scholarly journals Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs (Preprint)

2018 ◽  
Author(s):  
Hannah Brown Amoakoh ◽  
Kerstin Klipstein-Grobusch ◽  
Diederick E Grobbee ◽  
Mary Amoakoh-Coleman ◽  
Ebenezer Oduro-Mensah ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Outcomes ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Time Of Day ◽  
Neonatal Health ◽  
Facility Type ◽  
Maternal And Neonatal Health ◽  
The Relationship

BACKGROUND Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.

scholarly journals Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs

10.2196/12879 ◽  
2019 ◽  
Vol 7 (5) ◽  
pp. e12879 ◽  
Author(s):  
Hannah Brown Amoakoh ◽  
Kerstin Klipstein-Grobusch ◽  
Diederick E Grobbee ◽  
Mary Amoakoh-Coleman ◽  
Ebenezer Oduro-Mensah ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Outcomes ◽  
Health Worker ◽  
Mobile Health ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Neonatal Health ◽  
Maternal And Neonatal Health

Introduction

2018 ◽  
Author(s):  
John R. Peteet ◽  
Mary Lynn Dell ◽  
Wai Lun Alan Fung
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Ethics Committees ◽  
Clinical Decision ◽  
Cultural Formulation ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Religious Professionals ◽  
The Relationship

Historical tensions between psychiatry and religion continue to hinder dialogue and restrict consensus on how to approach areas of overlap in clinical decision making. In Part One, contributors to this volume discuss concerns arising in the general areas of values, religious and psychiatric ethics, diagnosis and treatment, and the work of religious professionals and ethics committees. In Part Two, chapter authors consider these issues as they arise within various subspecialties of psychiatric practice, often using the Jonsen Four Topics (or Four Quadrants) Model. The theme of the relationship between religion and culture runs throughout and is addressed more directly than in the Outline for Cultural Formulation in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 672-673
Author(s):  
JOHN M. LEVENTHAL ◽  
ROBERT M. LEMBO
Keyword(s):  
Decision Making ◽  
Likelihood Ratio ◽  
Clinical Finding ◽  
Clinical Decision Making ◽  
Skull Fracture ◽  
Clinical Decision ◽  
Clinical Findings ◽  
Skull Fractures ◽  
Fractures In Children ◽  
The Relationship

To the Editor.— In the February 1982 issue of Pediatrics, Leonidas et al1 examined the relationship between clinical findings and skull fractures in children evaluated with skull roentgenograms to develop reliable criteria for the ordering of roentgenograms in patients with head trauma. In their analysis, the authors used the liklihood ratio (LR) to characterize quantitatively the relationship between a clinical finding and the presence of a skull fracture. As defined by the authors, the LR is that ratio between the probability of a certain clinical finding occurring in the presence of a fracture and the probability of the same clinical finding occurring in the absence of a fracture.

scholarly journals The Relationship Between Critical Thinking and Clinical Decision-Making in Emergency Nurses of Hospitals Affiliated to Zanjan University of Medical Sciences in 2020

2021 ◽  
Vol 11 (2) ◽  
pp. 30-37
Author(s):  
Hadi Khanmoradi ◽  
Ali Aghajanloo ◽  
Mohammadreza Dinmohammadi ◽  
Farhad Ramazani Badr ◽  
◽  
...  
Keyword(s):  
Decision Making ◽  
Critical Thinking ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Medical Sciences ◽  
Emergency Nurses ◽  
The Relationship

Device representatives in hospitals: are commercial imperatives driving clinical decision-making?

2018 ◽  
Vol 44 (9) ◽  
pp. 589-592 ◽  
Author(s):  
Quinn Grundy ◽  
Katrina Hutchison ◽  
Jane Johnson ◽  
Brette Blakely ◽  
Robyn Clay-Wlliams ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Daily Basis ◽  
Clinical Settings ◽  
Ethical Concerns ◽  
The Relationship ◽  
Expert Support ◽  
Device Industry

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.

Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making

1997 ◽  
Vol 2 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Angela Coulter
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Shared Decision ◽  
Pros And Cons

The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.

The Relationship Between Managerial and Clinical Decision Making in the Hospital

1988 ◽  
Vol 8 (3) ◽  
pp. 151-154 ◽  
Author(s):  
Paul F. Griner
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Relationship

scholarly journals An ethical relationship with pharma

2018 ◽  
Vol 24 (6) ◽  
pp. 398-401
Author(s):  
Sarmishtha Bhattacharyya ◽  
Susan Mary Benbow
Keyword(s):  
Decision Making ◽  
Clinical Trials ◽  
Royal College ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ethical Principles ◽  
Pharmaceutical Companies ◽  
The Public ◽  
The Relationship

SUMMARYThis brief article reflects on the relationship between psychiatrists and pharmaceutical companies (pharma), which continues to generate debate and concerns. We suggest that psychiatrists should consider both the biomedical ethical principles and how values guide actions and clinical decision-making in their dealings with pharma. In addition, the Royal College of Psychiatrists should err towards eschewing influences that might be regarded by others as distorting its position, and individual psychiatrists should declare interests that others might regard as competing/conflicting in order to maintain the trust of patients and the public.DECLARATION OF INTERESTS.M.B. practises as an independent systemic psychotherapist. Both authors have undertaken various roles within the Royal College of Psychiatrists and S.B. is involved in recruiting patients for clinical trials.

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