scholarly journals Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making

2009 ◽  
Vol 29 (5) ◽  
pp. 606-618 ◽  
Author(s):  
Karen E. Lutfey ◽  
Carol L. Link ◽  
Lisa D. Marceau ◽  
Richard W. Grant ◽  
Ann Adams ◽  
...  
Keyword(s):  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Medical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Practice Variation ◽  
Diagnostic Certainty ◽  
Cross National

The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up.

scholarly journals The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

2006 ◽  
Vol 26 (2) ◽  
pp. 303-321 ◽  
Author(s):  
ANN ADAMS ◽  
CHRISTOPHER D. BUCKINGHAM ◽  
SARA ARBER ◽  
JOHN B. MCKINLAY ◽  
LISA MARCEAU ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Decision Making ◽  
Health Care Systems ◽  
Clinical Decision ◽  
Adverse Outcomes ◽  
Patients Âgés ◽  
Co Morbidity

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

scholarly journals Cognitive Computing-Based CDSS in Medical Practice

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Jun Chen ◽  
Chao Lu ◽  
Haifeng Huang ◽  
Dongwei Zhu ◽  
Qing Yang ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Practice ◽  
General Framework ◽  
Clinical Decision Making ◽  
High Efficiency ◽  
Clinical Decision ◽  
Machine Intelligence ◽  
Medical Community ◽  
Current Status ◽  
Cognitive Computing

Importance. The last decade has witnessed the advances of cognitive computing technologies that learn at scale and reason with purpose in medicine studies. From the diagnosis of diseases till the generation of treatment plans, cognitive computing encompasses both data-driven and knowledge-driven machine intelligence to assist health care roles in clinical decision-making. This review provides a comprehensive perspective from both research and industrial efforts on cognitive computing-based CDSS over the last decade. Highlights. (1) A holistic review of both research papers and industrial practice about cognitive computing-based CDSS is conducted to identify the necessity and the characteristics as well as the general framework of constructing the system. (2) Several of the typical applications of cognitive computing-based CDSS as well as the existing systems in real medical practice are introduced in detail under the general framework. (3) The limitations of the current cognitive computing-based CDSS is discussed that sheds light on the future work in this direction. Conclusion. Different from medical content providers, cognitive computing-based CDSS provides probabilistic clinical decision support by automatically learning and inferencing from medical big data. The characteristics of managing multimodal data and computerizing medical knowledge distinguish cognitive computing-based CDSS from other categories. Given the current status of primary health care like high diagnostic error rate and shortage of medical resources, it is time to introduce cognitive computing-based CDSS to the medical community which is supposed to be more open-minded and embrace the convenience and low cost but high efficiency brought by cognitive computing-based CDSS.

Alternative Medicine and Multiple Sclerosis: An Objective Review from an American Perspective

2000 ◽  
Vol 2 (3) ◽  
pp. 15-28 ◽  
Author(s):  
Allen C. Bowling ◽  
Ragaa Ibrahim ◽  
Thomas M. Stewart
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Alternative Medicine ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Care Providers ◽  
American Perspective ◽  
Conventional Medical Therapy

Abstract The use of complementary and alternative medicine (CAM), or unconventional medicine, may be challenging for health care providers in the United States. There are several definitions of CAM, and therapies that are considered alternative in one country may be conventional in other countries. Unconventional medical practices may be used instead of, or in addition to, conventional medical therapy. It may be difficult for people with multiple sclerosis (MS) to obtain reliable MS-relevant CAM information, and there may be conflicts between the values of patients and those of health care providers. These issues may create problems in the clinical decision-making process. The relevance to MS of some commonly used CAM therapies is discussed: herbal medicine, vitamins and minerals, marijuana, and a histamine and caffeine transdermal gel patch. Current information about the efficacy and safety of CAM therapies is extremely variable. Some therapies appear promising, others are unsafe or ineffective, and nearly all need to be studied further.

scholarly journals Appropriate use criteria for cardiovascular magnetic resonance imaging (CMR): SIC—SIRM position paper part 1 (ischemic and congenital heart diseases, cardio-oncology, cardiac masses and heart transplant)

2021 ◽  
Vol 126 (3) ◽  
pp. 365-379
Author(s):  
Gianluca Pontone ◽  
Ernesto Di Cesare ◽  
Silvia Castelletti ◽  
Francesco De Cobelli ◽  
Manuel De Lazzari ◽  
...  
Keyword(s):  
Heart Disease ◽  
Magnetic Resonance ◽  
Heart Transplant ◽  
Congenital Heart ◽  
Clinical Decision Making ◽  
Heart Diseases ◽  
Integrated Approach ◽  
Clinical Decision ◽  
Italian Society ◽  
Cardiac Masses

AbstractCardiac magnetic resonance (CMR) has emerged as new mainstream technique for the evaluation of patients with cardiac diseases, providing unique information to support clinical decision-making. This document has been developed by a joined group of experts of the Italian Society of Cardiology and Italian society of Radiology and aims to produce an updated consensus statement about the current state of technology and clinical applications of CMR. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac radiology. Part 1 of the document will cover ischemic heart disease, congenital heart disease, cardio-oncology, cardiac masses and heart transplant.

What Is Medical Ethics Consultation?

2008 ◽  
Vol 36 (1) ◽  
pp. 95-118 ◽  
Author(s):  
Giles R. Scofield
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Medical Ethics ◽  
Medical Technology ◽  
Clinical Decision Making ◽  
Ethics Consultation ◽  
Clinical Decision ◽  
Law Students ◽  
Medical Ethicist ◽  
Care Decision

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside.

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