Patient-centred medicine: The use of expert patients in medical education (Preprint)

2019 ◽  
Author(s):  
Kenrick Chan ◽  
George Samoutis
Keyword(s):  
Medical Education ◽  
Treatment Plan ◽  
Holistic Approach ◽  
Decision Making Process ◽  
Common Goal ◽  
Secure Environment ◽  
Causes Of Disease ◽  
Open Dialogue ◽  
Expert Patients ◽  
Learning To Listen

UNSTRUCTURED Abstract Patient-centred medicine (PCM) involves looking at more than just a disease and how to treat it. It has evolved from the realisation that all patients are different physiologically, psychologically, emotionally, and socially, and it therefore encompasses all of these domains in its application. The mainstay of this approach is the promotion of a mutual relationship between patient and doctor that involves creating a secure environment to allow for open dialogue. By learning to listen to patients, and exploring other causes of disease other than physiological ones, doctors are able to provide a holistic approach to treatment. Patients are also actively encouraged to participate in the decision making process by adding their ideas, concerns and expectations. This negotiation allows for flexibility and individualisation of each treatment plan that is tailored to suit each individual patient. In essence, PCM encourages concordance: the agreement between doctor and patient on how to proceed towards a common goal. It is therefore important to teach medical students about PCM as early on in their medical education as possible. This will give them time to hone skills in communication so that they can better understand and explore their patient’s circumstances as well be aware of other domains that may require support. But how can medical schools effectively teach their students PCM? Here we suggest the use of expert patients as a beneficial method for promoting PCM in medical school curriculums as students have the opportunity to gain first hand knowledge of what a patient with a specific disease actually feels, what impact it has on their lives and those around them, and what support they find lacking or useful. Encourage medical curriculums to incorporate expert patients as a resource of information to teach future doctors abotu patient-centred medicine and its holistic objectives.

scholarly journals Sustainable Empowerment Initiatives among Rural Women through Microcredit Borrowings in Bangladesh

2020 ◽  
Vol 12 (6) ◽  
pp. 2275
Author(s):  
Jesmin Akhter ◽  
Kun Cheng
Keyword(s):  
Rural Women ◽  
Holistic Approach ◽  
Living Standards ◽  
Decision Making Process ◽  
Women Empowerment ◽  
Rural Bangladesh ◽  
Effective Instrument ◽  
Matching Techniques ◽  
The Empirical Analysis ◽  
Poor Rural Women

Microcredit is an effective instrument that has been recognized to alleviate poverty, especially in developing countries such as Bangladesh. This study seeks to use microcredit as an instrument to bridge the gap between the accessibility of microcredit among poor rural women and sustainable socio-economic development, providing novelty to the concept of “sustainability of empowerment”. In addition, this study employed poor rural women to estimate the empowerment performance of microcredit borrowers compared to non-borrowers in the same socio-economic environment as it relates to microcredit in rural Bangladesh. A regression analysis was used to accomplish these objectives. This study also used propensity score matching techniques to find an easy way to access microcredit. The empirical results not only involve participation in microcredit accessibility but also the particular qualitative attributes of women empowerment. The results also suggest that sustainability is accompanied by affluence among microcredit borrowers, as indicated by women empowerment. The outcome of the empirical analysis shows that there is a significant impact of microcredit on increasing participation in the overall decision-making process, in legal awareness, independent movements, and mobility, as well as enhancing living standards to encourage sustainable women empowerment. This study recommends future investigations for microcredit providers to explore how to build an integrated, holistic approach to women empowerment in Bangladesh.

“ABCD” Implant Classification: A Comprehensive Philosophy for Treatment Planning in Completely Edentulous Arches

2020 ◽  
Vol 46 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Ali Tunkiwala ◽  
Udatta Kher ◽  
Nupur H. Vaidya
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Present Article ◽  
Treatment Plan ◽  
Bone Volume ◽  
Classification Systems ◽  
Decision Making Process ◽  
Careful Attention ◽  
Treatment Needs ◽  
Vital Parameters

A thorough and precise treatment plan that considers various factors such as age, availability of bone, interarch space for prosthesis design, smile line, lip support, patient desires, and economics is a necessity before implant surgery. Many previous classification systems for treatment planning in edentulous situations tend to focus on only a certain parameter such as esthetics, or available bone volume, or are specifically designed for the maxilla or mandible. The authors have proposed a simplified and universal ABCD classification that uses the 4 vital parameters of age, bone volume, cosmetic display, and degree of resorption to create an algorithm that satisfies the treatment needs of every patient. Various permutations of the 4 parameters can be used to arrive at a solution that streamlines the further phases of the rehabilitative process. The aim of the present article is to provide a science-driven approach to understand a patient's individual needs with careful attention to the interplay of all the aforementioned factors in the decision-making process.

STRATEGIC PLANNING OF FUTURE PRODUCTS WITH PRODUCT SCENARIOS

2010 ◽  
Vol 07 (03) ◽  
pp. 237-246 ◽  
Author(s):  
VOLKER GRIENITZ ◽  
VOLKER BLUME
Keyword(s):  
Decision Making ◽  
Strategic Planning ◽  
Evolutionary Algorithms ◽  
Holistic Approach ◽  
Decision Making Process ◽  
Managerial Decision ◽  
Managerial Decision Making ◽  
Manufacturing Resources ◽  
Technology Strategies ◽  
Innovation Processes

Manufacturing based corporations often find themselves confronted with complexities of increased pressures to innovate in order to ensure their comparative market positions. In order to react to various exogenous changes corporations need to develop strategies that match their manufacturing resources as well as products with the markets requirements. Product scenarios represent a holistic approach for managing innovation processes and technologies efficiently. The analysis through evolutionary algorithms for compatibility between and amongst the product structure segments provides the necessary information about their suitability. The resulting scenarios, roadmaps and regular monitoring processes are prerequisite for the managerial decision making process and the implementation of product and technology strategies.

scholarly journals At-home Cosmeceutical Application and Outpatient Treatments: A 3D Stepwise Facial Rejuvenation Approach

2020 ◽  
Vol 8 (B) ◽  
pp. 1041-1046
Author(s):  
Fabrizio Melfa ◽  
Daniela Siragusa ◽  
Daniela Caruso ◽  
Carmelo Lo Faro ◽  
Giovanni Francesco Nicoletti ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Holistic Approach ◽  
Facial Rejuvenation ◽  
Dimensional Structure ◽  
Skin Elasticity ◽  
Duration Of Treatment ◽  
3 Dimensional ◽  
Outpatient Procedures ◽  
Analysis System ◽  
At Home

BACKGROUND: Aging affects the 3-dimensional structure of all the facial tissues: Bones, muscles, ligaments, adipose tissue, and skin. AIM: To customize minimally invasive treatments for facial rejuvenation, we present a standardized holistic approach characterized by at-home treatments in associations with outpatient procedures. METHODS: Forty-four patients underwent 3-dimensional stepwise facial rejuvenation and were evaluated prospectively. Each patient received a customized treatment plan based on a clinical examination and consultation. Treatment outcomes were evaluated from patient photographs with and skin analysis was performed with an A-One Smart automated skin analysis system. RESULTS: The mean age of the patients was 41.7 years and the approximate mean duration of treatment was 160 days. Patients applied cosmeceuticals such as retinoic acid. Outpatient procedures included the delivery of botulinum toxin or dermal fillers, thread lifting, chemical peels, etc. Upon treatment completion, significant improvements were noted in multiple domains: Skin elasticity and hydration increased, areas of hyper-pigmentation were less extensive, and there were fewer visible wrinkles and pores. CONCLUSION: Outcomes of the present article suggest how important is to customize facial anti-aging treatments. Nonsurgical treatments carried out progressively, involving the patient to perform at-home treatments in associations with outpatient procedures, let to achieve facial improvements in terms of increased skin elasticity and hydration, reduction of hyperpigmentation, wrinkles, and pores.

scholarly journals Indigenous Collaborative Governance: An Understanding of Decision-Making Process at Desa Adat in Bali, Indonesia

2020 ◽  
Vol 4 (2) ◽  
pp. 119
Author(s):  
Md Putri Wiyantari Sutaryantha ◽  
Bevaola Kusumasari
Keyword(s):  
Decision Making ◽  
Conceptual Framework ◽  
Public Administration ◽  
Local Governance ◽  
Practical Implication ◽  
Collaborative Governance ◽  
Decision Making Process ◽  
Common Goal ◽  
Depth Interviews

The decision-making process that took place at desa adat (indigenous village) involved many actors and stakeholders from various elements of the community, to achieve a common goal. This research highlights the linkages of indigenous collaborative governance among actors involved in the decision-making process at Balinese Desa Adat, Indonesia. This research has, thus, discovered how indigenous collaborative governance was linked to the decision-making process and linked to the implementation of local governance, especially in the implementation of Adat in Bali Province. This study emphasizes the extensive use of public administration literature about collaborative governance and the decision-making process. Additionally, in-depth interviews and live experience in desa adat were conducted, as it is aimed to explore and understand more about the case. The result provided aligned with the conceptual framework because all of the actual implementation of the decision-making process at Desa Adat Peliatan met the criteria or indicators of collaborative governance. It showed that there was an involvement of indigenous collaborative governance in the process of decision-making at the desa adat level. The practical implication, in this case, is that collaboration matters in the decision-making process involving various elements of society with diverse interests.

scholarly journals Brain mapping for lesions in primary motor cortex: integrated surgical approach

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv18-iv18
Author(s):  
José Lavrador ◽  
Prajwal Ghimire ◽  
Christian Brogna ◽  
Luciano Furlanetti ◽  
Sabina Patel ◽  
...  
Keyword(s):  
Decision Making ◽  
Process Model ◽  
Primary Motor Cortex ◽  
Treatment Plan ◽  
Extent Of Resection ◽  
Motor Deficit ◽  
Decision Making Process ◽  
Total Resection ◽  
Intraoperative Mapping ◽  
Subcortical Mapping

Abstract Background Lesions within the corticospinal tract (CST) represent significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centred treatment plan. Methods Patients with lesions within the CST with preoperative cortical and subcortical mapping (nTMS and tractography), intraoperative mapping and intraoperative provisional histological information (smear +- 5-ALA) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results 10 patients (6 patients with metastatic precentral tumour; 1 patient with Grade III and 2 patients with grade IV gliomas; 1 patient with precentral vascular malformation) were included in the study. Majority of the patient had pre-operative motor deficit (60%). 50% patients underwent gross total resection and 40% patients underwent near total resection of the lesions. In only one patient, no surgical resection was possible after both pre-operative and intraoperative mapping. 70% of patients remained stable postoperatively and 20% improved from previous motor weakness. Conclusion The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) in patients with CST lesions provide a more accurate guide for resection. The inclusion of the histological information (smear +- 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the centre of the informed decision making process.

Pre- and Intraoperative Mapping for Tumors in the Primary Motor Cortex: Decision-Making Process in Surgical Resection

2020 ◽  
Author(s):  
José Pedro Lavrador ◽  
Prajwal Ghimire ◽  
Christian Brogna ◽  
Luciano Furlanetti ◽  
Sabina Patel ◽  
...  
Keyword(s):  
Decision Making ◽  
Motor Cortex ◽  
Surgical Resection ◽  
Process Model ◽  
Primary Motor Cortex ◽  
Treatment Plan ◽  
Motor Deficit ◽  
Decision Making Process ◽  
Total Resection ◽  
Intraoperative Mapping

Abstract Background Lesions within the primary motor cortex (M1) and the corticospinal tract (CST) represent a significant surgical challenge with a delicate functional trade-off that should be integrated in the overall patient-centered treatment plan. Methods Patients with lesions within the M1 and CST with preoperative cortical and subcortical mapping (navigated transcranial magnetic stimulation [nTMS] and tractography), intraoperative mapping, and intraoperative provisional histologic information (smear with and without 5-aminolevulinic acid [5-ALA]) were included. This independently acquired information was integrated in a decision-making process model to determine the intraoperative extent of resection. Results A total of 10 patients (6 patients with metastatic precentral tumor; 1 patient with grade III and 2 patients with grade IV gliomas; 1 patient with precentral cavernoma) were included in the study. Most of the patients (60%) had a preoperative motor deficit. The nTMS documented M1 invasion in all cases, and in eight patients, the lesions were embedded within the CST. Overall, 70% of patients underwent gross total resection; 20% of patients underwent near-total resection of the lesions. In only one patient was no surgical resection possible after both preoperative and intraoperative mapping. Overall, 70% of patients remained stable postoperatively, and previous motor weakness improved in 20%. Conclusion The independently acquired anatomical (anatomical MRI) and functional (nTMS and tractography) tests in patients with CST lesions provide a useful guide for resection. The inclusion of histologic information (smear with or without 5-ALA) further allows the surgical team to balance the potential functional risks within the global treatment plan. Therefore, the patient is kept at the center of the informed decision-making process.

Education for the Next Frontier in Patient Safety: A Longitudinal Resident Curriculum on Diagnostic Error

2016 ◽  
Vol 32 (6) ◽  
pp. 625-631 ◽  
Author(s):  
Emily Ruedinger ◽  
Maren Olson ◽  
Justin Yee ◽  
Emily Borman-Shoap ◽  
Andrew P. J. Olson
Keyword(s):  
Decision Making ◽  
Medical Education ◽  
Medical Decision Making ◽  
Diagnostic Error ◽  
Medical Decision ◽  
Decision Making Process ◽  
Education Programs ◽  
Cognitive Error ◽  
Error Mitigation ◽  
Second Victim

Diagnostic error is a common, serious problem that has received increased attention recently for its impact on both patients and providers. Presently, most graduate medical education programs do not formally address this topic. The authors developed and evaluated a longitudinal, multimodule resident curriculum about diagnostic error and medical decision making. Key components of the curriculum include demystifying the medical decision-making process, building skills in critical thinking, and providing strategies for diagnostic error mitigation. Special attention was paid to avoiding the second victim effect and to fostering a culture that supports constructive, productive feedback when an error does occur. The curriculum was rated by residents as helpful (96%), and residents were more likely to be aware of strategies to reduce cognitive error (27% pre vs 75% post, P < .0001) following its implementation. This article describes the development, implementation, and effectiveness of this curriculum and explores generalizability of the curriculum to other programs.

Understanding Veterinary Practitioners' Decision-Making Process: Implications for Veterinary Medical Education

2012 ◽  
Vol 39 (2) ◽  
pp. 142-151 ◽  
Author(s):  
Jean-Michel Vandeweerd ◽  
Solène Vandeweerd ◽  
Catherine Gustin ◽  
Geneviève Keesemaecker ◽  
Carole Cambier ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Education ◽  
Decision Making Process
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