scholarly journals Case discussions using WeChat: Are they reliable?

2020 ◽  
Author(s):  
Yongwei Li ◽  
Shugang Hu ◽  
Tariq Alkhatatbeh ◽  
Jialin Wang ◽  
Jidong Song ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Online Discussions ◽  
The Other ◽  
Surgical Results ◽  
Orthopedic Surgeons ◽  
Group Members ◽  
Case Discussions ◽  
Analyze Case ◽  
Consistency Rate

Abstract Background : At present, more and more clinicians in China are partaking in case discussions using WeChat groups for the purposes of communication, diagnosis, treatment planning, and information sharing. However, the reliability of discussions using WeChat groups remains debatable. This study aimed to analyze case discussions in WeChat groups and evaluate their significance. Methods : By taking screenshots of the chat records from the most-used WeChat groups by orthopedic surgeons, all of the data related to the cases were collected from June to August in 2019. We analyzed the purpose, participation, and completeness of each case. Furthermore, we analyzed whether the conclusion reached in each case discussion, which was supported by the majority of members, was consistent with the opinion of three experts after evaluating all of the data from the case records. Results : Seven WeChat groups and 60 cases were included. WeChat group members often discussed cases to show surgical results (40.0%), to obtain treatment advice (39.0%), and to seek diagnostic advice (9%). The rate of ‘likes’ for ‘surgical results show’ was greater than the rate of ‘likes’ for alternative purposes (P<0.05). The percentage of complete, relatively complete and incomplete cases was 23%, 32%, and 45%, respectively. The relatively complete cases received more effective comments than the other cases (P<0.05). The cases for diagnostic purposes were more complete than those for other purposes (P<0.05). Among 60 cases, only 29 cases led to the same conclusions being reached among the three experts and WeChat group members. The consistency rate of conclusions relating to treatment was higher than that associated with the other purposes (P<0.05). The consistency rate of the complete cases was higher than that of the relatively complete and incomplete cases (P<0.05). Conclusions : Clinicians should treat discussions in WeChat groups for clinical decision-making with caution. Online discussions using WeChat groups should be standardized in respect to the cases presented and the comments that are generated.

scholarly journals Observation and Analysis of Case Discussions Using WeChat Groups Among Orthopedists

2020 ◽  
Author(s):  
Yongwei Li ◽  
Shugang Hu ◽  
Tariq Alkhatatbeh ◽  
Jialin Wang ◽  
Jidong Song ◽  
...  
Keyword(s):  
Social Media ◽  
Online Discussions ◽  
Surgical Results ◽  
Case Discussion ◽  
Social Media Networks ◽  
Orthopedic Surgeons ◽  
The Common ◽  
Case Discussions ◽  
Consistency Rate

Abstract Background: With the vigorous development of social media networks, an increasing number of orthopedists in China are taking part in case discussions using WeChat groups. The case discussion process using WeChat is quick, convenient and not limited by time or space, but this kind of case discussion is also chaotic and unconstrained. This study is aimed to observe and analyze the purpose, participation, case completeness, opinion consistency of orthopedic case discussions using WeChat groups.Methods: We collected data related to the case discussions of three orthopedic surgeons by taking screenshots of the chat records in the most-used WeChat groups from June to August 2019, and analyzed the purpose, participation, completeness and the opinion consistency between the majority of members and experts in related fields.Results: The common purposes of orthopedic case discussions were showing surgical results and obtaining treatment advice. The number of likes received for cases showing surgical results was significantly higher than those for cases requesting diagnostic advice and obtaining treatment advice. The complete and relatively complete cases attracted more participants and received more effective comments than the incomplete cases. The opinion consistency rate of the complete cases was higher than that of the relatively complete and incomplete cases.Conclusions: The case discussions using WeChat groups among orthopedists was mainly to show surgical results and request for diagnostic advice. Incomplete cases had low discussion participation and low opinion consistency. Online discussions using WeChat groups should be standardized with respect to the completeness of cases.

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

Magnetic resonance imaging, knee arthroscopy, and clinical decision making: A descriptive study of five surgeons

2009 ◽  
Vol 25 (4) ◽  
pp. 577-583 ◽  
Author(s):  
Sarah Derrett ◽  
Gayle D. Walley ◽  
Stephen A. Bridgman ◽  
Paula Richards ◽  
Nicola Maffulli
Keyword(s):  
Magnetic Resonance Imaging ◽  
Decision Making ◽  
Magnetic Resonance ◽  
Clinical Decision Making ◽  
Knee Arthroscopy ◽  
Controlled Trial ◽  
Clinical Decision ◽  
Patient Choice ◽  
Resonance Imaging ◽  
Orthopedic Surgeons

Objectives: A randomized controlled trial (RCT) showed magnetic resonance imaging for patients waiting for knee arthroscopy did not reduce the number of arthroscopies. Our study aimed to identify decisions made by orthopedic surgeons about whether patients on a waiting list should proceed to arthroscopy, and to describe surgeons’ decisions.Methods: Five surgeons were asked to Think Aloud (TA) as they made their decisions for twelve patients from the original RCT. Audiotapes of the decision making were transcribed for analysis.Results: For five patients, surgeons agreed about proceeding with arthroscopy, although reasoning differed. In no cases did surgeons agree about not proceeding to arthroscopy. Agreement was more likely in patients with clinically diagnosed meniscal abnormality, and less likely in patients with osteoarthritis.Conclusions: Surgeons’ decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. Surgeons disagreed more often than they agreed about the decision to proceed with arthroscopy, particularly when OA was diagnosed. This has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. The treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.

scholarly journals Effect of insole material on lower limb kinematics and plantar pressures during treadmill walking

2011 ◽  
Vol 36 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Aoife Healy ◽  
Dave N Dunning ◽  
Nachiappan Chockalingam
Keyword(s):  
Contact Area ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Medium Density ◽  
Ethyl Vinyl ◽  
Plantar Pressures ◽  
Time Integral ◽  
Material Conditions

Background: Currently there is a paucity of research providing recommendations on the type of orthotic or material used in its construction for different patient requirements.Objectives: To gain a greater understanding of the characteristics of orthotic materials and how they affect gait so to enhance the clinical decision-making process.Study Design: Repeated measures.Methods: Plantar pressures and kinematics were evaluated for 10 participants while walking on a treadmill under various conditions which included, shoes only and shoes with four different flat insoles and custom devices created in each of two densities of two materials.Results: For the flat insoles, medium density ethyl vinyl acetate was found to produce greater peak pressures than at least one of the other material conditions and low and medium density polyurethane were most effective at increasing average contact area and at reducing pressure time integral. For the custom devices, while no significant differences were evident, when compared to the shoe only condition, medium density polyurethane increased average contact area by a greater percentage than the other materials.Conclusions: Results for medium density polyurethane suggest a possible difference in loading characteristics, indicating a potential material suitability for patients with a compromised ability to deal with pressure.Clinical relevanceFindings from the present study provide information for a clinician to draw an evidence-based orthotic prescription based on material properties.

Perioperative Pain Management for Orthopedic and Spine Surgery

2018 ◽  
Keyword(s):  
Pain Management ◽  
Clinical Decision Making ◽  
Preoperative Evaluation ◽  
Clinical Decision ◽  
Perioperative Pain ◽  
Orthopedic Surgeons ◽  
Chronic Pain Patients ◽  
Perioperative Pain Management ◽  
Pain Care ◽  
Pain Patients

All physicians are involved in the management of pain at some level or other, with orthopedic surgeons at the frontline of delivering perioperative pain care for a wide variety of problems that range from skeletal trauma, joint replacement procedures, and bone tumors to spinal conditions. Orthopedists need to be able to diagnose pain and be cognizant of the common and rare painful conditions that present perioperatively so that they can manage them effectively. This book assists surgeons in safe perioperative care from preoperative evaluation, to laboratory tests, to imaging orders and interpretations for patients with acute pain and also for those chronic pain patients undergoing surgery. It focuses on how to solve common dilemmas facing orthopedic surgeons who are managing patients with pain-related problems and assist in clinical decision-making. Chapters explore essential topics required for the orthopedist to quickly assess the patient with pain, diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed.

To report or not to report: a proposal on how to deal with altered test results in hemolytic samples

2017 ◽  
Vol 55 (8) ◽  
pp. 1109-1111 ◽  
Author(s):  
Janne Cadamuro ◽  
Cornelia Mrazek ◽  
Elisabeth Haschke-Becher ◽  
Sverre Sandberg
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
General Information ◽  
The Other ◽  
Test Results ◽  
Scientific Discussion ◽  
Laboratory Values ◽  
Test Result

Abstract Preanalytically altered test results are a challenge every laboratory has to face. The release of such results may be to the harm of the patient by triggering wrong clinical decision making in monitoring or treatment. On the other hand, their deletion also might be to the harm of the patient by delaying the time to decision making as the exact value sometimes is not even necessary but rather an answer to the question “Is it raised or lowered”. Based on this dilemma and forced to produce laboratory values without any clinical information on the respective patient, laboratories have developed their own preferred way on how to deal with preanalytically altered test results. Some release the value with a comment, some reject the value with or without a comment and others again provide only general information about the hemolytic sample. To date there is no guideline or standardization to this postanalytical topic. Therefore, with this opinion paper, we want to start the scientific discussion on this important issue by providing one possible method to overcome the lack of clinical information which the laboratory would need to correctly decide whether or not to release an altered test result. We suggest providing the clinician with all the information on the hemolytic sample and its impact on the respective parameter needed to make his/her own decision on the usage of the respective test result. We believe that reporting a preanalytically altered laboratory value including a respective comment is preferable to not reporting it.

scholarly journals Clinical profile of patients with fibromyalgia syndrome

2017 ◽  
Vol 30 (2) ◽  
pp. 287-296 ◽  
Author(s):  
Andrei Pereira Pernambuco ◽  
Lorena Rodrigues Terra da Silva ◽  
Angélica Cristina Souza Fonseca ◽  
Débora d’Ávila Reis
Keyword(s):  
Sleep Disturbances ◽  
Fibromyalgia Syndrome ◽  
Clinical Decision Making ◽  
Pittsburgh Sleep Quality Index ◽  
Clinical Decision ◽  
Chronic Widespread Pain ◽  
The Other ◽  
Anxiety And Depression ◽  
Healthy Controls ◽  
Significance Level

Abstract Introduction: The new diagnostic criteria for fibromyalgia (FM) include the presence of chronic, widespread pain associated with other symptoms such as fatigue, sleep disturbance, anxiety and depression. All these symptoms should be considered when thinking and clinical decision making of physiotherapists dealing with FM. However, it is clear that the other symptoms that accompany the pain are often neglected. Objective: To measure the levels of fatigue, sleep disturbances, anxiety and depression in patients with FM and compare them to levels found in healthy controls. Methods: Forty-six women diagnosed with FM and 30 healthy controls participated in the study. The levels of each of the symptoms were assessed by four validated questionnaires in Brazil (Piper Fatigue Scale - Revised, Pittsburgh Sleep Quality Index, Beck Anxiety Inventory and the Beck Depression Inventory). Statistical analysis was performed using GraphPad Prism software and all tests used a significance level of 5% (α = 0.05). Results: FM patients had significantly elevated levels of fatigue (p = 0.0005), sleep disturbances (p = 0.003), anxiety (p = 0.0012) and depression (p = 0.0003) compared to healthy controls. Symptoms fatigue and depression correlated strongly and positively with one another and with other symptoms evaluated. Conclusion: The other symptoms that comprise the clinical picture of FM need be considered not only in order to recover the health of patients, but above all in an attempt to preserve it and promote it.

scholarly journals Basics of Dental Implantology for the Oral Surgeon

2021 ◽  
pp. 385-405
Author(s):  
Supriya Ebenezer ◽  
Vinay V. Kumar ◽  
Andreas Thor
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Oral Surgical Procedures ◽  
Implant Placement ◽  
Treatment Concepts ◽  
Implant Dentistry ◽  
New Treatment ◽  
Implant Treatment

AbstractOver the past decades, implant dentistry has evolved to be a very predictable treatment modality for the replacement of lost teeth and has now become one of the most common oral surgical procedures carried out worldwide. This chapter introduces the history and evolution of dental implants, discusses the concept of osseointegration, mentions the types of implants and discusses clinical decision making and execution of straight forward implant placement. It must be noted that the field of implantology is rapidly developing with new treatment concepts and increasing use of digital technology. The surgical part of implant treatment although extremely important, is only a part of the overall treatment, the other important factors being the laboratory and prosthodontics. This chapter only provides a basic surgical overview of implantology for the beginner surgeon clinician.

Method, Judgement, and Clinical Reasoning

1999 ◽  
Vol 16 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Tony Ward
Keyword(s):  
Cognitive Skills ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Cognitive Tasks ◽  
Sources Of Knowledge ◽  
Wide Range ◽  
Gut Feelings ◽  
Cognitive Continuum ◽  
The One

AbstractResearchers have tended to take one of two mutually exclusive positions concerning the nature and status of clinical decision-making. On the one hand, clinicians are urged to be more rigorous and analytical when assessing a client, to disregard their intuitions and instead utilise explicit rules and algorithms. On the other hand, they are counselled to regard their “gut feelings” as valuable sources of knowledge about clients. As a way of reconciling these two perspectives, it is important to acknowledge that clinical psychologists are confronted with a wide range of assessment and clinical tasks that vary in their degree of structure. Therefore, in order to effectively manage the diverse tasks they face during a typical assessment, they need to possess a wide range of cognitive skills. These skills, and their associated cognitive tasks, will span the cognitive continuum from the intuitive to the analytical poles (Hammond, 1996).

Persons over models: shared decision-making for person-centered medicine

2020 ◽  
Vol 8 (3) ◽  
pp. 355
Author(s):  
Marco Annoni ◽  
Charlotte Blease
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
The Other ◽  
Shared Decision ◽  
Patient Relationship ◽  
New Paradigm ◽  
The Core

In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.

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