scholarly journals Diagnostics 4.0: the medical laboratory in digital health

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Michael Neumaier
Keyword(s):  
Health Care ◽  
Clinical Decision Making ◽  
Digital Health ◽  
Preventive Health Care ◽  
Clinical Decision ◽  
Laboratory Medicine ◽  
Cloud Services ◽  
Added Value ◽  
Medical Laboratory ◽  
The Way

AbstractDuring recent years, the digital revolution has changed the face of societies including industrial production, economies and peoples’ social lives. From these changes we may extrapolate the developments that digitization of health care will bring to medicine in general and laboratory medicine in particular. Disruptive technologies will fundamentally change the way laboratory tests are going to be ordered, carried out and interpreted in the future, and test results from various sources need to be curated to be of added value for the patient’s condition. Wearables and implantables will quantify the concentrations for an unknown number of laboratory parameters, and the data will be stored in cloud services at the fingertips of the patient as the sovereign of his/her health care data. A 24/7 online availability of health services will strengthen predictive medicine and may enable a vastly improved preventive health care that is supported by deep-learning algorithms for clinical decision-making not only on behalf of the physician, but also the empowered patient (e.g. health bots). This will likely shift the current role of Laboratory Medicine as a central provider of diagnostic information from a “hidden champion” towards a higher visibility redefining the patient-physician-laboratory relationship. For example, accessing digital health data will allow Laboratory Medicine to more efficiently contribute to the medical dialog than is often the case today. From this perspective, this will require major readjustments in the way we execute our profession, and it will also need new concepts of education and continuous professional development.

scholarly journals Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula

2020 ◽  
Vol 7 ◽  
pp. 238212052094359 ◽  
Author(s):  
Amanda A Olsen ◽  
Lana M Minshew ◽  
Kathryn A Morbitzer ◽  
Tina P Brock ◽  
Jacqueline E McLaughlin
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Precision Medicine ◽  
Clinical Decision Making ◽  
Interprofessional Collaboration ◽  
Digital Health ◽  
Pharmacy Practice ◽  
Clinical Decision ◽  
Professional Skills ◽  
Wide Range

To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students’ abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

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.

Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice

2016 ◽  
Vol 25 (4) ◽  
pp. 453-469 ◽  
Author(s):  
Jennifer Horner ◽  
Maria Modayil ◽  
Laura Roche Chapman ◽  
An Dinh
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Legal Advice ◽  
Medical Context

PurposeWhen patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice.MethodThe authors use a hypothetical case of a “noncompliant” individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient–practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy.ConclusionsSpeech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

Quality specifications: self pleasure for clinical laboratories or added value for patient management?

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Added Value ◽  
Internal Quality ◽  
Laboratory Services ◽  
Management Procedures ◽  
Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

scholarly journals A prospective evaluation of the Flacker-Kiely One Year Mortality Score and the added value of NT-proBNP

2020 ◽  
Vol 11 (2) ◽  
pp. 13
Author(s):  
Kjell Krüger ◽  
Bård R. Kittang ◽  
Sabine P. Solheim ◽  
Kristian Jansen
Keyword(s):  
Heart Failure ◽  
Failure Criterion ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Clinical Decision ◽  
Blood Chemistry ◽  
Discriminatory Power ◽  
Added Value ◽  
Youden Index ◽  
Mortality Data

Objective: Several mortality indices have been constructed to aid clinical decision making in older adults. We aimed to prospectively validate the Flacker-Kiely (FK) mortality index in a Norwegian nursing home cohort, which has not been done before, and explore whether NT-ProBNP could improve its discriminatory power.Methods: We performed a cohort/mortality study. From November 2017 to July 2018, physicians in all public long-term nursing homes in Bergen, Norway, scored residents according to the original Flacker Kiely index. Mortality data were derived from the Norwegian Cause of Death Registry and NT-ProBNP values were obtained from routinely collected blood chemistry. An alternative FK index using the NT-ProBNP-value as a marker for the presence of heart failure was constructed (FK NT-ProBNP index). The ProBNP cut-off value was selected based on a Cox regression model (“dead/alive 1 year”/” NT-ProBNP (Ng/l)”, where the value with the highest Youden index was identified. We judged index performance by using c-statistics.Results: Both the original FK index and the constructed FK NT-ProBNP index discriminated between risk strata. The FK NT-ProBNP index yielded a C-index of 0.66 compared to 0.62 for the original FK index. Optimal discriminatory power was shown with a NT-ProBNP cut-off value of 1,595 Ng/l as heart failure criterion, and FK NT-ProBNP score 6.6.Conclusions: The prospective mortality estimation ability of the FK-index was comparable to previous retrospective studies. The inclusion of NT-ProBNP as a heart failure criterion strengthen the discriminatory power and utility of the index, both in clinic and administration.

scholarly journals Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons

2020 ◽  
Vol 18 (4) ◽  
pp. 2033
Author(s):  
Roxana De las Salas ◽  
Javier Eslava-Schmalbach ◽  
Claudia Vaca-González ◽  
Dolores Rodríguez ◽  
Albert Figueras
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Inappropriate Medication ◽  
Clinical Decision ◽  
Potentially Inappropriate Medication ◽  
Kappa Statistics ◽  
Primary Health

Objective: The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. Methods: We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity‏ ratio, item-level content validity, and Fleiss’ Kappa statistics was measured to establish reliability. The same voting method was used for round 2. Results: A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). Conclusions: This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient’s and caregiver’s preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons’ medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.

Creating Public Health Policy

2014 ◽  
pp. 210-223
Author(s):  
Bruce F. Chorpita ◽  
Jeanne Miranda ◽  
Adam Bernstein
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Real World ◽  
Clinical Decision Making ◽  
Mental Health Policy ◽  
Clinical Decision ◽  
Quality Practices ◽  
Mental Health Treatments ◽  
And Training ◽  
The Way

In recent years, clinical psychology has made significant contributions to mental health policy through its increasing focus on the notion of evidence-based practice and an empirical approach to clinical decision-making. These developments have not been without challenges, however. Most notable are issues with the acceptability of treatment design among practitioners and the difficulty of implementing and sustaining high-quality practices in real-world contexts. Two specific barriers central to these challenges are discussed, namely, the highly specialized architecture of most research-based mental health treatments and the unavailability of a dedicated supervisory and training infrastructure. Solutions are proposed that suggest the need to rethink both the way treatments are packaged and the way they are supported in real-world practice.

Sign in / Sign up

Export Citation Format

Share Document