Effects of sleepiness on clinical decision making among paramedic students: a simulated night shift study

2021 ◽  
pp. emermed-2019-209211
Author(s):  
Danielle Bartlett ◽  
Sara Hansen ◽  
Travis Cruickshank ◽  
Timothy Rankin ◽  
Pauline Zaenker ◽  
...  
Keyword(s):  
Decision Making ◽  
Reaction Time ◽  
Shift Work ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Night Shift ◽  
Clinical Decision ◽  
Night Shift Work ◽  
Clinical Scenarios ◽  
Perceived Workload

ObjectiveParamedics are at the forefront of emergency healthcare. Quick and careful decision making is required to effectively care for their patients; however, excessive sleepiness has the potential to impact on clinical decision making. Studies investigating the effects of night shift work on sleepiness, cognitive function and clinical performance in the prehospital setting are limited. Here, we aimed to determine the extent to which sleepiness is experienced over the course of a simulation-based 13-hour night shift and how this impacts on clinical performance and reaction time.MethodsTwenty-four second year paramedic students undertook a 13-hour night shift simulation study in August 2017. The study consisted of 10 real-to-life clinical scenarios. Sleepiness, perceived workload and motivation were self-reported, and clinical performance graded for each scenario. Reaction time, visual attention and task switching were also evaluated following each block of two scenarios.ResultsThe accuracy of participants’ clinical decision making declined significantly over the 13-hour night shift simulation. This was accompanied by an increase in sleepiness and a steady decline in motivation. Participants performed significantly better on the cognitive flexibility task across the duration of the simulated night shift and no changes were observed on the reaction time task. Perceived workload varied across the course of the night.ConclusionOverall, increased sleepiness and decreased clinical decision making were noted towards the end of the 13-hour simulated night shift. It is unclear the extent to which these results are reflective of practising paramedics who have endured several years of night shift work, however, this could have serious implications for patient outcomes and warrants further investigation.

scholarly journals Return to Play after Cervical Spine Injuries: A Consensus of Opinion

2016 ◽  
Vol 6 (8) ◽  
pp. 792-797 ◽  
Author(s):  
John C. France ◽  
Michael Karsy ◽  
James S. Harrop ◽  
Andrew T. Dailey
Keyword(s):  
Decision Making ◽  
Cervical Spine ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Return To Play ◽  
Spine Injury ◽  
Cervical Cord ◽  
Clinical Scenarios ◽  
Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

scholarly journals Updates on the Latest Surgical Approach of the Aortic Stenosis

2021 ◽  
Vol 10 (21) ◽  
pp. 5140
Author(s):  
Lucian Geicu ◽  
Olivier Busuttil ◽  
Nicolas D’Ostrevy ◽  
Mathieu Pernot ◽  
Walid Benali ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Daily Practice ◽  
Integrated Approach ◽  
Clinical Decision ◽  
Heart Team ◽  
Surgical Indications ◽  
Therapeutic Decisions ◽  
Clinical Scenarios ◽  
Technical Advances

Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice.

scholarly journals Evaluation of a clinical decision-making aid for nutrition advice in age-related macular degeneration

2017 ◽  
Vol 35 (3) ◽  
pp. 185-196 ◽  
Author(s):  
Rebekah Stevens ◽  
Hannah Bartlett ◽  
Richard Cooke
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Central Area ◽  
Clinical Decision ◽  
Age Related Macular Degeneration ◽  
Preliminary Evaluation ◽  
Eye Care ◽  
Eligibility Criteria ◽  
Age Related ◽  
Clinical Scenarios

Age-related macular disease (AMD) is a multifactorial degenerative condition affecting the central area of the retina. Patients with AMD report that eye care practitioners are not giving consistent advice regarding nutrition and reported confusion as to what advice, if any, to follow. The aim of this study was to design and conduct a preliminary evaluation of a flowchart to support eye care practitioners in providing accurate, evidence-based nutritional advice to their patients. A flowchart was designed to take practitioners through a decision-making process that would determine whether a patient matched the Age-Related Eye Disease Study (AREDS) 2 eligibility criteria for supplementation. The flowchart was evaluated using a qualified and student optometrist cohort, with both cohorts completing confidence scales and students completing clinical scenarios. Qualified participants showed a significant increase in confidence scores from the initial survey ( M = 69.7%, standard deviation [ SD] = 16.2%) to the second survey after use of the flowchart for 2 weeks ( M = 82.1%, SD = 11.6%; t(45) = 7.33, p < .001; rs = .61, p < .001). The student participants also increased confidence scored after receiving the flowchart ( M of first survey = 41.7, SD = 14.6; M of second survey = 69.1, SD = 1.7; t(25) = 7.92, d = .81, p < .001) and increased the number of correct answers on five clinical scenarios. Overall, the flowchart has proved to be useful in boosting the self-efficacy of both qualified practitioners and student practitioners, as well as improving clinical decisions made by student practitioners.

scholarly journals COVID-19 Era Effect on Pandemic and Post-pandemic Pediatric Telemedicine Use: A Survey of the European Academy of Pediatrics Research in Ambulatory Settings Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen M. Reingold ◽  
Adamos Hadjipanayis ◽  
Diego van Esso ◽  
Stefano del Torso ◽  
Hans Jürgen Dornbusch ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Acute Otitis Media ◽  
Clinical Decision ◽  
Text Messages ◽  
Pediatric Care ◽  
Care Providers ◽  
Phone Calls ◽  
Clinical Scenarios ◽  
June July

Background: During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care.Objective: The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends.Material and methods: Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June–July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine.Results: A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters via telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2–9%), text messages (1–6%), social media (3–11%), cell-phone pictures/video (1–9%), and video conferencing (1–7%) (p &lt; 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (p &lt; 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (p &lt; 0.005).Conclusions: This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.

scholarly journals A Cognitive Autopsy Approach towards Understanding Diagnostic Failure

2020 ◽  
Author(s):  
Pat Croskerry ◽  
Samuel Campbell
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Critical Role ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Base Line ◽  
Root Cause ◽  
Knowledge Based

Diagnostic failure has emerged as one of the most significant threats to patient safety, and it is important to understand the antecedents of such failures. A consensus has developed in the literature that the majority are due to individual or system factors or some combination of the two. A major source of variance in individual clinical performance is due to cognitive and affective biases, however, their role in clinical decision making has been difficult to assess partly because they are difficult to investigate experimentally. A significant drawback has been that experimental manipulations appear to confound assessment of the context surrounding the diagnostic process itself. The present qualitative study uses a detailed narrative account of selected actual cases of diagnostic error to explore the effect of biases in the ‘real world’ emergency medicine (EM) context. Thirty anonymized EM cases were analysed in depth through a process of root cause analysis that included an assessment of error producing conditions, knowledge-based errors, and how clinicians were thinking and deciding during each case. A prominent feature of the study was the identification of specific cognitive and affective biases – through a process called cognitive autopsy. The cases covered a broad range of diagnoses across a wide variety of disciplines. A total of 24 discrete cognitive and affective biases that contributed to misdiagnosis were identified and their incidence recorded. 5-6 biases were detected per case, and observed on 168 occasions across the 30 cases. Thirteen error-producing conditions (EPCs) were identified. Knowledge-based errors were rare, occurring in only 5 definite instances. The ordinal position in which biases appeared in the diagnostic process was recorded. This study provides a base-line for understanding the critical role that biases play in clinical decision making and sheds light on important aspects of the diagnostic process.

The Influence of Linguistic Bias Upon Speech-Language Pathologists’ Attitudes Toward Clinical Scenarios Involving Nonstandard Dialects of English

2021 ◽  
pp. 1-17
Author(s):  
Catherine Easton ◽  
Sarah Verdon
Keyword(s):  
Decision Making ◽  
Service Provision ◽  
Clinical Decision Making ◽  
Linguistic Diversity ◽  
Clinical Decision ◽  
Assessment Tools ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Clinical Scenarios ◽  
Language Pathology

Purpose Variation within languages, including dialects, takes on an indexical function, marking belonging and connection. Meanwhile, attitudes toward these speech varieties become marked by linguistic bias. Within the speech-language pathology profession, research evidence, assessment tools, and intervention programs have largely been designed for and by the White, English-speaking middle class. As such, linguistic bias with a preference for standardized dialects is prevalent in the training and practice of the speech-language pathology profession, resulting in discriminatory and racialized practices. Method To investigate the influence of linguistic bias upon speech-language pathologists' (SLPs') clinical decision making, data were collected from 129 Australian SLPs via an online survey. Inferential statistics were used to investigate the relationship between clinical decision making and SLPs' attitudes toward nonstandard dialects as well as personal and professional factors. A content analysis of extended responses was conducted to identify themes in clinical decision making. Results SLPs with more years of experience and those who had received professional development were significantly more likely to seek out more information before making a diagnosis, while those with more negative attitudes toward linguistic diversity were significantly more likely to identify a disorder than a difference. SLPs provided a range of justifications for their clinical decision making, but few acknowledged the influence of their own attitudes and bias upon their decision making. Conclusions SLPs' linguistic bias towards speakers of nonstandard dialects has the potential to impact upon their clinical judgment of difference versus disorder and lead to inequality of service provision for speakers who do not express themselves in standardized forms. Before the profession can truly move toward an antiracist approach of equitable service provision for all, SLPs must engage in critical self-reflection to disrupt the adherence of the speech-language pathology profession to standardized “White” norms of communication.

scholarly journals The Clinical Applications of Serum and Urinary Biomarkers in Prostate Cancer

2020 ◽  
Vol 1 (1) ◽  
pp. 30-38
Author(s):  
Renu S Eapen ◽  
Peter E Lonergan ◽  
Dominic Bagguley ◽  
Sean Ong ◽  
Ben Condon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Clinical Decision ◽  
Urine Biomarkers ◽  
Clinical Scenarios ◽  
Risk Prognosis

At every stage of the prostate cancer journey from screening and diagnosis to management of advanced disease, patients and clinicians face dilemmas and decisions that can impact long-term outcomes. Although traditional risk stratification in prostate cancer is based on serum prostate specific antigen, clinical stage and Gleason score, in recent years, biomarkers have been developed that may be useful in several clinical scenarios. Biomarkers that can accurately predict an individual patient’s risk, prognosis, and response to specific treatments could lead to improvements in decision-making and clinical care. Although there is evidence to support the use of biomarkers to guide management decisions, the optimal scenario in which to use them, how to interpret the results, and how to incorporate those results into clinical decision-making can be confusing. Nevertheless, in the era of personalized and precision medicine, it is important for clinicians to be aware of what tests are available, what clinical questions they seek to answer, and what limitations they have. This review focuses on the serum and urine biomarkers for the management of prostate cancer that have been under intense investigation in recent years.

scholarly journals Impact of Point-of-Care Diagnostics on Clinical Decision-making in Low- and Middle-Income Countries

2018 ◽  
Vol 3 (3) ◽  
pp. 456-459
Author(s):  
Andrea DeLuca ◽  
Joshua Betz ◽  
Robert Bollinger ◽  
Stuart C Ray ◽  
Yukari C Manabe
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Middle Income ◽  
Resource Limited ◽  
Clinical Scenarios ◽  
Low And Middle Income ◽  
The Way

Abstract Background Rapid tests have transformed the landscape of available tools for clinicians caring for patients who are critically ill. Their emergence as part of routine care increases the capacity for similar devices to reverse or minimize major epidemics and assist healthcare providers in their clinical decision-making. To assess how a point-of-care complete blood count (CBC) could change patterns in clinical decision-making, we presented low and middle income (LMIC) healthcare providers with hypothetical clinical scenarios to understand how such a device could impact the way they treat and refer patients. Methods Our survey asked about current use of CBC results, and then presented three separate scenarios that occur in LMICs. Survey respondents were queried about how they might change hospitalization plans and/or mediations based on point-of-care CBC results. Results In all three scenarios, a majority of clinicians were likely to modify the way they triage patients based on real-time results. Conclusion Our survey demonstrates that a point-of-care CBC diagnostic could change the way providers in resource-limited settings treat and refer critically ill patients. All hypothetical clinical scenarios describe common, urgent case presentations that can occur at any level of a health system in resource-limited settings. Rapid, simple and accessible technology for basic lab tests like CBC could impact patient care in low and middle-income countries by providing health care workers with actionable data with the potential to affect patient-centered outcomes.

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