Making Tool

scholarly journals A First Step Toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study

2021 ◽  
pp. 154596832199906
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Brain Lesion ◽  
Basic Research ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

Background The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms. Objective Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures. Methods We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models. Results Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Conclusions The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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